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Critical Care Practice Residency Rotation Overviews

Critical Care Practice Residency
Rotation Overviews

Surgical-Trauma Intensive Care Unit

The Surgical - Trauma Intensive Care Unit rotation is a four week surgery / critical care rotation for pharmacy residents. This rotation provides provision of pharmaceutical care for those patients in the SICU. The SICU is a 10 bed unit for critically ill general surgery, trauma, orthopedic, and transplant patients. The complete spectrum of pharmaceutical care services experienced during the rotation include:

  • Patient profile review with problem medication order identification and resolution
  • Assistance with medication order entry, order review and order clarification
  • Rounding with SICU and primary surgery teams
  • Providing pharmacokinetic and nutritional support consults
  • Interaction with nurses, physicians, and nutritional support specialists
  • Coordination of distribution problems not resolved by in-patient pharmacy
  • Core content which will be covered via patient experiences, discussions of reading materials, and/or case presentations includes a review of:
  • Post-operative infectious complications
  • Venous thrombosis prophylaxis
  • Gastrointestinal stress ulcer prophylaxis
  • ICU analgesia, sedation, and neuromuscular blockade
  • Monitoring cardiovascular parameters when using inotropes
  • Sepsis and inflammatory response syndrome (SIRS)
  • Nutritional support for critically ill surgery patients
  • Pharmacokinetics in critically ill patients
  • Multiple organ failure and oxygen delivery in critically ill patients
  • Fluid balance and fluid replacement in critically ill patients

 

Medical Intensive Care Unit

The Medical Intensive Care Unit rotation is a four week medicine/critical care rotation for pharmacy residents. This rotation allows for the provision of pharmaceutical care for those patients in the MICU. The MICU is a 12 bed unit for critically ill medicine patients. The complete spectrum of pharmaceutical care services experienced during the rotation include:

  • Patient profile review with problem medication order identification and resolution
  • Assistance with medication order entry, order review and order clarification
  • Rounding with MICU multidisciplinary team
  • Providing pharmacokinetic and nutritional support consults
  • Interaction with nurses, physicians, and nutritional support specialists
  • Coordination of distribution problems not resolved by in-patient pharmacy
  • Core content which will be covered via patient experiences, discussions of reading materials, and/or case presentations includes a review of:
  • Acute respiratory distress syndrome (ARDS)
  • Venous thrombosis prophylaxis
  • Gastrointestinal stress ulcer prophylaxis
  • ICU analgesia, sedation, and neuromuscular blockade
  • Monitoring cardiovascular parameters when using inotropic/vasoactive agents
  • Sepsis/septic shock/systemic inflammatory response syndrome (SIRS)
  • Nutritional support for critically ill patients
  • Pharmacokinetics in critically ill patients
  • Multiple organ failure and oxygen delivery in critically ill patients
  • Fluid balance and fluid replacement in critically ill patients
  • Acute alcohol withdrawal
  • Diabetic ketoacidosis (DKA)
  • Hypertensive emergency
  • Acute gastrointestinal bleeding
  • Status asthmaticus
  • Acute overdoses (tricyclic antidepressants, acetaminophen)
  • Acute renal failure/uremic bleeding/acid-base disturbances
  • Disseminated intravascular coagulation (DIC)

 

Pediatric Intensive Care Unit

The Pediatric Intensive Care Unit (PICU) rotation is a four week critical care rotation for pharmacy residents. The focus of this rotation is the provision of complete pharmaceutical care services to the PICU patient population. The PICU is a 12 bed medical/surgical tertiary care unit. The patients range in age from newborns to young adults. In addition to trauma and general medical cases, the most frequent post-operative admissions are for neurosurgical procedures, open heart surgery, orthopedic surgery, or solid organ transplantation. The PICU is also capable of providing many new and investigational therapies, including extracorporeal membrane oxygenation (ECMO) and inhaled nitric oxide. Residents will be required to provide the following services:

  • Daily patient profile review with identification and resolution of patient medication problems
  • Daily rounding with the PICU service
  • Pharmacokinetic consultations
  • Drug information services
  • Coordination of medication ordering and distribution problems, working in conjunction with the inpatient pediatric pharmacy
  • Attendance at the daily PICU resident lecture series
  • Documentation of activities through the MIS intervention pathway
  • Core content which will be covered through patient experiences, discussions of reading materials, workbook exercises, and/or case presentations include:
  • Basics of pediatric pharmacotherapy
  • Drug dosing in children
  • Post-operative care of the critically ill child
  • Nutritional management of the critically ill child
  • Management of sepsis and meningitis
  • Management of asthma exacerbations
  • Management of status epilepticus
  • Basic principles of toxicology
  • The role of the pharmacist during a pediatric emergency

 

Neonatal Intensive Care Unit

The Neonatal Intensive Care Unit (NICU) rotation is a four week critical care rotation for pharmacy residents. The focus of this rotation is the provision of complete pharmaceutical care services to the NICU patient population. The NICU is a 34 bed unit, divided into 4 "pods" based on patient acuity. The patients include both premature infants and term babies with underlying disease. One "pod" is devoted solely to infants born weighing less than 1 kg. The NICU is involved in several investigational drug studies and is capable of providing many new therapies, including extracorporeal membrane oxygenation (ECMO) and inhaled nitric oxide. Residents will be required to provide the following services:

  • Daily patient profile review with identification and resolution of patient medication problems
  • Daily rounding with the NICU service
  • Pharmacokinetic consultations
  • Drug information services
  • Coordination of medication ordering and distribution problems, working in conjunction with the inpatient pediatric pharmacy
  • Participation with the NICU Interdisciplinary Quality Improvement Committee
  • Documentation of activities through the MIS intervention pathway
  • Core content which will be covered through patient experiences, discussions of reading materials, workbook exercises, and/or case presentations include:
  • Basics of neonatal pharmacotherapy
  • Drug dosing and fluid management in neonates
  • Post-operative care of the critically ill infant
  • Nutritional management of the critically ill infant
  • Management of sepsis and meningitis
  • Management of congenital heart defects
  • Management of neonatal seizures
  • Management of apnea of prematurity
  • Management of neonatal necrotizing enterocolitis 

 

Transplant Surgery Service

The Transplant Surgery rotation is a four week surgery / critical care rotation for pharmacy practice residents. This rotation provides pharmaceutical care for those patients in the SICU for immediate postoperative care and the transplant unit for preparation for discharge. The Transplant Surgery Service performs surgery and long term care for adult and pediatric liver, kidney and pancreas recipients. An extensive research program is associated with the Transplant Surgery Service to learn more of the pharmacology of transplant immunosuppression and to provide cost effective therapy to transplant recipients. The complete spectrum of pharmaceutical care services are experienced during the rotation including:

  • Patient profile review with problem medication order identification and resolution
  • Enforcement of transplant service policies to initiate / discontinue standard medical therapies
  • Assistance with medication order entry, order review and order clarification
  • Aid patient enrollment into and monitoring on investigational drug protocols
  • Participation in patient education program and discharge planning process
  • Rounding with Transplant Surgery team
  • Provision of pharmacokinetic and nutritional support consults
  • Interaction with nurses, physicians, and nutritional support specialists
  • Coordination of distribution problems not resolved by in-patient pharmacy
  • Completion of core content will be achieved via patient experiences, discussions of reading materials, and/or case presentations to include:
  • Surgical techniques of organ transplantation
  • Medical and surgical complications of organ transplantation
  • Techniques of immunosuppression
  • Identification and treatment of rejection
  • Post-operative infectious complications
  • Nutritional support for critically ill transplant patients
  • Pharmacokinetic analysis in unstable / dynamic patients
  • Fluid balance and fluid replacement in surgical patients

 

Thoracic Cardiovascular Post Operative Unit

The Thoracic Cardiovascular Post Operative Unit rotation is a six week surgery/critical care rotation for pharmacy residents. This rotation provides provision of pharmaceutical care for those patients in the TCVPO and 4 West. TCVPO is a 10 bed post-operative unit for cardiac, thoracic and vascular surgeries, and for cardiac and lung transplant patients. The complete spectrum of pharmaceutical care services are experienced during the rotation include:

  • Patient profile review with problem medication order identification and resolution
  • Assistance with medication order entry, order review and order clarification
  • Rounding with the Cardiac surgery team
  • Providing pharmacokinetic and nutritional support consults
  • Interaction with nurses, physicians, and nutritional support specialists
  • Coordination of distribution problems not resolved by in-patient pharmacy
  • Core content which will be covered via patient experiences, discussions of reading materials, and/or case presentations includes a review of:
  • Post-operative infectious complications
  • Post-operative atrial fibrillation
  • Gastrointestinal stress ulcer prophylaxis
  • ICU analgesia, sedation, and neuromuscular blockade
  • Cardiovascular hemodynamic monitoring
  • Nutritional support for the TCVPO surgery patients
  • Pharmacokinetics in critically ill surgery patients
  • Fluid balance and replacement in the TCV surgery patient
  • Post operative nausea and vomiting

 

Ambulatory Care

The ambulatory care rotation is a four week rotation for pharmacy residents. This rotation provides provision of pharmaceutical care for patients seen in the University Medical Associates clinic. The UMA clinic is an internal medicine clinic composed of medical residents and attendings, nurses, nurse practitioners, social workers, and pharmacists serving a dual purpose of providing patient care and offering an ideal setting for resident outpatient education and training. The Therapeutic Drug Monitoring clinic provides drug therapy monitoring and medication adjustment for diagnosed and treated patients referred by their primary physician. The pharmacy services that will be experienced during the rotation include the following:

  • Therapeutic drug monitoring and medication adjustment utilizing subjective and objective data
  • Medication counseling and education - new prescriptions, medication compliance, inhaler technique teaching, glucometer technique
  • Follow-up of detected drug therapy problems by alteration in therapy, initiation of new therapy, health education, referral to other sources of care, or other appropriate measures
  • Monitoring of serum drug concentrations providing appropriate recommendations
  • Provide educational inservices to nursing staff
  • Provide presentations to medical staff at Morning report - new drug therapy and optimal drug utilization
  • Provide drug information to physicians, nurses, and other health care providers in UMA
  • Core content which will be covered via patient experiences, discussions of reading materials, and/or case presentations includes a review of:
  • Hypertension
  • Anticoagulation
  • Diabetes Mellitus
  • Hypercholesterolemia
  • Chronic lung disease
  • Tobacco abuse

 

Acute Care Cardiology

The Coronary Intensive Care Unit (CCU) rotation is a six week elective rotation for pharmacy residents. This rotation provides provision of pharmaceutical care for patients assigned to the CCU team. The CCU is a 10 bed unit for critically ill cardiac patients and a 29 bed acute cardiology step-down unit that care for patients with ischemic cardiac disease, heart failure, arrhythmias, and other cardiovascular diseases The spectrum of pharmaceutical care services experienced by this rotation include:

  • Daily patient profile review and identification of and resolution of any medication related issues
  • Daily rounding with the CCU team
  • Proactive involvement in selecting, modifying and monitoring drug therapy
  • Provide pharmacokinetic consultations
  • Provide nutritional support consultations
  • Documentation of interventions including adverse drug reactions through the MIS computer system
  • Serve as liaison between nursing staff and pharmacy to help resolve issues
  • Involvement in multidisciplinary team approach to patient care
  • Core content that will be covered by patient experiences, discussions, and readings include but is not limited to
  • Post Myocardial Infarction Management
  • Venous thrombosis prophylaxis
  • Stress ulcer prophylaxis
  • Management of Acute Decompensated Heart Failure
  • Ventricular and atrial arrhythmia management
  • Monitoring cardiovascular parameters when using inotropes
  • Cardiogenic shock
  • Cardiac Transplant Rejection
  • Acute renal failure and diuretic management

 

Hematology/Oncology

The Hematology/Oncology (Hem/Onc) rotation is a four week acute care rotation for pharmacy residents. This rotation provides provision of pharmaceutical care for those patients that are admitted to the Hematology/Oncology service. This may include patients admitted to the Adult Bone Marrow Transplant Unit as well as the Hospice and Palliative Care Unit. The complete spectrum of pharmaceutical care services are experienced during the rotation including:

  • Patient profile review with problem medication order identification and resolution
  • Assistance with medication order entry, order review and order clarification
  • Rounding with the Hem/Onc team which includes rounds on the general Hem/Onc patients as well as the adult Bone Marrow Transplant patients
  • Providing pharmacokinetic dosing consults and participating in nutrition support consults
  • Researching and providing answers to drug information questions
  • Monitoring for and reporting of Adverse Drug Reactions
  • Participating in Medication Use Evaluations
  • Interaction with nurses, physicians, dietitians and nutritional support specialists and other health care providers
  • Coordination of distribution problems not resolved by in-patient pharmacy
  • Core content which will be covered via patient experiences, discussions of reading materials, and/or case presentations includes a review of:
  • Common hematology/oncology disease states
  • Antineoplastic and biologic cancer chemotherapy
  • Pain management in cancer patients
  • The prophylaxis and treatment of chemotherapy induced nausea and vomiting
  • The management of patients with neutropenic fever
  • The management of patients with hypercalcemia associated with malignancy
  • Common toxicities of cancer chemotherapy and supportive care management
  • Autologous and Allogeneic Bone Marrow and Stem Cell Transplantation

 

Neurology Intensive Care Unit

The Nerancy Neuro Intensive Care Unit rotation provides a four week experience in critical care of neurological and neuro-surgical patients. The focus of this rotation is on provision of pharmaceutical care to critically ill patients with a review of the specific disease processes and surgical indications/implications. The NNICU is a 12-bed unit which provides care for critically ill neurosurgical, neurological, orthopedic, trauma, and otolaryngology/head & neck surgery patients.

Goals

  • Review central nervous system anatomy and physiology
  • Understand the etiology and pathophysiology of cerebrovascular disorders
  • Know the management and treatment of cerebrovascular disorders
  • Understand the various classifications of seizures
  • Know the various treatment strategies for each of the seizure classifications
  • Recognize the adverse effects of antiepileptic drugs
  • Understand the specific antimicrobial treatments for central nervous system infections
  • Understand the mechanisms of electrolyte disorders of CNS origin
  • Know the various treatment strategies for electrolyte disorders in neurology and neurosurgery patients
  • Be able to describe the pathophysiology of myasthenia gravis and myasthenic crisis.
  • Describe the various treatment strategies for myasthenia gravis
  • Apply all above information to the provision of pharmaceutical care of critically ill neurological/neurosurgical patients

Expectations

  • Participate as an active member of the NNICU team. Providing input into pharmacotherapeutic decisions is essential
  • Attend "Neurology Rounds" in NNICU from 8:30-8:45 Monday-Friday, followed by unit rounds in the NNICU with the unit team
  • Attend NNICU Conference on Wednesdays at 10:00 in the NNICU Conference Room
  • Attend Neurology Grand Rounds on Fridays at 12:05pm in Camp Heart Auditorium
  • egular discussion/interchange between pharmacy preceptor(s) with frequency determined by all involved parties and influenced by team census, patient acuity, resident responsibilities/activities, etc.
  • Evaluate role of preceptor(s) and value of rotation at its conclusion
  • Solicit help from preceptor(s) at any time

 

Infectious Diseases

The Infectious Diseases rotation is a four week rotation for pharmacy residents. The Infectious Diseases rotation consists of experiences on the Antimicrobial Surveillance Team and in the Infectious Diseases Clinic at the University of Virginia Health Sciences Center.

Activities on the antimicrobial surveillance team include:

  • Attending and participating in daily rounds with the antimicrobial surveillance team which includes infectious diseases clinical pharmacist and an attending infectious diseases physician
  • Participation in educational activities of the antimicrobial surveillance team (lectures, grand rounds, development of guidelines and prescribing policies)
  • Participation in monitoring and documentation of the antimicrobial surveillance team's interventions
  • Evaluation of clinical and cost outcomes of team's interventions

Infectious Diseases Clinic Site:

  • Evaluation of HIV pharmacotherapy regimens for efficacy, drug interaction potential, allergies and side effect profile
  • Participation in patient counseling of HIV medications and adherence to antiretroviral therapies
  • Provide drug information to multidisciplinary infectious diseases clinic staff
  • Monitor patient regimens for adverse effects, efficacy, compliance, and drug interactions
  • Participate in HIV journal club

Adult Inpatient Infectious Diseases Consultation Service:

  • Provide infectious diseases pharmacotherapy for patients on the Adult Inpatient Infectious Diseases Consultation Service by:
  • Designing appropriate antimicrobial therapy regimens
  • Recommending appropriate antimicrobial regimens and corresponding monitoring plans
  • Redesigning regimens and corresponding monitoring plans based on evaluation of monitoring data
  • Providing antimicrobial medication-use education to patients and medial staff
  • Providing concise and timely responses to requests for drug information for patients and medical staff related to anti-infectives
  • Attending weekly ID case and didactic conference