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At some point during your pharmacy education, perhaps while learning therapeutics in the classroom or while practicing patient care on your rotations, you will learn something very important about yourself. Either you will decide that you belong in a primary care setting (e.g., clinic and outpatient pharmacy) or that your calling is in the acute care environment (e.g., inpatient hospital and emergency department [ED]). Of course, there are some students who are not inclined either way and others who make this decision during their Postgraduate Year One (PGY-1) residency or later in their career. Nonetheless, if you prefer a fast paced environment, thrive under stressful conditions, or if you consider yourself to be an “adrenaline junkie,” then your passions likely fall into the acute care category.

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“Choosing a PGY1 residency program with a broad selection of rotations is one of the most common recommendations that I give to students inquiring about and candidates interviewing for residency.”

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Kara G. – Pharmacy Resident, Georgia

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The term acute care is rather broad and incorporates a variety of disciplines within the hospital setting. However, in this chapter we will discuss three specific areas of pharmacy practice, in which patients require a very high acuity of care. These specialties are critical care, emergency medicine, and nutrition support.

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When you conjure up images of a hospital setting in which you see a healthcare team, what do you see? Well, perhaps because of subtle biases that may have crept into my psyche during my training or maybe because of watching too many movies and television shows, I usually see professionals wearing white coats, standing in a circle next to a patient, while contemplating life or death decisions. Most of them look very serious. One of them is older than the rest, and appears to be listening intently to a younger doctor explaining the situation at hand. In my mind, I also see a pharmacist providing drug-related suggestions. It is possible that you may dream differently, but if there is one place in the hospital where you will see a scene like this, it is in the intensive care unit (ICU).

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The value of pharmacists on the critical care team in the ICU is well studied. In fact, in one landmark study published in the Journal of the American Medical Association (JAMA) in 1999,1 the presence of a pharmacist on patient care rounds in the ICU decreased preventable adverse drug events by 66%, compared to a time period when there was no pharmacist. Also, a historic moment for critical care pharmacists was when a pharmacist (Dr. Judith Jacobi) was elected as the president of the Society of Critical Care Medicine (SCCM) in 2010. In addition, the Critical Care PRN is one of the largest groups of all sections in the American College of Clinical Pharmacy (ACCP). When you look globally at the literature ...

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