Of medication orders and deli sandwiches.
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Drug Therapy, Computer-Assisted↗
Biomedical subjects
K G Jozefczyk
Publications and source records attributed to K G Jozefczyk.
Costs of anesthetic drugs: experiences with a cost education trial.
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Anesthesia↗
A multidisciplinary approach to patient controlled analgesia.
Patient controlled analgesia (PCA) is an innovative method for delivering intravenous analgesia, which requires therapeutic and technical expertise from various health care professionals. This article describes a multi-disciplinary process of implementing a PCA program including approaches to solving problems encountered. A pharmacy and therapeutics subcommittee was established with various aspects of the program assigned to the medical, nursing and pharmacy staffs, intravenous (IV) therapy team, and clinical equipment support. A detailed comparison of PCA pumps was prepared to aid in selection. A pharmacy-based protocol describes the role of each health care professional. Usage guidelines are presented and evaluated. Physician order sheets and narcotic disposition forms were designed specifically for PCA. Problems encountered include dedicated IV access, PCA use in specialized hospital units, and use in pediatric patients. A multi-disciplinary approach was successful in implementing and maintaining a quality PCA program. Similar approaches should be used for other sophisticated drug-delivery systems.
Analgesia↗
Providing 24-hour nutrient infusions to critically ill patients.
The outcome of critically ill patients receiving total parenteral nutrient (TPN) therapy was evaluated, and the percentage of wasted TPN solutions administered as one-per-day (2- or 3-L) or multiple-per-day (750-mL or 1-L) infusions was determined. Between March 31 and June 1, 1984, all patients who were treated by the nutritional support service (NSS) and who met the study criteria were included in the study. The 24-hour nutrient content of each TPN solution was determined using a published method. Patient outcome was determined using TPN therapy data that were collected from the patients' medical charts and NSS records. To determine waste, all discarded TPN solutions were recorded. A total of 20 patients (10 men and 10 women) were included, representing 23.6% of the 76 patients who received TPN therapy during the study period. Study patients received 24-hour nutrient solutions for a mean of 16.4 +/- 12.9 days and required a mean of 3.9 +/- 4.6 days to reach sufficient metabolic stability to qualify for 24-hour infusions. During the study period, 56 (2.8 +/- 2.5 per patient) orders were changed. The percentage of wasted TPN solutions was low; 4.3% (17 of 1326) multiple-per-day and 1.7% (5 of 292) one-per-day solutions were wasted. Twenty-four-hour TPN solutions can be used successfully in critically ill patient populations.
Critical Care↗
Medication errors in a pharmacy-coordinated drug administration program.
The medication error rate in a pharmacy-coordinated drug administration program was determined. During a five-week study period, two pharmacy interns observed pharmacy technicians administering medications to patients on five nursing units. Observations were made from 0800 to 1200 and from 1700 to 2100, Monday through Friday. The ASHP Standard Definition of a Medication Error served as the basis for the classification of medication errors. A total of 2028 usable observations were made. The predominant type of error was wrong-time error. The overall medication error rate was 4.4%; excluding wrong-time errors yielded a medication error rate of 1.6%. Comparison of this medication error rate with those of other studies must be made cautiously, with consideration given to methods, study objectives, and definitions.
Humans↗
Managing employee apprehension toward handling cytotoxic drugs.
A strategy for dealing with employee apprehension about handling cytotoxic agents without a biological safety cabinet is described. Available evidence in the literature concerning the health risks of handling cytotoxic drugs was reviewed with employees. A committee was appointed to evaluate the institution's needs and current practices for handling cytotoxic agents. Airflow studies were conducted in the pharmacy department's sterile preparation areas, and policies and procedures were developed for use until biological safety cabinets could be installed. Plans were developed for dealing with special situations, such as exemption of certain employees from preparation of cytotoxic drugs or refusal of an employee to prepare these drugs. Managers can substantially reduce employees' apprehension about handling cytotoxic drugs by keeping employees informed about departmental plans, listening to their concerns, and developing procedures for safe handling of these agents.
Antineoplastic Agents↗