American journal of hospital pharmacy
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The pharmacist's role in the implementation of patient-controlled analgesia (PCA) in a 400-bed community hospital is described. PCA for postoperative patients was introduced on the recommendation of the pharmacy and therapeutics committee. A subcommittee selected a PCA pump, developed a physician order form and patient monitoring sheet, and in March 1987 initiated a two-month pilot study of PCA therapy in orthopedic-surgery patients. ⋯ Pharmacists in the decentralized areas also provided one-on-one instruction to physicians, nurses, and patients. Positive evaluations of PCA therapy by patients and nurses and favorable patient pain assessment scores, in addition to the hospital-wide acceptance and use of PCA by medical staff, indicated that the program was a success. Active pharmacist participation was a major factor in PCA being well accepted by physicians, nurses, and patients as an effective alternative method of narcotic administration.
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Pharmacist involvement in a small hospital for the treatment and rehabilitation of patients with chemical dependency is described. The pharmacist's primary responsibilities include provision of pharmaceutical services to meet the medical needs of patients during detoxification; development of detoxification protocols for management of withdrawal from drugs of abuse; education of patients and their families, other clinical staff members, and pharmacy students about the pathophysiology of addiction, treatment options, and the foundations of recovery; medication and addiction counseling; and multidisciplinary team support of recovery. ⋯ The pharmacist employed at this hospital spends about 70% of her time with pharmaceutical services and 30% with counseling services. A pharmacist working in a chemical-dependency rehabilitation program has a unique opportunity to affect positively the physical and emotional health of the recovering individual by taking on responsibilities beyond those traditionally associated with pharmacy practice.
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The current status of reimbursement for home health-care (HHC) products and services is described, and the influence of competition and consolidation on the HHC industry is discussed. Despite inadequate financing and reimbursement pressures, the demand for HHC services continues to grow. The degree of competition in the HHC industry is reflected in bundling of services (gathering payments for services into a single per-capita rate), prospective price negotiations, and competitive bidding. ⋯ Three important recent federal measures revised definitions of Medicare coverage, established minimum and maximum payment periods for Medicare reimbursement, reduced payments for services and products covered under Medicare Parts A and B, resurrected prospective-pricing demonstration projects, reduced payments for durable medical equipment and home oxygen supplies, and expanded coverage of services for AIDS patients. State Medicaid program budgets are threatened by recurring administration proposals to cap federal matching payments and by the adoption of a competitive-bid approach to health-care contracting. To survive over the next few years, home health agencies and home-care suppliers will need to monitor operating costs even more closely and pay attention to the patient (payer) mix.
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The standard format of preoperative, perioperative, and postoperative patient anesthesia records, the categories of information included, and pharmacists use of this information are described. On the preoperative evaluation form, the anesthesiologist or anesthetist records information on the physical status of the patient and an overall impression of the anesthetic risk. ⋯ Finally, the anesthesiologist notes postoperative problems related to anesthesia on the postoperative section of the record. The anesthesia record can be used by pharmacists for medication scheduling and therapeutic drug monitoring, assessment of fluid status, evaluation of hemodynamic response to drug and fluid interventions, quality assurance, and drug-use reviews.
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Review Comparative Study
Continuous arteriovenous hemofiltration: an alternative to hemodialysis.
An introduction to the procedure of continuous arteriovenous hemofiltration (CAVH) for management of acute renal failure, as well as a review of hemodialysis, is presented. Initially developed for the management of hemodynamically unstable patients with acute renal failure, CAVH now is also used for management of fluid overload and acid-base disturbances resulting from conditions such as acute pulmonary edema, congestive heart failure, septic shock, and oliguric states in which pharmacologic or parenteral nutrition therapy necessitates administration of large volumes of fluids. CAVH, in contrast to hemodialysis, does not typically involve use of blood pumps but uses the patient's own mean arterial pressure to generate a driving force across the hemofilter membrane. ⋯ Although CAVH membrane materials may differ, they all permit the removal of plasma water and non-protein-bound solutes with molecular weights less than 10,000. To prevent blood from clotting in the hemofilter, most patients will require administration of heparin, which in some patients may increase the possibility of hemorrhaging. CAVH also can remove pharmacologic agents from the blood; however, only the non-protein-bound fraction of the drug has the potential to be cleared from the bloodstream by CAVH.(ABSTRACT TRUNCATED AT 250 WORDS)