Characterization of tele-pharmacy interventions performed via an expanded tele-critical care pharmacist protocol

Background: To enhance patient care during the COVID-19 pandemic, tele-critical care (TCC) pharmacists within Atrium Health (AH) managed therapy in multiple domains under a Critical Care Pharmacist Emergency Protocol Agreement (CCPEPA).Methods: This was a multicenter, retrospective quality improvement (QI) study conducted at AH's North Carolina facilities to compare TCC pharmacist interventions between shifts (timeframes 1 and 2), identify and categorize medication management interventions (timeframe 3), and to assess how the CCPEPA was utilized during these different timeframes.Results: After removing duplicate patients and interventions that were recorded in overlapping timeframes, 5681 interventions were performed on 1665 unique patients. Timeframe 1 documented 2150 interventions on 861 patients with an average of 37.2 interventions/shift on first shift and 14.3 interventions/shift on second shift. Medication management (46.5%) was the most common activity on first shift whereas glucose management activities (42.8%) were most common on second shift. During timeframe 2, the full time TCC pharmacists documented 710 interventions on 395 patients with an average of 15.8 interventions/shift on first shift and 11.3 interventions/shift on second shift. Activity results were similar to timeframe 1. During timeframe 3, 2331 medication management interventions were performed on 700 patients, averaging 18.4 interventions/day, including medication discontinuation (39.2%), medication addition (15.7%), and order clarification (11.8%). The most common medication class was sedation and analgesia (26.3%).Conclusions: The CCPEPA provided TCC pharmacists various opportunities to enhance patient care and practice at the top of their license. First shift hours with proactive patient review for both faculty and full-time TCC pharmacists resulted in more interventions per shift and increased medication management interventions. These QI initiatives demonstrate the benefit of having TCC pharmacists as part of the healthcare team. Within AH, the success of the CCPEPA protocol has supported advocating for Clinical Pharmacist Practitioner status and increases in TCC pharmacist staff.