An International, Multicenter Evaluation of Pharmacist Medication Management in Icu Recovery Centers

ABSTRACT

INTRODUCTION: Post Intensive Care Syndrome (PICS) is a new or worsening impairment in physical, cognitive, or mental health following critical illness. Similar to PICS, survivors of critical illness due to COVID-19 may develop Post Acute Sequelae of SARS-CoV-2 Infection (PASC) or Long COVID. ICU recovery centers (ICU-RC) are suggested as an interprofessional approach to treat patients with PICS or PASC. Currently, over 40 different ICU-RC worldwide report having a clinical pharmacist. The purpose of this study was to describe the role of pharmacists in identifying and treating medication-related problems in survivors of critical illness. METHOD(S) This prospective, observational study was conducted in 12 ICU-RC between September 2019 and July 2021. A full medication review comprising of medication reconciliation, a patient interview, and counseling session was conducted by a clinical pharmacist on patients seen at the ICU-RC. Baseline demographic and hospital course data were obtained from the electronic health record and at the ICU-RC appointment. Data are reported using descriptive statistics. RESULT(S) A total of 507 patients were referred to an ICU-RC, of which 474 attended and 472 had a full medication review performed by a pharmacist. 237 (47%) of referred patients had a diagnosis of COVID-19. Pharmacy interventions were made in 397 (84%) patients. The median number of pharmacy interventions per patient was 2 (IQR 1,3). Medications were stopped and started in 124 (26%) and 91 (19%) patients, respectively. There was no difference in median total number of medications prescribed at the start and end of the patient visit (10, IQR = 5, 15). The number of patients that had a dose decreased and a dose increased was 51 (11%) and 43 (9%) patients, respectively. Adverse drug event (ADE) preventive measures were implemented in 115 (24%) patients and ADEs were identified in 69 (15%) patients. Drug interactions were identified in 30 (6%) patients. CONCLUSION(S) Pharmacists play an integral role in ICURC resulting in identification, prevention, and treatment of numerous medication-related problems. This paper should serve as a call to action on the importance of including a pharmacist on the interprofessional team in ICU-RC.