Claire Murphy

Ensuring appropriate dosing of medications is an essential practice of clinical pharmacists. Dose adjustments in the setting of decreased renal function are common but may also be warranted for patients with supraphysiologic or augmented renal clearance (ARC). Conventional estimates of creatinine clearance using only serum creatinine may not be accurate in the setting of ARC, thus a measured creatinine clearance using serum and urine creatinine measurements are preferred. We describe the development of an 8‐h urine collection and ARC dosing program at a large academic medical center initiated by critical care and infectious disease pharmacists. Using a Plan–Do–Study–Act approach, we implemented and updated the 8‐h collection program with the guidance of our clinical laboratories. Eight‐hour urine collections are useful for patients with suspected ARC and for other scenarios where accurate dose adjustments are needed to minimize toxicity in the absence of therapeutic drug monitoring.

Purpose Pharmacists are integral members of the healthcare team, but interventions are not always captured due to documentation limitations. This study evaluated the impact of implementing a tracking tool to address gaps in capturing pharmacist interventions. Methods A prospective, observational study was conducted to assess pharmacist interventions between July and November 2020. Twelve critical care pharmacists captured interventions on 10 weekdays using a tracking tool (iVent—Epic®) embedded in the electronic medical record (EMR) to capture high frequency interventions not standardly captured via existing standard note documentation (e.g., renal/hepatic dose adjustment, parenteral nutrition management). Value added of the interventions is proposed. Patients' baseline demographics, interventions, Sequential Organ Failure Assessment (SOFA) score, and intensive care unit (ICU) length of stay (LOS) were collected. The primary outcome was to determine the added benefit of using a tracking tool within the EMR to capture pharmacist interventions compared to progress note documentation. Results Two thousand seven hundred and eighty‐three interventions were documented on 514 unique patients over 120 pharmacist shifts. Of these, 2363 (84.9%) interventions were captured through iVent tracking. The median SOFA score on day of intervention was 4 [interquartile range (IQR) 2–7] and ICU LOS was 3.5 days [IQR 1.5–9]. The median number of interventions per patient per day was 2 [IQR 1–3]. A significant difference was observed among days of the week and the number of iVents documented ( χ 2 = 13.172, p = 0.01, df = 4). The post hoc pairwise comparison revealed more documented iVents on Tuesday than Friday. Conclusion This study reveals that an iVent tracking tool increased total capture of pharmacist interventions by 563%. These interventions can be associated with value‐based programs and further work is needed in highlighting the pharmacist's role in these new payment models. This study confirms that the current standard practice at this institution of solely entering pharmacist progress notes into the patient chart misses a majority of pharmacist interventions.