In this episode, I’ll discuss what predicts critical care pharmacist intervention – patient acuity or medication regimen complexity?
It makes intuitive sense that both scenarios of high patient acuity and high medication regimen complexity would be legitimate ways of identifying ICU patients who are more likely to need pharmacist intervention.
I will often prioritize my day in the ICU by looking first at the patients who appear the sickest, although this does not necessarily represent who requires an intervention.
Researchers recently published in AJHP a post-hoc analysis of an already completed prospective observation trial to compare the relationship of medication regimen complexity versus a traditional patient acuity metric for evaluating pharmacist interventions.
The data the analysis was performed on was 100 patients, split evenly between medical and surgical reasons for admission.
The primary outcome was the relationship between medication regimen complexity defined by the medication regimen complexity–intensive care unit (MRC-ICU) score, and acuity defined by the Acute Physiology and Chronic Health Evaluation (APACHE) II score, and pharmacist interventions at 24 hours, 48 hours, and ICU discharge.
While both metrics were correlated to pharmacist intervention in the raw dataset, when adjusting for patient age, gender, and admission type only the MRC-ICU score was associated with pharmacist intervention at each time point.
The study is limited by its post-hoc design however it does suggest that medication regimen complexity could be a good way of identifying patients in need of a critical care pharmacist intervention. Because the MRC-ICU score is calculated based on medication names and classes, the scoring system could be built into an electronic health record or report to allow critical care pharmacists to better prioritize their day.
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