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PubMed2001

The perceived role and skills of pharmacists in asthma management after in-house training.

OBJECTIVE: To evaluate perceived roles and skills of pharmacists in asthma management before and after a training intervention that consisted of six in-house training sessions. METHOD: Altogether 315 pharmacists in the intervention group and 121 pharmacists in the control group participated in the study. The data on study variables were collected by a questionnaire during the first and last training sessions. MAIN OUTCOME MEASURES: Pharmacists' perceptions of their role, perceived skills, estimates of patients receiving counselling and experienced problems. RESULTS: Based on their ratings for 16 topics, the pharmacists' perceptions about their role in counselling asthma patients remained rather stable. Handling of the inhalers and inhalation technique were considered as the most important aspects of counselling and issues dealing with the disease were regarded as the least important. Using a self-rated scale (4-10 scale), pharmacists' perceived counselling skills improved in the intervention group (6.5 vs 7.6), but not in the control group (6.5 vs 6.4). In the intervention group, the pharmacists' estimates of the proportion of new users of asthma medicines receiving counselling increased from 48% to 61% and that of old users from 18% to 26%. Before the training, the most commonly experienced problem in counselling was the pharmacists' lack of knowledge and skills. After the training, pharmacists experienced problems mainly with communication. CONCLUSION: When pharmacists are included in the support system for any patients group, their capabilities of fulfilling their role have to be assessed. In particular, communication skills and outcome-oriented counselling require attention.

Asthma↗
PubMed2003

"Death was a blessing"--should it ever be pharmaceutically hastened? British pharmacists' views.

OBJECTIVES: To investigate the views and experiences of British pharmacists in physician-assisted suicide (PAS) and voluntary active euthanasia (VAE) and to examine whether differences in views were associated with personal characteristics. METHOD: A postal questionnaire was mailed to a random sample of 500 registered pharmacists, with addresses in England or Wales, stratified according to sex and community/hospital working environments. MAIN OUTCOME MEASURE: Pharmacists' reports of their views and experiences of PAS and VAE. RESULTS: Completed questionnaires were received from 295 respondents (response rate: 59%). The majority of respondents (83%) reported that at times, a person had the right to choose their own manner of death; 61% and 53% thought that there should be changes in the Law to legalise VAE and PAS, respectively. If it were legal to do so, 63% stated that they would be willing to dispense medication for VAE and 64% for PAS. However, only 45% agreed that the pharmacist should have a role in advising the prescriber on the choice and dose of drugs used. Sex, age, and years registered as a pharmacist were not found to be significantly associated with views on the practices of PAS and VAE. However, pharmacists who reported having a religion were significantly less likely to favour such practices. On comparing the views of community and hospital pharmacists, community pharmacists were significantly less likely than expected to want to be informed about the intended purpose of lethal drugs. CONCLUSION: In this survey, while over half of British pharmacists did not disagree in principle to the legalisation of VAE and/or PAS, they were less supportive of direct involvement in such procedures. Religion was a discriminatory factor associated with negative views of VAE and PAS. The significant minority of pharmacists not wanting to know the purpose of drugs they suspected might be for PAS or VAE is not in accordance with professional accountability, reflecting the complex and sometimes conflicting legal and moral aspects of such practices when deciding upon a course of action.

Adult↗
PubMed1995

Pharmacist participation in cardiopulmonary resuscitation.

Pharmacist participation in cardiopulmonary resuscitation (CPR), including the basic life support (BLS) activities of artificial respiration and chest compressions, was studied. A questionnaire was mailed in September 1991 to the 197 graduates (1986-90) of a Michigan college of pharmacy requiring BLS training for graduation. Another questionnaire was mailed in April 1992 to the 181 pharmacy directors at all general acute-care hospitals in Michigan. The "graduate" survey covered practice setting, current status of BLS certification, use of BLS, and attitudes toward BLS training. The "director" survey covered the characteristics of the institution and its pharmacists, pharmacist involvement in CPR, and departmental BLS-training requirements. The response rates for the graduate and director surveys were 81% (160 questionnaires) and 76% (138), respectively. Only 66 (41%) of the graduates were currently certified in BLS, and only 77 (48%) had completed a BLS course since graduation. More than half (84, or 53%) indicated they had never been involved in any CPR activity. Activities most likely to be reported were drug preparation, dosage calculation, documentation, and drug information; very few pharmacists had given artificial respiration or chest compressions. Forty-six (33%) of the directors indicated that pharmacists routinely were members of the CPR team. Most (59%) of these 46 hospitals did not require BLS training for pharmacists. Hospital size significantly affected whether pharmacists were included on the CPR team. Hospitals with decentralized pharmacists were more likely than hospitals with centralized pharmacists to have pharmacist involvement on the CPR team. Both study groups expressed ambivalence about the value of BLS training for their current pharmacy practice situations.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗
PubMed1996

Research on the effects of pharmacist-patient communication in institutions and ambulatory care sites, 1969-1994.

Research on the effects of pharmacist-patient communication that appeared in the pharmacy literature between 1969 and 1994 is reviewed. The terms patients education and patient counseling were used in identifying relevant research. Many authors used these terms interchangeably; also, the terms counseling and consultation often were not clearly defined. Studies of pharmacists' history-taking in institutional settings and of other communication with patients in ambulatory care settings were examined by decade. The research questions, theories, methods, results, and limitations were analyzed. More than 30 studies examined the effect of pharmacists' communication on patient outcomes, primarily knowledge and medication compliance; generally, the results suggested that pharmacists' communication led to increased knowledge and compliance. A few researchers raised concerns about patients' knowledge as an indicator of effective communication by pharmacists, and in the 1980s a few suggested that better medication compliance could be associated with the time and attention given to patients rather than the informational content of the interaction. Little was reported about the communication theories or models on which the studies were based, and there was little indication in most studies that patients' ideas about their therapy were considered. Often, the numbers of patients and pharmacists were small, and the pharmacists may have had training or motivation exceeding that of the average practitioner. In studies of pharmacists' versus physicians' history-taking, the physicians were not well described; their involvement and their approach may not have been comparable to those of the pharmacists. Before 1990, a few researchers had examined outcomes such as pulmonary function and control of diabetes. In the 1990s, more researchers looked at outcomes such as medication-related problems and use of health care resources. The research indicated that pharmacists can increase patients' knowledge of and compliance with their pharmacotherapy; however, additional research on other outcomes may be warranted.

Humans↗
PubMed1997

Reliability and validity of hospital pharmacists' clinical intervention data.

The reliability and validity of pharmacist intervention data documented at a hospital in England were studied. The study involved intervention data recorded from September 1 to December 31 in 1990 (a pilot study), 1991, and 1992 by a total of 23 pharmacists. The interventions in 1990 were coded by a single pharmacist manager and compared with coding by pharmacists of their own interventions during 1991 and 1992. To test for internal reliability of the intervention data, 25% (584) of the 2342 interventions recorded in 1991 and 1992 were randomly sampled after interventions by the 11 pharmacists no longer at the site were eliminated. In September 1993 the 12 remaining pharmacists were asked to recode the interventions they had previously entered. In March 1994 a panel of 12 pharmacists recoded 62 interventions randomly selected from the 684 recoded interventions. Each panel member also assigned financial values to interventions. Medical records corresponding to the 62 recoded interventions were inspected for evidence of the interventions. The distribution of interventions among the drug-use-process (DUP) indicators used in the coding differed significantly between 1990 (when a manager assigned all codes) and 1991 plus 1992 (when pharmacists coded their own interventions). There were similar differences between 1991 and 1992. Results from code-recode and panel testing showed the DUP indicators to be reliable. Clinical outcome indicators were unreliable, as were financial indicators. Medical records verified the occurrence of 50 (81%) of the 62 interventions selected, but in only one case was there evidence that the change in drug therapy was initiated by a pharmacist. The capacity of pharmacists at a British hospital to reliably code interventions was poor.

Chi-Square Distribution↗
PubMed1999

Work patterns of ambulatory care pharmacists with access to electronic guideline-based treatment suggestions.

The effects of the electronic display of guideline-based, patient-specific treatment suggestions on pharmacist work patterns were studied. A total of 28 pharmacists at a hospital-based ambulatory care pharmacy were randomly assigned to intervention and control groups. The intervention group had access to electronic treatment suggestions for heart failure, ischemic heart disease, reactive airways disease, and uncomplicated hypertension, while the control group did not. Starting 9 and 19 months after the initial display of treatment suggestions, all pharmacists recorded the time they spent on a variety of activities, the purpose of each activity, and persons contacted during the activity; these observations were recorded in response to a pager-like device that randomly buzzed four times an hour. A total of 11,102 observations were recorded. Pharmacists in the intervention group spent significantly more of their time discussing information, advising and informing, and solving problems than pharmacists in the control group but significantly less of their time checking and filling prescriptions. Pharmacists in both groups completed a majority of their work alone, but pharmacists in the intervention group worked significantly less by themselves and significantly more with other pharmacy personnel, patients, and physicians and nurses than control-group pharmacists. The delivery of patient-specific information to pharmacists at the time of dispensing had a significant positive impact on pharmacist work patterns.

Clinical Pharmacy Information Systems↗
PubMed1994

Consumers' preference and willingness to pay for pharmacist counselling for non-prescription medicines.

Pharmacist counselling for non-prescription medicine purchases is one way of ensuring that these medicines are used in a safe and effective manner. Data collected as part of a larger study of information sources on non-prescription medicines were used to determine consumers' preference for pharmacist counselling for non-prescription medicine purchases, their willingness to pay for the service, and the amount they were willing to pay. A total of 458 (15.2%) consumers from six contiguous states in the U.S.A. responded to the mailed questionnaire. Of the consumers who responded, 63.4% indicated a preference for such a counselling service and, of these consumers, 20.4% indicated a willingness to pay for the service. Of the consumers who indicated a willingness to pay for pharmacist counselling for non-prescription medicines, 56.5% were willing to pay between 50 cents and $1.50, 28.2% between $1.51 and $3, and about 15.3% were willing to pay more than $3. Significant differences were noted in consumers' preference for pharmacist counselling when compared on the basis of certain consumer characteristics. Consumers who indicated a preference for pharmacist counselling for non-prescription medicines showed a significantly higher involvement in non-prescription medicine purchase decision, perceived pharmacists to be more credible, and indicated more favourable previous encounters with pharmacists than consumers who did not prefer pharmacist counselling. Consumers who consulted pharmacists and usually accepted their recommendations were also more likely to prefer pharmacist counselling for non-prescription medicines.

Adult↗
PubMed2005

Improving medication management for patients: the effect of a pharmacist on post-admission ward rounds.

PROBLEM: Medication management in the NHS has been highlighted by the UK Department of Health as an area for improvement. Pharmacist participation on post-take (post-admission) ward rounds was shown to reduce medication errors and reduced prescribing costs in the USA and in UK teaching hospitals, which can contribute to improved medication management. We sought to demonstrate the problem in our hospital by collecting data on prescribing practice from three consecutive general medical post-take ward rounds. SETTING: Northwick Park Hospital, a district general hospital in north-west London, which provides acute medical services to a population of 300,000. STRATEGY FOR CHANGE: A pharmacist was invited to become a member of the post-take ward round team that reviewed medical patients admitted within the preceding 24 hours. Patients also continued to receive care from a ward based pharmacist. Patient notes were analysed for cost of drugs on admission and discharge, discrepancies between admission drug history and pharmacist history, number of admission drugs stopped before discharge, and pharmacist recommendations. Pharmacist recommendations and actions were classified using a National Patient Safety Agency risk matrix. EFFECTS OF CHANGE: Discrepancies between the admission and the pharmacist derived drug history were noted in 26 of 50 in the pre-intervention group and 52 of 53 in the intervention group. The annual drug cost per patient following discharge increased by pounds 181 in the pre-intervention group and by pounds 122 in the intervention group. Five pre-admission drugs were stopped in three pre-intervention patients saving pounds 276 per annum, while the 42 drugs stopped in 19 intervention patients saved pounds 4699 per annum. No ward based pharmacist recommendations were recorded in the pre-intervention group. Recommendations regarding drug choice, dose, and need for drug treatment were most common; 58 minor, 48 moderate and four major risks to patients were potentially avoided. LESSONS LEARNT: The presence of a pharmacist on a post-take ward round improved the accuracy of drug history documentation, reduced prescribing costs, and decreased the potential risk to patients in our hospital. As a result of this work a full time pharmacist has now been funded to attend daily post-take ward rounds on a permanent basis.

Drug Costs↗
PubMed1987

The clinical pharmacist in drug research and development: the publication record.

A viable discipline requires the generation of new information. Clinical pharmacists have recognized that their success depends on their ability to contribute to (Table: see text) the expansion of the body of knowledge of their discipline. They have developed practice and research programs in a variety of areas. One of the results of these programs is the publication of articles in a variety of pharmacy and medical journals. Clinical pharmacists with specialty interests publish in journals that represent those interests. In comparing the type of clinical pharmacists' publications in the area of drug development, it is also clear that they are most suited for research in the clinical phase; that is, clinical pharmacists conduct research on the pharmacokinetics, pharmacodynamics, and safety and efficacy of new and old drugs. Clinical pharmacists tend to be members of research teams but bring a unique perspective to the team. In their collaboration with physicians, basic scientists, and other health-care personnel, clinical pharmacists are often cited as first author. Their research is important to researchers with similar specialty interests, regardless of whether they are pharmacists. Data retrieval has developed so that researchers with similar interests can identify key publications wherever they are published. Articles published by clinical pharmacists in pharmacy journals are quoted by other researchers. Therefore, I conclude that a number of clinical pharmacists are active in drug research and development. Many of these pharmacists were trained as practitioners, but have developed into researchers through trial and error and hard work.(ABSTRACT TRUNCATED AT 250 WORDS)

Pharmacists↗
PubMed1995

Knowledge of and attitudes about adverse drug reaction reporting among Rhode Island pharmacists.

OBJECTIVE: To survey pharmacists' knowledge of the adverse drug reaction (ADR) reporting process, as well as the nature and seriousness of ADRs observed by pharmacists, and to determine how pharmacists perceive their role in monitoring and reporting suspected reactions. DESIGN: A survey was mailed to 793 Rhode Island pharmacists with a 40% (318) response rate. RESULTS: Two hundred and thirty-five surveys were reviewed for final analysis. Pharmacists in retail settings were more likely than hospital pharmacists to be aware of ADRs relating to therapeutic inequivalence and over-the-counter products, and more likely to ask the patient about ADRs (40% vs 16%). Hospital pharmacists were more likely to receive ADR information from physicians (40% vs 15%). Almost all pharmacists (97%) believed that action should be taken when a serious ADR is suspected. Younger pharmacists (< 45 y) were more willing to contact the physician and refer the patient to medical attention. CONCLUSIONS: Our results show that fewer than half of the respondents (41%) claimed to have observed a serious ADR (potentially life-threatening or requiring hospitalization), although almost all (97%) believed that pharmacists should take some action when a serious ADR is suspected. The influence of the practice setting, the number of years in practice, and the number of hours worked per week influenced the reporting practices and attitudes.

Adverse Drug Reaction Reporting Systems↗
PubMedDate not supplied

Pharmacy and immunization services: pharmacists' participation and impact.

OBJECTIVES: To conduct a follow-up to the National Pharmacist Immunization Survey of 1998 to determine changes in pharmacist involvement in immunizations and obstacles to pharmacy-based immunization services and to assess the descriptive information about pharmacy-based immunization services provided. DESIGN: Cross-sectional mail survey. SETTING: United States. PARTICIPANTS: A randomly selected national sample of 6,000 pharmacists. INTERVENTIONS: None. MAIN OUTCOME MEASURES: An updated version of the 1998 study questionnaire was used to collect data about pharmacists' current involvement in adult or childhood immunizations, perceived obstacles to such involvement, and characteristics of pharmacist-administered immunization services. RESULTS: Four mailings in fall 2001 yielded a response rate of 21.2% (1,266 completed, usable surveys out of 5,958 deliverable surveys). Immunization activities that reportedly increased during this period, compared with results from the 1998 survey, include counseling about adult immunizations (increase from 11.9% to 14.7%), nurse-administered childhood immunizations (6.3% to 7.8%), nurse-administered adult immunizations (16.2% to 30.2%), pharmacist-administered childhood immunizations (0.9% to 1.3%), pharmacist-administered adult immunizations (2.2% to 6.8%), and immunization promotion (18.9% to 27.3%). Only counseling for childhood immunizations appears to have decreased slightly, from 13.4% to 8.9%. Willingness to provide all of the above immunization services also increased during the 1998-2001 period. In addition to flu shots and pneumococcal vaccines, pharmacists were administering vaccines for hepatitis A and B, Lyme disease, tetanus, and chicken pox, but flu shots accounted for the majority of immunizations being administered. CONCLUSION: Pharmacist involvement in childhood and adult immunizations has increased significantly in the last few years. Pharmacists perceived obstacles to their involvement in immunizations as less problematic.

Attitude of Health Personnel↗
PubMedDate not supplied

Pharmacists' opinions regarding level of involvement in emergency preparedness and response.

OBJECTIVE: To assess opinions of pharmacist-members of the American Pharmacists Association Academy of Pharmacy Practice and Management (APhA-APPM) regarding the appropriate level of pharmacists' involvement in emergency preparedness and response activities and to determine whether opinions differed according to demographic characteristics. DESIGN: Cross-sectional, descriptive, Web-based survey. SETTING: United States. PARTICIPANTS: Five hundred eighteen APhA-APPM member-pharmacists. MAIN OUTCOME MEASURES: Responses to survey questions. RESULTS: Respondents to our survey indicated that pharmacists should have a high level of involvement in emergency preparedness and response activities. Traditional pharmacy practice activities (such as medication preparation and dispensing) and patient education were the most highly supported roles for pharmacists. Newer activities such as surveillance, vaccine administration, and mobilization were also strongly supported. Demographic characteristics, such as age, sex, degree, state of residence, practice setting, and employment setting, did not influence respondents' opinions. The only characteristic that influenced pharmacist opinions was previous participation in local and/or state emergency preparedness and response activities. Compared with other respondents, pharmacists who participated in these activities gave higher ratings to these possible roles for pharmacists: surveillance, triage/evaluation, community planning and preparation, mobilization, and training of others. CONCLUSION: Pharmacist-members of APhA-APPM who responded to this survey believe that participating in public health activities related to emergency preparedness and response is important for members of the pharmacy profession.

Attitude of Health Personnel↗
PubMedDate not supplied

Medication error reporting by community pharmacists in Vermont.

OBJECTIVE: To document community pharmacists' awareness and use of the United States Pharmacopeia Medication Errors Reporting (USP MER) program. DESIGN: Telephone survey. SETTING: Community pharmacies in Vermont. PARTICIPANTS: One self-identified community pharmacist from each community pharmacy. INTERVENTION: Each operating community pharmacy in Vermont was contacted by telephone between June 2002 and February 2003. The first individual to self-identify himself or herself as a pharmacist was asked to participate. The telephone surveys were conducted using a standard script. MAIN OUTCOME MEASURE: Survey responses to questions about awareness and use of USP MER. RESULTS: A pharmacist was contacted in 98% (122/124) of all operating community pharmacies in Vermont. Nine (7%) pharmacists refused to participate, leaving 113 pharmacists who responded to the survey. Although more than one half of all respondents (70/113; 62%) had heard of USP MER, less than one quarter (24/113; 21%) had ever submitted a report. Significantly more pharmacists employed by independent pharmacies had submitted a report, compared with pharmacists from other pharmacy types (chain, supermarket, mass merchandiser; P = .03). Submitting reports through a corporate hierarchy or to a corporate program was the reason most frequently cited by pharmacists for not submitting reports directly to USP MER (37%). Whether corporate reports were forwarded to USP MER is unknown. CONCLUSION: The majority of Vermont community pharmacists were aware of USP MER. However, use was low. Barriers to reporting to a common system such as USP MER may differ depending on pharmacy type. Further research to document the barriers to submitting reports is warranted.

Adverse Drug Reaction Reporting Systems↗
PubMedDate not supplied

Enhancing pharmacists' recommendation process in an internal medicine resident clinic.

OBJECTIVE: To determine the number and type of recommendations made by pharmacists in an internal medicine residency clinic, the percentage of recommendations that were addressed and acted upon by the residents, whether changes needed to be made to the recommendation process, and areas in which pharmacy services could be improved. SETTING: Outpatient, urban, internal medicine clinic. PRACTICE DESCRIPTION: The clinic operates Monday through Thursday afternoons. Each of these afternoons, six to eight medical residents evaluate patients. Pharmacists provide services on Monday and Thursdays. The pharmacists spend the mornings before patients' visits reviewing charts and making recommendations for more appropriate medication use. Originally, pharmacists' recommendations were listed on a form that was attached to the front of each patient's chart but did not become a part of the medical record. At times, pharmacists made recommendations while a medical resident presented the patient's case to the attending physician. PRACTICE INNOVATION: Data for calendar year 2002 were analyzed retrospectively to identify a recommendation acceptance rate, areas of potential improvement, and actions that might enhance pharmacists' effectiveness. MAIN OUTCOME MEASURES: Number of recommendations made, number of each type of recommendation made, percentage of overall recommendations addressed and acted upon by the residents, and percentage of each type of recommendation addressed and acted upon by the resident physician. RESULTS: For 61 patients, 135 recommendations were made by pharmacists during 2002. Of these, 72 (53.3%) were therapeutic interventions and 63 (46.7%) were recommendations for laboratory monitoring. Overall, 66 (49.0%) recommendations were addressed and acted upon by the residents, while 69 (51.1%) were not addressed by the residents. Because of deficiencies identified in the communication process, a new form was developed that includes spaces for pharmacists' recommendations and residents' responses. Other potential future enhancements include providing more education for residents and implementing a pharmacist-run disease clinic. CONCLUSION: This retrospective analysis showed that pharmacists were able to identify many therapeutic and laboratory interventions, thus serving a useful role in patient care and physician education in an internal medicine residency clinic.

Ambulatory Care Facilities↗
PubMed2002

Clinical pharmacist staffing in United States hospitals.

We evaluated hospital demographics (census regions, size, teaching affiliation, hospital ownership, hospital pharmacy director's degree, pharmacist location within the hospital) and clinical pharmacist staffing/occupied bed in United States hospitals. A database was constructed from the 1992 American Hospital Association's Abridged Guide to the Health Care Field and the 1992 National Clinical Pharmacy Services database. Simple statistical tests and multiple regression analysis were employed. The study population consisted of 1391 hospitals that reported information on clinical pharmacist staffing. The mean number of clinical pharmacists/100 occupied beds was 0.51 +/- 0.18. Factors associated with increased clinical pharmacist staffing were west north central region (slope = 0.0029439, p = 0.002), Pacific region (slope = 0.0032089, p = 0.004), affiliation with pharmacy teaching hospitals (slope = 0.0025330, p = 0.0001), teaching hospitals (slope = 0.0028122, p = 0.001), federal government ownership (slope = 0.0029697, p = 0.012), directors with Pharm.D. degrees (slope = 0.0335020, p = 0.002), directors with M.S. Pharmacy degrees (slope = 0.0028622, p = 0.003), pharmacists in a decentralized location (slope = 0.0035393, p = 0.0001), and pharmacy technician staffing (slope = 0.0517713, p = 0.0001). Statistically significant associations between demographic variables and decreased clinical pharmacist staffing/occupied bed were mid-Atlantic region (slope = -0.0028237, p = 0.002), small size (slope = -0.0028894, p = 0.001), pharmacy directors with B.S. degrees (slope = -0.0019271, p = 0.023), and pharmacy administrator staffing (slope = -0.0184513, p = 0.042). The R2 for this multiple regression analysis was 28.31% and adjusted R2 was 24.83%. Increased pharmacy technician staffing had the greatest association (slope = 0.0517713) with increased clinical pharmacist staffing. Significant differences were observed between clinical pharmacist staffing and hospital demographic factors. It appears that one of the most effective ways to increase clinical pharmacist staffing is to increase pharmacy technician staffing (slope). These findings will help future researchers determine specific reasons why some types of hospitals have higher and some lower levels of clinical pharmacist staffing.

Analysis of Variance↗
PubMed2006

Interventions of hospital pharmacists in improving drug therapy in children: a systematic literature review.

Medicines' management or pharmaceutical care in paediatric patients is particularly demanding, mainly because the majority of available drugs have been developed for use in adults. As a result, in children, drugs are often unlicensed or used off-label, suitable formulations or appropriate strengths are lacking, and drugs have to be extemporaneously prepared, liquids and injections diluted, and tablets split. These factors increase the likelihood of medication errors and may lead to a reduction in drug effect. Age-specific changes in pharmacokinetics and pharmacodynamics further complicate drug therapy in children. All these challenges provide unique opportunities for pharmacists to improve the quality of care for paediatric patients. We conducted a systematic literature review examining whether the interventions of hospital pharmacists improve drug therapy in children. Several medical and pharmaceutical databases were searched systematically to identify articles investigating hospital pharmacists' interventions that were intended to improve drug therapy in children. Inclusion criteria were English language, primary research papers and studies in which clinical pharmacists contributed directly to patient care. Exclusion criteria were reviews, editorials, questionnaire studies, modelling studies, letters and studies only available in abstract form. This systematic search identified 18 articles documenting the role of a clinical hospital pharmacist in paediatric care. These articles were divided into the following groups based on study type: (i) studies documenting interventions made by pharmacists and their role in inpatients; (ii) articles presenting the outcomes of a satellite pharmacy; and (iii) articles examining pharmacist involvement in paediatric outpatient clinics. No randomised study comparing pharmacist interventions with standard care was found. In conclusion, although it was difficult to compare the various studies identified because of the different settings, design, duration, size, methodology and definition, all these studies highlighted the importance of hospital pharmacists to medicines' management in paediatric patients. On the basis of this review, we can conclude that pharmacist reviewing of medication charts is very important in identifying medication errors; hence, it is likely to be the most effective method of improving drug therapy in children.

Adverse Drug Reaction Reporting Systems↗
PubMed1988

A practical approach enabling staff pharmacists to prospectively review and dose aminoglycoside therapy.

A simple and effective approach for staff pharmacists to prospectively review and dose aminoglycoside therapy is presented. A departmental policy was established requiring pharmacists to review each adult aminoglycoside order for appropriateness by means of a written audit form. Specific patient data and the aminoglycoside dose is obtained from an antibiotic order form and the patient's creatinine clearance is estimated using a modified Cockcoft and Gault equation. Proper initial dosage regimens are assessed by use of a modified Sarubbi and Hull nomogram or an in-house developed pharmacokinetic software program. The results demonstrate pharmacists were required to intervene in 26.8% of adult aminoglycoside orders. To determine if the percentage of pharmacist intervention changed over time, the results were compared to a sample period selected almost two years later. The percentage of pharmacists intervention was almost identical (25.3%). In both groups, over 90% of the pharmacists's dosing recommendations were accepted by the physician. The outcome of pharmacist's reviews were analyzed during the first study period. In courses of therapy with dosages recommended by pharmacists, therapeutic, non-toxic concentrations of gentamicin and tobramycin (peak 5-10 micrograms/ml, trough less than 2 micrograms/ml) comprised 47/54 (87%) of the interpretable levels. Patients judged by the pharmacist to have an appropriate dose during the initial review had 85/119 (71.4%) of interpretable serum levels in the therapeutic, non-toxic range. Without benefit of a formalized pharmacokinetic service, this program enables all staff pharmacists to perform a review of aminoglycoside therapy which ensures an appropriate initial dosage regimen. The completed aminoglycoside initial audit form serves as a communication tool as well as documentation for the department's quality assurance program.

Aminoglycosides↗
PubMedDate not supplied

Pharmacists' readiness to assess consumers' over-the-counter product selections.

OBJECTIVE: To measure and explain pharmacists' readiness to adopt a proposed new standard for assessing consumers' over-the-counter product selections. DESIGN: Cross-sectional, descriptive study based on the theoretical underpinnings of the Transtheoretical Model of Change. A questionnaire was used for data collection. Sections included: (1) pharmacists' readiness to engage in a proposed standard of practice; (2) the positive and negative aspects of doing so; (3) pharmacists' agreement with current legislative status of pharmacist-only products; and (4) demographics. SETTING: Community pharmacy. PARTICIPANTS: Community pharmacists in one Canadian province. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Pharmacists' readiness to adopt a proposed new standard of care. RESULTS: Response rate was 70.6%. Most respondents were staff pharmacists in independent pharmacies. The majority were not ready to adopt the proposed new behavior--57.6% were in the precontemplation stage. Age, sex, year of graduation, workload, and size of town/city had no significant effect on readiness for change. As expected, precontemplators showed less overall support for keeping pharmacist-only agents behind the counter. Positive and negative beliefs about the proposed standard varied across stages. CONCLUSION: Any initiatives to increase pharmacist involvement in assessing consumer nonprescription product selections must acknowledge that pharmacists differ in their degree of readiness for change.

Adult↗