Cost savings achieved through cephalosporin use review and restriction.

Attempts to control costs associated with antimicrobial therapy and surgical prophylaxis with injectable cephalosporins in a 335-bed, acute-care, county teaching hospital are described. An ABC analysis of our pharmacy inventory revealed that 11.8% of the annual pharmaceutical budget was represented by cefamandole and that this agent was used primarily for surgical prophylaxis. Initial attempts to replace cefamandole with cefuroxime met with unexpected resistance from the department of surgery and were unsuccessful. A cost analysis revealed that annual savings in supply and personnel costs of $115,819 could be realized if cefazolin were substituted for cefamandole. Substitution of cefazolin resulted in an additional cost savings of $40,000 above our original proposal involving cefuroxime. Persistent efforts of the department of pharmacy aided the effective implementation of this alteration in cephalosporin prescribing practices.

Implementing clinical pharmacy services in an outpatient oncology clinic.

The implementation of clinical pharmacy services in an outpatient oncology clinic is described. An oncologist hired by the department of internal medicine and the director of the department of pharmacy designed the program. Both departments agreed that the pharmacists should have central responsibility for the antineoplastic agents. Pharmacists for the program were selected from the existing staff. They were trained in an established i.v. therapy certification course offered by the hospital. The biweekly clinics are staffed by a team consisting of two pharmacists, three nurses, two faculty physicians, and a rotating resident physician. The pharmacists provide clinical and distributive services including patient monitoring and medication storage, delivery, preparation, administration, and disposal. A survey showed that the pharmacists were well accepted by the other members of the team. After a trial period, principles of break-even analysis and differential accounting were used to justify the costs of the program. This program will remain an integral part of this hospital's pharmaceutical services.

The pharmacy computer system at The Ohio State University hospitals.

The pharmacy computer system designed, developed, and implemented at The Ohio State University Hospitals is described. The computer system was developed to make more efficient use of hospital facilities and professional staff time. The pharmacy system operates on the mainframe hospital system using computer terminals with light-pen and keyboard access. Current online applications include order entry, patient profiles, pharmacokinetic calculations, and preparation of unit dose cart fill lists. Batch processing functions include drug-use review, drug-drug interactions, and financial management reports. Approximately 95% of unit dose orders and 20% of i.v. orders are conditionally entered by pharmacy technicians for subsequent verification by pharmacists. The system saves considerable staff time in the i.v. admixture and billing areas and has relieved pharmacists from performing many clerical and repetitive tasks. Disadvantages of the system include (1) its dependence on another department for patient admission, transfer, and discharge information and (2) delays in obtaining approval for program modifications and new applications. The advantages of the pharmacy computer system lie in its ability to access information from other computerized databases in the hospital. Future modifications and enhancements to the system are discussed.

Fiscal and clinical evaluation of home parenteral nutrition.

The clinical management activities performed by nonphysician members of a home parenteral nutrition (HPN) service were evaluated, and the costs of providing a home-care service with a hospital-based supply were projected. The nutrition support service team included two pharmacists, one nurse, one dietitian, one social worker, and two physicians. The clinical activities of the nonphysician members of the service were documented for a one-year period involving 13 patients. Inventory data for items dispensed were obtained from the commercial vender supplying the patients during the study. Projected charges for the hospital pharmacy to deliver supplies were based on actual contract costs to the hospital. An arbitrarily assigned markup of 40% was used to calculate break-even data. The clinical management of the HPN patients required 203 hours of the nonphysician health-care professionals' time. For the initial fiscal year, the fixed and variable costs were projected as $253,360, which amounted to $89.82 per calendar day of home therapy. The hospital would have to provide 1416 calendar days of home parenteral nutrition before revenues equaled expenses at $168,504. The projected annual savings for a patient receiving parenteral nutrition at home rather than in the hospital was $651,651. Supply alternatives for HPN should be evaluated according to specific institutional needs.