Pain, Agitation and Delirium In the ICU… What about in the ED?

In the recently published guidelines for management of pain, agitation, and delirium (PAD) in adult ICU patients, several key changes to the way PAD is approached were discussed.  Over the next few posts, I will go into depth into each one and tie in how we, in the ED, can help provide optimal PAD – another step towards the theory of “upstairs care, downstairs.”

But first, I wanted to point out the first three authors credited in the guideline document published in Critical Care Medicine.  Not necessarily the individuals, but rather their professions: MD, PharmD, RN.  In such a patient care centered environment that involves a highly coordinated team effort, I applaud our critical care colleagues for taking such a comprehensive approach to this guideline.

From the pharmacists perspective, critical care pharmacy has sort of been the playground for the heavyweight clinical pharmacists. Certainly as other professions can look up to Oslers, pharmacy no doubt will eventually look to Fraser, Devlin, Erstad, Dager and Papadoupoulos as the pioneers of what we do.

Personally, I’ve been searching for the identity of pharmacy lately. I think, it’s finally starting to reach the awkward stage; experimenting with weird drugs (pun intended), finding ourselves through exploration and challenging the traditional definition of the profession. While these guidelines are not the first major publication by pharmacists, the continued involvement in important clinical documents helps our profession create a sense of belonging alongside the health care providers.


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