Hospital pharmacy
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Comparative Study
A cost comparison of Canadian and U.S. hospital pharmacy departments.
The average Canadian hospital in 1990, with an almost 11-day average length of stay compared to 7.3 days in U. S. hospitals, had an average expense per discharge of $2,720 less than similar U. S. facilities. ⋯ S. acute care facilities could have curtailed their hospital pharmacy and drug discharge cost to correspond to Canadian averages, an estimated $4.6 billion might have been saved in the United States in 1993. Reductions in these expenses could be influenced by how closely our health reform plan eventually follows the Canadian global budgetary target model and whether the U. S. pharmaceutical industry is forced to reduce its wholesale drug prices.
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Budgetary constraints have compelled hospital administrators to take a more discerning look at the role of the pharmacist within the healthcare team. In 1991, financial difficulties and hospital-wide cutbacks at Northern Michigan Hospital resulted in the loss of pharmacy personnel. Consequently, the department has increasingly found it necessary to document the clinical activities of the pharmacists and their potential effect on patient care. ⋯ The authors realize it is essential for pharmacists to not only maintain, but to continually update their knowledge base to be prepared for the future. A staff development program was developed to help meet the educational needs of the pharmacists. This article describes how therapeutic interventions were integrated into the quality improvement and performance plans to help motivate staff to continually improve their pharmacy practice skills at this institution.
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The authors found that a concurrent review of use of antidote drugs commonly used for the treatment of adverse drug reactions is an effective method for identifying such reactions. Computer-assisted detection helped rule out false-positives and decrease the number charts to be screened, thereby reducing the time needed to find adverse drug reactions.
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Hospital pharmacists have shown clearly their benefit in patient care by intervening to improve the drug use process. In this era of cost containment, hospital administrators are likely to fund only those programs that clearly improve patient care or reduce costs. To demonstrate the impact on a hospital budget and to justify a position or service, documentation of improvement and generation of a cost-savings report is essential. This article discusses the types and methods of clinical and cost-saving interventions that are made in a busy inner city university trauma center's emergency department, and the methods by which our data are collected.
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Comparative Study
A comparison of patient-controlled and intramuscular morphine in patients after abdominal surgery.
This prospective, randomized study compared the effects of two methods of morphine administration after abdominal surgery in 62 adults. All patients were offered intravenous morphine in the Postanesthesia Care Unit. On the ward, one group (PCA-CI) received a continuous infusion of morphine that could be supplemented by a patient-controlled bolus every 10 minutes. ⋯ Comparison of both groups demonstrated no significant differences in analgesia, incidence of adverse opioid effects, 24 and 36 hour morphine dose, time to first oral analgesic medication, operating cost, and length of hospital stay. Patients in the PCA-CI group received a slightly greater dose of morphine in relation to body weight (24 hr, P = 0.03; 36 hr, P = 0.05) and reported a greater degree of satisfaction at each assessment (P = 0.005, P = 0.02, P = 0.01). These data support the greater patient satisfaction associated with patient-controlled analgesia but suggest that the wide range of reported pain scores and morphine requirements makes it difficult to demonstrate, in a small population, superior pain relief from patient-controlled analgesia when nurses are encouraged to administer intramuscular pain medication more effectively.