The history of hospital pharmacy in the United States from the Colonial period to the 1930s is explored. America's first hospital pharmacist was Jonathan Roberts, hired in 1752. Like most other early hospital apothecarie...The history of hospital pharmacy in the United States from the Colonial period to the 1930s is explored. America's first hospital pharmacist was Jonathan Roberts, hired in 1752. Like most other early hospital apothecaries, Roberts was an apprentice physician. His successor, John Morgan, proposed that the practices of medicine and pharmacy be separate. By 1811 the New York Hospital had a full-time pharmaceutical practitioner. The niche available for hospital pharmacy was small during the nineteenth century because most Americans were treated at home. Two pioneers who advanced the profession during the nineteenth and early twentieth centuries were Charles Rice and Martin Wilbert. Hospital pharmacists were sought out during the Civil War because of their experience in manufacturing drug preparations and as buyers. Immigration after the Civil War soon doubled the number of hospitals. The post-Civil War expansion of hospitals also coincided with the reform movement in nursing and the rise of scientific medicine. Hospital pharmacists became indispensable as supply masters and manufacturers. Physicians demanded professional pharmaceutical services for handling more complex therapies. Administrators learned that it was more economical to fill inpatient prescriptions inhouse. While community pharmacy had long since abandoned manufacturing and some compounding, hospital pharmacists retained these roles. However, the image of pharmacists as corner druggists was hard to shake. During the 1920s voices called for hospital pharmacists to organize. Edward Spease led in aligning schools of pharmacy with hospitals. In 1927 the first hospital pharmacy internship program was begun. A section for hospital pharmacists within the American Pharmaceutical Association was established in 1936, and the first state associations were founded during the 1920s. By the end of the 1930s, the stage was set for the national movement that followed. By the 1930s, American hospital pharmacists had reached the critical mass necessary for group identity on a national level.
The compatibility of paclitaxel injection vehicle with a variety of i.v. administration and extension sets was studied in terms of the amount of diethylhexyl phthalate (DEHP) leached from the sets. Test solutions of pacl...The compatibility of paclitaxel injection vehicle with a variety of i.v. administration and extension sets was studied in terms of the amount of diethylhexyl phthalate (DEHP) leached from the sets. Test solutions of paclitaxel injection vehicle corresponding to paclitaxel injection 0.3 and 1.2 mg/mL were prepared in polyolefin bags of 5% dextrose injection. The solutions were delivered in triplicate over 24 hours through 26 models of administration sets and 24 models of extension sets and collected in glass containers. Portions were removed after delivery and analyzed in duplicate for DEHP concentration by high-performance liquid chromatography. All the extension sets were compatible with paclitaxel injection vehicle. Most of the administration sets were also compatible. However, two administration sets were incompatible with paclitaxel vehicle corresponding to either drug concentration, and five sets were incompatible with the vehicle simulating the high (1.2-mg/mL) concentration. Some of the incompatible sets were labeled as not containing polyvinyl chloride (PVC). Solutions of paclitaxel vehicle leached DEHP from administration sets containing PVC and from some sets labeled as not containing PVC.
Prescribing patterns and appropriateness of morphine use in a neonatal intensive care unit (NICU) were evaluated in a concurrent drug-use evaluation (DUE). Data were collected for 99 infants who received morphine over a...Prescribing patterns and appropriateness of morphine use in a neonatal intensive care unit (NICU) were evaluated in a concurrent drug-use evaluation (DUE). Data were collected for 99 infants who received morphine over a six-month period. Patient charts were reviewed to collect the following data: patient's age, weight, dosage schedule, concurrent sedatives, ventilatory status, whether adequacy of analgesia was documented, and descriptions of adverse drug reactions (ADRs). The physicians' orders were reviewed to determine whether NICU morphine dosage guidelines were followed and whether the indication for use was noted. Seven ADRs occurred in six of the patients; three of the ADRs occurred after ophthalmic cryosurgery. Indications for use were noted in 79 of 285 physician orders (27.7%). The adequacy of sedation or analgesia was documented on 60 of the 360 patient days (16.7%). The DUE results prompted several changes: physicians were asked to select indications from a list in the computerized order-entry system, an analgesia or sedation assessment scale was added to nursing flow sheets, and endotracheal intubation became a requirement before ophthalmic cryosurgery. A follow-up DUE showed nearly complete compliance with the new guidelines for morphine use and a reduction in the number of adverse reactions to morphine. A DUE prompted policy changes that improved documentation of indications for and efficacy of morphine use and reduced adverse reactions to the drug in an NICU.
Kistner UA, Keith MR, Sergeant KA
… +1 more, Hokanson JA
Am J Hosp Pharm
· 1994 Nov · PMID 7856602
Accuracy of dispensing was studied in the outpatient pharmacy setting, and error rates were compared with workload. All prescriptions filled in an outpatient pharmacy over 12 weekdays were audited to determine the rate o...Accuracy of dispensing was studied in the outpatient pharmacy setting, and error rates were compared with workload. All prescriptions filled in an outpatient pharmacy over 12 weekdays were audited to determine the rate of dispensing errors. In this pharmacy, pharmacists filled prescriptions and technicians delivered the medications to the patients. Before the medication reached the patient, the auditors recorded any dispensing errors and determined whether they were potentially serious. Of the 9846 prescriptions filled, 1229 (12.5%) contained a total of 1371 errors. Of these errors, 155 (1.6%) were potentially serious. Statistical analysis of the data revealed differences between error rates and (1) the total number of prescriptions dispensed per hour and (2) the number of prescriptions filled per pharmacist hour. However, no correlation existed between the number of prescriptions dispensed per hour and the total number of errors made. No significant correlation was found between the rate of potentially serious errors and increasing work volume, suggesting that important factors in error avoidance are continuous quality improvement mechanisms and minimal interruption of dispensing. No association was found between work volume and the number of dispensing errors or potentially serious errors. Error rates were consistent with published estimates.