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Biomedical subjects

R L Mikeal

Publications and source records attributed to R L Mikeal.

At least 19 recordsLinked to original sources
PubMed1984

Consultant evaluation of a hospital medication system: analysis of the existing system.

A consultant team's evaluation of a system for distributing and controlling medications in a large teaching hospital is described. Through interviews with key personnel from administration, pharmacy, nursing, and the medical staff, an interdisciplinary research group identified problems in the reliability and response times of the hospital's existing medication system. After assessing staff expectations regarding acceptable standards for medication errors and response times and their attitudes toward proposed changes in the medication system, medication-error rates were determined using a pharmacist-observer method. Observations during 34 five-hour periods on four nursing units were conducted over a 17-day period. Medication-error rates were calculated as the frequency of medication errors during the observation period divided by the total opportunities for error (OE), which were defined as doses ordered plus unauthorized doses given. Response times for processing "now," "stat," and routine orders were also determined using work-sampling methods. The total medication-error rate for the nursing units studied was 9% excluding wrong-time errors; more than a third of doses were given more than 30 minutes before or after their scheduled administration times. Response times for "now" and "stat" orders averaged about 23 minutes, in conformance with the desired standard of 30 minutes. However, processing of routine orders required an average of two hours and seven minutes, much of which was attributed to delays in the messenger service. The basic design of the existing unit dose medication system contributed to problems in the reliability and efficiency of the system.

Attitude of Health Personnel↗
PubMed1984

Consultant evaluation of a hospital medication system: synthesis of a new system.

Recommendations of consultants for the implementation of a new medication system at a large teaching hospital are described. Based on a previous analysis of the hospital's existing drug distribution and control system that revealed problems in reliability and response time, an interdisciplinary consultant group offered 14 recommendations, which included implementation of a computerized unit dose delivery system and selected clinical pharmacy services. Functions identified for which computerization would produce the greatest benefits included maintenance of patient census data, medication order entry and retrieval, and preparation of a medication administration record for nursing. Recommendations for improving the unit dose system in the hospital consisted of increasing the number of medications packaged in true unit dose form, increasing the frequency of daily deliveries of scheduled medications, sending p.r.n. medications on an on-call basis, decreasing the lead time for preparation of i.v. solutions, and using a pharmacist-manned portable medication cart to reduce workload on the central pharmacy during peak workload periods. Clinical pharmacy services identified as having the greatest cost-benefit ratio were discharge consults, drug therapy monitoring, and drug-use review. Using information from published studies and cost data from the hospital, a net annual savings of over +152,000 was projected with implementation of these services. Improvements in the unit dose system and implementation of clinical pharmacy services were expected to result in substantial cost savings in the study hospital.

Computers↗
PubMed1984

Consultant evaluation of a hospital medication system: implementation and evaluation of the new system.

The effects of consultant-recommended modifications in a hospital medication system on medication-error rates and response times were evaluated. Fourteen recommendations for improving the medication system in a large teaching hospital were implemented to varying extents over a period of 1.5 years. The response times and medication-error rates of the newly implemented system were then measured using pharmacist-observers as was done in the old medication system. Medication-error rates were then compared on one medical-nursing unit and two surgical-nursing units both before and after implementation of the new system on the medical unit alone. Response times for routine medication orders decreased by 55% compared with the previous system; for "now" and "stat" orders, response times were reduced by 57% for orders filled from the central pharmacy and by 70% for orders filled from medication carts on the nursing units. No significant differences in medication-error rates were found when the old and new medication systems were compared. This finding was attributed primarily to the hospital's failure to implement recommendations related to computer printing and sorting of orders, use of dispensing envelopes for delivering medications in true unit dose form, and packaging of all medications in unit dose form. This study illustrates how the benefits of a unit dose system can be compromised in implementation and the need for close monitoring to ensure that performance standards are maintained.

Consultants↗
PubMed1982

Medication errors in nursing homes and small hospitals.

An observation method for measuring the rate of medication errors, which can be used as an outcome indicator of a medication system's quality, was evaluated in a national sample of long-term care facilities (LTCFs) and small hospitals. Trained nurse and pharmacist observers observed nurses administer medications during the three-hour period surrounding the peak medication workload on one day in national sample of 58 LTCFs and 10 hospitals. Opportunity-for-errors (OE), defined as the total number of doses ordered plus the unauthorized doses given, were counted, as well as all medication errors. The error rate was calculated as the proportion of errors in total OEs. The reliability of the method was evaluated on seven days by comparing the results of a researcher and observer, who were observing the same nurse. The mean-medication-error rate was 12.2 and 11.0% in the LTCFs and hospitals studied, respectively. Three LTCFs and four hospitals had error rates of zero. Only 31% of the LTCFs and 40% of the hospitals would pass a medication-error limit standard of 6%. The authors concluded that the observation method was promising. Recommendations for further study included: (1) implementation of a one-year project to evaluate observer efficiency after becoming proficient with the method, (2) improvement of the reliability measure, and (3) examination of the relationship of medication errors with structure and process variables.

Hospital Bed Capacity, 100 to 299↗
PubMed1980

Subclinical myopathy associated with hyperadrenocorticism in the dog.

One of seven dogs with clinical signs of hyperadrenocorticism had clinical evidence of neuromuscular disorder. Clinical diagnosis of hyperadrenocorticism was confirmed by plasma cortisol concentrations before and after adrenocorticotrophin hormone and dexamethasone administration. Electromyographic studies showed bizarre, high frequency discharges in all dogs. Examination of muscle biopsies taken from the biceps femoris muscle from each dog revealed mild degenerative changes of fiber size variation, focal necrosis and fiber splitting. Ragged red fibers were prominent and appeared to be related to mitochondrial aggregates. Significant (P less than 0.05) type 1 and 2 fiber atrophy was found in all dogs. Fiber grouping was present in four dogs. Studies of fascicular biopsies of the peroneal nerve showed thinly myelinated fibers, onion-bulb formation, segmental demyelination and short intercalated internodes. These findings suggested a glucocorticoid-related myopathy in hyperadrenocorticism that also may have a neurogenic component.

Adrenal Cortex Diseases↗
PubMed1980

Type I fiber atrophy in the vastus lateralis muscle in dogs with femoral fractures treated by hyperextension.

A syndrome characterized by limb hyperextension, generalized muscle atrophy, abducted gait, and a limited range of joint motion is reported in five dogs, four of which were immature. Distal femoral fractures, of traumatic origin, were found in all dogs; four dogs were subjected to limb immobilization in extension for three to seven weeks. Lesions in muscle biopsies included fiber size variability, increased prominence of subsarcolemmal nuclei, increased perimysial fibrosis and focal necrosis. Histochemical and morphometric studies demonstrated a significant (p less than 0.05), Type I fiber atrophy in the vastus lateralis muscles in the limbs with femoral fractures treated by hyperextension. The shortest time period between onset of fracture and the presence of type I fiber atrophy was seven weeks.

Animals↗
PubMed1980

Research design: general designs.

The conceptual foundations for some of the most widely used research designs are presented, and the various design models are analyzed. Research designs should specify the stimulus and response, the time-order sequence, the sampling and allocation procedures, and the generalized method of analysis. Results of symbolization, seriation, and classification investigations cannot be generalized beyond the study units investigated. Cohort or case-control investigations prevent determination of causality. Cause can be logically proven if the design uses random assignment of study units to study groups and of study groups to stimulus conditions. Crossover designs offer no advantages over similarly constructed noncrossover designs, and introduce new sources of invalidity.

Models, Theoretical↗
PubMed1979

Legal implications of the pharmacist's expanded clinical roles: a challenge to the clinical pharmacist's competencies.

Various sources have put forward the pharmacist as a clinician in addition to traditional functions. These expanded duties have been described as being beneficial to the health care system. This paper describes a project involving the clinical judgment and expertise of the doctor of pharmacy. The project validity and the competency of the doctor of pharmacy program(s) were challenged in the federal courts. The ruling in the case suggests a legal challenge to the pharmacist's clinical function(s).

Drug Prescriptions↗
PubMed1975

Quality of pharmaceutical care in hospitals.

The objective of this study was to measure the quality of pharmaceutical services provided to hospital inpatients. Using Donabedian's model, normative standards from the Joint Commission on Accreditation of Hospitals and the American Society of Hospital Pharmacists were used to develop a personal interview schedule to access the structure and process components of pharmaceutical services. To determine the effect of bed size, rural vs. urban, and presence of a full- or part-time pharmacist on the quality of pharmaceutical services, three samples of short-term hospitals were drawn: a random sample of Mississippi hospitals with less than 100 beds; all Mississippi hospitals of 100 or more beds; and a sample of hospitals in Philadelphia, Pennsylvania. In each of the 112 hospitals a personal interview was conducted with either the chief pharmacist or the administrator responsible for the pharmaceutical service. The responses to the items were then tabulated and a structure and a process score were obtained for each hospital. The following conclusions can be made: (1) The quality of the "structural" components is positively related to the bed size and not to whether the hospital is located in a rural or urban setting; (2) the quality of the "process" components is related to both the bed size and the location of the hospital--hospitals having 100 or more beds or located in an urban area have a higher process quality than those having less than 100 beds or located in a rural area; and (3) hospitals employing a full-time pharmacist have a higher quality of care than those who do not.

Beds↗