A Day in the Life of an ICU Integrated Clinical Pharmacist

By Salma Guerrero, Integrated Clinical Pharmacist

Read about her story here: My Journey as a Clinical Pharmacist: From Retail to Critical Care

Working as an Integrated Clinical Pharmacist

Working as an Integrated Clinical Pharmacist in the ICU comes with constant unpredictability. I cover the Medical ICU, Surgical ICU, and Neuro ICU during evening shifts from 2:00 PM to midnight, working seven days on followed by seven days off. Every day is different, so I rely on a general framework to keep myself organized.

Starting the Shift: 2:00 PM – 2:30 PM

My day begins with an in-person handoff from the morning pharmacists. This time is critical for continuity of care, allowing me to follow up on pending issues or clarify any concerns.

Nursing Shift Change: 7:00 PM – 7:30 PM

During the evening shift change, I attend nurse huddles when needed. This is an opportunity to provide medication-related education, discuss updates, and address any pharmacy concerns that may impact patient care.

Finding a Break: 7:30 PM – 9:00 PM

Somewhere within this window, I try to take a lunch break. I have found this to be an ideal timeframe as nurses and intensivists are busy with their own handoffs.

Evening Rounds: 9:00 PM – 10:00 PM

I participate in evening rounds to discuss treatment plans with appropriate medication management.

Wrapping Up: 10:00 PM – 12:00 AM

The final stretch of my shift is focused on completing any remaining tasks such as consults, follow-ups, and last-minute questions. I also make it a point to walk through the units to check in with staff and offer any needed pharmacy support.

Ongoing Responsibilities Throughout the Shift

While the schedule provides a framework, my role involves ongoing responsibilities that require constant attention throughout my shift:

• Patient Workups: I aim to review each patient early in the shift, though new admissions can happen at any time. On some days, I may be responsible for up to 55 ICU patients.

• Triage Communication: I handle calls from nurses, physicians, pharmacists, and other hospital staff, prioritizing issues as they arise.

• Emergency Response: I actively participate in critical events, including code blues, stroke alerts, and rapid sequence intubations (RSIs).

• Pharmacy Consult Management: I complete pharmacy consults such as warfarin dosing, vancomycin monitoring, aminoglycoside management, and total parenteral nutrition (TPN).

• Order Verification: This isn't just clicking a button. I carefully evaluate medication appropriateness, dosing, contraindications, drug interactions, and therapeutic alternatives.

Final Thoughts

No two shifts are alike, and that’s what makes this role so rewarding. Each day presents new challenges that demand critical thinking and adaptability. Even after long 10-hour shifts, I’m always learning and never bored!

💬 Have you ever considered a clinical pharmacy role in the ICU or another fast-paced hospital setting? Share your thoughts or questions in the comments below!