bluuebunny/crossref_metadata_2025 huggingface dataset:
Medication Errors Associated with Levothyroxine Products
Authors: Pamer Carol A. , Phillips Jerry
Published: January 2018

The FDA Office of Postmarketing Drug Risk Assessment conducted a review of medication errors that have been reported with levothyroxine. These cases were obtained from the FDA Adverse Event Reporting System (AERS) database as well as the published medical literature. A total of 18 reports of medication errors were obtained from these sources. Ten reports involved the dispensing of the incorrect drug. Four of these reports had a serious outcome. Six of the ten reports involved confusion between Lanoxin (digoxin) and levothyroxine. Eight other reports involved dispensing of the incorrect dose of levothyroxine. Three of these reports of dosing errors had a serious outcome, including one death. Based upon these data and general principles of patient counseling, recommendations were made to help prevent additional medication errors amd to promote patient understanding of their medications and medical conditions.
Case Management: An Overview of Challenges and Opportunities
Authors: Andolina Kathleen , Zander Karen , Vogenberg F. Randy
Published: January 2018

Managed health care has changed the way health services are provided and paid for. It is still evolving. Many pharmacists have already felt the impact of these changes. This continuing feature illuminates the many facets of managed care with special emphasis placed on how these changes may affect pharmacists working in health systems. The expertise provided by pharmacists will be needed to fulfill the potential of affordable, comprehensive, and quality health care as promised by managed care. Pharmacists must understand what is happening, why it is happening, and what is likely to happen in the future. To be an active and effective player, you must understand what is happening on the field.
• Orders to “Continue Previous Meds” are a Longstanding Problem/ • More Problems with Verbal Orders/ • FDA Advise-ERR: Dispensing Errors Associated with Zantac and Zyrtec
Authors: Cohen Michael R.
Published: January 2018

These medication errors have occurred in health care facilities at least once. They will happen again—lperhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program, which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 1-800-233-7767 (1-800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writer's names will be published if desired. ISMP may be contacted at the address shown below.
Coenzyme Q10: A Review
Authors: Al-Hasso Shahla
Published: January 2018

Coenzyme Q10 (CoQ10) is a provitamin manufactured by the body. It functions as a coenzyme for mitochondrial enzymes. It has been shown to be deficient in patients with cardiovascular disease, cancer, Acquired Immune Deficiency Syndrome (AIDS), muscular dystrophy, spontaneous abortion, male infertility, and periodontal disease. Studies of CoQ10 show preliminary efficacy in the treatment of cardiovascular disease, but there is not enough evidence to date to support its benefit in cancer, AIDS, muscular dystrophy, spontaneous abortion, male infertility and periodontal disease treatments. Additional research is needed to evaluate its benefits in the treatment of these other conditions.
Alteplase (t-PA) Bolus: Occluded Catheters
Authors: Generali Joyce , Cada Dennis J.
Published: January 2018

Off-Label Drug Uses

ThisHospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Facts and Comparisons. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form so that the reader can easily identify the scope of information available. A summary of the data—including, background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. Finally, references direct the reader to the full literature for more comprehensive information prior to patient care decisions.
Security of Crash Carts and Medication Security in Other Areas: New Interpretation
Authors: Rich Darryl S.
Published: January 2018

This column addresses questions from readers about any issue, process, standard, or future direction of the Joint Commission, whether it relates to home care, the hospital, or other practice environment. The objective is to give you a better insight into the Joint Commission accreditation process in your own practice site. Any question is fair game.
• Art Imitates Life: Error Portrayal Really Happened/ • Patients with Poor Eyesight Need Extra Help/ • Caution Advised to Prevent Mix-Ups with Sarafem and Serophene
Authors: Cohen Michael R.
Published: January 2018

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program, which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 1-800-233-7767 (1-800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writer's names will be published if desired. ISMP may be contacted at the address shown below.
Budesonide Inhalation Suspension
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: January 2018

Each month, subscribers to The Formulary® Monograph Service receive five to six researched monographs on drugs that are newly released or are in late Phase III trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. The monographs are published in printed form and on diskettes that allow customization. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board called The Formulary Information Exchange (The F.I.X). All topics pertinent to clinical pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The February 2001 Formulary monographs are iron sucrose injection, oxybate sodium, diclofenac sodium gel, tacrolimus ointment, and docosanol. The DUE is on iron sucrose injection.
More on Automated Dispensing Machines
Authors: Rich Darryl S.
Published: January 2018

This column addresses questions from readers about any issue, process, standard, or future direction of the Joint Commission, whether it relates to home care, the hospital, or other practice environment. The objective is to give you a better insight into the Joint Commission accreditation process in your own practice site. Any question is fair game.
Weekly Fluorouracil and Leucovorin as Adjuvant Therapy for Early Stage Colon Cancer or Primary Therapy for Advanced Colorectal Cancer
Authors: Waddell J. Aubrey , Solimando Dominic A.
Published: January 2018

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column reviews various issues related to the preparation, dispensing, and administration of cancer chemotherapy, both commercially available and investigational.
• Oral Feeding Formula Confused with Beta-Blocker/• Look-Alike Products from Bedford Laboratories/• Fatal Error with Simultaneous Low-Molecular-Weight and IV Heparins
Authors: Cohen Michael R.
Published: January 2018

These medication errors have occurred in health care facilities at least once. They will happen again–perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program, which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 1-800-233-7767 (1-800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below.
• Anaphylaxis: A Review/• Adverse Drug Reactions in Hospitalized Patients/• Antihypertensive Drug Therapies and the Risk of Ischemic Stroke/• Laxative-Induced Dermatitis of the Buttocks: Internet-Facilitated Diagnoses/• Hepatic Angiosarcoma Associated with Cyclophosphamide
Authors: Shuster Joel
Published: January 2018

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (1-800-FDA-1088).
Questions and Answers from the F.I.X./• Phenylpropanolamine (PPA) Withdrawal/• Intralipids and Tubing Changes/• Zyprexa Zydis/• H. Pylori Regimens in Pediatrics/• Vasopressin in ACLS/• MD Handwriting Courses
Authors: Cada Dennis J.
Published: January 2018

The Formulary Information Exchange (The F.I.X.) is an online drug information service available to subscribers of The Formulary Monograph Service or you may log on through drugfacts.com. In this column, we present samples of recent dialog on The F.I.X. If you would like more information on The Formulary Monograph Service or The F.I.X.
Alternatives to Urokinase for the Management of Central Venous Catheter Occlusion
Authors: Phelps Kathy C. , Verzino Kelly C.
Published: January 2018

The nationwide shortage of urokinase that began in late 1998 forced the medical community to find suitable alternatives to this agent for the management of various thrombotic processes. A high-use indication for urokinase in our institution is the management of occluded central venous catheters. A comprehensive search of the medical, pharmacy, and nursing literature produced limited but useful information on various alternative agents, including streptokinase, alteplase, hydrochloric acid, ethanol, and sodium hydroxide. This article reviews the available literature on each of these agents.
Queuing Theory and Customer Satisfaction: A Review of Terminology, Trends, and Applications to Pharmacy Practice
Authors: Nosek Ronald Anthony , Wilson James P.
Published: January 2018

Queuing theory is the formal study of waiting in line and is an entire discipline in operations management. This article will give the reader a general background into queuing theory, its associated terminology, and it relationship to customer satisfaction. Queuing theory has been used in the past to assess such things as staff schedules, working environment, productivity, customer waiting time, and customer waiting environment. In pharmacy, queuing theory can be used to assess a multitude of factors such as prescription fill-time, patient waiting time, patient counseling-time, and staffing levels. The application of queuing theory may be of particular benefit in pharmacies with high-volume outpatient workloads and/or those that provide multiple points of service. By better understanding queuing theory, service managers can make decisions that increase the satisfaction of all relevant groups – customers, employees, and management.
Prevention and Management of Chemotherapy-Induced Nausea and Vomiting, Part 2
Authors: Mullin Shantel , Beckwith M. Christina
Published: January 2018

Credit

This lesson is good for 0.3 CE units, with a passing grade of 70%.

Goal

The goal of this program is to inform the participant about cost-effective ways to prevent, identify, and manage nausea and vomiting induced by antineoplastic agents.

Objectives

At the completion of this program the participant will be able to: 1. List antineoplastic agents associated with a high incidence of nausea and vomiting. 2. Identify patient-specific risk factors for developing chemotherapy-induced nausea and vomiting (CINV) and how these factors may influence treatment of this syndrome. 3. Compare the three major types of CINV, including the pathophysiologic mechanism, time of onset, and symptom duration of each type. 4. Explain the mechanism of action and appropriate place in therapy for each type of antiemetic agent. 5. Differentiate between pharmacologic regimens for the prevention and treatment of CINV in adults. 6. Identify drug-specific factors that must be considered when developing a formulary management strategy for the antiemetic agents. 7. Describe specific information that the pharmacist can share with patients to help them understand and manage CINV.
Cimetidine: Weight Loss
Authors: Generali Joyce , Cada Dennis J.
Published: January 2018

Off-Label Drug Uses - This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Facts and Comparisons. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form so that the reader can easily identify the scope of information available. A summary of the data–including, background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations–precedes each table of published studies. references direct the reader to the full literature for more comprehensive information prior to patient care decisions.
New Drugs Approved by the FDA New Dosage Forms and Indications Agents Pending FDA Approval
Authors: Baker Danial E.
Published: January 2018

This monthly feature will help readers keep current on new drugs, new indications and dosage forms, and safety-related changes in labeling or use. Each month, new information will be added to the table (shown in bold type) and older information will be removed. Efforts have been made to ensure the accuracy of the information; however
• Checking Refrigerator Temperatures/• Storing Batteries in Refrigerators/• Use and Storage of Ketamine/• Class 100 Environment for IV Preparation/• Automatic Stop Orders/• Required Consent for Medications/• Patient Education on Medication Use/• Pharmacist Review of Orders against Medication Profiles
Authors: Rich Darryl S.
Published: January 2018

This column addresses questions from readers about any issue, process, standard, or future direction of the Joint Commission, whether it relates to home care, the hospital, or other practice environment. The objective is to give you a better insight into the Joint Commission accreditation process in your own practice site. Any question is fair game.
Rational Use of Parenteral Proton Pump Inhibitors
Authors: Hopefl Alan
Published: January 2018

Hospital Pharmacy welcomes contributions to this column. Articles originally published in pharmacy department newsletters are reprinted here. Material is selected because of its educational value to pharmacists or because it demonstrates the type of information of interest to newsletter readers. If you wish to have your newsletter material considered for publication in this column, mail a copy to Facts and Comparison, Attn: Journal Editor, Hospital Pharmacy, 111 West Port Plaza, Suite 300, St. Louis, MO 63146-3098.
The Balanced Budget Act and Ambulatory Payment Classification
Authors: Vogenberg F. Randy
Published: January 2018

Managed health care has changed the way health services are provided and paid for. It is still evolving. Many pharmacists have already felt the impact of these changes. This continuing feature illuminates the many facets of managed care with special emphasis placed on how these changes may affect pharmacists working in health systems. The expertise provided by pharmacists will be needed to fulfill the potential of affordable, comprehensive, and quality health care as promised by managed care. Pharmacists must understand what is happening, why it is happening, and what is likely to happen in the future. To be an active and effective player, you must understand what is happening on the field.
High-Dose Fluorouracil and Leucovorin: Weekly Continuous Infusions for Metastatic Colorectal Cancer
Authors: Solimando Dominic A. , Waddell J. Aubrey
Published: January 2018

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column reviews various issues related to the preparation, dispensing, and administration of cancer chemotherapy, both commercially available and investigational.
• Fentanyl Shortage Brought Errors/• Depakote ER: Easy to Confuse with Depakote (Delayed-Release)/• Computer Systems Should Stop Adding Terminal Zeroes to Drug Strengths and Doses
Authors: Cohen Michael R.
Published: January 2018

These medication errors have occurred in health care facilities at least once. They will happen again-perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program, which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 1-800-233-7767 (1-800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below.
• CNS Effects of Antiepileptic Drugs/• Depression and Suicide with Accutane/• Hepatitis Due to Celecoxib: An Allergic Reaction?/• Problem with Antabuse/• Renal Failure with Intravenous Rho(D)Immune Globulin/• ACE Inhibitor Causes Hyperkalemia and Rare Type of Paralysis
Authors: Shuster Joel
Published: January 2018

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (1-800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
Questions and Answers from the F.I.X./• Heparin Alternatives for Central Lines/• Bulk Albuterol Solution/• NAEPP Guidelines for the Use of Palm OS Devices/• Trimethoprim/Sulfamethoxazole and Hyponatremia/• Esmolol IV Infusion Guidelines/• Fentanyl Alternatives in Infants and Children/• H2 Blockers and Immunosuppression
Authors: Cada Dennis J.
Published: January 2018

The Formulary Information Exchange (The F.I.X.) is an online drug information service available to subscribers of The Formulary Monograph Service or you may log on through drugfacts.com. In this column, we present samples of recent dialog on The F.I.X. If you would like more information on The Formulary Monograph Service or The F.I.X.
An Observational Study of Medication Sample Use in a Family Practice Clinic
Authors: Dill Jennifer L. , Generali Joyce A.
Published: January 2018

This observational study was designed to quantify the value and characterize the types of medication samples used in a clinic setting. The volume and average wholesale price of samples dispersed over a one-week period were reported by drug classification and manufacturer. During the initial observation period, a total of 1,242 samples worth $11,860 were dispersed, of which 141 (11.4%) were documented appropriately with the date, patient's name, physician's name, medication, number of samples, expiration date, and lot number. This lack of documentation brought about concerns regarding quality of patient care, liability, and compliance with Joint Commission on the Accreditation of Healthcare Organizations standards with respect to medication samples. An educational intervention was performed to address these concerns and to encourage the development of a plan to improve documentation of medication samples dispersed, which was followed by a postinterventional evaluation of medication sample use and dispersement documentation.
Iron Sucrose Injection
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: January 2018

Each month, subscribers to The Formulary® Monograph Service receive five to six researched monographs on drugs that are newly released or are in late Phase III trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. The monographs are published in printed form and on diskettes that allow customization. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board called The Formulary Information Exchange (The F.I.X). All topics pertinent to clinical pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The April 2001 Formulary monographsare on caspofungin, peginterferon alfa-2b, ziprasidone, 90Y ibritumomab tiuxe-tan, and Abarelix depot. The DUE is on caspofungin.
The Individual Perspective: Did This Vaccine Harm this Person?
Authors: Grabenstein John D.
Published: January 2018

With the rapid pace of immunologic research, it is more important than ever for readers to understand rational immunodiagnosis, immunoprophylaxis, and immunotherapy. This column is intended to help you carry out proper immuno-logic drug use in your practice.
Dextromethorphan: Neuropathy
Authors: Generali Joyce , Cada Dennis J.
Published: January 2018

Off-Label Drug Uses

This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Facts and Comparisons. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form so that the reader can easily identify the scope of information available. A summary of the data—including, background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. references direct the reader to the full literature for more comprehensive information prior to patient care decisions.
New Drugs Approved by the FDA New Dosage Forms and Indications Agents Pending FDA Approval
Authors: Baker Danial E.
Published: January 2018

This monthly feature will help readers keep current on new drugs, new indications and dosage forms, and safety-related changes in labeling or use. Each month, new information will be added to the table (shown in bold type) and older information will be removed. Efforts have been made to ensure the accuracy of the information; however,
Pharmacy Issues: Total Parenteral Nutrition
Authors: Miller Alicia S.
Published: January 2018

This continuing feature will inform readers about the process of implementing, maintaining, and supporting prescriber computer order entry (PCOE) at the Ohio State University Medical Center. (By “prescribers,” we refer to health care professionals authorized to prescribe medications by their states.) Practical information on what worked and what failed will be provided, along with current updates on the status of PCOE at the Medical Center.
Surveying Medication Use in 2001
Authors: Rich Darryl S.
Published: January 2018

This column addresses questions from readers about any issue, process, standard, or future direction of the Joint Commission, whether it relates to home care, the hospital, or other practice environment. The objective is to give you a better insight into the Joint Commission accreditation process in your own practice site.
Lotrel and Glucotrol XL: QD or QID?
Authors: Dunn Eddie , Wolfe Jonathan
Published: January 2018

Hospital Pharmacy

welcomes contributions to this column. Articles originally published in pharmacy department newsletters are reprinted here. Material is selected because of its educational value to pharmacists or because it demonstrates the type of information of interest to newsletter readers. If you wish to have your newsletter material considered for publication in this column, mail a copy to Facts and Comparison, Attn: Journal Editor, Hospital Pharmacy, 111 West Port Plaza, Suite 300, St. Louis, MO 63146-3098.
Basic Bibliographies
Authors: Generali Joyce A.
Published: January 2018

In order to help readers monitor the most important developments in specialized areas of pharmacy practice in organized health systems, Hospital Pharmacy commissions Basic Bibliographies by guest editors, who have expertise in their respective fields. These guest editors survey the relevant literature and rank approximately 15 to 20 references that represent the most significant research and practice contributions in their areas. The more fundamental are listed first so that persons with limited time can select reading appropriate to their needs. A cum-mulative index to Basic Bibliography topics will be published semi-annually in June and December.
Cancer Chemotherapy Update: Protracted Venous Infusion Fluorouracil for Advanced Colorectal Cancer
Authors: Waddell J. Aubrey , Solimando Dominic A.
Published: January 2018

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column reviews various issues related to the preparation, dispensing, and administration of cancer chemotherapy, both commercially available and investigational.
• Drug Shortages Lead to Medication Errors; •Dispense from the Pharmacy, Not from Central Supply; •Use of Symbols Increases Medication Error Risk
Authors: Cohen Michael R.
Published: January 2018

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program, which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 1-800-233-7767 (1-800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below.
Questions and Answers from the F.I.X.;• Midazolam (Versed) Continuous Infusion;• High-Dose Concerta;• Noni Juice (Morinda Citrifolia) for Arthritis;• High-Dose Oxytocin;• Drotrecogin alfa (Zovant)
Authors: Cada Dennis J.
Published: January 2018

The Formulary Information Exchange (The F.I.X.) is an online drug information service available to subscribers of The Formulary Monograph Service or you may log on through drugfacts.com. In this column, we present samples of recent dialog on The F.I.X. If you would like more information on The Formulary Monograph Service or The F.I.X., please call 800-322-4349.
National Program for Medication Error Reporting and Benchmarking: Experience with MedMARx
Authors: Phillips Marjorie A Shaw
Published: January 2018

This article explains the value of moving to a standardized national reporting program for medication errors. Early benchmarking activities related to medication errors were ineffective due to difficulties in reporting and the stigma associated with higher reporting rates. One institution's participation and experience with MedMARxSM (an Internet-accessible program for tracking and analyzing medication error reports with a link to an anonymous national database) is described, and some useful features of the program are highlighted. Ninety-five percent (95%) of the errors reported in the database did not result in patient harm, yet these records provide information that may guide efforts to reduce errors. Participation in the MedMARx program has helped our institution's medication error reporting program focus on performance improvement through more careful analysis of the causes of errors and “near misses.”
Inventory Cost Reduction in the Perioperative Setting
Authors: Elkach Toni
Published: January 2018

An inventory cost-reduction project for our operating room was undertaken to reduce excess inventory, increase inventory turnover, and eliminate unusable items. The operating area consisted of three departments with different inventory control potentials. In the anesthesia department, the targeted areas with corresponding results in inventory savings were: anesthesiologists' trays stock, $2344; refrigerated neuromuscular blockers, $2025; intravenous fluids and miscellaneous items, $2817; reduction of midazolam waste, $5907. Inventory reductions in the postanesthesia care unit and the operating room (the second and third departments) totaled $565 and $496, respectively. In addition, a yearly report run by the pharmacy and its purposes were discussed. These simple interventions led to inventory savings of $14,154. Projects now underway should lead to more impressive results in the near future.
Interpretation of Parenteral Nutrition Prescriptions Transferred from Various Health Care Settings
Authors: Lu Arthur , Choi Terence
Published: January 2018

Parenteral nutrition (PN) prescriptions for patients transferred from other health care environments are written in a variety of prescribing formats and labeling templates. Six macronutrient and two micronutrient ordering formats have been identified. Interpretation and compounding of these PN prescriptions require time-consuming calculations. With the aid of a commonly used PC spreadsheet software, interpreting and compounding can be carried out within minutes after the ordering format is identified.
Ondansetron: Bulimia
Authors: Generali Joyce , Cada Dennis J.
Published: January 2018

Off-Label Drug Uses

This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Facts and Comparisons. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form so that the reader can easily identify the scope of information available. A summary of the data—including, background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. references direct the reader to the full literature for more comprehensive information prior to patient care decisions. Direct questions or comments on “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
New Drugs Approved by the FDA New Dosage Forms and Indications Agents Pending FDA Approval
Authors: Baker Danial E.
Published: January 2018

This monthly feature will help readers keep current on new drugs, new indications and dosage forms, and safety-related changes in labeling or use. Each month, new information will be added to the table (shown in bold type) and older information will be removed. Efforts have been made to ensure the accuracy of the information;
Pharmacy Issues: Unique IV Drug Ordering—Epidural Anesthesia
Authors: Miller Alicia S.
Published: January 2018

This continuing feature will inform readers about the process of implementing, maintaining, and supporting prescriber computer order entry (PCOE) at the Ohio State University Medical Center. (By “prescribers,” we refer to health care professionals authorized to prescribe medications by their states.) Practical information on what worked and what failed will be provided, along with current updates on the status of PCOE at the Medical Center.
Management of Acute Alcohol Withdrawal in the Inpatient Setting
Authors: Odegard Peggy Soule , Goe Mikell
Published: January 2018

Collaborative drug therapy management (CDTM) is a method for developing a patient-centered practice in which the pharmacist's activities are integrated with those of other health care providers. The goals of this continuing feature are to refine the concept of CDTM and provide patient-care applications from the authors' experience in Washington state. Questions or suggestions should be addressed to Timothy S. Fuller, FASHP, Fuller and Associates, 1948 Boyer Avenue East, Seattle, WA 98112-2924 (tel.206-860-8308). E-mail: timfuller@kendra.com
Patients' Rights: Federal vs State Governments
Authors: Wilson C. Nick
Published: January 2018

Managed health care has changed the way health services are provided and paid for. It is still evolving. Many pharmacists have already felt the impact of these changes. This continuing feature illuminates the many facets of managed care with special emphasis placed on how these changes may affect pharmacists working in health systems. The expertise provided by pharmacists will be needed to fulfill the potential of affordable, comprehensive, and quality health care as promised by managed care. Pharmacists must understand what is happening, why it is happening, and what is likely to happen in the future. To be an active and effective player, you must understand what is happening on the field.
Liposomal Doxorubicin for Ovarian Cancer
Authors: Patel Neel , Solimando Dominic A. , Waddell J. Aubrey
Published: January 2018

The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column reviews various issues related to the preparation, dispensing, and administration of cancer chemotherapy, both commercially available and investigational.
•Caution: Packaging of the New IV Bag of Brevibloc (Esmolol) Premixed Injection Could Lead to Errors; •New “Tall Man” Lettering Will Reduce Mix-ups due to Generic Drug Name Confusion; •Extra Caution Needed with U-500 Regular Insulin
Authors: Cohen Michael R.
Published: January 2018

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program, which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 1-800-233-7767 (1-800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below.
Questions and Answers from the F.I.X.;•Oral Phenytoin and Tube Feeding;•Zantac (Ranitidine) IV Push;•Corlopam (Fenoldopam) Use in Post CABG Patients;•Warfarin and Central Venous Catheters
Authors: Cada Dennis J.
Published: January 2018

The Formulary Information Exchange (The F.I.X.) is an online drug information service available to subscribers of The Formulary Monograph Service or you may log on through drugfacts.com. In this column, we present samples of recent dialog on The F.I.X. If you would like more information on The Formulary Monograph Service or The F.I.X., please call 800-322-4349.
Insulin Medication Error Reduction: A Quality Improvement Initiative
Authors: Kowiatek Joanne , Skledar Susan , Potoski Brian
Published: January 2018

This study describes a multidisciplinary approach to reducing insulin medication errors. In 1998, a medication error analysis at our institution demonstrated that insulin was the top drug associated with medication errors. A collaborative continuous quality improvement initiative was undertaken to develop recommendations for reducing insulin medication errors. Multidisciplinary root cause analysis revealed that during order prescribing and transcribing, the abbreviation of “u” for units—combined with the lack of a formal education program for physicians on appropriate use of abbreviations—was a major contributing cause to insulin medication errors. An extensive multidisciplinary education program was undertaken to target insulin orders for medication error reduction. To date, compliance with prescribing insulin orders within guidelines has increased from 30% to 74%, and compliance with transcribing insulin orders within guidelines has increased from 36% to 83%. This collaborative project increased awareness of insulin medication error causation and will be used as a template to reduce other types of medication errors.
Oxazepam Cost-Savings Conversion
Authors: Dillon Cherie L. , Lopez Julio R. , Leyba Christine M.
Published: January 2018

After Mylan Pharmaceuticals dramatically increased the cost of generic lorazepam, the projected impact on the 1998 VA Northern California Health Care System (VANCHCS) pharmaceutical budget was significant. Requests for voluntary conversion from lorazepam to less-expensive alternative benzodiazepines had no significant impact on prescribing practices. The objective of this project was to determine mental health patients' clinical tolerance with conversion from lorazepam to an alternative benzodiazepine, primarily oxazepam. A structured conversion program was developed as a combined effort between Pharmacy and Mental Health Services. Seventy patients cared for by five outpatient psychiatrists were enrolled in the 4-month project. The active conversion took place over 1 month and involved one of two methods: clinical pharmacy specialist recommendation or direct intervention. At the conclusion of the project, 88.6% of patients were converted from lorazepam to an alternative benzodiazepine or were taken off benzodiazepines completely. Oxazepam was chosen in 45.7% of these cases, resulting in an annual cost savings of $15,800. Based on the results of this project, lorazepam prescribing is now restricted to the mental health service.
Ziprasidone
Authors: Cada Dennis J. , Levien Terri , Baker Danial E.
Published: January 2018

Each month, subscribers to The Formulary® Monograph Service receive five to six researched monographs on drugs that are newly released or are in late Phase III trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. The monographs are published in printed form and on diskettes that allow customization. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board called The Formulary Information Exchange (The F.I.X). All topics pertinent to clinical pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The June 2001 Formulary monographs are on pantoprazole IV, darbepoetin, voriconazole, bimatoprost ophthalmic solution, and prasterone. The DUE is on pantoprazole.
Etanercept: Congestive Heart Failure
Authors: Generali Joyce , Cada Dennis J.
Published: January 2018

Off-Label Drug Uses

This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Facts and Comparisons. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form so that the reader can easily identify the scope of information available. A summary of the data—including, background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. References direct the reader to the full literature for more comprehensive information prior to patient care decisions. Direct questions or comments on “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
Drug-Induced Hyperkalemia
Authors: Chew Michael , Bult Judilynn , Schiff Gordon
Published: January 2018

Hospital Pharmacy welcomes contributions to this column. Articles originally published in pharmacy department newsletters are reprinted here. Material is selected because of its educational value to pharmacists or because it demonstrates the type of information of interest to newsletter readers. If you wish to have your newsletter material considered for publication in this column, mail a copy to Facts and Comparison, Attn: Journal Editor, Hospital Pharmacy, 111 West Port Plaza, Suite 300, St. Louis, MO 63146-3098.
Talking about and Using Pharmacoeconomics Properly
Authors: Vogenberg F. Randy
Published: January 2018

Managed health care has changed the way health services are provided and paid for. It is still evolving. Many pharmacists have already felt the impact of these changes. This continuing feature illuminates the many facets of managed care with special emphasis placed on how these changes may affect pharmacists working in health systems. The expertise provided by pharmacists will be needed to fulfill the potential of affordable, comprehensive, and quality health care as promised by managed care. Pharmacists must understand what is happening, why it is happening, and what is likely to happen in the future. To be an active and effective player, you must understand what is happening on the field.
•Confusion Possible between Colazal and Clozaril;•Failure to Adjust Dose of Amphotericin B When Route Changed from Oral to IV;•Fentanyl Transdermal System Unsafe in Inexperienced Hands
Authors: Cohen Michael R.
Published: January 2018

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program, which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 1-800-233-7767 (1-800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below.
Questions and Answers from the F.I.X.;•Vitamin K in Newborns;•Opioid Withdrawal Protocols;•Hydromorphone Pca Dosing;•Ru-486/Mifeprex Used in Ed for Rape Victim;•Role of Kaletra (Lopinavir/Ritonavir) in HIV Treatment
Authors: Cada Dennis J.
Published: January 2018

The Formulary Information Exchange (The F.I.X.) is an online drug information service available to subscribers to The Formulary Monograph Service at http://theformulary.com , or you may log on through drugfacts.com. In this column, we present samples of recent dialog on The F.I.X. If you would like more information on The Formulary Monograph Service or The F.I.X., please call 800-322-4349. If you would like to comment on any of the following questions or answers, please e-mail them to Dennis J. Cada at dcada@drugfacts.com .
The Stability of Diluted Vincristine Sulfate Used as a Deterrent to Inadvertent Intrathecal Injection
Authors: Trissel Lawrence A. , Zhang Yanping , Cohen Michael R.
Published: January 2018

The objective of this study was to evaluate the physical and chemical stability of vincristine sulfate diluted to a variety of concentrations in 0.9% sodium chloride injection and packaged in minibags and 30 mL syringes, to help deter inadvertent intrathecal injection of the drug. Test samples were prepared by diluting vincristine sulfate quantities of 0.5 mg, 1 mg, 2, mg, and 3 mg in 0.9% sodium chloride injection. These quantities were selected to span the range of doses normally expected for this cytotoxic drug. The vincristine was diluted with 0.9% sodium chloride injection in volumes of 25 mL and 50 mL packaged in polyvinyl chloride minibags and to 20 mL packaged in 30 mL polypropylene syringes. Physical and chemical stability evaluations were performed initially and after 1, 3, and 7 days of storage at 4°C followed by an evaluation at 9 days after 2 additional days of storage at a temperature of 23°C. Physical stability was assessed using visual observation in normal light and a high-intensity monodirectional light beam. In addition, turbidity and particle content were measured electronically. Chemical stability of the drug was evaluated by using a stability-indicating high performance liquid chromatographic (HPLC) analytical technique.

No physical instability was noted and no unacceptable loss of vincristine sulfate concentration was found in any sample throughout the study period. The use of vincristine sulfate doses diluted in infusion volumes of 0.9% sodium chloride injection and packaged in minibags or in 30 mL syringes to help deter inadvertent intrathecal administration may be performed with no unacceptable physical or chemical instability occurring.