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    Objectives: Upon completion of the chapter and exercises, the student pharmacist will be able to
  1. Describe the various departments and personnel that you may encounter in an institutional setting.

  2. Outline differences between the various drug distribution systems available in institutional settings.

  3. List the special needs of acutely ill patients in terms of dispensing oral and intravenous medications that a pharmacist needs to manage.

  4. Describe the role of government and accreditation bodies in terms of quality initiatives within institutional settings.

  5. State the role of a student during rounds.

  6. Identify potential medication regimen assessment activities to assist in patient monitoring.

Patient Encounter

You have been assigned to the ICU satellite for the day. A nurse approaches you with the following order for Patient X and asks for your help:

When you pull up patient X in the computer and quickly review his chart, you obtain the following additional information:

Ht: 5'10”

Wt: 70 kg

Allergies: PCN

SCr: 1.3 (baseline: 0.7, 3 days ago: 1)

Vitals: T 101°F, BP 82/56, P 109, R 25

Discussion for Introductory Pharmacy Practice Experience (IPPE) Students:

After receiving the order, what would you do first?

  1. Start crying.

  2. Put the order aside until your preceptor comes back from lunch.

  3. Go home. Your 8-hour shift is over.

  4. None of the above.

The choices above may seem funny, but this order requires immediate attention by a licensed pharmacist.

Consider the following issues related to the order above:

  • Legibility.

  • Do not use abbreviations.

  • Transfer orders.

  • Missing information.

  • Appropriateness of doses.

  • Do you know what all of the abbreviations stand for?

  • What issues with these orders might have been avoided in a computerized physician order entry (CPOE) environment?

  • Do you know what these drugs are and what they are used for? Where would you go to find out?

Discussion for Advanced Pharmacy Practice Experience (APPE) Students:

Consider the following issues related to the order above:

  • Can you answer all of the questions listed above that are geared toward an IPPE student?

  • Is this patient's renal function normal? Why or why not?

  • How would you empirically dose vancomycin for this patient? Would you recommend vancomycin levels?

  • What is the role of corticosteroids in sepsis?

  • What additional information do you need before dispensing the Zosyn?

  • Would this patient be appropriate for prolonged infusion of Zosyn? What is prolonged infusion? If appropriate, what would regimen be?

  • What coverage will this antibiotic regimen provide?

  • Levophed

    • What is missing from the order?

    • What is the dose?

    • What concentration would you make the drip?

    • What rate should you tell the nurse to set on the pump?

    • What monitoring parameters will you assess?

      • Efficacy

      • Toxicity

  • What additional information do you need from the physician or nurse?

  • Albumin

    • What is the dose?

    • How should the order be written?

    • Is the order appropriate?

    • How fast should it be infused?

    • What monitoring parameters will you assess?

    • Do you need ...

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