Title: Pharmacist Impact Within a Post-Intensive Care Clinic at a Safety Net Hospital
Objective: To evaluate the impact of a critical care pharmacist in the Post-ICU Clinic (PIC).
Self Assessment Question: Describe the most common interventions made by the critical care pharmacist in the PIC clinic?
Authors: Alexandria Howell1, Sam Pournezhad1, Tarun Kapoor2, Nicole Herbst3, Marina Rabinovich1
- Grady Memorial Hospital; Atlanta, GA
- Emory University Hospital, Atlanta, GA
- Hershey Medical Center, Hershey, PA
Background: It is estimated more than half of intensive care unit (ICU) survivors are faced with a constellation of new symptoms following prolonged ICU stays. Post-ICU Syndrome is defined as new onset weakness, fatigue, cognitive decline, intrusive memories, and/or depression, and is associated with poor quality of life and increased risk of rehospitalization. ICU survivors require close follow-up with continuity of care to ensure all problems are appropriately addressed. Post-ICU Clinics have been established to combat these public health concerns; however, there are a limited number of clinics nationwide. The PIC at Grady Memorial Hospital is a multidisciplinary clinic consisting of a critical care clinical pharmacist, critical care physician, and physical medicine and rehabilitation physician. Pharmacists play a critical role in the clinic by evaluating the patient’s quality of life and ensuring optimization of medication regimens.
Purpose: To describe and quantify the interventions made by critical care trained pharmacists in the post-ICU ambulatory setting.
Methods: This was a single centered retrospective chart review study evaluating critical care trained pharmacist interventions in the PIC Clinic from June 2022 to July 2024. Patients were referred to the PIC clinic if they spent more than 4 days in the ICU and/or more than 48 hours mechanically ventilated. Adult patients evaluated by the clinical pharmacist during the PIC visit were included for study evaluation. The primary endpoint was the total number of pharmacist interventions and median number per patient. Secondary endpoints included types of medication interventions and medications classes with interventions.
Results: One-hundred patients met inclusion criteria. More than half (53%) of patients were admitted to the medical ICU. The most common ICU diagnosis was respiratory failure (36%), followed by trauma (25%). Clinical pharmacists completed 254 interventions during the time period, with a median of 3 per patient (interquartile range [IQR] 1.8-4). The most common intervention was medication initiation (24%) followed by medication discontinuation (23%). Medication classes with the highest frequency of pharmacist interventions were analgesics (25%) followed by cardiac medications (22%).
Conclusion:
The critical care clinical pharmacist is a key member of the PIC by providing medication interventions with a median of 3 per patient. Medication interventions performed by the pharmacist may optimize patients’ pharmacotherapy regimens and quality of life but additional studies are needed.
