Stuart M. Speedie

Incidence and characteristics of antibiotic use in aged nursing home patients

Objective. To measure the prevalence, incidence, types, and certain characteristics of antibiotics prescribed in nursing homes.

Classification and evaluation of problem-solving tasks

Abstract Problem-solving tasks are classified on the basis of four task characteristics (ambiguity, number of solutions, complexity, and experience), three process categories (preparation, production, and evaluation), and four general outcome categories (number of solutions, time to solution, quality, and process measures). The classification scheme is compared with recent attempts to define “ideal” characteristics of measures, and seven general criteria are proposed for evaluating problem-solving tasks. Twelve categories of tasks commonly used in research are classified and evaluated. Concept identification, switchlight problems, verbal mazes, and simulations are concluded to be tasks that most closely satisfy all evaluation criteria, although each has some problems. Implications for improvement of measures of problem-solving are indicated.

Computers in Healthcare: Overview and Bibliography

OBJECTIVE: The objective of this article is to provide an overview of computer technology and an associated bibliography, emphasizing institutional-based healthcare applications and pharmacoinformatics. DATA SOURCES: References were selected from the authors files and from a computerized search over the last five years on computers in healthcare/medical informatics and in pharmacy. STUDY SELECTION: Articles selected for review and discussion were considered to be important contributions to the respective areas listed in the bibliography and representative of advancements in computer applications in healthcare and pharmacy. DATA SYNTHESIS: The computer has become an important support tool for healthcare professionals. Medical informatics and the discipline related to pharmacy, called pharmacoinformatics, have evolved from the cognitive underpinnings of medicine, pharmacy, and computer science. Recent developments in computer technology have resulted in computers that are fast, increasingly portable, and user friendly. Hospital information systems employ computers in various ways to deal with the vast amount of information used by various departments. Standards for electronic data exchange are being developed to increase the integration potential of these systems. Hospital pharmacists have used computers for drug distribution, financial analysis and inventory control, drug interaction detection, pharmacokinetic dosing, drug information, and drug therapy monitoring. Expert systems are being developed in several areas of drug therapy. Pharmacy educators have developed interactive courseware to help students learn problem-solving skills in the areas of calculations, therapeutics, and drug information. CONCLUSIONS: Pharmacists need to become more involved with applications of technology to pharmacy. Properly implemented, computers can provide more time for pharmacists to use their cognitive skills in the delivery of pharmaceutical care.

The Effect of Inservice Education Provided by Consultant Pharmacists on the Behavior of Nurses in Long-Term Care Facilities

The objectives of the study were to assess whether an in-service education program for nurses in long-term care facilities was effective in increasing the nurses knowledge of drugs and whether the increased knowledge affected nurses behavior regarding drug therapy monitoring. The four-phase study was conducted in two study homes and two control homes and consisted of pre-tests, inservice, post-tests, and a three-month evaluation period. The results indicate that nurses in the study homes demonstrated a statistically significant increase in drug knowledge, and this was reflected in an objective change in behavior to more appropriate monitoring of drug therapy. It may be concluded that intensive inservice education programs are an effective method for inducing behavioral changes in nurses working in long-term care settings. These changes can improve the nurses ability to monitor and promote safe and efficacious drug therapy in long-term care facilities.

Rule-Based Drug Prescribing Review: An Operational System

This paper describes an operational computer-based system for conducting Drug Prescribing Review (DPR). The system was designed to: arrive at specific judgements about the potential problems of drug orders taking into account the characteristics of the patient and their medical conditions; be relatively independent of the structure of the data base; and be capable of expressing and evaluating any DPR criteria. This was accomplished by developing a hierarchical, rule-based system for expressing and evaluating DPR criteria. This system was then linked with a specific patient data base for implementation. Drug orders for 65 patients have been evaluated and the results agree with expert judgement. The rule-based DPR system appears to be a feasible method of evaluation of drug orders.

The Effectiveness of Computerized Drug Interaction Screening Programs in Hospitals

The goal of this study was to evaluate the effectiveness of two computerized drug interaction screening programs in comparison to screening that pharmacists do without the use of these programs. Data were collected at three hospitals on patients who were at risk of experiencing certain drug interactions. Two of the hospitals had computer-based drug interaction screening programs and one hospital that did not served as the control. Differences in length of stay, the number of lab tests ordered, and the number of adverse effects were tested for significance using multiple regression analysis. Evidence of interventions by pharmacists when drug interactions occurred was also sought The computer screening programs investigated in this study were not found to be more effective than the screening for drug interactions done by pharmacists without the use of these programs. Patients who were prescribed interacting drugs, however, had longer lengths of stay at all three hospitals than patients who were not prescribed interacting drugs