• Critical Care - Pediatric Critical Care (ICU) - Progressive Care Unit (PCU) Rotation

    Preceptor(s)

    Sara J.D. Bork, PharmD, MBA
    Erin J. McDade, PharmD, BCPS

    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.
       

    Activities

    Rounds: 09:00- Monday, Wednesday, and Thursday
    08:30- Tuesday (Feigin Rounds)
    09:30- Friday (Grand Rounds)

    Required Meetings: Meetings as scheduled with preceptor.
    Pediatric Critical Care Conference, 6th floor PICU conference room, Mondays at 12:00.
    Patient Case Conference, 6th floor PICU conference room, Mondays at 13:00.
    Feigin Rounds, 6th floor NICU conference room, Tuesdays at 10:30.
    Grand Rounds, TCH auditorium, Fridays at 08:30.
     

    Topics of Discussion

    Topics to be discussed

    • Respiratory
      • Acid-base & blood gases
      • Bronchopulmonary dysplasia (BPD)
      • ECMO (extracorporeal membranous oxygenation)
      • Intubation & mechanical ventilation (SIMV, HFOV, etc.); tracheostomy
      • Pulmonary HTN
      • Respiratory failure & ARDS/ALI
      • Asthma & status asthmaticus
      • Cystic fibrosis
       
    • Cardiovascular
      • Cardiac physiology & pharmacology
      • Congenital heart disease
      • Inotropes & pressors
      • PALS
      • Shock- septic, cardiogenic, hypovolemic, anaphylactic, & neurogenic
       
    • CNS
      • Analgesics, sedatives, & muscle relaxants
      • Brain injury (traumatic & hypoxic-ischemic); Glasgow Coma Scale (GCS); ICP
      • MRCP
      • Status epilepticus
       
    • FEN/GI
      • Diabetic ketoacidosis
      • Enteral & parenteral nutrition
      • Fluids & electrolytes
      • Hepatic failure
       
    • Hematology
      • Disseminated intravascular coagulation (DIC)
      • HIT
      • Hemolytic-uremic syndrome (HUS), ITP, TTP
      • Oncologic emergencies
      • Sickle cell disease & crisis
      • Thromboembolic disorders
      • Vascular catheters- peripheral venous, arterial, central venous, PICC, IO, PAC
       
    • Infectious Disease
      • Immunosuppression & prophylaxis
      • Meningitis
      • Pneumonia
      • Sepsis
      • Line infection
       
    • Renal
      • Acute renal failure
      • Diabetes insipidus, SIADH, cerebral salt wasting
      • Diuretics
      • Renal replacement therapy- PD, HD, & CVVHD
       
    • Pharmacokinetics & pharmacodynamics
    • Toxicological emergencies