Pharmacists' Role in Critical Care: Environmental scan of current practices in Canada
CCCF ePoster library. Mailman J. Oct 3, 2017; 198173; 70
Dr. Jonathan Mailman
Dr. Jonathan Mailman
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Abstract
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Pharmacists' Role in Critical Care: Environmental scan of current practices in Canada

Mailman, Jonathan F.1,2; Semchuk, William1,2,3

Pharmacy Services, Regina Qu'Appelle Health Region, 1440-14th Ave, Regina, Saskatchewan, Canada; 2College of Medicine, University of Saskatchewan, Sasktatoon, Sasktachewan, Canada; 3College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada


Introduction
Clinical Pharmacists have been members of the multidisciplinary team providing direct patient care in Critical Care since the 1970’s. Practice has grown and developed in different parts of the country independently of each other, guided by American research and position papers. An environmental scan of current practices in Canada does not currently exist in the published literature.
 
Objectives
To describe current practices of ICU Pharmacists in Canada.
 
Methods                                                                               
An open-form survey consisting of 14 questions was distributed to all members of the Canadian Society of Hospital Pharmacists, Critical Care Practice Speciality Network via email. Follow-up telephone correspondence inviting participants working in critical care was then performed.
 
Results
A 10% response rate included 31 respondents from across Canada; 71% of those practiced within a  tertiary care centre, 93% in mixed medical / surgical units. The mean size of intensive care units was 21 beds (Median 20, Range 6-44, IQR 12-27) and mean pharmacist to patient ratio was 13 to 1 (Median 12, Range 6-23, IQR 10-17). (Table 1) A team of pharmacists shared ICU coverage in 77% of cases. Within those teams, 30% of staff have advanced training with either a Post-baccalaureate Doctor of Pharmacy (PharmD) or Masters degree, and 39% of organizations require an entry-to-practice degree and some on-the-job training as a minimum to practice in Critical Care. Advanced-degree training found more commonly in Vancouver and Toronto, where the Faculties of Pharmacy have offered PharmD degrees for more than a decade.
 
Patient care rounds are completed in a standardized fashion in 55% of centres, with another 11% of centers reporting a similar format determined by the Attending Physicians. (Table 2) Within rounds, the Pharmacist has an allotted time to present in 52% of critical care units, with the remainder either expected to support and comment on presentations from other members of the team or as agreed upon with the Attending Physician. Clinical Pharmacists provide 8 hour/day coverage in 92% of centres, five days a week in 84%, with 4 hours (range 3-8) devoted to rounding. During rounds, pharmacists describe their contribution as most commonly reviewing current medications; adjusting medication dosing for organ dysfunction; reviewing antimicrobial therapy; providing therapeutic drug monitoring; and ensuring appropriate prophylaxis for stress ulcers, venous thromboembolism, and ventilator associated pneumonia. Pharmacists report using a checklist 33% of the time to prepare for rounds.
 
A standardized patient monitoring form is used at 55% of sites and 80% of pharmacist documentation occurs outside the legal record on pharmacy documentation records. Pharmacists indicate that the majority of their suggestions/interventions on rounds are included in the Physician’s Progress notes in 87% of centres. Supplementation of the physician progress notes occurs in 56% of centres when the Pharmacist determines greater detail is required or if the pharmacist’s recommendation is discordant with the decision from rounds.
 
Conclusion
Pharmacists’ practice in critical care is variable in Canada. Higher credentialing is found in areas where a post baccalaureate PharmD program has been in existence for greater than 10 years. Documentation of interventions largely occurs within the physicians progress note and the majority of pharmacist documentation occurs outside of the legal record.

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