Microcomputer applications in hospital pharmacy practice.

Advances in microcomputer technology and the proliferation of applications software give hospital pharmacists the opportunity to manage their departments and provide services at higher levels of efficiency and sophistication than ever before. In a survey of clinical services in hospital pharmacies in the South Atlantic states, Perri, et al. note that pharmacies with computers (not necessarily microcomputers) provided significantly more services than those without computers. While other factors may explain the difference in the number of services provided, the observed relationship is no less intriguing. In order to keep pace with the changes in health care delivery, pharmacists, both managers and staff, must familiarize themselves with new technologies (such as the microcomputer) and incorporate them into their professional practice. Nold's reflections on the future of personal computing clearly state the challenge for the future: "Using a PC should be viewed as basic as reading, writing and arithmetic. By understanding the use of the PC and knowing the PC trends, pharmacists can evolve their practices and their profession for tomorrow's health care challenges."

Determining i.v. infusion rates for critical care drugs using a microcomputer.

Calculating intravenous (IV) infusion rates for critical care drugs can be a time-consuming and error-prone task. A microcomputer program was developed to: generate IV infusion rate charts that are both patient and drug-specific; provide the user with on-line drug information necessary to correctly prepare and administer the drug; and allow the user to rapidly perform individual dose-to-rate and rate-to-dose calculations. The program was written in BASIC programming language and runs in compiled form. It is completely menu-driven, requiring only single-keystroke commands. This program demonstrates that specific pharmacy software programs can be developed "in-house" easily and inexpensively.

Evaluation of computer-assisted instruction versus traditional new-employee training.

Personnel time and costs associated with computer-assisted instruction (CAI) and traditional "one-on-one" instruction in basic computer drug-order entry procedures were compared. Both programs consisted of an introduction to the training session, familiarization of users with the computer hardware and keyboard, and step-by-step instructions in unit dose and intravenous admixture order-entry procedures. The CAI module was developed by a pharmacist with no prior programming experience. It was designed to be used side-by-side with the actual inpatient pharmacy computer system. Fifth-year pharmacy students in their clinical clerkship rotation served as the study population. The personnel (both subject and pharmacy supervisor) time and costs associated with each method were evaluated for significant differences by a two-tailed Student's t test. Of 21 subjects who participated in this study, 11 received CAI and 10 received traditional instruction. CAI was associated with significantly less mean total personnel time (99.64 +/- 18.78 minutes) than one-on-one instruction (133.60 +/- 22.89 minutes). Mean total salary expense was significantly lower for CAI ($13.03 +/- 2.15) than for one-on-one instruction ($28.79 +/- 4.91). Program development time for the CAI module was 18.5 hours longer than that for the one-on-one program. The CAI module cost $1577.77 more to develop than the one-on-one program; however, 24 new employees would be required to offset development costs if the hardware were already available and 100 new employees if hardware had to be purchased. Computer-assisted instruction of new employees in computer order-entry procedures can be a cost-effective alternative to traditional training methods.(ABSTRACT TRUNCATED AT 250 WORDS)

Pleural effusions: pathophysiology and management with intrapleural tetracycline.

Chronic or recurrent pleural effusions are a consequence of a variety of disease states and may produce significant pain or discomfort in a patient. Both surgical and pharmacological attempts to control pleural effusions have been tried, with moderate success. This article reviews the pathophysiology of pleural effusion and the role of intrapleural tetracycline in its management. Irritating chemicals, when instilled into the pleural space, are known to produce adhesion of the pleural membranes. Tetracycline has been shown in both animal and human studies to be effective in preventing the recurrence of a pleural effusion while producing only minor side effects, such as fever and pleuritic pain. Studies involving tetracycline in treating pleural effusions are reviewed, and guidelines for the preparation and administration of intrapleural tetracycline are presented. Because of its efficacy, low toxicity, ease of preparation, ready availability, and low cost, tetracycline deserves strong consideration as a first-line agent in the management of recurrent pleural effusions.

Cost-effectiveness analysis as a tool to compare two methods of preparing and administering intravenous heparin solutions.

Thirty-six patients who received heparin infusions were prospectively monitored to determine costs involved in preparation and administration of heparin solutions and to determine the most cost-effective heparin concentration. Thirty-five courses of therapy were evaluated. All patients were treated with intravenous (IV) heparin in variable concentrations to allow for delivery of 20 ml/hour of solution (Standard Rate Method). Changes in dosing required preparation of a new solution. The average cost of a course of therapy was $36.62 +/- $23.98. Using a microcomputer, data for these courses of heparin were fitted to ten standard heparin concentration models. The solutions represented standard concentration models obtained from the pharmacy literature. Standard concentrations would allow for decreased preparation time and potential use of discontinued solutions. Of ten different standard concentrations evaluated, three (30,000 units/500 ml, 25,000 units/500 ml, and 25,000 units/250 ml) were found to be cost-effective when compared to the hospital's standard rate method. The potential cost savings of a standard heparin concentration in our institution is approximately $2000 each year.

The intensive care unit syndrome: causes, treatment, and prevention.

The psychological assessment and management of the critically ill patient is often overlooked as a part of the patient care plan. The intensive care unit (ICU) syndrome is a type of organic brain syndrome manifested by a variety of psychological reactions, including fear, anxiety, depression, hallucinations, and delirium. Causes, treatment modalities, and a multidisciplinary approach to preventing the ICU syndrome are presented. Causative factors that should be assessed in the psychological evaluation of ICU patients include: (1) preadmission history; (2) past ability to adapt to stress; (3) past and current medications; (4) current clinical status; and (5) environmental factors. The treatment of the ICU syndrome includes: (1) the correction or elimination of causative factors; (2) the appropriate choice, dose, and route of administration of anxiolytic and antipsychotic agents; (3) reduction or elimination of sources of environmental stress; and (4) frequent patient and family communication. Finally, the prevention of the ICU syndrome through the involvement of physicians, nurses, and pharmacists is stressed.