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)

Strategies for deleting popular drugs from a hospital formulary.

The approach used by a hospital pharmacy in planning, implementing, and evaluating a major formulary revision and the strategies used in deleting popular analgesics from the formulary are described. All phenacetin-containing products were deleted from the formulary of The Ohio State University Hospitals. The following steps of the process are described; identification of the problem, literature evaluation, soliciting medical staff support, presentation to the pharmacy and therapeutics committee, designing an implementation timetable, education, monitoring analgesic use, coordination of departmental activities, implementation and follow-up. The strategy used in this case resulted in the policy being implemented successfully.

Administrative audits of professional services: effective residency training experience.

The development of a structured method of providing administrative experience for hospital pharmacy residents, using internal audit techniques, is described. Residents were assigned topics to investigate in the administrative area of hospital pharmacy early during their two-year, academically affiliated residency. They were expected to review and evaluate the topic critically using internal audit techniques; written and oral reports were presented to the administrative staff. Residents were able to complete the audits while attending classes as part of their academic experience. As a result of performing the audits, residents have learned administrative skills in problem identification, assessed their personal competency by reviewing major components of contemporary practice, learned accepted standards of pharmacy practice, and developed skills in making improvements in conformity with quality assurance standards. This program has been incorporated as an integral part of the residency program.