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CRITICAL CARE

Critical Care Pharmacy Services in United States Hospitals

Assistant Professor, Department of Clinical Pharmacy, School of Pharmacy, University of Colorado Health Sciences Center, Denver, CO

John W Devlin, PharmD BCPS FCCM FCCP

Associate Professor, School of Pharmacy, Northeastern University, Boston, MA

Steven J Martin, PharmD BCPS FCCM FCCP

Associate Professor, The Infectious Diseases Research Laboratory, College of Pharmacy, University of Toledo, Toledo, OH

Joseph F Dasta, MSc FCCM FCCP

Professor, College of Pharmacy, The Ohio State University, Columbus, OH

Maria I Rudis, PharmD ABAT FCCM

Director, Emergency Medicine/Critical Care Pharmacy Residency Program; Assistant Professor, School of Pharmacy and Keck School of Medicine, University of Southern California, Los Angeles, CA

CA Bond, PharmD FASHP FCCP

Professor, Department of Pharmacy Practice, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX

Reprints: Dr. MacLaren, School of Pharmacy, C238, University of Colorado Health Sciences Center, 4200 E. Ninth Ave., Denver, CO 80262, fax 303/315-4630, rob.maclaren{at}uchsc.edu

BACKGROUND: Critical care pharmacy activities have been described as fundamental, desirable, and optimal, but actual services provided have not been evaluated.

OBJECTIVE: To characterize the type and level of pharmacy services provided to intensive care units (ICUs).

METHODS: A 38 question survey was sent in 2 consecutive mailings to all US institutions (N = 3238) with an ICU. Questions were categorized according to clinical, educational, administrative, and scholarly activities, with levels of services stratified as fundamental, desirable, or optimal.

RESULTS: Completed surveys were received from 382 (11.8%) institutions encompassing 1034 ICUs. Direct clinical pharmacy activities were provided at 62.2% of ICUs. The pharmacists in those programs attended rounds 4.4 ± 1.5 days/wk, mean ± SD, and had a workweek that consisted of patient care (43% of hours worked), drug distribution (26.2%), administration (12.6%), education (10.9%), and scholarly activities (7.3%). Fundamental clinical activities performed during at least 75% of patient ICU days were providing drug information, drug therapy evaluation, drug therapy intervention, and pharmacokinetic monitoring. Conducting inservices (92.8%), a fundamental service, was the only educational activity frequently provided. Most respondents were involved with at least one multidisciplinary committee, and 45.5% conducted scholarly activities. Desirable or optimal activities were not frequently provided across all service categories.

CONCLUSIONS: Clinical pharmacists are directly involved as caregivers in nearly two-thirds of ICUs in the US. Although they provide a range of clinical and administrative services, involvement in educational and scholarly activities is variable. The level of services provided is consistent with the criteria deemed fundamental for improving patient care. Higher-order services are far less likely to be provided.

Key Words: clinical pharmacy, critical care, pharmacotherapy, pharmacy services

Published Online, March 28, 2006. www.theannals.com, DOI 10.1345/aph.1G590

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