Impact of Pharmacists to Improve Patient Care in the Critically Ill Using the Medication Regimen Complexity-ICU Score
MRC-ICU trial design and results
Design
Multicentre observational analysis
Treatment
Higher pharmacist input relative to medication regimen complexity
Control
Higher pharmacist workload per patient
Population
3908 critically ill patients at 28 centres, scored using the Medication Regimen Complexity-ICU score over a 4-week period
Follow-up
Hospital discharge
Primary endpoint
Association of medication regimen complexity with mortality and length of stay
Result
Medication regimen complexity was associated with mortality (odds ratio 1.09, 95% CI 1.08 to 1.11, p<0.01) and ICU length of stay (beta 0.41, 0.37 to 0.45, p<0.01). A higher patient-to-pharmacist ratio was associated with longer ICU stay (beta 0.02, 0.00 to 0.04, p=0.02) and with reduced quantity (beta -0.03) and intensity of pharmacist interventions.
Secondary endpoints
Intervention quantity and intensity, staffing ratios
Increased medication regimen complexity, defined by the MRC-ICU, is associated with increased mortality, LOS, intervention quantity, and intervention intensity. Further, these results suggest that increased pharmacist workload is associated with decreased care provided and worsened patient outcomes, which warrants further exploration into staffing models and patient outcomes.
The trial authors, in the published abstract
How it has aged
Observational, and the causal direction is arguable — complex patients are both sicker and more demanding of pharmacist time. Its contribution is a validated complexity metric that makes pharmacist staffing arguments quantitative rather than anecdotal.
Publications
Impact of Pharmacists to Improve Patient Care in the Critically Ill: A Large Multicenter Analysis Using Meaningful Metrics With the Medication Regimen Complexity-ICU (MRC-ICU) Score
Sikora A, Ayyala D, Rech MA, et al. Impact of Pharmacists to Improve Patient Care in the Critically Ill: A Large Multicenter Analysis Using Meaningful Metrics With the Medication Regimen Complexity-ICU (MRC-ICU) Score. Crit Care Med 2022 Sep 1;50(9):1318-1328.
Medication regimen complexity associated with mortality and length of stay
Higher pharmacist workload associated with less care delivered