Rapid desipramine dose adjustment using 24-hour levels

Prior work indicates that plasma tricyclic levels obtained 24 hours after a single dose correlate well with steady state levels achieved. Although this suggests that 24-hour levels could be used to predict the dose needed to reach a desired plasma level, this method has seldom been tested prospectively. In the current study we test this strategy and determine patients' tolerance of rapid dose adjustment. First, the relationship of 24-hour levels and steady state levels in a sample of 16 inpatients was determined using a fixed dose paradigm. In a second sample of 26 depressed inpatients, plasma desipramine levels obtained 24 hours after a single test dose were applied to the regression equation derived from the first sample in order to estimate the dose needed to achieve a steady state level of 140 ng/ml. Once determined, the full dose was then rapidly administered. Sixteen of the 18 (89%) patients who completed the dose adjustment study had steady state drug concentrations within a target range of 125 to 300 ng/ml. This distribution of levels differed significantly from that previously reported for a fixed dose sample in which only 19 of 83 (23%) patients had levels within this range. Dose adjustment using 24-hour levels was well tolerated and should help to attain a more rapid response to antidepressant treatment. This has important implications for reducing lengths of hospitalization for depressed inpatients. The technique should also prove useful in research where a uniform plasma level paradigm is desirable.     

Missing medications associated with centralized unit dose dispensing.

The reasons for missing medications in a centralized unit dose system were studied, and means of improving the situation were recommended. Reasons for missing medications included: insufficient or incorrect medications dispensed by the pharmacy, differences in interpretations of orders by pharmacists and nurses, administration of extra medication or incorrect doses, waste of medication, administration of medication to patients other than for whom it was dispensed, delivery to wrong nursing unit, pilferage, and requests by nurses for medication before the orders were received by the pharmacy. A procedure for checking medications in unit dose carts by pharmacy and nursing personnel was implemented. Before this procedure, the rate of missing medications was 0.93% of the doses dispensed; after the procedure, the rate was 0.33%. Other recommendations designed to prevent missing medications in this unit dose system are presented.     

中心摆药室单剂量调配制的设计研究

药品管理是医院质量控制的重要内容，现存中心摆药的药品调配制度已不能适应日益规范的药品管理要求。本文分析了我国集中摆药的现状以及单剂量调配制的优缺点，介绍了单剂量调配制的运作过程，并探讨了单剂量调配制在我国住院药房推行的可行性及其对提高医院药学服务水平的意义。     

针对单剂量口服分包药品的病区“无纸化核对系统”的建立与应用

目的：研究"无纸化核对系统"能否提高病区护士核对口服药的工作效率。方法：选择五个口服分包药品长期医嘱合计100包以上的科室，连续10个工作日对其长期医嘱采用护士手工核对，然后对其进行"无纸化核对系统"操作培训，研究人工核对与无纸核对系统的单包核对时间差异。结果：与手工核对相比，各病区运用无纸化核对系统均可显著缩短口服药核对时间（P<0.05，P<0.01），在流程优化后病区平均核对时间降低了50%左右。结论：无纸化核对系统是药师针对临床工作中核对分包口服药遇到的实际难题，委托网络工程师研发出的新程序，能显著提高护士核对口服药的工作效率、减少核对时间。     

Print, prepare, check, and deliver a 24-hour supply of unit dose medication for 600 patients in one hour

The development of a new drug delivery system featuring cost containment, increased accuracy, and savings of time was the goal of the hospital. Using an assembly line approach and preparing 24-hour medication supplies just prior to delivery, we are able to fill and check 600 patients' medications in one hour. Personnel requirements have been reduced and accuracy increased, resulting in cost effectiveness and improved patient care. The annual cost savings in a 600-bed hospital are $110,000, and time for clinical pharmacy projects has been created.     

Cost-effectiveness of central automated unit dose dispensing with barcode-assisted medication administration in a hospital setting

BackgroundCentral automated unit dose dispensing (cADD) with barcode-assisted medication administration (BCMA) has been shown to reduce medication administration errors (MAEs). Little is known about the cost-effectiveness of this intervention.ObjectiveTo estimate the cost-effectiveness of cADD with BCMA compared to usual care.MethodsAn economic evaluation was conducted alongside a prospective before-and-after effectiveness study in a Dutch university hospital. The primary effect measure was the difference between the rate of MAEs before and after implementation of cADD with BCMA, obtained by disguised observation in six clinical wards and subsequent extrapolation to the entire hospital. The cost-analysis was conducted from a hospital perspective with a 12-month incremental costing approach. The total costs covered the pharmaceutical service, nurse medication handling, wastage, and materials related to cADD. The primary outcome was the cost-effectiveness ratio expressed as costs per avoided MAE, obtained by dividing the annual incremental costs by the number of avoided MAEs. The secondary outcome was the cost-effectiveness ratio expressed as costs per avoided potentially harmful MAE (i.e. MAEs with the potential to cause harm).ResultsThe intervention was associated with an absolute MAE reduction of 4.5% and a reduction of 2.7% for potentially harmful MAEs. Based on 2,260,870 administered medications in the entire hospital annually, a total of 102,210 MAEs and 59,830 potentially harmful MAEs were estimated to be avoided. The intervention was associated with an increased incremental cost of €1,808,600 annually. The cost-effectiveness ratio was €17.69 per avoided MAE and €30.23 per avoided potentially harmful MAE.ConclusionsThe implementation of cADD with BCMA was associated with a reduced rate of medication errors, including harmful ones, at higher overall costs. The costs per avoided error are relatively low, and therefore, this intervention could be an important strategy to improve patient safety in hospitals.     

Development of a controlled release low dose class II drug-Glipizide

The purpose of this study was to develop a new monolithic matrix system to completely deliver glipizide, a Biopharmaceutics Classification System (BCS) Class II drug in a zero order manner over an extended time period. Two approaches were examined using drug in formulations that contain swellable hydroxypropylmethylcellulose (HPMC) or erodible polyethylene oxide (PEO). The matrices were prepared by dry blending selected ratios of polymers and ingredients using direct compression technique. Dissolution was assessed using modified USP apparatus II. Glucotrol XL push-pull osmotic pump (PPOP) was used as the reference. The interrelationship between matrix hydration, erosion and textural properties were determined and analyzed under the dissolution test conditions. Linear and reproducible release similar to that of Glucotrol XL was achieved for optimized matrices (f2>50) independent of hydrodynamic conditions. The kinetics of drug delivery was directly related to the synchronization of swelling, erosion and fractional release. HPMC matrices showed a significantly greater degree of hydration and swelling and stronger texture property relative to PEO matrices. Results indicate that in the case of low dose/low soluble drug, total drug release in a zero order manner heavily depends on the synchronization of erosion and swelling fronts during the entire dissolution study.