Pharmacy-based automated medication records: methods, application, and a survey of use.

A literature review of articles describing the development and implementation of automated medication administration records is summarized, and the results of a survey undertaken of all hospitals in Missouri to determine the extent of an automated medication administration record (MAR) are reported. For hospitals with an automated MAR, the survey compiled information about the demographics of responding facilities and production and distribution, design, implementation, and procedures for use of automated MARs. The most frequently reported advantages of an automated MAR were a more legible document, increased accuracy, savings in nursing personnel time, and fewer medication errors. The most frequently reported disadvantages were increases in pharmacy personnel time, different interpretation of orders by pharmacy and nursing, and multiple entries required for a medication order to appear correctly on the MAR.

Practice guidelines and drug-usage evaluation.

Currently, there is a great deal of interest in the development of practice guidelines for medical care that will be more rigorous and clinically sound than what is available today. With the impetus of federal legislation mandating such an approach, it may continue to develop into a significant movement in the medical arena. Pharmacy managers should be aware of developments in this area, particularly as they relate to appropriateness of drug therapy and drug-utilization review. The result may eventually be an evolution from drug-utilization review programs to diagnosis-based, outcome-focused interdisciplinary systems for QA. Even with the development of practice guidelines as described, there will continue to be a need for competent pharmacy practitioners to ensure appropriate pharmaceutical care. With the increasing acuity of patients in the health care system and the rapid development of new drugs and technologies, the role of the institutional pharmacist in ensuring optimal patient care will be more important than ever.

Staffing for comprehensive pharmaceutical services in a small hospital.

The use of licensed practical nurses as medication administration personnel under the administrative authority of the pharmacy department in a 140-bed hospital is described. The pharmacy department assumed responsibility for medication administration in its efforts to expand the scope and quality of its services and to control drug distribution more completely. A medication administration team (MAT) was developed that involves licensed practical nurses and technicians. The MAT members are trained through programmed instruction, on-the-job experiences, and a 32-hour pharmacology course taught by staff pharmacists. This medication administration team gives the pharmacy department control of the entire drug distribution system.

Shared pharmaceutical services in small hospitals.

A system of shared pharmaceutical services between two small, rural hospitals is described. A contractural agreement was established between a 140-bed hospital and a 40-bed hospital located 15 miles apart in a rural area of eastern Kentucky. The larger hospital provided comprehensive pharmaceutical services to the smaller hospital for a monthly fee. Procurement of i.v. fluids and supplies was a function of the larger hospital; other drugs and supplies were procured separately. The director of pharmacy at the larger institution also served as the director at the small institution. Staff pharmacists rotated between the two hospitals. Supportive personnel were assigned permanently to each hospital. The shared service arrangement reduced costs associated with the implementation of comprehensive pharmaceutical services and made it easier to recruit and retain skilled pharmacy personnel.

Effects of acute alcohol administration on propranolol absorption.

Alterations in propranolol absorption secondary to concomitant ethanol administration was investigated in five normal adults. With alcohol administration, there was an increase in the area under the plasma concentration-time curve (AUC) and maximum plasma concentration (CPmax). Ethanol caused a decrease in the rate of absorption and an increase in the rate of elimination of propranolol. It appears that the acute, concomitant administration of alcohol with propranolol will alter the bioavailability of propranolol.