Let go of Latin!

Health care practitioners have long used Latin abbreviations. Using these shorthand terms does not consistently promote patient safety. although in some instances they offer a time-saving convenience. This article illustrates hazards associated with the common Latin abbreviation "Qd" by showing copies of actual medication orders. Other dangerous abbreviations are also discussed. The use of plain English is suggested as the prescribing practice most consistent with professional values.

Finding an optimal dose: considerations in accurate opioid dispensing.

Morphine sulfate is widely prescribed for the relief of moderate to severe acute and chronic pain. Unfortunately, medication errors associated with morphine sulfate can result in patient harm; profound respiratory depression can result from excessive doses in opioid-naïve patients. An actual medication order containing a potentially toxic overdose of morphine sulfate is examined. Patients habituated to high doses of morphine sulfate are at risk from underdosing, a hazard also of concern.

Unclear dose equals toxic dose.

Medication errors are a significant public health issue. Their frequency and severity are currently under increased scrutiny from many perspectives. In 1996, the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) was established to promote the reporting, understanding, and prevention of medication errors. NCCMERP has published prescription writing recommendations to remedy error-prone aspects of prescription writing. An example of a hazardously written medication order and its possible toxicity is provided.

Hospice support for families facing multiple deaths of children.

The hospice team can have significant impact in guiding families through the death of a second child by recognizing the additional dynamics inherent in such a grieving process. It is vital to recognize the unresolved grief these families may face when they have not been able to grieve the first child's death adequately. The impact this unresolved grief will have on their coping abilities, anticipatory grief, and grief work when they experience the death of another child can be overwhelming. It is important to be aware of familial changes that occur when working with families who are facing the death of a second child since the addition of other children. For example, a host of additional dynamics that the family may not be familiar with or prepared to cope with may well occur, demanding specialized grief support and follow-up as provided by Hospice.

Electrode potentials for bioreductive agents from neural networks.

The one-electron electrode potentials at pH 7 have been predicted to an average accuracy of about 70 mV for a number of nitrobenzenes, nitrofurans and nitroimidazoles using a neural network. The inputs were the heat of formation and the free energy of hydration of both the nitroarene and its radical anion. The heats of formation were calculated using semiempirical molecular orbital methods; the free energies of hydration were calculated using a modified Born equation with additional semiempirical terms. Since these inputs can be calculated quickly, the neural network promises to be very useful in the design of molecules such as bioreductive agents where the electrode potential is of crucial importance. The success of the neural network in this problem implies that the errors, primarily in the semiempirical heat of formation, are systematic, and offers the hope that these may be corrected in future generations of the semiempirical methods.

Clinical privileges program for pharmacists.

A clinical privileges program for pharmacists is described. In 1985 and 1989 the Department of Veterans Affairs (VA) issued circulars defining policy on clinical privileges for pharmacists at its medical centers. Pharmacists at one large VA medical center responded by developing a clinical privileges program. Bylaws under which medical staff members are granted clinical privileges were used as a model for the pharmacist program. A pharmacist seeking privileges prepares an application detailing his or her background and the practice areas involved in the request; the applicant also drafts a quality assurance protocol. The application is reviewed by a pharmacist clinical privileges review board (PCPRB). The PCPRB uses the quality assurance plan to verify that adequate measures are in place to meet standards of care. If a question of patient safety arises, the board meets to review the pharmacist's activities. Each pharmacist who is granted privileges must have a physician sponsor. Since the first meeting of the PCPRB in 1990, clinical privileges have been requested by all 24 clinical pharmacy specialists at the center. No pharmacist has been denied privileges, although the board has required additional training or improved quality assurance protocols for many. Acceptance of the program by the medical staff has been good. A clinical privileges program at a VA medical center offers pharmacists the opportunity to practice pharmaceutical care.

Monitoring chronic outpatient infections: providing comprehensive home healthcare pharmacy services.

Management of acute illness has been increasingly shifted to community practitioners. Expansion of community pharmacy into home healthcare has brought new opportunities and responsibilities to community practitioners. These practitioners are gaining expertise in total parenteral nutrition, intravenous infusion systems, intravenous catheters, parenteral antibiotics, and clinical pharmacokinetics--areas historically managed by hospital and long-term care facility pharmacists. This shift to community pharmacy-based care has brought with it the need for community pharmacists to develop expertise in therapeutic monitoring of chronic disease states. Dose adjustment of medications based upon careful analysis of blood concentrations is no longer limited to institutional pharmacy practice. Community pharmacists now must master basic infectious disease principles and possess internal medicine knowledge to ensure appropriate monitoring of their patients. This article discusses several disease states currently managed with community pharmacy-based home healthcare, summarizing basic monitoring parameters for comprehensive patient care, and provides sample supply lists and documentation forms for home healthcare providers.