Subject(s)
Hyperlipidemias/blood , Lipoproteins, LDL/blood , Pharmacists , Primary Health Care/methods , Humans , Hyperlipidemias/drug therapy , Hyperlipidemias/economics , Hypolipidemic Agents/economics , Hypolipidemic Agents/therapeutic use , Lipoproteins, LDL/drug effects , Patient Care Team/economics , Pharmacists/economics , Primary Health Care/economicsABSTRACT
The effect of a computerized drug regimen review and expanded clinical pharmacy services on medication use in a nursing-home care unit was studied. A full-time pharmacist assigned to the 120-bed nursing-home care unit of a Veterans Affairs medical center initiated a program to reduce medication use to an average of 6.1 medications per patient. The pharmacist used a monthly, computer-generated drug regimen review report to document the number of medications per patient and recommend decreases in medication use to physicians. Initiation of a standing-order policy, whereby nurses can initiate the use of specific medications, helped to reduce the number of as-needed (p.r.n.) orders and also decreased use of these medications. Within one year, the number of p.r.n. and scheduled medications used per patient was reduced from 7.20 to 5.34. Use of routinely scheduled medications was reduced by about 30%. Based on an average cost of medications administered ($0.24/dose), we calculated a cost savings of about $27,400. By reviewing patients' drug regimens, establishing a standing-order policy, and targeting scheduled medications for discontinuation, a pharmacist reduced medication use in a nursing home.
Subject(s)
Drug Therapy/statistics & numerical data , Medication Systems/organization & administration , Nursing Homes/organization & administration , Computers , Drug Prescriptions , Follow-Up Studies , Humans , Pharmaceutical Preparations/administration & dosage , Pharmacists , United StatesABSTRACT
Management of asthmatic or emphysematous elderly patients who cannot use metered-dose inhalers with spacers because of severe physical and mental disabilities is difficult. We report a case of a nursing-home patient with dementia and Parkinson's disease who required aerosolized corticosteroids to avoid repeated systemic corticosteroid courses for asthmatic exacerbations. The patient was unable to use a triamcinolone metered-dose inhaler with spacer devices because of his impairments. Therefore, nebulized dexamethasone solution was prepared and administered. Since initiation of nebulized dexamethasone, the patient has not required systemic corticosteroids. In addition, his hypopituitary adrenal axis has remained intact as evidenced by provocative cosyntropin testing. Therefore, nebulized dexamethasone solution may be an alternative to the aerosol corticosteroid metered-dose inhaler when patients are too impaired to use inhalers, even with spacers.
