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McDaniel et al
Sanchez et al developed a complexity-based approach to
their inpatient medication therapy management (MTM)
service.8 This approach was used to assign the appropriate
Current Procedural Terminology (CPT) code when billing
for the MTM service provided.8 Services were categorized
into 5 levels, ranging from simple assessment to very
complex.8
A 2004 survey designed to describe ICU pharmacy services currently being provided across the nation based on the
2000 ACCP and SCCM position paper reported that only
62.2% of 382 hospitals provided at least part of a full-time
equivalent pharmacist's time devoted to the ICU.9 This survey concluded that fundamental services are consistently
provided, but desirable and optimal services are far less
likely to be provided.9
Recently, SCCM started a nationwide effort to improve
outcomes for ICU patients. The ICU Liberation ABCDEF
Bundle Improvement Collaborative is a nationwide project
comprised of 77 selected hospitals committed to improving
outcomes for patients and families.10 Based on the 2013
Clinical Practice Guidelines for the Management of Pain,
Agitation, and Delirium in Adult Patients in the Intensive
Care Unit, the ABCDEF care bundle elements individually
and collectively can help reduce delirium, improve pain
management, and reduce long-term consequences for ICU
patients.11 As essential members of the ICU team, pharmacists are integral to the success of this project. Intensivists at
our facility expressed interest in increased pharmacist participation with this project.
The primary objectives of this study were to compare the
complexity of interventions made on patients admitted to 30
adult ICU beds and to determine the types of clinical activities performed when there were 2 weekday dayshift critical
care pharmacists versus the current standard of 1 weekday
critical care pharmacist. Secondary objectives included comparing the number of interventions related to the ICU
Liberation ABCDEF Bundle Improvement Collaborative,
determining the impact on ICU LOS and time on mechanical
ventilation, and qualitatively describing the impact of the
additional pharmacist on ICU team members' satisfaction.
Methods
This mixed-method prospective descriptive study was performed at a community medical center with approximately
600 beds. At the time of this study, there were 30 adult ICU
beds separated into three 10-bed units, with 1 intensivist covering each 10-bed unit. Prior to this study, there was 1 pharmacist who provided weekday ICU coverage. This was a
decentralized pharmacist who provided order entry and computerized provider order entry (CPOE) validation, provided
clinical dosing services (pharmacy to dose and renal adjustment services), answered drug information questions,
and completed other daily activities for the 30 adult ICU
beds and an additional 40 adult non-ICU patient beds. The
Table 1. ICU Liberation Campaign ABCDEF Care Bundles.
ABCDEF care bundles
A: Assess, prevent and manage pain
B: Both spontaneous awakening trials (SAT) and spontaneous
breathing trials (SBT)
C: Choice of analgesia and sedation
D: Delirium: assess, prevent, and manage
E: Early mobility and exercise
F: Family engagement and empowerment
pharmacist began attending daily rounds with the intensivists
in the fall of 2014 and was able to round in 1 unit (10 ICU
beds) on weekdays.
This study involved collecting interventions, recommendations, and clinical activities performed by the current critical care pharmacist and 2 postgraduate year 1 (PGY1)
pharmacy residents, serving as critical care pharmacists on
their ICU rotations. Baseline data were collected during two
4-week periods of November 23, 2015, to December 18,
2015, and February 1, 2016, to February 26, 2016. During
these time periods, only the current critical care pharmacist
performed daily ICU pharmacy services. For the intervention
period, data were collected during two 4-week periods of
December 28, 2015, to January 22, 2016, and March 14,
2016, to April 8, 2016. During these time periods, the current
critical care pharmacist and a PGY1 pharmacy resident
worked on weekdays, coordinating the daily ICU pharmacy
services and daily workload.
The critical care pharmacist and PGY1 pharmacy resident independently documented interventions and recommendations made throughout the day. Information collected
included the date of the intervention, a brief description of
the intervention, whether the intervention was related to
the ICU Liberation Campaign ABCDEF care bundles
(Table 1), and a complexity score. The complexity was
scored by the pharmacist making the intervention based on
a complexity table (Table 2) created by the research team
and modified from the Sanchez et al study.8 Interventions
were rated with a weighted point value (low complexity =
1 point, moderate complexity = 2 points, and high complexity = 3 points). Prior to the data collection, the 3 pharmacists participating in the study reviewed the intervention
complexity table, and this information was available to the
pharmacists throughout the study. An interrater reliability
test developed from modified real-life historical interventions and hypothetically developed interventions was
used to assess the variability of the raters' intervention
complexity scoring.
The critical care pharmacist and pharmacy resident independently documented the types of clinical activities performed throughout the day. Efforts were made to ensure no
duplications in interventions or clinical activities were
recorded. If duplicate data were recorded, it would have been
counted as one occurrence in data analysis.
Table of Contents for the Digital Edition of Hospital Pharmacy - September 2017
Pharmacy Transitions of Care and Culture
Bivalirudin Medication Use Evaluation and Cost Savings Initiative
Navigating the New Antimicrobial Stewardship Regulations
Safinamide
Biosimilar Substitution Laws
Evaluation of Corticosteroid Dose in Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Hazardous Drug Contamination of Drug Preparation Devices and Staff: A Contamination Study Simulating the Use of Chemotherapy Drugs in a Clinical Setting
A Case of Metronidazole Injection Infiltration Without Sequelae
Doubling Pharmacist Coverage in the Intensive Care Unit: Impact on the Pharmacists’ Clinical Activities and Team Members’ Satisfaction
Extended Stability of Epinephrine Hydrochloride Injection in Polyvinyl Chloride Bags Stored in Amber Ultraviolet Light–Blocking Bags
Formation of a Citywide Pharmacy Residents’ Collaborative Committee
Hospital Pharmacy - September 2017 - 513
Hospital Pharmacy - September 2017 - 514
Hospital Pharmacy - September 2017 - 515
Hospital Pharmacy - September 2017 - 516
Hospital Pharmacy - September 2017 - 517
Hospital Pharmacy - September 2017 - 518
Hospital Pharmacy - September 2017 - 519
Hospital Pharmacy - September 2017 - Pharmacy Transitions of Care and Culture
Hospital Pharmacy - September 2017 - 521
Hospital Pharmacy - September 2017 - Bivalirudin Medication Use Evaluation and Cost Savings Initiative
Hospital Pharmacy - September 2017 - 523
Hospital Pharmacy - September 2017 - 524
Hospital Pharmacy - September 2017 - 525
Hospital Pharmacy - September 2017 - 526
Hospital Pharmacy - September 2017 - Navigating the New Antimicrobial Stewardship Regulations
Hospital Pharmacy - September 2017 - 528
Hospital Pharmacy - September 2017 - 529
Hospital Pharmacy - September 2017 - 530
Hospital Pharmacy - September 2017 - 531
Hospital Pharmacy - September 2017 - Safinamide
Hospital Pharmacy - September 2017 - 533
Hospital Pharmacy - September 2017 - 534
Hospital Pharmacy - September 2017 - 535
Hospital Pharmacy - September 2017 - 536
Hospital Pharmacy - September 2017 - 537
Hospital Pharmacy - September 2017 - 538
Hospital Pharmacy - September 2017 - 539
Hospital Pharmacy - September 2017 - 540
Hospital Pharmacy - September 2017 - 541
Hospital Pharmacy - September 2017 - 542
Hospital Pharmacy - September 2017 - 543
Hospital Pharmacy - September 2017 - Biosimilar Substitution Laws
Hospital Pharmacy - September 2017 - 545
Hospital Pharmacy - September 2017 - Evaluation of Corticosteroid Dose in Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Hospital Pharmacy - September 2017 - 547
Hospital Pharmacy - September 2017 - 548
Hospital Pharmacy - September 2017 - 549
Hospital Pharmacy - September 2017 - 550
Hospital Pharmacy - September 2017 - Hazardous Drug Contamination of Drug Preparation Devices and Staff: A Contamination Study Simulating the Use of Chemotherapy Drugs in a Clinical Setting
Hospital Pharmacy - September 2017 - 552
Hospital Pharmacy - September 2017 - 553
Hospital Pharmacy - September 2017 - 554
Hospital Pharmacy - September 2017 - 555
Hospital Pharmacy - September 2017 - 556
Hospital Pharmacy - September 2017 - 557
Hospital Pharmacy - September 2017 - 558
Hospital Pharmacy - September 2017 - A Case of Metronidazole Injection Infiltration Without Sequelae
Hospital Pharmacy - September 2017 - 560
Hospital Pharmacy - September 2017 - 561
Hospital Pharmacy - September 2017 - 562
Hospital Pharmacy - September 2017 - 563
Hospital Pharmacy - September 2017 - Doubling Pharmacist Coverage in the Intensive Care Unit: Impact on the Pharmacists’ Clinical Activities and Team Members’ Satisfaction
Hospital Pharmacy - September 2017 - 565
Hospital Pharmacy - September 2017 - 566
Hospital Pharmacy - September 2017 - 567
Hospital Pharmacy - September 2017 - 568
Hospital Pharmacy - September 2017 - 569
Hospital Pharmacy - September 2017 - Extended Stability of Epinephrine Hydrochloride Injection in Polyvinyl Chloride Bags Stored in Amber Ultraviolet Light–Blocking Bags
Hospital Pharmacy - September 2017 - 571
Hospital Pharmacy - September 2017 - 572
Hospital Pharmacy - September 2017 - 573
Hospital Pharmacy - September 2017 - Formation of a Citywide Pharmacy Residents’ Collaborative Committee
Hospital Pharmacy - September 2017 - 575
Hospital Pharmacy - September 2017 - 576
Hospital Pharmacy - September 2017 - 577
Hospital Pharmacy - September 2017 - 578
Hospital Pharmacy - September 2017 - 579
Hospital Pharmacy - September 2017 - 580
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