Position Paper on Critical Care Pharmacy Services: 2020 Update

Supplemental Digital Content is available in the text. Objectives: To provide a multiorganizational statement to update recommendations for critical care pharmacy practice and make recommendations for future practice. A position paper outlining critical care pharmacist activities was last published in 2000. Since that time, significant changes in healthcare and critical care have occurred. Design: The Society of Critical Care Medicine, American College of Clinical Pharmacy Critical Care Practice and Research Network, and the American Society of Health-Systems Pharmacists convened a joint task force of 15 pharmacists representing a broad cross-section of critical care pharmacy practice and pharmacy administration, inclusive of geography, critical care practice setting, and roles. The Task Force chairs reviewed and organized primary literature, outlined topic domains, and prepared the methodology for group review and consensus. A modified Delphi method was used until consensus (> 66% agreement) was reached for each practice recommendation. Previous position statement recommendations were reviewed and voted to either retain, revise, or retire. Recommendations were categorized by level of ICU service to be applicable by setting and grouped into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development. Main Results: There are 82 recommendation statements: 44 original recommendations and 38 new recommendation statements. Thirty-four recommendations represent the domain of patient care, primarily relating to critical care pharmacist duties and pharmacy services. In the quality improvement domain, 21 recommendations address the role of the critical care pharmacist in patient and medication safety, clinical quality programs, and analytics. Nine recommendations were made in the domain of research and scholarship. Ten recommendations were made in the domain of training and education and eight recommendations regarding professional development. Conclusions: Critical care pharmacists are essential members of the multiprofessional critical care team. The statements recommended by this taskforce delineate the activities of a critical care pharmacist and the scope of pharmacy services within the ICU. Effort should be made from all stakeholders to implement the recommendations provided, with continuous effort toward improving the delivery of care for critically ill patients.

[1]  L. Vermeulen,et al.  Caution warranted when torturing data until they confess , 2019 .

[2]  M. Rech,et al.  Cost avoidance associated with clinical pharmacist presence in a medical intensive care unit , 2019, Journal of the American College of Clinical Pharmacy.

[3]  ASHP Statement on Pharmaceutical Research in Organized Health-Care Settings , 2019, Best Practices.

[4]  ASHP Guidelines on Clinical Drug Research , 2019, Best Practices.

[5]  J. Golembiewski,et al.  ASHP guidelines on perioperative pharmacy services. , 2019, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[6]  Amy L. Seybert,et al.  Intensive care unit drug costs in the context of total hospital drug expenditures with suggestions for targeted cost containment efforts , 2018, Journal of critical care.

[7]  S. Rough,et al.  Creation of a certification requirement for pharmacists in direct patient care roles. , 2017, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[8]  Elizabeth A. Henneman,et al.  Clinical Practice Guideline: Safe Medication Use in the ICU , 2017, Critical care medicine.

[9]  M. Rech,et al.  Pharmacist Participation in Acute Ischemic Stroke Decreases Door-to-Needle Time to Recombinant Tissue Plasminogen Activator , 2017, The Annals of pharmacotherapy.

[10]  J. Saseen,et al.  ACCP Clinical Pharmacist Competencies , 2017, Pharmacotherapy.

[11]  D. Covey,et al.  ACCP Template for Evaluating a Clinical Pharmacist , 2017, Pharmacotherapy.

[12]  Joel T. Feih,et al.  Pharmacist involvement on a rapid response team , 2017, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[13]  B. Erstad,et al.  Development of the Critical Care Pharmacotherapy Trials Network , 2017, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[14]  Patricia R. Louzon,et al.  Impact of pharmacist management of pain, agitation, and delirium in the intensive care unit through participation in multidisciplinary bundle rounds. , 2017, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[15]  Sylvain Grenier,et al.  Defining Roles for Pharmacy Personnel in Disaster Response and Emergency Preparedness , 2017, Disaster Medicine and Public Health Preparedness.

[16]  A. Flannery,et al.  Managing the Rising Costs and High Drug Expenditures in Critical Care Pharmacy Practice , 2017, Pharmacotherapy.

[17]  T. Rice,et al.  Efficacy and Outcomes After Vasopressin Guideline Implementation in Septic Shock , 2017, The Annals of pharmacotherapy.

[18]  D. J. Cobaugh,et al.  The time has come: Increased prescribing authority for pharmacists. , 2016, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[19]  J. Lewin,et al.  Elevating pharmacists' scope of practice through a health-system clinical privileging process. , 2016, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[20]  Pamela L. Smithburger,et al.  An Evaluation of Adverse Drug Reactions Associated With Antipsychotic Use for the Treatment of Delirium in the Intensive Care Unit , 2016, Journal of pharmacy practice.

[21]  S. Kane-Gill,et al.  Outcome Assessment of Critical Care Pharmacist Services , 2016, Hospital pharmacy.

[22]  Stephen F Eckel,et al.  Impact of the Pharmacy Practice Model Initiative on Clinical Pharmacy Specialist Practice , 2016, Pharmacotherapy.

[23]  J. Williamson,et al.  Pharmacist involvement in a multidisciplinary initiative to reduce sepsis-related mortality. , 2016, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[24]  B. Yegneswaran,et al.  Implementation of an Intensive Care Unit Delirium Protocol: An Interdisciplinary Quality Improvement Project , 2015, Dimensions of critical care nursing : DCCN.

[25]  S. Tripathi,et al.  Impact of Clinical Pharmacist on the Pediatric Intensive Care Practice: An 11-Year Tertiary Center Experience. , 2015, The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG.

[26]  S. Kane-Gill,et al.  Impact of a clinical pharmacist stress ulcer prophylaxis management program on inappropriate use in hospitalized patients. , 2015, The American journal of medicine.

[27]  J. Stollings,et al.  Postintensive care syndrome and the role of a follow-up clinic. , 2015, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[28]  Pamela L. Smithburger,et al.  A Multicenter Evaluation of Off-Label Medication Use and Associated Adverse Drug Reactions in Adult Medical ICUs , 2015, Critical care medicine.

[29]  I. Bates,et al.  Pharmacist's review and outcomes: Treatment-enhancing contributions tallied, evaluated, and documented (PROTECTED-UK). , 2015, Journal of critical care.

[30]  S. Halpern,et al.  An Observational Study of Decision Making by Medical Intensivists , 2015, Critical care medicine.

[31]  T. Rice,et al.  Pharmacist Leadership in ICU Quality Improvement , 2015, The Annals of pharmacotherapy.

[32]  Arnaldo Aires Peixoto Júnior,et al.  Recomendações farmacêuticas em unidade de terapia intensiva: três anos de atividades clínicas , 2015 .

[33]  S. Kane-Gill,et al.  Evaluation of an Automated Surveillance System Using Trigger Alerts to Prevent Adverse Drug Events in the Intensive Care Unit and General Ward , 2015, Drug Safety.

[34]  J. Decruyenaere,et al.  Expected net benefit of clinical pharmacy in intensive care medicine: a randomized interventional comparative trial with matched before-and-after groups. , 2014, Journal of evaluation in clinical practice.

[35]  Jing Chen,et al.  Implementation of pharmacists’ interventions and assessment of medication errors in an intensive care unit of a Chinese tertiary hospital , 2014, Therapeutics and clinical risk management.

[36]  Standards of Practice for Clinical Pharmacists , 2014, Pharmacotherapy.

[37]  C. Tsourounis,et al.  An Interprofessional Approach to Reducing the Overutilization of Stress Ulcer Prophylaxis in Adult Medical and Surgical Intensive Care Units , 2014, The Annals of Pharmacotherapy.

[38]  Ryan A Crowley,et al.  Principles Supporting Dynamic Clinical Care Teams: An American College of Physicians Position Paper , 2013, Annals of Internal Medicine.

[39]  C. Preslaski,et al.  Pharmacist contributions as members of the multidisciplinary ICU team. , 2013, Chest.

[40]  S. Kucukarslan,et al.  Evaluation of a Dedicated Pharmacist Staffing Model in the Medical Intensive Care Unit , 2013, Hospital pharmacy.

[41]  Pamela L. Smithburger,et al.  Impact of a Clinical Pharmacy Admission Medication Reconciliation Program on Medication Errors in “High-Risk” Patients , 2013, The Annals of pharmacotherapy.

[42]  R. MacLaren,et al.  Clinical and Financial Impact of Pharmacy Services in the Intensive Care Unit: Pharmacist and Prescriber Perceptions , 2013, Pharmacotherapy.

[43]  J. Vincent Critical care - where have we been and where are we going? , 2013, Critical Care.

[44]  Kelli A. Rumbaugh,et al.  Prevention of adverse drug events and cost savings associated with PharmD interventions in an academic Level I trauma center: An evidence-based approach , 2012, The journal of trauma and acute care surgery.

[45]  P. Leese,et al.  Method to determine allocation of clinical pharmacist resources. , 2012, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[46]  Philip J Schneider,et al.  ASHP national survey of pharmacy practice in hospital settings: dispensing and administration--2011. , 2012, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[47]  Julie A. Murphy,et al.  Importance of Direct Patient Care in Advanced Pharmacy Practice Experiences , 2012, Pharmacotherapy.

[48]  Sandra L Kane-Gill,et al.  A critical evaluation of clinical decision support for the detection of drug–drug interactions , 2011, Expert opinion on drug safety.

[49]  Kamila A. Dell,et al.  An Opinion Paper Outlining Recommendations for Training, Credentialing, and Documenting and Justifying Critical Care Pharmacy Services , 2011 .

[50]  S. Pickette Cutting-edge practice model: Experience in a community hospital system. , 2011, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[51]  Nannette M Berensen Cutting-edge practice model: a mixed integrated and clinical specialist model in a large health system. , 2011, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[52]  Brett L Geiger Cutting-edge practice model: experience in a Veterans Affairs hospital. , 2011, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[53]  R. Shane Critical requirements for health-system pharmacy practice models that achieve optimal use of medicines. , 2011, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[54]  K. Mason Cutting-edge practice model: an integrated model within a large academic medical center. , 2011, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[55]  R. Berry Cutting-edge practice model: experience in a small community hospital. , 2011, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[56]  M. Montello,et al.  Pharmacist readiness roles for emergency preparedness. , 2011, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[57]  A. Rivkin,et al.  Evaluation of the role of the critical care pharmacist in identifying and avoiding or minimizing significant drug-drug interactions in medical intensive care patients. , 2011, Journal of critical care.

[58]  J. Kalus,et al.  Impact of a Pharmacist-Directed Anticoagulation Service on the Quality and Safety of Heparin-Induced Thrombocytopenia Management , 2011, The Annals of pharmacotherapy.

[59]  J. Timsit,et al.  Automated drug dispensing system reduces medication errors in an intensive care setting , 2010, Critical care medicine.

[60]  C. Lilly,et al.  Evaluation of the Impact of a tele-ICU Pharmacist on the Management of Sedation in Critically III Mechanically Ventilated Patients , 2010, The Annals of pharmacotherapy.

[61]  D. Sasaki-Adams,et al.  COST EFFECTIVENESS OF A CLINICAL PHARMACIST ON A NEUROSURGICAL TEAM , 2009, Neurosurgery.

[62]  Jennifer M. Trujillo,et al.  Interprofessional Education: Principles and Application A Framework for Clinical Pharmacy , 2009 .

[63]  R. MacLaren,et al.  Effects of Pharmacist Participation in Intensive Care Units on Clinical and Economic Outcomes of Critically Ill Patients with Thromboembolic or Infarction‐Related Events , 2009, Pharmacotherapy.

[64]  A. Blue Interprofessional Education and Practice , 2009, Pharmacotherapy.

[65]  B. Erstad A Primer on Critical Care Pharmacy Services , 2008, The Annals of pharmacotherapy.

[66]  C. A. Bond,et al.  Clinical and economic outcomes of involving pharmacists in the direct care of critically ill patients with infections* , 2008, Critical care medicine.

[67]  A. Iglar,et al.  Implementation of pharmacy services in a telemedicine intensive care unit. , 2008, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[68]  Shu-Wen Lin,et al.  Impact of mecA Gene Testing and Intervention by Infectious Disease Clinical Pharmacists on Time to Optimal Antimicrobial Therapy for Staphylococcus aureus Bacteremia at a University Hospital , 2008, Journal of Clinical Microbiology.

[69]  Heather M. Draper,et al.  Association of Pharmacist Presence on Compliance with Advanced Cardiac Life Support Guidelines During In-Hospital Cardiac Arrest , 2008, The Annals of pharmacotherapy.

[70]  D. Touchette,et al.  Pharmacist Monitoring of QTc Interval–Prolonging Medications in Critically Ill Medical Patients: A Pilot Study , 2008, The Annals of pharmacotherapy.

[71]  A. Egan,et al.  SHPA Standards of Practice for Critical Care Pharmacy Practice , 2008 .

[72]  J. Devlin,et al.  Combined didactic and scenario-based education improves the ability of intensive care unit staff to recognize delirium at the bedside , 2008, Critical care.

[73]  S. Nasraway,et al.  Reversing oversedation in the intensive care unit: the role of pharmacists in energizing guideline efforts and overcoming protocol fatigue. , 2008, Critical care medicine.

[74]  John Marshall,et al.  Impact of a clinical pharmacist-enforced intensive care unit sedation protocol on duration of mechanical ventilation and hospital stay* , 2008, Critical care medicine.

[75]  H. Whitney,et al.  Francke's Legacy—40 Years of Clinical Pharmacy , 2008, The Annals of pharmacotherapy.

[76]  B. Erstad,et al.  Cost implications of and potential adverse events prevented by interventions of a critical care pharmacist. , 2007, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[77]  C. Raehl,et al.  Clinical and economic outcomes of pharmacist-managed antimicrobial prophylaxis in surgical patients. , 2007, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[78]  J. Burke,et al.  Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. , 2007, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[79]  C. Raehl,et al.  Clinical Pharmacy Services, Pharmacy Staffing, and Hospital Mortality Rates , 2007, Pharmacotherapy.

[80]  J. Burke,et al.  Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship , 2007 .

[81]  M. Alexander To Err is Human. , 2006, Journal of infusion nursing : the official publication of the Infusion Nurses Society.

[82]  John E. Murphy,et al.  American College of Clinical Pharmacy's Vision of the Future: Postgraduate Pharmacy Residency Training as a Prerequisite for Direct Patient Care Practice , 2006, Pharmacotherapy.

[83]  M. Rudis,et al.  Critical Care Pharmacy Services in United States Hospitals , 2006, The Annals of pharmacotherapy.

[84]  J. Jacobi,et al.  The critical care clinical pharmacist: Evolution of an essential team member , 2006, Critical care medicine.

[85]  Brian L. Erstad,et al.  Medication errors and adverse drug events in an intensive care unit: Direct observation approach for detection , 2006, Critical care medicine.

[86]  C. Raehl,et al.  Clinical and economic outcomes of pharmacist-managed aminoglycoside or vancomycin therapy. , 2005, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[87]  C. Raehl,et al.  Pharmacist‐Provided Anticoagulation Management in United States Hospitals: Death Rates, Length of Stay, Medicare Charges, Bleeding Complications, and Transfusions , 2004, Pharmacotherapy.

[88]  M. Haupt,et al.  Guidelines on critical care services and personnel: Recommendations based on a system of categorization of three levels of care* , 2003, Critical care medicine.

[89]  J. Dasta,et al.  The impact of critical care pharmacists on enhancing patient outcomes , 2003, Intensive Care Medicine.

[90]  D Teres,et al.  Critical care delivery in the intensive care unit: Defining clinical roles and the best practice model , 2001, Critical care medicine.

[91]  C. Destache,et al.  Individualized Pharmacokinetic Monitoring Results in Less Aminoglycoside‐Associated Nephrotoxicity and Fewer Associated Costs , 2001, Pharmacotherapy.

[92]  A. Petitta Assessing the Value of Pharmacists' Health‐Systemwide Services: Clinical Pathways and Treatment Guidelines , 2000, Pharmacotherapy.

[93]  R. MacLaren,et al.  A Prospective Evaluation of Empiric versus Protocol‐Based Sedation and Analgesia , 2000, Pharmacotherapy.

[94]  T. Albertson,et al.  Optimization of Inpatient Warfarin Therapy: Impact of Daily Consultation by a Pharmacist-Managed Anticoagulation Service , 2000, The Annals of pharmacotherapy.

[95]  M. Huycke,et al.  Outcomes of an antimicrobial control program in a teaching hospital. , 2000, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[96]  D. Bates,et al.  Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. , 1999, JAMA.

[97]  D. Bates,et al.  Preventable adverse drug events in hospitalized patients: a comparative study of intensive care and general care units. , 1997, Critical care medicine.

[98]  J. Devlin,et al.  The Effect of ICU Sedation Guidelines and Pharmacist Interventions on Clinical Outcomes and Drug Cost , 1997, The Annals of pharmacotherapy.

[99]  W. Wade,et al.  Pharmacist‐Managed Aminoglycoside Therapy in Combination With a β‐Lactam Agent in the Treatment of Nosocomial Pneumonia in Critically Ill Patients , 1995, Pharmacotherapy.

[100]  D. Cook,et al.  Impact of a clinical pharmacist in a multidisciplinary intensive care unit , 1994, Critical care medicine.

[101]  E. Michalets,et al.  Outcomes of expanded use of clinical pharmacist practitioners in addition to team-based care in a community health system intensive care unit. , 2015, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[102]  J. Swan Decreasing inappropriate unable-to-assess ratings for the confusion assessment method for the intensive care unit. , 2014, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[103]  J. Devlin,et al.  Impact of a delirium screening tool and multifaceted education on nurses' knowledge of delirium and ability to evaluate it correctly. , 2012, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[104]  The consensus of the Pharmacy Practice Model Summit. , 2011, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[105]  ASHP long-range vision for the pharmacy work force in hospitals and health systems: ensuring the best use of medicines in hospitals and health systems. , 2007, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[106]  ASHP statement on the role of health-system pharmacists in emergency preparedness. , 2003, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[107]  M. Rudis,et al.  Position paper on critical care pharmacy services. Society of Critical Care Medicine and American College of Clinical Pharmacy Task Force on Critical Care Pharmacy Services. , 2000, Critical care medicine.