The ICU at PMC

I spent my second block rotation at Pikeville Medical Center (PMC) in Pikeville, KY, with Tristan Davis in the ICU. During this rotation, you get a true clinical experience each day you come into work. Since I was working in the ICU, the patients that I worked with were in terrible shape. This rotation required me to use the information I learned in the Infectious Disease, Pharmacokinetics, Renal, Cardio, GI, and Advanced Compounding courses. I had to apply information to patients in order to recommend appropriate antibiotics, dose and monitor high risk drugs such as aminoglycosides and vancomycin, and make sure patients were receiving appropriate GI ulcer and DVT/PE prophylaxis.

While at PMC, I always started my day at 8am and worked till 6pm with lunch from 12-1pm (fun fact: Pikeville Medical has a TERRIFIC cafeteria). My preceptor allowed a lot of flexibility in my schedule, and I never had an issue with getting my hours in. We always began our days by "working up" all the patients in the ICU. On any given day, we had 25 or more patients that required a pharmacist's review. Many patients that you will be monitoring are going to be in the ICU for at least a week, so it is very important to use clinical judgement to provide the best care in a time sensitive manner. The information we received on each patient's daily sheet included culture and sensitivity (C/S) reports, Creatinine Clearance, white blood cell count, platelets, doctor/pharmacy notes, and drug monitoring information. We used this information to make our initial judgement and treatment plans.

To get a better understand of what our patients were going through, we had to do daily checks of the ICU progress notes from the doctors. The doctors at PMC were great at writing relatively condensed progress notes that explained the patients current medical status, their impressions, and why they made their therapy management decision. At 2pm each day, we got to participate in "patient rounds". At this time, we got to go to the ICU floor and discuss each individual patient's health status with doctors, nurses, social workers, as well as hospital administration. This gave the ICU pharmacist an opportunity for a face-to-face consult with other members of the healthcare team in order to ask questions and provide any incite we had to provide all patients with the most optimal care.

The other members of the healthcare team were always willing to hear our thoughts and often looked to us for therapy options and adjustments. It is a part of PMC's policy that the pharmacy were allowed to make any appropriate dose adjustments per renal adjustment protocol. This provided us with the ability to adjust a patient's medications without the need to constantly bother doctors to get the approval. The doctors actually allowed the pharmacy to make many drug therapy decisions such as dosing aminoglycosides and vancomycin, add/remove drugs based on the patient's health status, calculate TPN requirements/schedules, and give an alternative drug if patient had an allergy to a prescribed medication. It was incredibly comforting to be at a place where pharmacists were well respected and a valued member of the healthcare team.

For anyone looking for a site for their Acute Care Medicine rotation, I would strongly recommend them go to PMC. In addition to all the clinical pharmacy work, I also had the opportunities to see several surgeries such as a transesophageal echocardiography (TEE), an epidural injection, and a cardiac bypass surgery. This provided me the chance to see some of the procedures discussed in class, but we didn't get a lot of information on them. All members of the pharmacy staff as well as other healthcare professionals were extremely nice and professional. They also allowed me to go to the Leonard Lawson Oncology Center in downtown Pikeville for a couple days. I got to see how an Oncology Center operates and see their procedures for mixing chemo.This site gave me an opportunity to put my knowledge gained through didactic coursework and apply it in "real world" situations.

If you feel that you aren't really prepared for a rotation that has a strong emphasis on infectious disease and PK dosing, the staff at PMC will help you tremendously and explain things in a way that is simpler to understand. For anyone who has any questions about Pikeville Medical Center, rotations, or their current coursework, please feel free to contact me. I will answer any questions you have. You can email me at ryan.endicott@students.acp.edu, or message me on Facebook. *All images were taken from google search