Impact of pharmacist board certification on health outcomes of critically ill patients: An analysis of the Optimizing Pharmacist-Team Integration for ICU patient Management (OPTIM) study
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BACKGROUND
Critical care pharmacists (CCPs) reduce adverse drug events (ADEs) and mortality in the intensive care unit (ICU). Board certification is the established professional standard for CCPs but its impact on ICU patient outcomes, including its relationship between CCP characteristics and workload, remain unclear. The purpose of this study was to evaluate the association between pharmacist board certification, CCP workload characteristics, and patient outcomes.
METHODS
This was a pre-planned analysis of the multicenter, observational Optimizing Pharmacist-Team Integration for ICU Patient Management (OPTIM) study, including adult ICU patients cared for by CCPs. Patients cared for exclusively by board-certified pharmacists on every ICU day were categorized as the BCP group; those with at least one day of care from a non-board-certified pharmacist comprised the non-BCP group. The primary outcome was hospital mortality; secondary outcomes included the hazard of discharge alive (HDA) from the ICU and hospital. Multivariable logistic regression was used to evaluate the association between BCP and mortality; Fine-Gray competing risk models were used to assess the relationship between BCP and ICU and hospital HDA.
RESULTS
A total of 201 pharmacists (184 BCPs; 17 non-BCPs) from 63 institutions caring for 20,537 ICU patients were included. Care provided exclusively by a BCP (vs. ≥ 1 day by a non-BCP) was associated with lower mortality (OR 0.80, 95% CI 0.69–0.92, p=0.002) and both a higher ICU HDA (HR 1.08, 95% CI 1.03–1.13, p<0.001) and hospital HDA (HR 1.19, 95% CI 1.13–1.26, p<0.001).
CONCLUSION
Daily ICU care delivered by pharmacists with board certification was independently associated with reduced mortality and improved hazard of discharge alive from the ICU. Board-certified pharmacists may enhance the quality and/or efficiency of critical care pharmacy services. These findings support the role of board certification as a modifiable factor to improve patient outcomes and optimize workload in the ICU.
Importance and Relevance
Critical care pharmacists (CCPs), through their vital role in the intensive care unit multi-professional care team, reduce adverse drug events and mortality. However, CCPs remain underutilized therefore limiting care quality. This study, the first to evaluate the impact of pharmacist board certification on patient outcomes, demonstrates that CCP board certification is a modifiable factor associated with reduced mortality and a greater likelihood of successful ICU hospitalization discharge. These results highlight the value of pharmacist board certification to advance critical care pharmacy services, guide workforce development and efficiency of resource utilization, and inform institutional policy for better patient-centered care and outcome-driven performance.
