Critical Care Pharmacists Research Articles

Implementation and Impact of Critical Care Pharmacist Addition to a Telecritical Care Network.

To describe the implementation of a TCC pharmacist into an established TCC network, classify interventions performed, and quantify cost avoidance generated through pharmacist interventions. Multicenter, observational cohort study and retrospective return on investment, performed between December 2019 and December 2021. Critically ill adult patients, admitted to an ICU located in any of our eight community hospitals (50 ICU beds) within a large, 25-hospital integrated healthcare system (563 ICU beds total) in the United States. The TCC pharmacist service was implemented in 8-hour shifts, initially available 5 days per week, then expanded to 7 days per week. Critical care pharmacist interventions were categorized by clinical type established utilizing American Society of Health-System Pharmacists benchmarking standards and the latest cost avoidance data. During the 2-year analysis period, TCC pharmacists documented 2,838 interventions generating $1,664,254 of gross cost avoidance and a return on investment of 4.5:1. It is feasible to implement a TCC pharmacist within an established TCC network. Our experience showed enhanced comprehensive care of critically ill patients located in community hospitals within a large, integrated healthcare system, demonstrated significant cost avoidance, and has led to other initiatives, including a collaborative clinical/operational partnership with Life Flight.

Survey of critical care pharmacists on sedation and analgesia practices in adult and pediatric patients receiving continuous neuromuscular blocking agents

AbstractIntroductionThere is a lack of recommendations regarding sedation/analgesia practices for patients receiving continuous or frequent boluses of neuromuscular blocking agents (NMBAs), which may cause variation among different clinical practice sites.ObjectivesThe primary objective of this study was to determine critical care pharmacist's perceptions and practices regarding sedation/analgesia for patients receiving NMBAs and to compare sedation/analgesia regimens among adult and pediatric populations.MethodsA 10‐question survey was provided to critical care pharmacists regarding practice site, comfort using NMBAs, and monitoring practices. Respondents could select all sedation/analgesia regimens they commonly see, would recommend, and would consider inappropriate. Responses from adult and pediatric pharmacists were compared.ResultsOf the 2435 pharmacists who received the survey, 192 (7.9%) completed the survey. Most respondents practiced in the United States (97.9%), cared for adult patients (60.7%), and worked in a medical intensive care unit (ICU) (81.3%). Most respondents reported monitoring sedation depth (82.6%) with vitals (49%) and bispectral index (30.3%) being the most common methods. The most commonly observed regimens were continuous infusion (CI) benzodiazepine and CI opioid (n = 114, 66.7%), followed by propofol and CI opioid (n = 104, 60.8%). These were also the most commonly recommended regimens (n = 102, 59.6%; n = 108, 63.2%), respectively. Most respondents would not recommend monotherapy regimens. Dexmedatomidine was utilized and recommended significantly more by pediatric pharmacists while propofol was utilzied and recommended more by adult pharmaicsts. Regimens deemed inappropriate were similar between adult and pediatric pharmacists except for dexmedetomidine‐containing regimens which significantly more adult pharmacists deemed inappropriate.ConclusionDespite a lack of guideline recommendations, use of combination therapy with sedation/analgesia was frequently reported; however, the choice of sedation agent was variable. Given concern with the inability to achieve deep sedation with dexmedetomidine and a high response rate recommending/utilizing dexmedetomidine, further research is needed to guide recommendations for providing appropriate sedation/analgesia to patients receiving NMBAs.

Clinician-Designed Dashboards.

Critical care pharmacists play a crucial role in direct and indirect patient-care and professional service. Despite this, there is still an ongoing discussion on how to justify their role in the ICU and encourage the opening of more positions. A clinician-designed dashboard is an example of how to present relevant metrics to stakeholders. An example dashboard could include metrics such as pharmacist-to-patient ratio, number of interventions, and stewardship efforts. A dashboard could also convey contributions a critical care pharmacist makes outside of the ICU. This includes institutional services such as education and research. The measurement of such outcomes would justify new positions and protect current critical care pharmacists from unsustainable workloads by recognizing domains of value brought on by a pharmacist. The development of such a dashboard would be a step towards improving outcomes via interprofessional culture and patient-centered care.

519: ENHANCING NEUROCRITICAL CARE EDUCATION THROUGH MULTIDISCIPLINARY SIMULATION TRAINING

Introduction: Early recognition and response are paramount in treatment of neurologic emergencies. Due to its complexity, neurocritical care continues to provoke unease for practitioners and trainees. A simulation environment can provider a realistic opportunity for learners to detect and make rapid-fire decisions for an acutely deteriorating neurologic patient. A multidisciplinary simulation-based learning environment may improve education and trainee confidence when caring for the neurocritical care patient population. Methods: Three 45-minute simulation lab sessions were performed with a multidisciplinary team including medical students, neurology residents, critical care medicine fellows, advanced practice providers, and a critical care pharmacist. High fidelity manikins capable of reproducing acute neurologic and physiologic emergencies were used. Prior to the simulation, participants received Emergency Neurological Life Support resources. The simulation session lasted 45 minutes with an additional 10-minute debriefing with a neurointensivist and neurocritical care APP. After the simulation, participants were asked to complete a survey utilizing Likert scale responses, containing questions regarding pre- and post-simulation comfort levels managing specific acute neurologic emergencies. Results: Three simulation lab sessions were conducted and thirteen surveys were completed. Mean learner comfort levels in managing patients improved from pre- to post-simulation in patients with coma [3.25 vs 4.25 (p=0.007)], status epilepticus [3.25 vs 4.25 (p=0.007)], and procedures such as central lines [2.2 vs 3.8, p=0.003], intubations [2 vs 3.2, p=0.004], and bronchoscopies [2 vs 3.2, p=0.004]. Consistently, learners strongly agreed that faculty were knowledgeable, and sessions were well informed and thorough. Learners commented that the simulation experiences were realistic and allowed them to identify areas for improvement. Conclusions: Simulation training can be an effective method to improve education of neurocritical care team members by increasing clinician comfort in managing neurologic emergencies and procedures as well as providing opportunities for multidisciplinary collaboration. Further evaluation of the effectiveness of simulation education in this patient care setting is warranted.

852: IMPROVING KNOWLEDGE AND CONFIDENCE WITH BETA-LACTAM THERAPEUTIC DRUG MONITORING IN THE ICU

Introduction: Beta-lactam antibiotics are the backbone of sepsis treatment, but a ‘one-size-fits-all’ dosing strategy leads to unpredictable effects. Therapeutic drug monitoring (TDM; i.e., drug level testing) can personalize treatment and improve outcomes. Pharmacists are the key operational stakeholders for beta-lactam TDM in the ICU, but evidence suggests they have low knowledge and confidence with the practice. We hypothesized that delivery of bundled education intervention would increase pharmacist knowledge and confidence about beta-lactam TDM without jeopardizing the proportion that feel such a program is worthwhile. Methods: A questionnaire was developed and distributed to critical care and infectious diseases pharmacists at a large academic medical center before and after delivery of a bundled educational intervention on beta-lactam TDM. Component parts of the education included a web-based asynchronous learning module on beta-lactam TDM, an electronically available pharmacokinetic calculator, infographics of key content and workflow processes, a frequently asked questions document, and practice champion training. Questionnaire items were based on the ADKAR framework (awareness, desire, knowledge, ability, and reinforcement). Results were summarized descriptively and the Chi-square test was used for two-way binary comparisons. Results: Of 66 available pharmacists, 55 (83%) and 35 (53%) responded to the baseline and follow-up (after the educational intervention) questionnaires. Significantly more respondents felt comfortable recommending beta-lactam TDM for infected critically ill patients after the educational intervention (29% vs 97%; P < 0.001). Familiarity with operational considerations were similarly improved including with patient selection, number and timing of samples, and application of results. The proportion of respondents who felt beta-lactam TDM was worthwhile increased from 60% to 80% after education (P = 0.002). Conclusions: A bundled education intervention can increase knowledge, comfortability, and confidence with beta-lactam TDM in the critically ill among pharmacists, the key operational stakeholders.

935: PREDICTING DURATION OF MECHANICAL VENTILATION WITH MEDICATION REGIMEN COMPLEXITY VARIABLES

Introduction: Duration of mechanical ventilation is associated with adverse outcomes in critically ill patients. The increasing complexity of medication regimens has been associated with increased mortality, length of stay, and fluid overload but has never been studied in the setting of mechanical ventilation. As medication regimen complexity has also been associated with critical care pharmacist interventions, potential exists that guiding pharmacist intervention towards patients at highest risk of prolonged intubation may improve outcomes. The purpose of this analysis was to develop prediction models for mechanical ventilation duration to test the hypothesis that increasing medication regimen complexity is associated with increased duration of mechanical ventilation. Methods: In this single-center, retrospective cohort study of 354 adults managed in the intensive care unit (ICU), predictors of prolonged duration of mechanical ventilation (defined as > 5 days) were assessed. Patients were split into training (301, 85%) and testing (53, 15%) datasets. Multiple imputations were used for missing variables. Random forest was used for prediction including the variables age, sex, admission diagnosis, illness severity, and MRC-ICU. Variables with the highest importance from the random forest were selected to complementarily fit a logistic regression for better interpretation. Results: Upon random forest, medication regimen complexity was associated with prolonged mechanical ventilation. The random forest model yielded an accuracy of 0.925 (95%CI: 0.818-0.979). Upon area under the receiver operating characteristic (AUROC) analysis, the model incorporating MRC-ICU and CAM-ICU showed an AUC of 0.919 (95%CI: 0.831-1.000) for predicting whether the duration of mechanical ventilation beyond 5 days or not. Complementary logistic regression showed that the proportion of CAM-ICU positive days before intubation positively impacted the prolonged intubation duration (P < 0.100). Conclusions: The addition of medication related variables has the potential to improve prediction models and may provide specific insights into how pharmacotherapy affects patient outcomes, which has ramifications for identifying high-risk patients for pharmacist intervention.

Survey on Critical Care Pharmacists' Role Importance-Performance Analysis in Multidisciplinary Intensive Care Unit Teams: Gap Between Physicians and Pharmacists in South Korea

You Min Sohn, Hyeryeong Lee, Eunjeong Park, Eunyoung Choi, Chaewon Moon, Young Joo Song, Eunjeong Heo, Eunyoung Sa, Su Hyun Ryu, Sun Mi Jung, Kyung A Lee, Eun Jeong Choi, Myung Sook Min, Jeong Mee Kim and Eunyoung Kim. J. Kor. Soc. Health-syst. Pharm. 2022;39:445-61. https://doi.org/10.32429/jkshp.2022.39.4.002

An evaluation of standardised pharmaceutical handover on critical care units

Abstract Introduction Patients cared for in the Critical Care unit are severely ill and may require multiple changes to their usual medication and new medicines to manage their current clinical condition. Due to pharmacist working patterns at University Hospital Southampton (UHS) patients on the Critical Care unit will receive pharmaceutical care from more than one pharmacist. It is vital that any changes are communicated between members of the pharmacy team as deliberate clinical decisions and not accidental omissions or errors. It is recognised that transfer of patients between professionals or teams caring for them is “one of the very high-risk transactions of health care service” 1. Errors of omission in medication for chronic conditions on Critical Care may lead to continuing omission of this therapy following discharge from hospital.2 Aim To assess the impact on pharmacist time and patient care of a formalised pharmaceutical handover for Critical Care patients at UHS. Methods Handovers are part of routine pharmaceutical care and ethics approval was not required. A pharmacist handover tool was developed within the existing Microsoft Access database used on Critical Care at UHS. Prior to the implementation a cohort of patients were identified and followed up on Critical Care discharge. Data were collected regarding pharmacist documented pre-Critical care medication, changes to this medication, ITU prophylaxis therapies. Following implementation, a second cohort was identified and a further data set collected. Data was analysed using a series of chi-squared tests and two-sample t-tests. Qualitative data were collected about ward pharmacist perceptions of pharmaceutical handover issues from Critical Care and regarding the Critical Care pharmacists’ use of the system and perceptions following its introduction. Ethical approval was not required for this service development initiative and evaluation. Results Favourable trends were detected following the introduction of the standardised handover tool: these did not reach statistical significance in most of the outcomes measured. There wasa statistical difference in the number of changes to pre-ITU medication detected following the handover introduction (p=0.028). The ward pharmacists consulted often had queries about medication changes. Within the critical care team the system was regarded as easy to use and useful. Discussion/Conclusion The standardised handover was well received by the Critical Care team who considered it to be simple to use and a useful tool. Statistical significance was not reached for the majority of measures although a positive trend was detected, probably due to the small sample size. Further standardisation handover system will ensure consistency of pharmaceutical care for this group of complex patients. Since this project was completed, the tool developed has been incorporated into the clinical information system now used within the Trust and has been developed further as an integrated part of the system. The tool is also used within other areas who use the clinical information system and will be reviewed and developed for their specialist areas including neonatal and paediatric intensive care where the information hand over may require different priority areas to be highlighted. Ward pharmacists are also able to access the clinical information handover tool and has led to a reduction in post-critical care queries.

Development of a critical care pharmacist career coaching and professional development program at an academic medical center

AbstractContinuing professional development is a lifelong process that is multifaceted, holistic, self‐directed, and is not a replacement for continuing education. Through ongoing professional development, pharmacists can improve their skill set in a broad range of clinical, educational, research, and administrative activities. Not only does development of this growth benefit the individual pharmacist, but also the institution and pharmacy profession. In 2020, the American College of Clinical Pharmacy, the Society of Critical Care Medicine, and the American Society of Health‐System Pharmacists published an updated position paper on critical care pharmacy services. A new recommendation in the update was to create mechanisms for critical care pharmacists to develop their career and professional development. Herein, we describe our experience with the development and implementation of a critical care pharmacy career professional development program using peer‐to‐peer coaching within a large academic medical center. Professional development is not a one size fits all and should be individualized. We initially focused on developing research skills based on initial surveys. Afterwards professional development was varied we created new resources such as journal referee “how‐to” and teaching in a flipped classroom.

Critical Care Pharmacists: Improving Care by Increasing Access to Medication Expertise.

Critical Care Pharmacists: Improving Care by Increasing Access to Medication Expertise.

Impact of Pharmacists to Improve Patient Care in the Critically Ill: A Large Multicenter Analysis Using Meaningful Metrics With the Medication Regimen Complexity-ICU (MRC-ICU) Score.

Despite the established role of the critical care pharmacist on the ICU multiprofessional team, critical care pharmacist workloads are likely not optimized in the ICU. Medication regimen complexity (as measured by the Medication Regimen Complexity-ICU [MRC-ICU] scoring tool) has been proposed as a potential metric to optimize critical care pharmacist workload but has lacked robust external validation. The purpose of this study was to test the hypothesis that MRC-ICU is related to both patient outcomes and pharmacist interventions in a diverse ICU population. This was a multicenter, observational cohort study. Twenty-eight ICUs in the United States. Adult ICU patients. Critical care pharmacist interventions (quantity and type) on the medication regimens of critically ill patients over a 4-week period were prospectively captured. MRC-ICU and patient outcomes (i.e., mortality and length of stay [LOS]) were recorded retrospectively. A total of 3,908 patients at 28 centers were included. Following analysis of variance, MRC-ICU was significantly associated with mortality (odds ratio, 1.09; 95% CI, 1.08-1.11; p < 0.01), ICU LOS (β coefficient, 0.41; 95% CI, 00.37-0.45; p < 0.01), total pharmacist interventions (β coefficient, 0.07; 95% CI, 0.04-0.09; p < 0.01), and a composite intensity score of pharmacist interventions (β coefficient, 0.19; 95% CI, 0.11-0.28; p < 0.01). In multivariable regression analysis, increased patient: pharmacist ratio (indicating more patients per clinician) was significantly associated with increased ICU LOS (β coefficient, 0.02; 0.00-0.04; p = 0.02) and reduced quantity (β coefficient, -0.03; 95% CI, -0.04 to -0.02; p < 0.01) and intensity of interventions (β coefficient, -0.05; 95% CI, -0.09 to -0.01). Increased medication regimen complexity, defined by the MRC-ICU, is associated with increased mortality, LOS, intervention quantity, and intervention intensity. Further, these results suggest that increased pharmacist workload is associated with decreased care provided and worsened patient outcomes, which warrants further exploration into staffing models and patient outcomes.

Survey of critical care practices for alcohol withdrawal syndrome in the intensive care unit

AbstractIntroductionAlcohol use disorder affects up to 60% of intensive care unit (ICU) patients. Alcohol withdrawal syndrome (AWS) is associated with increased length of stay, mechanical ventilation, and mortality. The lack of clinical practice guidelines specific to ICU patients leads to ambiguity about the standard management of AWS in this population.ObjectivesThe aim of this study was to describe current practice patterns employed for AWS management in ICU settings across the United States.MethodsThis was a cross‐sectional survey of practicing critical care pharmacists identified via a pharmacy professional organization critical care listserv. Emails were sent four times to the recipient list from May 14, 2021 to June 25, 2021. Retired pharmacists and trainees on the listserv were excluded. The survey was conducted by REDCap and descriptive statistics were performed.ResultsThere were a total of 144/1534 (9.4%) responses. Predominant characteristics included university hospital settings (n = 71/143, 49.7%) with greater than 75 ICU beds (n = 54/144, 37.5%), and medical (n = 53/144, 36.8%) or mixed (n = 52/144, 36.1%) ICU populations. The majority reported having an institutional AWS guideline (n = 96/140, 68.6%). A total of 139/143 (97.2%) preferred benzodiazepines, with lorazepam (n = 136/143, 97.8%) as the primary benzodiazepine agent. Most preferred lorazepam as needed, rather than preemptively (n = 137/138, 99.3%). Phenobarbital use was reported by 82.6% (n = 119/144) of respondents, primarily for treatment of benzodiazepine‐refractory withdrawal (n = 96/117, 82.1%). Similarly, dexmedetomidine use was reported by 86.1% (n = 124/144) of respondents, primarily for refractory withdrawal (n = 48/121, 39.7%). Propofol was primarily preferred for patients on mechanical ventilation (n = 56/98, 57.1%) or refractory withdrawal (n = 51/98, 52.0%). Clonidine was preferred by 45.8% (n = 66/144) and atypical antipsychotics by 33.6% (n = 48/143) of respondents.ConclusionsMost ICU pharmacists prefer symptom‐triggered benzodiazepines first line, followed by propofol in intubated patients and dexmedetomidine and/or phenobarbital for refractory cases. Clinical practice guidelines may help provide guidance for the management of these patients.

What generates critical care pharmacist positions in the "real world"?

Disclaimer 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.

Utilizing eye tracking to assess electronic health record use by pharmacists in the intensive care unit.

A study was conducted using high-fidelity electronic health record (EHR)-based simulations with incorporated eye tracking to understand the workflow of critical care pharmacists within the EHR, with specific attention to the data elements most frequently viewed. Eight critical care pharmacists were given 25 minutes to review 3 simulated intensive care unit (ICU) charts deployed in the simulation instance of the EHR. Using monitor-based eye trackers, time spent reviewing screens, clinical information accessed, and screens used to access specific information were reviewed and quantified to look for trends. Overall, pharmacists viewed 25.5 total and 15.1 unique EHR screens per case. The majority of time was spent looking at screens focused on medications, followed by screens displaying notes, laboratory values, and vital signs. With regard to medication data, the vast majority of screen visitations were to view information on opioids/sedatives and antibiotics. With regard to laboratory values, the majority of views were focused on basic chemistry and hematology data. While there was significant variance between pharmacists, individual navigation patterns remained constant across cases. The study results suggest that in addition to medication information, laboratory data and clinical notes are key focuses of ICU pharmacist review of patient records and that navigation to multiple screens is required in order to view these data with the EHR. New pharmacy-specific EHR interfaces should consolidate these elements within a primary interface.

A descriptive report of the rapid implementation of automated MRC-ICU calculations in the EMR of an academic medical center.

Numerous clinical scoring tools exist for a variety of patient populations and disease states, but few tools provide information specifically designed for use by critical care pharmacists. The medication regimen complexity-intensive care unit (MRC-ICU) score was designed to provide high-level information about the complexity of critically ill patients' medication regimens for use by critical care pharmacists. To date, implementation of this score in the electronic medical record (EMR) has not been reported. Using an agile project management framework, the MRC-ICU score was rapidly implemented into an academic medical center's EMR. The score is automatically calculated for all critically ill patients and is available for critical care pharmacists to triage patient review in their individual workflow. Reporting capabilities of the score also allow for granular complexity trending over time and between units, supplementing other objective measures of pharmacist workload. The MRC-ICU score can be quickly implemented into the EMR for pharmacist use in real time. Future investigations into how pharmacists utilize this information and how to harness reporting capabilities for pharmacist workload assessment are warranted.

The Value of Nutrition Support Pharmacist Interventions.

The PHarmacist Avoidance or Reductions in Medical Costs in CRITically Ill Adults: PHARM-CRIT Study by Rech et al demonstrated the value of critical care pharmacists’ interventions. The services provided by nutrition support pharmacists were briefly mentioned. This article aims to highlight the value of interventions provided by nutrition support pharmacists.

Health Care Professionals’ Perceptions of the Role of the Clinical Pharmacist and Expanded Pharmacist Coverage in Critical Care

During the first wave of the COVID-19 pandemic, coverage by critical care pharmacists (CCPs) was expanded in 2 medical-surgical intensive care units at the Queen Elizabeth II Health Sciences Centre, in Halifax, Nova Scotia, from 8 hours per day, 5 days per week, excluding holidays, to 8 hours per day, 7 days per week, including holidays. To describe health care professionals' opinions about and perceived impacts of the expanded CCP coverage on patient care, as well as their opinions about the role of the CCP as a member of the critical care team. An electronic 22-item survey was distributed to critical care health care professionals to capture opinions and perceived impacts of expanded CCP coverage. The perceived importance of 25 evidence-informed CCP activities was assessed using a 5-point Likert scale. Thirty-eight complete responses were included (15% response rate, based on distribution of the survey to 249 health care professionals). Most respondents agreed or strongly agreed with the following statements: CCPs are integral members of the critical care team (34/38 [89%]), CCPs play an important role in improving patient outcomes (34/38 [89%]), the presence of CCPs on the unit and on patient care rounds allows other health care professionals to concentrate on their own professional responsibilities (33/38 [87%]), and the expanded CCP coverage improved patient care (29/35 [83%]). Respondents most frequently categorized 23 of the 25 CCP activities as very important. Expanded CCP coverage was perceived to have a positive effect on both patient care and members of the critical care team. Most CCP activities were perceived as very important. Given the findings of this quality project, novel staffing models are being explored to optimize CCP coverage.

What is the most important principle needed for pharmacy students training as critical care and emergency medicine pharmacists in Japan?

What is the most important principle needed for pharmacy students training as critical care and emergency medicine pharmacists in Japan?

Medication regimen complexity vs patient acuity for predicting critical care pharmacist interventions.

Quantifying and predicting critical care pharmacist (CCP) workload has significant ramifications for expanding CCP services that improve patient outcomes. Medication regimen complexity has been proposed as an objective, pharmacist-oriented metric that demonstrates relationships to patient outcomes and pharmacist interventions. The purpose of this evaluation was to compare the relationship of medication regimen complexity versus a traditional patient acuity metric for evaluating pharmacist interventions. This was a post hoc analysis of a previously completed prospective, observational study. Pharmacist interventions were prospectively collected and tabulated at 24 hours, 48 hours, and intensive care unit (ICU) discharge, and the electronic medical record was reviewed to collect patient demographics, medication data, and outcomes. The primary outcome was the relationship between medication regimen complexity-intensive care unit (MRC-ICU) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and pharmacist interventions at 24 hours, 48 hours, and ICU discharge. These relationships were determined by Spearman rank-order correlation (rS) and confirmed by calculating the beta coefficient (β) via multiple linear regression adjusting for patient age, gender, and admission type. Data on 100 patients admitted to a mixed medical/surgical ICU were retrospectively evaluated. Both MRC-ICU and APACHE II scores were correlated with ICU interventions at all 3 time points (at 24 hours, rS = 0.370 [P < 0.001] for MRC-ICU score and rS = 0.283 [P = 0.004] for APACHE II score); however, this relationship was not sustained for APACHE II in the adjusted analysis (at 24 hours, β = 0.099 [P = 0.001] for MRC-ICU and β = 0.031 [P = 0.085] for APACHE II score). A pharmacist-oriented score had a stronger relationship with pharmacist interventions as compared to patient acuity. As pharmacists have demonstrated value across the continuum of patient care, these findings support that pharmacist-oriented workload predictions require tailored metrics, beyond that of patient acuity.

Prospective Observational Evaluation of Predatory Journals in Critical Care Pharmacy Practice: Defining Characteristics Associated With Receiving Unsolicited Invitations to Publish

Open-access publishing promotes accessibility to scholarly research at no cost to the reader. The emergence of predatory publishers, which exploit the author-pay model by charging substantial publication fees for publication in journals with questionable publishing processes, is on the rise. Authors are solicited through aggressive marketing tactics, though who is targeted is not well described. The purpose of this study was to identify characteristics associated with critical care pharmacists that make them targets of unsolicited invitations to publish. A prospective, observational study of critical care pharmacists was performed. Participants archived emails received by their professional email that were unsolicited invitations to submit their original work for publication in a journal (unsolicited journals). Variables were evaluated to determine which were associated with unsolicited invitations; these were compared to legitimate journals, defined as all PubMed-indexed journals in which the participants were previously published. Twenty-three pharmacist participants were included, all of whom were residency and/or fellowship trained and practicing in an academic medical center. Participants had a median of 7 years of experience since their post-graduate training, 6 years since their last change in professional email address, and 2 years since their first PubMed-indexed publication. From these participants, 136 unsolicited and 59 legitimate journals were included. The average number of invitations increased 1.04 (95% CI, 1.02–1.05) times for every additional PubMed-indexed publication (P < .001). Most unsolicited journals were considered predatory. Legitimate and unsolicited journals differed significantly. The number of previous PubMed-indexed publications strongly correlates with the likelihood of critical care pharmacists receiving unsolicited publication invitations, often from predatory journal.