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 journalArticlepeer-review

16 Scopus citations


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 languageEnglish
Pages (from-to)1318-1328
Number of pages11
JournalCritical Care Medicine
Issue number9
StatePublished - Sep 1 2022

Bibliographical note

Funding Information:
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.

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


  • burnout
  • metrics
  • patient safety
  • pharmacy
  • quality
  • workload

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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