Remote critical care pharmacists: A pandemic bandage or sustainable staffing model

ABSTRACT

INTRODUCTION: The importance of critical care pharmacists has been well demonstrated in the literature and their inclusion on the multidisciplinary team is a best practice. During the COVID-19 Pandemic, resource allocation and surging intensive care unit (ICU) census generated staffing constraints around the world. At our 12 hospital midwestern health system, this became a new normal. In an effort to “keep care close to home”, ICUs were created at institutions that historically had not had a clinical pharmacist presence. This was quickly identified as an area of opportunity and a critical care pharmacist was deployed to remotely monitor patients 7 days a week from 0900-2030. The goal was to provide high quality critical care pharmacist coverage across the enterprise and establish a presence at institutions without an established clinical pharmacist position. METHODS: We describe a retrospective review of a twomonth dedicated pilot of critical care trained pharmacists remotely covering 7 hospital ICUs within the health system. We defined a critical care trained pharmacist as having board certification in critical care pharmacy and/or PGY2 Critical Care residency completion per health system guidance. Intervention data was obtained from the electronic medical record for the time period of November 30, 2020 to January 31, 2021. This data was subsequently compared to on-site critical care pharmacist intervention data from the largest institution to assess efficiency and efficacy of remote staffing. RESULTS: Over the course of 60-day pilot period, a total of 684 pharmacist interventions and 1984 routine monitoring completions were documented. The most frequently occurring pharmacist interventions were admission medication reconciliation, dosage form change, therapeutic monitoring, and dose change. When compared to standard critical care pharmacist staffing at the largest institution, the remote critical care pharmacist provided 11.4 documented interventions per day, compared to 4.3 per day by the on-site pharmacist. For routine monitoring documentation, the remote pharmacist completed 33 per day compared to 12 per day on-site. CONCLUSIONS: Our review suggests that a remote critical care pharmacist can provide efficient and appropriate patient care to ICU patients at multiple care sites.