Development of a pharmaceutical care system in a neonatal intensive care satellite pharmacy.

The development of a pharmaceutical care system for a neonatal intensive care unit satellite pharmacy from existing integrated clinical, distributive, and quality assurance activities is described. Components of practice already in place included pharmacotherapeutic monitoring, evaluations for childhood immunizations, monthly medication summaries, and daily follow-up on scheduled doses returned in the unit dose exchange carts. Pharmacists documented patient drug therapy consultations on a standard form. New elements of practice emphasized organization of patients' clinical data by problem, development of specific outcome-oriented standards of care for common neonatal conditions and disease states, and quality improvement activities that evaluated the appropriateness of patient monitoring and patient outcomes. Written standards of care for specific disease states improved clinical decision-making, documentation of pharmacists' performance, and communication about patient care with other health care professionals. Elements of pharmacy practice already in place may provide a good foundation for a structured pharmaceutical care system.

Effects of pharmaceutical care on medication cost and quality of patient care in an ambulatory-care clinic.

The effects of pharmaceutical care on medication cost and quality of care in a university-based family-practice clinic were studied. Prognostic indicators were used to target patients who should receive pharmaceutical care. Those patients who received care. Those patients who received pharmaceutical care over a 14-month period during 1988-89 were included in the study. A pharmacist interviewed each targeted patient, obtained the patient's medication history, made therapeutic recommendations to the patient's physician, and counseled the patient on his or her therapy. The pharmacist's recommendations were noted, and the outcome of each recommendation was documented on subsequent patient visits. For each recommendation, drug cost avoidance was calculated and patient outcome was analyzed. For quality assessment, a panel of three health-care professionals reviewed the pharmacist's recommendations for 25% of the study patients (randomly selected) and noted their agreement or disagreement with the pharmacist's actions. Over the study period, 184 targeted patients received pharmaceutical care. Clinic physicians accepted 297 (82.5%) of 360 pharmacist recommendations. Annual extrapolated cost avoidance associated with the pharmacist's recommendations was $19,076. For 213 (80.4%) of the 265 accepted recommendations for which outcome data were available, improvement or resolution of the patient's disease state occurred. For 8 (16%) of 50 unaccepted recommendations, the patient's status declined. The peer review panel agreed with 86% of the pharmacist's recommendations. The provision of comprehensive pharmaceutical care in an ambulatory-care clinic can both reduce medication costs and improve quality of care.

Expanding staff pharmacists' responsibilities to maintain pharmacy services in a neonatal intensive-care unit.

The conversion of pharmacist responsibilities in a neonatal intensive-care unit (NICU) pharmacy satellite from drug distribution to both clinical services and drug distribution is described. When the pharmacy department could not recruit a specialty-trained clinical practitioner to fill an open NICU position, the position was converted to a fourth satellite pharmacist position, and each of the four NICU satellite pharmacists assumed clinical responsibilities for the NICU. Clinical and distributive functions had previously been separate. Staff development programs and a contract with the previous NICU clinical practitioner for consultative services helped to ease the transition. NICU pharmacists currently provide inservice education to medical residents and the nursing staff, provide drug information, monitor drug therapy, perform pharmacokinetic monitoring, are involved in research, and work to streamline satellite operations. For one of every four months, the NICU pharmacists primarily provide clinical services; the remainder of the time clinical activities are combined with drug distribution responsibilities. The staffing schedule has enabled the department to extend the hours that clinical services are available. The NICU pharmacists maintain secondary areas of staffing, and other pharmacists periodically staff the NICU satellite. Staff pharmacists in the NICU pharmacy satellite developed clinical skills that permitted integration of clinical and distributive pharmacy services.