Computer-based system for maintaining and printing a hospital formulary

Use of a pharmacy department personal computer (PC) with database management and word processing (WP) systems to maintain a hospital formulary is described. Data input and formatting were accomplished with IBM-PC/XT-compatible equipment, the Nutshell (Leading Edge) database management system, and the Wordperfect (WordPerfect Corporation) WP system. Computer-generated pages were photocopied and placed in loose-leaf binders; reduced copies were made for pocket-size binders. The cost of an outside printing service was eliminated, and the loose-leaf format made it possible to replace only the pages with revisions. The large binders were prominently placed and clearly marked to encourage use by physicians; the number of copies needed was reduced because individual copies were no longer provided to each physician. Excluding first-year one-time costs, the annual formulary maintenance cost (for 250 copies) was projected to be approximately one sixth the cost incurred previously, when 1300 bound formularies were printed annually. Maintaining and printing the hospital formulary on a PC facilitated the updating of the formulary and reduced printing costs.     

Issues in implementing a real competency-based training and assessment system

"First, do no harm" is a medical admonition; but harm does occur. There is thus mounting pressure for Medicine to adopt more rigorous systems to ensure professional competency. Traditionally, medical education and professional development has focussed on developing clinical expertise and technical skills within each speciality. Recent studies into the causes of adverse events have highlighted that the failure of non-technical aspects of competency are more common than the failure of technical skills amongst health professionals. Traditional training has also focussed on the individual and yet error management strategies in organisations that require high reliability processes for maintaining safe practice puts the emphasis on the team. It is our contention that the delivery of safe patient care requires a redefinition of professional competency--in terms of the interface between members of the team, patients and the organisational and social requirements of the health system. A change to competency-based training and assessment will require a team-orientated definition of professional competency that may challenge individual professionals and the sovereignty of medical specialities.     

Cost effective method of implementing decentralized unit dose pharmacy services in a Friesen setting

A limited decentralized drug distribution system was implemented at the Graduate Hospital, a 310-bed Friesen Concept teaching hospital. This mobile system services 252 medical/surgical beds on three floors of the hospital. Operation was limited to hours of peak demand for pharmacy services and to initial doses. The system was able to reduce turnaround time from 217 minutes to 90 minutes for 80-85% of newly written orders. Further, the systems was found to increase the availability of the pharmacist as a reference source and to clarify unclear or inappropriate orders. This approach required no increase in full-time equivalents and minimal capital expenditure.     

Selective use of online literature searching by a drug information service

The use of online searching in a drug information center on a regular but selective basis is described. Of 90-100 information requests received monthly in a university-affiliated drug information center located within the health sciences library, five to eight computer searches are performed. All other questions are answered using a manual search. The computer searches are conducted by a medical librarian who works closely with the pharmacist. For each search, the library charges the drug information center for at least 12 minutes of connect time; charges cover the library's direct costs only. The drug information center is staffed by a director and assistant director; in addition, Pharm.D. students and clinical pharmacy residents work there. Factors influencing the decision to do an online rather than a manual search include budgetary constraints, how quickly an answer is needed, the success of a preliminary manual search, and the complexity of the request. Considerations for conducting online searches through a library rather than by the staff of the drug information center include requisite search skills, costs, and accessibility to computer search services. The selective use of online searches through a health sciences library is a viable means of accessing online information in a drug information center that cannot support its own online literature-retrieval system.     

Cost of implementing Veterans Administration directives for handling antineoplastic agents

Directives issued by the Veterans Administration central office for the safe handling of antineoplastic agents are described, and the costs associated with implementing these directives are reported. The directives are similar to other recent guidelines, including those issued by the Occupational Safety and Health Administration. Inventory records for a 12-month period were analyzed to determine the total number of doses of antineoplastic agents prepared and the total number of treatments administered at a 704-bed VA facility with a comprehensive cancer treatment program. For 3112 prepared doses and 2345 treatment regimens, the total cost of implementing the directives was $57,115, including $6,670 for the purchase of a vertical laminar-airflow hood. The VA central office directives represent reasonable guidelines for controlling the potential hazards of handling antineoplastic agents. Considerable expense is associated with implementing the directives; the degree of added expense will vary based on the particular hospital setting, the number of doses of antineoplastic agents administered, and the nature of the oncology services already in place.     

Developing and implementing a statewide formulary system: one state's experience

Prior to the Pennsylvania Department of Public Welfare (DPW) implementing a statewide formulary for its 21 mental health hospitals and mental retardation facilities, each facility had its own drug use policy. In many facilities, drugs were ordered with little or no cost-containment or drug-management consideration. To change drug purchasing and usage policies, a task force was created to develop a state formulary system. The task force appointed a formulary subcommittee to research and make recommendations on issues such as drug selections, formulary substitutions, and nonformulary drug use. The step-by-step process of developing and implementing the Pennsylvania DPW state formulary--including pitfalls and successes--is presented.     

Medline (PubMed)核医学杂志文献搜索引擎的研究

目的：为了方便核医学工作者快捷、准确地查阅核医学杂志文献,开发和利用NCBI的Medline数据库的核医学杂志文献资源。方法：从Medline(PubMed)中检索并列出72种有关核医学的杂志名录,制作了每种杂志及部分杂志年份相应的超级链接。结果：组成一个有关核医学杂志文献的搜索引擎。结论：此搜索引擎能快捷、准确、动态地检索72种核医学杂志全部文献题录及部分杂志各年的文献题录,并可在PubMed中进一步检索出文献的摘要和部分全文。     

Use and cost analysis of online literature searching in a university-based drug information center

The use of an online literature-retrieval system located within a university-based drug information center over a three-year period is described. The drug information center, which handles 50-100 questions/month, is equipped with a computer terminal and printer, as well as the standard printed reference sources. If a question cannot be answered in 10-15 minutes using general reference sources, a computer search is conducted. For the years 1979-81, the total number of online searches was determined. Data were also collected indicating the database accessed and the time spent for each search. The number of online searches performed for the successive years was 279, 397, and 274. Of these, 69% were conducted on the MEDLINE database. The average time for each search was 10.96 minutes in 1979, 6.40 minutes in 1980, and 8.54 minutes in 1981. The mean annual charge for online searching was $1772.32. Royalty fees and telecommunication charges for the respective years accounted for 23.5%, 32.6%, and 25.4% of the total bill. Online searching provides an efficient method of retrieving information, especially when questions are very complex. Drug information specialists handling many complex questions should consider acquiring the equipment and expertise to do online searches within their drug information center.     

Strengthening the formulary system by implementing a drug usage guidelines program

The development and implementation of a Drug Usage Guidelines (DUG) program in a 1,200-bed, federal teaching hospital are described. The program was designed to promote effective formulary control through established procedures for the review and evaluation of drugs submitted to the Pharmacy and Therapeutics (P & T) Committee for addition to the formulary. The procedures required the submission of the DUG and an oral presentation to the Committee prior to any final vote on the request. Anticipated potential benefits of the DUG program are to: (1) stimulate rational drug therapy, (2) provide reliable drug information to the professional staff in a usable format, (3) promote a thorough evaluation of therapeutic agents before approving for formulary inclusion, and (4) provide physician-generated guidelines for use as criteria in drug utilization review audits.     

The growth of treatment research in alcohol and drug use disorders: a computerized literature search

Index Medicus was searched to compare the number of articles on treatment trials for alcohol and for non-alcohol drug use disorders (abuse, dependence, withdrawal, intoxication, etc.) to that of two control conditions--anxiety and obesity--for the period 1967-1988. Over the entire 22 years, the number of articles for alcohol use disorders increased an average of 2.7 articles every 2 years and 5.8/2 years for drug use disorders compared to 5.7/2 years for obesity and 5.8/2 years for anxiety disorders. Over the most recent 8 years, articles for alcohol use disorders increased 7.7/2 years and for drug use disorders 7.9/2 years compared to--2.9/2 years and 12.0/2 years for obesity and anxiety disorders. The proportion of articles that cited using only pharmacotherapy decreased over time; however, studies of alcohol and drug withdrawal continue to almost exclusively use pharmacological therapies. We conclude that treatment research in alcohol and drug use disorders is growing as rapidly as that in similar psychological and psychiatric conditions and that such growth is not due to a focus on pharmacological treatments.     

Cost effectiveness of treatments for amyotrophic lateral sclerosis: a review of the literature

Amyotrophic lateral sclerosis (ALS) is a difficult to diagnose, fatal, progressive degenerative disease with an average survival time of 2 to 5 years. Percutaneous endoscopic gastrotomy (PEG) and bi-level intermittent positive pressure (BIPAP) ventilation may be the major interventions leading to longer survival of patients with ALS. Riluzole has been shown to have modest effects on survival (as opposed to functional) gains and is currently the only drug approved for the treatment of ALS. There is conflicting evidence with regard to the ability of recombinant human insulin-like growth factor (rhIGF-I) to retard ALS progression. Mechanical ventilation (via a tracheostomy tube) is expensive, but is widely used in later stage patients with ALS in the US. A review of nine cost-effectiveness studies of riluzole and one of rhIGF-I found the following: drug costs and survival gains are the major drivers of cost effectiveness; survival gains are estimated from truncated databases with a high degree of uncertainty; more accurate stage-specific utility weights based on patients who agreed to treatment are needed; case incidence-based evaluations should be carried out; cost-effectiveness ratios are insensitive to discount rates; employment and caregiver issues or externalities have been widely ignored; threshold acceptance cost-effectiveness values are ill-defined and evaluations are not generalisable to other countries because of cost and treatment style differences. On account of the high degree of uncertainty pertaining to survival gains and the relatively high costs per life years or quality-adjusted life-years gained, and while acknowledging that not every therapy has to be cost effective (e.g. orphan drugs), it is still inconclusive as to whether or not riluzole or rhIGF-1 can be considered as cost-effective therapies for ALS.     

Implementing and maintaining a private pharmacokinetics practice

The development and maintenance of a private-practice pharmacokinetics service is described. A contracted pharmacokinetics service has been in place at Georgia Baptist Medical Center, a 525-bed hospital, for the past eight years. Physician support, inhouse study results, and literature documentation of the benefits of scheduling drug concentration determinations were used to convince hospital administrators of the value of a pharmacokinetics service. Services were reimbursed by increasing the fee charged for each drug concentration determination, with payment made to the pharmacokinetics service on a monthly basis. The service is associated with the pathology department for administrative purposes. Each member of the pharmacokinetics service is credentialed by the medical staff. The group trains part-time personnel to provide services when needed. Services provided by the group but not required by the contract include collecting quality assurance data, conducting research, serving on hospital committees, writing newsletter articles, conducting inservice-education programs, and providing clinical interventions for nonconsultation patients. This private-practice pharmacokinetics service provides high-quality services and is well accepted within the institution.