A survey of critical care pharmacists to patient ratios and practice characteristics in intensive care units

Abstract

Introduction Pharmacists are widely recognized members of the critical care health care team. However, unlike other health care professions, critical care pharmacists do not have standardized pharmacist to patient ratios that establish maximal cost‐efficiency while maintaining optimal patient safety. Though many prior recommendations claim a ratio of 1:15 for safe pharmacy practice, recommendations have ranged as low as 1:8 to as high as 1:30. Objectives To determine critical care pharmacists' perceptions of pharmacist to patient ratios within the intensive care unit (ICU) and qualitatively and quantitatively describe critical care pharmacist work environments. Methods A cross‐sectional survey of pharmacists was conducted to identify current pharmacist to patient ratios and identify pharmacist perceptions of the safety of these ratios. Responses were presented using descriptive statistics. Multiple linear regression was conducted to determine factors associated with perceptions of workload and patient safety. Results The response rate was 11% (n = 185). The majority of respondents reported participating in activities beyond patient care. The majority of pharmacists cared for more than 15 patients daily (n = 155, 84%), and 16% took care of 15 or fewer patients. About 30% of pharmacists did not feel the pharmacist to patient ratio optimized patient safety, and over half reported perceptions overwork. A majority of participants (n = 130, 76%) expressed a need for additional critical care pharmacists at their institutions. Higher pharmacist to patient ratios were associated with increased perception of unsafe patient care −.343 (−.507 to −.180, P < .001). Conclusions Heterogeneity exists among critical care pharmacy activities that may influence pharmacists' perceptions of workload and patient safety. Critical care pharmacists report that their institutions should have more critical care pharmacists. Pharmacists' perceptions of workload vary based on differences in their activities outside of patient care.

Development of Machine Learning Models to Validate a Medication Regimen Complexity Scoring Tool for Critically Ill Patients

“…A previous evaluation noted that a majority of pharmacists care for >30 patients daily, which was associated with perceptions of reduced safety and, a priori, is likely too many patients to achieve optimal pharmacist-mediated patient benefit. 35 Although the present study is unable to answer these questions because of lack of pharmacist intervention data and sample size, these results are a vital first step in the optimization of an underutilized resource known to improve patient outcomes. 35 This study has several limitations.…”

“…35 Although the present study is unable to answer these questions because of lack of pharmacist intervention data and sample size, these results are a vital first step in the optimization of an underutilized resource known to improve patient outcomes. 35 This study has several limitations. First, the selected best classifiers can predict the inpatient mortality on average 90%, whereas their NPV values are <50%.…”

“…Historically, critical care pharmacists have been identified as vital members of the interdisciplinary team because of various outcome improvements; however, the mechanism of their benefit and how to maximize their value are key knowledge gaps. 35 These findings pose a unique hypothesis bridging pharmacist activity (measured as interventions) to patient outcomes (eg, mortality, LOS) through the mitigation of medication regimen complexity. Furthermore, MRC-ICU's specific orientation toward pharmacists as a resource allows for prediction of pharmacist interventions, which has been previously established as correlating to the MRC-ICU.…”

Clinically relevant drug interactions involving antimicrobials in a general hospital: a cross-sectional study

“…Such a situation reinforces the importance of clinical pharmaceutical activity both in ICU as well as in units for non-critical patients, at least with the careful pharmaceutical evaluation of the prescriptions and guiding the team as to the management and or monitoring of the patient in relation to clinically relevant pDDI. Newsome et al 22 identify that, although intensive care pharmacists are widely recognized members of the team, unlike other health care professions they…”

Evaluating the Association and Predictability of Complex Medication Regimen Scores with Clinical Outcomes Among the Critically Ill

“…In the intensive care unit (ICU) population, the MRC in ICU (MRCICU) scoring tool was developed and revised (modified MRCICU) in 2019 [22,23]. The modified MRCICU is the first validated quantitative weighted scoring tool intended to predict clinical outcomes (i.e., ICU mortality, length of stay (LOS), and need for mechanical ventilation (MV)) [24,25]. In a previous study, we have developed a novel proof-ofconcept method demonstrating improvement in the prediction of patient outcomes by incorporating the MRCICU score into the previously established Acute Physiology and Chronic Health Evaluation (APACHE II) scoring tool [26].…”