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.
Critical Care
A 46-bed unit that includes medical intensive care (21 beds divided between medicine and cardiology), surgical intensive care (21 beds divided among all surgical services - trauma, neurosurgery, cardiothoracic, general surgery, etc), and post-surgical care units (4 beds primarily dedicated to our Coronary Artery Bypass Graft (CABG) population). Each ICU has a dedicated pharmacist clinician.
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.
