Clinical Pharmacy

INTRODUCTION

Even as the scope of pharmacy practice expands, impedi­ments to optimal delivery of pharmaceutical care remain. These include shortages of pharmacists, increasing complexity of medication regimens, and increasing acuity of patients and the associated workload. Pharmacy technicians are well posi­tioned to augment direct patient care services because of their knowledge of the medication distribution system in their respec­tive health care centres. At the Royal Columbian Hospital, a 400-bed tertiary health care centre, pharmacy technicians play a large role in the preparation and distribution of medications. This has allowed pharmacists to be deployed primarily to set­tings where they practise direct patient care. Pharmacy techni­cians have not, however, been incorporated to any great extent into pharmacists’ direct patient care processes and workflows.

The adult tertiary intensive care unit (ICU) at the Royal Columbian Hospital has 26 beds. Patients in the ICU are cared for by 2 multidisciplinary health care teams. Each team is led by an intensivist and includes one clinical pharmacy specialist. Patient care rounds are performed daily from 0915 until about 1300. The clinical pharmacy specialist typically has 2 h to do a comprehensive work-up for more than a dozen patients before patient care rounds. During patient care rounds, the health care team reviews the information about each patient sequentially and sets up a plan for treatment for the day. The patients’ medications are also reviewed at this time. The clinical pharma­cy specialist is expected to be present during patient care rounds and to bring to the team’s attention any drug-related problem that has been identified. Because of the increasing demand for ICU beds and the lack of physical space in the current unit, patients requiring mechanical ventilation, who are followed by the ICU health care teams, are sometimes located on units outside the ICU, such as the Emergency Department, the Post- Anesthesia Care Unit, or the Cardiac Surgery ICU. viagra plus

The use of pharmacy technicians to support direct patient care services in the ICU has previously been reported by Ervin and others, who described the role of the data analyst technician. According to those authors, the activities of data analyst technicians in the ICU focus on retrieving data for individual patients. The information collected may include values for hemodynamic and respiratory parameters, demographic characteristics, fluid and nutritional status, and use of vasopres- sors. This support activity is valuable to the delivery of pharmaceutical care in the ICU because it allows pharmacists to focus more on cognitive-based activities, which increases their overall work efficiency. However, we felt that pharmacy technicians were capable of performing more value-added activities than had previously been reported and that they could play a larger role in the ICU. We hypothesized that incorporating a clinical pharmacy support technician (CPST) program in the delivery of direct patient care in the adult tertiary-level ICU would further increase pharmacists’ work efficiency. We defined work efficiency in terms of the number of patients that the pharmacist could comprehensively assess per day and the time spent on cognitive-based activities. This article describes the CPST program at the Royal Columbian Hospital, the activities performed by the technician in the ICU, the benefits of the program, and considerations for implementing similar programs elsewhere.