Practical approach to determining costs and frequency of adverse drug events in a health care network.

The frequency, preventability, severity, root causes, and projected costs of adverse drug events (ADEs) occurring after or causing admission to a four-hospital integrated academic health network were studied. The sample included all admissions during a 53-day study period. Events were identified through daily record review of a random patient sample, computerized flags, and self-reporting. A case review committee validated the occurrence, classification, and root causes of the events. Additional length of stay and costs associated with ADEs were analyzed by using a case-control, multiple linear regression model. The estimated ADE rate during hospitalization was 4.2 events per 100 admissions, with a cost of $2162 per ADE. In addition, 3.2% of admissions were caused by ADEs, with an associated cost of $6685 per event. Fifteen percent of hospital ADEs and 76% of ADEs causing admission were judged preventable. The annual cost to the organization for events occurring during hospitalization was $1.7 million, and the cost of preventable ADEs was $260,000, while the projected costs of preventable ADEs causing admission were $3.8 million. The rate of admissions to the mental health center caused by ADEs was higher than for other settings at 13.6%, with a cost of preventable ADEs of $1.3 million. Patient noncompliance was judged to be the cause of the 69% of the ADEs causing admission. Seventy-one percent of the serious medication errors occurred at the prescribing stage of the medication-use process. ADEs were frequent, costly, and often preventable and resulted in many admissions to a mental health center.

Latex allergy.

An overview of latex allergy, including methods for preventing reactions and reducing exposure to latex, is provided. Latex allergy is a serious medical problem for an increasing number of patients and health care workers. From an institutional perspective, several precautionary procedures need to be followed to ensure safe care for patients and to protect employees from unnecessary latex exposure. These include establishing a multidisciplinary committee to develop policies and procedures; identifying products containing latex; identifying latex-sensitive patients and employees as well as those at high risk of developing the sensitivity; implementing precautions against allergic reactions to latex; educating personnel and patients on latex allergy; and reviewing quality assurance data to continually improve precautionary procedures. Pharmacists should be involved in developing and implementing these procedures. In particular, they can play a major role in the education of health professionals and patients. There is a strong need for more information on latex sensitivity, especially in the areas of epidemiology, product development, and effectiveness of procedures. Each institution, including its pharmacists, must evaluate the available information about latex sensitivity and determine appropriate actions.

Factors that influence residency applicants in the selection of a specific program.

The relative importance of factors that influenced residency applicants in the selection of a specific program was determined through a national survey. A four-page questionnaire was developed through a series of focus groups with current and former pharmacy residents. A total of 370 questionnaires were mailed to the preceptors of all residencies participating in the 1987 ASHP Resident Matching Program; the preceptors were instructed to forward the questionnaires to all first-year residents in their programs. Respondents were asked to provide demographic information and to rate (using a seven-point Likert scale) the importance of 19 factors that might have influenced their choice of residency program. The respondents also were asked to list which 4 of the 19 factors had been most important to them in their choice. Most of the 243 respondents had entered the residency programs with little or no postgraduate pharmacy experience. The average residency candidate applied to 2.8 programs; approximately half of the respondents had accepted a residency position in the state in which they currently lived. The reputation of the residency program as a good learning program was rated most important by all groups. ASHP accreditation was rated slightly higher by residents in general programs, whereas the type of medical services provided by the hospital and the university teaching affiliation were rated slightly higher by respondents in clinical and specialty programs. Factors with low importance ratings included desirable climate and total number of residency hours worked. Residency preceptors can use the results of this study to focus their marketing and recruiting strategies.

Management consultant review of three departments of pharmacy to identify cost-reduction opportunities.

A review by a management consulting firm to identify cost-reduction opportunities at three hospital pharmacy departments is described. A multihospital corporation hired a management consulting firm to review the operating procedures of several departments, including pharmacy, and recommend measures for reducing costs. A team approach was adopted to enable the pharmacy department managers and the consultants to freely contribute their expertise; input was also solicited from staff members. A review of each pharmacy department's operating costs showed that drugs and i.v. supplies consumed 60-67% of the expenses, and salaries and wages 27-36%. Estimates of the full-time equivalents allocated to inpatient, clinical, support, and ambulatory and outside contract service activities were compared. The relative costs of personnel allocated to all inpatient drug distribution activities were also compared. Cost-reduction recommendations were divided into short- and long-term measures. Short-term measures involved decreasing drug expenditures, decreasing the number of personnel, and limiting decentralized services in one of the departments; savings of $500,000 were projected. Long-term recommendations involved increasing the use of technology, expanding the use of technicians, and consolidating the management staffs among the hospitals. Management consultants, in cooperation with pharmacy department managers and staff members, can identify cost-reduction opportunities without compromising patient care.