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PubMed1978

Errors remaining in unit dose carts after checking by pharmacists versus pharmacy technicians.

The accuracy of pharmacists and pharmacy technicians in checking unit dose carts was compared. One-half of the unit dose patient medication drawers, for a 92-bed medicine service in a 450-bed teaching hospital, were checked by pharmacy technicians and the remaining by pharmacists. These drawers then were checked again to determine the number and type of checking errors committed by technicians and pharmacists. During the 10-day study, carts checked by pharmacists contained over twice as many errors (1.85%) as similar carts checked by technicians (0.87%). The results suggest that pharmacy technicians could probably be trained to perform the cart-checking task in unit dose drug distribution systems. Time-extended studies should be done to determine if technician performance is maintained after the novelty of the task wears off.

Drug Packaging↗

PubMed1984

Aminoglycoside dosing service provided by baccalaureate-level pharmacists.

An aminoglycoside pharmacokinetic dosing service operated primarily by baccalaureate-level pharmacists is described. The service was initiated gradually by the clinical pharmacy coordinator. After detailed policies and procedures were developed, staff pharmacists received 14 hours of training in pharmacokinetics. The training program consisted of written study material and application to actual patient cases. The pharmacokinetic dosing service is initiated upon the written request of a physician. Nurses on the pharmacy i.v. team administer aminoglycoside doses, collect blood samples, and record sample collection and drug infusion times whenever possible; when workload is heavy, floor nurses and laboratory personnel assist in these functions. The entire dosing consult requires approximately one hour of pharmacist time per patient. A $20 fee is assessed for completed dosing consults. Approximately 50 consults are provided per months, and a survey showed that 50-70% of all hospital patients (except newborns in intensive care) receiving aminoglycosides had their dosages calculated by the service. A carefully developed limited aminoglycoside dosing service provided primarily by baccalaureate-level pharmacists has given the pharmacy department at this hospital an opportunity to further expand its involvement in clinical pharmacokinetics.

Aminoglycosides↗

PubMed1983

Staff pharmacists' job attitudes and job performance.

An instrument was developed and used to evaluate job performance of staff pharmacists, and the relationship between performance and job satisfaction was examined. In designing the performance rating instrument (PRI), 23 measurable work-related behaviors of hospital staff pharmacists were identified through interviews with pharmacy directors. For each of the 15 behaviors ranked most important by hospital pharmacy directors, a four-point scale of performance was defined. Job satisfaction was measured using the job descriptive index (JDI) augmented by questions specific to hospital pharmacy practice. Staff pharmacists at eight hospitals completed the JDIs, and their directors completed the corresponding PRIs. Of 66 sets of PRIs and JDIs distributed, 38 pairs of usable responses were returned. There were a number of significant correlations between individual items on the PRI and JDI, but the correlation between the composite scores for the two scales was not significant. JDI and PRI scores decreased with age and years of practice, but the decrease was not significant. The PRI is a short, understandable method of quantifying hospital staff pharmacist performance. No significant correlation between job satisfaction and performance was found.

Attitude of Health Personnel↗

PubMed1978

Measuring pharmacist time use: a note on the use of fixed-interval work sampling.

Pharmacist time use was studied to examine whether fixed-interval work sampling would provide results comparable to those obtained when random-interval observations were used. The study was conducted over a three-month period using pharmacists in a single community pharmacy as subjects; similar study methods have been used in hospital settings. Four separate measures of pharmacist time use were designated: tasks, duties, competencies and productivity. In every case the fixed-interval method gave an estimate that was not significantly different from the random-interval procedure (alpha greater than 0.05, difference of proportions test). The findings suggest that pharmacist work patterns are not sufficiently cyclical to introduce a bias in work sampling by fixed intervals. Fixed-interval work sampling yields results comparable to those using the standard work sampling methods that rely upon random time periods between observations.

Community Pharmacy Services↗

PubMed1981

Pharmacist involvement in an endocrinology clinic.

The patient-care activities of pharmacists involved in the operation of an endocrinology clinic are described. During the patient's initial clinic visit, the pharmacist completes a medication profile by interviewing the patients and reviewing each patient's medication. The clinic also serves as a teaching laboratory. Pharmacy students gain experience interviewing, obtaining medication profiles, evaluating drug-related problems, and conveying their findings to the physician. The pharmacists' activities include: (1) explaining the prescribed medication to the patients on a one-to-one basis, (2) discussing the importance of compliance with the family members who motivate and reinforce positive behavior, (3) fostering relationships with the patients, physicians, and other patient-care personnel, and (4) helping the patients obtain medications that are not commonly found in community pharmacies. Pharmacist involvement in an endocrinology clinic can be an effective means of ensuring patient compliance and enhancing interdisciplinary participation, and it can serve as a clinical learning experience for pharmacy students.

Endocrine System Diseases↗

PubMed1976

Pharmacist's effect on digoxin usage and toxicity.

Digoxin usage and toxicity were compared in a prospective group of patients who were monitored by a pharmacist and a retrospective group for which there was no pharmacist consultation. For the prospective group, the pharmacist monitored patients and estimated the steady-state digoxin levels by the use of a nomographic method. Level greater than 2.2 ng/ml and concurrent ECG or physical signs of digoxin toxicity were communicated to the physician. For the retrospective group, digoxin levels were calculated based on data from the patients' charts. The 49 patients in the two study groups were categorized according to four levels of digoxin toxicity (ranging from "no evidence" to "probable"). The only characteristic that was significantly different between the two groups was the calculated creatinine clearance (lower for the retrospective group). The maintenance dose of digoxin and the incidence of digoxin toxicity were significantly lower in the prospective group. It is concluded that pharmacist intervention may have had an effect in reducing digoxin dosage and toxicity.

Adult↗

PubMed1993

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↗

PubMedDate not supplied

Template for the evaluation of a clinical pharmacist. American College of Clinical Pharmacy.

Pharmacists are expected to deliver pharmaceutical care, that is, to accept responsibility for patients' well-being by ensuring optimum outcomes of drug therapy. Therefore, their performance must be evaluated based on this expectation. The template should be a useful tool for assessing the extent to which clinical pharmacists' performance meets predefined practice standards. Its adaptability will allow it to meet site- and pharmacist-specific requirements for performance appraisal. The evaluator and clinical pharmacist should work together to establish a priori percentage standards.

Clinical Competence↗

PubMed1993

Impact of an educational program on the treatment practices of diarrheal diseases among pharmacists and drugsellers.

The impact of an intervention program, measured by changes in the prescription of ORS, antibiotics and antidiarrheal drugs by those pharmacists and drugsellers after administering the proposed educational package was assessed. The results of the study indicated that, before the educational program started, ORS was prescribed by pharmacists for 31.4% and 15.7% of watery diarrhea and dysentery episodes, respectively. Only 18.9% and 13.3% of drugsellers gave ORS to assessors in case of watery diarrhea and dysentery. Antibiotics and antidiarrheal agents were prescribed extensively, watery and dysenteric diarrhea (84% and 56% for watery diarrhea by pharmacists and drugsellers; 92% and 60% for dysentery). Antidiarrheal drugs were used as frequently. After the educational program, the assessment of the prescription behavior of the pharmacists showed no change in ORS, antibiotics and antidiarrheal drugs prescribed to treat watery diarrhea. In dysentery, the effective percent change in prescribing ORS between pre- and post- intervention program was much higher in intervention group than the control group. For drugsellers, effective percent change in ORS usage in treatment of watery diarrhea was 11.8% compared with -7.7% in the control group. No such change was observed in treatment of dysentery. There was a slight significant change in behavior concerning use of antibiotics among subjects getting information by mail, compared to those who got full intervention, when the pre-intervention behavior, store type and treatment type was taken into account.

Anti-Bacterial Agents↗

PubMedDate not supplied

Effectiveness of clinical pharmacist interventions in a hemodialysis unit.

Many patients with end-stage renal disease are treated with a complex pharmacotherapeutic regimen that requires constant and thorough monitoring. The role of a clinical pharmacist in contributing to the care of patients receiving long-term hemodialysis in an outpatient dialysis unit was assessed. Therapeutic interventions provided routinely by the clinical pharmacist were recorded and then categorized and evaluated by two independent clinical pharmacists with expertise in nephrology pharmacotherapeutics. Of the 205 interventions recorded, 97.6% were initiated by the clinical pharmacist and 91.7% were accepted by the medical team; 80.9% were judged to have primarily affected the quality of care. The purposes of interventions were drug selection in 32.2% of cases, drug discontinuation in 19.0%, dose selection in 24.4%, and therapeutic monitoring in 24.4%. Most interventions were initiated in response to abnormal laboratory test results. When the interventions were ranked according to clinical significance, 34.6% were involved with the preservation of major organ function and 62.4% with improvement of the quality of care to acceptable standards. Of all the interventions accepted by the medical team, 90.5% resulted in positive patient outcome; 7.9% resulted in no observable change or had no effect on outcome. The results demonstrate the potential influence and effectiveness of clinical pharmacy interventions on the drug therapy of patients receiving long-term hemodialysis.

Costs and Cost Analysis↗

PubMed1995

Attention-deficit hyperactivity disorder: the pharmacist's role.

Included in the variety of options for treating ADHD are several classes of pharmacologic agents with various side effects and monitoring parameters. The pharmacist must understand the issues involved with the use of the agents in each class. The pharmacist is often the most accessible health care professional and can take advantage of this fact to counsel and support both patients and family members. Table 5 offers counseling tips and additional information for the pharmacist. Of the medications discussed here, the stimulants are recognized as the most effective for treating ADHD, with the amphetamines and methylphenidate providing equal benefit. In some instances, pemoline has also been shown to be as effective as the other stimulants. Second-line agents are the TCAs, of which imipramine is the most commonly prescribed. However, the other TCAs are probably just as effective; some may have a less burdensome profile of side effects and may result in better compliance. Next in line is bupropion or clonidine, both of which show promise for ADHD treatment. Nevertheless, these agents need to be tested in more rigorous trials. Agents of last resort include the MAOIs, of which tranylcypromine has been the most studied. The ideal agent for treating ADHD would have an immediate onset, provide benefit throughout the day, have few or no side effects, lack the potential for abuse, be effective for most patients, and be relatively inexpensive. This ideal agent has yet to be discovered. Clinicians and researchers are still looking for a medication to come as close to the ideal therapy as possible. Therefore, it is not uncommon for a pharmacist to see a patient with ADHD try several different medications. In addition, children in whom ADHD is refractory to currently available options or who cannot tolerate these options may also be given other psychotropic medications not mentioned in this review.

Antidepressive Agents, Tricyclic↗

PubMed1996

[Improved information on drugs to patients. A project with a pharmacist in the therapeutic team at a cardiology department].

Patients with cardiac disease knew more about medicaments after receiving medicament-related counselling by a pharmacist on discharge from hospital. This was demonstrated by a questionnaire answered by 49 patients whose answers were compared with the results of a study conducted in 1991, when patients did not receive information from a pharmacist in hospital. More patients were pleased with the information, and most of them were satisfied with the consultation with the pharmacist. Lack of time was stated to be the main reason why other hospital health care professionals often provided insufficient information on medicaments to patients. It was discovered that physicians did not record a proper history of the medication. This affected management of the therapy and the information given to patients. This investigation shows that a pharmacist can make an important contribution to the care of patients. Health care professionals should begin to discuss with the health authorities how best to organize the information patients receive on medicaments.

Cardiology Service, Hospital↗

PubMed1976

Medication maintenance of mentally ill patients by a pharmacist in a community setting.

The use of a community pharmacy as a facility for medication maintenance services usually provided by a mental health center was evaluated. The project pharmacist was affiliated with the community mental health center, the community pharmacy facility was borrowed for purposes of this study. Records and prepackaged medication were transported by the pharmacy-clinic. Medication histories were taken and maintained by the pharmacist. Problems such as medication noncompliance, drug side effects, drug interactions and minor alterations in the patients mental status were handled by the pharmacist. Telephone consultations with a psychiatrist were also available. Twenty-two patients were involved in the study over an eight-month period. The evaluation consisted of a patient acceptance questionnaire and a retrospective chart review analyzing the clinical response of patients. Data suggest that selected stabilized psychiatric patients can be safely maintained in the community pharmacy. A carefully structured program and a pharmacist with special competencies are felt to be prerequisites for this type of service.

Attitude↗

PubMed1988

Clinical education for hospital pharmacists in The Netherlands and the United States of America: some observations.

Three parameters for the quality of clinical education for hospital pharmacists are postulated: the number of pharmacists who can serve as preceptors, the depth and scope of clinical pharmacy services, and the structure of the training. Dutch hospital pharmacies exhibit consistently lower pharmacist staffing ratios than their American counterparts. For the scope of services provided in Dutch (as compared to American) hospitals, the emphasis is on pharmacokinetic consultation and handling of radiopharmaceuticals, services which require less patient involvement and are consequently less labour intensive than services, such as patient profile and drug interaction monitoring services, which are more prevalent in American hospital pharmacies. 17% of Dutch respondents were not exposed to patient profile monitoring during their training, 16% were not exposed to drug interactions monitoring, 9.8% were not exposed to pharmacokinetic services and 8.9% were not exposed to drug information services, although these services are provided at the current worksite. Dutch hospital pharmacists are often solo practitioners maintaining a high standard of practice by focusing on core tasks and activities.

Costs and Cost Analysis↗

PubMed2003

The impact of critical care pharmacists on enhancing patient outcomes.

The highly specialized knowledge and skills needed to care for critically ill patients requires a multidisciplinary team approach. Pharmacists are integral members of this team. They make valuable contributions to improve clinical, economic, and humanistic outcomes of patients. The purpose of this article is to review the literature pertaining to pharmacists' contributions within a multidisciplinary intensivist-led intensive care unit (ICU) team. Pharmacist interventions include correcting/clarifying orders, providing drug information, suggesting alternative therapies, identifying drug interactions, and therapeutic drug monitoring. Pharmacist involvement in improving clinical outcomes of critically ill patients is associated with optimal fluid management and substantial reductions in the rates of adverse drug events, medication administration errors, and ventilator-associated pneumonia. Furthermore, economic evaluations of clinical pharmacy services in the ICU consistently reveal the potential for considerable cost savings.

Cost-Benefit Analysis↗

PubMed1996

A critical review of the remuneration systems for pharmacists.

This paper provides a critical review of different systems of remunerations of pharmacists which exist in various countries: the percentage mark-up, the graduated mark-up, the capitation system, the fee for service system and mixed system. In these different systems, we refer to the various ways the provisions of pharmaceutical services are paid and reimbursed rather than how persons who physically deliver the services are paid. Therefore, the differences among various types of remuneration may not impact directly the level of responsibility and motivations of the various employees or owners in contact with the patient. The dispensing service remains the essential service of the pharmacist in all systems. However, according to the types of remuneration, the revenue of the pharmacist can be more or less linked to the volume and the price of drugs. Capitation systems, professional allowance and fees in particular can be used to shift the objective of the pharmacist towards increased professionalism. In each system, policy makers, when they can negotiate with the whole national profession, can use the remuneration system to achieve public policy objectives such as cost containment, better drug use, or provisions of large packages of services. This paper discusses to what extent each system can contribute to such objectives. In order to achieve public policy objectives, it may be time to shift the valuation of pharmaceutical services towards more safe and effective therapy instead of safe and effective drugs.

Canada↗

PubMed1996

A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy.

PURPOSE: To evaluate the effect of sustained clinical pharmacist interventions involving elderly outpatients with polypharmacy and their primary physicians. PATIENTS AND METHODS: Randomized, controlled trial of 208 patients aged 65 years or older with polypharmacy (> or = 5 chronic medications) from a general medicine clinic of a Veterans Affairs Medical Center. A clinical pharmacist met with intervention group patients during all scheduled visits to evaluate their drug regimens and make recommendations to them and their physicians. Outcome measures were prescribing appropriateness, health-related quality of life, adverse drug events, medication compliance and knowledge, number of medications, patient satisfaction, and physician receptivity. RESULTS: Inappropriate prescribing scores declined significantly more in the intervention group than in the control group by 3 months (decrease 24% versus 6%, respectively; P = 0.0006) and was sustained at 12 months (decrease 28% versus 5%, respectively; P = 0.0002). There was no difference between groups at closeout in health-related quality of life (P = 0.99). Fewer intervention than control patients (30.2%) versus 40.0%; P = 0.19) experienced adverse drug events. Measures for most other outcomes remained unchanged in both groups. Physicians were receptive to the intervention and enacted changes recommended by the clinical pharmacist more frequently than they enacted changes independently for control patients (55.1% versus 19.8%; P <0.001). CONCLUSIONS: This study demonstrates that a clinical pharmacist providing pharmaceutical care for elderly primary care patients can reduce inappropriate prescribing and possibly adverse drug effects without adversely affecting health-related quality of life.

Aged↗

PubMedDate not supplied

Use of pharmacists by older people in the community.

A random sample of community dwelling elderly people (> 65 years) was interviewed on two occasions, 6 months apart. Four hundred and thirty five completed both interviews. Subjects were asked about their medication, and about the advice sought from community pharmacists, on both drug and non-drug related health issues. Medication had been altered during the 6-month interval in 101 (23%) of people, but only 15 of these had discussed the change with a pharmacist. The majority of those who did discuss their medication, however, found the exchange helpful. Only 1% of the sample had discussed a health problem not related to drugs with a pharmacist in the previous month, although once again such discussions were felt to be useful. Of the total sample, 79% said they would never discuss medication-related issues with a community pharmacist, and 83% would not discuss other health matters. The majority of this sample - 96% - expressed a preference to discuss these issues with their general practitioner.

Journal Article↗