Protocol Development and Quality Improvement

Additionally, critical care pharmacist interventions may identify opportunities for protocol or guideline

development or may identify opportunities for an MUE to be completed.

Documenting CPS is important not only to quantify CPS and workload, but also to provide justification

for maintaining and expanding services.

CPS should be evaluated for cost impact and cost outcomes savings and should include the following:

Weighted metric for each variable to quantify measured activities

One way to add impact to each intervention is by using the Overhage and Lukes Scale to

capture severity of interventions.

Cost savings or cost avoidance

Provider education

Quality/safety improvement (value-based purchasing, HCAHPS)

Participation in emergency response (cardiac arrest, stroke, sepsis)

Prospective chart review

Rounding with health care providers

Formal pharmacy consults

Collaborative drug therapy management (CDTM) or collaborative practice agreements (CPAs) – When

a prescriber and a pharmacist establish written guidelines or protocols authorizing the pharmacist to

initiate, modify, or continue drug therapy for a specific patient. CDTM is a type of pharmacotherapeutic

intervention that should be documented and reported. Examples relevant to the practice of critical care

pharmacy include parenteral nutrition prescribing, antimicrobial stewardship programs, and analgesia/

sedation/delirium screening and management.

Patient Case

You round daily in your ICU as part of the multidisciplinary team. Your manager asks you to help them

justify clinical pharmacy services to obtain additional FTEs for the other ICUs at your institution. Which

of the following would be the most effective metrics to include in the justification to hospital leadership?

The pharmacy department should have a policy and procedure for documenting clinical pharmacy

interventions. In addition, a dashboard should be developed that incorporates these clinical interventions

and shared with key stakeholders (Appendix 2).

unsolicited interventions.

Documenting the pharmacotherapeutic intervention and plan in the EHR provides transparency between

all health care professionals – physicians, nurses, pharmacists, dietitians, respiratory therapists, and

social workers and provides written documentation of recommended changes.

Pharmacists can also document interventions in the pharmacy profile; however, this method generally

allows for review only by pharmacy personnel who have access to the pharmacy computer system such

as other pharmacists and pharmacy interns, students, and technicians.