A community-pharmacy-based callback program for antibiotic therapy.

OBJECTIVE: To develop a telephone callback program to reinforce basic patient counseling given at the time of dispensing. DESIGN: At the time each prescription was filled, the pharmacist or pharmacy student recorded the patient's name, telephone number, date of birth, diagnosis, drug regimen, prescriber, relevant concurrent medications, initial comments, and date. Follow-up phone calls were then made when appropriate to assess patient progress in therapy. RESULTS: Telephone assessment of 521 patients revealed that while 51.1% reported their condition had improved, 15.1% had worsened. Of the 79 therapeutic failures, 47 patients repeated the initial therapy or received a different antibiotic without another physician visit, 32 were referred back to their physicians, and 5 each resulted from noncompliance or adverse effects. CONCLUSIONS: A callback program is an effective and inexpensive mechanism for assessing and improving drug therapy outcomes.

Compatibility and stability of ondansetron hydrochloride, dexamethasone, and lorazepam in injectable solutions.

The stability of ondansetron hydrochloride, dexamethasone sodium phosphate, and lorazepam in 5% dextrose injection or 0.9% sodium chloride injection in polyvinyl chloride (PVC) minibags and glass bottles was studied. Triplicate solutions of 8 or 32 mg of ondansetron (as the hydrochloride salt) mixed with 20 mg of dexamethasone phosphate (as the sodium salt) with or without 2 mg of lorazepam were compounded in 50-mL PVC minibags and glass bottles containing either 5% dextrose injection or 0.9% sodium chloride injection and stored at 23-25 degrees C. Duplicate measurements were performed when drugs were added and at 1, 2, 4, 8, and 24 hours after addition. Samples of the 32-mg ondansetron admixtures were collected under aseptic conditions to inspect for precipitation and to count particles with a laser particle analyzer. Samples of all admixtures were evaluated for chemical stability by stability-indicating high-performance liquid chromatography. Ondansetron hydrochloride and dexamethasone were physically compatible and chemically stable for up to 24 hours under the study conditions. The concentration of lorazepam in PVC containers dropped below 90% of the original concentration within four hours. In addition, particle counts in lorazepam-containing solutions were higher when 0.9% sodium chloride injection was the diluent than when 5% dextrose injection was the diluent. In admixtures containing all drugs, ondansetron hydrochloride and dexamethasone sodium phosphate in 5% dextrose injection or 0.9% sodium chloride injection were stable for up to 24 hours when stored in PVC bags or glass bottles.(ABSTRACT TRUNCATED AT 250 WORDS)

National survey of quality assurance activities for pharmacy-prepared sterile products in hospitals.

The results of a survey of pharmacy department activities for quality assurance in the preparation of sterile drug products in short-term, nonfederal hospitals are reported. A questionnaire was mailed in March and April 1991 to pharmacy directors at hospitals that had indicated in ASHP's 1990 national survey of pharmaceutical services that they had formal quality assurance processes for intravenous admixture preparation. The adjusted gross sample size was 465. The net response rate was 71% (330 usable replies). Nearly all respondents indicated that sterile drug products were prepared extemporaneously in their departments; 61% reported batch preparation of such products. Both pharmacists and pharmacy technicians prepared sterile products. Respondents identified which guidelines were used in developing departmental policies and procedures for sterile product preparation. Specific areas were identified in which educational programs for pharmacists are needed; the most frequently indicated area (85%) was principles of aseptic technique. A majority of respondents used the following means for the orientation and training of personnel who prepare sterile products: aseptic technique lectures or videotapes, on-the-job training, written policies and procedures, and direct observation of technique. Almost all of the respondents (99%) had laminar-airflow hoods in their departments. Three fourths of those respondents indicated that laminar-airflow hoods were located in a limited-access room. Half of the respondents reported that laminar-airflow hoods were located certified every six months and that prefilters were changed monthly. Less than one third sampled environmental areas for microbial contamination. Less than one third of the surveyed hospitals routinely sampled sterile products for microbial contamination or pyrogens. Almost half indicated the absence of policies and procedures for testing chemical purity, drug concentration, sterility, pyrogenicity, or the environment for sterile preparations. Few respondents indicated the use of sterilization techniques other than microbial filtration, which was used by 32% of pharmacies involved in extemporaneous preparation and 16% of those involved in batch preparation. About 90% of the respondents used published references and manufacturers' recommendations to determine expiration dating. This survey revealed that certain quality assurance procedures related to pharmacy-prepared sterile products need major improvement.

Anabolic steroids--a review of the clinical toxicology and diagnostic screening.

Anabolic steroids have been used by athletes since the 1950s to increase size and strength in order to improve their performance. The abuse of these substances has since expanded to include junior high and high school male and female athletes and non-athletes. The anabolic and androgenic effects of these agents, when taken in the doses needed to produce increases in size and strength, result in significant serious adverse effects involving the skin, liver, cardiovascular, musculoskeletal, endocrine and reproductive systems. Some of these effects are irreversible. It is essential that clinical toxicologists, emergency room physicians and psychiatrists are familiar with the physical and psychological effects, as well as the changes in laboratory parameters, that typically occur from chronic use of anabolic steroids. The toxicities and representative clinical profiles of steroid users are presented, and the methods available for diagnostic screening using psychological testing and urine analysis are also reviewed.

Development and use of an automated clinical pharmacy services documentation system.

Clinical pharmacy practice has been shown to have a positive impact on patient care in hospitals, but is still the subject of much scrutiny in light of the current status of reimbursement for health care in the institutional environment. Although a number of systems have been utilized in an attempt to document workload and the impact of clinical pharmacy services, the ideal system has yet to be developed and methods for assessing the data generated are limited. This paper describes the development of an automated clinical pharmacy services documentation system which is interactive with database management, word processing, and statistics software. The present and future utilization of this system at the University of Nebraska Hospital and Clinics is discussed.

Preparation and sterilization by filtration of Renacidin irrigation.

A method for the sterilizing filtration of Renacidin, a urologic irrigating solution, was evaluated. Renacidin irrigation was prepared and sterilized by microporous membrane filtration. A sterilizing membrane filtration apparatus was challenged by inoculating a batch of irrigation solution with Escherichia coli. The sterility of both intentionally contaminated and routinely prepared batches was evaluated. The stability of the solution was monitored by pH measurement, visual examination, maintenance of a vacuum, and absorbance spectrum of a 1:100 dilution in deionized water over a wavelength range from 400 to 200 nm. The time required to prepare three one-liter units was about two hours. No microbial growth was detected in any of the samples. The predicted minimum shelf-life at 10 degrees C was six months. Because the prepared solution contains some unreacted citric acid and bicarbonates, storage at room temperature could produce excessive pressure inside the container from carbon dioxide gas evolution. Refrigerated storage is recommended. This method for the preparation and sterilization of Renacidin irrigation is reasonably expedient, economical, and reliable.

Lorazepam solubility in and sorption from intravenous admixture solutions.

The solubility of lorazepam in aqueous i.v. solutions and the potential for lorazepam sorption from i.v. admixtures in flexible polyvinyl chloride (PVC) bags and tubing were determined. The solubility of triplicate samples containing 15 mg of lorazepam and 20 ml of deionized water, 5% dextrose, lactated Ringer's, or 0.9% sodium chloride injections was determined. The decrease in lorazepam concentration from a 40-micrograms/ml admixture solution in 5% dextrose injection stored in PVC bags was calculated. Duplicate samples of (1) 50 ml in 50-ml PVC bags, (2) 100 ml in 50-ml PVC bags, and (3) 100 ml in 250-ml PVC bags were laid flat to approximate surface areas of 80, 160, and 270 sq cm, respectively, to determine sorptive loss. The continuous flow sorption of lorazepam from duplicate admixtures was tested at three rates through 180- and 350-cm PVC tubing. The solubility of lorazepam in deionized water, 5% dextrose, lactated Ringer's, and 0.9% sodium chloride injections was 0.054, 0.062, 0.055, and 0.027 mg/ml, respectively. Lorazepam solubility was pH dependent. The decrease in lorazepam concentration from the admixture solution stored in PVC bags for up to 121 hours followed biexponential kinetics that account for both the sorptive loss of the drug and the increasing ratio of bag surface area to solution volume. At least 90% of the initial concentration was maintained for five and two hours when the ratio was less than 2.0 and 2.7-2.8 sq cm/ml, respectively. The admixture solution retained a minimum of 95% of initial concentration when 50-ml aliquots were delivered at 600, 200, and 100 ml/hr through both sizes of PVC tubing. Because of its adequate aqueous solubility and slow sorption by PVC delivery components, lorazepam is suited for dilution in i.v. admixtures for treating conditions with intermittent or continuous infusions.