Critical care pharmacy components

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. 

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... 

Drug-related problems can be defined as Any undesirable event experienced by the patient that involves or is suspected to involve drug therapy and that actually or potentially interferes with a desired patient outcome (Strand et al. 1990). This is a vital component of Pharmaceutical Care and Clinical Pharmacy and will be described more in detail in another chapter. It should however be noted that there are several definitions and classification systems for DRPs. A literature review (van Mil et al. 2004) identified fourteen classifications and their critical elements. In the presented definition a potential problem is a DRP but this is not the case in all definitions and classifications. This is also the case for unavoidable adverse drug reactions (e.g. with cytotoxic agents). 

Leadership is an important concept that transcends all health care professions. The acceptance of this role by all health care professionals is vital to the invention of new technologies and dosage forms, changes in the delivery of health care, enhancement of patient outcomes and quality of life, and success of their specific health care organization. The opportunities for pharmacists to be leaders in their practice setting, the pharmacy profession, and the community are plentiful. Leadership is a critical component for positive change within pharmacy organizations and the profession. 

Patient data collection is an extremely critical component of a value-added service. The information collected provides pharmacists with important baseline and monitoring parameters for patients. The amount and type of information needed from the patient or other health care providers may differ depending on the service, but nonetheless, this information is the foundation on which the other components of the service are built. Forms can be developed to help pharmacists collect this information (see Figs. 25-2 through 25-4). In addition, some consideration should be given to how this information will be stored (e.g., paper charts or electronic patient database). The information that should be collected from the patient includes demographic information, medical history, family history, and medication history. Since some of the information may need to be collected from other providers and health care institutions, an authorization to release medical information should be signed by the patient and kept as part of the chart (see Fig. 25-5). Lastly, pharmacists should ensure that their site is in compliance with the Health Insurance Portability and Accountability Act (HIPPA) and reinforce to their patients that the information they provide is confidential and secure at the pharmacy. 

The term pharmacy and hospital services refers to departmental and institutional/organizational components of the infrastructure that support the pharmacist s activities. They consist of systems, operations, and personnel who facilitate and support the provision of patient care, teaching, and research to optimize safe and effective pharmaceutical care of the critically ill. 

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