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

Andrew J Webb; Bayleigh Carver; Sandra Rowe; Andrea Sikora

doi:10.1093/jamiaopen/ooad101

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

JAMIA Open. 2023 Dec 5;6(4):ooad101. doi: 10.1093/jamiaopen/ooad101. eCollection 2023 Dec.

Authors

Andrew J Webb^{1

2}, Bayleigh Carver³, Sandra Rowe², Andrea Sikora³

Affiliations

¹ Department of Pharmacy, Oregon Health and Science University, Portland, OR 97239, United States.
² Department of Pharmacy, Massachusetts General Hospital, Boston, MA 02114, United States.
³ Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA 30912, United States.

Abstract

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.

Keywords: clinical pharmacy; critical care; intensive care; medication regimen complexity; medication safety; pharmacy practice models.

Grants and funding

R01 HS029009/HS/AHRQ HHS/United States