MacLaren Robert, Roberts Russel J, Dzierba Amy L, Buckley Mitchell, Lat Ishaq, Lam Simon W
Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO.
Department of Pharmacy, Massachusetts General Hospital, Boston, MA.
Crit Care Explor. 2021 Jan 8;3(1):e0323. doi: 10.1097/CCE.0000000000000323. eCollection 2021 Jan.
Involvement of clinical pharmacists in the ICU attenuates costs, avoids adverse drug events, and reduces morbidity and mortality. This survey assessed services and activities of ICU pharmacists.
A 27-question, pretested survey.
1,220 U.S. institutions.
Critical care pharmacists.
Electronic questionnaire of pharmacy services and activities across clinical practice, education, scholarship, and administration.
A total of 401 (response rate of 35.4%) surveys representing 493 ICUs were completed. Median daily ICU census was 12 (interquartile range, 6-20) beds with 1 (interquartile range, 1-1.5) pharmacist full-time equivalent per ICU. Direct clinical ICU pharmacy services were available in 70.8% of ICUs. Pharmacists attended rounds 5 days (interquartile range, 4-5 d) per week with a median patient-to-pharmacist ratio of 17 (interquartile range, 12-26). The typical workweek consisted of 50% (interquartile range, 40-60%) direct ICU patient care, 10% (interquartile range, 8-16%) teaching, 8% (interquartile range, 5-18%) order processing, 5% (interquartile range, 0-20%) direct non-ICU patient care, 5% (interquartile range, 2-10%) administration, 5% (interquartile range, 0-10%) scholarship, and 0% (interquartile range, 0-5%) drug distribution. Common clinical activities as a percentage of the workweek were reviewing drug histories (28.5%); assessing adverse events (27.6%); and evaluating (26.1%), monitoring (23.8%), and managing (21.4%) drug therapies. Services were less likely to occur overnight or on weekends. Telemedicine was rarely employed. Dependent prescriptive authority (per protocol or via practice agreements) was available to 51.1% of pharmacists and independent prescriptive authority was provided by 13.4% of pharmacists. Educational services most frequently provided were inservices (97.6%) and experiential training of students or residents (89%). Education of ICU healthcare members was provided at a median of 5 times/mo (interquartile range, 3-15 times/mo). Most respondents were involved with ICU or departmental policies/guidelines (84-86.8%) and 65.7% conducted some form of scholarship.
ICU pharmacists have diverse and versatile responsibilities and provide several key clinical and nonclinical services. Initiatives to increase the availability of services are warranted.
临床药师参与重症监护病房（ICU）工作可降低成本、避免药物不良事件，并降低发病率和死亡率。本次调查评估了ICU药师的服务和活动。
一份有27个问题且经过预测试的调查问卷。
美国1220家机构。
重症监护药师。
关于临床实践、教育、学术和管理方面的药学服务与活动的电子调查问卷。
共完成了401份调查问卷（回复率为35.4%），代表493个ICU。ICU每日病床数中位数为12张（四分位间距为6 - 20张），每个ICU有1名（四分位间距为1 - 1.5名）全职等效药师。70.8%的ICU提供直接的临床ICU药学服务。药师每周参加5天（四分位间距为4 - 5天）查房，患者与药师的比例中位数为17（四分位间距为12 - 26）。典型的工作周包括50%（四分位间距为40 - 60%）的直接ICU患者护理、10%（四分位间距为8 - 16%）的教学、8%（四分位间距为5 - 18%）的医嘱处理、5%（四分位间距为0 - 20%）的直接非ICU患者护理、5%（四分位间距为2 - 10%）的管理、5%（四分位间距为0 - 10%）的学术研究以及0%（四分位间距为0 - 5%）的药品分发。作为工作周百分比的常见临床活动包括审查用药史（28.5%）；评估不良事件（27.6%）；以及评估（26.1%）、监测（23.8%）和管理（21.4%）药物治疗。这些服务在夜间或周末出现的可能性较小。远程医疗很少被采用。51.1%的药师拥有依赖处方权（根据方案或通过实践协议），13.4%的药师拥有独立处方权。最常提供的教育服务是内部培训（97.6%）和对学生或住院医师的实践培训（89%）。对ICU医护人员的教育中位数为每月5次（四分位间距为3 - 15次/月）。大多数受访者参与了ICU或科室政策/指南的制定（84 - 86.8%），65.7%的人进行了某种形式的学术研究。
ICU药师承担着多样且广泛的职责，并提供多项关键的临床和非临床服务。有必要采取措施提高服务的可及性。
