John A. Armitstead

Cost effectiveness of a clinical pharmacist on a neurosurgical team

OBJECTIVEIn 1999, the Society of Critical Care Medicine formally recognized that pharmacists were essential for the provision of high quality care to the critically ill population. This study is a brief quantitative analysis of the benefit provided by a clinical pharmacist in a multidisciplinary neurosurgical setting. METHODSPatients admitted to the neurosurgical service in the 2 years before and 2 years after the implementation of dedicated neurosurgical pharmacy services were retrospectively reviewed. The clinical pharmacist was responsible for monitoring and evaluating all adult patients on the service and rounding with the team 6 days a week. RESULTSA total of 2156 patients were admitted during the study period. No significant differences were noted among severity of illness scores between the 2 groups. During this time, 11 250 interventions were recorded by the pharmacist. The average pharmacy and intravenous therapy cost per patient between the pre- and postimplementation groups decreased from

Effect of emergency medicine pharmacists on medication-error reporting in an emergency department.

4833 to

Guidelines for the safe handling of hazardous drugs: Consensus recommendations

3239, resulting in a total savings of

ASHP guidelines: Minimum standard for pharmacies in hospitals

1 718 260 over the duration of the study period. The average hospital stay decreased from 8.56 to 7.24 days (P = 0.003). Early hospital mortality also decreased from 3.34% to 1.95% (P = 0.06). For those patients who were discharged from the hospital, there was a significant decrease in readmission rates between the 2 groups (P < 0.05) CONCLUSIONHaving a dedicated clinical pharmacist with critical care training rounding routinely with a neurosurgical team significantly reduced hospital stay, readmission rates, and pharmacy costs. Clinical pharmacists can have a significant effect on clinical and economic measures in the intensive care unit, and their participation on a multidisciplinary critical care team should be a standard of care.

Moving antimicrobial stewardship from restriction to facilitation.

PURPOSE The effect of an emergency medicine (EM) clinical pharmacist on medication-error reporting in an emergency department (ED) was studied. METHODS The medication-error reports for patients seen at a universitys ED between September 1, 2005, and February 28, 2009, were retrospectively reviewed. Errors reported before the addition of an EM pharmacist (from September 1, 2005, through February 28, 2006) were compared with those reported after the addition of two EM pharmacists (from September 1, 2008, through February 28, 2009). The severity of errors and the provider who reported the errors were characterized. RESULTS A total of 402 medication errors were reported over the two time periods. Pharmacy personnel captured significantly more errors than did other health care personnel (94.5% versus 5.7%, p < 0.001). The addition of two EM pharmacists resulted in 14.8 times as many medication-error reports as were made when no EM pharmacist was in the ED. More errors that actually occurred were captured with two pharmacists providing care (95.7% versus 4.3%, p < 0.001). A majority of the errors documented were ordering errors (79.8%). Of these, 73.7% were captured after the addition of two EM pharmacists. Performance (40.0%) and knowledge (27.9%) deficits were the most common contributing factors to medication errors. CONCLUSION During the study period after the addition of two EM pharmacists in the ED, 371 medication-error reports were completed, compared with 31 reports during the study period before the addition of the pharmacists. Pharmacy personnel reported the majority of medication errors during both study periods.

Evidence-Based, Multidisciplinary Approach to the Development of a Crotalidae Polyvalent Antivenin (CroFab) Protocol at a University Hospital

Determining the proper precautions that employees should take to reduce their exposure to potentially hazardous drugs is very difficult due to the many risk factors that must be considered. Some of these risk factors include the inherent toxicity of the drug, the drug’s mechanism of action, the

Drug costs and bacterial susceptibility after implementing a single-fluoroquinolone use policy at a university hospital.

The following minimum standard guidelines are intended to serve as a basic guide for the provision of pharmacy services in hospitals. These guidelines outline a minimum level of services that most hospital pharmacy departments should consistently provide. The reader is strongly encouraged to review the American Society of Health-System Pharmacy (ASHP) guidance documents referenced throughout these guidelines for more detailed descriptions. Certain elements of these guidelines may be applicable to other health care settings or may be useful in evaluating the scope and quality of pharmacy services.

A Retrospective Evaluation of Vitamin K1 Therapy to Reverse the Anticoagulant Effect of Warfarin

A comprehensive antimicrobial stewardship program can effectively improve the use of antimicrobial agents in a hospital. These programs are often able to document reductions in resistance rates and antimicrobial costs.[1][1] Infectious disease physicians and pharmacists are considered core personnel

Evaluation of a clinical scoring scale to direct early appropriate therapy in heparin-induced thrombocytopenia.

Background: Several thousand people are bitten annually by venomous snakes in the US. While the development of ovine Crotalidae polyvalent immune Fab antivenin (FabAV) for Crotalinae snakebite envenomations has greatly changed the way this clinical presentation is treated, multiple issues complicate its use. From patient assessment and evaluation, to medication preparation and administration, to the management of adverse drug reactions, the use of this antidote carries with it multiple points of possible medication variances. The inappropriate use of this agent can result in adverse patient consequences and a significant financial burden for both the hospital and the patient. Objective: To describe an evidence-based, multidisciplinary approach that was taken to ensure optimal, safe, and cost-effective treatment of patients with FabAV. Methods: Following an analysis of the available literature, a multidisciplinary committee was formed to construct a protocol for use of FabAV. This group included clinical pharmacists, pharmacy administrators, emergency medicine physicians who specialized in wilderness medicine and pharmacy residents. Results: A multidisciplinary FabAV usage protocol was constructed and implemented to ensure appropriate patient evaluation, FabAV use and preparation, monitoring, and follow-up. This protocol was based on the available literature and the expert opinion of the committee. Through the use of a 24-hour in-house pharmacy resident on-call system, clinical pharmacy services were provided to ensure a multidisciplinary approach to the care of these patients emergently. Although limited, initial data show that this approach is effective and may result in substantial cost savings. Conclusions: Initial results from implementation of a protocol for use of FabAV have limited inappropriate use, reduced medication wastage, and decreased costs.

Emergency medicine pharmacy.

SUMMARY The University of Kentucky Hospital investigated the feasibility of choosing a sole fluoroquinolone for its formulary in an effort to reduce costs without affecting clinical outcomes. A three-step process was used to plan, implement, and monitor the selection program. Based on the range of clinical indications, safety profile, local susceptibility, cost, and dosing convenience, levofloxacin was chosen over ciprofloxacin and gatifloxacin as the sole fluoroquinolone. Since the implementation of the program in May 2001, susceptibility to levofloxacin has been maintained or increased for the most common pathogens. In addition, University Hospital has saved nearly