Critical care pharmacy

Critically ill patients are at high risk for a variety of nosocomial infections. Knowledge of infection control techniques, as well as proper use of prophylactic and empiric antibiotics, is an important component of critical care pharmacy practice. Inappropriate antibiotic use can lead to antimicrobial resistance and outbreaks of nosocomial infection that are difficult to treat with conventional therapies. Critical care pharmacists work with infection control staff and infectious disease pharmacists to optimize the use of antimicrobial therapies. 

A focal point for critical care pharmacists and hospitals with critical care units is a position paper on critical care pharmacy services jointly developed and published by ACCP and SCCM. - This paper identifies and describes the fundamental, desirable, and optimal activities that define the scope of practice of the critical care pharmacist (Table 2 ). Fundamental activities are deemed vital to the safe provision of pharmaceutical care to the critically ill patient. The fundamental responsibilities of critical care pharmacists include a full-time commitment to critical care patients, evaluation of all drug therapy, identification of adverse events, individualized drug dosing, provision of drug information, documentation of activities, and... 

ASHP Supplemental Standard and Learning Objectives for Residency Training in Critical Care Pharmacy Practice. www.ashp.com/public/rtp/SUPPSTND.html (accessed Nov. 2000). 

Task Force of the Clinical Pharmacy and Pharmacology Section of the Society of Critical Care Medicine and the Critical Care Practice and Research Network of the American College of Clinical Pharmacy Position paper on critical care pharmacy services. Pharmacotherapy 2000, 20 (I I), 1400 1406. 

The object was to identify and describe the scope of practice that characterizes the critical care pharmacist and critical care pharmacy services. Specillcally the goals were to define the level of clinical practice and specialized skills characterizing the critical care pharmacist as clinician, educator, researcher, and manager and to recommend fundamental, desirable, and optimal pharmacy services and personnel requirements for the provision of pharmaceutical care to critically ill patients. Hospitals having comprehensive resources as well as those with more limited resources were considered. 

The discipline of critical care pharmacy practice evolved since the mid-1970s to become an essential component of the multidisciplinary team in the intensive care unit (ICU). In the early 1970s, there were a few practitioners in critical care who were members of surgical or... 

Since the early 1990s, clinical pharmacy became increasingly specialized and developed specialty board certification. The growth of critical care pharmacy practice paralleled this development. Pharmacists assumed in-... 

Despite the growing evidence supporting the critical care pharmacist s contribution to patient care, many ICUs have not taken full advantage of this vital resource.A description of pharmacy services and pharmacist activities in a critical care setting will assist practitioners and administrators in establishing or advancing these specialized pharmacy services. This article may be used to educate other health care providers, administrators, and developers of health care policy on the role of pharmacists and pharmacy services in the care of the critically ill. Furthermore, the application of the elements in this article will allow researchers to further document the effect of critical care pharmacy services on improving patient outcomes. 

This article identifies and describes the scope of pharmacy practice of the critical care pharmacist and critical care pharmacy services. Specifically, the aims of the Task Force on Critical Care Pharmacy Services were ... 

A single pharmacist cannot perform all the fundamental activities on all patients every day. Rather, these critical care pharmacy activities will require varying levels of involvement from multiple pharmacists and trained technicians acting as a team, along with support from pharmacy and hospital administrators, and other personnel. The exact allocation of labor and the pharmacist-to-patient ratio will vary by institution and depend on the level of care, the acuity of patients, and the degree of specialization of the institution. 

The pharmacist develops residencies and/or fellowships in critical care pharmacy practice. 

American Society of Hospital Pharmacists. Supplemental standard and learning objectives for residency training in critical care pharmacy practice. Am. J. Hosp. Pharm. 1990, 47, 609-612. 

Bearce, W.C. Documentation of clinical interventions Quality of care issues and economic considerations in critical care pharmacy. Hosp. Pharm. 1988, 23, 883-890. 

ACCP Position Statement. Position paper on critical care pharmacy services. Pharmacotherapy 2000, 20, 1400 1406. 

Assistant Professor of Chnical Pharmacy and Chnical Emergency Medicine, School of Pharmacy and Keck School of Medicine, Uiuversity of Southern Califoriua, Los Angeles, USC School of Pharmacy, Director, Emergency Medicine and Critical Care Pharmacy Residency Program, Los Angeles, California Chapter 23... 

---