The use of patient instructors to teach interviewing skills.

A program which utilizes patient instructors (PI) to teach and evaluate interviewing skills of pharmacy students is described. The PIs were programmed with a history of either hypertension, chronic pulmonary disease, or congestive heart failure. Content areas within each history included past and present drug therapy, adverse drug reactions, drug interactions, as well as socioeconomic and other factors affecting therapy. The interviews were done with small groups of students and followed by PI evaluation of interview content and process. The majority of students felt the experience helped them assess and improve their interviewing skills and agreed the program should continue. The advantages of utilizing PIs to teach interviewing skills are discussed.

Evaluation of various methods of digoxin dosing.

The ability to precisely predict serum digoxin concentrations using 12 published methods in a group of 85 patients was undertaken. Two methods of estimating creatinine clearance and two estimates of ideal body weight were employed as input variables using the 12 dosing methods. This resulted in 40 relationships from which correlation coefficients and linear regression constants were derived for predicted versus measured serum digoxin concentrations. The correlation coefficients between predicted and measured serum digoxin ranged from -0.393 to 0.389. Possible explanations for the low correlation coefficients are interpatient variability in the kinetics of digoxin, the small number of subjects used to generate some of the digoxin dosing methods, undetected patient noncompliance in the present study, the use of empirically derived dosing methods, and/or the use of rather homogeneous patient populations to develop a given method while this study is comprised of a heterogeneous group of patients. The methods studied tend to overpredict serum digoxin concentrations and therefore generally allow safe, first approximations for digoxin dosing.

Limitations of a portable infusion pump in ambulatory patients receiving continuous infusions of anticancer drugs.

The delivery of continuous iv bleomycin and 5-fluorouracil to nine ambulatory cancer patients was studied using a novel disposable portable infusion pump, the Ar/Med Infusor. Although the chemotherapy was satisfactorily delivered, there were significant mechanical problems, including variable flow rates and substantial drug cartridge failure. Most therapy courses were finished within 10% of the projected termination time. Serious venous complications did not occur. While further exploration of various devices for outpatient continuous iv therapy is recommended, we believe that technical improvements are needed for the Ar/Med Infusor.

Activity analysis and cost study of clinical pharmacists practicing in a university medical center: comparison with previously established criteria.

The activities of three staff clinical pharmacists practicing in a university medical center hospital were studied using work sampling direct observation techniques. The results of the activity analysis were compared with the functional criteria of the Task Force on the Pharmacist's Clinical Role. It was found that the clinical pharmcists devoted a large portion (72.36 percent) of their total practice time to accomplishing professional activities. A very low percentage (2.27) of time was observed to be spent in nonproductive idle time. The cost to provide clinical pharmacy services to the 165.23 average census of inpatients supported by the clinical pharmacists was calculated to be $1.18 per patient per day. It was concluded that the observed pharmacists were highly motivated and provided a wide variety and extensive amount of professional clinical pharmacy services. Recommendations were made calling for research of other clinical pharmacy practice models, standardization of pharmacy activity terminology, determination of clinical pharmacy outcomes and identification of motivational factors present in the study model environment.

The pharmacy clinic: a new approach to ambulatory care.

A pharmacy clinic was established to provide consultation and services to practitioners and patients in the ambulatory care department of a Veterans Administration hospital. Among the services provided by the pharmacist are drug therapy consultations and monitoring, drug use review, drug information, and patient education. The pharmacy clinic assures the staff of the pharmacist's availability for consultation, allows the pharmacist to better organize the time required for consultation, makes the services of the pharmacist available to all outpatients, and provides a good training environment for students.

Neonatal medication surveillance by the pharmacist.

Data on prenatal, labor and delivery, and postnatal medication exposure to neonates were collected. During an 11-week period, 100 neonates consecutively admitted to a hospital were studied. The pharmacist obtained a social and medication history from the mothers and reviewed maternal anesthesia records and the charts of the neonates. Fifteen definite and possible adverse medication reactions were detected in 13 neonates. The median number of different medications ingested prenatally was 4.7. The four most commonly ingested prenatal medications were vitamins (97%), iron preparations (90%), headache/pain/arthritis medications (68%) and antinausea/vomiting medications (40%). The most commonly used medications during labor and delivery were oxytocin (73%), meperidine (33%) and promazine (25%). The use of strong narcotics during this period produced neonatal respiratory depression in some cases. The four most commonly prescribed postnatal medications were vitamin K1 (100%), gentamicin (10%), ampicillin (8%) and Poly-Vi-Sol (6%). The maternal interview indicated that most mothers were unaware of the influence that many medications can play upon the fetus. It is recommended that the pharmacist conduct a maternal medication interview prior to labor and delivery.

Pharmacist as applied pharmocologist in association with a pediatric clinical pharmacologist.

The ability of a pharmacist to act as an applied pharmacologist and assist the pediatric clinical pharmacologist in providing influential drug information to attending pediatricians was studied. One hundred consecutive admissions to a pediatric unit of a university hospital were studied. The pharmacist, acting as a member of the department of pharmacology, attended ward rounds and closely followed patient therapy. He attempted to provide all information requested by the attending team of pediatricians and identify all problems in therapy without involving the pharmacologist. Regular meetings were held with the clinical pharmacologist in which the pharmacist made patient presentations and sought assistance in answering those requests for which he had been unable to provide sufficient information. The information provided by the pharmacist during the patient presentations was judged adequate for the clinical pharmacologist's evaluation of patient therapy 96% of the time. The pharmacist successfully answered 81% of the information requests and made 88% of the recommendations directed at change in therapy without involving the pharmacologist. It was concluded that the pharmacist performed successfully as an applied pharmacologist in this study.