The Use of Electronic Health Record Embedded MRC-ICU As a Metric for Critical Care Pharmacist Workload

Objective A lack of pharmacist-specific risk-stratification scores in the electronic health record (EHR) may limit resource optimization. The medication regimen complexity-intensive care unit (MRC-ICU) score was implemented into our center’s EHR for use by clinical pharmacists. The purpose of this evaluation was to evaluate MRC-ICU as a predictor of pharmacist workload and to assess its potential as an additional dimension to traditional workload measures. Materials Data were abstracted from the EHR on adult ICU patients, including MRC-ICU scores and two traditional measures of pharmacist workload: numbers of medication orders verified and interventions logged. Methods This was a single-center study of an EHR-integrated MRC-ICU tool. The primary outcome was the association of MRC-ICU with institutional metrics of pharmacist workload. Associations were assessed using the initial 24-hour maximum MRC-ICU score’s Pearson’s correlation with overall admission workload and the day-to-day association using generalized linear mixed-effects modeling. Results A total of 1,205 patients over 5,083 patient-days were evaluated. Baseline MRC-ICU was correlated with both cumulative order volume (Spearman’s rho 0.41, p < 0.001) and cumulative interventions placed (Spearman’s rho 0.27, p < 0.001). A one-point increase in maximum daily MRC-ICU was associated with 31% increase in order volume (95% CI 24-38%) and 4% increase in interventions (95% CI 2-5%). Discussion The MRC-ICU is a validated score that has been previously correlated with important patient-centered outcomes. Here, MRC-ICU was modestly associated with two traditional objective measures of pharmacist workload, including orders verified and interventions placed, which is an important step for its use as a tool for resource utilization needs. Lay Summary Measuring critical care clinical pharmacist workload is challenging because currently available metrics, including number of medication orders verified or medication interventions logged, do not capture the full breadth of work critical care pharmacists do. The medication regimen complexity-intensive care unit (MRC-ICU) score is a tool designed to quantify the complexity of an ICU patient’s medication regimen and may serve as an alternative measure of overall critical care pharmacist workload. In this study, we assessed whether MRC-ICU scores from 1,205 ICU patients admitted to a single academic medical center were correlated with traditional metrics used to assess pharmacist workload, including medication orders and documented interventions. MRC-ICU was correlated with both workflow measures and traditional measures of patient acuity and also was predictive of the next day’s workload, suggesting MRC-ICU could be explored as an additional tool to optimize critical care pharmacist resource utilization. Further studies should assess how MRC-ICU can be utilized to optimize critical care pharmacist workload. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by AHRQ grant #1R01HS029009. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: IRB of OSHU waived ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.