ABSTRACT Background Delirium is among the most common neurological complications in intensive care unit ( ICU ) patients, yet many medication‐related contributors remain poorly understood. As medication experts, pharmacists are uniquely positioned to lead efforts in identifying, mitigating, and preventing drug‐related risk factors for delirium. One underexplored risk factor is the frequency of medication‐related skin punctures. The purpose of this study was to evaluate the association between ICU delirium and the number of medication‐related skin punctures, with the goal of identifying potential pharmacist‐driven interventions to reduce delirium as well as improve patient experience and outcomes. Methods This was a retrospective, observational, exploratory cohort study conducted in the ICU of a 384‐bed community hospital. Patients were divided into two groups, low‐punctures and high‐punctures, using the median number of skin punctures per day as the threshold for defining groups. The primary outcome was the incidence of delirium. Secondary outcomes were delirium‐free days, all‐cause mortality, hospital length of stay ( LOS ), and ICU LOS . Results A total of 404 patients were included in this study. The median number of medication‐related skin punctures was 3.79 per day. There were 205 patients in the low‐punctures group (0 to less than 4 punctures per day) and 199 patients in the high‐punctures group (at least 4 punctures per day). The high‐punctures group was associated with increased odds of delirium (odds ratio [ OR ] 2.09, 95% confidence interval [ CI ] 1.22–3.58, p = 0.007). There was no significant difference in delirium‐free days, hospital LOS , and all‐cause mortality between groups; however, ICU LOS was significantly longer in the high‐punctures group (7 vs. 5 days, p < 0.001). Conclusion The frequency of medication‐related skin punctures ICU patients received may be associated with an increased risk of delirium. These exploratory findings support future research evaluating the impact of pharmacist‐driven “skin puncture stewardship” on ICU delirium prevention, patient experience, and overall clinical outcomes.
ABSTRACT Background Pharmacist interventions (PIs) are vital for patient safety in pediatric intensive care units (PICUs). However, linking these recommendations to definitive outcomes like mortality remains limited by methodological challenges. This study evaluated the association of cumulative PIs and interprofessional team adherence with survival among patients requiring pharmacotherapeutic optimization who received at least one PI. Methods A retrospective cohort study was conducted with 565 patients admitted to a tertiary PICU (2019–2021) with a stay > 24 h who received at least one documented PI. To account for the time‐varying nature of exposures and attenuate confounding, total PIs and accepted pharmacist interventions (aPIs) were modeled exploring their interaction with time using extended multivariable Cox proportional hazard models. Baseline clinical severity was adjusted using the Pediatric Index of Mortality‐2 score (PIM‐2). Data classification integrity was ensured through independent external validation (Cohen's kappa = 0.702). Results Overall mortality was 11.9%, and total PIs presented an acceptance rate of 72.2%. In extended multivariable models, among patients who received at least one PI, cumulative total PIs were significantly associated with a lower hazard of in‐PICU mortality (hazard ratio [HR] = 0.989; p = 0.040), an association predominantly observed in non‐surgical patients (HR = 0.951; p = 0.029). Interprofessional adherence was more strongly associated with survival; cumulative PIs had a significant association with survival across the entire cohort (HR = 0.983; p = 0.025), remaining consistent in both surgical (HR = 0.983; p = 0.041) and non‐surgical strata (HR = 0.950; p = 0.043). Baseline clinical severity (PIM‐2 > 30%) remained the strongest independent predictor of death ( p < 0.001). Conclusion Among patients requiring pharmacotherapeutic optimization who received at least one PI, cumulative pharmacist recommendations and interprofessional team adherence were independently associated with a lower time‐dependent hazard of in‐PICU mortality. Given the observational design, these findings reflect independent associations requiring prospective confirmation.
ABSTRACT This paper provides historical background, assessment of the current state, and future recommendations related to the recognition of Canadian Pharmacy Residency Board (CPRB)‐accredited year 1 residency completion within the Board of Pharmacy Specialties (BPS) board certification eligibility framework. The Canadian Society of Healthcare‐Systems Pharmacy's Vision for Pharmacy includes the statement: “Pharmacy professionals meet complex practice needs in healthcare systems by engaging in formal training opportunities, including specialization and credentialling.” As of 2025, over 8400 BPS certifications were held in over 60 countries outside the United States, with 835 in Canada. There are approximately 250 year‐1 pharmacy residency positions in CPRB‐accredited programs across Canada. To earn board certification, pharmacists meet eligibility requirements and pass an examination. For most certifications, one eligibility pathway is completion of a postgraduate year 1 (PGY‐1) residency and 2 years of post‐licensure practice experience in that specialty area. CPRB‐accredited year 1 pharmacy residencies provide a structured, practice‐based learning experience building on competencies developed in Doctor of Pharmacy (Pharm.D.) programs. In 2021, a BPS task force convened, evaluating the recognition of year 1 Accredited Canadian Pharmacy Residency (ACPR) credentials. The task force concluded that CPRB standards, similar to American Society of Health‐Systems Pharmacist's (ASHP) standards, help prepare pharmacists for board certification and advanced practice. The BPS Board of Directors approved CPRB‐accredited year 1 residency programs as part of the eligibility criteria, effective January 2022. From January 2022 to December 2025, BPS received 22 applications via ACPR eligibility: 1 in 2022, 3 in 2023, 11 in 2024, and 7 in 2025. Recommendations are provided for researchers, employers, graduates, residents, and the broader profession. Both residency training and BPS board certification are mechanisms for developing and validating specialized or advanced competencies that equip pharmacists to deliver high‐quality patient‐centered care. Recognition and incentivization of credentials and continued promotion of their value could help ensure sustainability.
ABSTRACT Background Health care access remains a challenge across the United States, particularly in rural areas. Board‐certified pharmacists (BCPs) have the knowledge and skills to provide high‐quality direct patient care and are a potential resource to improve health access and outcomes. However, their distribution within rural and underserved areas has not been systematically evaluated. This study aimed to characterize the geographic distribution, composition, and accessibility of the BCP workforce within the United States. Methods A cross‐sectional geospatial study of BCPs was conducted using the 2026 Board of Pharmacy Specialties public database. BCP locations were classified using 2020 Rural–Urban Commuting Area (RUCA) codes, assigned to counties using federal crosswalk files with US Census Bureau county code validation, and examined in relation to designated health professional shortage areas (HPSAs). Analysis was performed at the postal code, county, and state levels. Provider density was calculated using 2025 census estimates, and the distribution of certification types was analyzed across geographic categories. Results Data for 47 134 BCPs were extracted, representing 52 941 certifications. Of those, 94% were in metropolitan, 3.8% micropolitan, and 2.3% small‐town/rural areas. BCPs were absent in 44% of counties. In counties with BCPs, the median county resident‐to‐BCP ratio was 12 354:1, and BCP density ranged from 0.3 to 123.1 per 100 000 (coefficient of variation [CV] 101% vs. state‐level CV of 29%). The proportions of BCPs in geographic HPSAs were 3% and 18.9% based on postal code and aggregated county designations, respectively, with 59% of HPSA counties having none. Across RUCA categories, representation of certifications applicable to broader practice settings increased as area size decreased. Conclusion BCPs are concentrated in metropolitan areas, limiting access to specialized medication management services for patients in small‐town and rural areas. Development of workforce benchmarks and targeted strategies to increase BCP representation in underserved areas is warranted.
