A novel comprehensive DUE program--five years of experience.

A comprehensive program has been developed to evaluate prescribing practices in diverse drug therapy categories and in all areas of the institution. Input for topic selection comes not only from the pharmacy department, but also from QA, medical staff, and nursing. The development of monitoring criteria and review of the results by the P&T Committee, Medical Executive Committee, and other key medical staff members, promotes ownership of the program by the medical staff. The benefit of this ownership is active support for the program and participation in peer review. Overall, the results of this cost-effective program include limited use of broad spectrum antibiotics, select prescribing of high-risk drugs, and focused educational efforts to improve quality of patient care. The primary goal for the future of the program is to develop criteria and documentation mechanisms for reporting measurable clinical outcomes. In making the transition, it is important to use the success and impact of the current program as the foundation. This is particularly true for the concurrent monitoring program and its immediate feedback mechanism. The major challenge will be evaluating negative clinical outcomes and developing corrective actions as well as documenting the positive outcomes and the avoidance of negative outcomes of the current program. To meet this challenge, the DUE program must be integrated with all other institutional QA programs. Although a difficult task, this is a significant yet necessary step in the right direction for assuring optimal patient care.

Point-of-service computer system and drug-use evaluation: implications for pharmacy practice in ambulatory care.

The point-of-service (POS) computer system and its possible effects on ambulatory-care pharmacy practice are described. The POS system, a key component of the Medicare Catastrophic Coverage Act, is an electronic claims-transmittal device to be installed in community pharmacies. The system transmits information about the patient and the prescribed drug to a claims processor, which verifies the eligibility of the patient for Medicare drug benefits, determines the amount of payment allowed, and sends information back to the POS terminal in less than 30 seconds. Because prescription information can be consolidated into a central data pool, drug-use patterns can be reviewed. The system will also permit automated screening of drug-drug interactions. Problems posed by the POS system relate to (1) the lack of a claims-transmittal device that can communicate with all claims processors, (2) the lack of a direct interface between the POS system and all pharmacy computer systems, (3) the expense of training personnel to operate the POS system, (4) the cost incurred by pharmacies in installing the POS system, and (5) the conflict between protecting the privacy of a patient's drug profile and permitting the monitoring of drug interactions. The catastrophic coverage act proposes that POS data be used to assess the appropriateness of drug use with a focus on outcome and quality-of-care issues; for the full intent of the act to be achieved, the components of an effective drug-use-evaluation program must be employed. Drug-use evaluation should eventually decrease health-care costs and improve quality of care.(ABSTRACT TRUNCATED AT 250 WORDS)

Compatibility of medications with enteral feedings.

Administration of medications to patients with nasogastric tubes has traditionally been done in a bolus fashion. An alternative to this would be to mix the medications in the continuous drip enteral feeding with subsequent continuous administration. The purpose of this study was to determine the compatibility of select medications with Ensure, Ensure Plus, and Osmolite. We observed neither visible abnormalities in the mixtures nor change in pH of the enteral products after the addition of digoxin, theophylline, phenytoin, methyldopa, or furosemide. The addition of theophylline to all three enteral products caused a substantial increase in the osmolality. We also examined the concentrations of the mixtures to detect any changes occurring over the 12-hr infusion time. A wide variation in concentrations after the addition of phenytoin suspension was corrected by adding the injectable form to the enteral products. Digoxin and furosemide concentrations were essentially unchanged; however, the methyldopa concentration decreased up to 23% over the 12-hr study period. We, therefore, cannot recommend the addition of theophylline, phenytoin suspension, or methyldopa to the three enteral products tested.

Stability of nitroglycerin injection determined by gas chromatography.

The stability of nitroglycerin injection was studied over an eight-week period. Gas-liquid chromatographic assay and thin-layer chromatography were used to study the stability in relation to sorption by rubber and plastic (Viaflex), light and the effect of two diluents (5% dextrose in water and 0.9% sodium chloride for injection). More nitroglycerin was lost from vials with rubber closures, and the loss occurred at a faster rate when compared with nitroglycerin packaged in ampuls. There was no difference in the loss of nitroglycerin from injection packaged in ampuls when stored in the light or in the dark, or in the loss of nitroglycerin from two diluents, 5% dextrose in water and 0.9% sodium chloride for injection, packaged in glass bottles. A 70.4% greater loss of nitroglycerin occurred from Viaflex bags than from glass bottles. Loss of nitroglycerin in this study may have been characterized by reversible first-order kinetics.