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PubMed1991

Using a notification card to improve communication between community pharmacists and general practitioners.

A pilot scheme was set up to evaluate a notification card to be used by community pharmacists when referring patients to their general practitioner, with the aim of improving communication. Six community pharmacists and 15 general practitioners took part in the study. During the 18 month study period 120 cards were issued by pharmacists. The majority of patients (71%) advised to see their general practitioner by the pharmacist did so. Fourteen cards (12%) were issued for suspected adverse drug reactions. The card was received positively by patients, doctors and pharmacists.

Communication↗
PubMed1991

Pharmacist advice to asthmatics regarding antihistamine use.

Due to the frequency of asthmatics having concurrent allergic symptoms, patients may seek relief from antihistamines, which are currently labeled with warnings against their use in asthmatics. A survey was conducted in the Chicago area to evaluate the advice rendered by pharmacists regarding the use of antihistamines in asthmatics and their opinions about the current product labeling. Thirty percent of the surveys were returned. Nearly half (48%) of the surveyed pharmacists advise their asthmatic customers to avoid antihistamines and 75% of this group recommend avoidance because they believe antihistamines worsen asthmatic symptoms, despite the lack of sufficient clinical data to support this concern. Only 17% of pharmacists advise that antihistamines pose no problems for asthmatics. The latter group is the most aware that there is controversy surrounding the current labeling. Overall, half the pharmacists surveyed believe the current labeling is not appropriate for patients with asthma. Until the labeling is revised, physicians should be aware that pharmacists may advise their asthmatics against using antihistamines even though antihistamines should be only contraindicated in cases of proven adverse reactions.

Asthma↗
PubMed1990

Using pharmacists' perceptions in planning changes in pharmacy practice.

Pharmacists' perceptions of and goals for clinical pharmacy services, as well as the proportion of time devoted to clinical services, were studied at one hospital as part of the process for establishing departmental goals. Three methods were used in evaluating pharmacists' perceptions of clinical pharmacy services. The first was a departmental survey. Second, staff members were asked to generate and prioritize a list of goals for clinical pharmacy services; this was done by means of an interactive, small-group process. Finally, a work-sampling study was performed that indirectly measured use of staff pharmacist and technician time. Staff pharmacists perceived that clinical pharmacy services were being provided to individual patients; however, support for these services from upper management was perceived as inadequate. Staff development had the highest priority for the further development of clinical pharmacy services. Only 19.7% of pharmacists' time was devoted to clinical services. Data from all three studies were incorporated into the development of a strategic plan that set forth long-term departmental goals and objectives. The plan includes a statement of commitment to develop management systems to eliminate deficiencies identified in the study. Among the changes in pharmacy operations introduced as a result of the survey were (1) a career-ladder system, (2) new opportunities for staff development, and (3) improved documentation systems. Surveying staff perceptions of existing services, joint goal setting and prioritization, and work-sampling studies formed the basis for the development and implementation of a new model of integrated pharmacy services at this institution.

Attitude of Health Personnel↗
PubMed1990

Impact of a pharmacist on medication discontinuation in a hospital-based geriatric clinic.

The effect of a pharmacist on drug prescribing in a hospital-based geriatric clinic was studied. On July 1, 1987, a geriatric clinical pharmacist began participating in a geriatric ambulatory-care clinic at a Veterans Administration medical center. In this retrospective study, patients who had been seen at the clinic a minimum of every two months during both the control period (January 1 through June 30) and the study period (July 1 through December 31) were included. During the study period, the pharmacist reviewed each patient's medication profile and assessed whether drug dosages should be adjusted or medications should be discontinued. The pharmacist and the geriatrician who coordinated care at the clinic reviewed the cases before changes were made. The total number of prescription and nonprescription medications (excluding one-time orders for short-term therapy) was determined for each time period, as well as the average number of prescriptions per patient. Those drugs most frequently associated with adverse drug reactions (ADRs) in the elderly were analyzed separately. During the control period, the 72 patients in the study group received 414 prescriptions, 246 of which were for medications associated with ADRs in the elderly. During the study period, there was a 32% reduction in the total number of prescriptions; the number of medications associated with ADRs in the elderly was reduced by 42%. A direct cost savings of +3872, or +53.75 per patient, was realized over the six-month study period. The addition of a pharmacist to the staff of a hospital-based geriatric clinic resulted in a 32% reduction in the total number of medications prescribed.

Aged↗
PubMed1990

Pharmacist intervention in prescribing of cefuroxime for pediatric patients.

A targeted drug review of cefuroxime use in pediatric patients is described. Because of a 65% increase in cefuroxime costs over one year, pharmacists assessed the appropriateness of cefuroxime therapy from October 13 to December 20, 1987. This assessment was done within 48 hours after the prescription was written and again after 72 hours of cefuroxime therapy, when bacteriology and susceptibility data were available. When a drug order was inappropriate, a pharmacist intervened with the prescribing physician. For comparison, data collection forms were completed for patients who had received cefuroxime before and after the study period. Before the study period, 42% of the cefuroxime orders were inappropriate with respect to dosage or indication at the time of the initial order; this rate fell to 26% during the study period and increased to 33% after the study period. After 72 hours of therapy, the rates of inappropriate prescribing were 48% (before study period), 32% (during study period), and 40% (after study period). During the study period, pharmacists intervened in only half of the 51 cefuroxime orders initially deemed to be inappropriate, and only 26% of these interventions resulted in an order change. Although pharmacists met with some success in increasing the appropriateness of cefuroxime prescribing, both pharmacists and physicians resumed their previous monitoring and prescribing habits after the study period had ended.

Cefuroxime↗
PubMed1989

Biotechnology products: new opportunities and responsibilities for the pharmacist.

The opportunities and responsibilities of pharmacists with respect to the new biotechnology products are described. Recent advances in the fields of molecular genetics and nucleic acid chemistry have resulted in a proliferation of biotechnology products. Those produced by recombinant DNA techniques offer particular promise for the treatment of a wide variety of medical disorders such as cancer, anemia, neutropenia, diabetes, and myocardial infarction. Since the turn of the century, the pharmacy profession has expanded its role from drug preparation and distribution to modern clinical pharmacy, in which pharmacists act as a source of drug information for physicians, nurses, and patients. In response to the new biotechnology revolution, pharmacists must once again undergo a role expansion, this time actively assuming responsibility for educating themselves about the nature and clinical use of the new biopharmaceuticals. The curriculum of students undergoing training in pharmacy should cover such areas as immunoglobulins, immunomodulators, growth hormones, targeted drug-delivery systems, and advanced diagnostic techniques that use biotechnology products. Continuing-education programs in these areas will update currently practicing pharmacists on the new biotechnology products. Although use of biologic proteins is currently targeted toward hospitalized patients, future advances may allow for dispensing these new drugs through community pharmacies as well. Therefore, change will be necessary at all levels of the pharmacy profession. As pharmacists accept the responsibility of dispensing, monitoring, and providing information about the new biotechnologic agents, they will enhance the rational use of these compounds.

Biotechnology↗
PubMed1989

Risk of exposure to HIV infection for clinical pharmacists.

The increased risk for exposure of clinical pharmacists to human immunodeficiency virus (HIV) is described, and their role in minimizing the risk to themselves and others is delineated. Increasingly, pharmacists are becoming involved in patient-care activities that place them at risk for HIV exposure. These activities include participation on cardiac resuscitation teams, monitoring concentrations of drugs in patient samples that they themselves may collect, administering intravenous drugs, and performing a wide variety of primary-care duties in such outpatient settings as anticoagulation, diabetes, and acquired immunodeficiency syndrome (AIDS)-oncology clinics. Pharmacists can protect themselves against HIV infection by following established infection control procedures; at the same time, they must exercise responsibility for the safety of their associates, of pharmacy technicians, students, and residents, and of other health-care workers. In many institutions this responsibility is shared with nurses. As educators, pharmacists must play a leading role in the dissemination of correct, up-to-date information about HIV infection, body substances precautions, and new product use and availability in both the hospital and the community. The expanded role of pharmacists places them at higher risk for HIV infection but also creates opportunities for them to exercise leadership in the fight against AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Effect of a pharmacist's and a nurse's interventions on cost of drug therapy in a medical intensive-care unit.

The effect of interventions by a pharmacist and a nurse on the cost of drug therapy in a medical intensive-care unit (ICU) was determined. A pharmacist taught cost-avoidance concepts related to medication use to a senior member of the nursing staff. The pharmacist and the nurse documented during a 91-day period all interventions that resulted in a discontinuation or change in drug therapy or involved nonformulary drug requests or serum drug concentration determinations. Costs that were avoided or added as a result of these interventions were determined using drug acquisition costs and (for interventions involving i.v. therapy) the cost of related supplies. Costs were calculated for both the initial 24-hour period after each intervention and the expected duration of therapy. The 345 interventions of the pharmacist and the nurse represented $6,383 in 24-hour cost avoidance and $23,993 in total cost avoidance. The majority of interventions resulted in discontinuation of medications or changes in drug dosage; most of those interventions involved antimicrobial agents. Other frequent interventions involved changes in route of administration and the interchange of therapeutic alternates. A pharmacist and a nurse had a positive impact on the cost of drug therapy in a medical ICU.

Baltimore↗
PubMed1989

Streamlining antimicrobial therapy through pharmacists' review of order sheets.

The impact of a pharmacy-conducted intervention program designed to contain costs by "streamlining" antimicrobial therapy is described. Streamlining of antimicrobial therapy may involve simplifying routes of administration, decreasing the dose or frequency of antimicrobial administration, or converting from multiple-agent therapy to single-agent therapy. Beginning on December 1, 1987, pharmacists at this university-affiliated teaching hospital used the antimicrobial order sheet (AOS) filled out by all prescribers of anti-infective agents to identify orders that were potential candidates for streamlining. Interventions involved a discussion between the pharmacist and prescriber in which the pharmacist specified the reasoning behind the recommended change. For each recommendation that was accepted by the prescriber, the cost savings per day was determined by subtracting the daily cost of the recommended streamlined therapy from the daily cost of the original "problem" therapy. Data collection continued until May 1, 1988. During that five-month period, 162 out of 173 pharmacist-initiated streamlining recommendations were accepted by prescribers, resulting in a total cost savings of $19,864. The average cost savings per intervention was $122.62. The most frequent intervention involved decreasing the frequency of i.v. administration, decreasing the dose, or both. The intervention that resulted in the greatest average cost savings involved simplifying the route of administration or discontinuing antimicrobial therapy entirely. The projected annual cost savings of this program is $47,700. By using information from AOSs to identify problem antimicrobial orders, pharmacists were able to recommend streamlining of antimicrobial therapies that resulted in an average cost savings of about $122 per intervention.

Anti-Infective Agents↗
PubMed1989

Pharmacists' attitudes toward and use of cardiopulmonary resuscitation training received in pharmacy school.

Recent graduates of a pharmacy school were surveyed to determine their attitudes toward and use of cardiopulmonary resuscitation (CPR) and basic life support (BLS) training received as part of their pharmacy school instruction. Questionnaires were mailed to 215 pharmacists who had completed the mandatory CPR-BLS training; only those who had practiced pharmacy for at least 6 of the previous 12 months were asked to respond. Usable questionnaires were received from 187 of the pharmacists surveyed. Of the respondents, 134 (72%) believed that the CPR-BLS program should continue to be mandatory for graduation; 131 (70%) believed their training to be of value in their current practices, and 174 (93%) believed it would be of value in the future. Nine (5%) of the pharmacists had actually performed CPR since their graduation. Pharmacists practicing in small and large hospitals were more likely to participate in CPR than pharmacists in medium-sized hospitals, and such participation was associated with the presence of decentralized and clinical pharmacy services. Recent pharmacy graduates who had received mandatory CPR-BLS training in school had positive attitudes about the value of this training in their professional practices.

Attitude of Health Personnel↗
PubMed1988

Pharmacist involvement in a chemical-dependency rehabilitation program.

Pharmacist involvement in a small hospital for the treatment and rehabilitation of patients with chemical dependency is described. The pharmacist's primary responsibilities include provision of pharmaceutical services to meet the medical needs of patients during detoxification; development of detoxification protocols for management of withdrawal from drugs of abuse; education of patients and their families, other clinical staff members, and pharmacy students about the pathophysiology of addiction, treatment options, and the foundations of recovery; medication and addiction counseling; and multidisciplinary team support of recovery. To successfully fulfill this complex role, the pharmacist must have specialized education on alcoholism and addiction, develop good communications skills, and learn the dynamics of recovery support groups. The pharmacist employed at this hospital spends about 70% of her time with pharmaceutical services and 30% with counseling services. A pharmacist working in a chemical-dependency rehabilitation program has a unique opportunity to affect positively the physical and emotional health of the recovering individual by taking on responsibilities beyond those traditionally associated with pharmacy practice.

Education, Pharmacy↗
PubMed1987

Pharmacist participation in the management of incidents involving hazardous materials.

The role of the pharmacist as a hazardous materials consultant is described. Pharmacists in a university-affiliated teaching hospital are contacted by either emergency medical services or the emergency department to assist in the management of incidents involving toxic hazardous materials. These incidents can range from major chemical spills or leaks to long-term exposures involving generalized, nonspecific symptoms. An advanced pharmacy resident in emergency medicine is the primary pharmacy contact for hazardous materials consults. The services provided by the clinical pharmacist include identification of the hazardous materials involved, initiation of special precautions for rescue-squad and hospital-based personnel, clinical assessment of the toxicologic problem, and formulation of therapeutic recommendations. Teaching programs have been developed for pharmacy, nursing, and medical students, hospital employees, and emergency-response agencies. Pharmacy participation in the management of hazardous materials incidents has been well received by emergency department physicians and nurses, as well as by rescue personnel. During the period between January 1 and July 1, 1986, the pharmacy was consulted on 66 hazardous materials incidents. Since pharmacists have traditionally been used as information resources for clinical toxicology questions, it follows that their participation can extend into the field of environmental toxicology, specifically involving hazardous materials. The pharmacist's input as a hazardous materials consultant in our institution has been well received, and we believe that pharmacy departments can play an important role in the management of incidents involving hazardous materials.

Consultants↗
PubMed1986

Effect of pharmacist intervention on control of resistant hypertension.

The effect of a pharmacist's clinical intervention on blood pressure control in ambulatory adults with resistant hypertension was studied. Twenty patients of an internal medicine clinic who had diastolic blood pressures greater than 96 mm Hg on two consecutive visits and antihypertensive regimens consisting of two or more agents were entered in the study between November 1, 1980, and February 1, 1981. After asking each patient 15 questions about hypertension and its treatment, the pharmacist counseled the patient about antihypertensive therapy, obtained a medication history, and discussed diet. The patient's blood pressure was measured, and the pharmacist evaluated the appropriateness of the patient's antihypertensive regimen (based on compliance, adverse reactions, and regimen complexity) and possible reasons for the poor response to treatment. The pharmacist then recommended drug therapy to the physician; stepped care including hydrochlorothiazide, reserpine, and hydralazine was used when possible. Patients' mean age was 56 years. Most did not know the names of their medications or understand their dosage schedules. Eight patients had severe hypertension (193/124 +/- 23/4 mm Hg), five had moderate hypertension (161/109 +/- 20/2 mm Hg), and seven had mild hypertension (171/100 +/- 29/0 mm Hg). Factors contributing to poor blood pressure control were noncompliance and adverse drug effects. After five to eight months of follow-up, mean blood pressures for patients with severe, moderate, and mild hypertension were, respectively, 140/92 +/- 23/10 mm Hg, 131/92 +/- 8/6 mm Hg, and 137/88 +/- 26/3 mm Hg; the mean for each group was significantly different from baseline. In this study, pharmacists intervened successfully with patients and physicians to enhance blood pressure control through drug therapy.

Antihypertensive Agents↗
PubMed1981

Standardized versus pharmacist-monitored individualized parenteral nutrition in low-birth-weight infants.

The clinical contribution and cost effectiveness of pharmacist involvement in peripheral-vein total parenteral nutrition (TPN) in a neonatal intensive-care unit was studied. Fourteen neonates who received a standardized TPN solution without pharmacist monitoring (Group 1) were compared with 14 neonates who received an individualized TPN solution with pharmacist monitoring (Group 2). Infants were excluded from the study if they received oral feeding, or TPN for less than five days, or were fluid-restricted. No significant difference in mean gestational age, birth weight, gestational size, age at initiation of therapy, duration of therapy, or daily amount of fluid administered was found between the two groups. The mean weight gain in Group 1 (4.9 g/day) was significantly less than in Group 2 (11.8 g/day) (p less than 0.02). The amount of protein provided to Group 2 (2.2 g/kg/day) was significantly greater than to Group 1 (1.9 g/kg/day) (p less than 0.01). The number of calories provided per day was greater for Group 2 (63 kcal/kg/day) than for Group 1 (53 kcal/kg/day) (p less than 0.001). When only those infants who received lipids were analyzed, Group 2 received significantly more lipid (2.0 g/kg/day) than group 1 (1.5 g/kg/day) (p less than 0.001). The mean daily cost was greater for Group 2; however, when cost was related to efficacy, Group-2 cost per gram of weight gain was lower than Group-1 cost. Pharmacist monitoring of an individualized program of TPN in neonates provided a greater mean daily weight gain, allowed a greater amount of nutrients to be provided, and was cost effective compared with the use of a standardized solution without pharmacist monitoring.

Body Weight↗
PubMed1983

Pharmacists and their relationship with elderly patients.

A survey of 60 randomly selected pharmacists explored their relationship with elderly patients, including their information storage systems, dispensing practices and the major problems they encounter with these patients. Nearly all the pharmacists kept a medication profile for each elderly patient, and one third used a computer, which facilitated recording of additional information. However, few recorded the age of the patient. Many pharmacists counselled their elderly patients on the correct use of medications, but few provided counselling on the use of nonprescription drugs. Most of the pharmacists reported using techniques to improve compliance among elderly patients. More than 80% of the pharmacists reported apparently inappropriate prescribing by physicians at least occasionally.

Aged↗
PubMed1982

Effect of pharmacist counseling on drug information recall.

The effect of counseling by pharmacists on patients' long-term recall of drug information was studied. Clinic and hospital neurological patients were counseled by a physician regarding a drug newly prescribed for them. Each patient in the study was then given a 15-item multiple-choice pretest specific for the new medication. Patients in the control group were given a posttest identical to the pretest eight weeks later. Test group patients were counseled by a pharmacist and were given the posttest eight weeks later. Specific information was categorized as to source. The mean scores of the test group patients increased 26.2 percentage points between pretest and posttest. Scores on information covered by the physician and reinforced by the pharmacist increased 19.6 percentage points, and scores on information presented only by the pharmacist with written reinforcement increased 30.6 percentage points. Scores of the control group patients showed no improvement between pretest and posttest. Pharmacist counseling had a significant effect on patients' recall of drug information after eight weeks.

Age Factors↗
PubMed1982

Perceptions of work among men and women pharmacists in nonadministrative positions.

Perceptions of the types of duties performed by men and women hospital pharmacists in one section of a single state were studied, and differences in job attitudes that may be attributable to discriminatory job assignments are identified. A survey consisting of 153 questions was mailed to 507 pharmacists (328 men, 175 women, 4 whose sex was unknown) practicing in southeastern Michigan hospitals. Participants used a seven-point scale to rate the relative amounts of time they spent in various job activities. Activities were grouped as dispensing functions and clinical functions. Allotted time ratings for six clinical and six dispensing functions were averaged for each pharmacist. The survey used modules from the Michigan Organizational Assessment Questionnaire to measure pharmacists' perceptions of the quality of their work. Information from 279 questionnaires (60% men) was analyzed. No difference was evident in the perceived amounts of time men and women spent performing clinical activities. Women reported significantly greater time than men performing dispensing functions. Based on job dimensions, psychological states, and personal and work outcomes, a higher level of job satisfaction was expressed by men than by women. Men and women nonadministrative hospital pharmacists in this limited study perceived thier tasks differently.

Age Factors↗
PubMed1980

Legal standard of due care for pharmacists in institutional practice.

The process by which courts determine negligence on the part of a pharmacist is discussed, and important malpractice decisions involving pharmacists and other medical professionals are summarized. Courts expect pharmacists to exercise a high level of "due care." It is unclear whether a hospital pharmacist would be held t a standard created by general practitioners or by specialists in institutional practice; but a good case can be made for a special standard. If the court finds that professional standards are deficient, the court may establish higher standards. Pharmacists should ensure that their performance meet legal expectations by keeping abreast of new developments in pharmaceutical practice.

Humans↗