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Biomedical subjects

J G Kitrenos

Publications and source records attributed to J G Kitrenos.

13 recordsLinked to original sources
PubMed1994

Medication cart-filling time, accuracy, and cost with an automated dispensing system.

Medication cart filling with an automated dispensing system was compared with manual cart filling with respect to personnel time, costs, and accuracy. At a 650-bed tertiary-care medical center, technician cart filling and pharmacist cart checking were timed for the existing manual system and for the Baxter ATC-212 automated dispensing system. Subsequently, carts filled with each system were checked for accuracy of dispensing. On the basis of drugs used in the automated system over three months, drug acquisition and dispensing costs were calculated for automated and manual cart filling; the costs of personnel time were also compared. Daily cart filling time for technicians was significantly less with the automated system. The savings of pharmacist time was not significant; pharmacists had to cut the strip-packaged drugs into individual doses as they checked patients' medications. For both systems, errors were found in fewer than 1% of the doses (0.84% for the manual system and 0.65% for the automated system). Drug costs were higher with the automated system; acquisition prices for the bulk drugs purchased for use in the dispensing machine were higher than the prices of the same products in unit dose packaging. Personnel time saved amounted to less than 0.5 full-time equivalent. With the automated system, overall time savings was not great enough to substantially affect pharmacy operations, and drug costs were higher.

Automation↗
PubMed1993

Clinical appropriateness, therapeutic equivalence, and cost of conversion of H2 antagonist therapy.

A 12-month drug monitoring program targeting the use of H2 antagonists was initiated at the Erie County Medical Center, a 650-bed academic teaching hospital in Buffalo, NY. Discussed in this article are the development of indicators used to determine appropriateness of therapy, implementation of a H2 antagonist monitoring and screening program, examination of the effect of the program on budgetary expenditures for H2 antagonist therapy, evaluation of adverse effects and potential drug interactions associated with drug use, and measurement of possible drug cost savings resulting from the implementation of the program.

Cimetidine↗
PubMed1991

Use of refractometers to detect controlled-substance tampering.

Hospital pharmacies presently lack a simple and cost-effective procedure to monitor the integrity of solutions of controlled substances that they distribute. Thus, the use of refractive-index values, measured by inexpensive hand-held refractometers, in monitoring such solutions was studied. Four refractometers were used to measure the refractive index or % Brix (an index of the percentage of solid in solution) of solutions of a number of controlled substances, including fentanyl citrate, morphine sulfate, hydromorphone hydrochloride, and meperidine hydrochloride. The hand-held refractometers provided precise readings with small variabilities. Although this method does not determine the actual drug concentration per se, subversion of the monitoring procedure for many solutions would require considerable forethought and scientific knowledge. A refractometric survey of 83 controlled-substance solutions returned to the hospital pharmacy showed the procedure to be capable of identifying a solution of unexpected concentration. The described refractometric procedure is rapid, simple, reproducible, inexpensive, and applicable to a wide array of drug solutions. Hospital pharmacies may consider using the procedure for routine monitoring of solutions of controlled substances.

Drug and Narcotic Control↗
PubMed1990

Pharmacist intervention program focused on i.v. ranitidine therapy.

A staff pharmacist intervention program designed to modify inappropriate dosage intervals for i.v. ranitidine and promote timely conversion to oral therapy is described. Records of patients who were receiving i.v. ranitidine were reviewed for eight weeks to determine whether the dosage interval was appropriate and whether they began receiving oral ranitidine within 24 hours of an order for an oral diet or other oral medications. Pharmacists were then asked to determine the proper i.v. ranitidine dosage interval based on creatinine clearance and the oral dosage that would be appropriate when i.v. therapy was no longer indicated. The information was used to complete an intervention form that was placed in the patient's chart. During the baseline phase the i.v. dosage interval was inappropriate for 49 of 139 patients; 617 i.v. doses costing $4214 were administered to 62 patients for whom oral therapy was indicated; conversion to oral therapy occurred appropriately for 39 of 68 patients (57%). In the intervention phase 138 patients received i.v. ranitidine. Pharmacists made 51 recommendations for adjusting the i.v. dosage interval, and 18 were implemented within 24 hours. All six recommendations to convert immediately to oral therapy were also implemented within 24 hours. A total of 280 inappropriate i.v. doses costing $1912 were given to 30 patients for whom oral therapy was indicated. Conversion to oral therapy occurred appropriately for 53 of 76 patients (70%). A simple program of monitoring and intervention by staff pharmacists when i.v. ranitidine therapy is begun can save money and promote the appropriate use of this drug.

Adolescent↗
PubMed1989

Clinical considerations and costs associated with formulary conversion from tobramycin to gentamicin.

The clinical and financial effects of replacing tobramycin with gentamicin on the formulary of a 550-bed teaching hospital were studied. On the recommendation of the pharmacy and therapeutics committee, the formulary aminoglycoside was changed from tobramycin to gentamicin in June 1985; the nonformulary status of amikacin was unchanged. Five weeks later, physician compliance was assessed and the reasons for prescribing nonformulary aminoglycosides were determined. Two four-month-long evaluations were done at 6 and 18 months after implementation to assess patterns of use of nonformulary aminoglycosides. The impact on costs was determined after one and two years by considering use patterns of formulary and nonformulary aminoglycosides, as well as those of third-generation cephalosporins and mezlocillin. Resistance patterns of two gram-negative organisms, Pseudomonas aeruginosa and Serratia marcescens, were assessed for 1982-1987. Finally, the rate of nephrotoxicity in gentamicin-treated patients was determined. During the first five weeks after the formulary conversion, 80.3% (106 of 132) of the aminoglycoside orders received were for gentamicin. After telephone follow-up by the pharmacy department, that figure rose to 93.9%. During the four-month reviews beginning at 6 and 18 months, nonformulary orders accounted for 10.9% and 7.4%, respectively, of the total number of courses of aminoglycosides prescribed. In the majority of these cases, tobramycin and amikacin were used to treat infections caused by organisms with documented resistance to gentamicin or to gentamicin and tobramycin, respectively. No clear-cut changes in resistance patterns for Ps. aeruginosa or S. marcescens could be associated with the formulary conversion.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacteria↗
PubMed1988

Delivery of gentamicin by a controlled-release infusion system versus a minibag system.

Delivery of gentamicin via a new controlled-release intravenous infusion system was compared with conventional delivery via small-volume injections in minibags by measuring serum drug concentrations in 10 healthy men. Each volunteer received gentamicin (as the sulfate salt) 2 mg/kg. In phase 1, subjects randomly received the drug either as a 50-mL admixture in 5% dextrose injection (D5W) or from the controlled-release system (CRIS, IVAC Corporation), in which drug was diluted in a vial with 10 mL of sterile water for injection (density of drug solution, approximately 1.5% w/v) and was delivered when the primary solution (D5W; density, 5% w/v) displaced drug from the vial and infused it into the subject over 30 min; subjects were then crossed over. In phase 2, nine of the subjects received the drug via CRIS with the diluent changed to 10 mL of 5% dextrose and 0.9% sodium chloride injection (D5NS; density of drug solution, approximately 5.9% w/v). In phase 3, 10 men (seven of the original subjects) received the gentamicin dose via CRIS with 20 mL of D5NS as the diluent or via minibags in a crossover design. The amount of drug remaining in each vial used with the CRIS system was determined. Drug administration via CRIS with 10 mL of sterile water diluent resulted in serum concentrations approximately 35% of those obtained with the minibag system, and a substantial portion (71 +/- 8%) of the dose to be administered remained in the vials.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Comparison of seven methods of preparing and administering cefazolin sodium small-volume injections.

The time and costs of preparing and administering cefazolin sodium small-volume injections using automated and manual systems were compared. Doses of cefazolin sodium 1 g were prepared in batches of 100 using each of seven methods, and preparation and administration times were recorded during five time trials. Personnel time and total material costs were determined. Bulk-vial reconstitution methods included manual piggyback, manual 24-hour piggyback, and manual syringe systems and one automated syringe infusion method (Bard programmable dispensing pump). Three prefilled container systems (Faspak flexible plastic bags, manufacturers' partial-fill glass bottles, and cefazolin sodium 1-g vials reconstituted using the ADS 100 Physio-Control peristaltic pump and administered via the IVAC CRIS system) were compared with each other and with the bulk reconstitution methods. Of the bulk-vial methods, total preparation process times were significantly shorter for the 24-hour piggyback system. Of the prefilled container systems, total preparation process time was significantly shorter for the Faspak system. Total daily administration process time was shortest for the IVAC CRIS system. Material costs per dose were lowest for the IVAC CRIS system and highest for the syringe pump systems (manual syringe and Bard syringe). Although lowest cost per dose was identified with the IVAC CRIS system, the 24-hour piggyback system was the system of choice on the basis of similar cost savings, its ability to manage primary fluids, and practicality of use at this institution.

Cefazolin↗
PubMed1983

Comparison of six methods for preparing cefazolin sodium for intermittent injection.

The time and cost of preparing i.v. piggyback doses of cefazolin sodium using automated and manual methods were compared. One-gram doses of cefazolin sodium were prepared in batches of 100 using each of six methods. Total equipment process times were recorded during five trials with each method. Personnel time and total materials costs were determined. Bulk-vial reconstitution methods, including a manual syringe and three automated fluid-delivery devices (Burron Multi-Ad syringe pump, Unispense peristaltic pump, and Valleylab heart-valve cassette pump), were compared. Two prefilled container systems (Faspak flexible plastic bags with Physio-Control peristaltic pump, and glass piggyback bottles with the Multi-Ad pump) were compared with each other and with the bulk-reconstitution methods. Of the bulk-vial methods, total process times were significantly shorter for the Multi-Ad and Unispense systems. Of the prefilled container systems, total process time and personnel time were significantly shorter for the Faspak method than for the manufacturer's piggyback bottle method. Materials costs were similar for all bulk-vial methods and were significantly lower for both prefilled container systems. Overall costs were lower for prefilled systems; the cost per dose was $3.63 for the manufacturer's piggyback bottle system and $4.26 for the Faspak system. Total personnel time required by the Faspak method was 21.5 minutes per batch, approximately one third the time required by any other method. In terms of personnel time and materials costs for preparation of i.v. cefazolin sodium doses, manufacturers' prefilled container systems have advantages over bulk-reconstitution methods.

Cefazolin↗
PubMed1979

Analysis of missing medication episodes in a unit dose system.

The unit dose drug distribution system at The Buffalo General Hospital in Buffalo, New York, was evaluated by an analysis of cases in which doses of medication were missing from the unit dose administration cart. When a dose was missing, the medication administration nurse reported the occurrence to the pharmacy. When time permitted, the cause of the missing dose was determined and recorded. Thirty causes for missing doses are cited. The causes were found to arise from misuse of the unit dose system by nurses, misunderstandings between the Nursery and Pharmacy Departments, or from oversights on the part of nurses or pharmacy personnel. Missing doses can be prevented in the future by instructing nurses in the use of the system, improving communication between the Departments of Pharmacy and Nursing concerning the needs of the patients, and being aware of mistakes that can occur so care can be taken to prevent them in both departments.

Evaluation Studies as Topic↗
PubMed1978

Comparison of selected intravenous infusion pumps and rate regulators.

Selected intravenous infusion pumps and rate regulators were compared to determine the relative advantages and disadvantages and to formulate guidelines for purchase of these devices. Three basic types of devices were studied: infusion rate regulators, nonvolumetric (peristaltic) infusion pumps and volumetric infusion pumps. Simple syringe-type infusion pumps were not studied. After use and close study of the devices, both in the laboratory and in the clinical area, desirable features were identified. Ideally, the infusion device should operate over a wide rate range, use standard administration sets, be easy to assemble and service, have an internal battery of good power for several hours, have appropriate malfunction alarms, have an automatic keep-open device in alarm situations, be accurate under a variety of situations, and be easy for the nurse to understand and operate. All devices tested were accurate within the limits claimed by the manufacturer, although a couple of models have features which can cause gross volume errors. Overall evaluation resulted in preference of some devices over others. Cost of infusion devices and administration sets can vary widely, and this should be a factor in the final choice of intravenous infusion equipment.

Evaluation Studies as Topic↗
PubMed1978

Use of a pharmacy technologist to manage technicians' activities.

The role of a pharmacy technologist, in comparison with that of a pharmacist and a pharmacy technician, is discussed as it was developed at one hospital. Training, staffing patterns, personnel functions, acceptance and salary of the technologist are described. The use of the technologist to manage technician-level personnel is suggested as a means of providing the pharmacist with more time for professional activities.

Hospital Bed Capacity, 500 and over↗
PubMedDate not supplied

Conversion of treatment from cefoxitin to ampicillin/sulbactam: experience in a university teaching hospital.

A 12-month trial, conducted in a 650-bed university teaching hospital, evaluated the conversion from cefoxitin to ampicillin/sulbactam. This report discusses the methodology used to evaluate the feasibility of the change and the challenges encountered during the trial period. The effect of cost and overall therapeutic outcome were other aspects of the evaluation. Results indicate that a conversion from cefoxitin to ampicillin/sulbactam is not only feasible but is also a realistic approach to achieving high-quality, cost-effective care.

Ampicillin↗