Andrea Sikora, BCCCP, PharmD
Critial Care Pharmacy Specialist
University of Georgia College of Pharmacy
Augusta, Georgia
Disclosure information not submitted.
Deepak Ayyala, PhD
Biostatistician
Augusta University, United States
Disclosure information not submitted.
Megan Rech, BCCCP, MS, PharmD
Clinical Pharmacist, Emergency Medicine
Loyola University Medical Center
Chicago, Illinois, United States
Disclosure information not submitted.
PHARMCRIT MRCICU Investigators
Pharmacist
PHARMCRIT MRCICU Study Team, United States
Disclosure information not submitted.
Title: MRC-ICU as a Predictor of Patient Outcomes and Pharmacist Workload: An Evaluation of PHARM-CRIT
Introduction: The medication regimen complexity in the intensive care unit (MRC-ICU) has been validated to correlate with patient acuity, length of stay, mortality, development of fluid overload, drug-drug interactions, and pharmacist interventions in small, retrospective cohorts. This study evaluated the relationship of MRC-ICU to both patient outcomes and pharmacist workload in a diverse cohort of critically ill patients.
Methods: PHARM-CRIT was a multi-center, multi-ICU observational cohort study wherein pharmacists prospectively documented medication interventions. Patient outcomes, including mortality and length of stay (LOS), institutional demographics, and the MRC-ICU were retrospectively recorded from the electronic health records. Multivariable regression was performed to characterize MRC’s relationship to mortality, length of stay, and pharmacist interventions.
Results: A total of 3,908 patients at 28 centers were included. Overall mortality was 14.6%. The most common practice setting was the medical ICU (45.7%). Mean MRC-ICU score was 10.4 (± 6.3). Upon multivariable regression adjusting for institution type, ICU type, and region, for every 1-point increase in MRC-ICU, a 7% increase in mortality (95% CI OR 1.05-1.1, p < 0.001) and 0.25 day increase in length of stay (95% CI ß 0.19 – 0.31, p < 0.001) was observed. Pharmacist interventions increased as MRC-ICU increased (ß 0.08, 95% CI 0.05-0.11, p < 0.001).
Conclusion: In this large, multi-center study, increasing MRC is a quantifiable metric associated with both patient-centered outcomes and pharmacist interventions. The ability to predict future pharmacist workload at diverse sites may potentially be applied to optimizing stretched ICU resources.