Implementing the Use of Pharmacist Progress Notes in a Surgical ICU

Area of Science:

• Pharmacy Practice
• Critical Care Medicine
• Health Informatics

Background:

• Critical care pharmacists are integral to patient care teams but their daily contributions are often undocumented in electronic medical records (EMRs).
• EMR documentation, specifically pharmacist progress notes, offers a method to capture cognitive and clinical impact beyond traditional intervention tracking.
• This study explored the implementation and utility of daily pharmacist progress notes in a surgical intensive care unit (ICU).

Purpose of the Study:

• To investigate the feasibility of implementing daily pharmacist progress notes in a surgical ICU.
• To assess the utility of these notes in measuring pharmacist activity and clinical impact.
• To quantify pharmacist actions and classify their clinical significance.

Main Methods:

• A 2-month review of daily pharmacist progress notes from a surgical ICU.
• Quantification of pharmacist actions identified in progress notes.
• Scoring of actions using a novel Clinical Impact Score (CIS) system to classify clinical impact.

Main Results:

• 462 progress notes were reviewed over 2 months, identifying 1,055 actions leading to therapy changes.
• Four actions potentially avoided sentinel events.
• Most pharmacist actions occurred on ICU day 1 for patients with at least 5 progress notes.

Conclusions:

• Daily pharmacist progress notes are feasible in advanced practice settings.
• This documentation method effectively captures the critical care pharmacist's contribution to patient care within the EMR.
• Pharmacist involvement commonly optimizes pharmacotherapy and prevents drug misadventures.