Biomedical subjects

K A Fudge

Publications and source records attributed to K A Fudge.

3 recordsLinked to original sources

PubMed1993

Change in prescribing patterns of intravenous histamine2-receptor antagonists results in significant cost savings without adversely affecting patient care.

OBJECTIVE: The cooperative efforts and educational activities associated with a major histamine2-receptor antagonist (H2RA) formulary change and the clinical and financial results are described. EVALUATION PROCESS: An extensive financial and clinical evaluation was conducted. Sources included primary literature, reference texts, institution-specific financial data, and reports of other hospitals' experiences. INTERVENTIONS: Through cooperative efforts with key members of the medical staff, several interventions were adopted: maintain only one parenteral H2RA on the formulary; develop guidelines for H2RA use and stress ulcer prophylaxis; investigate a target drug-reminder system to promote oral H2RA use. RESULTS: Within a month after implementing the formulary change and educational process, prescribing of parenteral H2RAs changed from 80 percent ranitidine to 99 percent cimetidine. Monitoring of nonformulary ranitidine use revealed only three cases of possible or probable association of adverse central nervous system effects with cimetidine in an eight-month period. Elevations of theophylline, lidocaine, or phenytoin serum concentrations; or prothrombin time above the therapeutic range during warfarin therapy occurred in only 5 of 142 monitored patients who received concomitant therapy with an H2RA. No change in serum theophylline concentrations above the therapeutic range was noted to the hospital before and after the conversion. Savings have been estimated at $250,000 in the first year and $775,000 over four years, mostly from the conversion from intravenous ranitidine to intravenous cimetidine therapy. CONCLUSIONS: Successful intervention can be accomplished by cooperation between the pharmacy and the medical staff to achieve cost savings without sacrificing the quality of care.

Cimetidine↗

PubMed1991

A novel comprehensive DUE program--five years of experience.

A comprehensive program has been developed to evaluate prescribing practices in diverse drug therapy categories and in all areas of the institution. Input for topic selection comes not only from the pharmacy department, but also from QA, medical staff, and nursing. The development of monitoring criteria and review of the results by the P&T Committee, Medical Executive Committee, and other key medical staff members, promotes ownership of the program by the medical staff. The benefit of this ownership is active support for the program and participation in peer review. Overall, the results of this cost-effective program include limited use of broad spectrum antibiotics, select prescribing of high-risk drugs, and focused educational efforts to improve quality of patient care. The primary goal for the future of the program is to develop criteria and documentation mechanisms for reporting measurable clinical outcomes. In making the transition, it is important to use the success and impact of the current program as the foundation. This is particularly true for the concurrent monitoring program and its immediate feedback mechanism. The major challenge will be evaluating negative clinical outcomes and developing corrective actions as well as documenting the positive outcomes and the avoidance of negative outcomes of the current program. To meet this challenge, the DUE program must be integrated with all other institutional QA programs. Although a difficult task, this is a significant yet necessary step in the right direction for assuring optimal patient care.

Anti-Bacterial Agents↗

PubMed1988

Sensitivity and specificity of three methods of detecting adverse drug reactions.

The sensitivity and specificity of three methods of detecting adverse drug reactions (ADRs) were determined. Minimal use of a voluntary ADR reporting program prompted this investigation of three ADR detection methods, as follows: screening of laboratory reports, pharmacist screening of medication orders, and voluntary reporting. A total of 98 patients who were receiving oral or i.v. digoxin therapy, oral or i.v. theophylline therapy, or i.v. gentamicin therapy were randomly selected and monitored for possible ADRs. A physician reviewed the charts of patients with suspected ADRs using the Naranjo algorithm to assess causality. The chart review served as the reference method to which the other three methods were compared. Thirteen "true" (i.e., confirmed by the Naranjo algorithm) ADRs were identified in 11 different patient charts, resulting in a 13.3% ADR incidence rate for the 98 sampled patients. For the three ADR detection methods, the decreasing order for level of sensitivity was screening of laboratory reports, pharmacist screening of medication orders, and voluntary reports; however, only the difference between laboratory reports and voluntary reports was significant. For level of specificity, the decreasing order for the three methods was voluntary reports, pharmacist screening of medication orders, and pharmacist screening of laboratory reports; the differences among all three methods were significant. Screening of laboratory reports and pharmacist screening of medication orders are two detection methods that appear to exhibit an appropriate combination of sensitivity and specificity for identifying ADRs; trials with larger sample sizes are needed to confirm the results of this study.

Algorithms↗