Wa Gouveia

ASHP guidelines: Minimum standard for pharmacies in hospitals

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.

Evaluation of a Community-Based Poison Education Program

This study suggests that: (1) a program directed at a specific town and coordinated by a local community group is more effective in transmitting poison control knowledge than is a statewide poison prevention week effort; (2) that transmission of educational material is optimized through programs directed at a specific age group (in this study ages 6 through 14); and, (3) that information about where to get the poison center number and actual acquisition of Ipecac syrup in homes was well transmitted.

The dilemma of establishing effective pharmacy staffing levels

As new and enhanced pharmacy practice models are implemented to meet the complex needs of patients in health systems, it is imperative to establish the staffing and the skill levels of pharmacy generalists and specialists within our organizations. Specialty care such as that provided by pediatric,

Pharmacy as a patient-centered practice: Reflections from center stage

Ten years ago in my Whitney address, I forecasted that our profession would be at center stage of health care in the new century.[1][1] Now, upon concluding 36 years as a pharmacy director, I want to share what I believe pharmacy must do to stay center stage and further advance our roles in health

Short-term comparative outcomes associated with the use of GP IIb/IIIa antagonists in patients undergoing coronary intervention.

AbstractBackground:Platelet glycoprotein (GP) IIb/IIIa antagonists reduce the occurrence of death, myocardial infarction (MI) and urgent revascularization among patients undergoing percutaneous coronary intervention (PCI). Despite a similar mechanism of platelet inhibition, the three currently approved agents vary widely in cost. Purpose: The purpose of this prospectively designed, retrospective analysis was to determine clinical outcomes for patients receiving abciximab, tirofiban or eptifibatide as adjunctive therapy during PCI at a single center. We hypothesized that there would be no difference in outcomes during hospitalization following PCI in patients receiving tirofiban or eptifibatide compared with those patients who received abciximab. Outcomes examined included in-hospital mortality, hemorrhagic procedural complications, need for recatheterization, peak creatine kinase following intervention and length of hospital stay (LOS). Results: Two hundred and sixty seven consecutive patients in whom GP IIb/IIIa antagonist therapy was initiated in the catheterization laboratory for PCI were analyzed. Abciximab-treated patients were more likely to be undergoing primary (p<0.001) and rescue (p=0.022) PCI and to have received fibrinolytic therapy (p=0.013) when compared to patients receiving tirofiban or eptifibatide. There were no significant differences between abciximab- and non abciximab-treated patients in either the primary PCI or non primary PCI groups in any of the studied endpoints. In patients undergoing primary PCI, abciximab-treated patients when compared with non abciximab-treated patients exhibited a trend toward an increase in hospital LOS (7.8±7.0 d vs 6.2±3.9, p=0.19) and in the frequency of hemmorhagic complications (22.1% vs 5.3%, p=0.11). In patients not receiving fibrinolytic therapy, abciximab-treated patients experienced a trend toward increased hemmorhagic complications following PCI when compared to non abciximab-treated patients (10.2% vs 6.0%, p=0.28). Complications distant from the vascular access site comprised 62.5% of hemmorhagic complications in the abciximab-treated group, but only 20% of the complications in the non-abciximab treated population (p<0.001). These data suggest no differences in acute outcomes between groups of patients receiving abciximab or other approved GP IIb/IIIa antagonists highlighting a potential significant cost saving. These data will require interpretation following the publication of comparative trials.

Watershed events in health-system pharmacy practice

Three conferences sponsored by the American Society of Health-System Pharmacists (ASHP) over the past 26 years are watershed events for our profession. The Hilton Head Conference in 1985 gave us the courage and determination to convince ourselves that pharmacy is a clinical profession.[1][1] The

Alert fatigue: A lesson relearned

A recent Informatics Exchange installment by Cash[1][1] delineated the issues related to alert fatigue. In 1969, my colleagues and I reported on the same topic as it related to the implemention of a hospital information system at the Massachusetts General Hospital.[2][2] One of the project’s

REGULATORY AUTHORITY AFFECTING AMERICAN DRUG TRIALS: ROLE OF THE HOSPITAL PHARMACIST

Clinical drug trials in the United States are influenced by many regulatory and policy–recommending organizations, chief among them are institutional review boards, the National Institutes of Health, the Food and Drug Administration, the American Society of Hospital Pharmacists, the Joint Commission on the Accreditation of Healthcare Organizations, and the pharmaceutical industry. The hospital pharmacists role is a multifaceted one ranging from protocol authorship and primary investigator status to support of institutional research programs. The latter encompasses such activities as ordering, storing, preparing, packaging, labeling, and dispensing clinical research drugs, providing investigational drug information to other health professionals associated with a particular study, and maintaining appropriate drug use accountability records. Development and maintenance of a hospital–wide quality assurance or quality improvement program as well as the provision of clinical pharmacy services to research subjects are also among the hospital pharmacists roles related to clinical drug trials.

Celebrating three decades of excellence in pharmacy management: The John W. Webb Lecture award

Sweeping and profound changes in any profession do not come easily; they require thoughtful, focused, and persistent leadership. Over many years, key leaders and managers in the profession of pharmacy have set bold and exciting directions that have enabled health systems to better serve the needs of

Investing in our human resources

The management of human resources is central to virtually all of our endeavors in health care. Well-trained pharmacists who are nurtured in their positions become competent, compassionate practitioners who take good care of patients. Strong and effective organizations cherish and mentor their staff