Hospital formulary
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Patient controlled analgesia (PCA) has a number of advantages compared with traditional methods of pain management. Some of these advantages include superior pain relief, less sedation due to superior drug titration, increased psychological satisfaction due to patient control of pain management, individualized analgesic dosing, decreased staff time for patient care, and increased patient activity and mobility. ⋯ Appropriate candidates for PCA include terminally ill-cancer patients, postoperative patients, mentally clear and alert trauma patients, and patients who require massive doses of oral narcotics to control pain but are experiencing intolerable side effects. This article focuses on the principles involved in selecting the optimal analgesic and the therapeutic variables involved in using PCA.
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Drug use patterns observed in an intensive care unit (ICU) at a large tertiary teaching hospital (Brigham & Women's Hospital [BWH], Boston) were documented and compared with patterns reported from ICUs of hospitals at two other sites. Antibiotics, analgesics, and H2 antagonists were the most frequently prescribed classes of drugs. ⋯ Pharmacy charges for ICU care at BWH were calculated with respect to total hospitalization charges and were found to account for 10% of total charges. Identifying drug use patterns in ICUs--an area of potentially high drug use, risk, and cost--provides valuable information for P & T Committees as well as for medical staff quality assurance and usage evaluation functions.
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Abstracts in Inpharma, deHaen Drugs-in-Use, International Pharmaceutical Abstracts (IPA), Reactions, and Clin-Alert were evaluated using the number of omissions and errors as endpoints. Fifty-one abstracts were compared with original articles by pharmacy students using a standardized checklist for drug therapy and adverse drug reaction articles. The overall omission rate per abstract was 3.2 +/- 2.5. ⋯ One error occurred in approximately every fifth abstract. No differences were shown between abstracting services in this regard. Although abstracts and abstracting services can provide useful information--particularly when information is needed in a timely fashion, when an original article is difficult to obtain, or when written in a foreign language--they should not be considered a consistently reliable source of information upon which to base decisions, as evidenced by the number and types of omissions and errors described in this study.