Impact of Pharmacists to Improve Patient Care in the Critically Ill: A Large Multicenter Analysis Using Meaningful Metrics With the Medication Regimen Complexity-ICU (MRC-ICU) Score

Andrea Sikora; Deepak Ayyala; Megan A. Rech; Sarah B. Blackwell; Joshua Campbell; Meghan M. Caylor; Melanie Smith Condeni; Ashley Depriest; Amy L. Dzierba; Alexander H. Flannery; Leslie A. Hamilton; Mojdeh S. Heavner; Michelle Horng; Joseph Lam; Edith Liang; Jennifer Montero; David Murphy; Angela M. Plewa-Rusiecki; Alicia J. Sacco; Gretchen L. Sacha; Poorvi Shah; Michael P. Smith; Zachary Smith; John J. Radosevich; Antonia L. Vilella; Aaron Chase; Ah Hyun Jun; Allison Hollis; Amy Siu Yan Yeung; Ashley Martinelli; Bhavna Jois; Brittany Bissell; Carly Cheng; Christy Cecil Forehand; Dalila Masic; Sadaf Khan; Derex Louie; Dina Ali; Edith Liang; Elise Metts; Brian Murray; Ellen Huang; Gavin Howington; George Ndongai; James Mease; Jason Davis; Jason Sai Ho Chui; Karen Huang; Karen Williams; Vincent Soriano; Susan E. Smith; Nataša Stevković-Rašeta; Katherine Spezzano; Kelsie Kaier; Komal Pandya; Melissa Thompson Bastin; Victoria Ramos; Michael A. Ruggero; Michael Armahizer; Sarah Won; Sharon Wilson; Thomas Adriaens; Tina Yoo

doi:10.1097/CCM.0000000000005585

Impact of Pharmacists to Improve Patient Care in the Critically Ill: A Large Multicenter Analysis Using Meaningful Metrics With the Medication Regimen Complexity-ICU (MRC-ICU) Score

Andrea Sikora, Deepak Ayyala, Megan A. Rech, Sarah B. Blackwell, Joshua Campbell, Meghan M. Caylor, Melanie Smith Condeni, Ashley Depriest, Amy L. Dzierba, Alexander H. Flannery, Leslie A. Hamilton, Mojdeh S. Heavner, Michelle Horng, Joseph Lam, Edith Liang, Jennifer Montero, David Murphy, Angela M. Plewa-Rusiecki, Alicia J. Sacco, Gretchen L. SachaPoorvi Shah, Michael P. Smith, Zachary Smith, John J. Radosevich, Antonia L. Vilella, Aaron Chase, Ah Hyun Jun, Allison Hollis, Amy Siu Yan Yeung, Ashley Martinelli, Bhavna Jois, Brittany Bissell, Carly Cheng, Christy Cecil Forehand, Dalila Masic, Sadaf Khan, Derex Louie, Dina Ali, Edith Liang, Elise Metts, Brian Murray, Ellen Huang, Gavin Howington, George Ndongai, James Mease, Jason Davis, Jason Sai Ho Chui, Karen Huang, Karen Williams, Vincent Soriano, Susan E. Smith, Nataša Stevković-Rašeta, Katherine Spezzano, Kelsie Kaier, Komal Pandya, Melissa Thompson Bastin, Victoria Ramos, Michael A. Ruggero, Michael Armahizer, Sarah Won, Sharon Wilson, Thomas Adriaens, Tina Yoo

Research output: Contribution to journal › Article › peer-review

26 Scopus citations

Abstract

OBJECTIVES: Despite the established role of the critical care pharmacist on the ICU multiprofessional team, critical care pharmacist workloads are likely not optimized in the ICU. Medication regimen complexity (as measured by the Medication Regimen Complexity-ICU [MRC-ICU] scoring tool) has been proposed as a potential metric to optimize critical care pharmacist workload but has lacked robust external validation. The purpose of this study was to test the hypothesis that MRC-ICU is related to both patient outcomes and pharmacist interventions in a diverse ICU population. DESIGN: This was a multicenter, observational cohort study. SETTING: Twenty-eight ICUs in the United States. PATIENTS: Adult ICU patients. INTERVENTIONS: Critical care pharmacist interventions (quantity and type) on the medication regimens of critically ill patients over a 4-week period were prospectively captured. MRC-ICU and patient outcomes (i.e., mortality and length of stay [LOS]) were recorded retrospectively. MEASUREMENTS AND MAIN RESULTS: A total of 3,908 patients at 28 centers were included. Following analysis of variance, MRC-ICU was significantly associated with mortality (odds ratio, 1.09; 95% CI, 1.08-1.11; p < 0.01), ICU LOS (β coefficient, 0.41; 95% CI, 00.37-0.45; p < 0.01), total pharmacist interventions (β coefficient, 0.07; 95% CI, 0.04-0.09; p < 0.01), and a composite intensity score of pharmacist interventions (β coefficient, 0.19; 95% CI, 0.11-0.28; p < 0.01). In multivariable regression analysis, increased patient: Pharmacist ratio (indicating more patients per clinician) was significantly associated with increased ICU LOS (β coefficient, 0.02; 0.00-0.04; p = 0.02) and reduced quantity (β coefficient,-0.03; 95% CI,-0.04 to-0.02; p < 0.01) and intensity of interventions (β coefficient,-0.05; 95% CI,-0.09 to-0.01). CONCLUSIONS: Increased medication regimen complexity, defined by the MRC-ICU, is associated with increased mortality, LOS, intervention quantity, and intervention intensity. Further, these results suggest that increased pharmacist workload is associated with decreased care provided and worsened patient outcomes, which warrants further exploration into staffing models and patient outcomes.

Original language	English
Pages (from-to)	1318-1328
Number of pages	11
Journal	Critical Care Medicine
Volume	50
Issue number	9
DOIs	https://doi.org/10.1097/CCM.0000000000005585
State	Published - Sep 1 2022

Bibliographical note

Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.

Funding

Dr. Newsome has received research funding through the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Numbers UL1TR002378 and KL2TR002381. Dr. Rech’s institution received funding from Spero Pharmaceuticals; she received funding from Harm Reduction Therapeutics. Dr. DePriest received funding from Baxter. Dr. Flannery’s institution received funding from the National Institute of Diabetes and Digestive and Kidney Diseases, the American Society of Nephrology, and La Jolla Pharmaceutical Company. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Funders	Funder number
Harm Reduction Therapeutics
National Institutes of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases
American Society of Nephrology
La Jolla Pharmaceutical Company
Baxter International
National Center for Advancing Translational Sciences (NCATS)	UL1TR002378, KL2TR002381
National Center for Advancing Translational Sciences (NCATS)

Keywords

burnout
metrics
patient safety
pharmacy
quality
workload

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine

Access to Document

10.1097/CCM.0000000000005585

Cite this

Sikora, A., Ayyala, D., Rech, M. A., Blackwell, S. B., Campbell, J., Caylor, M. M., Condeni, M. S., Depriest, A., Dzierba, A. L., Flannery, A. H., Hamilton, L. A., Heavner, M. S., Horng, M., Lam, J., Liang, E., Montero, J., Murphy, D., Plewa-Rusiecki, A. M., Sacco, A. J., ... Yoo, T. (2022). Impact of Pharmacists to Improve Patient Care in the Critically Ill: A Large Multicenter Analysis Using Meaningful Metrics With the Medication Regimen Complexity-ICU (MRC-ICU) Score. Critical Care Medicine, 50(9), 1318-1328. https://doi.org/10.1097/CCM.0000000000005585

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title = "Impact of Pharmacists to Improve Patient Care in the Critically Ill: A Large Multicenter Analysis Using Meaningful Metrics With the Medication Regimen Complexity-ICU (MRC-ICU) Score",

abstract = "OBJECTIVES: Despite the established role of the critical care pharmacist on the ICU multiprofessional team, critical care pharmacist workloads are likely not optimized in the ICU. Medication regimen complexity (as measured by the Medication Regimen Complexity-ICU [MRC-ICU] scoring tool) has been proposed as a potential metric to optimize critical care pharmacist workload but has lacked robust external validation. The purpose of this study was to test the hypothesis that MRC-ICU is related to both patient outcomes and pharmacist interventions in a diverse ICU population. DESIGN: This was a multicenter, observational cohort study. SETTING: Twenty-eight ICUs in the United States. PATIENTS: Adult ICU patients. INTERVENTIONS: Critical care pharmacist interventions (quantity and type) on the medication regimens of critically ill patients over a 4-week period were prospectively captured. MRC-ICU and patient outcomes (i.e., mortality and length of stay [LOS]) were recorded retrospectively. MEASUREMENTS AND MAIN RESULTS: A total of 3,908 patients at 28 centers were included. Following analysis of variance, MRC-ICU was significantly associated with mortality (odds ratio, 1.09; 95% CI, 1.08-1.11; p < 0.01), ICU LOS (β coefficient, 0.41; 95% CI, 00.37-0.45; p < 0.01), total pharmacist interventions (β coefficient, 0.07; 95% CI, 0.04-0.09; p < 0.01), and a composite intensity score of pharmacist interventions (β coefficient, 0.19; 95% CI, 0.11-0.28; p < 0.01). In multivariable regression analysis, increased patient: Pharmacist ratio (indicating more patients per clinician) was significantly associated with increased ICU LOS (β coefficient, 0.02; 0.00-0.04; p = 0.02) and reduced quantity (β coefficient,-0.03; 95% CI,-0.04 to-0.02; p < 0.01) and intensity of interventions (β coefficient,-0.05; 95% CI,-0.09 to-0.01). CONCLUSIONS: Increased medication regimen complexity, defined by the MRC-ICU, is associated with increased mortality, LOS, intervention quantity, and intervention intensity. Further, these results suggest that increased pharmacist workload is associated with decreased care provided and worsened patient outcomes, which warrants further exploration into staffing models and patient outcomes.",

keywords = "burnout, metrics, patient safety, pharmacy, quality, workload",

author = "Andrea Sikora and Deepak Ayyala and Rech, {Megan A.} and Blackwell, {Sarah B.} and Joshua Campbell and Caylor, {Meghan M.} and Condeni, {Melanie Smith} and Ashley Depriest and Dzierba, {Amy L.} and Flannery, {Alexander H.} and Hamilton, {Leslie A.} and Heavner, {Mojdeh S.} and Michelle Horng and Joseph Lam and Edith Liang and Jennifer Montero and David Murphy and Plewa-Rusiecki, {Angela M.} and Sacco, {Alicia J.} and Sacha, {Gretchen L.} and Poorvi Shah and Smith, {Michael P.} and Zachary Smith and Radosevich, {John J.} and Vilella, {Antonia L.} and Aaron Chase and Jun, {Ah Hyun} and Allison Hollis and {Yan Yeung}, {Amy Siu} and Ashley Martinelli and Bhavna Jois and Brittany Bissell and Carly Cheng and Forehand, {Christy Cecil} and Dalila Masic and Sadaf Khan and Derex Louie and Dina Ali and Edith Liang and Elise Metts and Brian Murray and Ellen Huang and Gavin Howington and George Ndongai and James Mease and Jason Davis and {Ho Chui}, {Jason Sai} and Karen Huang and Karen Williams and Vincent Soriano and Smith, {Susan E.} and Nata{\v s}a Stevkovi{\'c}-Ra{\v s}eta and Katherine Spezzano and Kelsie Kaier and Komal Pandya and Bastin, {Melissa Thompson} and Victoria Ramos and Ruggero, {Michael A.} and Michael Armahizer and Sarah Won and Sharon Wilson and Thomas Adriaens and Tina Yoo",

year = "2022",

month = sep,

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doi = "10.1097/CCM.0000000000005585",

language = "English",

volume = "50",

pages = "1318--1328",

number = "9",

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Sikora, A, Ayyala, D, Rech, MA, Blackwell, SB, Campbell, J, Caylor, MM, Condeni, MS, Depriest, A, Dzierba, AL, Flannery, AH, Hamilton, LA, Heavner, MS, Horng, M, Lam, J, Liang, E, Montero, J, Murphy, D, Plewa-Rusiecki, AM, Sacco, AJ, Sacha, GL, Shah, P, Smith, MP, Smith, Z, Radosevich, JJ, Vilella, AL, Chase, A, Jun, AH, Hollis, A, Yan Yeung, AS, Martinelli, A, Jois, B, Bissell, B, Cheng, C, Forehand, CC, Masic, D, Khan, S, Louie, D, Ali, D, Liang, E, Metts, E, Murray, B, Huang, E, Howington, G, Ndongai, G, Mease, J, Davis, J, Ho Chui, JS, Huang, K, Williams, K, Soriano, V, Smith, SE, Stevković-Rašeta, N, Spezzano, K, Kaier, K, Pandya, K, Bastin, MT, Ramos, V, Ruggero, MA, Armahizer, M, Won, S, Wilson, S, Adriaens, T & Yoo, T 2022, 'Impact of Pharmacists to Improve Patient Care in the Critically Ill: A Large Multicenter Analysis Using Meaningful Metrics With the Medication Regimen Complexity-ICU (MRC-ICU) Score', Critical Care Medicine, vol. 50, no. 9, pp. 1318-1328. https://doi.org/10.1097/CCM.0000000000005585

Impact of Pharmacists to Improve Patient Care in the Critically Ill: A Large Multicenter Analysis Using Meaningful Metrics With the Medication Regimen Complexity-ICU (MRC-ICU) Score. / Sikora, Andrea; Ayyala, Deepak; Rech, Megan A. et al.
In: Critical Care Medicine, Vol. 50, No. 9, 01.09.2022, p. 1318-1328.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Impact of Pharmacists to Improve Patient Care in the Critically Ill

T2 - A Large Multicenter Analysis Using Meaningful Metrics With the Medication Regimen Complexity-ICU (MRC-ICU) Score

AU - Sikora, Andrea

AU - Ayyala, Deepak

AU - Rech, Megan A.

AU - Blackwell, Sarah B.

AU - Campbell, Joshua

AU - Caylor, Meghan M.

AU - Condeni, Melanie Smith

AU - Depriest, Ashley

AU - Dzierba, Amy L.

AU - Flannery, Alexander H.

AU - Hamilton, Leslie A.

AU - Heavner, Mojdeh S.

AU - Horng, Michelle

AU - Lam, Joseph

AU - Liang, Edith

AU - Montero, Jennifer

AU - Murphy, David

AU - Plewa-Rusiecki, Angela M.

AU - Sacco, Alicia J.

AU - Sacha, Gretchen L.

AU - Shah, Poorvi

AU - Smith, Michael P.

AU - Smith, Zachary

AU - Radosevich, John J.

AU - Vilella, Antonia L.

AU - Chase, Aaron

AU - Jun, Ah Hyun

AU - Hollis, Allison

AU - Yan Yeung, Amy Siu

AU - Martinelli, Ashley

AU - Jois, Bhavna

AU - Bissell, Brittany

AU - Cheng, Carly

AU - Forehand, Christy Cecil

AU - Masic, Dalila

AU - Khan, Sadaf

AU - Louie, Derex

AU - Ali, Dina

AU - Liang, Edith

AU - Metts, Elise

AU - Murray, Brian

AU - Huang, Ellen

AU - Howington, Gavin

AU - Ndongai, George

AU - Mease, James

AU - Davis, Jason

AU - Ho Chui, Jason Sai

AU - Huang, Karen

AU - Williams, Karen

AU - Soriano, Vincent

AU - Smith, Susan E.

AU - Stevković-Rašeta, Nataša

AU - Spezzano, Katherine

AU - Kaier, Kelsie

AU - Pandya, Komal

AU - Bastin, Melissa Thompson

AU - Ramos, Victoria

AU - Ruggero, Michael A.

AU - Armahizer, Michael

AU - Won, Sarah

AU - Wilson, Sharon

AU - Adriaens, Thomas

AU - Yoo, Tina

PY - 2022/9/1

Y1 - 2022/9/1

N2 - OBJECTIVES: Despite the established role of the critical care pharmacist on the ICU multiprofessional team, critical care pharmacist workloads are likely not optimized in the ICU. Medication regimen complexity (as measured by the Medication Regimen Complexity-ICU [MRC-ICU] scoring tool) has been proposed as a potential metric to optimize critical care pharmacist workload but has lacked robust external validation. The purpose of this study was to test the hypothesis that MRC-ICU is related to both patient outcomes and pharmacist interventions in a diverse ICU population. DESIGN: This was a multicenter, observational cohort study. SETTING: Twenty-eight ICUs in the United States. PATIENTS: Adult ICU patients. INTERVENTIONS: Critical care pharmacist interventions (quantity and type) on the medication regimens of critically ill patients over a 4-week period were prospectively captured. MRC-ICU and patient outcomes (i.e., mortality and length of stay [LOS]) were recorded retrospectively. MEASUREMENTS AND MAIN RESULTS: A total of 3,908 patients at 28 centers were included. Following analysis of variance, MRC-ICU was significantly associated with mortality (odds ratio, 1.09; 95% CI, 1.08-1.11; p < 0.01), ICU LOS (β coefficient, 0.41; 95% CI, 00.37-0.45; p < 0.01), total pharmacist interventions (β coefficient, 0.07; 95% CI, 0.04-0.09; p < 0.01), and a composite intensity score of pharmacist interventions (β coefficient, 0.19; 95% CI, 0.11-0.28; p < 0.01). In multivariable regression analysis, increased patient: Pharmacist ratio (indicating more patients per clinician) was significantly associated with increased ICU LOS (β coefficient, 0.02; 0.00-0.04; p = 0.02) and reduced quantity (β coefficient,-0.03; 95% CI,-0.04 to-0.02; p < 0.01) and intensity of interventions (β coefficient,-0.05; 95% CI,-0.09 to-0.01). CONCLUSIONS: Increased medication regimen complexity, defined by the MRC-ICU, is associated with increased mortality, LOS, intervention quantity, and intervention intensity. Further, these results suggest that increased pharmacist workload is associated with decreased care provided and worsened patient outcomes, which warrants further exploration into staffing models and patient outcomes.

AB - OBJECTIVES: Despite the established role of the critical care pharmacist on the ICU multiprofessional team, critical care pharmacist workloads are likely not optimized in the ICU. Medication regimen complexity (as measured by the Medication Regimen Complexity-ICU [MRC-ICU] scoring tool) has been proposed as a potential metric to optimize critical care pharmacist workload but has lacked robust external validation. The purpose of this study was to test the hypothesis that MRC-ICU is related to both patient outcomes and pharmacist interventions in a diverse ICU population. DESIGN: This was a multicenter, observational cohort study. SETTING: Twenty-eight ICUs in the United States. PATIENTS: Adult ICU patients. INTERVENTIONS: Critical care pharmacist interventions (quantity and type) on the medication regimens of critically ill patients over a 4-week period were prospectively captured. MRC-ICU and patient outcomes (i.e., mortality and length of stay [LOS]) were recorded retrospectively. MEASUREMENTS AND MAIN RESULTS: A total of 3,908 patients at 28 centers were included. Following analysis of variance, MRC-ICU was significantly associated with mortality (odds ratio, 1.09; 95% CI, 1.08-1.11; p < 0.01), ICU LOS (β coefficient, 0.41; 95% CI, 00.37-0.45; p < 0.01), total pharmacist interventions (β coefficient, 0.07; 95% CI, 0.04-0.09; p < 0.01), and a composite intensity score of pharmacist interventions (β coefficient, 0.19; 95% CI, 0.11-0.28; p < 0.01). In multivariable regression analysis, increased patient: Pharmacist ratio (indicating more patients per clinician) was significantly associated with increased ICU LOS (β coefficient, 0.02; 0.00-0.04; p = 0.02) and reduced quantity (β coefficient,-0.03; 95% CI,-0.04 to-0.02; p < 0.01) and intensity of interventions (β coefficient,-0.05; 95% CI,-0.09 to-0.01). CONCLUSIONS: Increased medication regimen complexity, defined by the MRC-ICU, is associated with increased mortality, LOS, intervention quantity, and intervention intensity. Further, these results suggest that increased pharmacist workload is associated with decreased care provided and worsened patient outcomes, which warrants further exploration into staffing models and patient outcomes.

KW - burnout

KW - metrics

KW - patient safety

KW - pharmacy

KW - quality

KW - workload

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DO - 10.1097/CCM.0000000000005585

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Impact of Pharmacists to Improve Patient Care in the Critically Ill: A Large Multicenter Analysis Using Meaningful Metrics With the Medication Regimen Complexity-ICU (MRC-ICU) Score

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

Access to Document

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