January 09, 2014
Critical care clinical pharmacy services have been available for decades within hospital and healthcare systems. These services have shown time and time again the value of assisting and demonstrating outcomes in many aspects of critical care pharmacotherapeutics including sedation of the mechanically ventilated patient, anticoagulation, and infections in the critically ill to name a few. Recently, CHEST published “Pharmacist Contributions as Members of the Multidisciplinary ICU Team.” In it, the authors discussed partnering with physicians and nurses to garner support from hospital administrators for the addition of clinical pharmacy services. The authors also suggest that adding a pharmacist to an interdisciplinary critical care team should be encouraged.
I applaud this group for their continuing advocation of these services, however, how long do pharmacists need to continue to justify their value? How many published clinical studies, manuscripts, posters, and national presentations are needed to prove this point? Although pharmacists for decades have been able to demonstrate value in patient outcomes by our own judgment, it does not seem that other healthcare providers or administrators interpret the data as we do. I believe a great percentage of hospitals (i.e., large academic medical centers) across the country have been able to see the value of pharmacists in these roles. However, since many hospitals in the country are smaller rural or community hospitals, a large majority do not have specialized critical care services and if they do many hospital pharmacy staff are taking on critical care responsibilities. I believe many hospitals consider critical care clinical pharmacy services a luxury service not a mandatory one. I can’t tell you the number of times I heard: you are a valued member of the ICU team, however, there is no money either from the pharmacy budget, administrative budget, or critical care budget to hire another critical care clinical pharmacist. Based upon the need to do more with less, many pharmacy directors may hire individuals with a broad scope of skill sets, not just critical care expertise. In addition, hospital administrators still may not know the value of our services and may not be willing to justify critical care clinical pharmacist’s positions.
Do you believe these services will ever be seen as the standard of care as opposed to a luxury service? What do you think would be needed for critical care clinical pharmacists to be recognized as a standard service in every hospital in the United States? Has your institution hired more critical care clinical pharmacists? If so, how did this occur? Has your institution eliminated critical care positions? Is so, what was the reason? Critical care clinical pharmacists will soon have a board certification exam in critical care; do you think this is necessary? Is this extra certification justify the need? I welcome your thoughts on the need for critical care clinical pharmacist services and the ongoing challenge to demonstrate value.
Michael J. Cawley, PharmD, RRT, CPFT, is a Professor of Clinical Pharmacy at the Philadelphia College of Pharmacy, University of the Sciences. He has greater than 25 years of experience practicing in the areas of medical, surgical, trauma, and burn intensive care as both a critical care clinical pharmacist and registered respiratory therapist.