2025 ACCP Annual Meeting Highlights: Elevating Clinical Pharmacy in the ICU

Welcome to Pharmacy to Doge, the critical care podcast, and I'm your host, Nick Peters. Wherever you are and whoever you are listening, thank you. Really awesome last day of highlights from the 2025 ACCP Annual Meeting and today's episode starts off with Julie Fera highlighting the multi-center research network or MRN grant highlighted by the critical care period and highlighting the fact that over 20K is available for research assistance in various different grants and such. So great chat and then very lucky to be joined by four speakers, Mojda Hevner, Susan Smith, Brian Murray, and Andrew Sikora highlighting their session from consensus to practice tools for elevating clinical practice in the ICU. Of course highlighting the recommendations of the consensus document published in JACCP. So encourage everyone to download that, listen to that, it was a great session, incredible roundtable by four of the brightest and also incredible talking with Julie highlighting all of our research considerations, awesome. Great last day of highlights to highlight a great conference. So here we go. Propel Fitness Water with Gatorade Electrolites, Zero Sugar, and Vitamins. Propel hydrates better than water to help you get the most out of your workout and get back to your best self. What propels you? Propel with Gatorade Electrolites. I want to date with Rawls, Carty says. Rawls, Ruffa Ars. This is the love story of real hinged couple Carty and Rocker. Written and read by me, Nicola Dynan, listen to the free audiobook now. I am so lucky to be joined by four of four pharmacists that are leading the way in research and changing practice for pharmacists across the country, all returning guests, all friends of the pod, all critical care PRN members, we are of course here at the ACCP annual meeting. And I am here with four friends who are going to introduce themselves shortly, highlighting their talk tools for elevating clinical pharmacy in the ICU. So a talk that really sorts to highlight the consensus recommendations for the integration of critical care pharmacist on ICU teams. So we'll get into all of these things, intros first, we'll of course go left right, Andrea. Thank you so much for having us, I am delighted to be here. My name is Andrea Sakura and I am an associate professor at the University of Colorado School of Medicine. Glad to be back on the pod, I am Brian Murray, an assistant professor at the University of Colorado, Skag School of Pharmacy and Pharmaceutical Sciences. Also, I am very happy to be back on the pod, for those of you who may not know, I was actually the first guest that Nick had on the show. And this is the first return back I think. We might have done one in between, but thanks for remembering that. I have been trying to open invite you now. I know. I know. So yeah, this is much to have, and I am a professor at the University of Maryland School of Pharmacy, also assistant dean for experiential learning there. It's great to be here, I'm Susan Smith, I'm an associate professor at the University of Georgia College of Pharmacy. I guess right, we're in, we're like in presentation land, so I guess we should get disclosures. These people are awesome and they're my friends, so this is a great round table here. Now, first things first, so we're recording this Monday afternoon. So what is it like giving a talk with essentially, like, for a group of friends, because that's kind of what this is essentially, no? So Mojda sent a text and was like, hey, should we prep for this and are we ready? And I was like, we are going to be in great shape. And I actually had not one, but two people say that it was obvious about how comfortable we work with each other, of like playing off of each other, and how much they enjoyed that. It was definitely a lot of fun. I couldn't think of a better group to give a talk with, super fun. We definitely, at least for me, I don't get nervous when I'm just sitting around with my friends. I felt like that's what we were doing, so it was really great and was super glad that Mojda kind of brought us together and put all the pieces together so that we could do this. I clearly got nervous and that's okay, but I had a lot of fun. And I also heard from a lot of people that they felt like, yeah, these guys all know each other and they seem to like kind of feed off of each other really well. It also helps that we've had some retreats for Optum and have spent a significant amount of time traveling together, so yeah, definitely fun. Yeah, vibes are high. You all are kind of doing, you know, the Adam Sandler makes movies with all of his friends. You all are doing that except kind of in the research environment. So that's strong work, right, that's thinking ahead. So Brian, did you have any, like how were you with this group, good Optum group, three very big personalities, how was that? I will just say that these ladies are all powerhouses and so I just kind of get to sit back in the back seat and they can tell me what to do and I just show up and put a smile on my face and it all just works out in the end. That's the nice thing about working with this group, exactly. Brian is a powerhouse. We all know that. We have four powerhouses here, right, for sure. Five. Okay, well, so we can't talk about these 20, 25 consensus recommendations without briefly highlighting some history and I love that the presentation included that, right? That's one of the things like, you know, you're getting old when you love everything about history. So here I love it and how have we gotten to the point that we are today as critical care pharmacists? There could be people that are at school that just think this is the way that it's always been and that's definitely not the case. One of the things that I love to emphasize to trainees when they're like, I wonder why it's like this and I don't know if I like how it's set up and I like to point out that the first I see you is like 100 years old, less than that, you know, we didn't have antibiotics all that long ago, all these types of things and so when you look at how fast things have developed, it's pretty incredible. So as much as I think we have a long way to go, I also think it's important to celebrate how far we have come. Because it looks like the timeline, I mean, it looks like in the 1960s when there's kind of the first mention or documentation of the critical care pharmacist so it's that does put in perspective though when you think about ICUs in general. But still definitely not something that is a super, something that we've been working for for 60 some years to get where we are now. So the session, of course, highlighting these recommendations for integration of the pharmacist on the ICU team, published open access in JACCP. So just a note that JACCP is not in PubMed and this isn't, it says no direct target to anybody. I just want to make sure, so Google this, if you're looking for it, there'll be a link in the episode description but I want to make sure you can find the episode or the paper itself. In JACCP, you can kind of just Google the title, the link, what not, but that would be the way to find it to get access to it. Don't search for Andrea Secoro's name because you'll get like 500 hits. Which one would you recommend searching? Probably me. No, that's not true, stop that. So what was the process? How did you ultimately establish it? Because like the idea of just sitting down and being like establishing these consensus recommendations feels like an insanely daunting task, like looking at a tsunami, like as it's coming at you. So how did you, what was the process and what were the methods from idea to kind of the paper? All right, so I'll jump in for this initial part. So Andrea gave a great presentation at the critical care PR and focus session a couple of years ago. I think I was like the rising chair at the time and so was kind of running programming committee at that point, but we were all really inspired, I think by her talk. And then Susan and I were sitting at one of the PRN officers meetings and like orientation and they were talking about how the PRNs can have their opinion papers or position papers and like there's a process for that and it's actually pretty easy. And so we immediately started thinking, wow, that would be a really great opportunity for Andrea to kind of highlight what she talked about in her presentation as a PRN opinion paper, you know, kind of like a commentary type thing. And then it very quickly evolved into something really bigger, but I think that speaks to clearly there was a need for this and I'll let Andrea kind of speak to the next part. One of the things I always wanted to say about Mojda is she is classically out of grants, given take, we're making the pie bigger, so there's always more pie with Mojda creating opportunities for other people. I have this distinct memory when I was trying to figure out how we were going to approach this of writing out all of the different individual recommendations from the 2020 position paper and trying to like reorganize them. I remember having a meeting with Susan, Ryan and Kelly and I was like, I don't even know to talk to about this because I just have this like weird document that I've been creating and thinking about, but I think, you know, there's a lot of iterations and conversations and I think one of the things that I loved about this the group of authors was that all of them were willing to sit down and talk about things and then you could tell like a week later I'd get a random email from somebody thinking hey do you think about it from this perspective and that really was a very special thing about this team. Did it feel very well number one I have to ask the way you describe that is this like when you watch the true crime or like the police drama did you have like all of them on your wall and you had like yarn that mean were they're going like this yes that's what it felt like I'll add like this was a very daunting task like just you know establishing this as a charge and a new task force for the peer end was huge when Moisha did that but then Andrea had a lot of work ahead of her and I mean one just figuring out how to even approach it I mean that was huge and she ended up coming up with like I think a really great like clear structure that's very readable and also actionable but coming up with that structure was one I think assembling a team was a huge task and she did an amazing job of making the team not just interprofessional but including representatives from the US Public Health Service ISMP the joint commission like really kind of thinking outside of the box and getting some really good minds together she got the team but then she also had to make sure all of the team could come to consensus which I think was another kind of daunting task so this was a really massive undertaking and Andrea did a phenomenal job of leading the efforts and so is this something just so so the listeners have an idea so is this something where the 15 to 20 of you kind of sat in a room or what not and you all created and deliberated and created these or what was the process for the actual recommendations themselves how did like what sort of input did you get from others so one of the most important things about consensus building is you need to allow people to share their ideas and be a part of the process and what I was somewhat fearful of is that I do like to chitchat sometimes and that I would do too much chitchatting and so what I was very excited about was having work groups and so Brian, Susan, Mojda and Kelly Henry all had a work group that they were in charge of that allowed for smaller groups and I think that sometimes that also can bring out different personalities that don't necessarily want to talk among 22 you know big personalities and stuff like that and I found that those relationships were really powerful even just seeing like one of the members of Kelly's group was like she's so great and we should be helping her and I was getting notes about that in emails because they were now connected and that was really special to watch yeah I just want to add to that so my husband was on the consensus paper by the way and happened to be in Kelly's group and you know I'd worked with Kelly for quite a while before this and kind of talked about her all the time about how great she was but that was a cool experience for him like to be able to work with her also and there was a lot of here's just like the way she ran those meetings and just it was a smaller group but just like the organization of like getting everyone's input making sure that everybody in the group was like providing their their expertise and like their perspectives on it and really truly like gaining consensus on that smaller scale I think it sounds like she did an awesome job and I know everybody in the subgroup sit an awesome job as well but then it was kind of cool to watch because you would see like one of the work group leads would be presenting and then you could see the team like their smaller team kind of back them and then want to like describe the different points and so it was really nice to watch like all these different individual dynamics and relationships coming into play to create something that was far better than any one of us was going to come up with. Okay now wait a second so I just asked if there was any sort of other decision making other than the 22 and I love the idea of like the small groups and whatnot but you look at the list of this and you look at the institutions I would say over 80% large academic rounding faculty so how did we get the input for because it's a consensus document for pharmacists in general so how do we get the input of people that aren't in institutions like this. Yeah that's a great point and and really it was like the voice of the critical care PRN to kind of start with and so we didn't mention this but like the first year basically of the task force was dedicated to working on the survey of the critical care PRN's perspectives and so Zach Smith in a great job of leading that and many of us who were involved in the PRN gave input on like what kind of questions we would like to ask to understand like what does the PRN what are the members think of the activities that are in like the position paper and like what do they think are important what do they think the ideal model is and understanding a little bit about not only like what are their current practice practice models and their current practices but also what do they think we should move towards as a profession and then that data was like immensely helpful especially in that initial round one level of discussions about where we wanted to go with this consensus recommendation. I love that and I mean of course I know you all know that in the planning but I want to make sure the listeners know right that obviously everyone's going to have different workloads and different perspectives and so making sure that those are are heard and kind of taken into account that's a really good job so I think that's important to highlight there so there are three domains that are sort of highlighted within the document so direct patient care, indirect patient care professional engagement so help us out we don't have to go through every single one per se but give some examples of what activities are in sort of some of those domains so we can idea of what those encompass. Yeah I will kick us off with direct patient care and I think that's kind of what we conceive of as our job as critical care pharmacist this is the the day-to-day patient care rounding activities making interventions answering questions communicating with providers that kind of thing that anchors you to critical care and that's where we all spend a lot of our time but the reason why we wanted to kind of pull in these other domains is because we understand the interconnectedness between direct patient care and professional engagement and indirect patient care and so wanted to highlight the importance of those other activities as well. An indirect patient care some examples there these are things that are supporting patient care but you're not directly at the bedside so doing medication use evaluations medication safety type activities this is what we think about as your indirect patient care and then professional engagement are kind of all of those extra things I think it was Andrea yesterday during the talk some of the hobbies are kind of our quote hobbies although this shouldn't be your hobby right this is what we're saying in the consensus recommendations this should be part of your job but this is education precepting mentoring research scholarship all of those types of additional activities. Where would for example like being on like a hospital committee fall what would where would that fall like which domain would that fall under would that be indirect patient care. Yeah so I think that would mostly be indirect patient care so being on or being on or leaving a committee in the hospital. Identifying that it really feels like like you said direct patient care is the anchor and what keeps us and sometimes it's the indirect patient care that can kind of creep up and and take over your day in some of those cases based on the because it's all kind of responsibilities right it's all indirectly related but it's you know not necessarily the same daily deliverables like you know maybe you're saying tasks or however you track those. I think it's so interesting to draw attention to like the indirect patient care activities of pharmacists because I actually feel like that's where we're unique as healthcare professionals compared to a lot of our colleagues maybe do less of that type of activity and so it's very important and I will say there are I know that there are models of critical care pharmacists practice out there where maybe they're less involved at the bedside but really heavily involved in the indirect patient care aspects and I don't know that that is going to lend itself to like the best outcomes either but similarly like there are sites that have really heavy bedside involvement not a lot of involvement on committees where there aren't isn't really pharmacist representation and so I think what I love about that figure of like the the triple pharmacist aims of like where we bring value is critical care pharmacists it really emphasizes I think Andrew's point that she's made many times of like you really need all three of these to work together in order to optimize outcomes and you can't have a heavy focus on one and at the expense of like not doing as much of the others. My classic example with this is direct patient care is for a while every time I came in with a patient and Pella they all the orders were wrong and sometimes dangerous and so I would spend the morning fixing them and talking with the team and being like let's not do this and so as opposed to doing that I took one afternoon and started to make up a new order set that had correct orders and created an education and then went around and did that and so to me that element is indirect patient care that is directly affecting a patient that is admitted but by doing that as opposed to be having to fix the same problem every day now I haven't had to fix it you know in years but I think that is at times hidden labor that we do not think about and it is extremely important that we value that for pharmacists and then professional engagement would be you presenting in MUE or research from said change in protocol from like a safety or something perspective, right, to close the loop? Yes. And then that you're sitting in the audience going, wow, we also have that problem. I could go talk to that person and learn how they fix this and you can brainstorm and all of that. And I think at times we do not value that sitting around at ACCP, listening to these types of podcasts, actually then directly influences the quality of care that you're providing because you're learning new things. Maybe you feel revitalized, have new ideas, but that is essential. And I think at times we like to think that you can get away with just one aspect, but in fact all three of them are very important for each other. And I'll add that with regards to professional engagement, it's more than the professional society involvement. It's actually, we lumped in like the teaching and precepting that goes into it also. And I think it's similar. Like when you have a student who's on rotation, and obviously this is the experiential hat that I'm coming out, but they oftentimes ask questions that we maybe didn't think about. And so in a similar way, kind of forces to think outside of like our traditional mindset and perhaps help us elevate our practice as well. Now this is all great, right? But when going through this process, right, all of us understand that we have, there are different barriers to like being able, like it would be amazing to be able to have all three of these done in my eight to nine hour day, right? So whether the group identified or it's things that have come up through the process, what's sort of like barriers or things have you identified that make it hard for pharmacists to feel like they can adequately achieve all of these within the work day? So I think there are a couple things that come to mind here. One is one of the kind of specific recommendations that we made is that everyone should have 10 to 20% of dedicated time for working on those non-direct patient care and professional engagement type activities. And so that's one challenge is how do we make that time and how do we make it a priority? So that's kind of a large topic of discussion we could go on and lots of different ideas of how to do that. But I think another key factor is that we had a lot of discussion with the professional engagement areas in particular that not every pharmacist should be doing every single one of those, but some pharmacist should be doing every single one of those. That came a lot in our discussion with research in particular. Not everybody wants to do research and that's okay, not everybody needs to, but somebody, some pharmacist needs to be involved in any research related to medications in the ICU. If there's a large trial going on for new medication or something like that, there needs to be a critical care pharmacist involved. So I think that distinction of not everyone needs to do all of this all the time, but somebody has to be doing it. And as we think about barriers, I think the biggest one is how do you resource that time? Like how do you make the 10 or 20% that we should be giving people for indirect patient care or professional engagement? And I think that's the biggest barrier that people have right now is just the staffing model and the number of people available to make that happen. Another barrier is that I think because critical care pharmacists have been in systems that are not set up to support this, they are defensive of their time. And they look at a project and go, I don't want any more work, I'm plenty busy right now. And so I think some of this is also generating trust between leadership and between the pharmacist at the bedside to say, hey, we need you to be involved in these things, but we're going to support you with real support to do that work. So this might be a little naive of me, but I think that critical care pharmacists probably have too much on their plate in terms of the patient load and number of teams. I think we can say confirm, like I don't think that's a fact. So it's a set up for failure in terms of the workload and it's impossible to carve out any time within that normal day to work on these other activities. However, I think if we at some point get to the point where critical care pharmacists are appropriately staffed, safely staffed with the correct ratios or correct number of teams assigned, that they will inherently be able to have some dedicated time to work on these other things. And we know that these other activities have value, both for patients and improving their outcomes, but also for just increasing the well-being and job satisfaction of pharmacists, which is really important. We want to keep them and retain them as critical care pharmacists, right? So we know these things are valuable, but we don't really show that in how we design jobs for critical care pharmacists. So all of these other activities, they should be part of job descriptions. They should be included as elements in annual evaluations. They need to really be valued and be considered when we're designing kind of what a work week looks like. Yeah. So, one of the things that I love about this document is it goes a little bit further than just laying out these sort of recommendations or things. It in the supplementary appendix, which is a gold mine, like that that should just be required download with the actual PDF of it, because within that gives a lot of tools for implementing and actually making some of these happen. So is there any, I would love to go through every single one of them because there's a lot of really good ideas, but does anything, is there any one or two like notables or things as you were going through the process that you love to highlight or something that people always sort of point out from when the paper was published? I think what we'd like to highlight about those tools and the supplementary appendix is that they are a useful snapshot for where your organization currently is. There are not going to be answers in those tables for necessarily like the exact right ways to make things better and improve on your infrastructure or the processes, but like example, like this document is not going to help you retain your overnight pharmacy team better or like then before this document. Exactly. But it gives you an idea of this is where we are right now at this moment in time. Where are the areas where we can be doing better? Where are the areas that we can fill in gaps in our staffing model and give people time to do these other things and then you know of you implement change and you reassess after a period of time and it gives you an opportunity for continual growth. I will also say that the document has a lot of excellent writing I like to think and a lot of big ideas that are present, but I also wanted to make sure that this was easy to digest. And so the tables at the end I am particularly proud of how each work group worked through those and so it's a beautiful summary of each section on one page. Incredible. With the recommendations, the metrics, the advocacy agenda. So even if you feel you know pressed for time and I can't convince you to read the whole thing I would recommend downloading the supplemental and looking at those tables. And I think this checklist and the supplemental materials are so great because you can go through that checklist use it as a self assessment and then use that as a starting point for discussion at your institution. So I hope that everyone downloads this supplement like you mentioned and really gives through that and kind of talks it out with their pharmacy team and managers too. This is really easy to work through checklist. I mean it looks like somebody we just onboarded residents and things. It looks like a checklist that you would do as you were onboarding somebody like in a program or something. So it's very, it's something that you could probably look at and have an answer to know if you do for the majority of them sort of ride off the bat. It gives you not only guidance on implementing. It also gives you metrics for the process and how looking from an outcomes perspective. And I agree as somebody who feels like I do not speak research language. This is certainly very easy to read and understand and truly meant for everybody. So yeah, that's kudos, only thing is two pages, but it's front and back one page. So that is, I like that. I'm just giving Andrea a hard time here. It pained me when it went over to two pages. I tried so hard and then they'd come back and they're like, "Angery, you can just leave it alone." Were you like, was it like seven point font initially? Oh, I tried so hard. Point two margins. Okay, so this talk was yesterday and it looked like there was a component for like some audience participation discussion. Was there any sort of questions or discussion points from yesterday or just in general that you thought were really good points or things that you might want to highlight to a different audience? First, I just want to say that we were thrilled with the engagement that we got in that session. People had great questions and great ideas and I personally am excited for what people are going to do with this guidance after this meeting. But I do want to personally shout out Rob McClaren, who serves as our personal gut check so often, who shout out ways. Rob, at a really good point, like yes, we now have this guidance document for critical care pharmacy, but now do we need one for P, it's an oncology and all this other stuff. The first key opinion statement in our document is that every critically ill patient needs the care of a critical care pharmacist. And I think we all believe that you should be able to just excise critical care from that sentence altogether and say every patient needs the care of a pharmacist. And I do think a more global approach to this would be a great, a great idea. And I think that if you remove critical care from the whole thing altogether, like all those statements will still ring true to people as things that we should be pushing towards. So what's the process for having organizations endorse your documents? I thought it was notable, right? Susan, you highlighted that there are not only multiple, but they're unique in things that are very related to this idea of a critical care pharmacist consensus statement. So what did that look like trying to get the endorsement from a variety of national organizations? One of the things that I remember, Greg Martin, challenging me on several years ago when we were working on an invited editorial piece was, he's like, I love pharmacists. And I think pharmacists are amazing, but my real belief is that it is the ICU team that is actually affecting the best outcomes and making the best outcomes happen. So are you advocating for pharmacists? Are you advocating for the team? And it was a really interesting point. And that gut check is actually helped inform the title that we have, which is the team integration of the pharmacist. So within that, there is power from having interprofessional representation in the authorship, but also from the different major organizations. So this was a beautiful thing about having people that are leaders in all these different organizations that now have connections. So most have brought in AACN for our nursing perspective. We were able to get physicians through our connections with SCCM working with them. And then in terms of the endorsement process, what I will say is that every institution organization has a different endorsement process. But the goal was to talk to people early. So there was a pitch document that just kind of had the title, the intro, some major concepts of a version of that triangular figure with a triple domain that was sent out to each of the major organizations that you see, saying, hey, we want to do this. We would love to have your insights. We think that you are a valuable member. And I was really honored by the excitement and the replies that we received in those conversations. And so then at that point, like ISMP is like, okay, if you have this person on, we'll have to go through this board review. But that's very different than how ACCP does it, how SCCM does it, and so forth. But I also think that that was a really valuable process to bring in those different perspectives and go through that. And so, definitely added a few months to the process, but I think was a very valuable thing to do. I mean, this is in a bad way, but it's the least shocking thing of all time that they all follow like a completely different process, like no uniformity at all. And then of course, in case you're not familiar, Greg Martin, physician, previous president of SCCM practicing in Georgia, just so you kind of understand the people that Andrew is like working and collaborating with there. So a lot of familiar faces from the Optum group here, right? Optimizing pharmacist team integration for ICU patient management. And I hear there would look like there was a tease in the presentation that there may be some data being released soon to help answer some of this. Is that true? Are there nuggets of that happening? Yeah, so coming very soon, so Optum just real quick, I guess, review for anyone and familiar with it is about a, over 30,000 ICU patient study, more than 200 critical care pharmacists from about 64 sites across mostly the US and two international sites contributed data to look at a pharmacist to patient ratio that is associated with reduced mortality in the ICU. So we've been hard at work analyzing many, many, many data points. And it seems to be looking, I guess we'll kind of release our numbers here, it seems to be looking like exactly what critical care pharmacists have self identified in survey data that they think is a safe ratio, which is somewhere around that one pharmacist to 15 to 18-ish patients. So very cool, very exciting. We can't wait to get these results out there soon. Another really interesting aspect that we saw in the Optum data or are seeing right now is that having a pharmacist on rounds on the first day is extremely important as a mortality indicator. And I feel like that is also something that pharmacists have had a feeling of like that first day, there's a lot happening and it's really important to be there or like, oh, we didn't have someone on the weekends and now I'm dealing with this on Monday. And so I think, you know, one of the parts that really struck me yesterday is I was re-looking at the survey data as we were presenting was how many things pharmacists know intuitively and that we're able to show is true. And so that has been very exciting. But I think what I want to say is that, you know, if you have a feeling that something's unsafe, you should believe that gut feeling. And like, the, I think the really cool thing that you all do is, you know, like you said, Optum is a, it is the collective of a large group of people. And so I think it's, I've always thought it's very notable how much recognition and sort of support you do. It feels like it stands out to me whether it's get together at conferences, sending people things like the water bottles, of course, and those sorts of things. And so I think it's cool to really highlight the fact that like this really is a representation of like data and contributions from across the country and a real cool as we think about multidisciplinary and collaborative things truly having that in action to help answer these questions is like a testament to the group and you also it's really cool. One of my favorite parts about Optum has been the, the team and the amount of excitement that we've been able to give and then hopefully representation and acknowledgements back to them. But I also like to think that this is going to be a paradigm for how we approach research in the future as a pharmacy profession, which is that we could not have achieved any of these results without power and power meant you had to have an individual who was tracking information for 100 days. It was a lot of work, even when I was doing it. And so I shout out to that, but I also hope that this is a future model for how we approach research as a profession. Okay, we're going to end with this. I'm going to flip it on you. So you, the presentation ended with challenging the audience, right? What's the most important change you'll make because of the 2025 consensus recommendation? So maybe it's not the biggest change that you've truly implemented, but is there something that was the biggest change in your mind or thinking or anything like that from the beginning of the process to now? Because I'm sure you've been inundated with data and had your thoughts change when we're the other on issues that you've gone through this process. So I think one thing that I definitely focused on is a critical care pharmacist. Same my career kind of continued was the importance of like standardization of practice wherever possible and that, you know, deviations are definitely necessary on a case by case basis. But like there are ways that we should all be kind of doing things, certain things the same way in order to really achieve optimal outcomes and translating that approach to this. And I definitely think site by site, you know, they're going to be nuances. Everybody should really come up with like an approach that works for them. But I would love to see, you know, this collective whole kind of continuing to work together to figure out further implementation, especially after optimum comes out. And we have like really robust data to support the change in ratios. How can we continue to support the critical care pharmacy community, but also mobilize the critical care pharmacy community to provide input on how we can do that? And so I think, you know, Brian transitioning into PAC chair within the CPP of SCCM and like I'll be taking over his chair next year. Maybe there's something there that we can work together and kind of mobilize PAC to take on some implementation guidance on in addition to all the wonderful supplements that we have in the paper and the baseline checks, like what can we provide as resources to people so that they can maybe implement this at their sites in a somewhat standardized fashion? What was really validating and exciting for me with this paper is that I like to think that it marks a paradigm shift from us discussing justification of a critical care pharmacist versus optimization of how they do their job. Justification to me has to do with whether you are worthy of being there, a critical care pharmacist is innately worthy of being on the ICU team. Full stop. So don't talk to me about justification. What I want to talk about is how do we optimize the care that they are providing. And that maybe includes metric tracking and includes, you know, targeted quality improvement efforts because there's always ways to be better, but it is not to do with justification that were valuable members of the team. Well, oh my gosh. Well said, of course, Andrea with just an incredible sum up of a phrase there, because it's really, really true, tired of seeing things justifying our need and all these value sorts of things. Very well said. Yeah. Well, this was awesome. Everybody, this paper will definitely be, hopefully, something you see at your institution that you start to look at and start to see how, where you are at, what things you can optimize in all those three domains. But Andrea, Brian, Mojda, Susan, all the best. So good to see you. Thanks for coming on. for all this. tremendous work that win into creating this document that's going to help so many people. Low energy, unfocused, foggy, you might be dehydrated. Gatorade Zero powders have been scientifically designed to help improve hydration balance in the body, with a clinically proven electrolyte blend and no artificial colors or flavors. Great tasting hydration, no matter where you're going, shop now online or at retailers nationwide. Gatorade hydrates better than water. Is it in you? Symptoms noted are signs of mild to moderate dehydration, consult a healthcare professional if symptoms persist. I don't think I can be your friend, Isabella said. Rebecca's stomach flipped. This is the love story of Real Hinge Couple Isabella and Rebecca, written in red by me 10 interviews, listen to the free audiobook now, always love highlighting cool initiatives involving pharmacists, and especially ones that overlap within the critical care PRN and today is no exception, very lucky to be joined by incoming chair of the Research Committee for the critical care PRN Julie Farah, Julie, Marco. Yes, from University of Tennessee, Memphis, so one of the things we want to highlight is a really awesome opportunity that the PRN gives the members, and I think they've heard me on old literature of you series being like we got to find a way to stop having 10 retrospective single center studies all looking at the exact same thing. So the MRN grant that does not stand for medical record number, what is this, what are we highlighting and talking about today? Yeah, so the MRN grant, it stands for Multicenter Research Network Grant, so the goal with this is to encourage collaboration, create an opportunity for people to connect, to share ideas, to share responsibilities and workload with conducting research. Whether that is because you feel like you don't have a large enough patient population to have a meaningful study as a result from just your own institution, or maybe you're a little bit less experienced with research as well, maybe you want to connect with somebody who has a little bit more experience more of a senior investigator, and that opportunity again for collaboration is really what we're trying to emphasize with the MRN grant. So how is it for a certain amount of money, or is it whatever your project costs? Yeah, great question. So we have the opportunity to provide up to $15,000 with this grant. Wait, say that again. 15,000, that's right, with 300. Okay, that is actually a way more money than I would have if you would have just made me guess. Right, it's not insignificant at all. The true intention is to conduct meaningful research, right? So $15,000 or up to that amount, I know I get asked, especially for people who have not had experiences with great writing or conducting research. I have no idea. What can we actually spend that on? I have no grant experience. Perfect. So some things that it has been used for in the past, consulting purposes. So that might be building data warehouses. That might be statistical analysis. So hiring a statistician, people have built in within their budget travel money. So if you want to go present that research in the future, also publication costs. So if you're looking to publish in an open access journal, other data storage, red cap, for example, accounts and utilization. So there's a lot of different ways that you can use this money that's not like a randomized control trial in rolling patients. So I think that again, connecting with some more senior investigators to come up with some creative ways to use this $15,000 grant is something that we certainly encourage. So especially with like without amount of money connected to it, right? How do you connect with others? Because especially you might have this idea, but just be terrified that you're going to screw something up in this process, you know, and sort of ruin a study or the funding related to it. So how do you connect with others to try to start the discussion, the process, and that sort of thing from a networking perspective? Absolutely. So we were really fortunate to have an in-person networking event here at the ACCP Annual Meeting, which was really great. We had multiple people come with ideas. They shared their own experiences. And so there was a lot of really great troubleshooting of different clinical ideas, potentially some like operational things as well. So this in-person event, we're hoping to continue that on an annual basis when we do have the annual meeting. We also are going to have some virtual networking sessions coming up in the next two to three months. And so we're going to be advertising that, providing links for those sessions in our listserv for the critical care PRN. So be sure to be checking your emails for that. And one of the interesting things is before the meeting, hopefully you're looking at your emails and you saw the info emails that Julie was sending out prior. But if you were interested in this, right, they asked you to fill out a survey. And they asked sort of the barriers if you're interested to applying for the grant or just conducting multi-center research in general. And it was not surprising that the mentorship for both the multi-center research and grant writing was almost you. It looked like a unanimous response from everybody. And that to me, when I think about it makes sense because the pool of those who could mentor people and something like that is smaller, but that's where national organizations that bring all those people together, right, really, that's why they're so important. Yeah, absolutely. And we did have a few people respond or survey more senior researchers saying that they would be willing to serve in that mentorship role. And so I think that, you know, we're trying to, like I said, become creative with ways to connect these people more junior and senior investigators through this opportunity because writing a grant or knowing what to do or how to design a study or conduct research for the first time maybe is super daunting. So I think that that's also something that we want to continue on with, helping connect people. And we're also exploring different ways that we can maybe have an online resource, for example, to just show contact information, people who are willing to put their names out there and serve in that mentorship role. All right, what does the timeline look like on this? Is it something like, do I need to scramble home right away and like get on it? Or what is what is kind of this timeline process look like for? Yeah, so you have a little bit of time. Our grant, our MRN application grant materials are going to be due March 31st of 2026. So that is the upcoming cycle. We'll start advertising sending some emails out within the month or two before that. So be on the lookout early 2026. We'll send out information application and contact information for my charge lead, myself. So if you do see any of those materials come out, have any questions, feel free to give us a shout. And I like that this is like, there's plenty of time, right? If you're thinking about it now. And I like that the deadline sort of kind of goes into like that, you've probably figured out unless you're in the different phases, you know, what your PGY2, whether you're a resident where you are, if you're the program, who's coming to you, and you can sort of, it's cool that that process sort of is in line with each other. Absolutely. So the thing is, that would be great in and of itself if that was the only grant offered. But while you're here, right, might as well highlight a few of the other tremendous opportunities. And like if you're listening, like a free money. That's right. Here's scholarship. Like, I don't think people understand that that is a check in your account. That's right. This is not college where you buy books and board with that. Yeah, we are, we are looking to give some money away. Let me tell you. So in addition to the M.R. and Grant, we do have three other grant or scholarship opportunities. So the first is our PGY2 resident research grant. That is for an amount of $1,500. We'll begin also advertising for that in early 2026. And that'll have a due date of March 31st as well. So again, hopefully by that time, residents have had a good idea about what their research is going to look like. Again, if you have matched at that point and you're looking to perhaps expand on your research into the future, you can start working with your future program about what that might look like or look to carry on a project into the following year. So March 31st is going to be the due date, like I said, for the PGY2 grant. We also have a critical care peer in member grant worth $5,000. The due date for that is going to be August 1st. And so we'll start advertising for that around summertime. So that has already been awarded for this year cycle, but 2026 August 1st. And then we do provide a fit merit scholarship as well. So people who have been accepted into either the fit or the merit programs, the critical care PRN will provide registration expenses to those people. So application requirements look a little bit different based on which program that you've been accepted into since the programs themselves are meant to support researchers in different areas of their careers. Um, but that. is going to be due also in 2026 May 10th. So those are our upcoming deadlines if you're looking to start planning out for the upcoming year. But we are really really looking forward to trying to disseminate some of this money. So please I would encourage you to apply if you know somebody who is looking for a small portion to fund a study or a resident who's looking to get an award for the first time. Please please please feel free to send them to the critical care PRN. I love this. I feel like I'm hosting a game show right now. And it's like yeah so many prizes for everybody. Behind door number one is the Immarring Grant. Okay now I have to ask so listeners may or may not know Julie is a big LSU fan. How are we? Perhaps a disappointed one at this moment in time. How are we handling the losses and how is it having Notre Dame's ex-coach Brian Kelly in the Louisiana Swamp? I texted my family this weekend and I said bring back coach. So those are my feelings. How can you fire out the cage and accent? I know he was just so fun wasn't he? I agree. I agree. Okay I only giving Julie a hard time but anyone else that you want to shout out because it's a it's a committee so like who's the like can you highlight who like the vice chair is? Yeah so our incoming vice chair is Stephanie Chen and she has had experience working with as our member grant charge leads. So she also has seen kind of from the side of disseminating some of that information and looking at applications. She's got some experience with that. So we're really excited for the upcoming year. We also will be if you're interested in joining either the PRN or the Research Committee within the PRN. We'll be asking for people to sign up as charge leads for those various grants to help us you know solicit applications provide information all of the above. I guess it was implied but I should probably state that you do need to be a critical care PRN member to get any of the critical care PRN member grants. Yes bingo. Now I will say for the MRN research grant we have actually wanted to cast a wider net again encourage more collaboration. We've reached out to other PRNs the cardiology infectious diseases and emergency medicine PRNs too. The PI or primary investigator would need to be a member of the critical care PRN however we are open. We are open to other members of that research team not being directly critical care related because there's a lot of overlap right. There's a lot of opportunity for critical patients to have you know certain things going on that fall under those other specialty umbrellas too. And you know if this is something you're interested in right go to it's communities.acp.com you'll go to the threads just your search MRN multidisciplinary research network even just Julie's name you'll find her message reply to her let her know easy to find and that'll get the ball rolling if not if you're not a critical care PRN member what the heck are you doing right. Yeah why are you listening to the critical care podcast. Well okay no you everyone is so everyone is allowed to listen but we need you as a member of the PRN so definitely encourage you all to do that if you are not. Please join we're a fun crew. Great crew business meeting tonight it should be a blast I'm gonna go record the recap and we shall go from there but Julie the MRN grant so excited to highlight what an awesome opportunity to really get some of that pharmacist driven practice changing research that's that's really starting to become more and more common awesomely within the profession. Absolutely. Thanks again to all four guests really really great discussion highlighting all the really cool things that are available and happening within critical care clinical pharmacy and the ACCP. Reach out to me at pharmacy to dose Tio to dose pharmacy to dose at gmail.com but until next time I'm Nick Peters. This is pharmacy to dose the critical care podcast. I don't think I can be your friend Isabella said Rebecca's stomach flipped. This is the love story of real hinged couple Isabella and Rebecca written in red by me Temy Dentonhurst. Listen to the free audiobook now.