(1022) Evaluating the Impact of Expanding Decentralized Clinical Pharmacy Services to the MICU on Weekends

Introduction: Decentralized rounding pharmacy services in the intensive care unit (ICU) has been shown to improve patient outcomes. Previously at our institution, there were no decentralized clinical pharmacy services provided on weekends. Many medication orders are optimized by the rounding pharmacist, as they are present for the multidisciplinary discussion and plan of care. This is exceptionally important for critically ill patients who are often prescribed numerous high-risk medications.

Methods: On November 11th, 2023, an ICU pharmacist started rounding in a 32-bed Medical ICU (MICU) on weekends. Prior to this date, any weekend inpatient pharmacist would be assigned MICU orders in central pharmacy. We compared order verification turnaround time and pharmacist interventions before and after the implementation of a weekend MICU rounding pharmacist. The pre-implementation phase included nine weekends (18 days) was compared to 15 weekends (30 days) in post-implementation phase (11/11/23 to 2/18/24). Order verification turnaround time was measured via an electronic health record report and was sorted to include the rounding period (7am to 12pm). Pharmacist interventions were measured by communication order type "pharmacist". This order type is chosen by the pharmacist upon order verification when a medication order is modified after clarification from the ordering provider.

Results: Seven ICU pharmacists participated in the MICU rounding expansion verifying a total of 1659 medication orders in the post-group. There was no difference in percentage of orders entered during rounding times between the pre-group (29.5%) compared to the post-group (30%), p=0.62.Overall, the average time to order verification was faster in the post-group (13.3 minutes) compared to the pre-intervention group (20.5 minutes), p < 0.001.The percentage of orders with pharmacist intervention increased from 34 out of 1110 (3%) in the pre group to 500 out of 1234 (41%) in the post group, p< 0.001.

Conclusions: Pharmacists on MICU rounds intervened on more orders and provided a faster time to order verification compared to being in central pharmacy on weekends. This project emphasizes the value of an ICU pharmacist being on the unit and on rounds, and their presence should be a priority seven days a week.