Being Critical as a Critical Care Pharmacist

Critical care is a rapidly expanding pharmacy specialty, and today's pharmacy students have more opportunities than ever to become successful critical care pharmacists if they demonstrate their expertise and their commitment to the lives of their patients. As our role as pharmacists expands towards decentralization in the hospital setting, the ability to analyze and practice evidence-based medicine will become crucial in providing optimal patient care. In particular, being hands-on with the interdisciplinary health care team will be imperative to identifying patients’ needs.

Working as pharmacists in the intensive care unit begins with our ability to be engaged and meticulous in identifying key patient interventions. Pharmacists must be able to assess the status of each organ and determine the patient’s problem list. Addressing the patient’s neurological status, checking vitals for hemodynamic stability, managing pain, and knowing when prophylaxis is indicated are all factors in providing a care plan for the patient.

Along with the roles aforementioned, the pharmacist aids in evaluating the need for fluids, diuretics, or stool-inducing medications, while taking into consideration the patient’s input/output, nutritional status, and comorbidities. Additionally, pharmacists must remember to address liver function, as well as any drug monitoring parameters. Ensuring that patients are on their home medications, identifying possible intravenous to enteral agents, and verifying proper medications are also important in performing an intervention. Antibiotic stewardship is a core part of critical care, and many times, the physician will rely on the pharmacist’s recommendations and expertise.

There are many other variables contributing to a patient’s stay in the intensive care unit, and it may often prove challenging to address each variable. Prioritizing a patient’s problem list correctly can be useful when mapping out a clear treatment approach; listing short term goals for a patient's hospital stay and long term goals for after discharge can be a suitable mechanism in this regard. Goals for each patient are both patient and disease specific, and require understanding a patient’s baseline; for example, the blood pressure goal of a patient with hypertension will be different than the goal of a patient without hypertension. Often, something that may appear pertinent will not be addressed during the hospital stay because it is not contributing to the chief complaint and underlying cause of the patient’s current health state.

As health care providers, we take an oath to provide the best attainable care to our patients. Today, the pharmacist’s role continues to grow into an integral part of the medical field. We are no longer verifying orders alone, but also contributing to rounds, managing medication therapies for our patients, and participating in codes and medical emergencies. Ultimately, intensive care pharmacists are accessible and skilled health care providers who go above and beyond their minimal required duties to care for the patient while doing their due diligence to promote the highest attainable level of care. How will you make a difference in your hospital and career? The opportunity is find out is here.

Dina F. Kheir is a 2019 PharmD candidate at the Florida A&M University College of Pharmacy.