Survey of wastage from intravenous admixture in US hospitals.

The purpose of this study was to assess current wastage from intravenous systems designed for intermittent use in US hospitals. Questionnaires were mailed to pharmacy directors at 1393 randomly selected hospitals. Respondents were asked to indicate their overall percentage intravenous wastage rate, intravenous admixture policies and procedures, and wastage rates for currently used intermittent intravenous drug delivery systems. If actual data were not available, respondents were asked to provide estimates based on their perceptions of waste. A total of 237 (17.0%) usable responses were returned. The mean intravenous wastage was 2.85% (+/- 3.40) for respondents who provided actual values and 4.28% (+/- 3.83) for respondents who provided estimated values. Lower mean wastage rates were found for hospitals which: (a) received written notification of discontinued intravenous systems; (b) had an elapsed time of less than or equal to 1 hour from discontinuation of the intravenous system to notification in the pharmacy; (c) actively retrieved discontinued intravenous systems from the nursing unit; and (d) had a daily return of discontinued intravenous systems to the pharmacy. Based on actual values provided by respondents, for 9 intravenous systems the mean wastage rates were lowest for commercially prepared intermittent systems such as frozen piggyback systems {1.5% (+/- 1.4)} and piggyback systems stored at room temperature {3.2% (+/- 5.2)}, and 4.4% (+/- 16.0) for nursing-activated ADD-Vantage systems. We expected that pharmacy managers would monitor waste regularly and be able to provide actual values for wastage rates. However, only 124 (53.3%) of the respondents provided actual data.(ABSTRACT TRUNCATED AT 250 WORDS)

Perspectives on pharmacy-coordinated drug administration programs.

This article has described the history, operation, and impact of a pharmacy-coordinated drug administration program that existed for 20 years. It enabled pharmacy to reduce medication errors and expand its clinical role. It is not clear whether medication error rates have increased or will increase as a result of transferring this responsibility back to nursing. The clinical programs have been well established, so that their existence no longer depends on the program. Recent audit results suggest that pharmacy-nursing relations are not as good. PCUDDA programs still have a logical place in organized health care settings, particularly in view of the nursing shortage and nursing salaries. The program has clearly proven to be safe and effective and to reduce the incidence of medication errors. It is also likely to reduce cost. It is unfortunate that decisions about programs such as PCUDDA are often made on the basis of professional turf and politics rather than on patient care and economic factors, which should be the basis for such decisions.

Perception of the role of medical-service representatives in hospitals.

How sales directors of pharmaceutical manufacturing firms and hospital pharmacy directors perceive the role of medical-service representatives (MSRs) in hospitals was studied. Pharmacy directors at U.S. hospitals and sales directors of Pharmaceutical Manufacturers Association member firms were surveyed by questionnaire in February 1988. Respondents were presented with a list of 13 product-related services and a list of 11 professional and informational services; they were asked to use a five-point scale to indicate how important they believed each service was and how frequently they believed that most MSRs performed the service. A total of 251 (47.0%) usable questionnaires were returned from the hospital pharmacy directors, and 35 (38.5%) were returned from the pharmaceutical sales directors. Hospital pharmacy directors perceived professional and informational services as more important than product-related services. The results suggest that pharmacy directors would like MSRs to place more emphasis on (1) providing drug information to pharmacy before promoting their products to physicians, (2) supporting the role of the clinical pharmacist in promoting appropriate and rational use of a product, and (3) complying with pharmacy and therapeutics committee formulary decisions. Compared with sales directors, pharmacy directors placed less emphasis on information about new dosage forms, assistance in drug recalls, and assistance in obtaining hospital-specific pricing. Differences in perceptions of the role of MSRs exist between hospital pharmacy directors and sales directors of pharmaceutical manufacturing firms.

Growth of bacteria and fungi in total nutrient admixtures.

Total nutrient admixtures (TNAs) containing dextrose, amino acids, and fat emulsion were evaluated for their ability to support bacterial and fungal growth. The following solutions were tested: a standard adult total parenteral nutrient (TPN) solution with dextrose, amino acids, and electrolytes, a standard neonatal TPN solution with dextrose, amino acids, and electrolytes, a 10% fat emulsion, a 20% fat emulsion, a TNA with 40% of the total calories as fat, a TNA with 25% of the total calories as fat, a neonatal TNA with 25% of the total calories as fat, a control (fat emulsion was replaced with an equal amount of sterile water) for solution 5, and a control for solution 6. Serial dilutions of each solution were inoculated with 5 X 10(5) bacteria/mL or 5 X 10(3) fungi/mL, incubated, and visually rated on a scale of 0 (no growth) to 4 (maximal growth). Bacterial growth of Pseudomonas aeruginosa, Staphylococcus aureus, Staph. epidermidis, Streptococcus faecalis, and Group JK Corynebacterium was greater in the TNA solutions than in the control or standard TPN solutions. Escherichia coli, Candida tropicalis, and C. albicans grew in all solutions tested. Torulopsis glabrata grew better in solutions that did not contain fat emulsion. Growth characteristics did not differ significantly between the adult and neonatal (more dilute) solutions. The addition of fat emulsion to TPN solutions enhances the ability of these solutions to support bacterial growth; this possibility must be considered when evaluating patients for this type of total parenteral nutrition therapy.