Tele-critical care medication management interventions via an emergency pharmacy protocol

ABSTRACT

INTRODUCTION: As a result of the COVID-19 pandemic, this healthcare system enacted a critical care pharmacist emergency prescribing protocol allowing pharmacists to manage therapy in multiple domains. Interventions performed by tele-critical care (TCC) pharmacists across 8 ICUs were categorized into venous thromboembolism prophylaxis, glucose management, electrolyte management, stress ulcer prophylaxis, and general medication management. The purpose of this study was to further characterize TCC pharmacist medication management interventions. METHODS: This multi-center, multi-ICU, retrospective observational review evaluated TCC pharmacist interventions categorized as medication management for adult, ICU-status patients documented from January 4th, 2021, to June 30th, 2021. Descriptive statistics were reported. RESULTS: A total of 2331 medication management interventions were documented for 700 unique patients (mean 3.3 interventions per patient). The average age was 63.4 years and 54.7% of patients were male. An average of 388.5 interventions were performed per month. The most common activities included discontinuing medications (39.2%), adding medications (15.6%), order clarification (11.8 %), dose adjustment (7.7%), changing route/ formulation (5.7%), and laboratory management (5.7%). Sedation medications were the most commonly involved (25.2%) followed by bowel regimens (14.2%), vasopressors (8.2%), and antibiotics (5.8%). Updating sedation score goals (45.5%) and discontinuing orders (45.3%) accounted for the majority of sedation interventions. Other interventions included neuromuscular blockade management, drug shortage management, adding corneal abrasion and ventilator-associated pneumonia prophylaxis, and home medication management. Four of the 8 facilities covered accounted for 83.6% of interventions performed, with one facility accounting for 25.2% of interventions. CONCLUSION: An emergency prescribing protocol allowed TCC pharmacists to proactively optimize pharmacotherapy across multiple categories of medication management interventions. This data will be used to support clinical pharmacist practitioner status in the TCC setting.