In health care, the roots of interprofessional collaboration can be traced back to the 1850s, when Florence Nightingale championed independent clinical decision making and procedural autonomy for nurses, allowing them to support physicians beyond merely executing direct orders. Today, the growing complexity of patient care in the intensive care unit (ICU), combined with rapid technological advancements, demands a coordinated approach led by specialized professionals with diverse expertise, advanced training, and a shared commitment to high-quality care. Given that the ICU is a specialized hospital unit dedicated to the care of critically ill patients with complex, acute conditions, interprofessional teams should be composed of members whose collective expertise spans the full range of skills required to manage rapidly evolving patient needs. In addition to diverse team composition, interprofessional teamwork is essential to optimize health care delivery and improve patient outcomes.

Several factors can undermine core dimensions of teamwork. ICU team members often work across different locations and schedules and represent diverse professional backgrounds with varying training, knowledge, attitudes, and expectations—factors that can pose barriers to cohesive collaboration. Moreover, ICU teams typically exhibit low temporal stability, with frequent turnover in individual team members leading to a constantly evolving team composition on a day-to-day basis. Therefore, teamwork must transcend simply working side by side; it involves critical dimensions, such as adaptability, shared goals, continuous performance monitoring and feedback, effective leadership, coordinated action, open communication, mutual trust and psychological safety, respect among team members, and clearly defined roles and responsibilities. ^,,

Prior research indicates that patient outcomes improve when health care teams have more experience working together. For example, one study found that cardiac surgeons achieved significantly better outcomes when performing a higher volume of procedures at a single hospital, compared with equally trained surgeons performing the same volume across multiple institutions. This finding suggests that surgical performance is not entirely portable and may be influenced by the familiarity developed with a specific institutional environment and care team. Similarly, a multicenter cohort study across 5 ICUs demonstrated that a one-standard-deviation increase in team familiarity, measured by the average number of patients shared among clinicians, was associated with a 4.5% higher likelihood of spontaneous breathing trial implementation, a 23% reduction in the duration of mechanical ventilation, and a 3.8% lower probability of dying.

The coordination and expertise of a high-performing, intensivist-led team is foundational to optimal ICU care delivery. The interprofessional critical care team often includes critical care nurses, advanced practice providers, pharmacists, respiratory therapists, dietitians, physiotherapists, and research scientists, each bringing specialized knowledge essential to comprehensive patient management. Depending on the clinical scenario, leadership may be dynamic, with different team members taking the lead based on the task, while all contribute meaningfully to team efforts.

Bedside rounding serves as a critical platform for team-based communication and coordination, ultimately improving clinical outcomes. In a retrospective cohort study, daily interprofessional rounding teams were associated with improved patient survival, demonstrating a 16% relative reduction in mortality (OR, 0.84; 95% CI, 0.76–0.93). Interprofessional rounds have also been linked to enhanced communication, more effective information exchange, increased cost efficiency, and improved patient safety. When teamwork is less evident, specifically in the operating room, poor outcomes may result, such as increased risk of complications or death (OR [95% CI] = 4.82 [1.3–17.9]).

Implementation of the ICU Liberation Bundle (Awakening and Breathing Coordination, Delirium, Early Exercise/Mobility, and Family Empowerment [ABCDEF] bundle) is a compelling example of collaboration among the interprofessional team ( Fig. 1 ). The ICU Liberation Bundle involves a series of interventions aimed toward mitigating the harmful effects of an ICU stay. Full adherence of the bundle has been associated with improvements in several outcomes, including reduction in duration of mechanical ventilation, incidence of coma, and mortality. A consistent dose-response relationship was noted, with higher levels of compliance yielding better outcomes. Nonetheless, full bundle adherence is difficult to achieve given various delivery challenges. A systematic review identified 107 possible barriers to ICU Liberation Bundle implementation, of which some were related to the lack of interprofessional team coordination. Pharmacists are well positioned to serve as stewards of the ICU Liberation Bundle because of their consistent presence on the interprofessional team and minimal service rotation.

Patient scenario demonstrating interprofessional teamwork for the management of delirium. CAM-ICU, confusion assessment method for the ICU.

(Created in BioRender. Barletta, J. (2025) https://BioRender.com/qbv4ox1 )

The benefit of critical care pharmacists on patient-centered outcomes has been widely documented. A landmark study by Leape and colleagues showed pharmacist participation on patient rounds reduced preventable adverse drug events by 66%. The most common interventions were clarification or correction of an order (eg, dose reduction for kidney failure), provision of drug information at the time of prescribing (eg, education on the selection of sedatives), and recommendation for alternative therapy (eg, a safer but equally efficacious alternative). A systematic review compared outcomes, such as mortality, ICU length of stay, and adverse drug events, in groups that did and did not receive critical care pharmacist interventions. In this analysis, pharmacist participation as part of the interprofessional ICU team was associated with reductions in mortality (OR [95% CI] = 0.78 [0.73–0.83]), lower ICU length of stay (mean difference [95% CI] = −1.33 [−1.75 to −0.9] days), and fewer adverse drug events (OR [95% CI] = 0.35 [0.25 to 0.5]). Other research has demonstrated the favorable impact of pharmacist interventions in areas such as sepsis, thromboembolism, sedation, stress ulcer prophylaxis, ICU liberation, and fluid management ( Table 1 ). ^{,,,,,,,,,,,,,,,,,,,,,,}

The complexity of a medication regimen has also been linked to patient outcomes. In one study of 28 ICUs in the United States, medication complexity, as measured by the Medication Regimen Complexity-Intensive Care Unit (MRC-ICU) scoring tool, was significantly associated with an increase in mortality, prolonged ICU length of stay, and number of pharmacist interventions. Specifically, for each one-point increase in MRC-ICU score, mortality increased by 7%; ICU length of stay increased by 0.25 days, and quantity of interventions increased by 0.08 per patient. ICU length of stay was also related to the patient-pharmacist ratio, indicating the adverse sequelae associated with increased pharmacist workload. Buckley and colleagues sought to identify optimal patient-pharmacist ratios in a prospective, multicenter time-motion study. There were 128 pharmacists who recorded their daily activities, and self-perception of the quality of patient care provided more than 703 unique observation days. The highest perceived quality of care was achieved when patient-pharmacist ratios remained between 16:1 and 19:1. Pharmacist workload has also been linked to burnout, with factors such as the total number of ICU and non-ICU patients and overtime hours worked each identified as independent risk factors. Careful attention should be given to ICU clinical pharmacist staffing models to positively impact quality of care, patient outcomes, and pharmacist wellness.

The primary responsibility of the pharmacist is to assure safe and appropriate use of medications guided by evidence-based principles. In many settings, though, evidence may be conflicting, not methodologically sound, or inconclusive. In addition, the heterogeneity of the ICU population provides additional challenges with the application of evidence-based medicine. Pharmacists must therefore individualize treatment regimens, considering the balance of overall risks versus clinical benefit.

Pharmacists use a structured, comprehensive process to provide patient-centered care delivered in collaboration with other members of the interprofessional team. Critical care pharmacists, as part of that process, use a systems-based or “head-to-toe” approach, similar to other ICU clinicians but with an emphasis on drug-related problems and pharmacotherapy plans ( Fig. 2 , Table 2 ). For example, a critical review of the electronic health record may reveal duplications in therapy (eg, both fentanyl and hydromorphone for severe pain), medications that lack an indication (eg, pantoprazole for stress ulcer prophylaxis in a low-risk patient), opposing medications (eg, norepinephrine and an angiotensin-converting enzyme [ACE] inhibitor), or the need to reinitiate home therapy (eg, continuation of a beta-blocker). In addition, ICU pharmacists must be knowledgeable and integrate nondrug topics, such as mechanical devices (eg, mechanical ventilation, kidney replacement therapies), monitoring devices (eg, advanced hemodynamic monitoring catheter), neurologic assessments (eg, Glasgow Coma Scale), microbiology techniques (eg, minimum inhibitory concentration interpretation), and procedural processes (eg, paracentesis, bronchoalveolar lavage) into treatment plans. Pharmacists also evaluate prior medication use outside the ICU or before hospital admission and incorporate these therapies where appropriate. Some regimens may be inappropriate for use in the ICU because of factors, such as significant drug interactions, altered pharmacokinetics (PK) or pharmacodynamics (PD), newly diagnosed disease states, or an increased risk of adverse effects. Examples are highlighted in Table 3 .

A systems-based assessment for drug-related problems in ICU patients. ABG, arterial blood gas; BP, blood pressure; CBC, complete blood count; CPOT, critical-care pain observation tool; CPP, cerebral perfusion pressure; CrCl, creatinine clearance; GCS, Glasgow Coma Scale; HR, heart rate; ICP, intracranial pressure; NMBA, neuromuscular blocking agent; p bto ₂ , partial pressure of brain tissue oxygen; RASS, Richmond agitation-sedation scale; Tmax, maximum temperature; VTE, venous thromboembolism; WBC, white blood count.

Table 2

Common drug-related problems and examples in intensive care unit patients

Drug-related Problem	Example
Medication used with no medical indication	Acid suppressive therapy for stress ulcer prophylaxis in a patient at low risk for clinically important bleeding
Medical conditions exist with no medication prescribed	Antihypertensive medication for a patient with elevated blood pressure
Medication prescribed inappropriately for a particular condition	Thrice daily octreotide SQ for variceal bleeding instead of continuous infusion
A better alternative exists based on clinical evidence (efficacy/safety)	IV propofol infusion instead of IV midazolam
A more cost-effective alternative exists	Low-molecular-weight heparin for VTE prophylaxis in place of unfractionated heparin
Inappropriate medication dose	Medication adjustment for AKI or ARC
Inappropriate route or method of administration	An opioid medication written for IM administration when IV access is available
Therapeutic duplication	IV hydromorphone and IV fentanyl for severe pain
Medications with conflicting effects or prescribing cascades	Continuation of loop diuretic in a patient requiring fluid boluses for hypovolemia
Severe allergies	Piperacillin/tazobactam in a patient with prior history of anaphylaxis to penicillin
Presence of or potential for adverse drug events	A patient receiving lisinopril for hypertension, ibuprofen for pain, and furosemide for volume overload
Presence of or potential for clinically significant drug-drug, drug-disease, drug-nutrient, or drug-laboratory interactions	A patient receiving enteral levofloxacin with continuous enteral nutrition

Only gold members can continue reading. Log In or Register to continue

Share this:

• Click to share on Twitter (Opens in new window)
• Click to share on Facebook (Opens in new window)

Related

Related posts:

Challenges in Creating a Critical Care Organization at Your Institution Assessing Workforce Competencies for Physicians and Advanced Practice Providers Innovation, Technology, and Telemedicine in Critical Care Critical Care Billing ICU Capacity Management and Surge Preparedness How to Start and Sustain a System-Based High-Reliability Medicine Venture for Your Critical Care Organization

Stay updated, free articles. Join our Telegram channel

Join