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PubMed2005

Influence of computerised medication charts on medication errors in a hospital.

INTRODUCTION: In hospitals where computerised physician order entry systems will not be available in the near future, there is a need to explore other ways of reducing medication errors that occur in the drug ordering and delivery system. One of these ways is the use of a computerised medication chart that is updated daily. The aim of this study was to evaluate the frequency, types and potential clinical significance of drug prescription and administration errors by comparing a traditional medication distribution system (where the transcription of handwritten into printed medication orders takes 3-5 days and the transfer of medication orders was not complete) with the use of a computerised medication chart (which was updated daily by pharmacy assistants on the ward). METHODS: Data were collected during two 3-week periods, from a 32-bed internal medicine unit, before and after the introduction of the computerised medication charts. Prescribing errors were observed by evaluation of all new and changed medication orders and administration errors were detected by using the disguised-observation technique. RESULTS: For prescribing errors, a total of 611 prescriptions before and 598 prescriptions after the intervention were evaluated. The total prescription error rate (of medication orders with >or=1 error) was found to be significantly higher with the computerised charts when compared with the old system (50.0% [299 of 598] vs 20.3% [124 of 611], odds ratio [OR] 3.80 [95% CI 2.94, 4.90]). This increase was caused by an increase in administrative prescription errors with a low potential clinical significance (mainly omission of the prescriber's name and the prescription date). The error rate for errors with a potential clinical significance was found to be significantly lower because the prescription error 'duplicate therapy' was eliminated (3.4% with the traditional medication chart vs 0% with the computerised chart). For administration errors, a total of 1122 drugs before the intervention and 1175 drugs after the intervention was observed to be administered. The total administration error rate was found to be significantly lower after the intervention (6.1% [72 of 1175] vs 10.5% [118 of 1122], OR 0.61 [95% CI 0.45, 0.84]), as was the error rate with a potential clinical significance. The contribution of handwritten medication orders to the total amount of medication orders was significantly decreased after the intervention (12.8% vs 20.6% [95% CI 4.6, 11.0]) and the administration of a drug ordered by a handwritten medication order resulted in a significantly higher administration rate than with administration of a drug ordered by a printed medication order (before the intervention 20.7% vs 8.0%, OR 2.99 [95% CI 1.96, 4.56], after the intervention 11.4% vs 5.6%, OR 2.18 [95% CI 1.16, 4.11]). CONCLUSION: This observational study shows a significant reduction in clinically relevant, administration and (therapeutic) prescription error rates when applying a system using computerised and daily updated medication charts compared with a system using traditional medication charts. Therefore, the use of computerised and daily updated medication charts has the potential to improve the quality of the medication distribution process in hospitals waiting for the implementation of a computerised physician order entry system.

Aged↗
PubMed1993

Managing pharmacy information systems.

The current state of pharmacy information systems is described, and a future direction for information management efforts is proposed. Today's pharmacy information systems are supported by excellent hardware and software. Systems are less expensive, more responsive, more flexible, and smaller than ever before. However, we have been ineffective at tailoring information systems to the pharmaceutical-care needs of patients. Instead, there is overemphasis on traditional requirements to support unit dose drug distribution, i.v. admixture preparation, and admission-discharge-transfer and billing systems. Deficiencies of current systems include a lack of real-time interfaces among hospital systems; redundancy of effort by users; ineffective capturing, reporting, and integration of data; and a cumbersome order-entry process. A vast amount of information is circulating; the challenge is to focus on those clinical and financial data on which patient-care decisions can be based. Each hospital pharmacy should develop a clinical information management strategy. Existing systems should be examined to determine which functions are not being used and which could be enhanced without major software modifications; enhancements might include routine entry of drug allergy information so that all orders may be screened and the use of networks and interfaces to provide medication profiles to physicians and nurses.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Pharmacy Information Systems↗
PubMed1986

An epidemiological approach to targeting drug information.

Reliance on pharmaceuticals for medial therapy, especially for chronic conditions in an aging society, poses important questions regarding patient's understanding of and adherence to their drug regimens. Related policy issues have been debated chiefly in the context of regulations administered by the Food and Drug Administration (FDA), such as the once proposed 'patient package inserts'. A population-based analysis of the distribution of health risks and drug utilization errors--including errors of omission--identifies a set of allocation issues for improving use of medications for public health as well as medical and pharmacy practice. These issues center particularly on channels and targets of drug information, including mass media, community and private medical practices, age and sex groupings within the patient and non-patient populations, and selected diseases, conditions and drugs requiring more attention. A conceptual framework for determining information needs is developed with recommendations for a combined public health and patient education strategy for the reduction of drug errors and the enhancement of drug benefits.

Drug Information Services↗
PubMed2004

Academic detailing has no effect on prescribing of asthma medication in Danish general practice: a 3-year randomized controlled trial with 12-monthly follow-ups.

BACKGROUND: Educational outreach visits, particularly when combined with social marketing, appear to be a promising approach to modifying health professional behaviour, especially prescribing. Results from previous studies have shown a varying effect. OBJECTIVE: The purpose of the study is to examine the effect of academic detailing as a method of implementing a clinical guideline in general practice. METHODS: A cluster randomized, controlled, blinded study was carried out of the effect of an academic detail visit compared with postal distribution of a guideline for prescribing asthma medication. Half the practices in a Danish county with 100 practices were visited once. The outcome measure was routinely collected data from all Danish pharmacies on the sales of asthma medication. Data were collected monthly for 2 years before to 1 year after the intervention. RESULTS: There was no effect on the pattern of prescription of asthma medicines following the visit, neither immediately nor long term. CONCLUSION: We found no effect of academic detailing as a single intervention.

Asthma↗
PubMedDate not supplied

Pharmacy access to sterile syringes for injection drug users: attitudes of participants in a syringe exchange program.

OBJECTIVE: To examine attitudes of participants of a van-based syringe exchange program (SEP) toward the hypothetical prospect of pharmacy-based syringe access. DESIGN: One-time, cross-sectional survey. SETTING: Baltimore, Maryland. PARTICIPANTS: 206 injection drug users who participate in the Baltimore SEP. INTERVENTIONS: Face-to-face interviews. MAIN OUTCOME MEASURES: Location preferred for obtaining syringes, drug and syringe use, past experience with pharmacies, and willingness to pay. RESULTS: The sample was 67% men, 95% African American, and 95% unemployed; mean age was 39.8 years. A total of 19% of respondents had bought syringes at a pharmacy during the prior six months. Some 37% reported having been turned down when asking for syringes at a pharmacy, most commonly due to lack of identification to prove diabetic status (50%). If legal restrictions were lifted, 92% of respondents would obtain syringes from pharmacies, and would be willing to pay a mean price of $0.80 (median = $1.00) per syringe. Women were more likely than men to report the intention to switch from van-based SEP to pharmacy (57% versus 38%, p = .045). CONCLUSION: If current legal restrictions were lifted, pharmacies would be a viable syringe source appealing particularly to women, suggesting gender-specific access issues that should be addressed. The per-syringe price that study participants would be willing to pay exceeds typical retail prices, suggesting that pharmacists could charge enough per syringe to recoup operational costs.

Adult↗
PubMed1989

Management consultant review of three departments of pharmacy to identify cost-reduction opportunities.

A review by a management consulting firm to identify cost-reduction opportunities at three hospital pharmacy departments is described. A multihospital corporation hired a management consulting firm to review the operating procedures of several departments, including pharmacy, and recommend measures for reducing costs. A team approach was adopted to enable the pharmacy department managers and the consultants to freely contribute their expertise; input was also solicited from staff members. A review of each pharmacy department's operating costs showed that drugs and i.v. supplies consumed 60-67% of the expenses, and salaries and wages 27-36%. Estimates of the full-time equivalents allocated to inpatient, clinical, support, and ambulatory and outside contract service activities were compared. The relative costs of personnel allocated to all inpatient drug distribution activities were also compared. Cost-reduction recommendations were divided into short- and long-term measures. Short-term measures involved decreasing drug expenditures, decreasing the number of personnel, and limiting decentralized services in one of the departments; savings of $500,000 were projected. Long-term recommendations involved increasing the use of technology, expanding the use of technicians, and consolidating the management staffs among the hospitals. Management consultants, in cooperation with pharmacy department managers and staff members, can identify cost-reduction opportunities without compromising patient care.

Centralized Hospital Services↗
PubMed2000

Traditional medicine, professional monopoly and structural interests: a Korean case.

Oriental medicine (OM) is a widely practised traditional healing modality across the East Asian countries. The typical operating mode of traditional medicine in the region is characterized by a relatively stable, though asymmetrical, relationship with the biomedically-oriented health care system with a varying degree of collaboration. The present paper looks at the major conflict between OM and pharmacy in South Korea in the 1990s. Most of the discussions over the so-called 'Hanyak Punjaeng'(OM vs pharmacy dispute) have so far been carried out in the perspective of interest/pressure group politics. But this paper presents an alternative analysis about the genesis, process and resolution of the dispute. It is argued that Robert Alford's 'structural interests' model, rather than the conventional pluralist perspective, offers the most plausible explanation of the conflict. Three key findings are ascertained. First, a sectional, inter-professional conflict can erupt into a major social cataclysm beyond the confines of health care services, an unlikely incident of a 'low politics' case becoming a 'high politics' affair. Second, a bipartite professional monopoly based on the principle of professional credentialism came to be established. Third, the dispute brought about a notable change in the structural power distribution between the corporate rationalizer and professional monopolist.

Competitive Behavior↗
PubMed1991

The Canadian Oncology Pharmacy Research Network.

Research in hospital pharmacy has been increasingly highlighted in recent years, with special attention focused by the Research Committee of the Canadian Society of Hospital Pharmacists (CSHP). In a first attempt to organize potential oncology pharmacist researchers, an invitation to join a research network was distributed to hospital pharmacists across Canada in late 1988. Data sheets, including personal demographic data, practice and research information, members' perceived roles in future research projects, experience and training, interest in multi-centre research projects, and specific areas of research involvement were used to create a roster of pharmacist researchers. Sixty-nine pharmacists submitted their names to the roster. Details on each respondent were then transferred to a standardized data spreadsheet which was distributed back to each network member. Members then had a listing of potential researcher colleagues to aid in their development or participation in multi-centre studies. Data provided by the respondents were analyzed to characterize the nature of this network. Twenty of 60 members reported qualifications beyond BSc and 11 members hold advanced degrees. There was a wide variation of time available for research activities. A weekly commitment of three to ten hours (reported by 25/48) is a reasonable amount of time for successful research involvement. Previous training and experience are also positive factors: 25/69 had postgraduate training, 25/68 had previous experience conducting a research project and 34/67 had collaborated on a study project. There were two cohorts of potential researchers in oncology pharmacy--those who are prepared to run a project, and those who wish to contribute to projects.(ABSTRACT TRUNCATED AT 250 WORDS)

Canada↗
PubMed2004

Longitudinal prescribing patterns for psychoactive medications in community-based individuals with developmental disabilities: utilization of pharmacy records.

BACKGROUND: Little is known about longitudinal prescribing practices for psychoactive medications for individuals with intellectual disabilities and developmental disabilities (IDDD) who are living in community settings. METHODS: Computerized pharmacy records were accessed for 2344 community-based individuals with IDDD for whom a total of 3421 prescriptions were written during a 17-month period of study. Forty-two psychoactive medications were rank ordered in terms of prescription frequency. RESULTS: Fifty-two per cent (52%) of all prescriptions written during the study period were for psychoactive medications. Anticonvulsant, antipsychotic and antidepressant medications were the most commonly filled prescriptions among psychoactive medications. Sixty per cent (62%) of the study population was given prescriptions for more than one psychoactive medication and 36% received three or more psychoactive medications. During the study period there was a statistically significant increase in prescriptions filled for olanzapine, risperidone, valproic acid, and clonazepam whereas prescriptions filled for thioridazine, haloperidol, and benzotropine showed a significant decline (P < 0.05-0.001). Distribution of psychoactive drug class by age showed that the majority of prescriptions were filled for individuals between 20 and 50 years with the exception of prescriptions for psychostimulants which peaked for individuals prior to 20 years. CONCLUSIONS: (1) Analysis of pharmacy billing records provides a method for assessing prescribing patterns of psychoactive medications in community-based individuals with IDDD. (2) Polypharmacy for psychoactive medications is prevalent in this setting. (3) The second-generation antipsychotic medications are prominently represented by an increasing number of filled prescriptions during the study period.

Adult↗
PubMed1988

Comparison of practice patterns and job satisfaction of entry level PharmD and BS level graduates in hospital and community practice.

Controversy has and continues to exist over whether schools of pharmacy should make the PharmD the universal entry level pharmacy degree. Proponents argue that doctorate status would enhance pharmacy's professional image and society would benefit from doctoral-level training. Opponents counter that, given the present health care system, society can place only a small percentage of pharmacists in positions requiring training at the doctorate level and, further, placing pharmacists with highly developed clinical skills in positions not requiring such skills will lead to both frustration and loss of clinical skills. The present study investigated the following research questions with regard to community and hospital pharmacy practice: (i) do job activities of entry level PharmD graduates differ from those of BS graduates; and (ii) does the job satisfaction of entry level PharmD and BS graduates differ? Questionnaires were mailed to randomly selected California entry level PharmD graduates and Georgia BS graduates to elicit responses regarding practice patterns and job satisfaction. Response rates were 68 percent for PharmD and 62.5 percent for BS respondents. The subsequent data revealed that both PharmD and BS respondents devoted the greatest portion of their time to drug distribution in both practice settings. Minimal differences were noted in other work activities in either on practice setting. No differences in job satisfaction were found.

California↗
PubMed2001

Dental health and access to dental treatment: a comparison of drug users and non-drug users attending community pharmacies.

OBJECTIVE: To investigate the self-reported oral health, access to dental treatment and recent use of dental services among a group of drug users attending community pharmacies and to make a comparison with a group of age and gender matched community non-drug users/patients not using services for drug users. METHOD: Review instrument completed by pharmacist interviewing drug users and other pharmacy users. SETTING: Community pharmacists SAMPLING: All known drug users attending participating pharmacies plus an equivalent number of age and gender matched non-drug using pharmacy customers. Final sample size drug users N = 125; non-drug users N = 129. KEY FINDINGS: The data show that drug users self-report considerably more difficulty in accessing dental treatment, are less likely to have visited the dentist in the last 12 months and have a significantly higher level of self-assessed oral health problems, with less use of treatment services than non drug users. CONCLUSIONS: Drug users need to be encouraged to access free dental treatment available to them on the NHS. Closer collaboration between the dental profession and others in contact with drug users, such as community pharmacists, may enhance uptake of dental services.

Adolescent↗
PubMed1994

Program for procurement of drugs for indigent patients.

A program for procuring free medications for indigent patients from pharmaceutical manufacturers is described. A medical center that provides $36 million in free care annually to indigent patients sought a way to offset drug costs for these patients while maintaining the same level of care. The pharmaceuticals with the greatest impact on the pharmacy budget were identified; manufacturers of these pharmaceuticals were surveyed to determine if they offered free drugs to qualified patients. The net potential cost avoidance resulting from procuring these free drugs was estimated at $150,000 for the first year. A full-time pharmacist was hired to identify patients likely to qualify for such assistance, help patients apply for assistance, and coordinate the receipt and distribution of the resulting medication supplies. The program served 200 patients the first year (fiscal year 1992) and more than 300 patients the next year. Medications obtained for these patients included i.v. immune globulin, cancer chemotherapy agents, growth factors, antimicrobials, antiemetics, and interferons. The acquisition cost of the medications received was $448,851 in 1992 and $504,211 in 1993. A pharmacy-based program to procure free medications for indigent patients has helped to defray a medical center's expense of providing care.

California↗
PubMed2001

Effect of pravastatin-to-simvastatin conversion on low-density-lipoprotein cholesterol.

The effects of a pravastatin-to-simvastatin conversion program on low-density-lipoprotein (LDL) cholesterol levels were studied. Patients receiving pravastatin at a Veterans Affairs medical center were switched to simvastatin beginning in 1997. The dosage of simvastatin was based on the additional percent reduction in LDL cholesterol needed to achieve the goal specified by the National Cholesterol Education Program. The primary endpoint was the change in the percentage of patients meeting their LDL cholesterol goal at baseline and follow-up. Changes in lipid indices, the relative risk (RR) of coronary heart disease (CHD), and program costs were also evaluated. A total of 1032 patients completed the program. The mean +/- S.D. daily doses of pravastatin and simvastatin were 25.2 +/- 11.3 and 22.7 +/- 13.3 mg, respectively. Median baseline and follow-up LDL cholesterol concentrations were 116 and 99 mg/dL, respectively (p < 0.001). Overall, 44% of the patients met their LDL cholesterol goal while taking pravastatin, compared with 69% after conversion to simvastatin (p < 0.001). The predicted mean RR of a future CHD event (based on changes in serum lipids) was 0.87 (95% confidence interval, 0.83-0.91) four years after conversion. The total cost of the program was $40,644 in the first year, and there was a net saving thereafter. Therapeutic interchange between pravastatin and simvastatin increased the number of patients meeting their LDL cholesterol goal.

Aged↗
PubMed2002

Improving blood pressure control in a pharmacist-managed hypertension clinic.

OBJECTIVE: To determine whether pharmaceutical care provided by a pharmacist-managed hypertension clinic results in better treatment outcomes when compared with traditional health care from a primary care physician. DESIGN: Prospective, controlled study SETTING: Veterans Affairs Medical Center, Philadelphia, Pennsylvania. PATIENTS: Fifty six patients with essential hypertension; 27 were randomly assigned to the intervention group and 29 to the control group. INTERVENTION: Patients in the intervention group were scheduled monthly to meet with a clinical pharmacist who made appropriate changes in prescribed drugs, adjusted dosages, and provided drug counseling in accordance with the hypertension guidelines in the sixth report of the Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). Patients in the control group received standard care from their physicians. The study period was 6 months. MEASUREMENTS AND MAIN RESULTS: Treatment outcomes were measured by changes in compliance, blood pressure, and patient satisfaction. The Short Form-36 health survey and a patient satisfaction survey were used to measure changes in patient satisfaction, and a compliance evaluation survey measured compliance. Twenty-one (81%) patients in the intervention group attained their blood pressure goal of below 140/90 mm Hg at the completion of the study versus only eight (30%) in the control group (p < 0.0001). Of 11 patients with diabetes in the intervention group, 10 (91%) attained their blood pressure goal (< 130/80 mm Hg) versus only two (12 %) of 16 patients with diabetes in the control group (p < 0.0001). No significant differences in patient satisfaction or compliance were reported between the intervention and control groups. CONCLUSIONS: Pharmaceutical care improves blood pressure control and results in more patients with hypertension reaching their blood pressure goal.

Aged↗
PubMed1990

Procedures on handling mifepristone (RU 486) in France.

Mifepristone (Mifegyne 200 mg) is a newly approved drug in France for termination of early pregnancy. Consequently, doctors and pharmacists have to follow strict legal rules of prescription, administration, storage, and dispensing. French requirements are reviewed with particular regard to practical procedures of dispensing.

Abortion, Induced↗