(1025) Quantifying Critical Care Pharmacist Interventions in Critically Ill Patients

Introduction: Critical care (CC) pharmacists serve as integral members of multiprofessional teams in the management of critically ill patients. Pharmacists help reduce medication errors, optimize regimens, enhance outcomes, reduce cost and waste, and lower mortality. Increasing pharmacist-to-patient ratio in addition to pharmacists’ evolving roles in non-patient care activities may lead to inconsistent pharmacist coverage, abd impact patient care and prolong length of stay. To extend pharmacist services across all ICUs, there is a need to quantify the different types of interventions that they make in these patients daily. This study aims to quantify and characterize clinical pharmacists’ interventions across all ICUs at a large academic medical center.

Methods: Single center, retrospective chart review evaluating CC pharmacists’ interventions across all ICUs, between July 1, 2023, and September 30, 2023. The interventions included were those made and documented in the electronic medical record for critically ill patients. Primary outcome was the number of interventions per day by critical care clinical pharmacists and residents across all ICUs. Secondary outcomes included subtypes of interventions, and percentage of high-risk medications of all medications intervened on.

Results: Interventions collected on 65 weekdays, with an average pharmacist-to-patient ratio of 1:24 and average pharmacist-to-team ratio of 1:2. Between 6 critical care pharmacists providing coverage during the day. Total of 4,752 interventions, with an average of 73 interventions per day across all ICUs. The most common type of interventions documented were neurology management (19.5%), followed by antimicrobial stewardship (14.9%), and therapeutic drug monitoring (7.5%). Every third medication intervened on was deemed to be a high-risk medication, with medications related to the management of pain, agitation, and delirium representing the number one category of high-risk medications intervened on by critical care pharmacists (12.5%).

Conclusions: Number of daily interventions, high pharmacist to team ratio, increasing demand of critical care pharmacists in the evenings, and additional daily responsibilities, all suggest need for expansion of critical care pharmacist services.