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Surveying Residents of Postgraduate Year 2 CriticalCare Pharmacy Residencies About Their Level ofPreparedness to Practice
Mitchell S. Buckley PharmD, FCCM, BCPS, RobertMacLaren PharmD, FCCM, FCCP, Erin N. FrazeePharmD, BCPS, Pamela L. Smithburger PharmD,BCPS, Heather A. Personett PharmD, BCPS, SandraL. Kane-Gill PharmD, FCCM, FCCP
PII: S1877-1297(13)00162-7DOI: http://dx.doi.org/10.1016/j.cptl.2013.09.013Reference: CPTL251
To appear in: Currents in Pharmacy Teaching and Learning
Cite this article as: Mitchell S. Buckley PharmD, FCCM, BCPS, Robert MacLarenPharmD, FCCM, FCCP, Erin N. Frazee PharmD, BCPS, Pamela L. SmithburgerPharmD, BCPS, Heather A. Personett PharmD, BCPS, Sandra L. Kane-Gill PharmD,FCCM, FCCP, Surveying Residents of Postgraduate Year 2 Critical Care PharmacyResidencies About Their Level of Preparedness to Practice, Currents in PharmacyTeaching and Learning, http://dx.doi.org/10.1016/j.cptl.2013.09.013
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Surveying Residents of Postgraduate Year 2 Critical Care Pharmacy Residencies About
Their Level of Preparedness to Practice
Mitchell S. Buckley, PharmD, FCCM, BCPS [corresponding author]
Clinical Pharmacist, Banner Good Samaritan Medical Center
Department of Pharmacy
1111 E. McDowell Rd Phoenix, AZ 85006
Office: 602-839-3095
Fax: 602-839-6734
Robert MacLaren, PharmD, FCCM, FCCP
Associate Professor
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
Department of Clinical Pharmacy
12850 E. Montview Blvd. V20-1227
Aurora, CO 80045
Office: 303-724-2622
Fax: 303-724-0979
Erin N. Frazee, PharmD, BCPS
Critical Care Pharmacist
Mayo Clinic – Rochester Methodist Hospital
200 1st St SW
Rochester, MN 55905
Office: 507-255-5165
Fax: 507-255-7556
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Pamela L Smithburger, PharmD, BCPS
Assistant Professor
University of Pittsburgh School of Pharmacy
200 Lothrop St.
Pittsburgh, PA 15213
Office: 412-647-0899
Fax: 412-647-0899
Heather A. Personett, PharmD, BCPS
Critical Care Pharmacist
Mayo Clinic – Rochester Methodist Hospital
200 1st St SW
Rochester, MN 55905
Office:507-255-5165
Fax: 507-255-7556
Sandra L. Kane-Gill, PharmD, FCCM, FCCP
Associate Professor
University of Pittsburgh
Department of Pharmacy and Therapeutics School of Pharmacy
Department of Critical Care Medicine, School of Medicine
918 Salk Hall
Pittsburgh, PA 15213
Office: 412-624-5150
Fax: 412-624-1850
Abstract: Objective: As the scope of pharmacy services in the critical care setting advances
there has been a parallel evolution in critical care pharmacy residency training programs. The
3��
purpose of this study was to assess the ability of critical care pharmacy residency learning
experiences to prepare trainees for provision of critical care pharmacy services. Methods: This
prospective, cross-sectional study of critical care pharmacy residents used a 53 item web-based
questionnaire to evaluate resident satisfaction and the exposure frequency, self-perceived
competency and satisfaction rates for the provision of clinical, administrative, educational, and
scholarly pharmacy services. Satisfaction and competency were rated on scale of -10 to +10. The
survey was distributed via email and reminder email to 98 critical care residency programs in
May 2012. Descriptive statistics were used to categorize responses. Results: 45 (54.1%)
respondents, representative of all 98 programs, completed the questionnaire. The majority of
residents reported feeling somewhat or very satisfied with both the program and their mentorship
(91% and 76%, respectively). With the exception of managing nutrition support, respondents felt
competently trained to provide most clinical services and educational activities. In contrast,
trainees were infrequently exposed as well as uncomfortable providing many administrative and
scholarly services. Conclusion: Most critical care pharmacy residents were satisfied with their
overall experience and mentorship and felt competent providing routine clinical and educational
functions. Programs should enhance administrative responsibilities of their residents to
adequately prepare them for real-world practice. Additional scholarship may be outside the
current resident requirements.
Keywords: pharmacy residency; critical care; practice; education; competency
Financial support: No financial and material support was available for this article.
Conflict of interest: No conflicts of interest are reported by the authors pertaining to this article.
Data have not been presented. The manuscript is not under consideration at another journal. A
300-word abstract was accepted for a poster presentation at the Society of Critical Care Medicine
at their annual congress meeting January 19-23, 2013.
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Introduction
The role of critical care clinical pharmacists has evolved over the past several decades to
assume greater responsibilities of direct patient care, resulting in beneficial clinical and
economic outcomes.1-21 Several organizations, including the Society of Critical Care Medicine
(SCCM), American College of Clinical Pharmacy (ACCP), and American Society of Health-
System Pharmacists (ASHP) acknowledge the value of the services provided by clinical
pharmacists in the intensive care unit (ICU).1-6 As a result, critical care clinical pharmacists are
recognized as an essential member of the multidisciplinary ICU team.1-6
A joint publication of ACCP/SCCM and another separate ASHP white paper have published
position papers on critical care pharmacy services.1,22 The scope of clinical pharmacy functions
are characterized as relating to patient care, administration, education, and scholarship.
Components of these services are further delineated as fundamental, desirable, or optimal
activities.1,22 The definitions of each level of activity (fundamental, desirable, optimal) has been
previously reported.1 A nationwide, hospital survey of critical care pharmacy services found that
ICU pharmacists frequently provided patient care and administrative services, but activities that
involved education and scholarship were much more variable.7 Moreover, fundamental functions
were much more likely to occur than desirable or optimal services. Ultimately, this survey
demonstrated the heterogeneity of clinical pharmacy services rendered in the ICU, highlighting
the disparity between current practice and ideal patient care.
Residency training appears to be an effective pathway in developing competent and skilled
pharmacy practitioners.23-27 Postgraduate year 2 (PGY2) residency programs in critical care
should prepare independent clinicians with advanced knowledge and skills to provide the full
scope of clinical pharmacy services and enhance patient care.2,22,24,28 Established training
standards and recommendations have been approved for PGY2 critical care residencies.29,30
Experiences offered by programs may influence the ability of trainees to feel comfortable
providing services in an independent manner. Several national surveys of postgraduate year 1
(PGY1) pharmacy residency training sites have shown significant variability in learning
experiences and requirements despite established ASHP accreditation standards.31-33 A national
assessment of current PGY2 critical care residency training characteristics has not been
5��
conducted. The purpose of this survey was to compare the learning experiences and expectations
of PGY2 critical care residency training programs in preparing graduates to independently
provide critical care pharmacy services pertaining to patient care, scholarly, and administrative
activities.
Methods
Survey Development and Measures
The research design consisted of a cross sectional evaluation using a web-based 53-item
questionnaire primarily assessing the residents’ perception of their ability to practice
independently. The survey questions were categorized according to 1) program and practice site
characteristics, 2) perceptions of comfort level to independently render pharmacy services, 3)
satisfaction with the overall program and the extent of mentoring, and 4) employment after
training. Respondent identifiers and institution-specific details were not collected. The pharmacy
functions evaluated represented all domains of practice including patient care (eleven functions),
administration (ten functions), education (five functions), and scholarship (six functions) across
fundamental, desirable, and optimal levels of service.1,7 For statistical analysis on categorical
responses pertaining to level of exposure for various activities, exposure frequency was
converted into a 1-7 scale (1 = never; 2 = once a year; 3 = few times a year; 4 = once a month; 5
= once a week; 6 = several times a week; 7 = daily). Their perceived level of preparedness to
perform each activity as an independent practitioner was assessed on a scale of -10 to +10 with
descriptive anchors of -10 representing that they felt completely unprepared, +10 that they felt
completely prepared, and 0 as neutral. Survey validation occurred by questionnaire review and
feedback from five PGY2 residents of programs with a critical care emphasis but not the primary
focus (e.g. transplant, infectious diseases), three critical care pharmacists that had completed a
PGY2 residency within the past year, and two critical care pharmacists with >10 years of
experience.
Recruitment Methods
The study protocol was approved by the investigational review board at the primary study
institution. The weblink to the questionnaire was distributed via email in May 2012 to the
program directors of the 98 PGY2 critical care residency programs identified on the ASHP
residency directory webpage.34 Program directors were requested to forward the email and
weblink to their respective PGY2 critical care resident. A reminder email was sent to the
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program directors eight weeks later. Instructions specified confidentiality and implied consent
with the completion of the questionnaire. All responses were blinded to the program director and
investigators. Incomplete survey responses were excluded from data analysis.
Data Analyses
It was anticipated that 33% of the questionnaires would be completed by eligible
respondents. Responses were not weighted and missing data were not imputed. Data were
collated into an excel spreadsheet (Excel 2007, Microsoft Corp., Redmond, WA) for
determination of frequencies, mean, median, standard deviation, and interquartile ranges.
Results
Institution and Residency Program Characteristics
A total of 98 PGY2 critical care programs involving a total of 115 potential PGY2 critical
care residents were surveyed with 53 independent responses. Eight responses were excluded
because of incomplete survey answers (n=7) or the residency program did not have a resident
during the 2011-2012 academic year (n=1). Therefore, the survey response rate was 54.1%
representing PGY2 critical care residency programs and 46.1% among all potential PGY2
residents. The majority of included programs were ASHP-accredited PGY2 residencies at large
academic institutions (Table 1). Residents report exposure to a diverse group of ICU patients
with a wide range of required and elective residency rotation experiences (Table 1). Twenty-
three (51.1%) programs offered “off-site” clinical rotations. Other residency requirements
included advanced cardiopulmonary life support certification (88.9%; n=40), pharmacy response
to resuscitation events (71.1%; n=32), and participation in an “on-call” program (35.6%; n=16).
Teaching certificate programs were available to 68.9% (n=31) of respondents. Most respondents
reported the staffing component during their PGY2 critical care residency training to be 4-11
hours per week, representing distributive, order entry and clinical pharmacy functions (Table 1).
Patient Care Services
The majority of patient care activities were reported as occurring daily or several times each
week and respondents generally perceived themselves as feeling comfortable to provide these
services after residency training (Table 2). The only fundamental (“evaluates parenteral nutrition
support regimens as a part of a multidisciplinary, collaborative team”) and desired
(“independently manages parenteral nutrition support”) clinical activities reported with a
moderate rating of preparedness involved the management of parenteral nutrition, which
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respondents were less frequently exposed. Assisting physicians with patient or family
discussions was the only optimal patient care activity assessed and was reported to occur on a
monthly basis with most respondents feeling somewhat prepared to perform this following
residency training.
Administrative Services
Residents were generally exposed to fundamental and desirable administrative activities a
few times in the year and felt at least somewhat comfortable providing these services (Table 3).
Respondents were rarely exposed to optimal activities and seemed uncomfortable performing
these functions.
Educational and Scholarly Services
Variable responses were observed for educational and scholarly activities during residency
training (Table 4). In general, respondents were exposed to fundamental and desirable
educational activities on a weekly or monthly basis and felt comfortable providing these services.
The comfort level providing optimal educational functions was related to the frequency of
exposure. With the exception of designing research methods and performing data assessment,
residents were rarely exposed to scholarly functions and did not feel comfortable delivering these
services.
Resident Satisfaction and Position Attainment
Respondents rated their overall rates of satisfaction with the PGY2 program as 57.8% “very
satisfied”, 33.3% “somewhat satisfied”, 4.4% “neutral”, and 4.4% “somewhat dissatisfied”.
Respondents described their level of satisfaction with the degree of mentoring and time-
commitment from clinical preceptors as 48.9% “very satisfied”, 26.7% “somewhat satisfied”,
15.6% “neutral”, and 8.8% either “somewhat” or “very dissatisfied”. All 45 (100%) responding
PGY2 residents anticipate completing certification as Board of Pharmacy Specialties after
completing their training. As of June 2012, respondents indicated their employment status
immediately after training would be 53.3% Clinical Pharmacy Specialist in critical care, 22.2%
unknown, 11.1% Clinical Staff Pharmacist in a critical care setting, 11.1% academic positions,
and 2.2% Clinical Staff Pharmacist in a non-ICU setting. Nearly 90% of residents stated the
PGY2 program significantly influenced the type of position they had obtained.
Discussion
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These findings suggest PGY2 critical care residents 1) are exposed to a variety of ICU
populations; 2) frequently provide patient care functions and are comfortable delivering services
with the exceptions of nutrition support services and patient or family discussions; 3) deliver
most fundamental and desirable administrative, educational, or scholarly functions frequently
enough to feel comfortable providing most of these services; 4)perceived lack of confidence in
rendering services to which they were rarely exposed during their training; 5) are generally
satisfied with their residency experiences and mentoring. With few exceptions, these results are
consistent with the ASHP goals and objectives for PGY2 critical care programs and the job
functions most commonly reported by clinical critical care pharmacists.7,34
The ASHP goals of PGY2 critical care programs are intended to ensure graduates are
“equipped to be fully integrated members of the interdisciplinary critical care team, able to make
complex medication and nutrition support recommendations in a fast-paced environment.”30
Training focuses on developing resident capability to deal with a range of diseases and disorders
that occur in the critically ill. Graduates of the critical care residency are experienced in short-
term research in the critical care environment and excel in their ability to teach other health
professionals and those in training to be health professionals.34 These goals guide programs to
train residents to become independent practitioners and appear to emphasize the knowledge and
skills to perform direct patient care activities.1-6 Therefore, it is not surprising that respondents
were frequently exposed to these functions and felt competent to deliver these services.
Respondents indicated they were somewhat uncomfortable delivering nutrition support services
and interacting with patients or families. This lack of self-perceived competency likely relates to
the fact that trainees were infrequently exposed to these functions. It may also partly explain why
these two services are the patient care activities delivered the least by ICU pharmacists with rates
less than 33% of patient ICU days.7 Since ASHP goals R1.3 and R2.3 as well as objective R2.4.3
specifically address these services, programs should strive to enhance training opportunities to
ensure residents possess the skills to feel competent providing these services.34 In addition,
patient and family interaction continues to increase in importance with the emphasis on patient
reported outcomes in the Hospital Consumer Assessment of Healthcare Provides and Systems
(HCAHPS) and influence on reimbursement, thus supporting the need for residents to feel
comfortable with these interactions.35 This may advance the delivery of these important
functions by practicing pharmacists.
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With respect to other domains of clinical pharmacy, respondents generally felt at least
somewhat comfortable providing most fundamental and desirable administrative, educational, or
scholarly functions. Regarding patient care activities, their perceived level of preparedness
seemed related to how frequently they were exposed to the particular activity. The level of
preparedness for most administrative and scholarly activities also corresponded with the
frequency of each activity. However, some activities were less frequently performed with the
resident reporting a higher level of preparedness. For example, an exposure frequency of several
times per year to various administrative activities provided residents enough skill development to
feel somewhat comfortable providing these services. However, for the two administrative
functions, “evaluates new or existing clinical pharmacy programs by analyzing institutional
pharmacoeconomic data” and “involvement with developing and implementing a new clinical
pharmacy program”, the median exposure frequency was “never” so it’s not surprising
respondents felt unprepared to independently render these functions. Residency programs should
attempt to expose trainees to these activities at least several times so residents feel as
comfortable with these services as they do with other administrative functions. Although most
practicing critical care pharmacists are involved with administrative functions, the specific
activities vary considerably.7 Therefore, it’s important for trainees to be exposed to all
administrative functions. Similar to the administrative functions, residents were rarely exposed to
educational and scholarly functions. Residents reported a lack of comfort with the independent
delivery of research and educational initiatives (i.e. teach advanced cardiac life support, educate
lay people about the ICU pharmacist, assist in patient enrollment for research, and
grantsmanship). Practicing pharmacists frequently provide educational services, but teaching
advanced cardiac life support and educating lay people about the ICU pharmacist are delivered at
rates less than 20%.7 Less than half of all practicing ICU pharmacists are involved with
scholarship and the activities of enrolling subjects and grantsmanship are rarely provided.7
Therefore, it may be impractical to expect programs to provide training related to these
educational and scholarship goals and PGY2 graduates wishing to perform these activities may
need to pursue additional training or seek mentorship.22
While each residency program and institution is unique, programs generally provide skill
development to the extent that almost all ASHP goals are consistently attained and residents feel
competent providing these activities. Moreover, the large majority of respondents were satisfied
10��
with their training program and the mentoring they received. However, it is equally important to
note 11 responses stated the level of satisfaction of their training was either indifferent or
dissatisfied. We believe satisfaction levels may be influenced by multiple factors including
staffing levels, job outlook at time of survey, and quality of preceptors. Other elements possibly
influencing their satisfaction levels may involve the quality of professional relationships among
the PGY2 resident possibly with the residency program director, preceptors, and other pharmacy
residents Unfortunately, we did not survey reasons or provide responders to comment on factors
supporting their satisfaction or dissatisfaction responses. While certain deficiencies identified by
this survey exist and offer opportunities for program improvement, it’s important for PGY2
residencies to remain diversified so trainees are offered learning experiences tailored to their
needs.
Many potential limitations may exist as a result of the survey development process and
distribution approach. While question items were pretested, issues with content validity may
have arisen from a systematic error in the structure, representation, or interpretation of the
questions, response categories, or rating scales. Additionally, inter- and intra-rater reliability
cannot be assessed as respondents were anonymous. A related issue is that the questionnaire was
designed to assess perceptions. Therefore, the reported results are beliefs or attitudes, and must
not be misinterpreted to indicate that these respondents can or cannot independently provide
certain services in a demonstrable manner. For example, the residency training program may be
very effective with highly competent preceptors in a challenging academic environment.
However, the resident’s level of confidence in his or her abilities may result in a lower rank in
their perceived rather than actual ability to perform these services. The web-based mode of
surveying and the distribution of the questionnaire to program directors have inherent problems
that may infer biases. While most items were consistently answered, the order of questions may
have influenced the responses to the items concerning satisfaction as respondents may have
answered these in the context they addressed their perceptions about various clinical pharmacy
services. Primacy effect did not appear to occur as response categories were evenly and
appropriately selected. The response rate is satisfactory, but multiple PGY2 residents from the
same program may have completed the questionnaire. This may limit the generalizability of the
results as a lack of reflection from all residency programs, but from the limited sample size.
Also, it is important the resident’s satisfaction rate with the residency program may have been
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influenced by their employment status.. Lastly, our findings reflect perceptions of PGY2 critical
care residency training. However, perceptions are important because they bridge attitudes, which
are our interpretation of data or facts as well as beliefs that are based on personal thought.
Residents will make decisions and convey their thoughts about a program based on their
perceptions, possibly not due to reality. We did not track each resident over an extended period
of time to assess this since our potential response rate would be expected to be decrease more so
from our initial survey. Therefore, perceptions are the next best option to assess.
Conclusion
Critical care pharmacy residents are exposed to a variety of activities during their training
and feel competent providing most patient care and common educational functions. Similarly,
they are exposed to fundamental and desirable administrative or scholarly functions frequently
enough to feel comfortable providing the majority of these services. However, infrequent
exposure of some scholarly and administrative functions was perceived as uncertain to
independently render these services. Programs should enhance administrative responsibilities of
their residents to adequately prepare them for real-world practice, while customizing the
residency learning experience to the specific interests of the PGY2 critical care pharmacy
resident. It may be overambitious to expect programs to provide additional training related to
educational and scholarship goals based on current standards and practices.
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Tab
le 1
. Hos
pita
l and
Res
iden
cy P
rogr
am C
hara
cter
istic
s
Cha
ract
eris
tic
Cat
egor
y n
%
ASH
P ac
cred
itatio
n st
atus
of t
he
resi
denc
y pr
ogra
m
Acc
redi
ted
37
82.2
%
Can
dida
te
3 6.
7%
Pre-
cand
idat
e 5
11.1
%
Geo
grap
hic
loca
tion
New
Eng
land
: Mai
ne, N
ew H
amps
hire
, Ver
mon
t, M
assa
chus
etts
,
Rho
de Is
land
, Con
nect
icut
4
8.9%
Mid
-Atla
ntic
: New
Yor
k, P
enns
ylva
nia,
New
Jers
ey
5 11
.1%
Mid
wes
t (Ea
st N
orth
Cen
tral):
Wis
cons
in, M
ichi
gan,
Illin
ois,
Indi
ana,
Ohi
o 14
31
.1%
Mid
wes
t (W
est N
orth
Cen
tral):
Mis
sour
i, N
orth
Dak
ota,
Sou
th
Dak
ota,
Neb
rask
a, K
ansa
s, M
inne
sota
, Iow
a 1
2.2%
Sout
h A
tlant
ic: D
elaw
are,
Mar
ylan
d, D
istri
ct o
f Col
umbi
a, V
irgin
ia,
Wes
t Virg
inia
, Nor
th C
arol
ina,
Sou
th C
arol
ina,
Geo
rgia
, Flo
rida
10
22.2
%
Sout
heas
t: K
entu
cky,
Ten
ness
ee, M
issi
ssip
pi, A
laba
ma
5 11
.1%
Table
Sout
h C
entra
l: O
klah
oma,
Tex
as, A
rkan
sas,
Loui
sian
a 1
2.2%
Mou
ntai
n W
est:
Idah
o, M
onta
na, W
yom
ing,
Nev
ada,
Uta
h, C
olor
ado,
Ariz
ona,
New
Mex
ico
2 4.
4%
Paci
fic: A
lask
a, W
ashi
ngto
n, O
rego
n, C
alifo
rnia
, Haw
aii,
Am
eric
an
Sam
oa, G
uam
, Nor
ther
n M
aria
na Is
land
s, Tr
ust T
errit
ory
of th
e Pa
cific
Isla
nds
3 6.
7%
Type
of h
ospi
tal s
ettin
g U
nive
rsity
28
62
.2%
Com
mun
ity (t
each
ing/
acad
emic
) 13
28
.9%
Com
mun
ity (n
on-te
achi
ng/n
on-a
cade
mic
) 2
4.4%
Gov
ernm
ent
2 4.
4%
Num
ber o
f tot
al li
cens
ed b
eds i
n
the
hosp
ital s
yste
m
>100
0 12
26
.7%
750-
1000
7
15.6
%
500-
750
17
37.8
%
250-
499
9 20
.0%
<250
0
0.0%
Num
ber o
f tot
al li
cens
ed IC
U b
eds
in th
e ho
spita
l >8
0 28
62
.2%
61-8
0 6
13.3
%
41-6
0 5
11.1
%
21-4
0 4
8.9%
<20
1 2.
2%
Type
of I
CU
pat
ient
s app
licab
le in
the
resi
denc
y tra
inin
g pr
ogra
m
Bur
n 21
46
.7%
Car
diac
42
93
.3%
Med
ical
45
10
0.0%
Neo
nata
l 31
68
.9%
Neu
rosu
rgic
al
43
95.6
%
Pedi
atric
24
53
.3%
Surg
ical
45
10
0.0%
Tran
spla
nt (s
olid
org
an a
nd/o
r bon
e m
arro
w tr
ansp
lant
) 23
51
.1%
Trau
ma
34
75.6
%
Oth
er
4 8.
9%
Tim
e re
quire
men
ts fo
r the
prof
essi
onal
serv
ice/
staf
fing
com
pone
nt o
f the
resi
denc
y
prog
ram
for w
eeke
nds o
r “af
ter
hour
” co
vera
ge
>16
hour
s / w
eek
7 15
.6%
12-1
6 ho
urs /
wee
k 4
8.9%
8-11
hou
rs /
wee
k 15
33
.3%
4-7
hour
s / w
eek
14
31.1
%
<4 h
ours
/ w
eek
2 4.
4%
Not
app
licab
le
3 6.
7%
Type
of s
taff
ing
resp
onsi
bilit
ies f
or
wee
kend
s or “
afte
r hou
r” c
over
age
Dis
tribu
tion
(cen
traliz
ed o
r dec
entra
lized
staf
fing,
etc
.) 11
24
.4%
Clin
ical
(e.g
. the
rape
utic
dru
g m
onito
ring)
12
26
.7%
Bot
h 19
42
.2%
Not
app
licab
le
3 6.
7%
REQ
UIR
ED c
ore
clin
ical
rota
tions
B
one
mar
row
tran
spla
nt
0 0.
0%
Bur
n un
it 10
22
.2%
Car
diac
-rel
ated
ICU
30
66
.7%
Emer
genc
y m
edic
ine
19
42.2
%
Infe
ctio
us d
isea
ses
11
24.4
%
Med
ical
ICU
45
10
0.0%
Neo
nata
l IC
U
2 4.
4%
Neu
rosu
rgic
al IC
U
25
55.6
%
Nut
ritio
n su
ppor
t 10
22
.2%
Pedi
atric
ICU
7
15.6
%
Res
earc
h (i.
e. ro
tatio
n de
vote
d to
rese
arch
) 22
48
.9%
Solid
org
an tr
ansp
lant
2
4.4%
Surg
ical
ICU
40
88
.9%
Teac
hing
6
13.3
%
Toxi
colo
gy
2 4.
4%
Trau
ma
ICU
27
60
.0%
Oth
er
1 2.
2%
ELEC
TIV
E cl
inic
al ro
tatio
ns
offe
red
Bon
e m
arro
w tr
ansp
lant
17
37
.8%
Bur
n un
it 20
44
.4%
Car
diac
-rel
ated
ICU
21
46
.7%
Emer
genc
y m
edic
ine
25
55.6
%
Infe
ctio
us d
isea
ses
32
71.1
%
Med
ical
ICU
13
28
.9%
Neo
nata
l IC
U
25
55.6
%
Neu
rosu
rgic
al IC
U
20
44.4
%
Nut
ritio
n su
ppor
t 21
46
.7%
Pedi
atric
ICU
25
55
.6%
Res
earc
h (i.
e. ro
tatio
n de
vote
d to
rese
arch
) 6
13.3
%
Solid
org
an tr
ansp
lant
29
64
.4%
Surg
ical
ICU
14
31
.1%
Teac
hing
10
22
.2%
Toxi
colo
gy
15
33.3
%
Trau
ma
ICU
14
31
.1%
Oth
er
7 15
.6%
ASH
P =
Am
eric
an S
ocie
ty o
f Hea
lth-S
yste
m P
harm
acis
ts; I
CU
= in
tens
ive
care
uni
t
Tab
le 2
. Pat
ient
Car
e Ph
arm
acy
Serv
ices
Lev
el o
f Act
ivity
R
esid
ent A
ctiv
ity
Med
ian
(IQ
R)
Freq
uenc
y of
Exp
osur
e fo
r
Act
ivity
Perf
orm
ed
Mea
n (S
D)
Rep
orte
d
Lev
el o
f
Prep
ared
ness
Fund
amen
tal
Prov
ides
pha
rmac
okin
etic
mon
itorin
g 7.
0 (6
.0-7
.0)
9.2
(0.9
)
Pros
pect
ivel
y ev
alua
tes d
rug
ther
apy
for a
ppro
pria
te
indi
catio
n, d
ose,
dru
g in
tera
ctio
ns, d
rug
alle
rgie
s, an
d
mon
itors
the
patie
nt’s
pha
rmac
othe
rape
utic
regi
men
for
effe
ctiv
enes
s and
adv
erse
dru
g ev
ents
7.
0 (7
.0-7
.0)
9.1
(1.1
)
Doc
umen
ts c
linic
al a
ctiv
ities
in th
e pa
tient
’s m
edic
al
reco
rd in
clud
ing
dise
ase
stat
e m
anag
emen
t,
phar
mac
othe
rapy
mon
itorin
g/re
com
men
datio
ns, e
tc.
6.0
(5.0
-7.0
) 9.
0 (1
.4)
Ass
esse
s sus
pect
ed d
rug-
rela
ted
ICU
adm
issi
ons f
or
caus
ality
6.
0 (5
.0-7
.0)
7.2
(2.9
)
Table
Eval
uate
s par
ente
ral n
utrit
ion
supp
ort r
egim
ens a
s a
part
of a
mul
tidis
cipl
inar
y, c
olla
bora
tive
team
4.
0 (3
.0-5
.0)
4.9
(4.6
)
Des
ired
Atte
nds m
ultid
isci
plin
ary
criti
cal c
are
roun
ds to
prov
ide
drug
ther
apy
man
agem
ent r
ecom
men
datio
ns
7.0
(7.0
-7.0
) 9.
2 (1
.2)
Ass
esse
s the
pat
ient
’s m
edic
atio
n hi
stor
y to
det
erm
ine
cont
inua
tion
of m
aint
enan
ce p
harm
acot
hera
py d
urin
g
acut
e ill
ness
7.
0 (7
.0-6
.0)
8.7
(2.4
)
Util
izes
a d
ocum
enta
tion
tool
des
igna
ting
an o
utco
me
to a
clin
ical
inte
rven
tion
6.0
(4.0
-7.0
) 7.
8 (3
.0)
Act
ive
patie
nt c
are
parti
cipa
tion
durin
g re
susc
itatio
n
for c
ardi
ac o
r res
pira
tory
arr
ests
(“co
de b
lue”
) 5.
0 (4
.0-6
.0)
7.7
(2.7
)
Inde
pend
ently
man
ages
par
ente
ral n
utrit
ion
supp
ort
3.0
(1.0
-4.0
) 3.
4 (5
.6)
Opt
imal
Ass
ists
phy
sici
ans i
n di
scus
sion
s with
pat
ient
s and
/or
fam
ily m
embe
rs to
hel
p m
ake
info
rmed
dec
isio
ns
rega
rdin
g tre
atm
ent o
ptio
ns
4.0
(2.0
-5.0
) 4.
9 (4
.5)
ICU
= in
tens
ive
care
uni
t; IQ
R =
inte
rqua
rtile
rang
e; S
D =
stan
dard
dev
iatio
n
Tab
le 3
. Adm
inis
trat
ive
Phar
mac
y Se
rvic
es
Lev
el o
f Act
ivity
R
esid
ent A
ctiv
ity
Med
ian
(IQ
R)
Freq
uenc
y of
Exp
osur
e fo
r
Act
ivity
Per
form
ed
Mea
n (S
D)
Rep
orte
d L
evel
of
Prep
ared
ness
Fund
amen
tal
Invo
lvem
ent w
ith h
ospi
tal c
omm
ittee
s (e.
g. P
harm
acy
&
Ther
apeu
tics,
criti
cal c
are
com
mitt
ee, e
tc.)
4.0
(3.0
-4.0
) 6.
1 (3
.3)
Con
tribu
tes t
o th
e ho
spita
l new
slet
ter o
r dru
g
mon
ogra
phs r
elat
ing
to IC
U m
edic
atio
ns
3.0
(2.0
-3.0
) 5.
3 (4
.0)
Dev
elop
s and
impl
emen
ts in
stitu
tiona
l pol
icy
and
proc
edur
es re
late
d to
opt
imiz
ing
ICU
med
icat
ions
3.
0 (3
.0-3
.0)
5.5
(3.2
)
Parti
cipa
tes i
n A
DE
repo
rting
to in
stitu
tiona
l com
mitt
ees
3.0
(1.0
-4.0
) 4.
8 (4
.0)
Iden
tifie
s and
impl
emen
ts c
ost-c
onta
inm
ent s
trate
gies
rela
ted
to IC
U m
edic
atio
ns
3.3
(1.0
-4.0
) 4.
5 (4
.2)
Dev
elop
s a p
roce
ss im
prov
emen
t stra
tegy
to re
duce
med
icat
ion
erro
rs a
nd p
reve
ntab
le A
DEs
3.
0 (2
.0-3
.0)
4.2
(3.5
)
Table
Des
ired
Dev
elop
s and
impl
emen
ts d
rug
ther
apy
prot
ocol
s and
/or
criti
cal c
are
path
way
s 3.
0 (1
.0-3
.0)
4.2
(3.6
)
Opt
imal
Eval
uate
s the
impa
ct o
f ins
titut
iona
l gui
delin
es a
nd/o
r
prot
ocol
s in
the
ICU
3.
0 (1
.0-3
.0)
3.9
(4.4
)
Eval
uate
s new
or e
xist
ing
clin
ical
pha
rmac
y pr
ogra
ms b
y
anal
yzin
g in
stitu
tiona
l pha
rmac
oeco
nom
ic d
ata
1.0
(1.0
-3.0
) 1.
8 (0
.9)
Invo
lvem
ent w
ith d
evel
opin
g an
d im
plem
entin
g a
new
clin
ical
pha
rmac
y pr
ogra
m
1.0
(1.0
-2.0
) 0.
9 (3
.7)
AD
E =
adve
rse
drug
eve
nt; I
CU
= in
tens
ive
care
uni
t; IQ
R =
inte
rqua
rtile
rang
e; S
D =
stan
dard
dev
iatio
n
Tab
le 4
. Edu
catio
nal a
nd S
chol
arly
Pha
rmac
y Se
rvic
es
Lev
el o
f Act
ivity
R
esid
ent A
ctiv
ity
Med
ian
(IQ
R)
Freq
uenc
y of
Exp
osur
e fo
r A
ctiv
ity
Perf
orm
ed
Mea
n (S
D)
Rep
orte
d L
evel
of
Prep
ared
ness
Fund
amen
tal
Prov
ides
info
rmal
dru
g th
erap
y ed
ucat
ion
to th
e IC
U
team
mem
bers
5.
0 (4
.0-6
.0)
7.8
(2.9
)
Des
ired
Prov
ides
form
al d
idac
tic le
ctur
es to
hea
lthca
re
prof
essi
onal
s (ph
ysic
ians
, pha
rmac
ists
, nu
rses
, etc
.)
and/
or h
ealth
care
pro
fess
iona
ls in
trai
ning
(res
iden
ts,
stud
ents
) 4.
0 (3
.0-4
.0)
7.4
(3.0
)
Parti
cipa
tes i
n th
e tra
inin
g of
pha
rmac
y st
uden
ts o
r
resi
dent
s thr
ough
exp
erie
ntia
l crit
ical
car
e ro
tatio
ns
5.0
(3.0
-6.0
) 7.
3 (3
.3)
Des
igns
rese
arch
met
hods
and
per
form
s dat
a
asse
ssm
ent (
anal
ysis
and
/or r
esul
t int
erpr
etat
ion)
3.
0 (2
.0-4
.0)
6.0
(2.7
)
Publ
icat
ion
(or w
ill b
e su
bmitt
ing
for p
ublic
atio
n in
2.
0 (2
.0-3
.0)
4.5
(3.5
)
Table
the
next
12
mon
ths)
in p
eer-
revi
ewed
jour
nal (
case
repo
rt, o
rigin
al re
sear
ch, r
evie
w a
rticl
e, e
tc.)
Invo
lved
in re
sear
ch b
y as
sist
ing
in th
e pa
tient
scre
enin
g an
d/or
enr
ollm
ent p
roce
ss
1.0
(0.0
-4.0
) 3.
2 (5
.0)
Opt
imal
Pr
ovid
es a
ccre
dite
d co
ntin
uing
edu
catio
n se
ssio
ns
3.0
(2.0
-3.0
) 7.
1 (3
.2)
Pres
ents
(or w
ill b
e pr
esen
ting
in th
e ne
xt 1
2 m
onth
s)
clin
ical
rese
arch
or p
harm
acoe
cono
mic
ana
lyse
s at
regi
onal
or n
atio
nal o
rgan
izat
iona
l mee
tings
(pla
tform
and
/or p
oste
r pre
sent
atio
n)
2.0
(2.0
-3.0
) 5.
5 (4
.3)
Invo
lved
in te
achi
ng a
dvan
ced
card
iac
life
supp
ort
1.0
(1.0
-2.0
) 2.
3 (3
.8)
Educ
ates
lay
peop
le a
nd m
edic
al g
roup
s in
the
com
mun
ity a
bout
the
role
of I
CU
pha
rmac
ists
as p
art
of a
mul
tidis
cipl
inar
y te
am
1.0
(1.0
-2.0
) 0.
0 (6
.0)
Parti
cipa
tes i
n th
e gr
ant f
undi
ng p
roce
ss (p
ropo
sal
writ
ing,
bud
get m
anag
emen
t, et
c.) f
or c
ondu
ctin
g
rese
arch
1.
0 (1
.0-1
.0)
-1.8
(4.5
)
ICU
= in
tens
ive
care
uni
t; IQ
R =
inte
rqua
rtile
rang
e; S
D =
stan
dard
dev
iatio
n
