The Critical Care rotation at Cape Fear Valley Health System is a one month, clinically oriented experience.  The resident would assume the role of Critical Care Pharmacist and be involved in pharmaceutical care in the Medical and Surgical Intensive Care Units. The resident would rotate through with the Rapid Response Team and carry the RR pager (after completing CPR and ACLS certification). Activities include pharmacokinetic dosing, reviewing and developing therapeutic antibiotic regimens (TDM), and rounding with various physician services that provide pharmaceutical care for the critical care patient.

Resident Learning Activities

1. Participate in interdisciplinary rounds – this will help gain an understanding of rational drug therapy and its application to patient care.  Develop skills in working as a member of the multidisciplinary critical care team. The resident will round with different members of the interdisciplinary team and with various physicians as time permits.

2. Monitor and follow patients in the surgical and medical intensive care units.  Monitor patients daily for most recent vital signs and labs (weight, temperature, pulse, respiration, blood pressure, serum creatinine, fluid balance, WBC, cultures and sensitivities).

3. Review medication administration data (Medication Reconciliation form from inception in ED to floor) and assist in reconciling patient’s home medications with hospital treatment.

4.  Evaluate basic drug information and be prepared to discuss.

5. Describe and understand the pathophysiology and medication implications of commonly encountered disease states / topics in critical care patients.   Various critical care disease states / topics will be covered during the month through reading assignments, discussions, case presentations and/or direct patient care. Topics may include, but are not limited to the following:

• ICU sedation and neuromuscular blockade

• Vasopressors and inotropes

• Antibiotics and antifungals

• Stress ulcer prophylaxis

• Deep vein thrombosis- prevention and treatment

• Sepsis, Severe Sepsis, and Septic shock

• Adult Respiratory Distress Syndrome

• Acid/Base Disorders

• Pneumonia (Community acquired, nosocomial, VAP)

• Dialysis and Renal failure (chronic vs. acute renal failure)

• Fluid and electrolyte disorders

• Tight glycemic control in ICU

6. Document ADRs and Medication Occurrences on-line per hospital protocol.

7. Apply pharmacokinetic principles to the critically ill patient. Dose and monitor vancomcyin, aminoglycosides, heparin, warfarin and other antibiotics and medications as per hospital protocol.

8. Interdisciplinary experiences as time permits: shadow a clinical dietician, respiratory therapist, and wound care nurse. If possible, observe an organ harvest with Carolina Donor Services team.

9. Perform and document IV to PO conversions as part of the IV to PO Step-down program.

10. Answer medication-related questions from physicians, nurses, other health care professionals, patients, and families.

11. Document all clinical pharmacy interventions and drug information requests throughout the month.

12. Evaluate new and existing medications for use in a critical care setting and take part in the formulary review process, if the opportunity is available.  Attend Pharmacy and Therapeutics Committee meeting.

13. Become proficient in the use of computers for data-gathering and patient care.

14. Provide at least two oral presentations on a critical care topic to pharmacists, physicians, nurses, students, or other health care professionals.   Topic must be selected by end of 2^nd week.

15. Inservice to Critical Care school nurses.

16. Provide Coumadin education for patients and families upon consult.