bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Implementation of a Personnel Training and Assessment Program for New Standards in the US Pharmacopeia General Chapter <797> Pharmaceutical Compounding of Sterile Preparations
Authors: Trapskin Philip J. , Reagan Rebecca , Hite Kimberley , Armitstead John A. 
Published: August 2010

Purpose The US Pharmacopeia (USP) general Chapter <797> sets standards for personnel training and assessment of aseptic manipulation skills. We describe the implementation of a training and assessment program to meet these standards at an academic medical center. Methods Exempt approval by the University of Kentucky Institutional Review Board was granted. All pharmacy personnel responsible for compounding sterile preparations were included. Participants completed three computer-based learning modules (CBLs) related to mathematics skills, aseptic manipulations, and USP <797>. Participants were given an online test, prior to viewing a CBL (pretest) and after completion of a CBL (posttest). Mean pre- and posttest scores were analyzed using a paired Student's t-test. A proctored practical examination involved manipulations of sterile fluid culture media (media-fill challenge) to assess aseptic manipulation skills. Culture media were incubated at room temperature for 14 days and monitored for growth. Results A significant increase was found in mean percentage of correct answers for pre- and posttest scores for the aseptic manipulation (85% vs 93%; P < 0.05) and USP <797> (78% vs 90%; P < 0.001) CBLs. The mean percentage of correct answers on the mathematics test was 92%. The results of the media-fill challenge revealed that 4 of the 84 (4.2%) proctored assessments were contaminated. Conclusion This personnel training and assessment program meets the requirements of USP <797>. The use of CBLs was effective in teaching and assessing participants on the theoretical and practical principles of aseptic manipulations. The proctored practical assessment meets USP <797> requirements for medium-risk level media-fill challenge tests.
Ramelteon
Authors: Cada Dennis J. , Levien Terri , Baker Danial E. 
Published: August 2010

Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late phase 3 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. With a subscription, the monographs are sent to you in print and CD ROM forms and are available online. Monographs can be customized to meet the needs of your facility. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital 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 January 2006 monograph topics are deferasirox, nelarabine, sitaxsentan, sorafenib, and decitabine. The DUE is on deferasirox
Daptomycin–Dactinomycin Confusion; Oral Liquid Given IV; Misspelling Leads to Mix-Up; Duragesic-12
Authors: Cohen Michael R. 
Published: August 2010

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 (MERP), 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 800-233-7767 (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. Errors, close calls, or hazardous conditions may be reported through the ISMP ( www.ismp.org ) or USP ( www.usp.org ) Web sites or communicated directly to ISMP by calling 800-FAIL-SAFE or via E-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.
Chemotherapy Dose Limits Set by Users of a Computer Order Entry System
Authors: Dubeshter Brent , Griggs Jennifer , Angel Cynthia , Loughner John 
Published: August 2010

Objective The elimination of dosing errors related to chemotherapy administration remains an elusive goal. Computerized order entry reduces errors but is not widely used. One problem in implementing computer dose checking is the lack of standardized dose limits. We evaluated the dose limits set for chemotherapeutic agents by users of a computer order entry system. Methods Oncology practices from 82 sites using a computer order entry system submitted data via the Web to a central data warehouse on 280,047 drug administrations for 16,976 patients. Data were blinded to patient and site but included the diagnosis, age, chemotherapy regimens, dosages, and dose adjustments. Dose limits, set by users at each location, were assessed. For commonly used regimens, the range of customary doses was also assessed. Results The mean dose limit was less than that for a body surface area (BSA) of 2.2 meter squared in 43/44 (98%) of the drugs dosed according to BSA. This user set dose limit was exceeded in only 3% of drug administrations. Conclusion In setting computerized dose limits, most oncologists use a dose limit below that for a BSA of 2.2 meters squared. This user set limiting dose was rarely exceeded, with 97% of dosages below the limits set in this computer order entry system.
Metabolic Support of the Thermally Injured Patient
Authors: Dickerson Roland N. 
Published: August 2010

Nutrition Support Pharmacist features issues pertinent to the practice of clinical pharmacy in the area of nutritional support. The column is edited by Dr. Roland Dickerson, Professor of Pharmacy, University of Tennessee Health Science Center; Memphis, TN. Address correspondence to Dr. Roland N. Dickerson, University of Tennessee Health Science Center, 26 South Dunlap St., Memphis, TN 38163. This article provides a summary of our approach to the nutritional management of the thermally injured patient. However, it must be pointed out that there are other alternative effective evidence-based approaches to managing this problematic patient population. There are numerous exceptions to the above outlined guidelines that the astute clinician must be able to identify. However, for the beginning reader, this approach will provide a sound foundation upon which to build their practice in the management of these difficult patients.
Tadalafil: Raynaud Phenomenon
Authors: Generali Joyce , Cada Dennis J. 
Published: August 2010

Off-Label Drug Uses This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Wolters Kluwer Health. 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 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 regarding “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
Evaluation of Turnaround Time for Medication Order Processing with Use of a Novel Scanning System
Authors: Carswell Jody L. , Dipiro Cecily V. , Gomez Tad A. , Phillips Marjorie S. , Herrington Ben 
Published: August 2010

Purpose The efficiency in turn around time for medication order processing and level of compliance with the Pharmacy's Service Level Agreement with Nursing were assessed using a novel scanning system developed by the Information Services Department at the Medical College of Georgia Health System. Methods Two phases: Phase 1 assessed medication turn around time for a nursing unit prior to implementation of OrderComm. Phase 2 assessed medication turn around time post implementation of OrderComm. Evaluating points for both phases included order entry time (time the order reaches the pharmacy to entry into computer), order entry to delivery (time it takes for medication to become available to the nursing staff), and order completion time (time the order reaches the pharmacy to the time it becomes available to the nursing staff). Both phases occurred over 5 days on the dayshift (8 AM to 5 PM). Results Average order entry time for phase 1 was 43 minutes (SD = 28.22 min, N = 96) and for phase 2 was 9.4 minutes (SD = 13.12min, N = 95). Average order completion time was 44 minutes (SD = 30.03 min, N = 96) for phase 1 and 14.2 minutes (SD = 20.01 min, N = 95) for phase 2. Based on Service Level Agreement criteria, only 71% of Pyxis orders met goal in phase 1 compared to 98% in phase 2. Conclusion Use of a novel scanning system had a positive impact on pharmacy services. With the use of OrderComm, the Pharmacy Department can now meet the agreements outlined with nursing in the Service Level Agreement.
Lidocaine/Tetracaine Patch
Authors: Cada Dennis J. , Arnold Barbara , Levien Terri , Baker Danial E. 
Published: August 2010

Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late phase 3 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. With a subscription, the monographs are sent to you in print and CD ROM forms and are available online. Monographs can be customized to meet the needs of your facility. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital 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 March 2006 monograph topics are conivaptan hydrochloride injection, abatacept, sorafenib tosylate, lenalidomide, and tetanus toxoid, reduced diptheria toxoid, and acellular pertussis vaccine absorbed (Tdap). The DUE is on conivaptan.
Adalimumab: Psoriatic Arthritis
Authors: Generali Joyce , Cada Dennis J. 
Published: August 2010

Off-Label Drug UsesThis Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Wolters Kluwer Health. 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 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 regarding “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .
Association of Mortality Risk with High Serum Digoxin Concentrations
Authors: Rising Susanne E. , Welch Justin M. , Koo Ji M. 
Published: August 2010

Background There are data suggesting a possible association of serum digoxin concentrations (SDC) and risk of mortality in patients treated with digoxin. Objective To determine whether SDCs in the therapeutic range of 1.2 to 2 ng/mL increase the risk of mortality when compared to a lower range of 0.5 to 1.1 ng/mL. Methods Retrospective cohort study to compare the risk of mortality in male patients with SDCs less than 1.2 ng/mL to patients with SDCs of 1.2 to 2 ng/mL. Results A total of 261 male patients were included, 191 (73%) had SDCs in the low range (0.5 to 1.1 ng/mL), and 70 (27%) had SDCs in the high range (at least 1.2 to 2 ng/mL). A high SDC showed a significant increase in risk for mortality with a hazard ratio (HR) of 1.656; 95 % HR confidence interval, 1.153 to 2.38; P = 0.0063. Conclusion Our results showed an increased risk of mortality in the high SDC group (1.2 to 2 ng/mL). This study's findings are consistent with the results of a post hoc evaluation of SDC in male patients in the DIG trial. 1 A prospective trial is warranted to confirm our findings.
Opportunities for Optimizing Pantoprazole Therapy in Patients with Acute Upper Gastrointestinal Bleeding
Authors: Saran Mandeep K. , Loewen Peter S. , Zed Peter J. 
Published: August 2010

Purpose To evaluate the appropriateness of intravenous (IV) pantoprazole in subjects presenting with signs suspicious of acute gastrointestinal bleeding (AGIB) and to identify opportunities for optimizing its use. Methods Retrospective health record review of subjects receiving IV pantoprazole for suspected or confirmed AGIB was conducted at two affiliated teaching hospitals. Results Of the 175 subjects enrolled, 157 (90%) received a diagnostic endoscopy. The median time to endoscopy was 18.5 hours, and the median time to start pantoprazole was 6.9 hours. Thirty-seven subjects (21%) did not receive the appropriate pantoprazole dose of 80 mg bolus followed by 8 mg/h infusion, and 22 high-risk subjects (33%) received less than 60 hours of IV pantoprazole. The median duration of pantoprazole following endoscopy for low-risk subjects was 21.1 hours. Conclusion Opportunities to optimize the use of IV pantoprazole include initiating therapy quickly at the appropriate dosing regimen, continuing the infusion for 72 hours in patients with high-risk bleeds, and discontinuing the infusion promptly once a high-risk AGIB is ruled out.
Core Competencies in Hospital Pharmacy - Intravenous Admixtures
Authors: Sanborn Michael 
Published: August 2010

The next several Director's Forum articles will focus on core practices or competencies in hospital pharmacy practice. This series of articles will discuss the key fundamentals, resources, challenges, and opportunities associated with drug dispensing. Future core competency forums will include discussions on medication ordering, intravenous admixtures, data analysis, and regulatory requirements. In Director's Forum, we hope to answer key questions that pharmacy directors face and provide others with information to foster growth in pharmacy leadership. The articles in this column will build on one another and, when put together, will serve as a “tool kit” to develop patient-centered pharmacy services in hospitals of all sizes. Examples of topics in future Director's Forums will include establishing clinical service priorities, justifying clinical pharmacist positions, implementing a patient safety program, and budgeting for patient-centered services.
Cardiothoracic Surgery Discharge Guideline
Authors: Dadyan Mitra , Sanborn Michael 
Published: August 2010

Patient safety is a complex issue that is constantly evolving. Communication via standardized drug ordering is recognized as one of the key elements to providing a safer hospital stay, as well as a stronger patient outcome. This feature will publish bimonthly and will provide examples of standardized drug prescribing and a forum for discussion. If you have a template that you believe other hospital pharmacies can benefit from, please submit it along with answers to the questions (seen below in the text) to Joyce Generali, Director of Drug Information at Kansas University Medical Center, 3901 Rainbow Center, Kansas City, KS 66160 or E-mail at jgeneral@kumc.edu .
Confusion between Two Forms of EDTA; Identical Name Error which Spans Three Continents; New Form and Strength
Authors: Cohen Michael R. 
Published: August 2010

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 (MERP), 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 800-233-7767 (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. Errors, close calls, or hazardous conditions may be reported through the ISMP ( www.ismp.org ) or USP ( www.usp.org ) Web sites or communicated directly to ISMP by calling 800-FAIL-SAFE or via E-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.
Extended Stability of Oxytocin in Ringer's Lactate Solution at 4° and 25°C
Authors: Boothby Lisa A. , Madabushi Rajanikanth , Kumar Vipul , Breland Burnis D. , Hatton Randy C. , Doering Paul L. , Derendorf Hartmut 
Published: August 2010

Purpose Since IV admixtures of oxytocin in the final working concentrations are not commercially available, oxytocin admixtures must be prepared immediately before use or compounded in a sterile laminar flow hood and stored until needed. Although published reports indicate short-term stability of oxytocin in Ringer's lactate solution and Ringer's lactate-dextrose 5%, longer-term stability data at various temperatures are lacking. Methods A stability assay was developed, validated, and executed with oxytocin at two different concentrations in Ringer's lactate solution. Stability was assessed at 4 and 25°C over 31 days. Results This study shows that commonly used dilutions of oxytocin in Ringer's lactate solution retain greater than 90% of initial concentrations, when stored at room temperature or refrigerated for 31 days. These data show that oxytocin admixed with Ringer's lactate solution has extended chemical stability after preparation. Conclusions Demonstration of extended stability of oxytocin in Ringer's lactate solution will allow hospitals to give longer dating to oxytocin IV admixtures, provided they are prepared in a sterile environment and monitored in compliance with USP <797> guidelines. This should help minimize the potentially dangerous practice of admixing this IV solution at the bedside.
JCAHO Med Management - Managing High-Risk Medications: Implementing Medication Management Standard 7.10
Authors: Shlom Elizabeth A. , May Sondra K. 
Published: August 2010

This continuing feature highlights the experiences of various health care organizations in implementing the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Medication Management Standards and National Patient Safety Goals. Practical information on what worked and how organizations have been surveyed regarding the standards and goals will be provided along with updates on revisions and recommendations being established by JCAHO. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Medication Management Standards are guidelines for health care organizations to improve patient medication safety and quality of care. Medication Management Standard 7.10 states, “The hospital develops processes for managing high-risk or high-alert medications.” An institution's list of high-risk medications can be derived from published lists, retrospective review of hospital-specific incidents, and/or prospective evaluation as new drugs are added to the formulary. The hospital's policy will include the list of high-risk medications and the risk-reduction strategies that it is undertaking to reduce medication errors associated with them. One method of identifying risk-reduction strategies is to conduct a failure mode and effects analysis (FMEA). The process of conducting an FMEA is described and a list of risk-reduction strategies from two hospitals are provided.
Determining Nurses' Satisfaction with Pharmacy Services: A Suggested Methodology and Demonstration
Authors: Matthias Kathryn R. , Gibson Kimberly D. , Draugalis Jolaine R. , Spravzoff Steve R. 
Published: August 2010

Purpose The level of nurses' satisfaction regarding pharmacy services provided at a rural medical center was evaluated and compared to data collected in a previous study at the same institution. Information obtained was used to determine potential areas for pharmacy service improvements. Methods This project employed a survey research design that acquired demographic and descriptive data. The updated survey contained 43 items including 34 scaled, seven demographic, and two open-ended items. Aspects assessed by this instrument included accessibility of pharmacists, accuracy of medication delivery, quality of drug information services, and perceptions of pharmacists' value by nursing staff. All inpatient nurse practitioners, licensed practical nurses, and registered nurses who were employed at the Medical Center in the winter of 2004 were eligible to participate in this study. The a priori level of significance for all analyses was two-tailed at 0.05. Results A total of 199 surveys were returned for a response rate of 43.9%. The overall level of nurses' satisfaction with pharmacy services at the Medical Center had not significantly changed between the years of 2000 and 2004; however, satisfaction with several specific aspects of pharmaceutical services changed over time. Increased levels of satisfaction were related to medication accuracy and inpatient pharmacy hours; decreased levels of satisfaction were reported for medication availability in automated medication dispensing machines and pharmacy telephone services. The level of nurses' satisfaction with pharmacy services was increased in relation to the communication between pharmacists and nurses and decreased in relation to technology associated pharmacy services. Conclusion The data gleaned from the survey were evaluated in order to make recommendations to the Medical Center's Director of Pharmacy. An instrument was developed and validated to discern nurses' level of satisfaction with pharmacy services. This methodology may also be used at other institutions.