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A quality assurance (QA) technique that measured process and outcome was tested on a clinical pharmacokinetic dosing service (CPDS). The process measurement criteria evaluated the CPDS pharmacists' ability to maintain serum aminoglycoside levels within the desired range (peak 6-10 micrograms/ml, trough less than 2.0 micrograms/ml). The outcome measurement criteria evaluated the patients' clinical response to the aminoglycoside therapy based on changes in the patients' temperature, white blood cell count, bacterial cultures, and other variables. The process evaluation found that in a majority of the patients (80 percent), the CPDS pharmacist was performing at a level exceeding the process criteria. The outcome evaluation found that in a majority of the patients (76 percent), the therapeutic outcome criteria were not met. Statistical analysis using Spearman's Rho was not able to relate process and outcome measures significantly (p greater than 0.05). The patient outcome criteria may not have accurately measured patient outcome because of inflexibility, not measuring other patient variables, and the lack of a subjective component. Validation of the QA technique was not possible in this study.

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Differences in outcome between patients whose aminoglycoside dosing regimens were individualized by a clinical pharmacokinetic dosing service (CPDS) and patients who did not receive CPDS consultation were evaluated by retrospective chart review. Data for a number of dependent variables that might affect patient outcome were collected from the medical records of 42 patients with culture-proven gram-negative pneumonia or sepsis who had received CPDS dosing consultations and 60 similar patients who had not received CPDS consultations. Data were also collected for a number of analytical and categorical independent variables to evaluate sources of variation between the groups. Variables were compared using both parametric and nonparametric statistical tests. For patients whose dosing regimens had been individualized by the CPDS, length of aminoglycoside therapy and length of stay were significantly shorter, changes in serum creatinine concentration from baseline were significantly smaller, and mortality was significantly lower; morbidity was reduced by significantly fewer incidences of aminoglycoside nephrotoxicity. Significant differences existed between the mean dosing intervals, mean numbers of serum aminoglycoside concentration determinations, and mean baseline serum creatinine concentrations for the two groups. Although a favorable difference in patient outcome was demonstrated for patients whose dosing regimens were individualized by the CPDS, unmeasurable differences between the two groups of patients make it difficult to attribute the difference solely to the effect of the dosing service.

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Every pharmacist, whether in the hospital or in a community environment, faces the daily possibility of a holdup, burglary, or forged prescription. Statistics on drug-related crime are on the upswing as an increasing number of perpetrators recognize that wholesalers and hospitals are large depots of injectable narcotics and controlled substances. In response to this, many Federal drug crime laws and increased security have been proposed. This report identifies many types of security devices available to provide early warning or deter robberies. They include perimeter security systems, motion detectors, surveillance cameras, bullet-resistant windows, and key-lock systems. This report also suggests several considerations to be used in developing a security system in a hospital pharmacy. A basic understanding of security devices will enhance the manager's ability to choose the appropriate devices(s) for a particular service.

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The development and evaluation of a training manual for pharmacists participating in cardiopulmonary resuscitation (CPR) efforts at an institution encompassing ambulatory-care, acute-care, and emergency-trauma facilities are described. The manual was developed to familiarize pharmacists who had little or no experience in CPR procedures with the equipment and medications used and the pharmacist's role on the CPR team. To evaluate the effectiveness of the manual, a 29-question multiple-choice test was administered to 35 staff pharmacists who were randomly assigned to study and control groups. Training manuals were issued to members of the study group, who were asked to document time spent studying them. Three weeks after the pretest, the same test was administered to all subjects. There was no control on the number of CPR events attended during the three-week period. The study group spent less than two hours (mean +/- S.D. = 97.5 +/- 34.22 min) using the manual. For the study group, posttest scores were significantly higher than pretest scores. The difference in pretest scores for the study and control groups was not significant, but for the posttest the study group scores were significantly higher. Because use of the manual appeared to improve knowledge of drug therapy and procedures used in CPR, the pharmacy department incorporated it into its orientation procedure.

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A method of preparing cytopathology specimen collection bottles with a heparin solution is described. The need and benefits of using heparinized bottles for the collection of body cavity fluids are discussed briefly. The formulation of the heparin solution and procedure for preparation of the bottles are given in detail. Collection techniques are discussed briefly. Use of the heparinized bottles results in more reliable diagnostic procedures.

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The manufacture and assay of progesterone suppositories by a hospital pharmacy department are described. The compounding formula and procedures are presented. The product is used to treat luteal phase insufficiency.

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