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PubMed1989

National survey of critical-care pharmaceutical services.

The results of a national survey of critical-care pharmaceutical services are reported. A questionnaire was mailed on March 8, 1988, to 1500 of the 6800 U.S. hospitals with more than 100 beds. The questionnaire was divided into four sections: (1) critical-care pharmaceutical services; (2) critical-care clinical pharmacy activity; (3) critical-care pharmacy standards; and (4) general information on the hospital, including pharmaceutical services provided to patients who are not critically ill. A total of 613 usable questionnaires were returned, for a response rate of 41%. Respondents from 124 hospitals reported having a critical-care satellite pharmacy. Critical-care beds served by satellite pharmacies were more likely to have unit dose drug distribution services than were critical-care beds not served by satellite pharmacies. The level of clinical and educational services provided to critical-care patients was significantly lower for intensive-care unit (ICU) pharmacists practicing in satellite pharmacies than it was for ICU pharmacists not associated with satellite pharmacies. There were no differences between satellite and nonsatellite ICU pharmacists in either the percentage of a typical day spent providing clinical services to critical-care patients or the percentage of critical-care patients receiving those services. Respondents expected their hospitals to add 301 full-time-equivalent critical-care pharmacists to their staffs during the next two years, for a 39% increase. Respondents strongly favored establishing 24-hour unit dose drug distribution and i.v. admixture services, providing inservice education to nurses and physicians, and providing written pharmacokinetic consultations.(ABSTRACT TRUNCATED AT 250 WORDS)

Critical Care↗
PubMed1989

[Prospective evaluation of admission for acute abdominal pain in children].

Acute abdominal pain (AAP) is one of the most frequent causes of admission to an emergency department of a childrens' hospital. The diagnosis viewed with the most apprehension is acute appendicitis. We present the results of a prospective study on the evaluation of the clinical and paraclinical symptoms generally observed in an AAP, and discuss the benefit of a diagnostic score for acute appendicitis. Twenty-five different diagnoses were observed, the 5 most frequent being: "non specific" (34.2%), constipation (16%), otorhinolaryngological infection (11.6%), gastroenteritis (10.7%) and acute appendicitis (10.5%). The study of 12 symptoms showed an elevated sensitivity for each one (92-50%), but a low positive predictive value (72-12%). Rigid adhesion to a diagnostic score would have led to unnecessary medical examination.

Abdominal Pain↗
PubMed1988

Association of length of stay and total hospital charges with antimicrobial regimen changes.

The association of changes in antimicrobial therapy with length of stay and total hospital charges in a 600-bed general medical hospital was studied. Changes in antimicrobial regimens were examined in three diagnosis-related groups (DRGs): DRG 79 (respiratory infections and inflammations, age greater than 69 years, and/or secondary diagnosis), DRG 89 (simple pneumonia and pleurisy, age greater than 69 years, and/or secondary diagnosis), and DRG 416 (septicemia, age greater than 17 years). These changes were defined as follows: (1) switching from one drug or drug combination to another, (2) adding one or more drugs to a regimen, or (3) discontinuing one drug of a multiple-drug regimen. Variables examined for association with these changes were length of hospital stay and pharmacy, antimicrobial, intravenous therapy, and hospital charges. In DRGs 79 and 89, changes in antimicrobial regimens were associated with significantly longer hospital stay and significantly higher pharmacy, antimicrobial, intravenous therapy, and total hospital charges. In DRG 416, changes in antimicrobial regimens were not associated with higher charges or longer stay. Significant differences among DRGs were found with respect to the types of changes, with more changes from broad- to narrow-spectrum coverage occurring in DRGs 89 and 416 than in DRG 79. At this institution, patients whose antimicrobial regimens were changed had significantly longer hospital stays and higher charges in two of three DRGs.

Anti-Bacterial Agents↗
PubMed1987

The impact of induced abortion on black and white birth outcomes in the United States.

This paper examines the impact of induced abortion on birth outcomes by treating abortion as an endogenous input into the production of infant health. To gauge the direct and indirect effects of abortion, three measures of infant health are considered simultaneously: the neonatal mortality rate, the percentage of low-weight births, and the percentage of preterm births. All three are race specific and all pertain to large counties in the United States in 1977. The results suggest that by preventing unwanted births, abortion enhances the survivability of newborns of a given birth weight and improves the distribution of births among high-risk groups.

Abortion, Induced↗
PubMed1987

Functional and structural prerequisites for clinical pharmacy services.

Pharmacy directors and pharmacists in charge of clinical services at 46 medium-sized hospitals were surveyed to identify possible explanations for previously documented inconsistency in the implementation of clinical pharmaceutical services. There were three study objectives: to determine the extent to which basic structural and functional management prerequisites have been implemented at these institutions; to determine whether a relationship exists between the kind and number of clinical services offered and implementation of these prerequisites; and to identify discrepancies between responses of the pharmacy director and the pharmacist in charge of clinical services at the same hospital to the same questions. One hundred hospitals providing clinical pharmaceutical services were randomly selected from a master list of 190 hospitals that had been grouped into nine geographic areas. Of 17 functional and structural prerequisites studied, 4 to 13 of them had been implemented at the hospitals surveyed. Only 24% of the hospitals had implemented the basic functional prerequisites of unit dose drug distribution and decentralized pharmaceutical services. Of nine clinical pharmaceutical services, one to eight were being delivered. A weak correlation between the number of prerequisites implemented and the number of clinical services provided was found. Significant disagreement was found between the directors and their pharmacists about which prerequisites and clinical services were being implemented. This pilot study suggests that pharmacy directors and clinical pharmacists need to assess how effectively basic management prerequisites are being put into practice in the delivery of clinical pharmaceutical services.

Medication Systems, Hospital↗
PubMed1987

Qualifications for future hospital pharmacy directors as perceived by pharmacy directors and hospital administrators in Wisconsin.

Hospital pharmacy directors and administrators in Wisconsin were surveyed to determine their perceptions of the responsibilities, skills, postgraduate education, training, and experience necessary for hospital pharmacy directors during the next 10 years. Packages containing two identical questionnaires were mailed in April 1985 to the pharmacy directors at all 159 hospitals in Wisconsin. The pharmacy director and his or her immediate supervisor were asked to use a 5-point Likert-type scale to rate the importance of various responsibilities and skills and also to rank the most important responsibilities, skills, and issues. In addition, respondents answered forced-choice questions about postgraduate education and training and an open-ended question about academic coursework. All responses were compared by respondent characteristics and hospital size. There was a response rate of 48.1% to the questionnaire, representing 60.7% of the pharmacy directors (n = 96) and 34.6% of the administrators (n = 55). Both groups agreed on which responsibilities and issues will be very important (mean importance rating of greater than 4) for future pharmacy directors. However, administrators rated clinical and technical skills as significantly more important than did pharmacy directors. Only 48% of pharmacy directors believed that a residency is essential and preferred either a general or administrative residency coupled with an advanced degree, whereas more than 50% of the responding administrators favored residencies not affiliated with a degree program. The majority of pharmacy directors and administrators believed that both general staff and administrative experience is necessary for future pharmacy directors.(ABSTRACT TRUNCATED AT 250 WORDS)

Education, Pharmacy↗
PubMed1986

Patient acuity indicators as predictors of pharmacy workload.

The feasibility of using two workload indicators from a nursing patient-classification system as a means of predicting pharmacy workload was studied. Frequency data for 13 pharmacy distribution and clinical activities were recorded daily for 28 consecutive days and compared with daily data for acuity of patient illness and number of standard hours of nursing care required on nine nursing units. The strength of the associations between (1) pharmacy workload and patient acuity and (2) pharmacy workload and standard hours of nursing care was determined by linear regression analysis. Both same-day and one-day-lagged analyses were performed; the one-day-lagged analyses looked at pharmacy workload on a given day in relation to nursing workload on the previous day. A total of 252 observations were available for analysis. Pharmacy workload and same-day standard hours of nursing care were correlated most strongly, although all of the analyses yielded large coefficients of correlation. Analysis of data from individual nursing stations yielded smaller coefficients of correlation, especially for the one-day-lagged analyses. At least 73% of the variance in pharmacy workload could be attributed to variance in nursing workload. The index of patient acuity of illness and the number of standard hours of nursing care are good predictors of pharmacy workload of the same and the following days; the potential exists to use these nursing workload indicators in determining pharmacy staffing requirements.

Minnesota↗
PubMed1985

Decision analysis applied to pharmacy practice.

The use of decision analysis is discussed as it relates to pharmacy practice. Decision analysis is a valuable approach to selecting a choice from among several uncertain alternatives. It encourages the practitioner to define his views explicitly and weigh the merits of each alternative. The decision maker lists the choices or options to be considered. These choices are incorporated into a decision tree with their probability of occurrence and the relative worth of each potential outcome (utility) to the concerned party. A limitation of the method is that utility values and probabilities are often estimated on the basis of the decision makers' biases. Examples of applying decision analysis to clinical and administrative choices in pharmacy practice are presented.

Bayes Theorem↗