Fletcher Allen, a Vermont university hospital and medical center, serves all of
Vermont and the northern New York region. Located in Burlington, Fletcher Allen is a regional, academic healthcare center and teaching hospital in alliance with the University of Vermont.
Inpatient Pharmacy at Fletcher Allen
Learn how the pharmacy serves Fletcher Allen hospital patients with the medication they need.
The cardiology practice site is a 55-bed acute care unit providing patients with pharmacologic and non-pharmacologic treatment options for a wide range of cardiovascular problems. The pharmacist has a workstation centrally located in the unit, readily accessible to patients, medical and nursing staff. The pharmacist coordinates the delivery of pharmaceutical care for the unit, including pharmacokinetic dosing services, patient and drug-specific monitoring services and patients/staff education. The pharmacist also serves on the Cardiology Subcommittee of the Pharmacy and Therapeutics Committee. This multidisciplinary group, composed of physicians, pharmacists, nurses and nurse practitioners, is responsible for the review of drugs and drug policy for cardiology related issues throughout the organization.
The critical care pharmacist clinician participates in daily hour-long "pharmacy pre-rounds" (if a pharmacy student or resident is also in critical care that month), followed by multidisciplinary rounds in the surgical Intensive Care Unit (ICU). During formal rounding each day, the pharmacist follows patients' pharmacotherapy and participates by proactively providing recommendations regarding drug therapy and related disease state management of critically ill patients. The pharmacist clinician acts as primary preceptor for the pharmacy resident on critical care rotations, and provides numerous in-services to physicians, nurses, and pharmacists. As an affiliated faculty member with the University of Vermont, the pharmacist is involved in the education of medical students, and serves on various committees for ICU policy and procedure, including, but not limited to, the Fletcher Allen critical care committee, Pharmacy and Therapeutics committee, ICU initiatives committee and numerous subcommittees, stroke improvement team, pharmacokinetics committee, and the Northern New England Cardiovascular Group at Fletcher Allen. The pharmacist clinician is also responsible for ongoing studies and research in the intensive care.
The staff pharmacists in critical care act as co-preceptors for the pharmacy resident and in general, serve as additional resources to the pharmacy resident for ICU patient therapy issues and questions. The resident, while on service in either the medical or surgical ICU, reports to the staff pharmacist on a daily basis as a "sign-out" after rounds are complete. The staff pharmacists work as a team with the pharmacist clinician and residents to solve therapeutic problems relating to ICU patient care. The primary responsibilities of the staff pharmacists include order verification after technician order entry, answering drug information inquiries by physicians and nurses, aminoglycoside and vancomycin dosing/monitoring, total parenteral nutrition monitoring, and evaluation of warfarin, digoxin, phenytoin, and related medications. The critical care satellite is not currently a first-dose dispensing satellite, although a proposal has been suggested to management to try and initiate a first-dose dispensing area.
Services are provided from two locations, a work-station on the inpatient unit and a satellite pharmacy operation at the ambulatory clinic site. In addition to medication preparation and dispensing, services provided include monitoring of departmentally determined target drugs and specialized monitoring for various Hematology/Oncology protocols. Pharmacy staff maintain individual patient files containing protocol information which is monitored at each visit, and work closely with medical and nursing staff to facilitate the medication process. In addition, research service support is provided as outlined previously. The Hematology/Oncology specialist serves as the resource person for services provided in the area.
The pharmacist clinician for the infectious disease service is responsible for promoting appropriate antimicrobial therapy within Fletcher Allen. The pharmacist applies specialized knowledge of infectious disease pharmacotherapy to direct patient care, teaching, consultation and clinical research. This individual participates in patient care rounds with physicians from infectious disease, provides clinical leadership in infectious disease pharmacotherapy as well as antimicrobial policy and program development.
The Pharmacotherapy Department provides an aminoglycoside and vancomycin dosing service to the medical staff. This service consists of the provision of dosing recommendations and serum drug concentration interpretation to all adult and pediatric patients. In addition, pharmacists review all antimicrobial orders to ensure that dosage is appropriate based on renal and hepatic function.
Investigational Drug Service
For the Investigational Drug Service, pharmacists provide consultative services in the areas of study design, protocol evaluation, study feasibility, and implementation. As members of the Institutional Review Board (IRB) at Fletcher Allen, they review proposed research protocols to ensure compliance with Good Clinical Practice Guidelines and compliance with all applicable federal, state, and local laws, IRB requirements, and Fletcher Allen policies. Working with the principal investigators, they provide oversight for the control, administration, and disposition of investigational agents at all locations within the organization.
The Adult Medicine practice site is a decentralized, acute setting providing pharmaceutical care to a patient population that includes general medicine, oncology and geriatric patients. The pharmacist is directly responsible for the drug therapy of the patients they are assigned. This includes overseeing proper prescribing of medications based on all patient demographics, efficient distribution and administration of medications. The pharmacist is also responsible for providing drug information to other health care providers, therapeutic drug monitoring and ensuring continuity of care from outpatient to inpatient setting. The pharmacist is directly involved in providing educational opportunities for other health care providers including participating in daily physician rounds.
We have a specially trained group of clinical staff pharmacists that provide care for the patients at Vermont Children's Hospital at Fletcher Allen. We provide continuity of care by following these patients through the various areas of the hospital that specialize in pediatrics. These areas include the Pediatric Intensive Care Unit, the Neonatal Intensive Care Unit, the Neonatal Transition Suite, the newborn nursery, and the general pediatric floor.
Provides direct patient care as a member of a specialized team whose responsibilities include care of patients with end-stage renal disease, chronic kidney disease and renal transplantations. The pharmacist is responsible for overseeing proper prescribing of medications, providing drug information to other health care providers (includes nephrologists, renal nutritionists and the dialysis community of Vermont), therapeutic drug monitoring and ensuring continuity of care from outpatient to inpatient setting. Co-precepts the pharmacy residents for renal care as well as conducts on-going primary research and CQI projects.
The variety of surgical procedures performed at Fletcher Allen requires the pharmacist to address issues ranging from the selection and dosing of medications in post-transplant patients to making sure that the patient stays on the right dose of levothyroxine after he has his gallbladder out. We work closely with the medical and nursing staff, reviewing all medication orders for appropriateness and ensuring that information and technology is used for the correct administration and monitoring of medication therapies.
Our pharmacists are specifically responsible for the dosing and monitoring of aminoglycoside antibiotics in patients on the surgical services as well as patients with cystic fibrosis. Patients on anticoagulants, vancomycin, anticonvulsants, and digoxin are flagged with more intensive scrutiny, as are all patients with renal impairment.
Fletcher Allen Health Care
Medical Center Campus
111 Colchester Avenue
Burlington, VT 05401
Karen K. McBride, RPh
Erica Counter, CPhT