Critical care pharmacy services in United States hospitals.
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 in-services (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.
Department of Clinical Pharmacy, School of Pharmacy, University of Colorado Health Sciences Center, Denver, CO 80262, USA. rob.maclaren@uchsc.edu
Robert
R
Maclaren
John W
JW
Devlin
Steven J
SJ
Martin
Joseph F
JF
Dasta
Maria I
MI
Rudis
C A
CA
Bond
D016303:Clinical Pharmacy Information Systems; D003422:Critical Care / Q000458:organization & administration* / Q000592:standards; D064420:Drug-Related Side Effects and Adverse Reactions; D006761:Hospitals; D007362:Intensive Care Units / Q000600:supply & distribution*; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D014481:United States