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KEY CONCEPTS
Pharmacists are one member of the interdisciplinary patient care team; other members include physicians, nurses, advanced providers, physical therapists, and respiratory therapists.
There are numerous types of ICUs that pharmacists can work in such as burn, cardiovascular, medical, neurology, surgical, trauma, and tele-ICU. Patients in each of these units will have specific care needs.
Fundamental activities of a critical care pharmacist include evaluation of medications for appropriate indication, dose, and general appropriateness; monitoring of medications and identification of ADEs.
The management of ICU patients may lead to long-term cognitive effects in survivors.
Medication errors and ADEs are more common in the ICU than general care units. Medication errors can lead to ADEs, which are often preventable.
Management of renally-excreted and nephrotoxic drugs is important to avert unwanted adverse effects and possibly prevent disease progression.
Critical care pharmacists’ participation in patient care rounds decreases the rate of ADEs.
One-third of total hospital drug costs are attributed to drug use in the ICU, so pharmacoeconomic analyses are important to make informed decisions about drug selection.
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Preclass Engaged Learning Activity
Watch the video “ICU episode 1, season 1” at https://youtu.be/bSJnu5Btdmg. This short video provides insight into the complexity of care provided in a contemporary intensive care setting, as well as the differences in the care required of critically ill patients compared to patients in general care units. The video is useful to enhance student understanding regarding the COLLECT and ASSESS steps in the patient care process.
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A clinician’s initial exposure to critically ill patients within the intensive care unit (ICU) is challenging. Critically ill patients commonly have multiple lines in place and are attached to life-support machines (eg, mechanical ventilation, continuous renal replacement therapy), which may appear foreign and/or difficult to manage. This chapter provides a brief overview of the complexity of care and the role of a pharmacist in the care provided in a contemporary intensive care setting.
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History of Critical Care Pharmacy
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Clinical pharmacy services began in the 1970s and are currently considered an essential resource for ICU patient care.1–3 This is unique as few disciplines have documented the positive value of pharmacists as clearly as critical care medicine. Despite this, a survey in 2006 found that only 62.2% of respondents (n=382) in the United States had a dedicated ICU pharmacist.4 Similarly, only 74.4% of respondents (n=168) to an international survey indicated a dedicated pharmacist attended daily rounds.5
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Over the past three decades, critical care pharmacy has evolved considerably. Select examples of notable advances include the following:
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Creation of the Clinical Pharmacy and Pharmacology section within the Society of Critical Care Medicine (SCCM; 1989)
Creation of the Critical Care Practice and Research Network within the American College of Clinical Pharmacy (1992)
Critical ...