Evolution and Validation of Practice Standards, Training, and Professional Development

Answer: A

The journal Drug Intelligence and Clinical Pharmacy

lish a critical care therapeutics column in 1982, which

was a landmark event relative to the evolution of critical

care pharmacy (Answer A). Although the other journals

C), and Heart and Lung (Answer D)—publish critical

was the first to incorporate a critical care therapeutics

column into its publication.

In 2001, ACCM, which exists within the organiza-

tional framework of SCCM, formed the two task forces

focused on models of critical care delivery, the definition

of an intensivist, and the practice of critical care medi-

cine within three different proposed models (Answer C).

Neither the Institute of Medicine (Answer A) nor ACCP

(Answer B) was involved in formulating the levels of

critical care delivery. Although the Clinical Pharmacy

and Pharmacology Section of SCCM (Answer D) may

have contributed to this document, it is not mentioned in

the publication.

Answer: D

In a 2009 study by MacClaren and Bond, mortality

increased in thromboembolic and infarction-related

events in ICU patients without clinical pharmacy services

compared with ICU patients with clinical pharmacy ser-

vices: 37%, p<0.0001 (Answer D). Although the impact

of clinical pharmacists in affecting QTc-interval prolon-

gation (Answer A), preventable adverse drug interactions

(Answer B), and drug-drug interactions (Answer C) has

been evaluated, differences in mortality have not been

documented. Therefore, these answers are incorrect.

Answer: A

The core knowledge areas for pharmacists caring for

critically ill patients include pulmonary, cardiology,

psychiatry, oncology, neuroscience, nephrology, hepatol-

ogy, nutrition, gastroenterology, surgery, trauma, burn,

pharmacology, transplantation, supportive care, medical

emergencies, immunology, endocrinology, hematology,

nephrology, toxicology, and surgery. Therefore, nephrol-

ogy (Answer A) is correct. Dermatology (Answer B),

rheumatology (Answer C), and obstetrics (Answer D) are

not considered core knowledge areas and are therefore

incorrect.

Answer: C

The landmark study documenting a decrease in pre-

ventable adverse drug reactions after the inclusion of

pharmacists on interdisciplinary medical rounds was

published in the Journal of the American Medical

Association by Dr. Lucian Leape and colleagues

(Answer C). This highly publicized article published in a

mainstream medical journal by a physician remains one

of the foundational studies documenting the association

of critical care pharmacy services with favorable health

care outcomes. The other mainstream medical journals

listed, New England Journal of Medicine (Answer A),

(Answer D), have not published similar articles on pre-

ventable adverse drug reactions after the inclusion of

pharmacists on interdisciplinary medical rounds.

Answer: B

As stated, there were eight ASHP-accredited critical care

pharmacy residencies in 2001. In 2021, ASHP notes 168

ASHP-accredited critical care pharmacy residencies.

Assuming linear growth, the 160-residency increase

over 20 years equals an increase of eight residencies

per year (Answer B is correct). Although this represents

significant growth, more than 2200 pharmacists would

be needed to provide critical care pharmacy services,

assuming 30 patients/pharmacists in the more than

67,000 adult ICU beds in the United States as of 2009.

Answer A (5 residencies/year), Answer C (12 residencies/

year), and Answer D (15 residencies/year) are incorrect.

Answer: C

The preferred and recommended pathway to training

in critical care pharmacy is a PGY1 pharmacy practice

residency, followed by a PGY2 critical care residency.

This is especially true for the provision of desirable-to-

optimal pharmacy services in ICUs providing level I

and II services. Critical care fellowship training is an

option that would also be considered preferred; how-

ever, the intent is for a greater research and academic

focus. The demands of the workplace often exceed the

supply of PGY2-trained critical care pharmacists. And