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Coe et al

Figure 2. Activities to initiate and sustain pharmacist services in an intensive care unit recovery clinic.

Our results extend beyond this past report to suggest that
the main medication-related problems identified by ICU
recovery clinic pharmacists across diverse settings were
issues with medication adherence, medication-related side
effects, and need for medication education. These results
provide guidance to pharmacists practicing in or aiming to
set up an ICU recovery clinic by revealing core areas to prioritize in a medication review. In addition, the identification
of patient's failure to receive medications has implications
for improving ICU survivors' care transitions, suggesting
early follow-up to assess discharge medication receipt or
methods to increase access to discharge medications. As the
implementation of ICU recovery clinics including pharmacists in the United States expands, additional research is warranted to describe the medication management needs of ICU
survivors and their caregivers including strategies to mitigate
medication-related problems in this vulnerable population.
Moreover, the practice of pharmacists in an ICU recovery
clinic provides a remarkable opportunity for pharmacists to
have an equal, independent clinical role and a co-equal role
in management, clinic design, and driving the research
agenda of the clinic. This provides an important, innovative
area of growth for pharmacist services and development.
Currently, although pharmacists are recognized as providers
in some states, most institutions are not supporting billing
due to the low reimbursement rates of pharmacists and the
associated administrative burden. Pharmacy professional
societies and health care payers should explore encouraging
the expansion of pharmacists practicing in this space and
reimbursement for their services. Pharmacy professional
organizations can influence state or nationwide reimbursement policies to ensure pharmacists' ability to continue the
necessary work in this setting and overcome financial barriers. The reimbursement of pharmacist services is also in the
substantial interest of payers given the exceptional opportunity for cost savings by pharmacists in this setting. There are
modest costs of a pharmacist providing care relative to the
substantial costs of a physician specialist managing medication ICU survivors' needs, continuing unnecessary high-cost
medications, or the potential cost of an ICU survivor's readmission or nursing home stay related to an adverse event
from one of these medications.

When initiating an ICU recovery clinic, first, the pharmacist needs to seek support from their management or leadership. This support would include not only coverage of
activities such as order verification or emergency code
response from other pharmacists during their clinic time, but
also support to bill for services if the pharmacist is considered a licensed provider in that state. Second, the pharmacist
needs to determine how to manage their schedule to enable
attendance at the clinic. This might require the pharmacist to
share their contact information with the rounding team and
how to contact them while in the clinic. Third, the pharmacist
will need to create a list of questions for not only the patient
but also their family members to perform a full medication
review and detect any ongoing medication problems. Fourth,
the pharmacist should develop a data collection tool to quantify interventions to help justify sustainment of pharmacist
services. Last, the pharmacist should seek feedback from
other members of the interdisciplinary clinic team to determine how to perform their job more effectively. These activities are summarized in Figure 2.
This study has several strengths including being the first
to report perceptions of a pharmacist's role within ICU
recovery clinics and barriers and facilitators to pharmacists
practicing in this setting. Although the ideal composition of
the interprofessional team that comprises an ICU recovery
clinic has not been established, many of the ICU recovery
clinics in the United States do include a clinical pharmacist.
The current article adds to the body of literature by providing
practice patterns, facilitators, and barriers encountered by
pharmacists who work in ICU recovery clinics. These findings can provide guidance to other pharmacists beginning to
practice or involved with implementation of services within
an ICU recovery clinic. This study also includes one pharmacist who practices in Europe. This international representation is important as the National Institute for Health and Care
Excellence (NICE) guidelines recommend adults who have
stayed in an ICU for greater than 4 days have a medical
review within 2 to 3 months following ICU discharge.33
This study also has some limitations which should be recognized. This study only included 9 pharmacists who practice in
ICU recovery clinics and are active participants in an
international collaborative focused on ICU recovery efforts.

Hospital Pharmacy - April 2020

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