Hospital pharmacy
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The documentation of clinical pharmacy activities is an important issue and the authors describe a relatively simple and easily implemented method of documenting concurrent clinical pharmacy interventions. This quality assurance measure was added to the quality assurance calendar of a tertiary care medical center/teaching hospital to: (1) document to the Joint Commission on Accreditation of Healthcare Organizations that the pharmacy department is involved in direct patient care, and (2) demonstrate to hospital administrators that pharmacists are an integral and necessary component of the health care team. At least 115 of 428 (27%) documented interventions during 1988 prevented patients from suffering potentially serious side effects and adverse drug reactions. ⋯ Nurses, pharmacists, and physicians initiated 37%, 33%, and 30% of the clinical interventions, respectively. Most of the physician (89%) and nurse (82%) initiated interventions were requests for drug information, whereas most of the pharmacist initiated interventions were order clarifications (51%). The daily documentation of clinical pharmacy interventions demonstrated that the quality of patient care and patient outcome was improved and served as an effective method of cost-justifying pharmacist positions in this era of fiscal constraints.
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Management of chronic cancer pain using a computerized ambulatory patient-controlled analgesia pump.
Chronic pain associated with neoplastic disease can be difficult to treat. The development of a computerized ambulatory, patient-controlled analgesia (PCA) pump may provide the patient and clinician with an alternate approach in management of chronic cancer pain. The pump delivers a constant infusion of analgesic and allows for additional on-command doses for breakthrough pain. ⋯ At home, patients reported acceptable pain relief while engaging in many activities of daily living. Complications included constipation, possible drug tolerance, and accidental catheter removal. Overall, patient acceptance of the pump was good with improved pain control, minimal adverse reactions, and ease of use at home.
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JCAHO is increasingly emphasizing the importance of quality patient care and has recently mandated the involvement of pharmacy to help optimize patient care. To comply with the JCAHO requirements, the pharmacy department must develop standards and protocols that are ultimately designed to improve patient care. This article describes how we optimized patient care by complying with the JCAHO standards and prepared for the survey.
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Pharmacists employed in the critical care area in a 350 bed, community-based, Class II trauma facility demonstrated cost savings through documentation of clinical interactions. Data collection took place between January 1, 1986 and December 31, 1986. ⋯ Under current prospective reimbursement programs, cost containment and quality care are of primary concern for pharmacy departments. The presence of a critical care satellite staffed by qualified pharmacists can provide these measures.