Introduction: Post-intensive care syndrome (PICS) is associated with an increased risk of mortality. Critical illness recovery clinics have been recommended by the Faculty of Intensive Care Medicine (FICM) as an approach to manage the complexity of PICS. The COVID-19 pandemic has provided many healthcare challenges, not least how to support those who have survived critical illness related to the virus. Recent guidance from the FICM also recommends pharmacist involvement in rehabilitation and recovery clinics for patients discharged from hospital following COVID-19 critical illness. This evaluation was undertaken to determine the impact of the inclusion of a clinical pharmacist in this setting.
Method: All patients discharged following a COVID-19-related intensive care unit (ICU) admission in the Belfast Health and Social Care Trust, Northern Ireland, from 26 March 2020 to 15 May 2020 were offered enrolment in a rehabilitation and recovery programme. This involved an initial 6-week remote review, followed by a multidisciplinary face-to-face assessment at 12 weeks post-discharge. Each healthcare professional at the clinic contributed to an overall treatment plan, which was communicated to the patient’s GP. The clinical pharmacist carried out a structured medicines optimisation review and identified medication-related interventions, which were recorded and graded according to the Eadon criteria. Cost savings resulting from these interventions were estimated using the model described by the University of Sheffield School of Health and Related Research (ScHARR), a type of economic modelling that uses literature-based values of the costs of medication errors and compares this with the benefits of different medication-related interventions.
Results: A total of 42 patients were discharged during this period following COVID-19 ICU admission, with 93% (n=39) agreeing to enrolment in the follow-up clinic. Medication-related interventions were identified in 82% (n=32) of the 39 patients. The most common medication-related intervention was patient education, accounting for 38% (n=24) of all interventions.
Discussion: Analgesics were the class of medications most associated with requiring an intervention and 65% of interventions were graded as significant, resulting in improved care standards (i.e. Eadon ≥grade 4). Clinical pharmacist interventions yielded potential savings of £4.20–£8.59 per £1 invested, based on total potential savings in the range of £6,204–£12,699, with a total pharmacist investment of £1,478.
Conclusion: Clinical pharmacists have a role in medicines optimisation for patients recovering from COVID-19-related critical illness. Most interventions by a clinical pharmacist in a post-ICU recovery clinic were related to symptom management and patient education. Their role in this setting can help rationalise medicines and improve patients’ understanding, resulting in potential healthcare-related cost-savings and safer patient-centred care.
Keywords: Clinical pharmacy, COVID-19, critical care, integrated care, intensive care, interventions, medicines optimisation, outpatient clinic.