Impact of first and second shift tele‐critical care pharmacy services and virtual rounds on interventions at Atrium Health Lincoln

Abstract

BackgroundIn 2015, Atrium Health (AH) established second shift pharmacy services in the tele‐critical care (TCC) setting to optimize medication therapy and serve as a drug information resource to facilities across the health care system. TCC pharmacy services expanded to the first shift in July 2017. In September 2017, the first shift pharmacist began participating in virtual multidisciplinary rounds 1 day per week, which increased to 3 days per week in October 2019 at AH Lincoln, a community hospital with a 10‐bed intensive care unit (ICU).MethodsThis was a nonrandomized retrospective cohort study of adult ICU patients at AH Lincoln across two different time periods. The primary outcome was the number and type of pharmacy interventions made on rounding day(s) vs nonrounding days and first vs second shifts. Data are reported using descriptive statistics.ResultsDuring time period 1, a total of 1174 patients were admitted to the ICU for a total of 2115 patient days, with an average length of stay (LOS) of 1.8 days (SD ± 1.8 days). During time period 2, a total of 812 patients were admitted to the ICU for a total of 1775 patient days with an average LOS of 2.2 days (SD ± 2.7 days). During time period 1, a total of 753 interventions (297 on first shift and 456 on second shift) were performed as compared to time period 2, which had 1276 interventions (816 on first shift and 460 on second shift). For both time periods, the most common intervention on the first shift was medication management (45%) vs glycemic control (36%) on the second shift.ConclusionsThe addition of TCC pharmacy services to AH Lincoln has resulted in a positive impact on medication management, with the largest impact demonstrated through virtual rounding by the first shift TCC pharmacist.

Critical care tele‐pharmacy services during COVID ‐19 pandemic: A qualitative exploration of healthcare practitioners' perceptions

“…Although some of these domains were specific to COVID‐19 era, others may be generalized to ICU settings in general such as drug interactions and diabetes management. This finding is similar to the results of a retrospective cohort study of adult ICU patients which showed that most interventions done by tele critical care pharmacists aimed at providing proper glycemic control (36%) 13 …”

“…This finding is similar to the results of a retrospective cohort study of adult ICU patients which showed that most interventions done by tele critical care pharmacists aimed at providing proper glycemic control (36%). 13 …”

“…12 In our study, participants cists aimed at providing proper glycemic control (36%). 13 Although Qatar reported the maximum number of people per million affected by COVID-19 amongst Gulf Cooperation Council (GCC) countries, the most updated analysis showed that it also had the highest recovery rate (96.99%) and the lowest death rate (0.15%). 14 Remote CPs service was part of the changes implemented in the national healthcare system to cope with the pandemic, hence they may have contributed to this favourable mortality statistics by ensuring that patients are receiving evidence-based and up-to-date treatments.…”

Characterization of tele‐pharmacy interventions performed via an expanded tele‐critical care pharmacist protocol

“…CCPEPA: The CCPEPA, similar to a collaborative practice agreement, allowed the TCC pharmacists, and other AH critical care trained pharmacists identified in the agreement, to initiate, modify, or discontinue medications in various focus areas to optimize therapy (Appendix ) 13 . For example, if the patient was receiving neuromuscular blocking agents (NMBAs), the TCC pharmacist could add ocular lubricant to avoid corneal abrasions.…”

“…During the COVID‐19 pandemic, AH's intensive care units (ICUs) saw an increase in capacity and patient acuity resulting in a corresponding increase in TCC services across the system to augment ICU needs 2 . As part of this augmentation, a Critical Care Pharmacist Emergency Protocol Agreement (CCPEPA) was approved in April 2020 13 . This CCPEPA allowed critical care pharmacists the ability to manage various categories of ICU medications.…”