The multiplicity of drugs available and the complexities surrounding their safe and effective use make it necessary for organized health-care settings to have a sound program for maximizing rational drug use. The pharmacy and therapeutics (P&T) committee, or its equivalent, is the organizational keystone to this program. The P&T committee evaluates the clinical use of drugs, develops policies for managing drug use and drug administration, and manages the formulary system. This committee is composed of physicians, pharmacists, and other health professionals selected with the guidance of the medical staff. It is a policy-recommending body to the medical staff and the administration of the organization on matters related to the therapeutic use of drugs.
The compatibility of filgrastim with selected drugs during simulated Y-site injection was studied. Five-milliliter samples of filgrastim 30 micrograms/mL in 5% dextrose injection were combined with 5-mL samples of solutions of each of 97 other drugs in 5% dextrose injection at clinically used concentrations at 22 degrees C. Immediately after and one and four hours after the samples were combined, visual examinations were performed in fluorescent light with the unaided eye and with a high-intensity monodirectional light (Tyndall beam) to enhance the visualization of small particles and low-level turbidity. The turbidity of each drug combination was measured as well. Combinations yielding inconclusive results were subjected to particle sizing and counting. Most of the drugs tested were compatible with filgrastim 30 micrograms/mL during the observation period. However, 22 drugs showed various incompatibilities with filgrastim, including filament formation, particulate formation and precipitation, and color change. Filgrastim 30 micrograms/mL in 5% dextrose injection was compatible with 75 drugs for up to four hours at 22 degrees C; 22 drugs were not compatible with filgrastim.
The stability of isradipine in an extemporaneously compounded oral liquid was studied. A suspension was prepared from the powder of commercially available 5-mg isradipine capsules and sufficient Simple Syrup, NF, to make a final volume of 50 mL. A control suspension was prepared from analytical-grade isradipine powder and Simple Syrup, NF. The final concentration of isradipine in both suspensions was 1 mg/mL. Three identical volumes of each suspension were stored in 2-oz amber glass prescription bottles, which were stored at 4 degrees C. Immediately after preparation and at 7, 16, 22, 28, and 35 days, samples were visually inspected and assayed in duplicate by high-performance liquid chromatography; the pH of the samples was also determined. At least 95% of the initial isradipine concentration remained throughout the study period in all samples of both suspensions. Color, odor, and pH did not change appreciably. Isradipine 1 mg/mL in an oral liquid compounded from Simple Syrup, NF, and powder from capsules was stable for at least 35 days in amber glass bottles at 4 degrees C.
The concept of computerized expert systems is explained, the potential utility of these systems in pharmacy is explored, and strategies and imperatives for implementing them are described. Computerized expert systems attempt a higher level of analysis than traditional computer programs. They can be defined as systems that attempt to make or assist in a decision that is not yet completely and reliably definable in objective terms. Because of the information-intensive nature of pharmacy practice, this field is particularly suited to use of expert systems. Current applications include screening for drug interactions and therapeutic drug monitoring. Expert systems must offer a substantial advantage over human expertise (for example, by quickly analyzing enormous quantities of data); those that perform functions that humans could perform have failed to gain widespread use. An ideal hospital expert system would have access to any data available about a patient's care and would detect critical situations as they occur. Such a system would require pharmacists to shift from a prescription-based orientation to a case-management orientation. Factors to consider in implementing an expert system include linkage among multiple departments, usage options, development strategies, and maintenance requirements. Computerized expert systems hold great potential for application to pharmacy and may influence the pharmacist's role in patient care.
The evolution of pharmacy as a caring profession is discussed. Pharmacy has always been a caring profession. However, the focus of that caring has shifted over time. During the compounding and manufacturing era of the 1950s, pharmacists expressed their caring by preparing drug products in accordance with stringent quality-control procedures. The unit dose era saw pharmacists caring by seeking to eliminate unnecessary nursing manipulations, ensuring that patients received their drugs, and decreasing the medication error rate. The clinical pharmacy era had pharmacists providing drug information and monitoring pharmacokinetics. Until recently, activities centered on the drug and were geared primarily to the physician or to economics. Today, dissemination of the philosophy of pharmaceutical care is causing pharmacists to take full responsibility for actions devoted to ensuring the best possible outcomes of drug therapy for the least cost. Pharmaceutical care has become pharmacy's mandate. But pharmaceutical care cannot be embraced with rhetoric and changed departmental names alone; it must be practiced. Under pharmaceutical care, pharmacists are gaining more prescribing authority. Pharmaceutical care also offers the opportunity for greater continuity of care and broader professional unity among pharmacists. Pharmacy has always progressed most during times of adversity like these. Pharmacy must strive to uphold the profile of the department, and pharmacy directors must maintain their leadership, along with their ability to practice on the front lines. Pharmacists should continue to demonstrate their value to physicians and administrators. Residency programs must not neglect the mentor-resident relationship, as this nourishes the development of future leaders.(ABSTRACT TRUNCATED AT 250 WORDS)
Journal Article In whose best interest? Get access Dennis M. Kostrzewa, M.B.A. Dennis M. Kostrzewa, M.B.A. Pharmacy Owen Healthcare. Inc. Crittenton Hospital 1101 W. University Drive Rochester. MI 48307 Search for other works by this author on: Oxford Academic Google Scholar American Journal of Hospital Pharmacy, Volume 51, Issue 17, 1 September 1994, Page 2209, https://doi.org/10.1093/ajhp/51.17.2209 Published: 01 September 1994
