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Interprofessional Partnerships and Intersections in Neurocritical Care: A Focus on the Neurointensivist and Neurocritical Care Pharmacist

By Currents Editor posted 08-16-2021 13:55


Salia Farrokh, Lucia Rivera Lara, Jon Cokley and Hana Nobleza

Specialized neurocritical care teams have been found to improve outcomes such as mortality, length of stay, and discharge dispositions for patients who are both neurologically devastated and critically-ill. These teams within the Neurocritical Care Unit (NCCU) can comprise an attending neurointensivist, trainees (fellows, residents, and medical students), a dedicated pharmacist, advanced practice providers (APP), a respiratory therapist, and others. It has been reported that a dedicated pharmacist’s inclusion in the NCCU team can result in improved ICU length of stay, decreased hospital cost, and a decrease in medication errors, all of which can affect patient outcome. Beyond these benefits, the interaction of the neurointensivists with pharmacists can go beyond rounding. Protocols and policies for medication use, , quality improvement, educational initiatives, and research projects can all be done in collaboration with each other. Through these projects, interprofessional growth and diversity can occur within the NCCU and ultimately benefit the patients and NCCU staff. Physicians may not only have projects with other physicians but also with NCCU pharmacists that are relevant to the type of patients they see in the NCCU. This offers an opportunity for mutual learning and support. The following stories exemplify these relationships that should be nurtured and developed in every NCCU.

A model relationship of impactful women in neurocritical care: Salia Farrokh, PharmD, and Lucia Rivera Lara, MD

Though these two women come from very different backgrounds—Salia, a pharmacist with Middle Eastern heritage, and Lucia, a neurointensivist with Hispanic heritage—they developed a strong friendship while rounding together in the NCCU at the Johns Hopkins Hospital in Baltimore, MD. What made their professional relationship stronger over the years was their passion for patient care and desire to work hard to collaborate on research projects that helped improve patient outcomes. Despite their many differences, they were able to create a robust pharmacist-physician team that championed many projects focused on patient care, quality improvement, and clinical research. 

A few examples of their collaboration include original research examining the associations between prophylactic use of anti-seizure medications and short- and long-term outcomes in intracerebral hemorrhage patients. This research led to a publication in Seizure while also helping to streamline care for stroke patients in their clinical practice. Additionally, their research in antiplatelet use in neuroendovascular patients identified gaps in practice which led to a publication in Journal of Pharmacy Practice and the creation of more effective protocols to improve care in these patients. 

Salia and Lucia’s relationship has also provided them with opportunities for personal and career growth. Salia calls Lucia “a determined and motivated physician with integrity, and who was respectful to all team members but kept everyone accountable as well.”  She helped Salia learn how to voice her concerns and stand up for the best interests of her patients and team. Lucia, meanwhile, lauds her counterpart as “a motivated, mindful, reliable and knowledgeable pharmacist who is very passionate to provide the best care. Lucia says she has personally learned a lot from Salia and encourages other neurointensivists to routinely engage their pharmacists on multidisciplinary rounds. After all, she says, “pharmacists are drug experts who are there to help us improve patient care and provide [support for] our pharmacological interventions and decision-making every day; we should be appreciative of their support.”  

Despite their reputation among their close colleagues and friends as impactful women in neurocritical care, Salia and Lucia have overcome many challenges faced by women in the field, and they both agree that there is a lot more that needs to be done for voices like theirs to be heard and create healthier work environments in the neurocritical care community. Within NCS, there are opportunities to participate in the NCS mentorship program, Inclusion in Neurocritical Care (INCC) section, developing educational programs, and joining committees to improve diversity. But these opportunities would benefit even more from the kind of synergy exemplified in Lucia and Salia’s collaborative relationship. 

Interprofessional education in neurocritical care and its role in diversity: Jon Cokley

Interprof2.jpgAn African-American pediatric clinical pharmacy specialist is a rare intersection in healthcare, even with the ongoing push for improving diversity. As an HBCU (historically black colleges and universities) alumnus, Jon is passionate about increasing diversity and expanding the role of pharmacists in neurology. He has a strong belief in the impact of advocacy and strives to help others receive quality education and training, both in the classroom and in the workplace. He has dedicated his career to service through treatment and guidelines committees along with various diversity counsels. Within NCS, he serves as the co-chair elect for Underrepresented Ethnicities in Neurocritcal care and Intersectional Concepts (UENCIC) and has contributed to numerous educational projects. His colleagues have celebrated his addition to the neurocritical care team at Texas Children’s Hospital: 

“I cannot say enough positive things about Jon.  He is incredibly important to our NCC rounds. This year I have learned what an outstanding teacher he is.  Neurodevelopmental Disabilities trainees have a mandatory Pharmacology rotation. Jon not only agreed to teach our trainees and allow them to round but he was proactive, thorough and developed more sessions and learning opportunities than I could have imagined.  Our first trainee working with him has given such positive feedback!  He took his own time and initiative.  He is a great teacher to all levels (I know I learn from him as much as trainees do!).  He is hardworking, incredibly knowledgeable, pro-active, helpful... all around outstanding.” - Sarah Risen, MD 

“Dr. Cokley has been a great addition to our Neurocritical Care team, immediately becoming an active participant in this program. We are spoiled to have him with us during patient rounds. His fund of knowledge is vast, he is very insightful, inquisitive, and extremely dedicated in making sure that the patient gets the treatment needed. But especially important is that he understands the neurological and neurocritical care disorders for which pharmacotherapy is needed. He goes above and beyond what is expected and is always available for a question or to discuss an acute problem. Dr. Cokley helped us launch a ketogenic diet program for status epilepticus which previously had not been offered to our Pediatric Intensive Care Unit (PICU) population. I doubt that we would have been able to do this without his input and experience. We have just started a Pediatric Stroke Code Team and he has been invaluable in helping plan this program.” - James J. Riviello., Jr., MD, FACNS, FNCS


Lauren Koffman, DO, MS As a member of the Educational Products Committee, one of many committees within the Neurocritical Care Society, I was recently asked to review A Guide to Traumatic Brain Injury: The Intensive Care Unit . This guide was written several years ago by Dr. David Y. Hwang and ...
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Gantner D, Wiegers E, Bragge P, Finfer S, Delaney A, van Essen T, Peul W, Maas AIR, Cooper DJ. Decompressive Craniectomy Practice following Traumatic Brain Injury in Comparison with Randomized Trials: Harmonized, Multi-Center Cohort Studies in Europe, the United Kingdom, and Australia. J Neurotrauma. ...