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Biomedical subjects

M F Ivey

Publications and source records attributed to M F Ivey.

At least 19 recordsLinked to original sources
PubMed1993

Harvey A. K. Whitney Lecture. Shifting pharmacy's paradigm.

Changes occurring in the pharmacy profession and their effects on the paradigm for pharmacy practice are discussed. The paradigm of pharmacy, the pattern or model of pharmacy's structure, services, daily activities, and organization, is shifting, and if pharmacists do not shift with it, they will be left behind. Advances in technological capabilities often result in automation and centralization of services. Improvements in drug therapy have caused shifts in the performance of clinical functions. Philosophical changes about the way health care should be delivered have produced the concepts of pharmaceutical care, patient-focused care, and continuous quality improvement of care. Teams of caregivers whose primary concern is the patient have replaced caregiving based on technology, discipline, or employee needs. Pharmacists have focused on the patient as their primary customer instead of the nurse or practitioner, and they anticipate the patient's needs in a structured and documented fashion. The principles of continuous quality improvement have been applied to every aspect of providing pharmaceutical care. If pharmacists are to adjust to the shift in the pharmacy paradigm, they must recognize their strength as a group, make proper recommendations about pharmaceutical use, move horizontally to grow as professionals, consider themselves clinicians, be active in the making of pharmaceutical care decisions, and believe in themselves.

Pharmacy↗
PubMed1991

Expanding staff pharmacists' responsibilities to maintain pharmacy services in a neonatal intensive-care unit.

The conversion of pharmacist responsibilities in a neonatal intensive-care unit (NICU) pharmacy satellite from drug distribution to both clinical services and drug distribution is described. When the pharmacy department could not recruit a specialty-trained clinical practitioner to fill an open NICU position, the position was converted to a fourth satellite pharmacist position, and each of the four NICU satellite pharmacists assumed clinical responsibilities for the NICU. Clinical and distributive functions had previously been separate. Staff development programs and a contract with the previous NICU clinical practitioner for consultative services helped to ease the transition. NICU pharmacists currently provide inservice education to medical residents and the nursing staff, provide drug information, monitor drug therapy, perform pharmacokinetic monitoring, are involved in research, and work to streamline satellite operations. For one of every four months, the NICU pharmacists primarily provide clinical services; the remainder of the time clinical activities are combined with drug distribution responsibilities. The staffing schedule has enabled the department to extend the hours that clinical services are available. The NICU pharmacists maintain secondary areas of staffing, and other pharmacists periodically staff the NICU satellite. Staff pharmacists in the NICU pharmacy satellite developed clinical skills that permitted integration of clinical and distributive pharmacy services.

Hospital Bed Capacity, 500 and over↗
PubMed1987

Bacterial and fungal growth after freezing or refrigerating parenteral nutrient solutions.

Parenteral nutrient (PN) solutions were evaluated for growth of pathogenic organisms after refrigeration or freezing and then thawing. Sixteen bags of hypertonic dextrose and amino acid solutions were divided into two series (refrigerated and frozen), inoculated with Escherichia coli. Candida albicans, Staphylococcus aureus, or Streptococcus faecalis, and exposed to freezing or refrigeration. The inoculum concentration was greater than would likely occur with patient contamination of the solution. Microbial growth in the solutions was determined after warming to room temperature and at 17 or 18 hours after reaching room temperature. There was no increased growth of C. albicans in PN solutions that were frozen versus the refrigerated samples. Counts for all of the organisms in the frozen series, immediately after freezing and then thawing, decreased or stayed the same compared with baseline counts. Growth of E. coli, Staph. aureus, and Strep. faecalis increased in the frozen samples compared with the refrigerated samples after room-temperature storage, suggesting a possible increased risk of infectious complications if contaminated solutions are left at room temperature for extended periods. Since no increased risk of microbial growth is likely in frozen versus refrigerated PN solutions that are thawed and promptly infused, batch freezing may be an effective and convenient means of preparing PN solutions for home patients.

Bacteria↗
PubMed1987

Cost analysis of using premixed frozen versus hospital-reconstituted cefazolin sodium injection.

The costs of preparing cefazolin sodium 1-g small-volume injections (SVIs) by each of two reconstitution methods were compared with the costs of using premixed frozen cefazolin SVIs at two hospitals. Both hospitals routinely used premixed cefazolin 1-g SVIs. Each converted to its previous reconstitution system for approximately two weeks. One hospital used a once-weekly "batch" system, and the other hospital used the twice-daily "extemporaneous" system. Pharmacist and technician time involved in both systems was determined using time-and-motion methods. A total of 40 preparation cycles of 10 SVIs each were monitored to determine labor costs. Hospital purchase-contract prices were used for determining material costs per SVI, and waste was calculated based on the number of SVIs that could not be recycled. The total time required for preparation of 10 cefazolin 1-g SVIs by each method was comparable (6.2 minutes for the batch method, 5.8 minutes for the extemporaneous method); labor costs contributed minimally to overall costs of each reconstituted SVI. Approximately 5% of reconstituted SVIs were wasted in each system. The conversion to premixed cefazolin SVIs resulted in an annual cost increase of more than $5000 at each hospital, compared with the reconstitution methods. However, subjective evaluations indicated that use of the premixed admixtures resulted in increased efficiency of i.v. preparation by allowing pharmacy personnel to devote more time to other labor-intensive duties. The results of this study allowed the pharmacies to negotiate more equitable prices for premixed cefazolin sodium injection.(ABSTRACT TRUNCATED AT 250 WORDS)

Cefazolin↗
PubMed1984

Monitoring a primary wholesaler depot program.

Techniques for monitoring a primary wholesaler depot program used by a university hospital pharmacy department are described. One year after the program began, data from the past four months, obtained from monthly management reports provided by the wholesaler, were reviewed. Attention was focused on the drugs and drug categories that represented the bulk of purchases (in dollar value). Summary purchase orders showed that approximately half the drugs were purchased at the most favorable prices (usually contract bid prices). Most drugs not purchased at the most favorable bid prices were accounted for by sole-source items, inadequate computer documentation by the wholesaler, and atypical orders. A study of ordering patterns revealed that 16 of the top 40 drugs ordered (by volume and dollar expenditures) were ordered less than once per month; the inventory management goal was to order a two-week supply. The wholesaler could not completely fill orders for 18% of the contract drugs, often because of back orders from manufacturers. Although the computerized management reports used in this study did not allow evaluation of all aspects of the primary wholesaler depot program, they provided a convenient mechanism for concurrent assessment of the program's effectiveness. The program appeared to be advantageous to the pharmacy department, and most problems encountered were easily remedied. Several performance measures for institutions considering depot programs are recommended.

Contract Services↗
PubMed1983

Influence of propranolol on supraventricular tachycardia early after coronary artery revascularization. A randomized trial.

A total of 116 patients undergoing coronary revascularization were randomized preoperatively in a double-blind manner to receive 80 mg daily of propranolol or placebo in the postoperative period. Preoperatively, all patients had been receiving at least 80 mg of propranolol a day to the time of the operation. In addition, all patients had a left ventricular ejection fraction of 0.4 or more, no history of supraventricular tachyarrhythmia (SVT), and no need of digitalis preparations or other antiarrhythmic drugs. All patients were monitored for 5 days and propranolol or placebo was started 24 hours postoperatively. SVT was documented with biatrial electrograms in all cases. Study groups were similar in postoperative creatine kinase MB levels and postoperative weight gain, but the placebo group tended to be older and have more grafts per patient. Seven patients randomized were dropped from the study, two with perioperative infarction, four with persistent ventricular arrhythmias necessitating quinidine or procainamide, and one with persistent postoperative hypotension (placebo). There were no significant differences in the incidence of postoperative SVT in these two groups: 13.2% in the propranolol group and 16.1% in the placebo group. We conclude that 80 mg daily of propranolol given postoperatively to patients undergoing coronary revascularization does not effectively reduce the incidence of SVT.

Clinical Trials as Topic↗
PubMed1983

Pharmacy department costs and patient charges associated with a home parenteral nutrition program.

The pharmacy department costs of a home parenteral nutrition (HPN) program were identified, and the patient charges for HPN were compared with the charges for hospitalization for parenteral nutrition. Ten patients were randomly selected from 55 patients active in the HPN program at the University of Washington Hospital. Cost identification included quantification of supplies, personnel, equipment, freight, miscellaneous, and indirect costs. Patient charges were identified through billing documents. Charges included clinic visits and laboratory tests. Inpatient charges were identified in a similar manner and included a standard daily hospital charge. Average yearly costs to the pharmacy department were nearly +9000 per HPN patient. Patient charges for HPN were +48.19 per infusion day compared with +205.68 per infusion day for the hospitalized patient. The cost savings of HPN to the patient and the hospital were clearly demonstrated.

Costs and Cost Analysis↗
PubMed1983

Subjective assessment of patient outcomes of home parenteral nutrition.

The medical, financial and psychosocial impact of home parenteral nutrition (HPN) therapy on patients' lives was assessed. A questionnaire that solicited patient characteristics and therapeutic outcomes of HPN therapy, such as number of hospital admissions, physiological complaints, and psychosocial interferences, was sent to 49 patients currently participating in a HPN program based at a university hospital. Questionnaires were returned by 42 patients. HPN-related complications were responsible for 39% of all reported hospital admissions during the previous year; of these, 27% were related to HPN catheters. Patients reported few physiological complaints, except for cramping in the hands and feet. Patients who complained of diarrhea had significantly more physiological complaints and psychosocial interferences than those who did not. The majority of patients had medical insurance coverage, but 26% had to pay at least part of the costs of HPN therapy. Only 25% of patients who were able to work did so. Most patients believed that HPN therapy had a very positive effect on their lives. The majority of patients in this HPN program appear to have a reasonable quality of life.

Adult↗
PubMed1979

Savings achieved through use of a less concentrated amino acid solution.

The administrative process of adding a 5.5% crystalline amino acid solution to the formulary of two affiliated hospitals and the results of the addition are discussed. A formulary change was sought after it was found that many patients on parenteral nutrient therapy were receiving more amino acids than they needed. Nearly all patients on parenteral nutrient therapy were receiving 8.5% crystalline amino acid solution. The approach to achieving the pharmacy and therapeutics committee's approval of the formulary change included documenting amino acid needs from the literature, securing a multidisciplinary base of support and providing economic impact information. A standard TPN order form for physicians, education through the pharmacy newsletter, and presentations at surgery and medical conferences and grand rounds were implemented to assure that the change was effective. During the 12 months following approval of the formulary addition, 66% of the more than 20,000 total parenteral nutrient solutions were prepared using 5.5% amino acid solutions. This resulted in an annual savings of $41,028

Amino Acids↗
PubMed1978

Right atrial indwelling catheter for patients requiring long-term intravenous therapy.

The use of a central venous catheter for long-term intravenous therapy is described. The catheter's history, physical description, and uses are discussed. Also reviewed are complications from use of the catheter, the pharmacist's role in patient teaching, and the procedure for administering medications through the catheter. A listing of drugs administered through the catheter, incompatibility data and patient teaching instructions are also included.

Catheters, Indwelling↗