R.Ph.s are playing greater role in critical care

A huge focus on patient safety, a severe nursing shortage, and a shift in philosophy about how traditional medicine has come to view the role of pharmacy have led to health-system pharmacists playing a much larger role in critical care and emergency medicine. Nationwide, especially at large tertiary care centers, pharmacists have become permanent and welcome members of healthcare teams in intensive care units, trauma centers, and coronary care units. The demand for pharmacists is so great that some facilities have developed critical care residencies for pharmacists.

At Dallas' Parkland Health & Hospital System, pharmacist teams rotate through intensive care units (ICUs), where they help put together drug therapy protocols, assist with antimicrobial monitoring, check the compatibility of drugs, check for allergies, consult with doctors, and counsel patients. In the hospital's level one trauma center, a pharmacist is on duty 24/7 in the acute care emergency room pharmacy.

For pharmacy director, Vivian Johnson, Pharm.D., the focus on patient safety and responding to a nursing shortage is driving the demand for pharmacists to provide support in critical care areas. "We have been able to reduce the potential for medication errors because of our presence in those high-risk areas," said Johnson.

At Charleston Area Medical Center-Memorial (CAMC) in Charleston, W.Va., critical care pharmacists monitor patients in the open heart, coronary critical care unit, and in the medical and surgical ICUs. "They provide a full complement of clinical services, including total drug regimen monitoring," said director of pharmacy Clyde Spence, Pharm.D. Spence contends that pharmacists are attracted to critical care because it's multifaceted and presents great challenges. In some health systems, demand is soaring for pharmacists in critical care areas. Spence said that he's looking to increase FTEs (full-time equivalents) from 14 to 18.

In the past, physicians had to be sold on the idea of including pharmacists as part of the mainstream medical team along with nurses and doctors. Not anymore, contends Daniel Page, Pharm.D., director of pharmacy at Sharp Memorial Hospital in San Diego. "The doctors are becoming more receptive to the use of pharmacy in areas such as critical care and emergency medicine. The demand that's out there for us is extremely high," he said.

At Sharp, pharmacists attend trauma rounds, provide specialized anticoagulation, offer antibiotic surveillance, and are part of several multidisciplinary teams that address rapid response to sepsis and optimal sedation in the ICU.

According to John Engelbert, Pharm.D., Sharp's clinical pharmacy coordinator, in the area of medication error prevention, pharmacists have been an excellent resource as consultants working with physicians in optimizing therapy. "There's the safety component, because by optimizing therapy, you're going to reduce the adverse drug events that occur and the treatment failures. And where we've really carved out a niche is in more of the high-risk, difficult-to-treat patients," said Engelbert.

Page told Drug Topics that recent pharmacy school graduates have been showing a very strong interest in critical care. To meet that growing demand, the pharmacy department at Sharp Memorial is developing a critical care residency that may start as early as November. "It helps recruiting," said Engelbert. "This is where pharmacists want to go, and we have services where they really feel they are contributing directly to patient care and where they can partner with different disciplines, including medicine."