Carrie Griffiths, PharmD, BCCCP, FCCM
Associate Professor, Virtual Critical Care
Wingate University School of Pharmacy
Wingate, North Carolina
Disclosure information not submitted.
Desiree Kosmisky, PharmD, BCCCP
Clinical Pharmacy Specialist-Critical Care
Atrium Health Cabarrus
Concord, North Carolina
Disclosure information not submitted.
.jpg "Sonia Everhart, PharmD, BCPS, BCCCP photo")
Sonia Everhart, PharmD, BCPS, BCCCP
Clinical Pharmacy Specialist-Critical Care
Atrium Health
Charlotte, North Carolina
Disclosure information not submitted.
Title: Tele-Critical Care (TCC) Pharmacy First Shift Compared to Second Shift TCC Pharmacist Interventions
Introduction: Tele-critical care (TCC) use expanded dramatically during COVID19 pandemic. As a result of anticipated surges in ICU capacity and increased patient acuity secondary to the pandemic, this healthcare system enacted a critical care pharmacist emergency protocol (CCPEP) allowing critical care pharmacists to manage therapy in multiple domains, ultimately increasing provider bandwidth for additional patient review and higher acuity activities. The purpose of this study was to characterize TCC pharmacist interventions made using the CCPEP comparing first shift versus second shift.
Methods: This multi-center, multi-ICU, retrospective observational review evaluated TCC pharmacist interventions documented from September 1, 2020 through November 30, 2020 for first shift vs. second shift. Prospective chart review occurred for each ICU status patient on first shift, while patient review on second shift was in response to alerts or new admissions. Descriptive statistics were reported.
Results: A total of 2152 (1266 on 1st shift and 886 on 2nd shift) documented pharmacist interventions were made during the 3-month period using the critical care pharmacist emergency protocol for 861 unique patients (52.1% on 1st shift). An average of 2.8 interventions per patient were made on 1st shift and 2.1 interventions per patient on 2nd shift.
In addition to interventions made for glucose, electrolyte management, stress ulcer prophylaxis and venous thromboembolism prophylaxis, the most common interventions (873/2150, 40%) were categorized as medication management. First shift had 588 interventions versus 2nd shift with 285 interventions. Examples of these interventions overall include sedation, analgesia, and paralytic management (35%); dose adjustments (13%); vasopressor management (4%); fluid management (3%) and clustering care for patients (3%). Adverse drug events avoided totaled 103, with 84% of interventions occurring on 2nd shift.
Conclusion: Proactive review of patients led to more medication management interventions through use of the CCPEP. The use of the CCPEP expanded pharmacist practice during the COVID-19 pandemic to practice at the top of their license. Future directions include using this data as justification for clinical pharmacist practitioner status and additional critical care pharmacist positions.