đź”´My top 10 key points to help first timers ICU pharmacist/ trainees đź”´ #icuRxlesson @icu_pharm #pharm_icu
1/Know the ICU protocols, each hospital and critical care units have several protocols. These protocols are either guidelines driven, or hospital-based on best practice. Understanding your units’ protocols will save you a lot of time and effort when assessing therapeutic plans
2/don't start your patients work up by reviewing medications. Use the ICU checklist, there are tons of readily available ICU checklists that can be utilized by any ICU staff. One commonly uses is the FASTHUGBID, MAIDENS..etc
3/Now you are familiar with the ICU protocols & you have created ICU checklist (there is no right or wrong use any list that ensures covering all aspects of the therapeutic plan)..
3/.. Play in your playground, once you start reviewing the patient’s profile, we tend to be lost with a huge amount of information especially for long-standing ICU patients. Don’t overwhelm yourself with information that other providers are taking care of
4/So be the PHARMACIST and focus on the information that helps you to assess the patients' therapeutic plans, identify drugs related problems, evaluate, monitor the therapy..etc
5/ I can’t stress enough on the importance of prioritization. Review overnight admissions before other patients, review sicker patients before stable patients, check patients on high-risk medications m or needing TDM first..etc
6/Have more questions than answers. Remember, you are in a dynamic environment, things change very fast, patients becoming unstable suddenly, minor errors can be major in ICU patients.
” don’t rush yourself to answer the questions but question everything”
” don’t rush yourself to answer the questions but question everything”
7/Train yourself that things can’t wait in the ICUs. If you want to adjust medications, make recommendations…etc. do it when it is time. Practice critical thinking and divide your recommendations to part need to be addressed now, some can be addressed during the round..
7/others could be done after round. Remember to close the loop and to communicate your recommendation clearly to the person taking care of that patient (multiple levels of care in ICU requires multiple providers involved in one patient, things get lost in the communication cycle)
8/One size doesn’t fit all. A Septic patient in ICU bed number one is totally different than a Septic patient in ICU bed number 2, there are tons of points making their management completely different!
9/Not all ICU patients are comatose, not everyone in ICU are intubated, not every patient needs to be sedated, CrCl is inaccurate for dose adjustments, drips are MEDICATIONS that needs to be evaluated by pharmacist and working with ICU team in weaning them as soon as feasible
10/Emotions can get you so hard, connections with your patients, being part of their management makes you feel being part of their story. Just remember as ICU pharmacist that one minor intervention in the therapy could lead to improving your patient outcomes @rattibha
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