In this episode, I’ll discuss five circumstances that should make an ICU pharmacist stop what they are doing to investigate further.
One thing that critical care pharmacists develop over time is their “Pharmacy Spidey-Sense” – that feeling they get when something happens in the ICU that means they should drop whatever they are doing to go investigate, because someone might need their help. What follows is a list of 5 signals that should prompt a pharmacist to stop what they are doing to see if help is needed. Shout out to Nurse Dawne & Nurse Practitioner Meagan for helping me round out the items on this list:
#1: A nurse or other clinician is running. Nobody runs as part of a normal day in the ICU, so if someone is running, chances are high that there is a problem. It may or may not be something a pharmacist can help with, but you should stop what you are doing, follow whoever is running, and see if you can be of assistance.
#2: Someone is moving the code cart from its usual spot. Whether they are moving fast or slowly, any movement of the code cart should pique an ICU pharmacist’s interest. Generally, one of the following three things is going on when a cart is moved out of place: First, a code could be in progress or felt to be imminent, and you can help with meds for the code. Second, a high-risk bedside procedure might be about to happen, such as a high-risk intubation, and you can help with meds for the procedure. Third, the acuity level of an existing or new patient may be increased, and someone wants the code cart near just in case, and you can re-prioritize this patient in your pre-rounding.
#3: Anyone is yelling loudly. This could be as simple as a nurse yelling, “I need help in room 3!” Maybe the patient is trying to self-extubate, or a code seems imminent. You’ll find out soon enough when you join them in room 3. Even if medications are not the solution, you can be an extra pair of hands to grab something urgent from the supply room or find whatever clinician the nurse urgently needs while they stay with the patient. If it is a patient doing the yelling, the pharmacist can investigate to see if acute agitation is happening that perhaps is best treated with a sedative.
#4: Anyone is talking about medications. It doesn’t matter who is talking or what the context is – if you hear anyone talking about medications in the ICU, it is your role as the pharmacist to listen closer and see if you can do anything to help.
#5: The monitor alarms are going off, and you see something scary on the monitor. The monitors will ding all day long in the ICU, and it is easy to tune them out. But an alarm that is not quickly silenced or one that catches the attention of another clinician, such as the charge nurse, should prompt the pharmacist to go look at the monitor as well. Wide complex tachycardias and profound bradycardias are probably the two scariest things that can be seen on a monitor, but extremes of blood pressure readings can be just as important.
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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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