Susan Smith, BCCCP, BCPS, PharmD
Clinical Associate Professor
University of Georgia
Athens, Georgia
Disclosure information not submitted.
Andrea Sikora, BCCCP, PharmD
Critial Care Pharmacy Specialist
University of Georgia College of Pharmacy
Augusta, Georgia
Disclosure information not submitted.
Title: Comparison of Medication Regimen Complexity and Patient Acuity to Predict Pharmacist Interventions
INTRODUCTION: Several tools are used to predict critical care clinician workload and inform clinician-to-patient ratios in the ICU; however, no such tool has been established for critical care pharmacists (CCP). The medication regimen complexity-intensive care unit (MRC-ICU) score is an objective, pharmacist-oriented metric that has demonstrated relationships with patient outcomes and pharmacist interventions. The purpose of this study was to compare the utility of MRC-ICU versus a traditional patient acuity score for CCP workload prediction.
Methods: This was a post hoc analysis of a prospective, observational study of patients admitted to a medical/surgical ICU for at least 24 hours between March and May 2018. The MRC-ICU score and Acute Physiology and Chronic Health Evaluation (APACHE) II score were calculated on ICU day one. The primary outcome was to compare the relationship between patient acuity (APACHE II) and MRC-ICU with the number of pharmacist interventions at 24 hours, 48 hours, and ICU discharge. The secondary outcome was to compare these measures with the number of potential drug-drug interactions (DDIs) at 24 hours. These relationships were assessed by Spearman rank-order correlation and by multiple linear regression, controlling for age, gender, and type of ICU admission.
Results: One-hundred patients were included with a median MRC-ICU score of 11 (IQR 8-14) and a median APACHE II score of 18 (11-24). APACHE II score positively correlated with the number of pharmacist interventions at 24 hours, 48 hours, and ICU discharge; however, this relationship was lost in the adjusted analysis accounting for potentially confounding variables (24 h: rs=0.283, p=0.004; β=0.031, p=0.085). MRC-ICU score positively correlated with the number of pharmacist interventions at each time point, and this relationship remained true in the adjusted analyses (24 h: rs=0.370, p< 0.001; β=0.099, p=0.001). APACHE II score was not associated with DDIs in either analysis, whereas MRC-ICU score was associated with the number of DDIs.
Conclusion: The MRC-ICU score had a stronger relationship with pharmacist workload than a traditional patient acuity measure. The ability to predict CCP workload has important implications for informing pharmacist staffing models, improving patient outcomes, and mitigating burnout.