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Biomedical subjects

R S Nakagawa

Publications and source records attributed to R S Nakagawa.

9 recordsLinked to original sources
PubMed1994

Exponential smoothing method for forecasting drug expenditures.

A model for forecasting a hospital pharmacy drug budget is described, and its results in 10 hospital pharmacy departments are evaluated. A model for forecasting inpatient drug expenditures was developed based on the method of exponential smoothing. Exponential smoothing predicts a value based on the forecast for the prior period, with adjustment for the error of that forecast. Recent data are weighted more heavily than older data; as data become older, weights decline exponentially. The model incorporates changes in workload in addition to drug expenditure data. The variable used for workload can vary from one hospital to another, depending on the statistics that are available. The model was designed to be more accurate than current methods, easy and quick to use, and usable with a minimal knowledge of statistics and forecasting theory. The model was tested on fiscal 1988-1992 drug budget data from 10 British Columbia hospital pharmacy departments. Four departments had insufficient data; of the remaining six, the forecasting model performed better than the hospitals' current methods in four departments. The mean absolute deviation between budgeted (by current methods) and actual drug expenditures was 8.70% (range, 6.19-15.16%). The forecasting model yielded a mean absolute deviation of 5.93% (range, 3.13-7.66%). Better forecasts resulted when pharmacy medication-order volume was used as a workload variable, as compared with hospital inpatient days. An exponential smoothing model improved the accuracy of drug-budget forecasts in four of six pharmacy departments.

British Columbia↗
PubMed1993

Obtaining a critical care pharmacist position: a marketing case study.

Marketing theory is used to explain how Pharmacy Department managers at a Vancouver-area hospital secured a new ICU pharmacist position in a period of severe fiscal constraint. Market segmentation, target marketing and pull marketing strategy were combined to obtain support for the new position. Improved drug information services for ICU nurses were promoted to Nursing Administration and enhanced pharmacotherapy monitoring was promoted to the two critical care physicians primarily responsible for patient care in the ICU. These physicians and Nursing Administration voiced their support for the new position to the V.P. of Nursing (the functional officer for Pharmacy), who then promoted the new position to Hospital Administration. A half-time DUR commitment by the ICU pharmacist was offered to Hospital Administration, expanding this already successful service and guaranteeing cost recovery for the new position. Hospital Administration approved the new ICU clinical pharmacist position in a budget which saw other hospital departments lose several positions.

British Columbia↗
PubMed1987

The effect of pharmacy intervention on aminoglycoside costs.

Antibiotics constitute a large percentage of every hospital's drug budget. In an effort to control the escalating costs of antimicrobial therapy, we focused on the usage of aminoglycosides at our institution. The aminoglycosides, gentamicin and tobramycin, are similar in terms of antimicrobial spectra and toxicities. Since gentamicin is much less expensive, it was felt that significant cost savings would be realized if gentamicin were to be used preferentially over tobramycin. Specific criteria for the use of tobramycin were developed and approved by the Pharmacy and Therapeutics Committee. All patients prescribed parenteral tobramycin during the five week data collection period were entered into the study. We chose to use direct verbal intervention as our method for altering physician's prescribing patterns. An educational program of intervention was set up such that when a physician prescribed tobramycin, the patient's chart was immediately reviewed. If tobramycin was prescribed for a purpose other than those in the approved criteria for tobramycin use, the physician was contacted personally to discuss the cost-effectiveness of gentamicin use. Utilization figures from the previous six months showed that our interventions would save approximately $32,000 over a one year period. Our interventions on aminoglycoside prescribing represents a highly successful, cost-effective and educational method for altering physician's prescribing patterns.

Aminoglycosides↗
PubMed1986

An automatic substitution policy for cefazolin.

An automatic substitution policy was developed at Lions Gate Hospital whereby all orders for cefazolin to be administered Q6H were changed to Q8H without contacting the physician. Exceptions were made if "no substitution" was requested by the physician. Anticipated annual savings for drug and non-drug costs were $13,810 and $12,431 respectively, based on four months of the intervention. This policy proved to be a useful intervention in controlling drug costs at our institution and similar interventions will be considered in the future.

Canada↗
PubMed1983

Calculator programs to deal with non-steady state, multiple dosage regimen clinical pharmacokinetics.

Serum drug levels have become a useful tool in the optimization of dosage requirements for several therapeutically important drugs. In the acute care situation the interpretation of these levels is complicated by multiple dosage regimens and inadequate time to achieve steady-state serum drug levels. Mathematical equations describing first order single compartment pharmacokinetics have been compiled. An alpha-numeric programmable calculator has been programmed to accept information regarding up to seven different serial dosage regimens. The calculator is also programmed to predict concentrations at any time during a complex set of dosage regimens or peak, trough, and average concentrations given a maintenance dosage regimen. Examples are given to demonstrate the usefulness of the programs in the clinical setting.

Aged↗
PubMedDate not supplied

The development of a drug measurement service at St. Paul's Hospital: a pharmacy perspective.

Recently, there has been much emphasis on the value of "Therapeutic Drug Monitoring" (TDM). TDM includes clinical attention to the appropriateness, efficacy, side effects and toxicity of drug usage as it relates to the pharmacokinetics of the drug in the patient. The goal of TDM is to optimize drug therapy in each patient through the appropriate choice, dose and monitoring of drug use. The Drug Measurement Service (DMS) at St. Paul's Hospital is a cooperative venture of the departments of medicine, laboratories and pharmacy. The main function of the DMS is TDM. Also, the service educates staff physicians, residents and interns in the proper use and interpretation of serum drug levels. This will make future drug level measurements more beneficial to the patient. This paper outlines the need for a TDM service, the structure and activities of the service, the materials and methods used, and the basic pharmacokinetics and dosing recommendations of the first drug monitored (theophylline). The results of the first six months' experience are presented and discussed.

British Columbia↗