PurposeCritical care pharmacy services have progressed since their origination in the 1970s and have been supported by a position paper that categorized these services as fundamental (eg, provides drug information to the critical care team), desirable (eg, responds to resuscitation events in the hospital), and optimal (eg, publishes clinical research in peer‐reviewed journals). Burnout syndrome is a serious problem with far‐reaching consequences and may be heightened by the demanding nature of critical care. The purpose of this study was to explore the relationship between pharmacy services provided (fundamental, desirable, optimal) and the incidence of burnout syndrome among critical care pharmacists.MethodsA cross‐sectional survey was distributed via email to critical care pharmacists through a professional association listserv and included three areas of assessment: position and institution‐based characteristics, activities performed, and burnout. The primary outcome was the number of activities performed in each category and was compared between respondents who did and did not experience burnout using the Mann‐Whitney U test. Logistic regression was performed to characterize the relationship between activities performed and burnout.ResultsIn total, 211 pharmacists (14.5%) completed the survey. Sixty percent (n = 128) experienced burnout and performed a median of 13 (interquartile range [IQR] 7‐15) fundamental (of 18 assessed), 11 (IQR 4‐13) desirable (of 16 assessed), and 6 (IQR 5‐8) optimal (of 12 assessed) activities. In logistic regression, performing desirable activities was associated with higher risk of burnout while performing optimal activities was associated with lower risk of burnout.ConclusionsOver half of critical care pharmacists experienced burnout. The performance of optimal activities was associated with reduced burnout. It is possible that higher level, higher yield activities increase personal engagement and decrease burnout.

Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Intravenous fluids are the most commonly prescribed medication in the intensive care unit (ICU) and can have a negative impact on patient outcomes if not utilized properly. Fluid stewardship aims to heighten awareness and improve practice in fluid therapy. This report describes a practical construct for implementation of fluid stewardship services and characterizes the pharmacist’s role in fluid stewardship practice. Summary Fluid stewardship services were integrated into an adult medical ICU at a large community hospital. Data characterizing these services over a 2-year span are reported and categorized based on the 4 rights (right patient, right drug, right route, right dose) and the ROSE (rescue, optimization, stabilization, evacuation) model of fluid administration. The review encompassed 305 patients totaling 905 patient days for whom 2,597 pharmacist recommendations were made, 19% of which were related to fluid stewardship. This corresponded to an average of 1.52 fluid stewardship recommendations per patient. Within the construct of the 4 rights, 39% of recommendations were related to the right patient, 33% were related to the right route, 17% were related to the right drug, and 11% were related to the right dose. By the ROSE model, 1% of recommendations were related to the rescue phase, 3% were related to optimization, 79% were related to stabilization, and 17% were related to evacuation. Conclusion Implementation of fluid stewardship pharmacy services in a community hospital medical ICU is feasible. Integration of this practice contributed to 19% of pharmacy recommendations. The most common recommendations involved evaluation of the patient for the appropriateness of fluid therapy during the stabilization phase. The impact of fluid stewardship on patient outcomes needs to be explored.

Objective: This case series describes the effect of angiotensin II administration on hemodynamics in patients with parenchymal lung injury due to submersion injury. Case Summary: A 33-year-old female and a 72-year-old female were both brought to the emergency department after incidents of near drowning. Upon arrival to the emergency department, both patients were hemodynamically unstable and were eventually intubated for airway protection. Imaging done by conventional chest radiograph for both patients revealed bilateral pulmonary edema. Due to their hemodynamic status, vasopressors were initiated for both patients and were quickly titrated, leading to the initiation of angiotensin II. In one patient, angiotensin II was initiated early in shock and resulted in rapid improvement of hemodynamics. In the other patient, angiotensin II was initiated later and a more muted response was observed. Conclusions: In patients with near drowning, angiotensin II appeared to improve hemodynamic status rapidly. This is the first case series to report the use of this new vasoactive agent in this population and poses noteworthy mechanistic considerations.