Heather Torbic, BCCCP, BCPS, PharmD
Medical ICU Clinical Pharmacy Specialist
Cleveland Clinic
Cleveland, Ohio
Disclosure information not submitted.
Grace Conroy, PharmD
Clinical Pharmacy Specialist, Critical Care
Cleveland Clinic
Rocky River, Ohio, United States
Disclosure information not submitted.
Jessica Ward, PharmD, BCCCP,
Cardiothoracic & Vascular Surgery ICU Pharmacy Clinical Specialist
Cleveland Clinic Foundation
Cleveland, Ohio
Disclosure information not submitted.
.jpg "Michelle Biehl, MD, MS photo")
Michelle Biehl, MD, MS
Pulmonary and Critical Care Medicine Physician
Cleveland Clinic Foundation
Cleveland, Ohio
Disclosure information not submitted.
Title: Pharmacist Interventions in a Post-Intensive Care Unit Recovery Clinic
Introduction:
Up to 80% of intensive care unit (ICU) survivors experience post-intensive care syndrome (PICS) which is a constellation of new or worsening physical, mental and cognitive impairment that can last for years following ICU admission. Post-intensive care unit recovery clinics (PIRCs) are multidisciplinary clinics which have been developed to promote patient and family recovery following critical illness and pharmacist involvement has helped to optimize medication therapy and promote recovery.
Methods: A retrospective chart review of patients who attended PIRC at the Cleveland Clinic from December 2019-September 2020 was completed. Patients were evaluated for baseline characteristics, in-hospital and PIRC variables, and number and type of pharmacist interventions.
Results: A total of 63 patients were seen in PIRC during the study period. The median (IQR) age was 59.1 (49.2-71.6) years and 37 (58.7%) patients were male. The median ICU and hospital length of stay were 7 (3-12.5) and 14 (10-22) days, respectively. A total of 26 (41.3%) patients had acute respiratory distress syndrome and 52 (82.5%) had COVID-19. The median time from hospital discharge to PIRC visit was 52.5 (32-78) days and the majority of appointments were virtual (61.3%). At PIRC, 21 (45%) patients had a new oxygen requirement, 6 (38%) had an abnormal cognitive test, 11 (52%) screened positive for new anxiety or depression, and 3 (19%) screened positive for post-traumatic stress disorder. Pharmacists made a median (IQR) 4 (1-6.5) interventions per patient. The majority of interventions were discontinuation of medications from a patient’s medication list (59.4%), followed by adding medications which were omitted from the patient’s medication list (25.5%) and updating medication records to reflect current doses and frequencies (15.2%). Routine vaccinations were recommended for 33 (52.4%) patients and education frequently included medication adherence, proper inhaler technique, management of medication adverse effects and optimal use of as needed medications.
Conclusions:
Pharmacists are an integral member of the multidisciplinary PIRC care team. Pharmacists optimize medication therapy and provide valuable patient education. Further studies evaluating long-term outcomes of patients presenting to PIRCs and pharmacist involvement are warranted.