The use of electronic health record embedded MRC-ICU as a metric for critical care pharmacist workload

Webb, Andrew J; Carver, Bayleigh; Rowe, Sandra; Sikora, Andrea

doi:10.1093/jamiaopen/ooad101

Cited by 2 publications

References 26 publications

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Relationship between medication regimen complexity and pharmacist engagement in fluid stewardship

Smith,

Sikora

et al. 2024

American Journal of Health-System Pharmacy

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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 The medication regimen complexity intensive care unit (MRC-ICU) score has previously been associated with pharmacist workload and fluid overload. The purpose of this study was to determine the relationship of MRC-ICU score with pharmacist-driven fluid stewardship recommendations as a means of establishing its role in risk stratifying critically ill patients for pharmacist intervention. Methods Adult patients admitted to the medical ICU and followed by the academic pharmacy team were included in this retrospective, single-center cohort study. Patient and pharmacist data were collected via electronic medical record and surveillance tool, respectively. MRC-ICU and sequential organ failure assessment (SOFA) scores were captured at ICU admission. The primary outcome was correlation between MRC-ICU score and number of pharmacist-driven fluid stewardship recommendations. Secondary outcomes included the relationships between MRC-ICU score, accepted recommendations, and patient outcomes (fluid overload and length of stay [LOS]). Descriptive statistics were calculated for each variable. Spearman’s rank-order correlation was used. Results Of 168 patients, 22 (13%) experienced fluid overload. Median MRC-ICU and SOFA scores were 13 and 7, respectively, and were higher for patients experiencing fluid overload than for those without fluid overload. MRC-ICU had a weakly positive correlation with the number of pharmacist-driven fluid stewardship recommendations (ρ = 0.200; P = 0.010), fluid overload (ρ = 0.167; P = 0.030), and ICU LOS (ρ = 0.354; P < 0.001). These relationships remained true when looking at only the fluid stewardship recommendations that were accepted by the team. Conclusion MRC-ICU displayed a weakly positive correlation with pharmacist workload, suggesting its potential use in identifying patients likely to benefit from pharmacist intervention.

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Relationship between medication regimen complexity and pharmacist engagement in fluid stewardship

Smith,

Sikora

et al. 2024

American Journal of Health-System Pharmacy

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Effect of comprehensive medication management on mortality in critically ill patients

Sikora,

Min,

et al. 2024

Preprint

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Background: Medication management in the intensive care unit (ICU) is causally linked to both treatment success and potential adverse drug events (ADEs), often associated with deleterious consequences. Patients with higher severity of illness tend to require more management. The purpose of this evaluation was to explore the effect of comprehensive medication management (CMM) on mortality in critically ill patients. Methods: In this retrospective cohort study of adult ICU patients, CMM was measured by critical care pharmacist (CCP) medication interventions. Propensity score matching was performed to generate a balanced 1:1 matched cohort, and logistic regression was applied for estimating propensity scores. The primary outcome was the odds of hospital mortality. Hospital and ICU length of stay were also assessed. Results: In a cohort of 10,441 ICU patients, the unadjusted mortality rate was 11% with a mean APACHE II score of 9.54 and Medication Regimen Complexity-Intensive Care Unit (MRC-ICU) score of 5.78. Compared with CCP interventions less than 3, more CCP interventions was associated with a significantly reduced risk of mortality (estimate -0.04, 95% confidence interval -0.06 - -0.03, p < 0.01) and shorter length of ICU stay (estimate -2.77, 95% CI -2.98 - - 2.56, p < 0.01). Conclusions: The degree by which CCPs deliver CMM in the ICU is directly associated with reduced hospital mortality independent of patient characteristics and medication regimen complexity.

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The use of electronic health record embedded MRC-ICU as a metric for critical care pharmacist workload

Cited by 2 publications

References 26 publications

Relationship between medication regimen complexity and pharmacist engagement in fluid stewardship

Relationship between medication regimen complexity and pharmacist engagement in fluid stewardship

Effect of comprehensive medication management on mortality in critically ill patients

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