Implementation and evaluation of an overnight critical care pharmacist shift

Affiliations

Illinois Masonic Medical Center

Abstract

Purpose: To investigate the impact of an overnight critical care pharmacist shift on pharmacy services in a quality improvement initiative.

Methods: The department of pharmacy implemented an overnight critical care pharmacist shift in October 2023 to better align with recommendations for critical care pharmacy services from the Society of Critical Care Medicine, American College of Clinical Pharmacy, and American Society of Health-System Pharmacy. This initiative focused on patient care services and aimed to increase compliance from 6.2% to 75% during overnight hours by May 2024. Characterization of the impact included time to order verification, time to administration, and number and type of pharmacist interventions. Plan-Do-Study-Act (PDSA) cycles were utilized to measure changes over time.

Results: Shift initiation (PDSA cycle 1) resulted in a mean time to order verification of 9.4 minutes (SD, 24.7 minutes) compared to 7.4 minutes (SD, 13.9 minutes) before initiation. There was no difference in the mean time to order verification of stat medications. Pharmacists documented an average of 214 interventions per month compared to 84 before initiation. For PDSA cycle 2, patient profile reviews of newly admitted patients occurred during 60 of 60 (100%) shifts, with an average of 9 patients reviewed per shift. Prospective profile review led to interventions for 93.3% of shifts.

Conclusion: This initiative increased institutional compliance with foundational patient care recommendations from 6.2% to 67.2%. Implementation of overnight critical care pharmacists led to an increase in the number of interventions documented over time without a significant corresponding increase in the time to order verification and administration. Opportunities exist for further optimization of clinical activities during the overnight hours.

Document Type

Article

PubMed ID

41364651

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