Use of staff pharmacists to reduce the inappropriate use of parenteral histamine-2 antagonist therapy.

This article describes the development and implementation of a target drug monitoring program using staff pharmacists as primary data collectors. This target drug program increased professional activities of staff pharmacists and showed how pharmacists could make an impact on drug therapy both financially and clinically. Parenteral histamine-2 antagonists were selected based upon amount of use and potential for inappropriate use and dosing. Criteria were developed in conjunction with the Pharmacy and Therapeutics Committee and medical staff. In phase I, pharmacists prospectively monitored all patients receiving parenteral cimetidine and ranitidine. Therapy was reviewed for justification of parenteral therapy (vs. oral), dosage adjustment in renal impairment, and monitoring of specific drug-drug interactions with cimetidine or ranitidine. During this phase, pharmacists collected data without intervening. Results from phase I and a program proposal for phase II were approved by the Pharmacy and Therapeutics Committee. Phase II consisted of the same monitoring procedures; however, when inconsistencies with the criteria were identified in one of the three categories, "chart education sheets" were placed in the chart. Results from phase I indicated a potential for cost savings. During phase II, 45% of the inappropriate parenteral therapy was changed to oral therapy, representing an annualized cost savings of $23,321 in this 540-bed hospital. The pharmacists were also successful in adjusting doses in renal impairment and monitoring potential drug interactions. The target drug program has proved to be an effective method of educating physicians and decreasing costs to the institution without the use of additional personnel.