ABSTRACT
A comprehensive drug-use review (DUR) program based on established criteria for use of each drug is described. The DUR program was developed to promote cost-effective drug therapy and satisfy Joint Commission on Accreditation of Hospitals standards for drug-use evaluation. Antibiotic and ambulatory-care drug-use subcommittees composed of physicians, pharmacists, nurses, and clinical laboratory personnel were formed as advisory groups to the pharmacy and therapeutics (P&T) committee. The subcommittees review overall drug-use patterns in their respective areas monthly and investigate the use of specific problem drugs. Drug-use reviews have been facilitated by the implementation of a mandatory antibiotic order form and pharmacy computer systems. Nonformulary drug use is monitored. The procedure for adding drugs to the formulary was modified to require the submission of specific criteria for appropriate drug use; when a drug is added to the formulary, the criteria for use are also adopted. The program has been successful in curtailing inappropriate drug use, reducing drug expenditures, and integrating P&T committee decisions into daily pharmacy practice. The implementation of this DUR program has enabled the P&T committee to conduct ongoing, systematic, criteria-based drug-use evaluations.
Subject(s)
Drug Utilization/standards , Pharmacy Service, Hospital/organization & administration , Pharmacy and Therapeutics Committee/organization & administration , Ambulatory Care , Anti-Bacterial Agents/therapeutic use , Florida , Formularies, Hospital as Topic , Hospital Bed Capacity, 300 to 499 , Joint Commission on Accreditation of Healthcare Organizations , Models, TheoreticalABSTRACT
A statistical interaction model explaining 27 per cent of the variation in physicians' attitudes toward clinical pharmacy among 180 Alabama physicians is presented. Young primary care physicians who prescribe drugs with a low risk of adverse reactions are the most favorable toward pharmacists practicing clinical tasks. Older solo-practice physicians who lack exposure to clinical pharmacy are the least favorable. The implications for the wider acceptance of clinical pharmacy are discussed in terms of its resources of professional power. (Am J Public Health 1983; 73:96-101.)
Subject(s)
Attitude of Health Personnel , Pharmacology, Clinical , Pharmacy Service, Hospital , Physicians/psychology , Adult , Alabama , Humans , Middle AgedABSTRACT
The ordering of serum theophylline concentrations in a 900-bed university hospital was evaluated. Data were collected during the first week of three consecutive months from the records of adult inpatients who had serum theophylline assays performed. The appropriateness of ordering the serum theophylline determinations was evaluated on the basis of criteria including sampling at steady-state concentrations and sampling in proper relationship to the dosage schedule to represent a peak or trough concentration. A total of 113 determinations in 79 patients were reviewed. Pulmonary service patients accounted for 54 (48%) of the determinations. For the 56 concentrations ordered for patients receiving aminophylline continuous infusions, 25 (45%) of the determinations did not meet the criteria for appropriateness. For the 57 other determinations (oral theophylline products and intermittent bolus injections of aminophylline), 42 (74%) were not ordered according to the established criteria. Overall, 67 (59%) of 113 serum theophylline determinations were found to be ordered inappropriately. Corrective educational programs based on standard guidelines for ordering serum theophylline concentrations were established.
Subject(s)
Theophylline/blood , Evaluation Studies as Topic , Hospitals , Humans , Infusions, Parenteral , Lung Diseases, Obstructive/drug therapy , Theophylline/administration & dosage , Theophylline/therapeutic useABSTRACT
An 18-week clinical educational training segment of a hospital pharmacy residency is described. The segment begins with a one-week orientation series to clinical services. This is followed by a four-week block in the drug information center, where the resident participates in all areas of the center. Following this block, the resident begins a planned series of elective clinical rotations (two four-week and one three-week elective rotations and a required two-week anesthesiology rotation). The clinical rotations are designed to provide training in all facets of the pharmaceutical care of hospitalized patients, with major emphasis on therapeutic management. The program's major objectives, instructional methods, activities and responsibilities, learning objectives, and evaluation methods are discussed. This training segment teaches residents how to integrate their knowledge of disease states and therapeutics into the provision of comprehensive pharmaceutical services.
Subject(s)
Education, Pharmacy, Graduate , Internship, Nonmedical , Pharmacy Service, Hospital , AlabamaABSTRACT
The steps involved in establishing a comprehensive pharmaceutical service in an operating and recovery room complex is described. Objectives of the operating room pharmaceutical satellite were to: (1) improve control of distribution, storage and charging for all drugs, especially Schedule II controlled substances; (2) reduce inventory costs and loss of revenue; (3) improve compliance with the drug formulary; and (4) establish patient-oriented pharmaceutical services. The pharmacy satellite improved inventory control and patient charging, assured continual access to all drugs and appropriate security for controlled substances, and expanded the pharmacy department's clinical, drug information and research activities.
