Hospital Pharmacy

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program, which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800–233–7767 (800–23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below.

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column focuses on the commercially available and investigational agents used to treat malignant diseases, reviewing issues related to the preparation, dispensing, and administration of cancer chemotherapy.

Meperidine (Demerol) is an opiate analgesic that is not considered first-line therapy for most pain management indications because of concerns about its safety and efficacy. Inpatient data from a 417-bed community teaching hospital revealed high use of meperidine in oral, IM, and IV forms. A multifaceted academic detailing approach was employed to change prescribing behavior and decrease meperidine use. This approach included conducting two concurrent Medication Use Evaluations; Grand Rounds presentations for pharmacy staff, nurses, and medical residents; solicitation of opinion leaders; pocket and table-top cards; newsletter articles; and provision of pharmaceutical care. Comparing the number of meperidine doses dispensed per adjusted patient day before and after the intervention, use was reduced by 0.0966 doses per patient (P < 0.05: 95% CI, 0.0955 to 0.0977). The number of patients receiving meperidine was reduced by 2.43% (P < 0.05: 95% CI, 1.97 to 2.88). This translates into a relative reduction of 29.5% in patients receiving meperidine and a relative reduction of 31% in meperidine doses dispensed per patient after academic detailing initiatives vs before. Eighty-five percent of standard orders were changed to improve therapy; these changes included converting meperidine to morphine or hydromorphone, decreasing cumulative acetaminophen daily dosages, using controlled-release and immediate-release opioids for pain management when oral therapy was tolerated, and combining modalities with different mechanisms of action for synergy and to decrease potential adverse effects from larger dosages of single entities. Academic detailing of meperidine resulted in short-term changes in prescribing patterns and decreased meperidine use at this institution. Long-term implications for pain management have not yet been assessed.

Pharmacist involvement on the cardiopulmonary resuscitation (CPR) team is associated with lower mortality rates. Despite this finding, pharmacists respond to cardiopulmonary emergencies in only 32% of institutions. The objective of this study was to determine the responsibilities and training of pharmacists as CPR team members and to assess their attitudes toward this role. A total of 1290 adult, acute-care hospitals were randomly surveyed nationwide. A total of 1108 questionnaires were received from 40% (517/1290) of institutions surveyed. Thirty-seven percent (189/517) of the institutions indicated that pharmacists participate on their CPR teams. Pharmacists' responsibilities at cardiopulmonary emergencies included recording medications administered (73.7%), medication preparation (96.6%), providing drug information (97.7%), and calculating doses (98.2%). The most common training methods were BLS certification (79%), the buddy system (59.4%), and continuing education programs (53.6%). Training methods that positively affected perceived qualification in the primary responsibilities were BLS/ACLS certification (P < 0.001) and training programs provided by the institution (P < 0.05). Positive attitudes toward participation on the CPR team were associated with the following factors: years of experience, BLS/ACLS certification, and the pharmacist's perception that he or she was adequately trained (P < 0.001). The results indicate that CPR team pharmacists should be proficient in providing drug information, preparing medications, recording medications administered, and calculating doses. Furthermore, because adequate training positively influenced pharmacists' attitudes toward participation and their perceived qualifications, we recommend that all pharmacists on CPR teams be required to obtain BLS/ACLS certification and participate in educational programs provided by their institution.

Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late Phase III trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. The monographs are published in printed form and on diskettes that allow customization. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800–322–4349. The January 2003 monograph topics are ezetimibe, enfurvitide, aripiprazole, atomoxetine, and amoxicillin/clavulanate potassium extended-release tablets. The DUE is on ezetimibe.

This monthly feature will help readers keep current on new drugs, new indications and dosage forms, and safety-related changes in labeling or use. Each month, new information will be added to the table (shown in bold type) and older information will be removed. Efforts have been made to ensure the accuracy of the information; however, if there are any questions, let us know at hospitalpharmacy@drugfacts.com.

This column addresses questions from readers about any issue, process, standard, or future direction of the Joint Commission, whether it relates to home care, the hospital, or other practice environment. The objective is to give you a better insight into the Joint Commission accreditation process in your own practice site. Any question is fair game.

This continuing feature will inform readers about the process of implementing, maintaining, and supporting computerized prescriber order entry (CPOE) at the Ohio State University Medical Center. (By “prescribers,” we refer to health care professionals authorized to prescribe medications by their states.) Practical information on what worked and what failed will be provided, along with current updates on the status of CPOE at the Medical Center.

As you continue to explore PDA software options, we recommend that you simultaneously begin expanding your PDA's hardware capabilities. In this installment, we discuss some of the hardware accessories available for PDAs.

To help readers monitor the most important developments in specialized areas of pharmacy practice in organized health systems, Hospital Pharmacy commissions Basic Bibliographies by guest editors, who have expertise in their respective fields. These guest editors survey the relevant literature and rank approximately 15 to 20 references that represent the most significant research and practice contributions in their areas. The more fundamental are listed first so that persons with limited time can select reading appropriate to their needs. A cumulative index to Basic Bibliography topics will be published semi-annually in June and December. Readers are urged to forward reactions or challenges to: Joyce A. Generali, Director, Drug Information Center, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160 or jgeneral@kumc.edu.