(1366) Implementation of a 24/7 On-Call Pharmacist Service for Patients With Mechanical Circulatory Support

Introduction: Critical Care Pharmacists (CCPs) are assets in managing medications for patients with mechanical circulatory support (MCS) but may not be available at all hours. To provide 24/7 access to a CCP at our institution, an On-Call MCS CCP service was created. The objective of this study is to describe the utility of an On-Call CCP to bridge gaps in on-site clinical coverage.

Methods: This was a retrospective study at a 1,000-bed teaching hospital. From November 2022 through June 2024, a team of CCPs rotated through an On-Call schedule to provide pharmacotherapy recommendations for MCS patients. On-Call CCPs were accessible via a central phone number on weekdays between 1600 and 0800 and all hours on weekends. They were also available for assistance in-person during day shifts. An electronic database was used to track calls received. At the end of the study period, a review of all database entries was conducted; descriptive statistics were used to quantify calls received, time spent, multidisciplinary team member engagement, and types of interventions.

Results: Call data was available for 18 months of the specified timeframe. In this time, the hospital served 25 ECMO, 39 Impella, 7 VAD, and 125 IABP patients. On-Call CCPs documented 118 calls and 147 interventions. Most calls (71.2%) were received between the hours of 1600 and 0800, and 28% of calls were answered on weekends. On-Call CCPs spent a median of 20 minutes per call (IQR 5-20) on patient care. The On-Call CCP was predominantly contacted by other pharmacists (67.1%), physicians (34.3%), and advanced practice providers (32.9%). The majority of calls involved patients requiring ECMO (42.5%), Impellas (15.1%), and VADs (15.1%). The most frequent clinical interventions included: anticoagulation and hemostasis (66%), pharmacotherapy management at device cannulation (14.4%), and hemodynamic support (8.2%).

Conclusions: In the absence of an on-site CCP, a 24/7 On-Call MCS CCP was utilized by members of the multidisciplinary team to bridge gaps in clinical coverage. Further research is needed to determine the pharmacoeconomic and clinical impacts of an On-Call CCP when on-site resources are unavailable.