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F
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- Feed – Route, total parenteral nutrition (consider pabrinex for re-feeding), target rate, aspirates (prokinetics and route of administration of drugs), feed breaks for some drugs.
- Filter/Acute Kidney Injury (AKI) – review medication doses & frequencies, anticoagulation.
- Fluids – maintenance & fluid balance, urine output (<0.5 ml/kg/hr = AKI), reviewing IV infusions in fluid restricted patients (advising on minimum volumes that can be given or appropriate concentrations for peripheral versus central administration).
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L
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- Lines – peripheral or central – consider drug compatibility & concentration of infusion.
- Laboratory tests, electrolytes and haematology – drug related causes of abnormalities.
- Laxatives – ensure bowels moving in patients being fed, as per local protocol.
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A
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- Allergies.
- Antibiotics or Anti-infectives – indications and review dates documented.
- Appropriate indications – all prescribed medications are necessary.
- Adjustments of dosing – based on renal/hepatic function/drug. interactions/age/weight/ clinical condition.
- Analgesia – monitor pain control and form of analgesia; epidural blocks, regional anaesthesia, infusions, modified release or regular short acting, patient-controlled analgesia.
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T
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- Thromboprophylaxis – Low Molecular Weight Heparin (adjusting dose based on weight & renal function) and unfractionated heparin if appropriate, all based on local protocol.
- Therapeutic Drug Monitoring – e.g. phenytoin, gentamicin, amikacin, vancomycin.
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C
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- Covid-19 Management:
- Ensuring patient is receiving most appropriate treatment for Covid-19 pneumonitis based on local protocol.
- Adjusting Thromboprophylaxis if appropriate.
- Maintaining stock surveillance for treatments, particularly those in short supply.
- Ensuring treatment as part of clinical trials is prescribed appropriately.
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H
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- Hypoactive or Hyperactive Delirium – for non-pharmaceutical and pharmaceutical management as per local protocols.
- Hydrocortisone - 50mg QDS when >0.2mcg/kg/min IV noradrenaline, despite optimal fluid resuscitation (low evidence).
- Hepatic Function – review impact on prescribed medication.
- High cost medicines – highlight to team, monitor use, review expenditure reports.
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U
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- Ulcer prophylaxis – pantoprazole 40mg IV OD, stepping down to lansoprazole when route available if appropriate, stopping if no risk factors and on full feed.
- Usual Medication- undertake full medication history including OTC/illicit/herbal, and ensure necessary medications continued where appropriate. Consider risk of withdrawal e.g. SSRIs, benzodiazepines, alcohol, nicotine, illicit drugs.
- Unlicensed Medication – ensure it is indicated / no licensed alternative available. Consider how it can be sourced and governance requirements when obtaining supply.
- Updating Unit Documentation – ensuring protocols and monographs in use are regularly reviewed and evidence-based.
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G
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- Glycaemic control – aim <10mmol/L. Identify causes in fluctuations; consider steroids, propofol, atypical antipsychotics.
- GPICS standards – endeavour to meet standards for pharmacy.
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S
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- Sedation, Agitation, Hypoactive/Hyperactive Delirium – consider daily sedation holds, contributing factors (sleep hygiene, noise etc.), consider Confusion Assessment method for the ICU (CAM-ICU), pharmaceutical management where appropriate as per local protocol.
- Supply – is drug stock? If non-stock, consider ordering adequate supply or alternatives if possible.
- Side effects, interactions and duplications – consider adverse effects from medications, consider drug-drug, drug-patient and drug-laboratory interactions, stop unnecessary duplications.
- Standard Drug Infusions – ensure infusions prescribed appropriately, documenting diluents, final volume, rate and route.
- Stop dates – e.g. anti-infective agents, steroids.
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