.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.
Desiree Kosmisky, PharmD, BCCCP
Clinical Pharmacy Specialist-Critical Care
Atrium Health Cabarrus
Concord, North Carolina
Disclosure information not submitted.
Carrie Griffiths, PharmD, BCCCP, FCCM
Associate Professor, Virtual Critical Care
Wingate University School of Pharmacy
Wingate, North Carolina
Disclosure information not submitted.
Katelyn Smith, PharmD Candidate, PharmD Candidate
PharmD Candidate
Wingate University School of Pharmacy, United States
Disclosure information not submitted.
Title: Categorization of Fulltime Tele-Critical Care (TCC) Pharmacist Interventions Based on Shift
Introduction: Due to an anticipated patient surge related to the COVID-19 pandemic, a critical care pharmacist emergency prescribing protocol (EPP) was enacted allowing pharmacists to manage therapy in multiple domains. As a result of the EPP and an identified need for more proactive medication management, fulltime tele-critical care (TCC) pharmacists transitioned from working second shift to first shift hours, facilitating collaboration with multiple bedside providers in intensive care units (ICU) at 8 facilities. The purpose of this study was to categorize pharmacists’ interventions completed on first versus second shift.
Methods: This multi-center, multi-ICU, retrospective observational review evaluated fulltime TCC pharmacist interventions documented from September 1, 2020 to November 30, 2020 (second shift) compared with February 8, 2021 to May 7, 2021 (first shift). While clinical decision support alerts triggered the majority of chart reviews on second shift, prospective chart reviews of select ICU patients were performed on first shift. Descriptive statistics were reported.
Results: On second shift, 710 interventions were performed in 395 patients; while on first shift, 1024 interventions were performed in 357 patients. Glycemic control interventions accounted for 43% of second shift interventions compared to 19.5% on first shift. Medication management interventions comprised 30% of second shift activities in contrast with 52.2% on first shift. As the TCC pharmacists cover multiple facilities across the system, a change in facility focus occurred as well. During second shift, one facility totaled 35% of all interventions. With the change to dayshift, two other facilities became the primary focus at 34% and 21.7%, respectively.
Conclusion: By changing from a reactive or alert-driven model to prospective chart review utilizing EPP, a change in intervention type occurred. Medication management, which included sedation management, was a greater focus on first shift owing to greater collaboration with bedside providers. This information will be shared with critical care and pharmacy leadership to continue advancing care and for eventual justification of clinical pharmacist practitioner status in the inpatient space.