Electronic data interchange for pharmacy inventory control

The use of electronic data interchange (EDI) for controlling pharmacy inventory at a 303-bed hospital is described. The hospital, which belongs to a group purchasing consortium, uses EDI to exchange information with its primary drug wholesaler. The pharmacy's personal computer and software provided by the wholesaler are used. EDI enables the pharmacy to (1) select and order items by using hand-held bar-code scanning devices, (2) upload this information into the pharmacy's computer, (3) review the order before transmission, and (4) access the wholesaler's inventory. The pharmacy also uses EDI with its primary i.v. supplier. Using EDI for placing the daily pharmaceutical and i.v.-supply orders reduces by one half the daily time expenditure for purchasing. In addition, EDI provides various inventory-related reports. EDI provides an efficient and effective way to control pharmacy inventory.

Hospital pharmacy-based service for patient-controlled analgesia

A hospital pharmacy-based patient-controlled analgesia (PCA) service is described. The pharmacy department at a 255-bed community hospital instituted a comprehensive PCA service in 1985. Pharmacists were given thorough training in the clinical aspects of pain management and were taught how to use the PCA device; nurses also received instruction. An order for PCA is issued by a physician, who may then delegate decisions about medication choice, duration of therapy, and device settings to a clinical pharmacist. The pharmacist reviews the order and evaluates the patient's status. If PCA is appropriate, the pharmacist selects the analgesic agent and PCA device settings and prepares a pharmacy monitoring card. Orders for syringes are filled in the central pharmacy or by the decentralized pharmacist. Each order is entered into the i.v. drug profile and the i.v. drug computer file, and a narcotics control card is completed. The nurse programs the device, instructs the patient, and records the patient's level of pain control on a PCA-monitoring record. The pharmacist observes patients daily and records observations and changes on the pharmacy monitoring card. Use of the PCA service has grown from an average of 56 patient days per month in 1985 to 919 in 1989, and pharmacy department revenue has increased accordingly. A moderate increase in workload has been absorbed without the need for an increase in staff. Surveys show broad acceptance of the service by physicians, nurses, and patients. A hospital pharmacy-based PCA service offered patients better control of pain, allowed pharmacists to demonstrate competence in non-distributive functions, increased the visibility of the pharmacy department, and was a source of revenue.

Training patients to administer intravenous antibiotics at home

A home intravenous antibiotic infusion program (HIAP) implemented in a 256-bed, nonteaching, primary-care hospital is described. Physicians initiate participation in the program by referring a patient to clinical pharmacists and intravenous team nurses. Patients are evaluated on the basis of the following five criteria: (1) the infectious process has responded clinically to treatment, the patient has been afebrile for at least five days, and the physician has noted that the patient could be discharged if continued i.v. antibiotic therapy were not necessary; (2) the patient has successfully completed the pharmacist's teaching sessions on aseptic technique, the heparin-lock system, and the mechanics of i.v. antibiotic piggyback administration; (3) the patient has a family member or close friend who can attend the patient instruction sessions; (4) the patient has reasonably good veins, i.e., they have not readily developed phlebitis or heparin-lock occlusions, and there are a number of viable sites or the antecubital veins are accessible for insertion of a catheter, if necessary; and (5) a preliminary cost comparison indicates that the patient's participation in the HIAP would result in a cost savings. The therapeutic results of the HIAP were considered successful by the physicians. The i.v. team nurses noted no increase in heparin-lock site problems. The pharmacists spent an average of four hours teaching the HIAP patients, at a rate of $25 per hour. This cost was billed as a part of pharmacy services. Most of the insurance companies were willing to pay the entire charge for the HIAP. For eight patients treated in the program, savings of 128 bed-days and $18,968 were shown. the HIAP was found to be successful in terms of medical treatment and cost containment in a medium-sized, primary-care hospital.

A total parenteral nutrition protocol

The need for guidelines on the use of concentrated nutritional solutions to achieve effective total parenteral nutrition has become very evident in our hospitals. As these are teaching hospitals, our physicians write TPN orders for short-term surgical patients, long-term patients (home TPN), burn patients, neonatal patients and selected cancer patients. This variance in patients, coupled with the rotation of the interns and resident house staff, has resulted in a need for a TPN protocol. Within the framework of this protocol, each patient can be approached.

The pharmacy's approach to this problem was to convene an Ad Hoc Committee for the purpose of developing a protocol and in early 1975 the protocol was submitted to our Pharmacy and Therapeutics Committee. The Committee approved its acceptance, and it was forwarded to the Medical Staff Advisory Committee and was approved. Since that time, new developments and the inclusion of other pertinent material have necessitated updating our protocol. The update has resulted in the following protocol.