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Preceptors  
Sara J.D. Bork, Pharm.D.;
Jeffrey Wagner, Pharm.D.

Rotation Site Description
The Pediatric Intensive Care Unit (PICU) is a 31-bed critical care unit with patients ranging in age from full-term gestation to adulthood. Common diagnoses seen in the PICU are respiratory distress syndrome, diabetes, seizure disorders, transplants, sepsis, organ failure, and patients that are dependent upon technology including High Frequency Oscillatory Ventilation (HFOV), Continuous Renal Replacement Therapy (CRRT) and Extracorporeal Membrane Oxygenation (ECMO). The Progressive Care Unit (PCU) is a 36-bed special care unit comprised of step-down ICU patients and patients with care needs preventing them from being admitted to a general inpatient care area.

Rotation Responsibilities
Provide clinical pharmacy services to pediatric progressive care patients, which includes:

• Participate in PICU/PCU multidisciplinary rounds and related activities on a daily basis.
• Develop an understanding of the medical management of patients in the PICU/PCU.
• Utilize available resources to review the history of the patient and build the information base needed to design a medication therapy regimen for a pediatric patient in the PICU/PCU.
• With understanding of the pathophysiology of common diseases in the pediatric patient, develop a prioritized problem list for each patient and ensure there is appropriate therapy for each disease state and problem.
• Review medication and patient profiles to evaluate drug therapy, necessity of use, rationale for use, appropriate dosing, alternative options, and any interactions.
• Pharmacokinetic monitoring, dosing adjustments, and appropriateness of drug levels obtained.
• Adherence to TCH’s medication-use policies.
• Renal and/or hepatic dosage adjustments.
• Design, recommend, and evaluate pharmacotherapeutic regimens and corresponding monitoring plans for pediatric patients in the PICU/PCU.
• Provide nutrition support for all patients on TPN’s, by following electrolytes, fluid status, and nutritional requirements.
• Aid in the detection and reporting of any adverse drug events and/or medication errors.
• Participate in the management of pediatric medical emergencies.
• Provide concise, applicable, and timely responses to requests for pediatric drug information from health care providers and patients.
• Provide inservices education to physicians, nurses, and other practitioners on issues related to pediatric medications.