A descriptive report of the rapid implementation of automated MRC-ICU calculations in the EMR of an academic medical center

Abstract

Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Numerous clinical scoring tools exist for a variety of patient populations and disease states, but few tools provide information specifically designed for use by critical care pharmacists. The medication regimen complexity intensive care unit (MRC-ICU) score was designed to provide high-level information about the complexity of critically ill patient’s medication regimens for use by critical care pharmacists. To date, implementation of this score in the electronic medical record (EMR) has not been reported. Summary Using an agile project management framework, the MRC-ICU score was rapidly implemented into an academic medical center’s EMR. The score automatically calculates on all critically ill patients and is available for critical care pharmacists to triage patient review in their individual workflow. Reporting capabilities of the score also allow for granular complexity trending over time and between units, supplementing other objective measures of pharmacist workload. Conclusion The MRC-ICU score can be quickly implemented into the EMR for pharmacist use in real time. Future investigations into how pharmacists utilize this information and how to harness reporting capabilities for pharmacist workload assessment are warranted.

An Evaluation of the Relationship Between Medication Regimen Complexity as Measured by the MRC-ICU to Medication Errors in Critically Ill Patients

“…10,11 The medication regimen complexity-intensive care unit (MRC-ICU) scoring tool has been proposed as a means of connecting objective metrics to pharmacy activity with the goal that administrators might be able to make predictive decisions regarding pharmacist resources or bedside clinicians could prioritize patient care as a triage approach. [12][13][14][15][16][17][18][19][20] While higher MRC-ICU scores at 24 hours have been associated with an increased need for pharmacist interventions as well as other outcomes like increased mortality and longer length of stay, an evaluation specifically focusing on medication safety has not been completed and is required prior to these types of implementations.…”

Impact of Pharmacists to Improve Patient Care in the Critically Ill: A Large Multicenter Analysis Using Meaningful Metrics With the Medication Regimen Complexity-ICU (MRC-ICU) Score*

“…The Medication Regimen Complexity-ICU (MRC-ICU) scoring tool is the first metric proposed with the specific intention of describing relevant relationships in the optimal critical care pharmacy practice model and has shown early promise at overcoming historical limitations in pilot studies (6)(7)(8)(9)(10)(11)(12)(13). This 37-line item score has been provided in Supplemental Digital Content -Table 1 (http://links.lww.com/CCM/H141).…”

“…For example, a patient receiving cefepime (2 points), vancomycin (3 points), norepinephrine (1 point), and vasopressin (1 point) on ICU day 2 would have a day 2 MRC-ICU score of 7. To date, this metric has been successfully correlated to patient acuity (as measured by the Acute Physiology and Chronic Health Evaluation [APACHE III]), patient-centered outcomes including mortality and length of stay (LOS), ICU-related complications including fluid overload and drug-drug interactions, and pharmacist workload, as measured by documented pharmacist interventions (6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Furthermore, it has been successfully built into the electronic health record in one academic medical center (12).…”

“…The studies that chronicle the development and evaluation of the MRC-ICU are summarized in Supplemental Digital Content -Table 2 (http://links.lww.com/CCM/H141). The primary limitation of all MRC-ICU evaluations to date has been the small sample and one (or two) center designs that inherently lack the robust external validity necessary for widespread use (6)(7)(8)(9)(10)(11)(12)(13)(14)(15).…”

“…To date, this metric has been successfully correlated to patient acuity (as measured by the Acute Physiology and Chronic Health Evaluation [APACHE III]), patient-centered outcomes including mortality and length of stay (LOS), ICU-related complications including fluid overload and drug-drug interactions, and pharmacist workload, as measured by documented pharmacist interventions (6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Furthermore, it has been successfully built into the electronic health record in one academic medical center (12). It has even shown superior correlation to pharmacist workload compared with the traditional patient acuity score Sequential Organ Failure Assessment (11).…”