Biomedical subjects

J J Maswoswe

Publications and source records attributed to J J Maswoswe.

5 recordsLinked to original sources

PubMed1995

Enforcing a policy for restricting antimicrobial drug use.

An institution's experience in enforcing a policy for restricting the use of antimicrobial agents is described. A policy to restrict the use of eight intravenous antimicrobial agents had been in place for two years at a large county teaching hospital but had never been enforced. In 1994 an organized effort to enforce the policy was begun. Memorandums were sent to all medical staff, residents, pharmacists, and nurses informing them that the policy would be diligently enforced. Before a restricted antimicrobial could be dispensed, the approval of a physician specializing in infectious diseases was required. Under the direction of the pharmacy and therapeutics committee and an antimicrobial subcommittee, a specially hired team of pharmacists started to encourage more effective and economical prescribing of antimicrobials. During a nine-month period after enforcement began, use of the restricted antimicrobials declined, and use of nonrestricted antimicrobials increased. After two months, acquisition costs for the restricted drugs had been reduced by more than $82,000; however, a similar increase in acquisition costs for nonrestricted antimicrobials occurred. As a result, one nonrestricted agent was reclassified as restricted, and inservice sessions were held to teach prescribes about the appropriate use of another agent. In general, physicians were very compliant with the antimicrobial-restriction policy; the greatest resistance was encountered from surgical residents. Some-pharmacists needed warnings beyond the initial memorandum. Enforcement of an antimicrobial-restriction policy led to decreased use of the restricted drugs and substantial cost avoidance. As new patterns of antimicrobial use emerged, the restriction policy was modified as necessary.

Anti-Bacterial Agents↗

PubMed1995

Criteria-based antimicrobial i.v. to oral conversion program.

Collaborative efforts among several departments and the P & T Committee resulted in an IV to oral conversion program for select antimicrobials in our 580-bed county teaching hospital. This criteria-based program was designed to monitor and educate physicians on the appropriateness of parenteral antimicrobial prescribing, ensure rapid transition from IV to oral therapy, and contain costs. In the first 2 months of the program, 78 patients were converted from IV to oral administration with an estimated savings of $12,935. Of the ordering physicians, 66 (84.6%) accepted the interventions. All patients who switched administration routes were successfully treated with an oral agent. This program also has had a positive effect on patient outcomes and physician prescribing habits.

Administration, Oral↗

PubMed1994

Emergence of multidrug-resistant isolates of Acinetobacter baumannii.

Patterns of antimicrobial resistance during an outbreak of nosocomial infections caused by Acinetobacter baumannii were studied. The medical records of all patients admitted to the hospital between February 1993 and February 1994 from whom A. baumannii was cultured were reviewed for demographic data, confirmation of the isolation report, admission date, date of first isolation of the organism, and antimicrobial use before and after the culture and susceptibility test results were obtained. The culture and susceptibility test data were reviewed for all specimens submitted to the laboratory during the review period. A total of 87 patients (mean +/- S.D. age, 37.9 +/- 8.7 years) with nosocomial infection or colonization with A. baumannii were identified. All the patients were surgical intensive care unit residents and had predisposing factors for acinetobacter infection. A total of 107 isolates of the organism were cultured from various sites; sputum was the most common source. The number of isolates per month increased steadily beginning in September 1993 and then declined over the winter. The median time between admission and first isolation of resistant A. baumannii was 11 days. Infections were manifested clinically as pneumonia (36 patients), bacteremia (8), wound infection (6), and urinary-tract infection (2). Of the 107 isolates, all were resistant to formulary cephalosporins, extended-spectrum penicillins, quinolones, and aztreonam. Only nine isolates were susceptible to one or more aminoglycosides. All the isolates were susceptible to imipenem-cilastatin. During an outbreak of nosocomial infections with A. baumannii, all or nearly all of the 107 isolates were resistant to a broad range of antimicrobials with the exception of imipenem-cilastatin, to which all the isolates were susceptible.

Acinetobacter↗

PubMed1994

Combating pharmacist shortage through labor certification.

Several solutions, ranging from increased technician duties to salary raises, automation, and increasing job satisfaction, have been presented in the literature as methods of assuaging the pharmacist shortage. Although a significant portion of pharmacy graduates from American pharmacy colleges are foreign nationals, no marketing strategies have been elucidated in the retention and recruitment of foreign nationals through labor certification. Labor certifications are generally approved by the Secretary of Labor if the following factors have been verified: 1) there are not sufficient United States workers who are able, willing, qualified, and available for employment; and 2) the employment of the foreign national will not adversely affect the wages and working conditions of U.S. workers similarly employed. When properly understood, the labor certification process is a test of the job market where foreigners, by virtue of their skills and qualifications, attain certification which subsequently leads to permanent residency (green card). The objective of this report is to elucidate the tedious yet effective method of retaining American-educated foreign nationals through labor certification.

Documentation↗

PubMed1987

Achieving parenteral nutrition cost savings through prescribing guidelines and formulary restrictions.

A hospital's use and pharmacy costs of parenteral nutrition (PN) therapy before and after implementation of standardized PN formulas, prescribing guidelines, and preprinted order forms were compared. The study hospital, a large teaching institution, did not have a formal PN team. Guidelines for prescribing were promulgated by the pharmacy and therapeutics committee, the quality assurance committee, and the medical staff executive committee. Records of all patients receiving PN therapy were audited for six-month periods before and after implementation of the program. Cost data associated with decreased PN and albumin wastage, reduced labor and materials costs, inventory reduction, decreased inventory holding costs, and competitive bidding were analyzed. After implementation of this program, the number of wasted PN solutions was reduced by 55.8%, and the cost of PN solutions decreased by 36.9%. Use of albumin-containing PN solutions was reduced by 85.3%. PN solution preparation times were reduced by 66.1% (a reduction of 58.7% in preparation costs), and PN acquisition costs were reduced by 54.5%. A total annual savings of $170,722 was realized, plus a one-time cost savings of $15,632 from inventory reduction. Use of standardized parenteral nutrition formulas and prescribing guidelines can substantially decrease the cost of patient care.

Albumins↗