Susan E Smith

• Doctor of Pharmacy
• Clinical Associate Professor at University of Georgia

Background: The optimal duration of antimicrobial therapy for treatment of complicated intra-abdominal infections (cIAI) in critically ill surgical patients is unknown. Recent evidence suggests that a short (four-day) course of therapy may be effective, however data in severely critically ill patients are limited. Patients and methods: A single-...

Two sliding scale regular human insulin (RHI) algorithms (SSI) were retrospectively evaluated to identify those who develop severe hyperglycemia (blood glucose (BG) ≥ 180 mg/dL) and for glycemic management of continuouslyfed, critically ill trauma patients with mild to moderate hyperglycemia (BG 126 to 179 mg/dL). Assignment of low or high SSI was...

Objectives To evaluate the relationship among ICU patient-to-pharmacist ratio, perceived quality of patient care, and pharmacist burnout. Design A prospective, multicenter, time-motion study conducted over a 10-month period (from May 1, 2022, to February 28, 2023). Setting Adult ICU, PICU, or neonatal ICU. SUBJECTS ICU clinical pharmacists Inte...

Background A penicillin allergy label promotes use of broad-spectrum and alternative antibiotics, which can cause an increase in resistance. Urinary tract infections are commonly encountered in health systems and few studies have shown how a documented penicillin allergy affects resistance on a yearly antibiogram for these isolates. Urinary Antibio...

Background Fluid overload (FO) in the intensive care unit (ICU) is common, serious, and may be preventable. Intravenous medications (including administered volume) are a primary cause for FO but are challenging to evaluate as a FO predictor given the high frequency and time‐dependency of their use and other factors affecting FO. We sought to employ...

Purpose The medication regimen complexity intensive care unit (MRC-ICU) score has previously been associated with pharmacist workload and fluid overload. The purpose of this study was to determine the relationship of MRC-ICU score with pharmacist-driven fluid stewardship recommendations as a means of establishing its role in risk stratifying critic...

The pursuit of research and scholarly productivity is critical for clinician scientists, yet achieving impactful outcomes often necessitates collaboration within a well‐structured team. This review explores the foundational elements of team building that support sustained research productivity among health care professionals and academicians. Drawi...

Background: Critically ill patients are managed with complex medication regimens that require medication management to optimize safety and efficacy. When performed by a critical care pharmacist (CCP), discrete medication management activities are termed medication interventions. The ability to define CCP workflow and intervention timeliness depends...

Background: Medication management in the intensive care unit (ICU) is causally linked to both treatment success and potential adverse drug events (ADEs), often associated with deleterious consequences. Patients with higher severity of illness tend to require more management. The purpose of this evaluation was to explore the effect of comprehensive...

Purpose Scientific journals have reportedly low acceptance rates. Peer review support services offering manuscript review before journal submission are uncommon but may increase success with the publication process. The purpose of this report is to describe the development and experience with a peer prereview (PPR) service offered by the Clinical P...

Background/Objective: Intravenous fluid shortages have led to fluid-sparing measures such as intravenous push (IVP) administration of antibiotics. This study aimed to compare the safety and efficacy of IVP and intravenous piggyback (IVPB) ceftriaxone in critically ill patients. Results: Demographics were similar in IVP (n = 201) and IVPB (n = 200)...

Background: Large language models (LLMs) have shown capability in diagnosing complex medical cases and passing medical licensing exams, but to date, only limited evaluations have studied how LLMs interpret, analyze, and optimize complex medication regimens. The purpose of this evaluation was to test four LLMs ability to identify medication errors a...

Purpose Critical care pharmacists (CCPs) are essential members of the multidisciplinary critical care team. Professional activities of the CCP are outlined in a 2020 position paper on critical care pharmacy services. This study looks to characterize CCP perspectives for priorities in optimizing pharmacy practice models and professional activities....

Purpose Critical care pharmacists (CCPs) have been clearly established as value-added members of the interprofessional team, and their contributions positively impact patient outcomes in the intensive care unit (ICU). Despite this, not every critically ill patient in the US receives care from a CCP and the model through which CCPs practice is varia...

Objective Common data models provide a standard means of describing data for artificial intelligence (AI) applications, but this process has never been undertaken for medications used in the intensive care unit (ICU). We sought to develop a common data model (CDM) for ICU medications to standardize the medication features needed to support future I...

Background: In critically ill patients, complex relationships exist among patient disease factors, medication management, and mortality. Considering the potential for nonlinear relationships and the high dimensionality of medication data, machine learning and advanced regression methods may offer advantages over traditional regression techniques. T...

Purpose: The Joint Commission standards for titrated infusions require specification of maximum rates of infusion. This practice has led to the development of protocolized maximum doses that can be overridden by provider order (“soft maximums”) and to dose caps that cannot be superseded (“hard maximums”). The purpose of this study was to determine...

Fluid overload, while common in the ICU and associated with serious sequelae, is hard to predict and may be influenced by ICU medication use. Machine learning (ML) approaches may offer advantages over traditional regression techniques to predict it. We compared the ability of traditional regression techniques and different ML-based modeling approac...

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...

Objective: Common Data Models provide a standard means of describing data for artificial intelligence (AI) applications, but this process has never been undertaken for medications used in the intensive care unit (ICU). We sought to develop a Common Data Model (CDM) for ICU medications to standardize the medication features needed to support future...

BACKGROUND The workload of healthcare professionals including physicians and nurses in the ICU has an established relationship to patient outcomes, including mortality, length of stay, and other quality indicators; however, the relationship of critical care pharmacist workload to outcomes has not been rigorously evaluated and determined. The object...

While medication regimen complexity, as measured by a novel medication regimen complexity-intensive care unit (MRC-ICU) score, correlates with baseline severity of illness and mortality, whether the MRC-ICU improves hospital mortality prediction is not known. After characterizing the association between MRC-ICU, severity of illness and hospital mor...

Background Fluid overload, while common in the ICU and associated with serious sequelae, is hard to predict and may be influenced by ICU medication use. Machine learning (ML) approaches may offer advantages over traditional regression techniques to predict it. We compared the ability of traditional regression techniques and different ML-based model...

Maternal mortality continues to be an issue globally despite advances in technology and pharmacotherapy. Pregnancy can lead to complications that necessitate immediate action to prevent severe morbidity and mortality. Patients may need escalation to the ICU setting for close monitoring and administration of advanced therapies not available elsewher...

The equivalence of intravenous push (IVP) and piggyback (IVPB) administration has not been evaluated in the critically ill population for most medications, but it is especially relevant for antibiotics, such as cefepime, that exhibit time-dependent bactericidal activity. A single center, retrospective, observational pre/post-protocol change study i...

Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are point‐of‐care viscoelastic tests of whole blood that provide real‐time analyses of coagulation. TEG and ROTEM are often used to guide blood product administration in the trauma and surgical settings. These tests are increasingly being explored for their use in other disease sta...

Background Identifying patterns within ICU medication regimens may help artificial intelligence algorithms to better predict patient outcomes; however, machine learning methods incorporating medications require further development, including standardized terminology. The Common Data Model for Intensive Care Unit (ICU) Medications (CDM-ICURx) may pr...

Background and purpose: Evolution of personal finance beliefs over the course of a college career are unknown. The purpose of this study is to compare perceptions and knowledge of personal finance in undergraduate and pharmacy students at baseline and after completing a personal finance course. Educational activity and setting: A personal financ...

Safe and thoughtful medication management of pregnant patients requiring intensive care unit (ICU) level of care is key to optimizing outcomes for both mother and fetus. Pregnancy induces physiologic alterations that closely mirror the changes expected in a critically ill patient. These changes can be predictable depending on the gestational age an...

Objectives: The objectives of this scoping review are to (1) describe the available literature regarding the utility of the debate-style journal club for health professional learners on literature evaluation skills and (2) report the themes found within debate-style journal club research and assessments in the context of professional education. F...

Objectives: To explore the landscape of mentorship within professional associations in pharmacy academia, including reviewing available literature and describing currently available programs within the American Association of Colleges of Pharmacy, and recommend key considerations for the development of mentorship programs within professional assoc...

Background: Evidence suggests that goal anti-Xa levels are achieved in only 33% of critically ill patients receiving standard prophylactic enoxaparin dosing. There has been limited focus on the potential suboptimal anticoagulation effect on medical intensive care unit (MICU) patients receiving therapeutic enoxaparin dosing for venous thromboembolis...

Use of dalbavancin in substance abuse patients

Background: Propofol is a key component for the management of sedation and shivering during targeted temperature management (TTM) following cardiac arrest. The cardiac depressant effects of propofol have not been described during TTM and may be especially relevant given the stress to the myocardium following cardiac arrest. The purpose of this stud...

Introduction De-resuscitation practices in septic patients with heart failure (HF) are not well characterized. This study aimed to determine if diuretic initiation within 48 hours of intensive care unit (ICU) admission was associated with a positive fluid balance and patient outcomes. Methods This single-center, retrospective cohort study included...

Background The inability to afford medications can lead to nonadherence and uncontrolled disease states. As a result, patients may require an increase in acute healthcare utilization to control potential complications. Qualifying patients can apply for patient assistance programs (PAPs) through various manufacturers to receive medications at little...

Introduction: Fluid stewardship targets optimal fluid management to improve patient outcomes. Intravenous (IV) medications, flushes, and blood products, collectively referred to as hidden fluids, contribute to fluid intake in the intensive care unit (ICU). The impact of specific IV medications on fluid intake is unknown. Objective: Characterize IV...

Introduction: The position paper on critical care pharmacy services describes two tiers of responsibilities: essential and desirable activities. Activities are categorized into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development. Documentation of these activities can be imp...

Disclaimer: In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these 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 ver...

We thank Drs. Haas and Dick for their thoughtful commentary on our team’s recent evaluation, which allows us to continue the vital discussion of optimizing critical care pharmacist services for critically ill patients.¹ We wholeheartedly agree that pharmacist workload (ie, the amount of work to be done) and productivity (ie, units of output divided...

Introduction Angiotensin II (Ang-2) is a non-catecholamine vasopressor that targets the renin-angiotensin-aldosterone system by agonism of the angiotensin type 1 receptor. Its utility as a vasopressor and a catecholamine-sparing agent was demonstrated in the pivotal ATHOS-3 trial, and numerous post-hoc analyses have shown reduced mortality in certa...

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...

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 s...

Background: Pharmacologic thromboprophylaxis (PTP) is the mainstay prevention strategy for venous thromboembolism (VTE). PTP agents traditionally dosed, like unfractionated heparin (UFH) and enoxaparin (ENOX), are associated with failure and bleeding in obese and underweight patients, respectively. Objectives: This study aimed to describe the preva...

Preexisting heart failure (HF) in patients with sepsis is associated with worse clinical outcomes. Core sepsis management includes aggressive volume resuscitation followed by vasopressors (and potentially inotropes) if fluid is inadequate to restore perfusion; however, large fluid boluses and vasoactive agents are concerning amid the cardiac dysfun...

Introduction Professional health care associations present a unique opportunity for formal mentorship programs, with membership often spanning a variety of experiences, professional ranks, and institutions. However, scarce literature describes the role of professional associations in the development and assessment of mentoring programs. This paper...

In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these 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 recor...

What gets measured, gets improved. —Robert Sharma Every critically ill patient requires care by a critical care pharmacist (CCP) for best possible outcomes. Indeed, these highly trained professionals generate benefit through direct patient care (eg, pharmacist-driven protocols, medication monitoring, etc), participation on the intensive care unit (...

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, b...

Background The optimal vasopressor management for septic patients with left ventricular (LV) dysfunction has not been well established, and current evidence is conflicting regarding the optimal vasopressor discontinuation order. Objective The objective was to evaluate the impact of LV dysfunction on the hemodynamic management of septic shock by as...

Despite the frequent use of maintenance intravenous fluids (mIVF) in critically ill patients, limited guidance is available. Notably, fluid overload secondary to mIVF mismanagement is associated with significant adverse patient outcomes. The Four Rights (right drug, right dose, right duration, right patient) construct of fluid stewardship has been...

Introduction The American Association of Colleges of Pharmacy Pharmacy Practice Section appointed a task force charged with developing a formal, national mentorship program for association section members. This manuscript provides insight into the creation of a mentorship program in a professional organization. Methods Eighteen task force voluntee...

We read with great interest the much-anticipated vancomycin therapeutic monitoring guideline published in the Journal.¹ As expected, trough-only monitoring of vancomycin levels with a target concentration of 15 to 20 μg/mL for invasive methicillin-resistant Staphylococcus aureus (MRSA) infections is no longer recommended. The revised recommendation...

Background Critically ill patients are at increased risk for fluid overload, but objective prediction tools to guide clinical decision-making are lacking. The MRC-ICU scoring tool is an objective tool for measuring medication regimen complexity. Objective To evaluate the relationship between MRC-ICU score and fluid overload in critically ill patie...

Purpose Critical 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 resea...

Background Penicillin allergy reconciliation is an important aspect of antimicrobial stewardship with ~10% of the population reporting a penicillin allergy. Our facility utilizes a Penicillin Allergy Reconciliation Program (PARP) led by an Infectious Diseases (ID) Pharmacist and pharmacy students to identify patients with penicillin allergies to re...

Background Fluid overload is associated with poor outcomes, but mitigating its occurrence poses significant challenges. Objective This study sought to assess the impact of hidden fluid volume on fluid overload. Methods This study was a multi-center, retrospective evaluation of adults admitted to a medical or surgical intensive care unit for at le...

This article was migrated. The article was marked as recommended. In response to the COVID-19 pandemic, many institutions changed their staffing models to incorporate remote work which created a need for pharmacy faculty and preceptors to also shift their rotation experience to a remote format. While initially this may be a daunting task, remote ex...

Introduction Many clinical faculty members are challenged by competing factors of scholarly productivity, education, service obligations, and patient care. A team-based approach has the potential to synergistically increase productivity and mitigate factors associated with burnout. Methods The purpose of this report is to discuss a prototype for a...

What is known and objective: Advanced Cardiovascular Life Support (ACLS) is an integrated, team-based approach to optimizing patient outcomes during acute cardiovascular events. Due to the fast-paced, high-stress environment, inherent strengths may impact performance and confidence with ACLS skills. The objective of this study was to assess pharma...

Purpose: Procalcitonin (PCT) is an endogenous hormone that increases reliably in response to bacterial infection, and measurement of serum PCT levels is recommended to help guide antimicrobial therapy. The utility of PCT assessment in special patient populations (eg, patients with renal dysfunction, cardiac compromise, or immunocompromised states...

High‐quality experiential education builds on didactic education to enable graduates to meet the full spectrum of entry‐level pharmacy‐related roles and responsibilities, including lifelong learning and professional development. The 2019 Educational Affairs Committee A, an ACCP standing committee, was charged to review and update the 2008 ACCP whit...

Background The MRC-ICU, a novel regimen complexity scoring tool, provides an objective measure of medication regimen complexity in critically ill patients. The MRC-ICU may have the ability to evaluate the impact of critical care pharmacists on patient outcomes but requires further validation. The objective of this study was to confirm the external...

Background and purpose Research electives are commonly offered in doctor of pharmacy programs but are typically limited to one faculty member mentoring individual students at a single site for a semester long self-study experience. The purpose of this paper is to describe pharmacy student experiences and perceptions of the research process after co...