This article discusses a clinical pharmacist, Dr. Keliana O’Mara, who works in the neonatal ICU at the University of Florida Health Shands Hospital. She is the only pharmacist in this unit, and her role there is incredibly important.
One of the sickest patients that O’Mara had to work with was a baby girl who was born at 28 weeks gestation. This baby had a congenital diaphragmatic hernia and cardiac defect. Because her diaphragm did not develop completely, her abdominal contents were pushed into her chest cavity, and as a result she only had the functionality of 1.5 of her lungs.
O’Mara did a significant amount to save this baby’s life while the baby was in the neonatal ICU. She was in charge of the pain and sedation management for the infant as she went in and out of several surgeries for developmental defects. After all of the infant’s surgeries, O’Mara realized that the infant had developed a fungus in her blood. As a pharmacist, she was able to notice that the antifungal that the infant was to be started on would most likely not work because the infant had been on it previously, and the fungus in the infant’s blood was most likely resistant to the medication as a result. O’Mara was able to collaborate with the primary physician and get the medication changed to a broader spectrum antifungal medication. This was beneficial because a later culture showed that the fungus in the infant’s blood would have indeed been resistant to the original medication.
Another role that O’Mara has in the neonatal ICU is to help implement better treatment methods there. For example, by looking at 2 years of vancomycin dosing data, O’Mara realized that half of the infants in the NICU never reached a therapeutic level of this antibiotic in their blood. As a result, she got permission to begin individualized pharmacokinetic/pharmacodynamic dosing for vancomycin. This is when a pharmacist evaluates serial blood concentrations of a drug after patients receive the first dose. The pharmacist then creates an appropriate dosing regiment personalized for each patient based on these values. Doing this for vancomycin ultimately led to a quicker clearance of bacterial infections in infants in this NICU, and therefore a shorter amount of time that they needed to be on the antibiotic.
Pharmacists who work in the neonatal ICU are additionally crucial because of how small the doses are for babies. Pharmacists must make sure that an infant is never getting too much medication and that mixtures of medications are always made properly. Adding more fluid to a dose to dilute it is not possible for a 500 mg infant because this could lead to fluid overload in the baby. As a result, pharmacists working in this unit have to be extra precise and careful. They also need to make sure the team they are working with understands the latest drug data. It is their job to show physicians when a medication should not be used in an infant, for example if scientific data shows that the treatment and placebo yields the same response from a drug.
I overall found this article very interesting. It is incredible how different one’s experience can be as a pharmacist just by working in one unit of a hospital over another. It also is crazy to think how easy and life threatening it can be to mess up one small part of an infant’s medication regimen. It is clear that a pharmacist is crucial in the NICU of every hospital, and it amazes me how much of an impact one pharmacist can have on saving someone’s life and allowing a premature baby to one day make it home.
Pharmacy Today. 2015;Health-System Edition:2-3.