Relationship between medication regimen complexity and pharmacist engagement in fluid stewardship

Area of Science:

• Critical Care Medicine
• Clinical Pharmacy
• Pharmacoeconomics

Background:

• The medication regimen complexity intensive care unit (MRC-ICU) score is a validated tool for assessing medication complexity.
• Previous studies linked MRC-ICU scores to increased pharmacist workload and fluid overload in ICU patients.

Purpose of the Study:

• To investigate the relationship between the MRC-ICU score and pharmacist-driven fluid stewardship recommendations.
• To determine if the MRC-ICU score can aid in risk stratification for pharmacist interventions in critically ill patients.

Main Methods:

• Retrospective, single-center cohort study of adult medical ICU patients.
• Collected MRC-ICU and SOFA scores at ICU admission.
• Correlated MRC-ICU scores with the number of fluid stewardship recommendations, accepted recommendations, fluid overload, and ICU length of stay using Spearman's rank-order correlation.

Main Results:

• A weakly positive correlation was observed between MRC-ICU score and the number of pharmacist-driven fluid stewardship recommendations (ρ = 0.200; P = 0.010).
• MRC-ICU scores also weakly correlated with fluid overload (ρ = 0.167; P = 0.030) and ICU length of stay (ρ = 0.354; P < 0.001).
• These correlations held true even when considering only accepted fluid stewardship recommendations.

Conclusions:

• The MRC-ICU score demonstrates a weak positive correlation with pharmacist workload, specifically fluid stewardship recommendations.
• Findings suggest the MRC-ICU score has potential utility in identifying critically ill patients who may benefit from targeted pharmacist interventions.