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

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 to 0.92, p=0.002) and both a higher ICU HDA (HR 1.08, 95% CI 1.03 to 1.13, p<0.001) and hospital HDA (HR 1.19, 95% CI 1.13 to 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.