In this episode, I’ll discuss 3 types of ICU patients and why they matter for making patient-focused risk:benefit assessments.
I find that I make better patient focused risk:benefit assessments when I start off by figuring out the answer to the following question:
Why is my patient in the ICU?
I consider there to be 3 broad types of patients that are admitted to the ICU:
Type #1 – A patient who has experienced failure of one or more vital organ systems and requires ICU-level support. This could be respiratory failure from pneumonia, or post-ROSC care of a cardiac arrest patient, or hypotension requiring vasopressors from sepsis.
Type #2 – A patient who has had something happen to them that places them at high risk of a vital organ system failing and requires ICU-level monitoring to immediately recognize and support them if/when that happens. This could be watching a patient for 24 hours after receiving alteplase for acute ischemic stroke, or a patient who just had a high-risk surgical procedure such as an esophagectomy, or a patient with delirium tremens requiring extremely high doses of benzodiazepines.
Type #3 – A patient who doesn’t have a good reason to be in the ICU but was admitted anyway. This could be due to a bed availability issue, a disagreement between treating physicians on what level of care the patient requires, or a misguided perception that due to the low nurse:patient ratio in the ICU that a “VIP” should be admitted to the ICU instead of an otherwise appropriate level of care.
Having a general idea of which category each patient in your ICU falls under can help a pharmacist make better decisions on how they allocate their limited pre-rounding time and which types of interventions they should focus on for each patient.
Type 1 patients are likely to have the highest acuity and probably stand to gain the most benefit from a thorough review from a critical care pharmacist.
Type 2 patients are likely to be receiving medication and monitoring that follows an institution-specific protocol and the critical care pharmacist might be a good position to ensure adherence to the protocol.
Type 3 patients might have the lowest acuity but could be at the highest risk of a preventable nosocomial infection. Even if the decision to admit to the ICU was not well-founded, the critical care pharmacist could still advocate for rational decisions regarding antibiotic stewardship and other areas of care, like stress ulcer prophylaxis.
The topic in this episode is inspired by an in-depth training available to members of my Hospital Pharmacy Academy. The Hospital Pharmacy Academy is my online membership site that will teach you practical critical care and hospital pharmacy skills you can apply at the bedside so that you can become confident in your ability to save lives and improve patient outcomes. To get immediate access to this and many other resources to help in your practice, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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