Practice Standards, Training, and Professional Development

1. Describe landmark events in the evolution of critical care pharmacy as a specialty, including summarizing key published documents and primary evidence validating critical care pharmacy as a specialty.
2. Identify the core knowledge areas for pharmacists caring for critically ill patients.
3. Outline criteria for credentialing, conventional training pathways and mentorship, and standards of practice for clinical pharmacy in the critical care practice environment.
4. Apply the principles and values of team-based care to conduct a gap analysis of the current local critical care practice environment.
5. Develop an approach to lifelong professional learning to maintain competency in critical care pharmacy practice using the principles of continuing personal professional development.
6. Identify the avenues and processes for contributing to the critical care body of knowledge as a presenter, author, or peer reviewer.

Research Design and Biostatistics

1. Identify factors influencing the conduct of essential critical care research.
2. Evaluate the appropriateness of various statistical tests for a set of data.
3. Apply concepts of research design and analysis to clinical care.

Fluids, Electrolytes, Acid-Base Disorders, and Nutrition 

1. Describe normal fluid requirements and common patient conditions that alter fluid needs and homeostasis.
2. Develop an appropriate assessment and treatment plan for common electrolyte disorders in critically ill patients.
3. Correctly identify complex acid-base disorders based on a patient’s laboratory data and clinical course.
4. Specify the appropriate route (parenteral or enteral) of nutrition administration, energy and protein needs, and key micronutrients to be provided to a critically ill patient.
5. Develop an appropriate assessment of the tolerance, safety, and efficacy of an enteral or parenteral nutrition regimen.

 Protocol Development and Quality Improvement

1. Determine the steps involved in the development of a guideline and/or policy.
2. Design a medication use evaluation (MUE) with selection of an appropriate medication and/or medication-related process suitable for an MUE.
3. Determine the appropriate quality improvement tool to use in order to optimize outcomes in a critically ill patient population.
4. Identify processes or quality improvement initiatives that would benefit from a gap analysis.
5. Describe the types of pharmacotherapeutic interventions and documentation processes to justify the value of clinical pharmacy services. 

Pharmacoeconomics and Safe Medication Use

1. Apply the principles of pharmacoeconomics to patient care.
2. Differentiate between a medication error, an adverse drug event (ADE), a preventable ADE, and an adverse drug reaction (ADR).
3. Design an ADE reporting program, including committee structure, committee reporting mechanisms, and methods of detecting, reporting, and managing ADEs.
4. Provide recommendations for improving medication use safety using the 2017 SCCM Safe Medication Use Guidelines for the ICU.
5. Provide safety measures for drug interaction detection and prevention.
6. Develop a drug formulary proposal.

Infectious Diseases I

1. Develop risk factor–based empiric antibiotic regimens for patients with suspected ventilator-acquired pneumonia.
2. Develop risk factor–based empiric antibiotic regimens for patients with suspected severe community-acquired pneumonia.
3. Differentiate between location of intra-abdominal infections and respective empiric antimicrobial therapy.
4. Develop a definitive management strategy for critically ill patients with severe Clostridioides difficile infection.
5. Provide empiric antibiotic therapy recommendations for critically ill patients with community-acquired or health care–associated meningitis.
6. Identify a disease-specific and supportive care management plan for critically ill patients with severe influenza and novel severe acute respiratory syndrome coronavirus 2.

Infectious Diseases II 

1. Compose a plan to incorporate quality metrics (eg, prevention of catheter-associated urinary tract infections and catheter-related bloodstream infections) into pre- and postsurgical care.
2. Develop antimicrobial therapy plans for patients with central line-associated bloodstream infections and catheter-associated urinary tract infections.
3. Develop appropriate empiric and definitive antimicrobial therapy for patients with severe postoperative wound infections or severe cutaneous infections.
4. Identify key members of, common strategies, and tools (including biomarkers and rapid diagnostic tests) used by an antimicrobial stewardship team.
5. Evaluate therapeutic options for the treatment of multidrug-resistant pathogens in the intensive care unit (ICU).
6. Devise an optimal treatment plan for critically ill immunocompromised patients with infectious diseases.

Pharmacokinetics/Pharmacodynamics

1. Describe the changes in critically ill patients that alter drug absorption.
2. Explain how critical illness affects drug distribution.
3. Depict the effects of changing hepatic blood flow, intrinsic activity, and protein binding on drug metabolism.
4. Differentiate between different critically ill patient populations and the expected pharmacokinetic (PK) changes.
5. Identify the desired pharmacodynamic variables associated with efficacy in select drugs.

Acute Kidney Injury and Kidney Replacement Therapy in the Critically Ill Patient

1. Define acute kidney injury (AKI).
2. Differentiate between common categories of drug-induced kidney disease.
3. Discuss key principles of continuous kidney replacement therapy (KRT), including indications, timing, and circuit components.
4. Apply drug-dosing concepts in continuous KRT to estimate a sieving coefficient, saturation coefficient, and/or drug clearance on the basis of drug characteristics and device settings.

 Neurocritical Care

1. Identify pertinent pathophysiologic and laboratory changes that acutely occur after neurologic injuries and require therapeutic intervention.
2. Describe monitoring devices commonly used in neurocritical care patients that help develop and optimize treatment strategies.
3. Develop an evidence-based treatment strategy for neurocritical care patients that optimizes patient outcomes and reduces the risk of adverse drug effects and drug interactions.
4. Recommend a monitoring plan to assess response to therapeutic regimens and specific therapeutic goals for neurocritical care patients.
5. Develop new plans of care for neurocritical care patients according to therapeutic and adverse outcomes and progress toward therapeutic goals.

 Cardiovascular Critical Care I

1. Develop an appropriate pharmacotherapeutic regimen based on a patient’s hemodynamic status and objective cardiac findings.
2. Design a treatment plan for patients with cardiogenic shock.
3. Develop treatment plans for critically ill patients with cardiovascular disease, including, but not limited to, coronary artery anatomy and disease presentation, arrhythmias, heart failure (HF), and valvular disease.
4. Recognize the utility of mechanical circulatory support and heart transplantation for patients with advanced heart failure and cardiogenic shock, as well as the common complications associated with these interventions.

 Cardiovascular Critical Care II

1. Manage cardiac arrest from the initiation of basic life support to the use of post-cardiac arrest care.
2. List the indications and special considerations for medication administration during cardiac arrest.
3. Categorize the patient groups that should receive temperature control after cardiac arrest.
4. Develop treatment plans for common complications of temperature control after cardiac arrest.
5. Analyze the therapeutic goals and clinical indications for the medications used in hypertensive emergency.

Hepatic Failure/GI/Endocrine Emergencies 

1. Develop a treatment strategy to help manage and reduce the complications associated with acute liver failure (ALF).
2. Construct a plan for pharmacologic, nutritional, and surgical management of acute pancreatitis based on the severity of an episode.
3. Identify risk factors and treatment options for gastrointestinal fistulas, postoperative ileus, and postoperative nausea and vomiting.
4. Design a treatment plan for patients who present with an acute upper gastrointestinal bleed.
5. Differentiate between the major endocrine emergencies in the intensive care unit and their appropriate treatment regimens.

Supportive and Preventive Medicine

1. Identify the key components of intensive care medicine that can be applied to all critically ill patients.
2. Recommend therapeutic options to prevent stress-related mucosal disease.
3. Recommend therapeutic options to prevent venous thromboembolism in a critically ill patient.
4. Compare therapeutic options for patients with heparin-induced thrombocytopenia.
5. Discuss medications that can be used to comfort a critically ill patient at the end of life.
6. Examine the pharmacists’ role in disaster response.
7. Examine the role of social determinants of heath in patient outcomes.

Shock Syndromes I 

1. Distinguish between the various shock syndromes on the basis of a patient’s clinical and hemodynamic parameters.
2. Interpret hemodynamic data from monitoring devices and markers of perfusion.
3. Devise a treatment strategy for when to use intravenous fluids and/or vasopressors in a patient with shock.
4. Develop a treatment pathway for the care of patients with sepsis or septic shock that incorporates current evidence and the Surviving Sepsis Campaign guideline recommendations.

Shock Syndromes II

1. Identify critical determinants affecting oxygen delivery and the physiologic response to hypovolemic and obstructive shock.
2. Evaluate resuscitation strategies and end points in the management of hypovolemic, hemorrhagic, and obstructive shock.
3. Devise a treatment strategy for pharmacotherapy adjuncts in the management of bleeding and acute coagulopathy when treating patients with hemorrhagic shock.
4. Develop a treatment pathway for the care of patients receiving anticoagulants and antiplatelet agents for a life-threatening hemorrhage or critical bleeding that incorporates current evidence and guideline recommendations.
5. Apply risk stratification to guide the effective and safe use of thrombolytic agents in the management of acute pulmonary embolism.

Pain, Agitation/Sedation, Delirium, Immobility, Sleep Disruption, and Neuromuscular Blockade 

1. Develop a management strategy for the prevention and treatment of pain, agitation/sedation, and delirium, immobility, and sleep disruption (PADIS) in an intensive care unit (ICU) patient with various comorbidities.
2. Discuss relevant pharmacokinetic and pharmacodynamic considerations of PADIS medications as they pertain to disturbances in critical care physiology.
3. Identify relevant adverse effects, drug interactions, and drug withdrawal syndromes in the management of PADIS.
4. Evaluate patients in the ICU for PADIS using a validated screening tool.
5. Construct a plan for the management of delirium.
6. Identify the long-term effects of critical illness in adult ICU patients.
7. Create a management strategy for PADIS-related medications that are continued beyond ICU discharge.
8. Describe a treatment and monitoring plan for critically ill patients receiving neuromuscular blockade.

Pulmonary Disorders I 

1. Recommend an evidence-based therapeutic plan to manage critically ill patients with acute respiratory distress syndrome. 
2. Assess appropriateness of drug therapy for endotracheal intubation, including agents for premedication, induction, and neuromuscular blockade.
3. Evaluate key variables and commonly used modes for treatment with mechanical ventilation.

Pulmonary Disorders II 

1. Design a treatment plan for a cystic fibrosis (CF) exacerbation.
2. Develop a pharmacotherapy plan for pulmonary arterial hypertension using a risk assessment-based strategy.
3. Describe classifications and risk factors for increased severity of asthma exacerbation and treatment plans for patients with acute respiratory failure caused by asthma exacerbation.
4. Recognize evidence-based treatment options for acute exacerbations of chronic obstructive pulmonary disease (COPD).

Toxicology 

1. Distinguish between the common clinical toxidromes associated with acute poisonings.
2. Describe the general management of a patient with an acute overdose.