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29-03-2024 | ECMO | Research Article

Critical care pharmacy service provision and workforce in adult extracorporeal membrane oxygenation centres: a multicentre cross-sectional survey

Authors: Christopher Remmington, Lynda Cameron, Fraser Hanks, Ya-Hui Liang, Linda Barrow, Ruth Coxhead, Reena Mehta, Nisha Bhudia, Haifa Lyster, Sarah Cooke, James Gilmartin, Phillisa Lee, Rhona Sloss, Cathrine McKenzie

Published in: International Journal of Clinical Pharmacy

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Abstract

Background

There is good evidence describing pharmacy workforce and service provision in general critical care units. However, no data exist from adult extracorporeal membrane oxygenation (ECMO) centres.

Aim

To describe workforce characteristics, pharmacy service provision, and pharmaceutical care activities in critical care units (CCUs) providing an adult ECMO service in the United Kingdom (UK) and compare to national staffing standards for CCUs.

Method

We conducted a multicentre, cross-sectional electronic survey inviting one pharmacy professional response per UK ECMO centre. We collated information on workforce, service provision, and pharmaceutical care activities provided by pharmacy teams in adult CCUs with an ECMO service.

Results

The survey response rate was 90.9%: representatives of 10/11 tertiary hospitals providing ECMO services responded. Median critical care pharmacist to critical care bed was 1:12.1 (IQR: 1:9.4–1:14.9). Most centres (90.0%) did not meet national standards for pharmacy professionals to critical care bed staffing ratios for weekday services. Total critical care beds covered by the critical care pharmacy team varied across the UK: median (IQR) – 45 (37–80) beds. Two centres funded pharmacist time for ECMO activity, and one centre funded a pharmacy technician post. Median peak ECMO activity was 4 ECMO patients in a single day (IQR: 3–5). Most respondents reported reduced pharmacy service at weekends compared to weekday, with limited on-site support.

Conclusion

Most responding ECMO centres in the UK reported pharmacy staffing ratios below nationally agreed critical care standards. There was high variability in clinical pharmacy services to ECMO patients over 7 days.
Literature
1.
go back to reference Kopp BJ, Mrsan M, Erstad BL, et al. Cost implications of and potential adverse events prevented by interventions of a critical care pharmacist. Am J Health Syst Pharm. 2007;64:2483–7.CrossRefPubMed Kopp BJ, Mrsan M, Erstad BL, et al. Cost implications of and potential adverse events prevented by interventions of a critical care pharmacist. Am J Health Syst Pharm. 2007;64:2483–7.CrossRefPubMed
2.
3.
go back to reference Lee H, Ryu K, Sohn Y, et al. Impact on patient outcomes of pharmacist participation in multidisciplinary critical care teams: a systematic review and meta-analysis. Crit Care Med. 2019;47:1243–50.CrossRefPubMed Lee H, Ryu K, Sohn Y, et al. Impact on patient outcomes of pharmacist participation in multidisciplinary critical care teams: a systematic review and meta-analysis. Crit Care Med. 2019;47:1243–50.CrossRefPubMed
4.
go back to reference Kane SL, Weber RJ, Dasta JF. The impact of critical care pharmacists on enhancing patient outcomes. Intensive Care Med. 2003;29:691–8.CrossRefPubMed Kane SL, Weber RJ, Dasta JF. The impact of critical care pharmacists on enhancing patient outcomes. Intensive Care Med. 2003;29:691–8.CrossRefPubMed
5.
go back to reference Rudall N, McKenzie C, Landa J, et al. Protected-UK–Clinical pharmacist interventions in the UK critical care unit: exploration of relationship between intervention, service characteristics and experience level. Int J Pharm Pract. 2017;25:311–9.CrossRefPubMed Rudall N, McKenzie C, Landa J, et al. Protected-UK–Clinical pharmacist interventions in the UK critical care unit: exploration of relationship between intervention, service characteristics and experience level. Int J Pharm Pract. 2017;25:311–9.CrossRefPubMed
7.
go back to reference Hanks F, Philips B, Barton G, et al. How critical illness impacts drug pharmacokinetics and pharmacodynamics. Pharm J 2022. Hanks F, Philips B, Barton G, et al. How critical illness impacts drug pharmacokinetics and pharmacodynamics. Pharm J 2022.
9.
go back to reference Seston EM, Ashcroft DM, Lamerton E, et al. Evaluating the implementation and impact of a pharmacy technician-supported medicines administration service designed to reduce omitted doses in hospitals: a qualitative study. BMC Health Serv Res. 2019;19:325.CrossRefPubMedPubMedCentral Seston EM, Ashcroft DM, Lamerton E, et al. Evaluating the implementation and impact of a pharmacy technician-supported medicines administration service designed to reduce omitted doses in hospitals: a qualitative study. BMC Health Serv Res. 2019;19:325.CrossRefPubMedPubMedCentral
10.
go back to reference Rathbone AP, Jamie K, Blackburn J, et al. Exploring an extended role for pharmacy assistants on inpatient wards in UK hospitals: using mixed methods to develop the role of medicines assistants. Eur J Hosp Pharm. 2020;27:78–83.CrossRefPubMed Rathbone AP, Jamie K, Blackburn J, et al. Exploring an extended role for pharmacy assistants on inpatient wards in UK hospitals: using mixed methods to develop the role of medicines assistants. Eur J Hosp Pharm. 2020;27:78–83.CrossRefPubMed
13.
go back to reference Shekar K, Fraser JF, Smith MT, et al. Pharmacokinetic changes in patients receiving extracorporeal membrane oxygenation. J Crit Care. 2012;27:741.e9-741.e18.CrossRefPubMed Shekar K, Fraser JF, Smith MT, et al. Pharmacokinetic changes in patients receiving extracorporeal membrane oxygenation. J Crit Care. 2012;27:741.e9-741.e18.CrossRefPubMed
14.
go back to reference Shekar K, Roberts JA, Mcdonald CI, et al. Sequestration of drugs in the circuit may lead to therapeutic failure during extracorporeal membrane oxygenation. Crit Care. 2012;16:R194.CrossRefPubMedPubMedCentral Shekar K, Roberts JA, Mcdonald CI, et al. Sequestration of drugs in the circuit may lead to therapeutic failure during extracorporeal membrane oxygenation. Crit Care. 2012;16:R194.CrossRefPubMedPubMedCentral
15.
go back to reference Boucher BA, Wood GC, Swanson JM. Pharmacokinetic Changes in Critical Illness. Crit Care Clin. 2006;22:255–71.CrossRefPubMed Boucher BA, Wood GC, Swanson JM. Pharmacokinetic Changes in Critical Illness. Crit Care Clin. 2006;22:255–71.CrossRefPubMed
16.
go back to reference Remmington C, McKenzie C, Camporota L, et al. Analgosedation in extracorporeal membrane oxygenation: a retrospective UK cohort study. Br J Anaesth 2023:S0007091223002477. Remmington C, McKenzie C, Camporota L, et al. Analgosedation in extracorporeal membrane oxygenation: a retrospective UK cohort study. Br J Anaesth 2023:S0007091223002477.
17.
go back to reference Barrett NA, Jones A, Whiteley C, et al. Management of long-term hypothyroidism: a potential marker of quality of medicines reconciliation in the intensive care unit†. Int J Pharm Pract. 2012;20:303–6.CrossRefPubMed Barrett NA, Jones A, Whiteley C, et al. Management of long-term hypothyroidism: a potential marker of quality of medicines reconciliation in the intensive care unit†. Int J Pharm Pract. 2012;20:303–6.CrossRefPubMed
19.
go back to reference Borthwick M, Barton G, Bourne RS, et al. Critical care pharmacy workforce: UK deployment and characteristics in 2015. Int J Pharm Pract. 2018;26:325–33.CrossRefPubMed Borthwick M, Barton G, Bourne RS, et al. Critical care pharmacy workforce: UK deployment and characteristics in 2015. Int J Pharm Pract. 2018;26:325–33.CrossRefPubMed
20.
go back to reference Borthwick M, Barton G, Ioannides CP, et al. Critical care pharmacy workforce: a 2020 re-evaluation of the UK deployment and characteristics. Hum Resour Health. 2023;21:28.CrossRefPubMedPubMedCentral Borthwick M, Barton G, Ioannides CP, et al. Critical care pharmacy workforce: a 2020 re-evaluation of the UK deployment and characteristics. Hum Resour Health. 2023;21:28.CrossRefPubMedPubMedCentral
21.
go back to reference Cheng C, Walsh A, Jones S, et al. Development, implementation and evaluation of a seven-day clinical pharmacy service in a tertiary referral teaching hospital during surge-2 of the COVID-19 pandemic. Int J Clin Pharm. 2023;45:293–303.CrossRefPubMed Cheng C, Walsh A, Jones S, et al. Development, implementation and evaluation of a seven-day clinical pharmacy service in a tertiary referral teaching hospital during surge-2 of the COVID-19 pandemic. Int J Clin Pharm. 2023;45:293–303.CrossRefPubMed
22.
go back to reference Oakley R, Al-Mahdi S, Guntschnig S, et al. Defining international critical care pharmacist contributions to sepsis and exploring variability. Curr Infect Dis Rep. 2024;26:15–29.CrossRef Oakley R, Al-Mahdi S, Guntschnig S, et al. Defining international critical care pharmacist contributions to sepsis and exploring variability. Curr Infect Dis Rep. 2024;26:15–29.CrossRef
25.
go back to reference Dee J, Dhuhaibawi N, Hayden JC. A systematic review and pooled prevalence of burnout in pharmacists. Int J Clin Pharm. 2023;45(5):1027–36.CrossRefPubMed Dee J, Dhuhaibawi N, Hayden JC. A systematic review and pooled prevalence of burnout in pharmacists. Int J Clin Pharm. 2023;45(5):1027–36.CrossRefPubMed
26.
go back to reference Newsome AS, Smith SE, Jones TW, et al. A survey of critical care pharmacists to patient ratios and practice characteristics in intensive care units. J Am Coll Clin Pharm. 2020;3:68–74.CrossRef Newsome AS, Smith SE, Jones TW, et al. A survey of critical care pharmacists to patient ratios and practice characteristics in intensive care units. J Am Coll Clin Pharm. 2020;3:68–74.CrossRef
27.
go back to reference Jebara T, Cunningham S, MacLure K, et al. Stakeholders’ views and experiences of pharmacist prescribing: a systematic review: views and experiences of pharmacist prescribing: a systematic review. Br J Clin Pharmacol. 2018;84:1883–905.CrossRefPubMedPubMedCentral Jebara T, Cunningham S, MacLure K, et al. Stakeholders’ views and experiences of pharmacist prescribing: a systematic review: views and experiences of pharmacist prescribing: a systematic review. Br J Clin Pharmacol. 2018;84:1883–905.CrossRefPubMedPubMedCentral
28.
go back to reference Weeks G, George J, Maclure K, et al. Non-medical prescribing versus medical prescribing for acute and chronic disease management in primary and secondary care. Cochrane Database Syst Rev 2016; 2017. Weeks G, George J, Maclure K, et al. Non-medical prescribing versus medical prescribing for acute and chronic disease management in primary and secondary care. Cochrane Database Syst Rev 2016; 2017.
29.
go back to reference Bourne RS, Whiting P, Brown LS, et al. Pharmacist independent prescribing in critical care: results of a national questionnaire to establish the 2014 UK position. Int J Pharm Pract. 2016;24:104–13.CrossRefPubMed Bourne RS, Whiting P, Brown LS, et al. Pharmacist independent prescribing in critical care: results of a national questionnaire to establish the 2014 UK position. Int J Pharm Pract. 2016;24:104–13.CrossRefPubMed
30.
go back to reference Handel AE, Patel SV, Skingsley A, et al. Weekend admissions as an independent predictor of mortality: an analysis of Scottish hospital admissions. BMJ Open. 2012;2:e001789.CrossRefPubMedPubMedCentral Handel AE, Patel SV, Skingsley A, et al. Weekend admissions as an independent predictor of mortality: an analysis of Scottish hospital admissions. BMJ Open. 2012;2:e001789.CrossRefPubMedPubMedCentral
31.
go back to reference MacLaren R, Bond CA, Martin SJ, et al. Clinical and economic outcomes of involving pharmacists in the direct care of critically ill patients with infections. Crit Care Med. 2008;36:3184–9.CrossRefPubMed MacLaren R, Bond CA, Martin SJ, et al. Clinical and economic outcomes of involving pharmacists in the direct care of critically ill patients with infections. Crit Care Med. 2008;36:3184–9.CrossRefPubMed
Metadata
Title
Critical care pharmacy service provision and workforce in adult extracorporeal membrane oxygenation centres: a multicentre cross-sectional survey
Authors
Christopher Remmington
Lynda Cameron
Fraser Hanks
Ya-Hui Liang
Linda Barrow
Ruth Coxhead
Reena Mehta
Nisha Bhudia
Haifa Lyster
Sarah Cooke
James Gilmartin
Phillisa Lee
Rhona Sloss
Cathrine McKenzie
Publication date
29-03-2024
Publisher
Springer International Publishing
Keywords
ECMO
ECMO
Published in
International Journal of Clinical Pharmacy
Print ISSN: 2210-7703
Electronic ISSN: 2210-7711
DOI
https://doi.org/10.1007/s11096-024-01719-9
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