Impact of the dial access drug information service on patient outcome.

OBJECTIVE: To determine the impact of a drug information service on patient outcomes. DESIGN: Prospective evaluation of patient-specific drug information requests. SETTING: Healthcare professional and consumer drug information service located at a college of pharmacy. PARTICIPANTS: Consumers and healthcare professionals of the province. INTERVENTION: Patient-specific questions received by the drug information service were reviewed and evaluated for actual patient outcome, inquirers' opinion of impact of the service with respect to patient outcome, and for objectivity and timeliness of the response. An expert panel determined whether the responses and recommendations given by the service were appropriate, determined what impact the service had on the patient, and assessed the seriousness of the inquiry. MAIN OUTCOME MEASURE: Classification of patient outcome by objective and subjective data based on predetermined desired outcomes. RESULTS: Ninety-eight and 68 patient-specific requests were received from healthcare professionals and consumers, respectively. The panel concluded that 94.9% of the healthcare requests and 98.5% of the consumer requests were answered appropriately and that the majority of the requests involved potentially serious drug-related problems. The panel also determined that 46.8% of the recommendations to healthcare professionals and 41.0% of the recommendations to consumers resulted in positive patient outcomes. The majority of the positive outcomes involved the prevention of a disease or its symptoms (professional section) and the reduction or elimination of symptoms (consumer section). CONCLUSIONS: The drug information service not only met its objectives of providing drug information in an accurate, objective, and timely manner, but was also able to provide positive patient outcomes.

Contamination study of multiple-dose vials.

OBJECTIVE: To document the number of opened, dated, and expired multiple-dose vials (MDVs) in patient-care areas and to determine what proportion of MDVs were contaminated with bacteria or cellular debris. DESIGN: Every tenth opened MDV (69/656) identified on the wards was collected, ensuring representation from each nursing unit. Contents were examined for contamination. SETTING: Medical-school-affiliated, tertiary care center. MAIN OUTCOME MEASURES: (1) Visual inspection for debris, medication type, location, lot number, manufacturer's expiration date, and date of opening; (2) culture in solid and broth media for bacterial growth; and (3) staining and microscopic examination for cellular constituents. RESULTS: No vials had been dated after opening and 4.6 percent were expired according to the manufacturer's expiration date. No bacterial contamination was evident; however, one vial was contaminated with red blood cells. CONCLUSIONS: Transmission of infection via contaminated MDVs has been well documented and contamination with red blood cells raises concerns about potential for transmission of bloodborne pathogens. Recommendations include dating MDVs after opening, emphasizing the need for proper aseptic technique, and discarding MDVs on the manufacture's date of expiration.