Care Pharmacy Services Research Articles

Critical Care Pharmacy Program Accreditation Standards Framework and Core Competencies in Saudi Arabia

Clinical pharmacy services in Saudi Arabia are expanding steadily, particularly with notable developments in critical care pharmacy services and training programs, including four critical care residency programs localized in Riyadh and one program in Jeddah. The Scientific Council of Pharmacy leads extensive efforts to advance clinical pharmacy practice and training under the Saudi Commission for Health Specialties (SCFHS), the accrediting body for critical care training programs and all other specialties. Despite launching critical care pharmacy programs in 2013, currently available accreditation standards and competency assessments for specialized residency programs in critical care were established in 2020. These accreditation standards and competency assessment modalities have been found to have significant areas of improvement based on the feedback of practicing critical care pharmacy residency program directors and trainees over the past few years. This is an opinion paper based on a consensus of critical care and emergency medicine pharmacy experts which recommends updating the current accreditation standards framework and competency assessment blueprint for specialized critical care pharmacy programs. Additionally, it highlights the need to modify the accreditation standards framework for critical care pharmacy programs. Further evaluation of these modalities can be revised as deemed reasonable by governmental authorities by recruiting practicing critical care clinical pharmacy experts.

Patient Satisfaction of Ambulatory Care Pharmacy Services.

The Ministry of Health (MOH) recently developed the Health Sector Transformation Program (HTSP) to focus on patient satisfaction, safety, and care. This study explored patient satisfaction with outpatient care services.A semi-structured questionnaire was designed to collect the data of patient satisfaction with pharmacy care services through face-to face interviews of participants and over the internet using an electronic format of the same questionnaire (web-based survey).A total of 508 participants responded of whom, 51.8% were male and 83% were below 46 years old. The average scores of domains 1, 2, 3, 4, 5, 6, 7, and 8 were 4.51, 4.11, 4.30, 3.70, 3.57, 3.82, 3.63, and 4.15, respectively. The general evaluation of pharmacy services demonstrated that respondents were very satisfied (245; 48.2%), satisfied (143; 28%), and willing to recommend the pharmacy to their families (380; 76.4%). There was no statistically significant difference in the overall satisfaction with pharmacy services among the 2 hospitals (P > .05).Most respondents were satisfied with outpatient care pharmacy services. More efforts are needed to improve the service of following up on patients’ adherence by the pharmacists.

Development of a combination didactic-experiential elective course within a college-based pharmacy call center

BackgroundPharmacy graduates should be prepared to provide patient care in a variety of healthcare settings as members of an interprofessional collaborative team. College-based pharmacy call centers can serve as settings to promote interprofessional practice through didactic and experiential coursework. An elective course, Team-Based Medication Management Practices, was developed to provide student pharmacists the opportunity to learn about pharmacy-led services within value-based care models and to prepare them for interprofessional care by incorporating experiential activities within a college-based call center. Educational activityA two-credit elective course was offered to third-year pharmacy students. The course was delivered through a combination of didactic lectures and experiential activities within a college-based pharmacy call center, with modules focused on medication adherence, medication therapy management, and transitions of care. A survey was administered to students at the end of the course to evaluate perceptions. FindingsSix students enrolled in the elective and completed the survey. Most students “strongly agreed” or “agreed” that they gained a better understanding of interprofessional care within value-based care models and pharmacy services that can be provided within a college-based call center while acquiring patient care skills. The role of telehealth in the delivery of pharmacist-led patient care services is likely to continue expanding as a result of the COVID-19 pandemic and it will become increasingly important to train students to provide these services.

The Development of an Enhanced Palliative Care Pharmacy Service during the Initial COVID-19 Surge.

The Northern Health and Social Care Trust developed an enhanced palliative care pharmacy service for acute inpatients within a large hospital in Northern Ireland during the initial COVID-19 surge. By training additional staff, there was an opportunity to increase service provision, utilising palliative care pharmacy skills to undertake activities such as the symptom management of patients, appropriate management of medicines, improved access to medicines, advice for other healthcare professionals, and supporting discharge from the hospital. The data collected showed a mean of 6.8 interventions per patient, and that, irrespective of the demand resulting from the COVID-19 pandemic, the palliative care pharmacy team had a role in improving the quality of care for palliative and end-of-life patients. Subsequent data analysis also demonstrated associated cost saving and the potential for the palliative care pharmacy team to reduce the length of stay at the hospital.

Profile of Therapy Adherence-Prolanis Related to Sociodemography: A Literature Review

The results of this literature review present a profile of measuring adherence to therapy in prolanis member. More specifically, the authors explored the adherence related to the sociodemographic variants. The literature search utilizes the Google Scholar data storage base. Researchers used two variants of keywords; (1) “prolanis” and “drug”, (2) “prolanis” and “pharmaceutical”. The literature search is limited to the results of publications during the years 2010-2020. Literature review studies only involve research results that meet the following inclusion criteria; (1) scientific articles published after going through the peer review process, (2) research involving sociodemographic variables and therapy adherence index, (3) research involving only prolanis participants, and (4) research results showing correlation values between variables. A total of 9 articles met the inclusion criteria according to the research objectives. This literature review involved 644 respondents from 12 health centers and 1 treatment center as subjects in this study. The results of our literature review confirm that prolanis participants need family support and adequate knowledge, in order to adhere to therapy. In addition, we also conclude that there is no relationship between gender differences and adherence to therapy. Based on these conclusions, we recommend community pharmacy practitioners, to optimize educational services and provide basic information about drugs, both to prolanis participants and their families. We note that researchers have not mutually agreed on the relationship between therapy adherence with age, education, type of work and home pharmacy care services in prolanis. The exploration of sociodemographic variables, which is still a matter of debate, is a priority for further research to identify adherence to prolanis therapy. We also suggest to future researchers to avoid the use of MMAS-8. The use of questionnaires without permission from the inventor is prone to licensing problems.

Critical care pharmacy in Saudi Arabia: Historical evolution and future directions—A review by the Critical Care and Emergency Medicine Pharmacy Specialty Network at the Saudi Society of Clinical Pharmacy

AbstractBackgroundClinical pharmacy services in Saudi Arabia (SA) have improved over the past few years, leading to improved patient‐centered outcomes. Clinical pharmacy services have been steadily incorporating critical care (CC) services in the country since the 1980s with a sustained growth in this field over the last few years.AimsThis review aims to describe CC pharmacy services in Saudi Arabia by exploring the historical evolution of patient care, education, research, and leadership, including challenges and opportunities for professional advancement.Materials and methodologyWe reviewed existing literature regarding CC pharmacy services in SA in addition to documented phone interviews with CC pharmacy pioneers in SA.ResultsCritical care pharmacy services improved in many facets. We identified possible areas for improvement and suggested an action plan for other countries to expand their CC pharmacy services.ConclusionIn Saudi Arabia, clinical pharmacy services are growing with sustained growth in CC pharmacy services.

The impact of pharmacy care and motivational interviewing on improving medication adherence in patients with cardiovascular diseases: A systematic review of randomised controlled trials.

Cardiovascular disease (CVD) is prevalent worldwide, and for many patients, non-adherence to medication remains a problem. Motivational interviewing is a behavioural, communication strategy used as an intervention aimed to improve health outcomes. This systematic review sought to investigate the effect of motivational interviewing delivered as part of pharmacy care on medication adherence, and the effect this has on clinical outcomes. These included systolic and diastolic blood pressure, haemoglobin A1C, lipid profiles and cardiovascular risk scores. A systematic review was conducted in six databases: PubMed Central UK, Cochrane Library, CINAHL (EBSCO), PsycINFO, EMBASE and MEDLINE from the inception of motivational interviewing in 1983 to November 2020. Randomised controlled trials (RCTs) that assessed motivational interviewing as part of pharmacy care interventions were selected. The Cochrane risk of bias tool was used to assess the risk of bias for each included study. This review was registered with PROSPERO (registration number CRD42020222954). A total of eight RCTs met the inclusion criteria. Five out of eight studies demonstrated medication adherence significantly improved following motivational interviewing interventions. One study showed a significant improvement for systolic blood pressure change by 7.2mmHg (95% CI 1.6-12.8mmHg); this reduction was observed in patients whose baseline blood pressure was above their target blood pressure. No statistically significant effect was seen across other clinical outcomes. Motivational interviewing could be an effective behavioural strategy to enhance medication adherence in patients with CVD. Although the evidence is promising thus far, further research is required to explore the impact of motivational interviewing on clinical outcomes as well as the feasibility of implementing motivational interviewing interventions within existing pharmacy care services.

Impact of first and second shift tele‐critical care pharmacy services and virtual rounds on interventions at Atrium Health Lincoln

AbstractBackgroundIn 2015, Atrium Health (AH) established second shift pharmacy services in the tele‐critical care (TCC) setting to optimize medication therapy and serve as a drug information resource to facilities across the health care system. TCC pharmacy services expanded to the first shift in July 2017. In September 2017, the first shift pharmacist began participating in virtual multidisciplinary rounds 1 day per week, which increased to 3 days per week in October 2019 at AH Lincoln, a community hospital with a 10‐bed intensive care unit (ICU).MethodsThis was a nonrandomized retrospective cohort study of adult ICU patients at AH Lincoln across two different time periods. The primary outcome was the number and type of pharmacy interventions made on rounding day(s) vs nonrounding days and first vs second shifts. Data are reported using descriptive statistics.ResultsDuring time period 1, a total of 1174 patients were admitted to the ICU for a total of 2115 patient days, with an average length of stay (LOS) of 1.8 days (SD ± 1.8 days). During time period 2, a total of 812 patients were admitted to the ICU for a total of 1775 patient days with an average LOS of 2.2 days (SD ± 2.7 days). During time period 1, a total of 753 interventions (297 on first shift and 456 on second shift) were performed as compared to time period 2, which had 1276 interventions (816 on first shift and 460 on second shift). For both time periods, the most common intervention on the first shift was medication management (45%) vs glycemic control (36%) on the second shift.ConclusionsThe addition of TCC pharmacy services to AH Lincoln has resulted in a positive impact on medication management, with the largest impact demonstrated through virtual rounding by the first shift TCC pharmacist.

Productivity Tracking: A Survey of Critical Care Pharmacist Practices and Satisfaction.

Introduction: The position paper on critical care pharmacy services describes two tiers of responsibilities: essential and desirable activities. Activities are categorized into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development. Documentation of these activities can be important for justifying pharmacist positions, comparing pharmacy practice models, conducting performance evaluations, and tracking individual workload; however, limited recommendations are provided for standardized productivity tracking, and national practices remain largely uncharacterized. Objectives: The purpose of this survey was to describe documentation practices of critical care pharmacist activities. Methods: A cross-sectional survey was distributed via email to 1694 members of the ACCP critical care practice research network. The survey asked respondents to describe the methods used to document productivity as it relates to the 5 domains. Results: Seventy-nine (4.7%) critical care pharmacists from 63 institutions completed the survey. Intervention documentation was used for position justification and annual reviews among 54.4% and 44.1% of pharmacists, respectively. Pharmacists were routinely expected to perform additional responsibilities beyond patient care that contribute to overall productivity, but the percentage of institutions that track these activities as a measure of pharmacist productivity was relatively low: quality improvement (46%), research/scholarship (29%), training/education (38%), and professional development (27%). Documentation of these additional responsibilities and activities was primarily used for annual evaluations, but the majority of respondents answered that no standardized method for tracking activities existed. In multivariate regression, dedicated ICU pharmacists was a significant predictor for increased satisfaction (Exp(ß) 4.498, 95% CI 1.054-19.187, P = .042). Conclusion: Practice variation exists in how and for what intent critical care pharmacists track productivity. Further evaluation and standardization of productivity tracking may aid in position justification and practice model evaluation for dedicated ICU pharmacists in today's value-based era.

The standards treatment

The standards treatment

Examination of critical care pharmacist work activities and burnout

AbstractPurposeCritical care pharmacy services have progressed since their origination in the 1970s and have been supported by a position paper that categorized these services as fundamental (eg, provides drug information to the critical care team), desirable (eg, responds to resuscitation events in the hospital), and optimal (eg, publishes clinical research in peer‐reviewed journals). Burnout syndrome is a serious problem with far‐reaching consequences and may be heightened by the demanding nature of critical care. The purpose of this study was to explore the relationship between pharmacy services provided (fundamental, desirable, optimal) and the incidence of burnout syndrome among critical care pharmacists.MethodsA cross‐sectional survey was distributed via email to critical care pharmacists through a professional association listserv and included three areas of assessment: position and institution‐based characteristics, activities performed, and burnout. The primary outcome was the number of activities performed in each category and was compared between respondents who did and did not experience burnout using the Mann‐Whitney U test. Logistic regression was performed to characterize the relationship between activities performed and burnout.ResultsIn total, 211 pharmacists (14.5%) completed the survey. Sixty percent (n = 128) experienced burnout and performed a median of 13 (interquartile range [IQR] 7‐15) fundamental (of 18 assessed), 11 (IQR 4‐13) desirable (of 16 assessed), and 6 (IQR 5‐8) optimal (of 12 assessed) activities. In logistic regression, performing desirable activities was associated with higher risk of burnout while performing optimal activities was associated with lower risk of burnout.ConclusionsOver half of critical care pharmacists experienced burnout. The performance of optimal activities was associated with reduced burnout. It is possible that higher level, higher yield activities increase personal engagement and decrease burnout.

Prescribing and documentation by critical care clinical pharmacy specialists with around‐the‐clock staffing: A single‐center evaluation

AbstractIntroductionEvidence supports pharmacists as essential team members in the intensive care unit (ICU). Data are limited for pharmacist prescribing and documentation, ideal pharmacist staffing, and timing of clinical pharmacy activities in the ICU.ObjectiveThe purpose of this evaluation was to assess the frequency, timing, and most common areas of prescribing and documentation for critical care clinical pharmacy specialists (CPSs) in a single medical center with around‐the‐clock staffing.MethodsA Veterans Affairs (VA) medical center implemented a collaborative practice model in which CPSs provide direct ICU patient care around the clock. Direct patient care activities are provided for two ICUs with three multidisciplinary teams (medical, surgical, and cardiovascular), the nutrition support team, and emergency response teams. Documentation through an electronic health record progress note is required any time a CPS performs a patient encounter and uses prescriptive authority. A retrospective evaluation was performed to evaluate critical care CPS patient encounters and clinical interventions from October 1, 2016 through September 30, 2020.ResultsCumulatively, 78 622 CPS clinical interventions requiring prescriptive authority were made during 17 938 documented encounters. For clinical interventions, 40 897 (52.0%) were during daytime hours and 37 725 (48.0%) were after‐hours. Of the documented encounters, 10 461 (58.3%) were during daytime hours compared with 7477 (41.7%) after‐hours. Medication‐related prescribing interventions accounted for 57 400 (73.0%) of the interventions, while 6931 (8.8%) were nonpharmacologic and 14 291 (18.2%) were additional interventions. The most common disease states for prescribing interventions included Anticoagulation (13.8%), Infectious Diseases (13.1%), Cardiovascular (10.5%), Nutrition/Gastrointestinal (6.6%), Neuropsychiatric (5.3%), Endocrine (4.3%), Nephrology (3.5%), and Pulmonary (1%).ConclusionThis evaluation provides details of prescribing and documentation by critical care CPSs with an around‐the‐clock staffing model. This may be useful for ICU clinicians and administrators considering expanding critical care pharmacy services.

Characterizing Critical Care Pharmacy Services Across the United States

A 27-question, pretested survey. 1,220 U.S. institutions. Critical care pharmacists. Electronic questionnaire of pharmacy services and activities across clinical practice, education, scholarship, and administration. A total of 401 (response rate of 35.4%) surveys representing 493 ICUs were completed. Median daily ICU census was 12 (interquartile range, 6-20) beds with 1 (interquartile range, 1-1.5) pharmacist full-time equivalent per ICU. Direct clinical ICU pharmacy services were available in 70.8% of ICUs. Pharmacists attended rounds 5 days (interquartile range, 4-5 d) per week with a median patient-to-pharmacist ratio of 17 (interquartile range, 12-26). The typical workweek consisted of 50% (interquartile range, 40-60%) direct ICU patient care, 10% (interquartile range, 8-16%) teaching, 8% (interquartile range, 5-18%) order processing, 5% (interquartile range, 0-20%) direct non-ICU patient care, 5% (interquartile range, 2-10%) administration, 5% (interquartile range, 0-10%) scholarship, and 0% (interquartile range, 0-5%) drug distribution. Common clinical activities as a percentage of the workweek were reviewing drug histories (28.5%); assessing adverse events (27.6%); and evaluating (26.1%), monitoring (23.8%), and managing (21.4%) drug therapies. Services were less likely to occur overnight or on weekends. Telemedicine was rarely employed. Dependent prescriptive authority (per protocol or via practice agreements) was available to 51.1% of pharmacists and independent prescriptive authority was provided by 13.4% of pharmacists. Educational services most frequently provided were inservices (97.6%) and experiential training of students or residents (89%). Education of ICU healthcare members was provided at a median of 5 times/mo (interquartile range, 3-15 times/mo). Most respondents were involved with ICU or departmental policies/guidelines (84-86.8%) and 65.7% conducted some form of scholarship. ICU pharmacists have diverse and versatile responsibilities and provide several key clinical and nonclinical services. Initiatives to increase the availability of services are warranted.

Transitioning ambulatory care pharmacy services to telemedicine while maintaining multidisciplinary collaborations

In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Can gatekeepers help contain health-care costs for diabetes in one eastern city in China: a multistage difference-in-difference analysis

BackgroundPrimary care has been recognised as an effective way to meet health demands and reduce health-care costs. As a key part of its health-care reforms, China has been striving to strengthen primary care and rebuild referral systems, with family physicians being considered as gatekeepers tasked with providing continuous treatment and management of chronic diseases. However, little is known about the effect of these gatekeepers on the health-care system in China. Our study aims to examine whether gatekeepers can effectively reduce the costs associated with patients with diabetes. MethodsWe chose an eastern city in China to do our study, given that it introduced a so-called gatekeeper system in 2015, as one of the earliest pilots in China. All registered patients with diabetes were identified from the official health management information system. By linking patient identifications, we extracted individual-level data from the medical insurance claim database, including patient demographic characteristics, health-care use, and expenditure from 2014 to 2017. Inclusion criteria for the target population were patients insured by social medical insurance and those who had health-care use records and diabetes management follow-up records in the information system for every single year. Because the gatekeeping system was rolled out in a gradual way, with patients with diabetes who newly register with general practitioners being included each year, we used a multistage difference-in-difference analysis to evaluate the net difference in annual medical costs caused by the reform. FindingsOur sample included 37 955 people with diabetes (mean age 67·8 years, IQR 61–76; 20 538 [54%] men and 17 417 [46%] women) who voluntarily registered with their family physicians between Jan 1, 2014 and Dec 31, 2017. Of these patients, 26 668 (70·2%) enrolled with the gatekeeping system for 3 years, 5426 (14·3%) enrolled for 2 years, and 2187 (5·8%) enrolled for 1 year, and a further 3674 (9·7%) were not enrolled with the gatekeeper system and acted as a control group. According to the regression model results, compared with patients who were not enrolled, patients enrolled with gatekeepers obtained a mean of 0·25 more follow-up visits (0·15 [SE 0·05] more in year 1, 0·22 [SE 0·08] more in year 2, and 0·35 [SE 0·14] more in year 3) and 1·9 more community outpatient visits (1·74 [SE 0·13] more in year 1, 2·00 [SE 0·19] more in year 2, and 2·09 [SE 0·27] more in year 3), and their medical cost slightly decreased by 2·30% (0·90% [SE 0·01] less in year 1, 2·65% [SE 0·01] less in year 2, and 3·32% [SE 0·02] less in year 3) compared with the control group, with a dose-response effect. All of these results were statistically significant. InterpretationFamily physicians voluntarily enrolled as so-called soft gatekeepers can be effective at increasing health-care use at the primary care level by patients with diabetes and at containing medical costs. The decrease in medical costs could be attributed to the substitution of hospital care and retail pharmacy services with primary care. These findings have substantial policy implications for China, and act as an incentive to further gatekeeper reforms. Further research is needed to provide evidence for the long-term use of this system. FundingNational Natural Science Foundation of China Grant (number 71603055), China Medical Board Health Policy, and System Science Open Competition Grant (number GNL 15-225).

Evaluation of online counselling services based on Turkish web-based pharmacy care setting: A retrospective observational study.

To determine the types of online pharmacy care services provided by the clinical pharmacists regarding identification of medication-related problems, provision of counselling services for health and disease conditions alongside medications' counselling for patients seeking online consultation about health, medication and lifestyle concerns based on Turkish web-based pharmacy care setting(WPCS). A retrospective, descriptive cohort study carried out on patients during their online visiting of Turkish WPCS seeking consultation for diverse kinds of concerns from September 2015 to March 2016. Patients' health and medication data were gathered for assessment of health-, medication- and lifestyle-related concerns. Descriptive analysis and Chi square test were used to analyse study data. Study outcomes included personalised online pharmacy care services regarding identification of medication-related problems, counselling services for health and disease conditions and medications' counselling alongside associations with counselling-related concerns by the WPCS. A total of 350 participants enrolled in this study and the majority of them were women (62.6%). Dermatological and gynaecological conditions represented the majority of disease conditions (51.4%, 44.6%), respectively. Within 1year, 63.7% of the study participants visited the Turkish WPCS more than three times. Medication- and health-related concerns were reported by 90.8% and 68.3% of the study participants, respectively. Medication side effects (44.1%) and an inappropriate medication timing (31.4%) were the major medication-related problems identified. A total of 477 different counselling services regarding health conditions and 990 counselling regarding medications were provided by the clinical pharmacist through the Turkish WPCS. The WPCS could be considered as an additional option for the clinical pharmacist to provide care services regarding identification of medication-related problems, provision of counselling about health and disease conditions alongside different medication counselling to improve health conditions and proper pharmacotherapy management.

LEGAL PROTECTION OF PHARMACY TAKES A PHARMACY CARE IN THE EVENT OF EMERGENCY

The legal protection of pharmacists is very important, because if there is no legal protection in carrying out pharmaceutical practices by a pharmacist it will become an obstacle in the running of pharmaceutical services to the public, especially with the new concept of pharmacy services at home (home pharmacy care). The instrument has not been regulated in the law so that the pharmacist profession is vulnerable to criminalization. The problem in this paper is (a) how is the legal protection of pharmacists in conducting home pharmacy care in the emergency services outside in their authority? How do you prevent the criminalization of pharmacists in conducting home pharmacy care? This study uses an empirical juridical and normative juridical approach. The results showed that the legal protection of pharmacists in carrying out home pharmacy care services in the emergency can carry out services outside their authority. The Indonesian Pharmacist Association (IAI) is obliged to provide protection to members as long as they carry out their duties in accordance with professional standards, professional service standards and operational procedure standards, and prevent the criminalization of pharmacists in practicing Home Pharmacy Care services. Suggestions by the authors in this study is expected the government to immediately issue a new law related to the validity of pharmacist activities in conducting home pharmacy care so that the existence of the law will guarantee legal certainty.

Position Paper on Critical Care Pharmacy Services (Executive Summary): 2020 Update.

Provide a multiorganizational statement to update the statement from a paper in 2000 about critical care pharmacy practice and makes recommendations for future practice. The Society of Critical Care Medicine, American College of Clinical Pharmacy Critical Care Practice and Research Network, and the American Society of Health-Systems Pharmacists convened a joint task force of 15 pharmacists representing a broad cross-section of critical care pharmacy practice and pharmacy administration, inclusive of geography, critical care practice setting, and roles. The Task Force chairs reviewed and organized primary literature, outlined topic domains, and prepared the methodology for group review and consensus. A modified Delphi method was used until consensus (> 66% agreement) was reached for each practice recommendation. Previous position statement recommendations were reviewed and voted to either retain, revise, or retire. Recommendations were categorized by level of ICU service to be applicable by setting, and grouped into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development. There are 82 recommendation statements: forty-four original recommendations and 38 new recommendation statements. Thirty-four recommendations were made for patient care, primarily relating to critical care pharmacist duties and pharmacy services. In the quality improvement domain, 21 recommendations address the role of the critical care pharmacist in patient and medication safety, clinical quality programs, and analytics. Nine recommendations were made in the domain of research and scholarship. Ten recommendations are in the domain of training and education and eight recommendations regarding professional development. The statements recommended by this taskforce delineate the activities of a critical care pharmacist and the scope of pharmacy services within the ICU. Effort should be made from all stakeholders to implement the recommendations provided, with continuous effort toward improving the delivery of care for critically ill patients.

Position Paper on Critical Care Pharmacy Services: 2020 Update.

To provide a multiorganizational statement to update recommendations for critical care pharmacy practice and make recommendations for future practice. A position paper outlining critical care pharmacist activities was last published in 2000. Since that time, significant changes in healthcare and critical care have occurred. The Society of Critical Care Medicine, American College of Clinical Pharmacy Critical Care Practice and Research Network, and the American Society of Health-Systems Pharmacists convened a joint task force of 15 pharmacists representing a broad cross-section of critical care pharmacy practice and pharmacy administration, inclusive of geography, critical care practice setting, and roles. The Task Force chairs reviewed and organized primary literature, outlined topic domains, and prepared the methodology for group review and consensus. A modified Delphi method was used until consensus (> 66% agreement) was reached for each practice recommendation. Previous position statement recommendations were reviewed and voted to either retain, revise, or retire. Recommendations were categorized by level of ICU service to be applicable by setting and grouped into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development. There are 82 recommendation statements: 44 original recommendations and 38 new recommendation statements. Thirty-four recommendations represent the domain of patient care, primarily relating to critical care pharmacist duties and pharmacy services. In the quality improvement domain, 21 recommendations address the role of the critical care pharmacist in patient and medication safety, clinical quality programs, and analytics. Nine recommendations were made in the domain of research and scholarship. Ten recommendations were made in the domain of training and education and eight recommendations regarding professional development. Critical care pharmacists are essential members of the multiprofessional critical care team. The statements recommended by this taskforce delineate the activities of a critical care pharmacist and the scope of pharmacy services within the ICU. Effort should be made from all stakeholders to implement the recommendations provided, with continuous effort toward improving the delivery of care for critically ill patients.

Position Paper on Critical Care Pharmacy Services (Executive Summary): 2020 Update.

Provide a multiorganizational statement to update the statement from a paper in 2000 about critical care pharmacy practice and make recommendations for future practice. The Society of Critical Care Medicine, American College of Clinical Pharmacy Critical Care Practice and Research Network, and the American Society of Health-System Pharmacists convened a joint task force of 15 pharmacists representing a broad cross-section of critical care pharmacy practice and pharmacy administration, inclusive of geography, critical care practice setting, and roles. The Task Force chairs reviewed and organized primary literature, outlined topic domains, and prepared the methodology for group review and consensus. A modified Delphi method was used until consensus (>66% agreement) was reached for each practice recommendation. Previous position statement recommendations were reviewed and voted to either retain, revise, or retire. Recommendations were categorized by level of ICU service to be applicable by setting, and grouped into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development. There are 82 recommendation statements: forty-four original recommendations and 38 new recommendation statements. Thirty-four recommendations were made for patient care, primarily relating to critical care pharmacist duties and pharmacy services. In the quality improvement domain, 21 recommendations address the role of the critical care pharmacist in patient and medication safety, clinical quality programs, and analytics. Nine recommendations were made in the domain of research and scholarship. Ten recommendations are in the domain of training and education and eight recommendations regarding professional development. The statements recommended by this taskforce delineate the activities of a critical care pharmacist and the scope of pharmacy services within the ICU. Effort should be made from all stakeholders to implement the recommendations provided, with continuous effort toward improving the delivery of care for critically ill patients.