[Pharmaceutical-chemical analysis; distribution of principle groups in qualitative analytical processes. I].
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Chemistry Techniques, Analytical↗
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Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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ASHP statement on the pharmacist's responsibility for distribution and control of drug products.
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Drug and Narcotic Control↗
[Cost of a mass screening program for colorectal cancer using the occult blood test].
The Cancer Registry of Burgundy, France, set up a controlled study involving 91,000 people aged 45 to 74 to ascertain the cost-effectiveness of mass screening for colorectal cancer with the Hemoccult test. The aim of this study was to estimate the cost of the first part of the screening campaign, which took place in 1988 and 1989. The overall cost of the campaign was 2,275,589 FF. The cost for the GPs' instruction course was 3.9 percent and the press campaign, 8.4 percent of total costs. The cost related to the distribution or prescription of tests by the GPs was 60.3 percent of the total cost of the campaign. The average cost per test was 39.8 FF when it was distributed by the GPs. The average cost per test was 116.4 FF when bought individually in drugstores or pharmacies. The average cost per test was 70.1 FF when mailing was used. The average cost per test for the analysis was 12.7 FF that is to say 13.7 percent of the total cost. The cost of scientific follow-up and analysis was 13.8 percent. The cost for one person completing the test averaged 92.7 FF. The preliminary results of the cost-effectiveness analysis make it possible to estimate the cost of the mass screening campaign for colorectal cancer. Better cost/effectiveness ratios have already been made according to these results.
Aged↗
[On the economics of work in a drug or pharmaceutical concern--distribution of working permits for hospital pharmacists].
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Economics, Hospital↗
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↗
Care plan for documenting pharmacist activities.
At a 393-bed hospital, a pharmaceutical care plan was developed and tested in a surgical intensive care unit (SICU). The trial care plan was developed and implemented with the following objectives: to integrate clinical and distributive elements of patient information in a care plan; to add new monitoring and intervention parameters to the pharmacy profile; and to assess and refine the care plan for implementation in other areas of the institution. One pharmacist performed and documented care for 10 patients in the SICU. The pharmacist planned appropriate drug administration schedules, noted appropriate indications for each medication ordered, established appropriate outcomes, monitored for drug-drug or drug-food interactions and allergies, recorded interventions and averted adverse drug reactions, and recorded the amount of time required for care according to disease state. Pharmacist involvement with medication administration and monitoring seemed to prevent many adverse effects and drug interactions. Because of the diversity of the patient population, there was substantial variation in the time spent on care. A trial pharmaceutical care plan in a surgical intensive care unit was useful for documenting pharmacists' productivity and effectiveness.
Colorado↗
Cost-benefit analysis of an automated medication system.
Automated medication distribution systems have helped solve issues of efficiency and effectiveness. Cost-benefit analysis conducted by nursing and pharmacy departments can help to objectify the decision to adopt this technology.
Capital Expenditures↗
Home intravenous antimicrobial therapy provided by a community hospital and a university hospital.
A home intravenous antimicrobial program that was implemented at both a private community hospital and a university hospital with a wide rural referral base is described. Over an 18-month period, 63 patients were screened and selected for home i.v. antimicrobial management according to stringent criteria. The hospital pharmacies and two home health-care companies were used as the central points for coordinating the preparation and distribution of drug products and providing specialty nursing services. Predischarge inhospital education for each patient was conducted by a pharmacist and a nurse. On-call pharmacists and nurses were available to monitor and assist the patients, and the patients were seen regularly by physicians during the period of home therapy. The 63 patients received a total of 1108 days of home i.v. antimicrobial therapy; the mean duration of therapy was 17.6 days. Heparin-lock peripheral cannulae were used for 51 patients, while 12 patients received their treatment through central-subclavian or Hickman catheters. Home i.v. antimicrobial treatment seemed to be as effective as comparable inpatient management for each type of infection. Drug- and i.v. catheter-related adverse effects were uncommon and seemed similar in type and frequency to those of hospitalized patients. The estimated cost savings per treatment course was $3,514 for a total net savings of $221,406 over the 18-month study period. Home i.v. antimicrobial treatment programs can be successfully implemented in both community-based and tertiary-care settings. Home therapy is a safe, efficacious, and cost-effective alternative to prolonged hospitalization for a variety of infectious diseases.
Anti-Infective Agents↗
ASHP national survey of pharmacy practice in acute care settings--1996.
The results of the 1996 ASHP national survey of pharmaceutical services in nonfederal community hospitals are presented and compared with the findings of the 1994 ASHP survey. A questionnaire was mailed to pharmacy directors at hospitals randomly sampled from those registered by the American Hospital Association. A total of 713 usable surveys were returned, for a net response rate of 37.1%. Inpatient pharmaceutical services were provided an average of 17.4 hours per weekday and ambulatory care pharmaceutical services 13.3 hours per weekday. Pharmacy directors were more likely to have duties beyond the department than in 1994 (24% versus 12%). The percentage reporting a patient-focused-care model increased from 18% in 1994 to 33% in 1996. The percentage reporting some automation of drug distribution increased from 55% in 1994 to 65% in 1996. Provision of ambulatory care pharmaceutical services was indicated by 63% of respondents, and 35% indicated providing home infusion services. Compared with 1994, pharmacy departments provided more clinical services to inpatients. The most commonly offered clinical pharmacy services for inpatients were drug-food interaction screening, drug-use evaluations, adverse-drug-reaction programs, and medication error management programs. The percentage providing pharmaceutical care to some extent increased from 44% to 60%. The percentage reporting that pharmacists had the authority to initiate or modify medication orders increased from 35% to 56%. A well-controlled formulary system was in place at 60% of hospitals, while 39% reported restrictions on prescribing. Nearly three fourths of respondents reported a therapeutic interchange policy. Mean inventory cost per patient day was $4.67, a decrease from $5.62 in 1994. About 68% of inpatient pharmacy expenditures went for drugs and fluids, 27% for staff, and 5% for other noncapital expenditures. The 1996 ASHP survey revealed continued growth in various activities related to patient care, such as implementation of patient-focused care, enhanced clinical services, and therapy management programs. Although the provision of pharmaceutical care increased, ample room for growth remains.
Ambulatory Care↗
Pharmacy internship: patient care experience through nursing service.
A pharmacy internship that offers graduated levels of hospital experience, with an emphasis on nursing assistant and medication administration programs, is described. Students work full time in the summer and part time during the academic year in the three-year program. The progression of duties is as follows: nursing assistant; inpatient drug distribution and control; sterile and nonsterile product production; patient education, monitoring and medication history-taking activities; drug information services; and medication administration. Interns are selected by the pharmacy department and trained and supervised by the nursing staff in nursing assistant and medication aide roles. The program provides the pharmacy department with a highly trained corps of interns who understand and appreciate the full range of systems required to deliver patient care and provides interns with patient-oriented work experiences valuable in their future roles as pharmacists.
Education, Pharmacy↗
Comparison of methods for detecting medication errors in 36 hospitals and skilled-nursing facilities.
The validity and cost-effectiveness of three methods for detecting medication errors were examined. A stratified random sample of 36 hospitals and skilled-nursing facilities in Colorado and Georgia was selected. Medication administration errors were detected by registered nurses (R.N.s), licensed practical nurses (L.P.N.s), and pharmacy technicians from these facilities using three methods: incident report review, chart review, and direct observation. Each dose evaluated was compared with the prescriber's order. Deviations were considered errors. Efficiency was measured by the time spent evaluating each dose. A pharmacist performed an independent determination of errors to assess the accuracy of each data collector. Clinical significance was judged by a panel of physicians. Observers detected 300 of 457 pharmacist-confirmed errors made on 2556 doses (11.7% error rate) compared with 17 errors detected by chart reviewers (0.7% error rate), and 1 error detected by incident report review (0.04% error rate). All errors detected involved the same 2556 doses. All chart reviewers and 7 of 10 observers achieved at least good comparability with the pharmacist's results. The mean cost of error detection per dose was $4.82 for direct observation and $0.63 for chart review. The technician was the least expensive observer at $2.87 per dose evaluated. R.N.s were the least expensive chart reviewers at $0.50 per dose. Of 457 errors, 35 (8%) were deemed potentially clinically significant; 71% of these were detected by direct observation. Direct observation was more efficient and accurate than reviewing charts and incident reports in detecting medication errors. Pharmacy technicians were more efficient and accurate than R.N.s and L.P.N.s in collecting data about medication errors.
Chi-Square Distribution↗
Fee structure for investigational drug studies.
The development and implementation of a fee structure for a pharmacy-coordinated investigational drug service is described. A pilot task and time study established specific time and cost elements for investigational drug services provided by the pharmacy department. To fully assess the costs in dispensing investigational drugs, each research study that used the investigational drug service was broken down into five phases of service. Each phase was further categorized by specific tasks or activities, and a time element to perform each activity or task was determined. Since some studies could require more elaborate randomization of patients, more extensive review of protocols, or more individualized dispensing procedures than others, a range of charges was derived: $2800 for standard protocols to $5700 for more complicated studies. An institutional drug therapy newsletter describing the services and costs was distributed to all medical staff members and principal investigators. The development of a fee structure for an investigational drug service coordinated by the pharmacy department has ensured that pharmacy services are adequately reimbursed and has allowed the department to allocate appropriate personnel to provide the services.
Drug Evaluation↗
Supporting pharmaceutical care through automation.
With increased use of automation in pharmacy operations, traditional roles for technicians, staff pharmacists, and managers will be altered. Demands will be for higher order skills, use of information, and technical expertise. The technologies available offer the promise of accurate and reliable distribution and administration of products, enabling pharmacists to assume accountability for medication use in patients and for the outcomes of pharmaceutical care.
Clinical Pharmacy Information Systems↗
Medication utilization and patient information in homes for the aged.
A random cross-sectional sample of 198 residents was taken from a convenience sample of 20 Flemish, community-based nursing homes for the aged. Twenty trained interviewers reviewed the medication list of these residents and interviewed the nurses responsible for their daily care to assess their activities of daily living (ADL) and cognitive status. Direct interview was possible of 128 residents (65%); communication with the other 70 residents was impossible because of dementia (55 patients) or communication problems, such as aphasia and deafness (15 patients). An average of 4.5 different medicines was mentioned on the medication lists of the 198 residents. Drug use increases with age but stabilises after the age of 80 y. Medicines are ordered from local community pharmacies and are delivered to the ward rooms in original drug dispensing packs. The nursing staff is responsible for distribution inside the institution. Nursing personnel read the inserts of the medicines given to 98% of the residents and keep the inserts of 77% in the nursing office. Only 11% of the residents maintained some autonomy in ordering, keeping and taking their medication, although 42% were evaluated by the nurses as functionally and cognitively fit. Only 4% of the 128 residents able to respond to an interview had a notion of the potential adverse effects of their medication; the two most important sources of information about medicines mentioned by those residents were the general practitioner and the nursing personnel; 4% mentioned relatives and friends, or the pharmacist, as information sources.
Activities of Daily Living↗
The Xyrem risk management program.
Sodium oxybate, also known as gamma-hydroxybutyric acid (GHB), was discovered in 1960 and has been described both as a therapeutic agent with high medical value and, more recently, a substance of abuse. The naturally occurring form of this drug is found in various body tissues but has been studied most extensively in the CNS where its possible function as a neurotransmitter continues to be studied. Sodium oxybate has been approved in different countries for such varied uses as general anaesthesia, the treatment of alcohol withdrawal and addiction, and, most recently, cataplexy associated with narcolepsy. During the 1980s, easy access to GHB-containing products led to various unapproved uses, including weight loss, bodybuilding and the treatment of sleeplessness, sometimes with serious long-term effects. The availability of these unapproved and unregulated forms of the drug led to GHB and its analogues being popularised as substances of abuse and subsequent notoriety as agents used in drug-facilitated sexual assault, or 'date rape', eventually leading to the prohibition of GHB sales in the US. Legal efforts to control the sale and distribution of GHB and its analogues nearly prevented the clinical development of sodium oxybate for narcolepsy in the US. However, following extensive discussions with a variety of interested parties, a satisfactory solution was devised, including legislative action and the development of the Xyrem Risk Management Program. Amendments to the US Controlled Substances Act made GHB a schedule I drug, but also contained provisions that allow US FDA-approved products to be placed under schedule III. This unique, bifurcated schedule for sodium oxybate/GHB allowed the clinical development of sodium oxybate to proceed and, in July 2002, it was approved by the FDA as an orphan drug for the treatment of cataplexy in patients with narcolepsy as Xyrem(sodium oxybate) oral solution. To promote the safe use of sodium oxybate, as well as alleviate concerns over possible diversion and abuse following product approval, a proprietary restricted drug distribution system was created, called the Xyrem Success Program. Components of the programme include a centralised distribution and dispensing system, a physician and patient registry, compulsory educational materials for patients and physicians, a specially trained pharmacy staff, a method for tracking prescription shipments, and an initial post-marketing surveillance programme. The system has created a unique opportunity to provide both physician and patient education and ongoing patient counselling, promoting greater drug safety and enhanced patient compliance.
Administration, Oral↗
[Detection and classification of medication errors at Joan XXIII University Hospital].
INTRODUCTION: Medication errors are multifactorial and multidisciplinary, and may originate in processes such as drug prescription, transcription, dispensation, preparation and administration. The goal of this work was to measure the incidence of detectable medication errors that arise within a unit dose drug distribution and control system, from drug prescription to drug administration, by means of an observational method confined to the Pharmacy Department, as well as a voluntary, anonymous report system. The acceptance of this voluntary report system's implementation was also assessed. MATERIAL AND METHODS: A prospective descriptive study was conducted. Data collection was performed at the Pharmacy Department from a review of prescribed medical orders, a review of pharmaceutical transcriptions, a review of dispensed medication and a review of medication returned in unit dose medication carts. A voluntary, anonymous report system centralized in the Pharmacy Department was also set up to detect medication errors. RESULTS: Prescription errors were the most frequent (1.12%), closely followed by dispensation errors (1.04%). Transcription errors (0.42%) and administration errors (0.69%) had the lowest overall incidence. Voluntary report involved only 4.25% of all detected errors, whereas unit dose medication cart review contributed the most to error detection. CONCLUSIONS: Recognizing the incidence and types of medication errors that occur in a health-care setting allows us to analyze their causes and effect changes in different stages of the process in order to ensure maximal patient safety.
Hospital Units↗
Improving medication administration systems: an evaluation study.
Medication errors are a universal health-care concern, and improving medication administration systems is important to enhance safety. The purpose of this study was to compare the effectiveness of an existing unit dose system using a medication cart to a new system where medications are decentralized to a locked cupboard at the patient's bedside. Quantitative and qualitative approaches were used to determine the effectiveness and efficiency of the medication administration systems. Data was collected using time studies to evaluate the efficiency of the two systems. This data included medication errors, missing doses and interruptions occurring during the medication preparation and administration process. Focus groups were conducted with nurses, pharmacists and pharmacy technicians to better understand the impact of changing systems. Study results demonstrated benefits associated with decentralizing the medication distribution to the bedside, including nurses spending more time with patients, nurses investing less time preparing and distributing medication and fewer interruptions for nurses as they prepared and distributed medication. Nurses and pharmacists associated the new system with enhanced patient safety and work satisfaction.
Attitude of Health Personnel↗
[Standard formulas of parenteral nutrition. A study of their use in a general hospital].
The goal of the study was to evaluate the use of parenteral nutrition formulas with standardized g. of nitrogen, carbohydrates and lipids, and to analyze whether the nutritional requirements of the patients treated in our hospital were covered by said formulas or whether it was necessary to change and/or standardize a new formula. To do so, a review was made of 5.646 parental nutrition mixtures prepared in the Pharmacy Service and patterned by the Nutrition Service from April, 1991, to May, 1992, for 308 adult patients. The distribution of the mixtures by services, diagnoses and the frequency of the different standard formulas were studied, comparing standard formula frequency with that of non-standard formulas. Findings showed that 41.9% of nutrition mixtures were patterned in surgery, and the most common diagnosis, cancer, appeared in 24%. Of the mixtures, 67.6% were preestablished formulas, and 32.4% were non-standard formulas. The order of frequency among standard formulas was: basic standard formulas, stress formulas, initial formulas, peripheral formulas, hemodialysis formulas and low-volume formulas. All covered the nutritional needs of a large share of the patients for the different pathologies in which they were indicated. Nevertheless the question of designing a new formula to cover a greater number of situations was raised. Protocolization should take place rationally, to meet the hospital's most frequent pathologies, and effectiveness should be evaluated after tracking and checking each patient.
Adult↗