Optimizing pharmacist-driven protocols and documentation of interventions using clinical decision support systems

The use of electronic health record embedded MRC-ICU as a metric for critical care pharmacist workload

Objectives

A lack of pharmacist-specific risk-stratification scores in the electronic health record (EHR) may limit resource optimization. The medication regimen complexity-intensive care unit (MRC-ICU) score was implemented into our center's EHR for use by clinical pharmacists. The purpose of this evaluation was to evaluate MRC-ICU as a predictor of pharmacist workload and to assess its potential as an additional dimension to traditional workload measures.

Materials and methods

Data were abstracted from the EHR on adult ICU patients, including MRC-ICU scores and 2 traditional measures of pharmacist workload: numbers of medication orders verified and interventions logged. This was a single-center study of an EHR-integrated MRC-ICU tool. The primary outcome was the association of MRC-ICU with institutional metrics of pharmacist workload. Associations were assessed using the initial 24-h maximum MRC-ICU score's Pearson's correlation with overall admission workload and the day-to-day association using generalized linear mixed-effects modeling.

Results

A total of 1205 patients over 5083 patient-days were evaluated. Baseline MRC-ICU was correlated with both cumulative order volume (Spearman's rho 0.41, P < .001) and cumulative interventions placed (Spearman's rho 0.27, P < .001). A 1-point increase in maximum daily MRC-ICU was associated with a 31% increase in order volume (95% CI, 24%-38%) and 4% increase in interventions (95% CI, 2%-5%).

Discussion and conclusion

The MRC-ICU is a validated score that has been previously correlated with important patient-centered outcomes. Here, MRC-ICU was modestly associated with 2 traditional objective measures of pharmacist workload, including orders verified and interventions placed, which is an important step for its use as a tool for resource utilization needs.

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

PURPOSE

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.

SUMMARY

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.

CONCLUSION

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.