Drug-use evaluation programs for psychotropic medications.

Drug-use evaluation (DUE) programs for psychotropic medications at a state-operated mental health center are described. DUE programs were developed at Western Missouri Mental Health Center to monitor prescribing of medications in the hospital and ambulatory-care settings. DUE criteria were developed for all major groups of psychotropic medications: antipsychotics, antidepressants, antianxiety and hypnotic agents, lithium, and antiparkinsonian drugs. The criteria appear on special forms developed for the programs; pharmacists use these forms to evaluate every medication order for inpatients and every 50th medication order for ambulatory-care patients. Physicians are alerted to noncompliant prescribing practices by memorandum, oral consultation, or both. In 3204 inpatient DUEs conducted from July 1986 to December 1988, orders for antiparkinsonian drugs showed the poorest compliance with DUE criteria. In both the hospital and ambulatory-care settings, antiparkinsonian agents required the most follow-up. The overall compliance rate for inpatient DUEs was 84%; for ambulatory-care DUEs, the compliance rate was 64%. As a result of the ambulatory-care DUE program, basic laboratory studies and dyskinesia rating scales are being ordered on a more timely basis. These DUE programs have increased pharmacist monitoring of patient care and improved documentation of medication use.

Comparison of videocassette and personal instruction methods for training pharmacy personnel in aseptic technique.

A videocassette self-instruction method of aseptic-technique training was compared with a one-on-one instructor-trainee method to determine the effectiveness and cost of each method. Pharmacy department personnel and pharmacy students with no previous training in aseptic technique were randomly assigned to receive either personal or videocassette instruction. The trainees completed an identical set of practice activities. Three measures were used to determine competency in aseptic technique: written testing on information presented, direct observation monitoring of trainees' technique in preparing broth admixtures, and sterility testing of end products. A total of 28 individuals participated in the study, 14 in each group. Trainees in the group receiving personal instruction had significantly higher overall test scores than did trainees receiving videocassette instruction. Trainees receiving videocassette instruction had more difficulty in aseptic manipulation of needles, syringes, vials, ampuls, bottles, and bags; in properly cleaning the laminar-airflow hood; and in inspecting the prepared admixtures. However, no broth admixture in either group showed evidence of microbial growth. The personal instruction method was more than two and one-half times as expensive as the videocassette method. A combination of videocassette instruction in aseptic technique and instructor intervention during the training process should result in a cost-effective training method.