The Elective Rotation: A Critical Care Hospital Pharmacy Podcast

Temporary summary

Show notes at pharmacyjoe.com/episode24. In this episode we ll be talking with one of the most talented and patient focused respiratory therapists I know.

Temporary summary

Temporary summary

Show notes at pharmacyjoe.com/episode23. In this episode, I ll give real world patient care examples of how to remember and apply the concepts of sensitivity, specificity and predictive value as they relate to medical tests.

Temporary summary

Show notes at pharmacyjoe.com/episode22. In this episode I ll discuss the recognition and treatment of acquired methemoglobinemia.

Show notes at pharmacyjoe.com/episode21. In this episode I ll be talking about how ICU rounds are structured and how I participate in ICU rounds, including when and how I present my recommendations.

Most of my pharmacy students are surprised that I look at medications last in my pre-rounding review of ICU patients.

I am constantly tweaking and improving my method for pre-rounding on ICU patients. Here is my current routine for evaluating new ICU patients in preparation for patient care rounds.

Whenever possible I like to be in front of the patient’s room when I evaluate them before rounds. By observing the patient I can see how sick they look, whether they are intubated or have SCDs on. If the NG tube is being used for tube feeding, I know it can be used for meds too. Inadequate sedation or other problems can easily be identified by a brief observation of the patient. Also, being this close to the bedside I am available for nurses to ask me questions and to be side-by-side with the provider as they determine solutions to the patient’s problems.

In this episode, I’ll discuss how I build my pharmacy problem list, use a paper report to supplement the electronic system, list my current 5 step pre-rounding process, and explain how I prioritize which patient to see first.

Pharmacy problem list

At each step of my evaluation of the patient, I am filling out my note template in the pharmacy computer system with my “pharmacy problem list". This note template is not meant as a permanent part of the record and is not viewable to non-pharmacy staff, rather it is meant for me (or my resident/student) to track the patient’s problems and our recommendations.

Recommendations -
VAP -
VTE –
SUP –
Reason for Admission -
PMH –
Drips –
Respiratory –
Infectious –
Cardiac –
Hematologic –
Metabolic –
Alimentary –
Neurologic –

The purpose of this note template is to:

-help track and solve problems
-remember my recommendations for rounds
-provide basic information to “refresh my memory” about a patient when asked a question in the middle of the day
-provide a starting point to begin my review of the patient the next day

I have limited time to finish pre-rounding, and the purpose of the note is to facilitate problem solving so I do not copy-paste lab values or medication orders into my note.

Paper report

I use a paper report to facilitate my pre-rounding review of patients. The report also serves as a “bare minimum” for me to review if other priorities cut into the time I have to pre-round on patients. The report includes basic demographic information for the patient, creatinine clearance estimate, allergies, creatinine/potassium/magnesium/wbc/hb/plt and any current orders for antibiotics, stress ulcer prevention, steroids, anticoagulants, or chlorhexidine.

The paper report serves as a “2nd computer screen” and allows me to see more information at once.

 

My 5 step pre-rounding process:

1. Read the history & physical, consult and progress notes to determine who is the patient and why are they here
2. Review home medications
3. Review labs, cultures and imaging reports
4. Review the bedside flow sheet
5.

Show notes at pharmacyjoe.com/episode20. In this episode, I ll discuss how I build my pharmacy problem list, use a paper report to supplement the electronic system, list my current 5 step pre-rounding process, and explain how I prioritize which patient to see first.