Effect of Clinical Pharmacy Services on Prescribing on an Orthopedic Unit

Herfindal, Eric T.; Bernstein, Linda R.; Kishi, Donald T.

doi:10.1093/ajhp/40.11.1945

Cited by 11 publications

(7 citation statements)

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“…One-to-one education initiated by a clinical pharmacist has been shown in two partially controlled studies (Brooks et al 1977;Herfindal, Bernstein, and Kishi 1983) to reduce the overall number or cost of drugs prescribed to inpatients. These results agree with the findings of a large-scale, controlled trial utilizing doctoral-level clinical phar macists as educational outreach consultants to improve prescribing in the ambulatory setting (Avorn and Soumerai 1983).…”

Section: Discussionmentioning

confidence: 99%

“…The rapid decay in drug-utilization effects was explained by the rapid rotations of house staff in this teaching hospital. The second, partially controlled study in a U.S. teaching hospital (Herfindal, Bernstein, and Kishi 1983) observed the effects of a clinical pharmacist making rounds with an orthopedic team in an attempt to reduce excessive drug use. The small but significant reductions (table 1) over a nonequivalent control hospital were sustained only as long as the program continued to operate; as in the previous study, these effects quickly deteriorated following withdrawal of the pharmacist.…”

Section: One-to-one Education In Itia Ted Hy a D Ru G U Tiliza Tio N mentioning

confidence: 99%

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Efficacy and Cost-Containment in Hospital Pharmacotherapy: State of the Art and Future Directions

Soumerai¹,

Avorn²

1984

The Milbank Memorial Fund Quarterly. Health and Society

102

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Section: Discussionmentioning

confidence: 99%

Section: One-to-one Education In Itia Ted Hy a D Ru G U Tiliza Tio N mentioning

confidence: 99%

Efficacy and Cost-Containment in Hospital Pharmacotherapy: State of the Art and Future Directions

Soumerai¹,

Avorn²

1984

The Milbank Memorial Fund Quarterly. Health and Society

102

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“…Nine showed a statistically significant reduction in costs after or with the intervention [20,25,28,32,35,38,39,49,60]. Seven studies showed trends towards cost reduction [23,29], a statistically significant reduction only on part of their analysis [26,56], or no change [48,52,59]. In six studies, statistical analysis was not performed [31,34,42,47,53,54].…”

Section: Costsmentioning

confidence: 99%

Clinical and economic outcomes of pharmaceutical services related to antibiotic use: a literature review

2007

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Over the years, the number of studies and quality of methodology has increased. The most frequently observed outcomes with a positive impact were appropriateness of prescribing and cost savings. The vast majority of studies used multiple interventions, in conjunction with pharmacists' recommendations to physicians. Coupled with the use of practice guidelines or educational strategies, these interventions demonstrated a positive impact on economic or clinical outcomes. However, the data are still sparse and sometimes contradictory; therefore, further studies with randomized controlled designs are needed.

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“…16,31,32,34 Substantial documentation indicates that clinical pharmacy services can improve therapeutic outcomes and reduce drug costs. [17][18][19][20][21][53][54][55][56][57][58][59][60][61][62][63][64][65] Providing clinical pharmacy services in a decentralized location may reduce medication errors by reducing inappropriate prescribing and improving the monitoring of patients. Decentralized pharmacists often serve as a final check on drugs provided from the central pharmacy.…”

Section: Medication Errors In United States Hospitals Bond Et Almentioning

confidence: 99%

Medication Errors in United States Hospitals

2001

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This study evaluated hospital demographics, staffing, pharmacy variables, health care outcomes measures (severity of illness-adjusted mortality rates, drug costs, total cost of care, and length of stay) and medication errors. A database was constructed from the 1992 American Hospital Association's Abridged Guide to the Health Care Field, the 1992 National Clinical Pharmacy Services database, and 1992 mortality data from the Health Care Financing Administration. Simple statistical tests and a severity of illness-adjusted multiple regression analysis were employed. The study population consisted of 1116 hospitals that reported information on medication errors and 913 hospitals that reported information on medication errors that adversely affected patient care outcomes. We evaluated factors associated with the 430,586 medication errors and 17,338 medication errors that adversely affected patient care outcomes. Medication errors occurred in 5.07% of the patients admitted each year to these hospitals. Each hospital experienced a medication error every 22.7 hours (every 19.73 admissions). Medication errors that adversely affected patient care outcomes occurred in 0.25% of all patients admitted to these hospitals/year. Each hospital experienced a medication error that adversely affected patient care outcomes every 19.23 days (or every 401 admissions). The following factors were associated with increased medication errors/occupied bed/year: lack of pharmacy teaching affiliation (slope = 0.8875, p=0.0416), centralized pharmacists (slope = 1.0942, p=0.0001), number of registered nurses/occupied bed (slope = 1.624, p=0.032), number of registered pharmacists/occupied bed (slope = 25.0573, p=0.0001), hospital mortality rate (slope = 2.8017, p=0.0192), and total cost of care/occupied bed/year (slope = 0.01432, p=0.0091). Factors associated with decreased medication errors were location in the Mid-Atlantic census region (slope = -1.5182, p=0.03), affiliation with a pharmacy teaching program (slope = -1.0252, p=0.0349), decentralized pharmacists (slope = -0.9843, p=0.0037), and number of medical residents/occupied bed (slope = -1.478, p=0.0014). There was a 45% decrease in medication errors (1.81-fold decrease) in hospitals that had decentralized pharmacists, compared with hospitals that had centralized pharmacists. In addition, there was a 94% decrease in medication errors that adversely affected patient care outcomes (16.88-fold decrease) in hospitals that had decentralized pharmacists compared with hospitals that had only centralized pharmacists. Based on previous field studies and our findings in 1116 hospitals, it appears that one of the most effective ways to prevent or reduce medication errors is to decentralize pharmacists to patient care areas. The results of this study should help hospitals reduce the number of medication errors that occur each year.

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Effect of Clinical Pharmacy Services on Prescribing on an Orthopedic Unit

Cited by 11 publications

References 0 publications

Efficacy and Cost-Containment in Hospital Pharmacotherapy: State of the Art and Future Directions

Efficacy and Cost-Containment in Hospital Pharmacotherapy: State of the Art and Future Directions

Clinical and economic outcomes of pharmaceutical services related to antibiotic use: a literature review

Medication Errors in United States Hospitals

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