Patient in Intensive Care Unit
By IHPL - May 1, 2024

Pharmacy workforce sustainability has emerged as a major public health problem in a variety of practice settings across the United States. While much of the focus has centered around workforce staffing shortages and burnout in corporate, retail chain pharmacies, it is important to acknowledge that similar workforce issues exist within hospital pharmacy environments as well.1-2  Hospital pharmacists face multiple challenges in terms of sustaining their workforce. A recent, cross-sectional evaluation of hospitalized inpatients in Canada revealed that the complexity of hospitalized inpatients has increased over the past 15 years.3  This complexity stems from factors such as the presence of clinical comorbidities, the number of acute medical issues, age, and the number of medications used, mirroring trends observed in the United States.4  As patient medication needs grow more complex, the demand for clinical pharmacy services increases, particularly in the face of staffing shortages.

While a number of national professional organizations, health system leaders, state boards, and government officials continue to raise concerns, offer wellness initiatives, or introduce regulations, these approaches fail to recognize and proactively address several of the inputs contributing to workforce sustainability issues across the profession. Some operational inputs involve tasks such as the increasing time burdens associated with managing immunization workflows, manual efforts to develop pharmacy staffing schedules, and refining monitoring strategies to mitigate an increasing number of drug shortages. Each of these tasks disproportionately consumes time that could otherwise be dedicated to direct patient care activities. Several of these inputs could be addressed by taking better advantage of improvements in technology, including AI, to address system-wide burdens such as pharmacist staff shortages and scheduling that impact patient outcomes.

Interestingly, pharmacist participation in the ICU at the time of drug prescribing has been shown to reduce adverse events.5  However, the precise practitioner-to-patient ratios to optimize pharmacist impact on ICU outcomes remains unclear.6  To address this, an observational cohort study, the Optimizing Pharmacist Team-Integration for ICU patient Management (OPTIM), is currently underway that leverages AI to quantify the impact, workload, and staffing of critical care pharmacists’ care in the ICU and their influence on patient outcomes.7  The study uses and compares traditional and machine learning methodologies to evaluate patient mortality, pharmacist workload, and a myriad of additional metrics in the ICU to identify whether clusters of patients receiving the most ICU resources have superior outcomes. The insights gleaned from this study can better inform resource allocation strategies and policies across inpatient pharmacy settings, ensuring adequate staffing during periods of heightened ICU and hospital occupancy to mitigate pharmacy workload effectively and improve workforce sustainability.

Author Bio:

Kyle M. Sousa, PhD

Dr. Sousa is a Professor of Pharmaceutical Sciences and currently serves as the Dean of the School of Pharmacy. His research interests include pharmacy workforce sustainability and professional advocacy efforts.


  1. California State Board of Pharmacy, Department of Consumer Affairs Workforce Survey:
  2. Assembly Bill 1286:
  3. Naik H, Murray TM, Khan M, et al. Population-Based Trends in Complexity of Hospital Inpatients. JAMA Intern Med. 2024;184(2): 183–192.
  4. Anderson LA, Goodman RA, Holtzman D, Posner SF, Northridge ME. Aging in the United States: opportunities and challenges for public health. Am J Public Health. 2012;102(3): 393-395.
  5. Leape LL, Cullen DJ, Clapp MD, et al. Pharmacist Participation on Physician Rounds and Adverse Drug Events in the Intensive Care Unit. JAMA. 1999;282(3): 267–270.
  6. Newsome, AS, Smith, SE, Jones, TW, Taylor, Van Berkel, MA, and Rabinovich, M. A Survey of Critical Care Pharmacists to Patient Ratios and Practice Characteristics in Intensive Care Units. JACCP. 2019; 3(1): 68-74.
  7. Keats, K, Sikora, A, Heavner, MS, Chen, X, Smith, SE. Optimizing Pharmacist Team-Integration for ICU Patient Management: Rationale, Study Design, and Methods for a Multicentered Exploration of Pharmacist-to-Patient Ratio. Critical Care Explorations. 2023; 5(9): e0956.