Fred M. Eckel

The Pharmacist's Role in a Hospital-Based Outpatient Clinic

THE UTILIZATION OF OUTPATIENT SERVICES IN COMMUNITY hospitals by the general population has increased by 33 percent between 1963 and 1968. During this same period, inpatient utilization has increased by only 19 percent.1 This increased outpatient utilization can be attributed to a number of reasons, perhaps the most significant being the decrease in the number of primary care physicians and the rise in the mobility of the population. People have begun to identify with the hospital as a .Primary provider of health care. During this same period, the hospital pharmacist has been attempting to develop an identity with patient care activities beyond his role as the dispenser of drugs. He has ventured into patient care areas to try to define what he could contribute. Even though there has been a greater increase in outpatient utilization, most of the pharmacists contributions have been confined to inpatient care. The reasons for this are not quite clear, but may be related to factors which led initially to the development of the clinical pharmacy concept. 2 Outpatient pharmacy services in the nations hospitals are either nonexistent or inadequate since the pharmacist usually performs only a limited distributive function. Mechanisms have been devised to improve the efficiency of the dispensing function, but little has been done to

A Practical Method of Sterility Monitoring of IV Admixtures and a Method of Implementing a Routine Sterility Monitoring Program

A practical procedure for sterility testing of intravenous admixtures contained in plastic bags using membrane filtration was developed. This technique was then evaluated in a pilot study involving 140 (18 percent) of the large volume intravenous admixtures prepared during June, 1972, by a central pharmacy admixture program. The technique was effective in detecting all of the positive controls, intentionally contaminated, in the pilot study. The pilot study furnished the necessary data to statistically determine a monthly sample size of intravenous admixtures to be cultured, which would represent the entire population at a 95 percent confidence level with a 5 percent allowable error of the mean, and to implement a program of routine sterility monitoring by the hospitals Epidemiology Department. Procedures involved in maintaining sterility in a centralized intravenous admixture program were also implemented and are discussed. Results of this study indicate that a program of routine sterility monitoring of a hospital pharmacy intravenous admixture program can be implemented simply and practically. The program would monitor potential contamination from both the pharmacy and pharmaceutical manufacturers.

Pharmacy sources of drug information.

Thank you for your invitation to address this Drug Information Association Workshop and to discuss “Pharmacy Sources of Drug Information.” As I thought about my presentation, I wondered if I should be addressing this sesslon on Drug Information Sources or tomorrow’s session on “Channels of Drug Information.” A place where a physician or other health professional goes to obtain drug information can be considered a source. The pharmacist who serves as a drug information consultant, then, is functioning as a pharmacy source of drug information. Others may view this as a channel of drug information. If you keep my perspective in mind throughout this presentation, you will understand my remarks in the context of drug information sources. The moderator for today’s session, Dr. John Millis, was introduced as the primary author of the Report of the Study Commission on Pharmacy. Their report, “Pharmacist for the Future,”’ attempts to determine where pharmacy practice is going, and therefore, how pharmacy education should be structured in the future to enable pharmacists to achieve this role. This Report criticizes pharmacy’s effectiveness as a source of drug information. The Report states, “The system of pharmacy cannot be described at the present as either effective or efficient in developing, organizing, or distributing knowledge or information about drugs.”

Academic-Drug Industry Fellowships

The UNC/BW fellowship, like other industry/academia collaborative fellowships, provides a unique training experience in clinical research. Both academia and the pharmaceutical industry have opened their doors and allowed clinical pharmacists to spend a year or more developing clinical research skills and an understanding of the drug development process. Is it worth it? Is this program a benefit to the individuals, to the sponsors, or to the profession of pharmacy? The survey of these fellows provides us with the individuals perspective on the benefit and quality of the fellowship. Most believed the fellowship provided them with training to meet their needs and interests. However, given this small number of individual opinions and comments, how do we determine whether the fellowship is meeting the original goal to train clinical pharmacists to be clinical researchers? By looking at the career paths of those who have completed the program, we may gain insight into whether the fellows are involved with research. Since the fellowship has been in existence for only six years, we really can look only at the initial placement of these clinical pharmacists. A majority have gained employment with clinical research responsibilities within the pharmaceutical industry. One measure of the research capabilities of these fellows is their contributions to the scientific literature; 10 papers and 3 abstracts have been generated by fellows since they completed their fellowships (Appendix I). As expected, the research contributions of the two-year fellows are greater than that of the one-year fellows. Seven one-year fellows did not have a publication.(ABSTRACT TRUNCATED AT 250 WORDS)

The Pharmacist's Dilemma—Drug Product Selection Using Bioavailability Data

One hundred fifty-six U.S. drug companies were surveyed to determine whether or not they would supply bioavailability data on 147 drugs marketed as 1894 drug products. The submitted data were analyzed for completeness, validity and potential usefulness to the pharmacist in making drug product selection decisions. Ninety (57.7 percent) companies responded to the survey. Thirty-eight (24.4 percent) sent data of which that from 29 (18.6 percent) was judged acceptable for use in drug product selection. Acceptable data were submitted on 59 drugs. Data on 46 drugs were considered blood-level bioavailability data while the data on 13 drugs were considered clinical bioavailability data. The results, though relatively limited in number of drugs, represented drugs in a number of different pharmacologic classes, so were judged to be of relatively wide applicability.

Ostomy Patient Care Program

The ostomate is often a forgotten patient with regards to proper psychological and emotional preparation for his surgery and proper continuing care of his ostomy. The pharmacist can play an important role in aiding the ostomy patient, especially in providing him adequate appliances and ostomy-care information. The development and implementation of the ostomy program of the N. C. Memorial Hospital Pharmacy is presented in detail. A brief explanation of why ostomy surgery is necessary, of the various types of ostomies and of the various appliances utilized is also presented. The following services of the program are described: Use of a patient profile card in order to have on record the patients specific appliance and replacement parts; Fitting the new ostomate with the proper appliance and instructing him on its proper use; Interviewing patient on return clinic visits to determine if the patient is having ostomy-related problems or needs any replacement parts for his appliance; Providing patients appliance needs through the mail or through communication with the patients local community or hospital pharmacist, and Conducting a presurgical consultation with the future ostomate to briefly explain appliances and how their use will affect his life, plus answer questions which may be making him apprehensive.