Documentation of the first steps of pediatric pharmaceutical care in a county hospital.

Pediatric pharmaceutical care is still a new concept in the pharmacy profession. In our county institution with 35% of the beds reserved for pediatric patients, there existed no formal process for providing specialized pediatric pharmacy services. In an effort to rectify this situation, a study was conducted to determine the benefits of providing pharmaceutical services by having a clinical pharmacist round with physicians on a daily basis for 3 hours. All services provided were documented for 6 months and direct cost-savings were calculated. Five hundred four different interventions and services were provided, with over $7000 in savings. Because of these findings, the pharmacy and hospital administration agreed to provide a staff pharmacist to round in pediatrics on a regular basis. This approach is considered to be more cost effective than using a clinical pharmacist for daily rounds.

Developing and implementing guidelines to promote appropriate use of fluconazole therapy in an AIDS clinic.

A retrospective and concurrent drug use evaluation for fluconazole in an outpatient AIDS clinic is described. Eighty-eight patient charts were reviewed in the evaluation during an 8-week period, and 72 patients were studied in the concurrent evaluation for a period of 5 weeks. A set of preestablished fluconazole usage and dosing guidelines was developed by the clinical pharmacist and the chairman of the antimicrobial subcommittee/chief of infectious disease and approved by the pharmacy and therapeutics committee. Patients who did not meet these guidelines were those being treated for oropharyngeal and esophageal candidiasis. The use of fluconazole was not indicated in 43 of 54 (80%) patients in retrospective evaluation and 31 of 39 (79.5%) patients before clinical pharmacist intervention in concurrent study. If guidelines had been followed during the retrospective evaluation, cost savings would have been $295 per day, which adds up to $16,520 for 8 weeks. In the actual evaluation, the cost savings with pharmacist intervention for 5 weeks was $5,460, which can be extrapolated to annual cost savings of $65,520.