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Biomedical subjects

C D Mahoney

Publications and source records attributed to C D Mahoney.

At least 19 recordsLinked to original sources
PubMed1996

Computer software for pharmacy oncology services.

A computer program designed to manage the informational, clinical, and data requirements for a pharmacy oncology service is described. Specialized pharmacy oncology software was developed at Rhode Island Hospital and implemented in a multihospital, integrated health system. The software performs various safety functions, supplies on-screen access to pertinent drug and patient information, manages data, and assists in the product formulation process. The programmed safeguards can be modified to meet changing requirements. The system has been in use for more than seven years and has helped detect prescribing errors and prevent preparation and administration errors. A pharmacy oncology computer program streamlines pharmacists' work and helps prevent errors in antineoplastic drug therapy.

Clinical Pharmacy Information Systems↗
PubMed1995

Cost-reducing treatment algorithms for antineoplastic drug-induced nausea and vomiting.

A treatment algorithm and preprinted order form developed to reduce the cost of treating antineoplastic drug-induced nausea and vomiting are described. A team including pharmacists, oncologists, and oncology nurses developed a treatment algorithm to reduce the cost of antiemetic therapy for patients receiving antineoplastic therapy at a 719-bed academic medical center. The algorithm incorporated the following concepts: matching antiemetic therapy with the emetogenic potential of the antineoplastic regimen, reducing ondansetron dosages, increasing the ratio of oral to intravenous therapy, and treating delayed-onset nausea and vomiting without using serotonin-receptor antagonists. To help physicians learn and use the treatment algorithm, it was incorporated into an order form for both antineoplastic and antiemetic drugs. Separate order forms were created for pediatric and adult patients. A comparison of outcome data before and after implementation of the practice guidelines showed that the patient outcomes were at least as good after implementation as before. More than a year after the guidelines were implemented, more than 85% of antiemetic regimens prescribed for antineoplastic drug-induced nausea and vomiting were in compliance with the guidelines. A cost avoidance of nearly $205,000 was realized in the first year. Collaboration with oncologists at the start of the care plan was a key element in its success. An antiemetic treatment algorithm, integrated with a preprinted physician order form, was well accepted and has reduced expenses for antiemetic therapy.

Adult↗
PubMed1992

Issues in formulary management: therapeutic interchange. The value, cost, and quality of therapeutic interchange.

Therapeutic interchange is a process of substituting a prescribed medication with one that offers therapeutic and cost benefits. The practice not only provides short-term savings but also is associated with decreases in lengths of stay in hospitals and total hospital drug expenses. There may be medicolegal implications when FDA-approved indications differ for interchanged drugs. The potential for liability is decreased when a standard of care is met, but since standards can change, guidelines should be reviewed regularly. High-tech, high-cost drugs are sometimes appropriate for therapeutic interchange. Pharmacy and therapeutics committees should assure best value by considering indirect expenses, quality, and therapeutic outcome, as well as product cost. Therapeutic interchange programs enable pharmacy managers to neutralize or at least slow the rate of drug cost increases, ensuring appropriate utilization of resources and more favorable patient outcomes.

Biotechnology↗
PubMed1990

Restructuring pharmacy services to reduce expenses without eliminating services.

The manner in which pharmaceutical services in a 719-bed teaching institution were restructured to reduce expenses without eliminating services is described. Before the department was restructured, the labor-intensive nature of the drug distribution system and high personnel costs hindered the introduction of upgraded services. Drugs were dispensed from a central pharmacy and 14 pharmacy satellites located throughout the hospital campus. A traditional floor stock system was used in the critical-care units, the operating suites, and the pediatric facility; i.v. admixture services were provided to only two patient-care units. Under a three-year strategic plan, the organizational structure of the department was changed to regroup existing functions and to give more autonomy to the managers. The 12 small pharmacy satellites in the main hospital building were replaced by two larger and more efficiently designed satellites. An automated medication order entry system with bar-code-reading capabilities was installed; automation was also used to increase the efficiency of the nutritional support and oncology services and to create an online file of all statistical, fiscal, and purchasing records. Fax machines that were installed on five critical-care units and the oncology unit decreased turnaround time for new medication orders. These changes enabled the department to eliminate 17 positions while adding 5 clinical pharmacist specialist positions and 6 technician group leader positions. By integrating automation technology with controlled downsizing and restructuring of drug distribution services, the department was able to reduce expenses while improving existing pharmaceutical services.

Automation↗
PubMed1990

Integration of clinical and administrative strategies to reduce expenditures for antimicrobial agents.

A comprehensive program of clinical and administrative strategies to reduce expenditures for antimicrobial agents is described. Clinical intervention strategies include the use of antimicrobial order sheets, standardized dosage regimens, restriction policies for certain antimicrobial agents, and position statements on the use of restricted agents. A cornerstone of the program is the support for cost-reduction interventions offered by the pharmacy and therapeutics committee and its subcommittee on therapeutics; that support is demonstrated through endorsement and enforcement of pharmacy programs. Physicians are reminded of the cost-reduction programs through periodic articles in the pharmacy newsletter and an "antibiogram" card supplied by the division of epidemiology. The effectiveness of these interventions has been demonstrated by progressive decreases in expenditures for antimicrobial agents during 1987 and 1988. Antimicrobial agents also account for increasingly smaller percentages of the total drug budget. This combination of clinical and administrative strategies reduced expenditures for antimicrobial agents by more than $700,000 over two years without the use of clinical specialists or any apparent sacrifice in the quality of patient care.

Anti-Infective Agents↗
PubMed1987

A comprehensive system for antimicrobial monitoring and review using a mandatory antimicrobial ordering sheet.

A comprehensive antimicrobial monitoring and review program using computer screening of information provided by antimicrobial order sheets (AOS) is needed to meet increasing pressures for ongoing review of all antibiotic use by indication. This article describes a program that has been successful in rapidly identifying areas of concern for further review and resolution. These multi-faceted programs passed JCAH scrutiny. Based on the authors experience, a system incorporating mandatory use of an AOS was preferred to a voluntary system. When used voluntarily, compliance to the use of an AOS was 84%. Compliance to use of parts of the form were stronger where check-off boxes were used instead of fill-in blanks. Surgical services personnel and first year residents were the most noncompliant. Admission orders lended themselves to noncompliance. Pharmacists using the forms were less compliant than physicians using them voluntarily, and gave different indications for use than did the physicians. Data documented on the AOS were verifiable with notes in the patient's medical record 92% of the time. Pharmacy coding and collection methods for AOS data presented problems in accurately determining compliance. When the use of the AOS became "mandatory," compliance increased to 97%. Trends in antimicrobial use were reported by an array of computer-generated reports of which several are illustrated. The system described here allows for the identification and monitoring of areas of concern in antimicrobial use, improves the efficiency of quality assurance activities, and can assess the effectiveness of a corrective action.

Anti-Bacterial Agents↗
PubMed1987

Providing financial justification to support a stand-alone computer system in a large tertiary-care hospital.

An assessment of the pharmacy's needs and an evaluation of the pharmacy's batch-oriented data processing system supported the acquisition of a new computer system to meet the pharmacy's requirements in the areas of: Medication order entry Response time Capability to interface a materials management system Capability to interface to a patient billing program Development of an audit trail for patient charges Management reports Flexibility for future needs Conversion from a dated batch-oriented system to a medication on-line computerization system has provided enhanced benefits in the areas of fiscal accountability, inventory management, improved quality of pharmaceutical services (drug distribution and drug therapy monitoring), and employee productivity.

Capital Expenditures↗
PubMed1986

Effect of pharmacists' clinical interventions on nonformulary drug use.

The effect on drug costs of pharmacists' interventions in reducing the use of nonformulary medications was studied in a private teaching hospital. During a four-month period, nonformulary medication request forms and pharmacist consultation logs were reviewed to determine physicians' actions taken on requests for nonformulary medications. Cost avoidance of interventions (nonformulary medication cost) and the cost of pharmacist cost) and the cost of pharmacist time for the interventions were determined. The pharmacist was able to contact The pharmacist was able to contact the physician in 388 of 394 instances in which the use of a nonformulary medication was considered. Of 230 recommendations by pharmacists to change a nonformulary drug order to one for a formulary alternative, 64.8% (149) were accepted by physicians. Of pharmacists' recommendations that were accepted, 75.8% (113/149) were from decentralized areas, which was a significantly higher acceptance rate than that for the centralized areas (24.7% or 36/149). Cost avoidance resulting from acceptance of pharmacists' recommendations during the four-month study was $2,645, or $13,573 per year; this was more than the cost of pharmacist time required to perform interventions. Pharmacist interventions to decrease use of nonformulary drugs can be cost-effective and appear to be more successful in decentralized pharmacy service areas than in areas served by a central pharmacy.

Costs and Cost Analysis↗
PubMed1984

Involving your staff in committees and meetings.

Committees serve as an ideal forum for members of an organizaton to exchange views and information. If managed effectively, they can be utilized to generate ideas and to provide sound recommendations to the pharmacy manager. This article describes a personnel management program in which all levels of pharmacy personnel are provided with several opportunities to actively participate and contribute to the establishment and attainment of departmental objectives. The involvement of the staff in serving on committees and attending meetings is outlined. Various intradepartmental and interdepartmental committees as well as continuing education conferences are described. The comprehensive program permits each member of the pharmacist staff to spend approximately 5-10% of their time participating in the three above-mentioned activities. This personnel management approach has had a positive effect on the role of the entire staff and has enabled all levels of employees to get involved and contribute to departmental services and hospital issues. Most importantly, it has successfully provided a stimulus to the staff to pursue avenues of professional specialization.

Group Processes↗
PubMed1983

Monitoring the hospital activities of medical service representatives.

A comprehensive program to monitor and regulate the activities of medical service representatives (MSRs) in a large teaching hospital is described. The MSR program consists of written policies and procedures for regulating the activities of MSRs within the hospital, an orientation program for MSRs, and quarterly MSR committee meetings. In addition, MSRs are involved in planning and implementing an annual drug fair for all hospital personnel and biannual continuing-education sessions for physicians. Compliance with policies and procedures is monitored using a MSR visitation roster in the pharmacy department. This organized program has resulted in an optimum exchange of information between the hospital and the pharmaceutical industry.

Drug Industry↗