Crucial, evolving pharmacist roles in intensive care gain new national standard

SHPA has comprehensively revised leading guidelines on the provision of intensive care, defining pharmacist-to-patient ratios, standardising national and state-based classifications for the first time and further marking the evolution of the Intensive Care Unit (ICU) pharmacist’s role as a key member of the multidisciplinary medical team caring for Australia’s most urgently and acutely unwell.

Covering adult and paediatric practices, SHPA’s Standard of practice in intensive care for pharmacy services appears in the latest issue of the Journal of Pharmacy Practice and Research (JPPR), alongside a complementary systematic review exploring the use of antimicrobials in prolonged intermittent renal replacement therapy (PIRRT), a hybrid form of dialysis increasingly used in critical care.

Melissa Ankravs, SHPA Critical Care Chair, says the clarification of health service levels allows for more precise pharmacist-to-patient ratios.

‘By aligning the state-based approaches of New South Wales, Queensland, Western Australia and South Australia with the College of Intensive Care Medicine of Australia and New Zealand (CICM) intensive care unit (ICU) service levels used in Victoria, Tasmania, the ACT and Northern Territory, we’re able to recommend staffing ratios across the country of 1:10 in larger, level 2/3 (CICM) services, and a 1:15 ratio for smaller, level 1 (CICM) services.

‘This is important to the consistent delivery of optimal patient care across Australia, as well as providing evidence of the increasingly complex cases and higher acuity patients we’re seeing, requiring clearer delineation regarding treatment intensity and care need.

‘As part of this advancement a number of emerging services are now addressed, showing the expanding scope of practice for ICU pharmacists and their direct impact on patient care. We’ve also included new information on self-care and burnout minimisation, reflecting grower understanding of the pressures of working in ICU.’

The Standard, which is further supported by a systemic review by Matt Rawlins et al., was co-authored by members of the SHPA Critical Care Leadership Committee.

In a supporting editorial, the CICM Board Executive writes that with the ever-increasing number of new drugs prescribed in the community, and the time-critical nature of intensive care practice, the ICU pharmacist is an important resource for medical and nursing staff.

‘The role of the ICU pharmacist has been repeatedly shown to reduce the adverse effects arising from poor practice in relation to drug prescription and administration, to improve patient outcomes and to reduce healthcare costs.

‘The ICU pharmacist is also invaluable for providing advice on medications unfamiliar to the average intensive care clinician, such as those prescribed for oncological and immunological conditions.’

The latest issue of JPPR – available free to SHPA members – also features ‘A time in motion study of impact of robotics on medication supply in an Australian hospital pharmacy’, described by Editor-in-Chief Professor Michael Dooley as invaluable for informed decision-making and ‘real world evaluation of implementation in the Australian setting’.

‘The challenge is to undertake more evaluations of implemented pharmacy automated, pharmacy distribution solutions. A systematic review and meta-analysis published in the last issue of this journal reinforced the need for further well-designed studies to evaluate these interventions to inform decisions regarding implementation and evaluation.’

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