Preceptor: Mary Eche, PharmD, BIDMC Clinical Coordinator, Critical Care, PGY2 Critical Care Residency RPD
Preceptor: Pansy Elsamadidsi, PharmD, BIDMC Clinical Pharmacist
Preceptor: Adrian Wong, PharmD, MPH, BCPS, BCCCP, Assistant Professor, Pharmacy Practice, MCPHS University
Rotation description: The Medical Intensive Care Unit (MICU) rotation is a required, 5-week learning experience at Beth Israel Deaconess Medical Center. The MICU typically has a service of up to 8 patients, but this may increase based on the specific location (East Campus versus West Campus) and service (MICU orange versus green). Each MICU team consists of an attending pulmonary/critical care physician, pulmonary/critical care fellow, 2-3 senior medical residents, and 2-3 medical interns. Additionally, rounds are attended by the critical care nurses and respiratory therapy/physical therapy as needed.
The medical intensive care unit (MICU) rotation allows the pharmacy resident to gain experience in caring for the critically ill patient with a focus on pulmonary or GI/liver disease. The resident will attend daily rounds and be involved with medication management with the MICU team. Responsibilities will include proactively assessing and monitoring all aspects of care of the critically ill patient with various end-organ failures (e.g. lung, kidney, liver etc.). The resident will participate in drug monitoring, renal dosing, individualized pharmacokinetics assessment, and patient interaction/education as needed. Along with these clinical requirements, the resident will be responsible for various topic discussions relating to critical care or respiratory or systemic end-organ disease, such as acute respiratory distress, acute/chronic/end-stage organ failure, fluid/nutrition/electrolyte imbalance, acid-base disorders, mechanical ventilation, sepsis and hemodynamic imbalance, sedation/analgesia, use of neuromuscular blocking agents, liver failure, GI bleeding and toxic ingestion or drug overdose.
The decentralized clinical pharmacist on the team is responsible for ensuring safe and effective medication use for all patients admitted to the team, including active participation in work and attending rounds daily, education of physicians and nurses, and education of pharmacy trainees, participation on organizational, pharmacy department and nursing unit-based medication policy and continuous quality improvement committees. When a pharmacy resident is on service, they will assume the roles of the decentralized clinical pharmacist, under the supervision of the critical care clinical coordinator. Both the decentralized pharmacist and clinical coordinator are available to the resident for any questions or assistance as needed. By week 3 of the rotation experience, the resident will also be asked to process all medication orders for the MICU team on which they are rounding as well as complete all departmental drug monitoring requirements (Vancomycin and Anticoagulation).