Evaluation of expanded pharmacist coverage in critical care areas during COVID-19

ABSTRACT

Background: During the first wave of the COVID-19 pandemic, an increased need for critical care pharmacist (CCP) coverage in the two medical/surgical intensive care units (ICUs) at the Queen Elizabeth II Health Sciences Centre (QEII HSC) in Halifax, Nova Scotia was identified. Description CCP coverage was expanded in two medical/surgical ICUs from 8 hours per day, 5 days per week excluding holidays to 8 hours per day, 7 days per week including holidays. Action Workflow within the pharmacy department was rearranged so that two CCPs, on a rotating schedule, provided dedicated clinical coverage to each ICU seven days a week. CCPs were not responsible for dispensary coverage during this time period. Evaluation A 22 question survey was developed by the research team and distributed to all health care providers (HCP) who work in the medical/surgical ICUs. Survey questions solicited HCP perceptions and opinions on the impact of expanded CCP coverage;importance of 25 evidenceinformed CCP activities was assessed via 5-point Likert scale. Clinical pharmacist output, reported as the number of drug-therapy problems (DTPs) addressed over a 6-week period, was retrospectively evaluated. The majority of respondents agreed/strongly agreed with the following CCP are integral members of the multidisciplinary healthcare team, CCP play an important role in improving patient outcomes, CCP presence in the unit and on patient care rounds allows HCP to concentrate on their own professional responsibilities, and that the expanded CCP coverage improved patient care. The majority of respondents categorized 23 of the 25 CCP activities as very important. During the 6-week time period, four CCPs addressed 798 DTPs for 140 discreet patients an average of 5.7 DTPs per patient. Implications HCPs felt that expanded CCP coverage improved patient care and that evidence-informed CCP activities were very important. Given the perceived impact of CCP in the ICU, novel staffing models are being explored to optimize CCP coverage.