Developing a Business Plan for Critical Care Pharmacy Services

Erstad, Brian L.; Mann, Henry J.; Weber, Robert J.

doi:10.1310/hpj5110-856

Cited by 6 publications

(3 citation statements)

References 23 publications

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“… Implementation and demonstration of cost-savings initiatives related to medications.  Service as a leader for critical care pharmacy services [28][29][30].…”

Section: R E T R a Cmentioning

confidence: 99%

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Pharmacists in Critical Care

Mohiuddin

2019

Innov Pharm

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The beginnings of caring for critically ill patients date back to Florence Nightingale’s work during the Crimean War in 1854, but the subspecialty of critical care medicine is relatively young. The first US multidisciplinary intensive care unit (ICU) was established in 1958, and the American Board of Medical Subspecialties first recognized the subspecialty of critical care medicine in 1986. Critical care pharmacy services began around the 1970s, growing in the intervening 40 years to become one of the largest practice areas for clinical pharmacists, with its own section in the SCCM, the largest international professional organization in the field. During the next decade, pharmacy services expanded to various ICU settings (both adult and pediatric), the operating room, and the emergency department. In these settings, pharmacists established clinical practices consisting of therapeutic drug monitoring, nutrition support, and participation in patient care rounds. Pharmacists also developed efficient and safe drug delivery systems with the evolution of critical care pharmacy satellites and other innovative programs. In the 1980s, critical care pharmacists designed specialized training programs and increased participation in critical care organizations. The number of critical care residencies and fellowships doubled between the early 1980s and the late 1990s. Standards for critical care residency were developed, and directories of residencies and fellowships were published. In 1989, the Clinical Pharmacy and Pharmacology Section was formed within the Society of Critical Care Medicine, the largest international, multidisciplinary, multispecialty critical care organization. This recognition acknowledged that pharmacists are necessary and valuable members of the physician-led multidisciplinary team. The Society of Critical Care Medicine Guidelines for Critical Care Services and Personnel deem that pharmacists are essential for the delivery of quality care to critically ill patients. These guidelines recommend that a pharmacist monitor drug regimen for dosing, adverse reactions, drug-drug interactions, and cost optimization for all hospitals providing critical care services. The guidelines also advocate that a specialized, decentralized pharmacist provide expertise in nutrition support, cardiorespiratory resuscitation, and clinical research in academic medical centers providing comprehensive critical care. Article Type: Commentary

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“… Implementation and demonstration of cost-savings initiatives related to medications.  Service as a leader for critical care pharmacy services [28][29][30].…”

Section: R E T R a Cmentioning

confidence: 99%

“…Service as a leader for critical care pharmacy services [ 28 - 30 ].…”

Section: Pharmacists' Role In Critical Carementioning

confidence: 99%

Pharmacists in Critical Care

Mohiuddin

2019

Innov Pharm

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“…Some have suggested that the time has come to discard the need for ICU pharmacists to justify their value and instead for ICUs and patients to expect the presence of direct pharmacy services either through accreditation standards or reimbursement ( 19 ). The multidisciplinary community of critical care must seek other modes and sources of financial support and explore payment for critical care pharmacy services ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

Characterizing Critical Care Pharmacy Services Across the United States

MacLaren

Roberts

Dzierba

et al. 2021

Critical Care Explorations

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OBJECTIVES: Involvement of clinical pharmacists in the ICU attenuates costs, avoids adverse drug events, and reduces morbidity and mortality. This survey assessed services and activities of ICU pharmacists. Design: A 27-question, pretested survey. SETTING: 1,220 U.S. institutions. Subjects: Critical care pharmacists. Interventions: Electronic questionnaire of pharmacy services and activities across clinical practice, education, scholarship, and administration. Measurements and Main Results: A total of 401 (response rate of 35.4%) surveys representing 493 ICUs were completed. Median daily ICU census was 12 (interquartile range, 6–20) beds with 1 (interquartile range, 1–1.5) pharmacist full-time equivalent per ICU. Direct clinical ICU pharmacy services were available in 70.8% of ICUs. Pharmacists attended rounds 5 days (interquartile range, 4–5 d) per week with a median patient-to-pharmacist ratio of 17 (interquartile range, 12–26). The typical workweek consisted of 50% (interquartile range, 40–60%) direct ICU patient care, 10% (interquartile range, 8–16%) teaching, 8% (interquartile range, 5–18%) order processing, 5% (interquartile range, 0–20%) direct non-ICU patient care, 5% (interquartile range, 2–10%) administration, 5% (interquartile range, 0–10%) scholarship, and 0% (interquartile range, 0–5%) drug distribution. Common clinical activities as a percentage of the workweek were reviewing drug histories (28.5%); assessing adverse events (27.6%); and evaluating (26.1%), monitoring (23.8%), and managing (21.4%) drug therapies. Services were less likely to occur overnight or on weekends. Telemedicine was rarely employed. Dependent prescriptive authority (per protocol or via practice agreements) was available to 51.1% of pharmacists and independent prescriptive authority was provided by 13.4% of pharmacists. Educational services most frequently provided were inservices (97.6%) and experiential training of students or residents (89%). Education of ICU healthcare members was provided at a median of 5 times/mo (interquartile range, 3–15 times/mo). Most respondents were involved with ICU or departmental policies/guidelines (84–86.8%) and 65.7% conducted some form of scholarship. Conclusions: ICU pharmacists have diverse and versatile responsibilities and provide several key clinical and nonclinical services. Initiatives to increase the availability of services are warranted.

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Justification of the value of critical care pharmacists: Still a work in progress?

Erstad

2020

American Journal of Health-System Pharmacy

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Developing a Business Plan for Critical Care Pharmacy Services

Cited by 6 publications

References 23 publications

Pharmacists in Critical Care

Pharmacists in Critical Care

Characterizing Critical Care Pharmacy Services Across the United States

Justification of the value of critical care pharmacists: Still a work in progress?

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