Residency
Medical Intensive Care Rotation
Preceptors:
Ben Gebhart, PharmD
Brian Barker, RPh
Site Description:
The Medical Intensive Care Unit (MICU) is a 12 bed critical care unit that serves as both the medical intensive care and coronary intensive care unit. Patient demographics vary considerably and may include cardiology patients (acute coronary syndromes, heart failure, arrhythmias, and cardiac transplantation) and all critically ill medical patients (respiratory failure, acute and chronic kidney injury, overdoses, sepsis, gastrointestinal bleeds, and acute and chronic liver failure to list some of the more common disease states).
Rotation Description:
The pharmacy resident on service will be responsible for providing comprehensive pharmaceutical care to all patients on the MICU service. Patient care is the primary focus of this rotation. The resident is expected to attend daily work rounds with the medical team as well as be the primary pharmacy contact person for the team. Rounds typically begin around 0900 and may last from 2-5 hours depending on the patient census and acuity.
A great deal of patient variety is seen on this rotation. Daily topic discussions typically encountered include infectious disease issues, renal failure, liver failure, respiratory failure and general critical care issues such as vasoactive medications, sedation, and emergency medications. The resident is expected to present one topic discussion per week in addition to leading a discussion on a relevant journal article each week.
Residents will also be expected to carry a cardiac arrest pager and respond (with a preceptor) to all cardiac arrests that occur during normal work hours.
Activities Evaluated:
| Rotation Activity | RLS Goal | Teaching Method |
| Demonstrate ownership of and responsibility for the welfare of the patient by performing all necessary aspects of the medication-use system. This includes analyzing patient data (up to a maximum of 12 patients daily). All medication concerns should be identified and addressed before completing of the clinical day. | R1.4 | M, F |
| Place practice priority on the delivery of patient-centered care to patients. Patient care during this rotation is the main priority and bedside assessment and involvement are expected during the MICU rotation. | R2.2 | C, F |
| Collect and analyze patient information for all assigned patients from all information resources - paper, people, and electronic. | R2.4 | C, M |
| Design evidence-based therapeutic regimens on a daily basis for each patient assigned in the MICU and present a systemic organ system base status. Patient presentations will takes place at least three days weekly during the MICU rotation. | R2.6 | I, C, M, F |
| Design evidence-based monitoring plans for each assigned MICU patient. | R2.7 | C |
| Recommend or communicate regimens and monitoring plans for each assigned MICU patient. | R2.8 | C, F |
| Implement regimens and monitoring plans. All assigned patients (up to maximum of 12) will be reviewed for pharmaceutical interventions throughout the clinical day. Clinical daily rounds are expected for attendance as well as attentiveness. After daily rounds, a brief review of each patient will take place to make sure all interventions took place. | R2.9 | M, F |
| Evaluate patients' progress and redesign regimens and monitoring plans for each assigned MICU patient. | R2.10 | C, F |
| Communicate ongoing patient information through patient notes and pharmacist-to-pharmacist pass off. | R2.11 | M, F |
| Document direct patient care activities in the MICU monitoring book daily and complete electronic patient care documentation as needed. | R2.12 | C, M |
Readings and Preparatory Work:
Contact preceptor prior to rotation for any preparatory work.
Typical Daily/Weekly/Monthly Activities:
Typical hours are 7AM until 4PM.
7AM - 8:30 AM - Work-up patients
8:30 AM - 1 PM - Rounds with multidisciplinary team
1 PM - 4 PM - Finish patient care items (i.e. medication reconciliation, order clarification, review orders, follow-up drug levels and microbiology). Discuss topics and give patient care presentations.
Evaluations:
The resident will receive oral feedback regarding their daily preparation, patient care plans, use of current evidence, effectiveness on rounds, etc. A short midpoint evaluation and final summative evaluation will be documented.
