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At least 199 records · Page 11Linked to original sources
PubMed1989

Effects of bar coding on a pharmacy stock replenishment system.

A bar-code stock ordering system installed in the ambulatory-care pharmacy and sterile products area of a hospital pharmacy was compared with a manual paper system to quantify overall time demands and determine the error rate associated with each system. The bar-code system was implemented in the ambulatory-care pharmacy in November 1987 and in the sterile products area in January 1988. It consists of a Trakker 9440 transaction manager with a digital scanner; labels are printed with a dot matrix printer. Electronic scanning of bar-code labels and entry of the amount required using the key-pad on the transaction manager replaced use of a preprinted form for ordering items. With the bar-code system, ordering information is transferred electronically via cable to the pharmacy inventory computer; with the manual system, this information was input by a stockroom technician. To compare the systems, the work of technicians in the ambulatory-care pharmacy and sterile products area was evaluated before and after implementation of the bar-code system. The time requirements for information gathering and data transfer were recorded by direct observation; the prevalence of errors under each system was determined by comparing unprocessed ordering information with the corresponding computer-generated "pick lists" (itemized lists including the amount of each product ordered). Time consumed in extra trips to the stockroom to replace out-of-stock items was self-reported. Significantly less time was required to order stock and transfer data to the pharmacy inventory computer with the bar-code system than with the manual system.(ABSTRACT TRUNCATED AT 250 WORDS)

Electronic Data Processing↗
PubMed1989

Effect of a cancer chemotherapy prescription form on prescription completeness.

Completeness of physicians' orders for cancer chemotherapy was compared before and after implementation of a preprinted form for these orders. When an oncology pharmacy service (OPS) in which pharmacy prepared all drugs for cancer chemotherapy was implemented in 1985 at an 879-bed teaching hospital, the pharmacists began educational sessions for house-staff physicians on writing orders for cancer chemotherapy. Pharmacists assessed the effectiveness of these sessions by comparing completeness of orders written before implementation of the OPS with orders during a four-week period starting two months after implementation. Orders were checked for nine components: patient's diagnosis, height, weight, and body surface area and drug regimen, dose, dosage, frequency, and route. Inclusion of the same components was assessed after implementation of a form that physicians were required to use for prescribing all antineoplastic agents. During the baseline period, orders for 143 patients were evaluated. Only two prescription components, dose and route, were present is more than 90% of the orders. Educational intervention led to some improvement in order completeness, but only dose and route appeared in at least 90% of the 87 orders evaluated. The components necessary to verify physicians' calculations for body surface area and dose--height, weight, and dosage--were absent in 29 of the orders, and a pharmacist spent 420 minutes clarifying them. After the order form was implemented, orders for 77 patients were reviewed. Compliance exceeded 90% for eight of the nine components, and 12 medication errors were prevented by the form. A pharmacist spent 70 minutes clarifying five orders.(ABSTRACT TRUNCATED AT 250 WORDS)

Antineoplastic Agents↗
PubMed1989

Reprint requests. How and why they were made.

Of the 457 reprint requests that I received over a two-year period, 432 (94.5%) came in the form of preprinted postcards and the remainder came in the form of letters. Only 235 (51.4%) were signed. There were 450 (98.5%) requests for one copy of the article and seven (1.5%) requests for more than one copy. Three hundred ninety-five (86.4%) requests were for one article, and 62 (13.6%) requests were also for any other previous articles on the subject. None of the reprint requests arrived with a self-addressed stamped envelope. One hundred twenty-seven (27.8%) requests came with a return address stick-on label. Most reprint requests were in English and came from the United States and countries in eastern Europe. A questionnaire was sent to each of the 457 persons who requested a reprint to determine how and why the request was made. There were 259 (56.7%) replies available for analysis. One hundred ninety-three (74.5%) reprint requests were made by the individuals requesting the reprint and 59 (22.8%) were made by their secretaries. The majority (81.1%) learned about the article and address from Current Contents. Forty-four (17%) had read the article (or abstract) before the reprint request was made. The two most common reasons given for the request were the unavailability of the journal and the high quality of the reprint. Two hundred fifty-six (98.8%) of the persons requesting reprints found them very useful.

Humans↗
PubMed1987

Achieving parenteral nutrition cost savings through prescribing guidelines and formulary restrictions.

A hospital's use and pharmacy costs of parenteral nutrition (PN) therapy before and after implementation of standardized PN formulas, prescribing guidelines, and preprinted order forms were compared. The study hospital, a large teaching institution, did not have a formal PN team. Guidelines for prescribing were promulgated by the pharmacy and therapeutics committee, the quality assurance committee, and the medical staff executive committee. Records of all patients receiving PN therapy were audited for six-month periods before and after implementation of the program. Cost data associated with decreased PN and albumin wastage, reduced labor and materials costs, inventory reduction, decreased inventory holding costs, and competitive bidding were analyzed. After implementation of this program, the number of wasted PN solutions was reduced by 55.8%, and the cost of PN solutions decreased by 36.9%. Use of albumin-containing PN solutions was reduced by 85.3%. PN solution preparation times were reduced by 66.1% (a reduction of 58.7% in preparation costs), and PN acquisition costs were reduced by 54.5%. A total annual savings of $170,722 was realized, plus a one-time cost savings of $15,632 from inventory reduction. Use of standardized parenteral nutrition formulas and prescribing guidelines can substantially decrease the cost of patient care.

Albumins↗
PubMed1987

Recording schedule II drug use in a decentralized drug distribution system.

A decentralized system for Schedule II controlled substance distribution and accounting that does not rely on proof-of-use sheets is described. Controlled substances are kept in a vault in the central pharmacy; technicians assigned to work in the controlled substances vault are responsible for monitoring, ordering, and storing these medications. The narcotic vault technicians also prepare narcotic boxes that are used by technicians in patient-care areas to transport and issue Schedule Ii substances to nursing units. Twice during each morning and evening shift, technicians in patient-care areas visit each nursing station, replenish the unit's stock of Schedule II medications, and document on a narcotic use form all doses that have been administered since the last technician visit. Nurses leave small cards preprinted with patients' names and room information in the narcotic drawers to alert technicians to administered doses of Schedule II substances; the technicians are responsible for reconciling medications missing from the drawers with doses recorded in patients' medication administration records as being administered. Periodic audits are performed to ensure that actual inventories and the recorded information are correct. The decentralized system for distribution and accounting of Schedule II substances has been successful in increasing the flexibility of inventories on individual nursing units and ensuring maximal pharmacy department control over the dispensation of these medications.

Humans↗
PubMed1986

Inventory of medical X-ray equipment in Dutch hospitals.

The results of an inventory of medical X-ray apparatus in Dutch hospitals are presented and discussed. An inquiry covering a total of 226 hospitals yielded a response of 92%. The questionnaires contained preprinted data from an earlier inventory of registered X-ray apparatus at the Ministry of Physical Planning, Housing and the Environment. At present the total number of X-ray apparatus in Dutch hospitals is 3,008, of which 2.820 are of the diagnostic X-ray type. The accumulated data show that approximately 8 million X-ray examinations were performed in hospitals during the year 1984, corresponding to 0.56 X-ray examinations per inhabitant per year.

Equipment and Supplies, Hospital↗
PubMed1987

Implementing nursing diagnoses.

This article has explained the strategies used in one institution to make nursing diagnosis an integral part of the daily practice of its professional nurses. It has also described what the professional nurses at one institution have accomplished to make recording of the nursing process, which clearly delineated nursing diagnosis, more efficient in short-term units. As nurses subscribe more to the professional imperative to describe our phenomena of concern, creative minds will undoubtedly develop alternate recording methods for these time-pressured units. Preprinted forms are excellent prototypes for the data screens that need to be developed as more nursing departments have computer capabilities.

Emergency Service, Hospital↗
PubMed1986

Direct order entry by physicians in a computerized hospital information system.

Implementation of a policy encouraging direct order entry by physicians in a computerized hospital information system is described. A fully integrated database system was implemented in this tertiary-care university hospital. Terminals are available in the patient-care areas, order entry is uncomplicated, and typing is not necessary. When entering medication orders, the physician can select screens that display either general-order or specialty-order sets that are similar to preprinted-order sheets. A program was developed by the pharmacy and nursing departments to help the physicians learn to use the computer system and to demonstrate its benefits. Physicians were offered a training program that could be taken in one six-hour session or as six one-hour segments. Pharmacy technicians were trained to assist physicians with order entry in the patient-care areas during the implementation phase. Hospital policy requires that orders not personally entered by the physician must be written by hand in the patient chart and reviewed and entered in the computer system by a pharmacist before being dispensed. The delays inherent in this procedure give physicians an incentive to use the terminals. The policy encouraging direct order entry by physicians has been broadly accepted and has enabled the hospital to standardize drug therapy ordering and encourage adherence to the formulary.

Computers↗
PubMed1984

Secondary structure of heart sarcolemmal proteins during interaction with metallic cofactors of (Na+ + K+)-ATPase.

he secondary structure of membrane proteins was studied in rat heart sarcolemma by circular dichroism under conditions of interaction with metallic cofactors of (Na+ + K+)-ATPase at their optimal concentrations and under metal free conditions. Approximately 80 per cent of polypeptide chains in the membrane were organized in alpha-helical structure. Upon stabilizing the E1. Na conformation state of (Na+ + K+)-ATPase by Mg2+ and Na+ ions, only a slight increase in the protein alpha-helix content (to 83 per cent) was observed. On the other hand, simultaneous addition of Mg2+ and K+ ions resulting in the establishment of the E2 . K conformational state of the enzyme, was followed by a significant decrease in the membrane protein helicity (to 72 per cent). The presence of all three metallic cofactors of (Na+ + K+)-ATPase did not induce any further conformational change in sarcolemmal proteins as compared to the state induced by the interaction with Mg2+ and Na+ ions. In contrast to results obtained with Mg2+ ions, the interaction of Na+ with the sarcolemmal membranes led to a considerable decrease and that of K+ to a significant increase in alpha-helicity of the membrane polypeptides. These findings have confirmed the regulatory role of magnesium in transition of the conformational state from E1 to E2 in the reaction sequence of (Na+ + K+)-ATPase. Specific modulation by Na+ and K+ of the helicity of sarcolemmal proteins in the presence of Mg2+ and in the absence of ATP might be considered as a preprint of conformational changes which will occur in the presence of ATP.

Animals↗
PubMed1983

Analysis of current approaches and a practical guide to prescription of exercise.

Based on current information, aerobic exercises offer the greatest benefit to patients with back pain. Evidence supports the use of abdominal and extension exercises in a selected group of patients, but indications are limited, as are the useful types of exercises in both of these approaches. No support exists for the use of preprinted handouts, which assume that every patient with back pain, regardless of clinical presentation, requires the same six or eight exercises. Rather, selectivity of exercises based on a thorough clinical evaluation is recommended. Use of a specific exercise should be governed by the sound scientific principles presented in this paper. Many other types of therapeutic exercises not mentioned in the present paper are currently utilized in the care of patients with back pain.

Back Pain↗
PubMed1983

Adult immunization: the medical record design as a facilitator for physician compliance.

A three-year prospective chart audit of a family practice residency program was performed to measure physician compliance in following the recommendations of an adult immunization program. Despite curriculum changes, performance self-evaluation, and reminders by faculty members to residents about the need for adult immunization, physician compliance was poor in the second year of the study. It was thought that components of the medical record might be improved to facilitate physician compliance in the adult immunization program. At the beginning of the third year of the audit, tetanus and pneumococcal vaccines were preprinted on the health maintenance inventory (HMI), but influenza was not. The chart design also was changed to put the HMI in a more prominent place. In the third year of the audit, physician compliance with tetanus and pneumococcus immunization improved significantly. The results of the chart review suggest that physician compliance with adult immunization programs can be improved with appropriate chart design.

Adult↗
PubMed1978

Distributing estrogen patient package inserts to institutional patients.

A procedure for the distribution of patient package inserts (PPIs) for estrogens to outpatients (ambulatory and home health care) and inpatients (acute and long-term) was developed. The pharmacist dispenses the PPI to outpatients along with the prescribed drug. The name of the drug, the date, the pharmacist's initials and the fact that the PPI was issued are recorded in the patient's profile. The pharmacist then orally reinforces the information in the PPI. For inpatients, a preprinted double-tab label is adhered to the PPI which is distributed with the medication upon new estrogen orders. The portion adhered to the PPI lists instructions to the physician. The unadhered portion contains an area for recording the name of the drug product, the patient's name, the physician's signature and the date; this tab is affixed to the order sheet by the physician after he has provided and explained the PPI to the patient. Estrogens are not administered until physicians comply with the PPI procedure. While compliance with the PPI procedure has been satisfactory, this may be the result of a substantial decrease in the number of physicians ordering estrogens, along with a corresponding reduction in the number of estrogen products they now prescribe.

Ambulatory Care↗
PubMedDate not supplied

Shuval automated problem-oriented record: an off-line record for a primary care clinic.

An off-line system for automating the problem-oriented record implemented at Kibbutz Shuval is described. The Shuval problem-oriented record consists of acute and chronic problem lists, a preprinted data base collected by patients and nurses, problem-oriented plan flow sheets, problem-oriented progress notes and a regular record audit. The mean conversion time from a traditional record to a problem-oriented record was 17 min for a child's record and 25 min for an adult's. The automated problem-oriented record consists of three data processing forms that contain almost all data in the record. Transfer of data took, on the average, 10 min (range, 5 to 30 min) for a child's record. The following five types of analysis can be performed with the Shuval automated problem-oriented record: administrative, patient care, epidemiologic, demographic and clinical research. Coupled with the manual problem-oriented record, the Shuval automated record provides many advantages of an on-line problem-oriented record at considerably less cost.

Computers↗
PubMed1981

Therapeutic substitution and the hospital formulary system.

Physicians consent and statutory regulations relating to therapeutic substitution are discussed. Some hospitals have adopted policies allowing the interchange of a chemically inequivalent product deemed therapeutically identical by the P & T committee. In the absence of statutory regulation, hospital pharmacists usually refer to (1) the physician's agreement to abide by hospital bylaws (including the formulary system) when joining the hospital staff, or (2) prescription blanks and order sheets preprinted with the statement "substitution permitted unless otherwise indicated" as the legal authority for therapeutic substitution. Only two states have addressed the legality of therapeutic substitution. An opinion of the Oregon Attorney General and a Washington state statute both authorize therapeutic substitution under certain circumstances if the prescriber has given prior consent. Neither of the states specifies, however, whether the agreement of prescribers to abide by hospital bylaws constitutes authorization of therapeutic substitution. It is proposed that state boards of pharmacy and state legislatures draft laws that address therapeutic substitution and specify acceptable methods of consent.

Formularies, Hospital as Topic↗
PubMed1995

Ordering accuracy. A College of American Pathologists Q-Probes study of 577 institutions.

Five hundred seventy-seven institutions examined how accurately physicians' test orders on inpatients were transmitted to the laboratory. Written orders could be found on laboratory requisitions or the medical record for 97.5% of 224,431 completed tests (median institution = 99.3%). Participants indicated that entry of extra tests into a hospital computer was the most common reason for completing unordered tests. In a multivariate analysis, factors associated with completing unordered tests were the lack of a policy requiring nursing staff to recheck computer orders against the medical record, average census of 301-450 patients, College of American Pathologists accreditation, and the use of preprinted "checkoff" order forms. Overall, 97.1% of 225,457 test orders were completed by the laboratories (median institution = 98.1%). Factors associated with not completing ordered tests were the lack of a policy requiring staff to check computer orders, teaching hospital status, and urban hospital location. Several interventions commonly thought to improve communication of orders were not found to affect performance. These results indicate that many institutions have a problem accurately transmitting test orders to their clinical laboratories.

Data Collection↗
PubMed1995

Nursing-based protocol for treatment of alcohol withdrawal in the intensive care unit.

Inappropriate benzodiazepine dosing in patients exhibiting signs of alcohol withdrawal cause staff and patient safety problems. Our primary goal was to develop an alcohol withdrawal protocol based on objective measures, and then to coordinate benzodiazepine dosing with those measures and improve care of the patient withdrawing from alcohol. A secondary goal was to give the primary care nurse the flexibility to administer benzodiazepine doses as needed to improve patient and staff safety. We developed and implemented a modified version of a published withdrawal symptomatology scale; a corresponding scale was developed for benzodiazepine dosing by observing the usual lorazepam doses needed to control withdrawal symptoms. Both scales and care guidelines for the patient withdrawing from alcohol were organized in the form of preprinted orders. Since implementation of the alcohol withdrawal protocol, complaints regarding patient and staff safety have decreased. Other patient care units are beginning to use the protocol. A hospital-wide task force is developing patient care plans based on the protocol for all patients withdrawing from alcohol.

Alcohol Withdrawal Delirium↗
PubMedDate not supplied

Cytology result entry without using the keyboard.

Many keystrokes are needed to enter routine gynecologic cytology results into many computer systems. Not only is this quite time consuming, but typing errors cannot be avoided and are not always detected before the report is sent to the clinician. Because of continuing shortages of staff time and the desire to avoid transcription errors, we began using $400 bar code wands to enter cytology results and billing information. No changes in our laboratory information system software or tables were necessary. Accession number labels are preprinted on a stand-alone printer. Bar code sheets, containing common keystroke sequences, are printed using a standard Macintosh computer and Laserwriter printer. Scanning the bar codes exactly emulates those keystrokes typed on the keyboard. We have entered the results of > 99% of our gynecologic cytology cases in the past two years without touching the keyboard.

Cytological Techniques↗
PubMed1993

[Standardization of medical forms in health care].

In the Norwegian health care system, resources worth several 100 millions of US dollars are tied up in traditional routines for handling forms. A standard form, combined with computer record systems, could potentially release a considerable share of these resources for alternative uses. Universal Form Medicine (UFM) has been used by Norwegian general practitioners since 1985. The Universal Form Medicine has been a stable standard, and replaces more than 95% of all health forms. Today, about 50% of all doctors with a computerized medical record system can use this standard form. From most aspects, the Universal Form Medicine has advantages over preprinted forms, and can be adapted to silent printers. To our knowledge, no other countries have taken the advantage of standardizing their medical forms.

Family Practice↗