Position Paper on Critical Care Pharmacy Services (Executive Summary): 2020 Update

Abstract

Objectives Provide a multiorganizational statement to update the statement from a paper in 2000 about critical care pharmacy practice and makes recommendations for future practice. Design The Society of Critical Care Medicine, American College of Clinical Pharmacy Critical Care Practice and Research Network, and the American Society of Health-System Pharmacists convened a joint task force of 15 pharmacists representing a broad cross-section of critical care pharmacy practice and pharmacy administration, inclusive of geography, critical care practice setting, and roles. The Task Force chairs reviewed and organized primary literature, outlined topic domains, and prepared the methodology for group review and consensus. A modified Delphi method was used until consensus (>66% agreement) was reached for each practice recommendation. Previous position statement recommendations were reviewed and voted to either retain, revise, or retire. Recommendations were categorized by level of ICU service to be applicable by setting, and grouped into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development. Main Results There are 82 recommendation statements: forty-four original recommendations and 38 new recommendation statements. Thirty-four recommendations were made for patient care, primarily relating to critical care pharmacist duties and pharmacy services. In the quality improvement domain, 21 recommendations address the role of the critical care pharmacist in patient and medication safety, clinical quality programs, and analytics. Nine recommendations were made in the domain of research and scholarship. Ten recommendations are in the domain of training and education and eight recommendations regarding professional development. Conclusions The statements recommended by this taskforce delineate the activities of a critical care pharmacist and the scope of pharmacy services within the ICU. Effort should be made from all stakeholders to implement the recommendations provided, with continuous effort toward improving the delivery of care for critically ill patients.

The role of a pharmacy administration and leadership rotation within postgraduate year two critical care residency training

“…Ultimately, the change to a focused rotation month was based on three core tenants. First, the jobs residents are seeking often blend patient care with administrative responsibilities in accordance with what is described by Lat et al 1 These responsibilities extend beyond those required in the ASHP Residency Standards. It is critical that residents leave with the knowledgebase, experience, and confidence to perform in these roles.…”

“…It serves to prepare graduates for various career paths, particularly clinical specialist roles. The role of the critical care pharmacy specialist has evolved over time to include patient care, education, research and scholarship, and institutional quality improvement 1 . As the accrediting body for pharmacy residency programs, the American Society of Health‐System Pharmacists (ASHP) has developed objectives to ensure graduates of critical care residency programs are trained to master these tasks 2…”

“…They highlight the importance of the critical care pharmacist in using pharmacoeconomic analyses to aid in clinical decision making. Moreover, they state the critical care specialist should prepare formulary reviews of medications used in critically ill patients for institutional Pharmacy and Therapeutics committees 1 . Feedback from graduates of our residency program echoed the sentiment and stated that while PGY2 specialty training prepares graduates well for direct patient care, it may not sufficiently prepare them for the non‐patient care roles related to quality improvement and administrative projects that are expected of them in health‐systems.…”

“…PGY2 critical care residents can gain valuable experiences away from the bedside that better prepare them for future tasks in addition to patient care that will be expected of them as clinical pharmacists. 1 As the accrediting body for pharmacy residency programs, the American Society of Health-System Pharmacists (ASHP) has developed objectives to ensure graduates of critical care residency programs are trained to master these tasks. 2 The evolving role of the critical care pharmacy specialist is well described in the 2020 Update to the Position Paper on Critical Care Pharmacy Services.…”