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John T. Mather Memorial Hospital - PTUPharmacist (Page 5)

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John T. Mather Memorial Hospital - PTUPharmacist
Unit-Specific Pharmacists
56 P&T
· January 2003 · Vol. 28 No. 1
Table 2 Performance Measurement of the Unit-Specific Pharmacist Program
Optimize drug-
distribution methods.
Decrease turn-around
time of new medication
Increase clinical phar-
macy staff to include
more nursing units.
Use CrCl laboratory
data for proper dosing
of histamine H
Consider therapeutic
substitution policy.
Suggest to medical
staff when drug dosage
changes are necessary
because of impaired
renal function.
Initiate an IV-to-PO
conversion policy.
Provide drug informa-
tion to nursing and
medical staff.
Expand clinical
pharmacy intervention
Expand clinical phar-
macy to nutrition team.
Monitor all drugs that
prolong QT interval
to identify possible
torsades de pointes
in cardiac patients.
Plan of Approach
Make efficient use of staff
for drug distribution.
Institute clinical
pharmacy program.
Utilize the positive
impact of nursing to
convince administration
of cost savings and
patient care.
Use clinical pharmacists
to evaluate dosing of
nizatidine (Axid®).
Include nizatidine
(Axid®), ciprofloxacin
(Cipro®), gatifloxacin
(Tequin®), simvastatin
(Zocor®), and pantopra-
zole sodium (Protonix®).
Evaluate patients who
are taking medications
that are affected by renal
Suggest conversion from
IV to PO route when
Obtain PDAs with drug
information software.
Document all pharmacy
interventions; tabulate.
Have clinical pharmacist
enter laboratory orders
needed by nutrition-
support team.
Train clinical pharmacists
to read ECGs and to
apply knowledge to
improve patient care.
Data Source
Observation by
clinical pharmacy
and nursing staff.
Nursing staff input,
journal references,
professional orga-
Nursing adminis-
tration, pharmacy
medical staff.
Laboratory data,
drug dosing data.
Dosing data, cost
information, policy
Dosing data,
patient laboratory
Dietary, nursing,
and drug data.
journal ads.
Dietary depart-
ment, laboratory,
Journal articles,
cardiac nursing
education, drug
sources for
QT syndrome.
Outcome and Impact
of Intervention
Creation of a schedule for
optimal delivery of medications
to facilitate nursing administra-
tion of drugs.
Pharmacist on nursing units;
direct-order entry of pharmacy
orders by clinical pharmacist.
Expansion of clinical pharmacy
services to all units with patient
stays over 24 hours, Monday
through Friday.
Dosing of histamine H
inhibitors to be monitored;
P&T committee suggests dose
adjustments by pharmacist
when needed.
Therapeutic substitution change
policy; reduction of pharmacy
Automatic dose changes
approved for Axid®, Tequin®,
and Cipro®. Dosing adjustments
to be suggested when renal
laboratory data warrant.
Ensure automatic conversion
from the IV to the PO route
for Diflucan®, Cipro®, Tequin®,
Pepcid®, and Protonix®.
Reduction of pharmacy costs.
Increased demand for drug
information; requests from
other professions as well.
Increased number of ADR
Improved utilization of pharmacy
staff and laboratory data.
P&T committee and administra-
tion convinced of need for moni-
toring of drugs that prolong QT
Other Findings
Pharmacy products to be returned
to pharmacy more quickly to
reduce overstocking of patient
medications in refrigerators.
Positive reactions by nursing and
administration; decreased number
of medication errors; improved
order entry and drug delivery.
Nursing's request to expand
service to include weekends;
administration has asked pharmacy
to submit proposal.
Therapeutic substitution of Axid®
for all histamine H
inhibitors; eval-
uation of other drugs according to
CrCl laboratory data.
Renal dosing of some medications
to be addressed; individualized dos-
ing should improve patient care.
Doctors are slow to change from
IV to PO therapy; patients would
benefit if clinical pharmacists
suggested oral dose therapy
when possible.
Policy to be expanded to include
other drugs.
Recording and documentation of
pharmacy intervention data to jus-
tify increase in staff and to satisfy
regulatory recommendations.
Satisfaction of medical and nursing
staff noted; increased number of
clinical interventions and requests
for information.
Information technology available
within the hospital to assist with
drug monitoring; need for expan-
sion of psychiatric units to monitor
drug therapy when a prolonged QT
interval is a common ADR.
ADR = adverse drug reaction; CrCl = creatinine clearance; ECG = electrocardiogram; IV = intravenous; PDA = personal digital assistant; PO = oral.

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