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Biomedical subjects

R R Shane

Publications and source records attributed to R R Shane.

5 recordsLinked to original sources
PubMed1996

Quality of pharmacists' documentations in patients' medical records.

Training pharmacists to appropriately document patient-specific problems and recommendations in patients' medical records and subsequent monitoring of pharmacist-written documentation are described. The medical staff of a tertiary care teaching hospital recommended that pharmacists be allowed to write in the permanent portion of patients' medical records. A six-month pilot program was approved to train pharmacists in writing chart notes. Notes would be assessed according to the following criteria: necessity (i.e., a chart note was the appropriate means of communication), clarity, legibility, completeness, correct format, and lack of judgmental language. Initial training was by physicians from the pharmacy and therapeutics committee, with more extensive training by a committee composed of clinical and administrative pharmacists. After training ended, each pharmacist's first few notes were reviewed by a member of the pharmacy committee. The quality of pharmacist-written notes is reviewed quarterly. The first quarterly evaluation and another review 1 1/2 years later showed that all pharmacist notes met all of the established criteria. A multidisciplinary approach was effective in training pharmacists to document interventions appropriately in patients' permanent records. Ongoing monitoring ensures the continuing quality of such documentation.

Documentation↗
PubMed1996

Pharmacy without walls.

Attributes of excellence in pharmacy management are described: big-picture thinking, the ability to exploit change, and willingness to take risks. Big-picture thinking means understanding trends that are shaping health care in order to determine where pharmacy fits. Health systems look beyond inpatient care and use case managers to maximize resource use; pharmacists might serve as case managers. Managed care has caused physicians to be more receptive to resource-management strategies, such as clinical pathways; pharmacists can collaborate in the development of clinical pathways. Pharmacists can serve as physician extenders; for example, by conducting anticoagulation or hypertension clinics. Pharmacists need flexibility to adapt to changes in the internal organization of acute care institutions; they will need to learn about the clinical, behavioral, operational, and fiscal aspects of managing the total patient. New reporting relationships give pharmacists the opportunity to demonstrate to other members of the health care team their role in preventing, managing, and resolving drug-related problems throughout the continuum of care. Risk-taking can mean setting ambitious goals. By setting and achieving ambitious goals for products and services, pharmacists can raise patients' and other health care providers' expectations for pharmacy services. Pharmacists' success will depend on their willingness to experiment with new services and discard services that do not substantially advance patient care. Pharmacists must monitor changes in the provision of health care, determine the implications for their practice and seek opportunities for participation outside the walls within which they have traditionally practiced.

Delivery of Health Care↗
PubMed1992

Prospective physician review of orders for colony-stimulating factors.

A program is described in which physicians prospectively review orders for the use of colony-stimulating factors (CSFs) at a tertiary-care private teaching hospital. Hospital officers and administrators and the heads of medical subspecialties were presented with three options for managing the use of CSFs. Prospective review by physicians was selected, and a task force of medical subspecialists was established to develop criteria for use and to review orders. Initially, every order was prospectively reviewed, but criteria were developed under which some orders do not require physician review. CSF use is documented retrospectively by a drug-use evaluation pharmacist and reviewed for appropriateness by the physician task force. Between March and October 1991, 115 patients were given courses of CSFs, and the use of the physician review system resulted in appropriate use of the drugs for 98% of the oncology patients and 61% of the patients infected with the human immunodeficiency virus. The prospective physician reviewer system has been accepted by the medical staff at the facility and has helped to ensure appropriate use of CSFs.

Colony-Stimulating Factors↗