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The clinical and distributive services that have been provided by clinical pharmacists for the past 14 years in the medical intensive care unit (MICU) of a 1600-bed urban teaching hospital are described. The MICU pharmacy staff consists of 4.3 full-time equivalent pharmacists who provide daily 24-hour services. The pharmacists are actively involved in all pharmacological decisions with hands-on control of drug distribution from preparation through delivery and administration. They maintain up-to-date patient medication records and monitoring flow sheets for each patients. The pharmacists identify adverse reactions, formulate contingency plans, and promptly intervene to prevent crises. They provide comprehensive pharmacokinetic services, select drug administration times and routes, and prepare and deliver all medications. All i.v. medications are custom-made to meet the patients' fluid, sodium, or potassium restrictions. The pharmacists set up infusion pumps and select the proper infusion rates for i.v. and intra-arterial drugs. They also recommend and monitor the patients' nutritional support therapy. The program has been well accepted by nurses and physicians; however, only 20% of the inpatient clinical pharmacists desire to work in the MICU. The skills and educational requirements for managing patients in an MICU are discussed. Pharmacists have become an integral part of this MICU by optimal drug therapy, increasing productivity and efficiency, providing prompt and accurate services, and participating in research.

A method for postoperative pain prevention is described using epidural bupivacaine infused by means of a variable rate peristaltic pump. High plasma concentrations of bupivacaine were found but no serious signs of bupivacaine toxicity were observed and the method proved satisfactory in practice. Theoretical and practical considerations and aspects of clinical management are discussed.