(418) High-Acuity Patients: Pharmaceutical Intervention Evolution to Remote Review

Introduction: Clinical pharmacists' value is well-elucidated in literature with minimal data beyond rounds. The evolution of remote clinical review has been accelerated by technology and workflow advancements, where timely and expert intervention can be life-saving. The aim of this remote pilot was to expand clinical pharmacy services to high-acuity patients and provide continuity of care over weekends, while promoting well-being. Creative efforts were employed to promote expansion of services from solely consults to clinical remote review of high acuity intensive care unit (ICU) patients while minimizing disruption to weekday rounds.

Methods: This retrospective review was conducted at a large academic medical center with 153 adult ICU beds. Critical care, cardiology, and emergency medicine trained pharmacists remotely reviewed patients on Saturday and Sunday from 0800 to 1200 between 1/6/2024 – 6/30/2024. The clinical pharmacy specialist (CPS) reviewed high acuity ICU patients and new ICU admissions. All interventions were documented in the electronic medical record. Value added and cost avoidance were calculated via validated studies. Post-implementation, a survey of participating specialists was conducted to evaluate effectiveness and promotion of well-being.

Results: During the 6 month time frame, 1,232 ICU patients were reviewed with 788 high value documented interventions. This pilot resulted in a total of $311,640 in both cost avoidance and value added. Interventions included 178 therapy recommendations, 146 dose adjustments, 111 therapeutic monitoring, 87 anticoagulation monitoring, 86 route changes, 75 antimicrobial stewardship, 63 discontinuations, 45 adverse drug event preventions, and 24 thromboembolism prophylaxis recommendations. The remote specialist also reviewed 323 pharmacy consults including continuous renal replacement therapy, drug information, and pharmacokinetics. All respondents to the survey agreed that remote review improves patient care with the majority agreeing it promoted well-being.

Conclusions: As healthcare systems adapt to the increasing demands and complexities of patient care, remote clinical review by pharmacists presents a viable solution to enhance patient safety, improve therapeutic outcomes, reduce healthcare costs, and promote well-being.