Quality of pharmacists' documentations in patients' medical records.

Training pharmacists to appropriately document patient-specific problems and recommendations in patients' medical records and subsequent monitoring of pharmacist-written documentation are described. The medical staff of a tertiary care teaching hospital recommended that pharmacists be allowed to write in the permanent portion of patients' medical records. A six-month pilot program was approved to train pharmacists in writing chart notes. Notes would be assessed according to the following criteria: necessity (i.e., a chart note was the appropriate means of communication), clarity, legibility, completeness, correct format, and lack of judgmental language. Initial training was by physicians from the pharmacy and therapeutics committee, with more extensive training by a committee composed of clinical and administrative pharmacists. After training ended, each pharmacist's first few notes were reviewed by a member of the pharmacy committee. The quality of pharmacist-written notes is reviewed quarterly. The first quarterly evaluation and another review 1 1/2 years later showed that all pharmacist notes met all of the established criteria. A multidisciplinary approach was effective in training pharmacists to document interventions appropriately in patients' permanent records. Ongoing monitoring ensures the continuing quality of such documentation.

A stepwise approach to the evaluation and selection of a hospital pharmacy information system.

The current demands for cost reduction, increased efficiency, and quality care placed upon hospital pharmacy departments underscores the need for an effective information system. In this article, we describe the stepwise approach we used to evaluate and select a new pharmacy information system. The importance of involving staff in the evaluation process is discussed, along with the mechanisms we used to learn as much as we could about the vendors before making our selection.

Pharmacist-directed heparin therapy using a standard dosing and monitoring protocol.

Use of a protocol for pharmacist determination of heparin sodium dosages administered by continuous i.v. infusion was evaluated by retrospective chart review in a California hospital. Charts of adult medical-surgical patients who received heparin infusions between June 1982 and December 1983 were reviewed for the following information: patient sex, age, and reason for receiving heparin; times, dates, numbers, and values of coagulation tests before and during heparin therapy; times, dates, and values of prothrombin time determinations during conversion to warfarin therapy; and times, number, and costs of heparin infusions. Charts were divided into two groups: those of patients for whom physicians prescribed heparin doses empirically and those of patients for whom physicians requested heparin dosing by the pharmacy department. Data were evaluated for 62 patients in the physician-dosed group and 26 patients in the pharmacy protocol group. Pulmonary embolism was the reason for heparin therapy in 34% of the physician-dosed patients and only 15% of the pharmacist-dosed patients. Pharmacists using the protocol ordered fewer anticoagulation tests and fewer heparin infusions per patient. Time from the start of heparin therapy to therapeutic anticoagulation was shorter in patients whose heparin dose was determined by the protocol, and values in the therapeutic range were achieved in a greater percentage of these patients than in the empirically dosed patients. Pharmacists using a standard dosing protocol effectively initiated and maintained heparin therapy that compared favorably with physician-dosed empiric therapy.

Achieving pharmacist proficiency in pharmacokinetic dosage adjustments.

A pharmacokinetics training and certification program for staff pharmacists in a community hospital is described. A pharmacokinetics committee consisting of six pharmacists with extensive clinical experience in pharmacokinetics was formed to implement the program. A self-teaching module incorporating basic pharmacokinetic concepts and sample problems was developed. Specific guidelines for calculating dosages of the aminoglycosides and theophylline were also developed, as were indications for the appropriate ordering and serum sampling of these drugs. These guidelines were used in the didactic training of pharmacists, and their knowledge of this information was evaluated by written examinations. Pharmacists were also required to calculate drug dosages for patients in the hospital. These pharmacokinetics calculations were evaluated by the pharmacokinetics committee at periodic meetings. Of the 12 pharmacists included in the training program initially, 9 completed the entire training and certification process. All new pharmacists are now required to obtain certification in pharmacokinetics; yearly recertification of all pharmacists is obtained by participation in patient case presentations involving calculation of drug dosages. This pharmacokinetics training program ensures a standard level of competency among staff pharmacists and may increase physicians' reliance on pharmacists for adjusting drug dosages.