The Use of Electronic Health Record Embedded MRC-ICU as a Metric for Critical Care Pharmacist Workload

Abstract

AbstractObjectiveA 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.MaterialsData were abstracted from the EHR on adult ICU patients, including MRC-ICU scores and two traditional measures of pharmacist workload: numbers of medication orders verified and interventions logged.MethodsThis 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-hour maximum MRC-ICU score’s Pearson’s correlation with overall admission workload and the day-to-day association using generalized linear mixed-effects modeling.ResultsA total of 1,205 patients over 5,083 patient-days were evaluated. Baseline MRC-ICU was correlated with both cumulative order volume (Spearman’s rho 0.41, p < 0.001) and cumulative interventions placed (Spearman’s rho 0.27, p < 0.001). A one-point increase in maximum daily MRC-ICU was associated with 31% increase in order volume (95% CI 24-38%) and 4% increase in interventions (95% CI 2-5%).DiscussionThe MRC-ICU is a validated score that has been previously correlated with important patient-centered outcomes. Here, MRC-ICU was modestly associated with two 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.Lay SummaryMeasuring critical care clinical pharmacist workload is challenging because currently available metrics, including number of medication orders verified or medication interventions logged, do not capture the full breadth of work critical care pharmacists do. The medication regimen complexity-intensive care unit (MRC-ICU) score is a tool designed to quantify the complexity of an ICU patient’s medication regimen and may serve as an alternative measure of overall critical care pharmacist workload. In this study, we assessed whether MRC-ICU scores from 1,205 ICU patients admitted to a single academic medical center were correlated with traditional metrics used to assess pharmacist workload, including medication orders and documented interventions. MRC-ICU was correlated with both workflow measures and traditional measures of patient acuity and also was predictive of the next day’s workload, suggesting MRC-ICU could be explored as an additional tool to optimize critical care pharmacist resource utilization. Further studies should assess how MRC-ICU can be utilized to optimize critical care pharmacist workload.