Pharmacy Charges Research Articles

Gastroesophageal Reflux Disease in a Managed Care Setting: Professional, Facility, and Pharmacy Charges

ABSTRACT: The objective of this study was to compare the overall health care charges of managed care organization (MCO) patients with gastroesophageal reflux disease (GERD) with comparison groups of MCO members. The study consisted of a retrospective review of eligibility data and claims filed for services dated January 1, 1994 through December 31, 1994 in a private benefit plan including HMOs and preferred provider organizations serving commercial and Medicare markets in the Midwest and South. Patients were continuously eligible for drug benefits and were not enrolled in a capitated benefit plan. The GERD group (n=5,254) inclusion required a claim with a diagnosis of GERD. Three comparison groups, age- and gender-matched to the GERD group, were randomly selected (n=5,254 in each group). The first comparison group inclusion required membership in the MCO plan in 1994 whether or not claims were submitted. The second group inclusion required that at least one claim had been submitted in 1994. The third requ...

Cost Effectiveness of Medical Nutrition Therapy Provided by Dietitians for Persons With Diabetes Mellitus

LEARNING OUTCOME: The economic impact of Medical Nutrition Therapy resulting from improving the nutritional status of patients with diabetes mellitus. Medical Nutrition Therapy (MNT) proves to be more cost effective by providing alternatives to more costly therapies. With increased emphasis on cost containment it is important for the Registered Dietitian to show MNT intervention is cost effective. Ten patients with diabetes mellitus, aged 17-75 years, who had been physician referred for MNT were randomly selected. Their medical records were reviewed to determine height, weight, blood glucose, current medications and general health. Nutrition intervention designed to improve glycemic control included portion control, constant carbohydrate counting and general principles of nutrition management. Follow-up phone calls were made to patients and/or physicians 4-6 months after MNT intervention to obtain current clinical outcomes. Patients who had been admitted to long term care were excluded from this study because of their inability to effect behavioral changes in a controlled environment. Costs were established through an average of actual current hospital/physicians and pharmacy charges that patients would have incurred. Positive health outcomes included increased nutritional status resulting in weight loss, decreased blood sugars, improved diet, and increased exercise levels. The average annual cost savings per Type II diabetic patient was $4,145, for Type I patient $9,990 and projected annual cost saving for patients with renal insufficiency $60,958. The average cost per patient for MNT was $41. Savings per case were annual net saving (cost of alternative therapy minus cost of dietitian services). Findings suggest substantial monetary savings, and improved quality of life can be achieved by MNT. Dietetic professionals are key members of the health care team and can play an aggressive roll in controlling health care expenses.

Epidemiology of vancomycin usage at a children's hospital, 1993 through 1995.

To describe the epidemiology of vancomycin usage at a children's hospital. A cohort study of patients at Egleston Children's Hospital who were charged for the receipt of vancomycin from October, 1992, through October, 1995, was performed. Data were obtained from pharmacy charge records in the hospital's medical records information system. During the study period there were 3589 patient hospitalizations in which vancomycin was used. Patients receiving vancomycin were predominantly male (56.6%) and white (62.4%), ranged in age from 0 to 31 (median, 3.8) years and had an average length of stay of 6.0 days. The total number of vancomycin doses was 105,704; the median number of vancomycin doses during each patient hospitalization was 11.0 (range, 1 to 1215). The total charge for vancomycin used was $2,009,746; the median charge for vancomycin per patient was $297.50 (range, $11 to 19,864). The majority (75.7%) of vancomycin doses were given on the hematology (27.6%), neurosurgery (17.9%), cardiothoracic surgery (13.4%), neonatology (9.7%) or general pediatrics (7.1%) services. Overall surgery service patients were significantly more likely to receive vancomycin than were medicine service patients (1267 doses/6221 admissions vs. 1954/19,446; relative risk, 2.03; P < 0.001). During the study period the number of vancomycin doses decreased significantly (P < 0.001). This study shows the value of evaluating antimicrobial use through a pharmacy database. Although vancomycin use decreased during the study period, large amounts of vancomycin are still being prescribed primarily on subspecialty service patients. Interventions to reduce vancomycin use should focus on these groups.

Predictors of dental use for low-income, urban elderly persons upon removal of financial barriers.

This study examines a low-income, urban elderly population of dental and medical, nondental users. A total of 1,378 medical, nondental users and 2,086 dental users were identified using longitudinal claims data (1983-1992) from a Medicare-waiver program that reimbursed for health care services at cost. Dental users were more likely to be from a younger age cohort (born after 1910, p = .0001) and were more likely to be black (63.3% vs 35.7%, P = .0001) than medical, nondental users. Medical, nondental users had more medical visits (p = .0001), higher medical and pharmacy charges (p = .0001), and more prescriptions (p = .0001) than did the dental users. These findings indicate that among this population of urban elderly, dental users were more likely to be black and have lower medical utilization than nondental users.

Effects of availability of patient-related charges on practice patterns and cost containment in the pediatric intensive care unit

To investigate the effects of the availability of daily patient-related charges to healthcare providers on practice patterns and cost containment in the pediatric intensive care unit (ICU) setting. Prospective, nonrandomized, controlled trial. Pediatric ICU. All patients admitted to the pediatric ICU during the study period. This number included a prospective control group (n=325) and an intervention group (n=273). These 598 patients spent 2,274 patient days in the pediatric ICU. The daily itemized patient charges related to diagnostic studies ordered in the pediatric ICU were made available to healthcare providers during the intervention period of the study. Information was collected prospectively on patients in the control group before the intervention period. This information included data on demographics, daily severity of illness measures, daily resource consumption, intensity of nursing and medical interventions, and daily patient-related charges. Outcome information on survival and length of pediatric ICU stay was also collected. The same data were collected prospectively during the intervention period of the study. Measurements on quality assurance and morbidity were made to ensure that there was no compromise in patient care. There were no significant differences in patient demographics and diagnoses between the control and intervention groups. There was a reduction in the average daily laboratory (16.7%), radiology (9.1%) computerized axial tomography (8.5%), and pharmacy (25.1%) charges in the intervention group as compared with controls. The decreases in laboratory and pharmacy charges were statistically significant (p<.0001). The decreases in laboratory and pharmacy charges remained significant even after adjustment for severity of illness. The availability of patient-related charges to healthcare providers can result in changes in practice patterns, producing a decrease of patient charges and an improvement in cost containment in the pediatric ICU.

Cost of Medical Care for Postoperative Spinal Infections

The movement towards managed care has raised the awareness of health care costs in today's society. The additional expense involved in treating patients with deep postoperative spinal infections after lower back fusion increases the total cost of care more than four times. Three areas of greatest increase in cost are room and board, pharmacy and laboratory charges. Decreasing the expense of this complication can best be effected through use of home nursing care, choice, and duration of antibiotic treatment and prudent laboratory testing.

Health care outcomes case study: Febrile neutropenia.

A case study of the clinical and economic impact of filgrastim in cancer patients in the home care setting is described. The risk of febrile neutropenia is greatly reduced when filgrastim therapy is begun prophylactically after a course of antineoplastic drug therapy. Such use of filgrastim may also reduce the need for hospitalization, prevent mucositis, and enable the next course of chemotherapy to be administered on schedule. Investigators at the University of New Mexico, noting studies showing merit in early hospital discharge of pediatric cancer patients with febrile neutropenia, decided to take the approach a step further by treatment febrile neutropenia entirely at home. Patients seen in the pediatric oncology clinic at the university hospital were considered candidates for home treatment if they had stable vital signs, were already receiving filgrastim after the completion of cancer chemotherapy, and lived within one hour of the hospital. Six cancer patients 2-17 years of age were studied between August 1992 and February 1994. These patients had 16 episodes of febrile neutropenia that were treated at home. The drug regimen consisted of prophylactic filgrastim (begun the day after completion of a course of antineoplastic therapy) and ceftazidime (when febrile neutropenia developed). None of the children were readmitted to the hospital. Infections resolved within 12 days in all cases. The total charge for treating the 16 episodes at home was $22,400 (drug charge for ceftazidime, visits by nurses, infusion-pump rental, and ancillary charges). The total charge for hospital treatment of these episodes would be $112,924 (bed charge and pharmacy charge). The difference suggests a potential savings of $90,524 from home care for this small group of patients. Treating febrile neutropenia in pediatric cancer patients at home is effective and cost-efficient if the patients are clinically stable and prophylactic filgrastim therapy has been started after the completion of cancer chemotherapy.

Pancuronium Infusion for Neuromuscular Block in Children in the Pediatric Intensive Care Unit

When neuromuscular blockade becomes necessary in the intensive care unit, there are several options available in regard to both the drug and the mode of delivery (continuous versus intermittent administration).Despite extensive experience with intermediate acting drugs such as atracurium or vecuronium, these muscle relaxants are costly and may account for a significant portion of the pharmacy charges. We undertook an open label study to evaluate the efficacy and dosing requirements for a less costly drug, pancuronium. The study group included 25 patients ranging in age from 3 mo to 17 yr and in weight from 3.2 to 68 kg. If the patient had not previously received neuromuscular blocking agents (NMBAs), pancuronium was administered as a bolus dose of 0.1 mg/kg followed by a continuous infusion of 0.05 mg centered dot kg-1 centered dot h-1. A nerve stimulator was applied to either the ulnar or peroneal nerve and a standard train-of-four (TOF) was monitored every 2 h. In patients that had previously received other NMBAs, no bolus dose of pancuronium was administered and the infusion was started at 0.05 mg centered dot kg-1 centered dot h-1. The pancuronium infusion was increased or decreased by increments of 0.01 mg centered dot kg-1 centered dot h-1 to maintain one to two twitches of the TOF. In patients that required an increase in the infusion rate, an additional bolus dose equivalent to the current hourly rate was administered and then followed by the increase in the infusion rate. Pancuronium infusion requirements varied from 0.03 to 0.22 mg centered dot kg-1 centered dot h-1 (mean = 0.07 +/- 0.03 mg centered dot kg-1 centered dot h-1). The infusion requirement was 0.05 to 0.08 mg centered dot kg-1 centered dot h-1 in 71 of 98 days (72.4%) and 0.03 to 0.09 mg centered dot kg-1 centered dot h-1 in 84 of the 98 days (85.7%). There was an increased infusion requirement in patients receiving anticonvulsants (0.056 vs 0.14 mg centered dot kg-1 centered dot h-1, P < 0.5) and in patients that required pancuronium for more than 5 days (0.059 on Day 1 vs 0.083 mg centered dot kg-1 centered dot h-1 on Day 5, P = 0.03). Pancuronium can be used by continuous infusion in children for neuromuscular block. Its use may be significantly less costly than newer NMBAs such as atracurium or vecuronium. (Anesth Analg 1995;81:13-6)

Trends in decreased hospitalization for anterior cruciate ligament surgery: Double-incision versus single-incision reconstruction

Over a 4-year period, hospital charges of 151 consecutive anterior cruciate ligament (ACL) reconstructions were retrospectively evaluated. Eightyone patients who underwent a two-incision ACL central third autogenous patellar bone tendon bone reconstruction were compared with 72 patients who had a singleincision endoscopic reconstruction with a similar graft. Charges were adjusted for inflation. There was a statistically significant difference in hospital days (2.8 v 1.57, P = .0001), total hospital charges ($15,063 v $13,520, P = .0001), as well as operating room/hospital ward charges ( P = .0001), pharmacy charges ( P = .035), and physical therapy charges ( P = .001). No statistical difference was observed for anesthesia or laboratory charges. A matched comparison of patients from each group who were in the hospital for 2 days showed a statistically significant reduction in operating room/hospital ward charges ( P = .037), but no significant reduction in total costs. There was a trend in both groups toward shorter hospital stays in each successive year. The reduction in charges observed for the endoscopic procedure correlated with a reduction in postoperative hospital days.

Hospital cost comparison between abdominal, vaginal, and laparoscopy-assisted vaginal hysterectomies: Nezhat C.; Bess O.; Admon D.; Nezhat C.H.; Nezhat F. USA Obstet Gynecol 1994 83/5 I (713–716)

To evaluate and compare the hospital charges for total abdominal hysterectomy (TAH), vaginal hysterectomy, and laparoscopy-assisted vaginal hysterectomy performed with the linear stapler.Thirty cases of each of the three types of hysterectomies, performed at the same hospital by various surgeons, were selected at random. The authors did not participate in any of the cases evaluated. Operating room, postoperative hospitalization, and pharmacy costs were compared. Independent, two-tailed Student t test analysis was performed.The mean cost of performing laparoscopy-assisted vaginal hysterectomy with the linear stapler ($7161.66) was significantly higher (P < .05) than that of both vaginal hysterectomy ($4868.06) and TAH ($4926.80). The cost of vaginal hysterectomy was nonsignificantly lower (P > .05) than that of TAH. The mean operating room supplies and equipment charge for laparoscopy-assisted vaginal hysterectomy with the linear stapler ($2468.43) was, as expected, significantly higher (P < .05) than those for both abdominal ($716.65) and vaginal ($676.16) procedures. The average operating room time charge for laparoscopy-assisted vaginal hysterectomy ($1264.56) was also significantly higher (P < .05) than for the other two procedures (TAH $642.76, vaginal hysterectomy $955.66). The mean total pharmacy charges were similar for all groups ($1114.27 for laparoscopy-assisted vaginal hysterectomy, $1163.16 for vaginal hysterectomy, and $1098.71 for TAH). Reflecting the longer operating time for laparoscopy-assisted vaginal hysterectomy, the intraoperative pharmacy costs were significantly higher for this type ($417.00) than for the TAH patients ($290.62). The difference, however, was almost erased when postoperative pharmacy charges were included, reflecting the lower cost of a shorter hospital stay in the laparoscopy-assisted vaginal hysterectomy group. Some savings were realized by laparoscopy-assisted vaginal hysterectomy when postoperative hospitalization charges were considered. The average hospitalization time was 2.3 days for laparoscopy-assisted vaginal hysterectomy, 3.0 days for vaginal hysterectomy, and 3.3 for TAH.The cost savings expected with the advent of laparoscopy-assisted vaginal hysterectomy when performed with the linear stapler have not been realized at present. In most cost categories studied, the use of laparoscopy to perform a hysterectomy was associated with much higher costs. The predicted savings associated with the shorter hospital stay in these patients failed to offset the exorbitant intraoperative costs. However, when bipolar electrocoagulation with the CO2 laser and reusable instruments replace staplers and disposables, respectively, the projected savings are appreciated.

Esophageal candidiasis in patients infected with the human immunodeficiency virus. A decision analysis to assess cost-effectiveness of alternative management strategies.

Currently no consensus exists concerning the timing of upper endoscopy and the choice of antifungal therapy for patients infected with the human immunodeficiency virus who also have esophageal candidiasis. The objective of this research was to determine the clinical and economic effects of alternative management strategies for these patients. Decision analysis was used to evaluate the outcomes, costs, and cost-effectiveness of two strategies for the diagnostic workup and treatment of patients infected with the human immunodeficiency virus with dysphagia and/or odynophagia: (1) empiric--a strategy to treat all patients empirically with an oral antifungal agent for up to 4 weeks; and (2) initial esophagogastroduodenoscopy (EGD)--a strategy to perform EGD on all patients and to treat only those with esophageal candidiasis with an oral antifungal agent for up to 4 weeks. Within each strategy, three antifungal regimens were evaluated: ketoconazole, 200 mg daily; fluconazole, 100 mg daily; and ketoconazole, 200 mg daily, for 2 weeks followed by fluconazole, 200 mg daily, for 2 weeks in nonresponders. Information on the probability of esophageal candidiasis in patients with esophageal symptoms and the efficacy of antifungal therapy was obtained from the literature. The costs for diagnostic workup were estimated using both teaching hospital charges and Medicare reimbursement payments. The costs of antifungal therapy were estimated from local pharmacy charges. The average cost per complete response and incremental cost-effectiveness were calculated and subjected to sensitivity analysis. Using the best available evidence for antifungal efficacy, empiric fluconazole was the most cost-effective strategy for all probabilities of esophageal candidiasis that were more than 0.55. Using teaching hospital charges in our base-case analysis, the average costs per complete response for empiric fluconazole and initial EGD and fluconazole were $2706 and $3141, respectively. The incremental cost-effectiveness of initial EGD and fluconazole compared with empiric fluconazole was $3792 per additional complete response. When the cost-effectiveness of the two strategies was compared as the cost of diagnostic workup was varied, initial EGD and fluconazole became the dominant strategy when the diagnostic workup cost fell below $710, a figure that is less than the current Medicare reimbursement payment. From the perspective of the payer of medical care, empiric fluconazole is the most cost-effective strategy for the initial management of patients infected with the human immunodeficiency virus with esophageal symptoms.

Relationship between severity, costs and claims of hospitalized patients using the Severity of Illness Index.

The results of the prospective application of Horn's 'Severity of Illness Index' in a teaching hospital during 1987, 1989, and 1990 constitute the basis of the present report. The average overall severity of illness scores for the three years were 1.42 in 1987, 1.65 in 1989, and 1.46 in 1990. Most of the processes evaluated in the three periods showed an overall distribution among severity levels 1 and 2, both overall and when the seven dimensions of the severity of illness index were analyzed. A statistically significant correlation between the overall severity of illness and average length of stay was found for patients in 1989 and 1990. The length of stay differed significantly in the different severity levels. When the four levels of the seven dimensions of the severity of illness index for 1987, 1989, and 1990 were compared, it was observed that figures were not uniformly distributed. There was a statistically significant association between severity of illness for hospital service and pharmacy charges per hospital stay for both 1989 and 1990, as well as a statistically significant inverse relationship between severity of illness and the number of claims per hospital service in both periods of time. Case-mix methods that account for the severity of patients constitute a useful indicator of quality for the management of different hospital services and of the hospital as a whole.

Cost comparison between laparoscopic hysterectomy and abdominal hysterectomy at the women and infants hospital of rhode island

Two cohorts of 10 women, 1 treated by laparoscopic hysterectomy, and 1 treated by abdominal hysterectomy were matched by age, gravity, parity, preoperative indications, and uterine size. The hospital charges for each cohort were then analyzed according to the following categories: operating room time, operating room supplies, laboratory charges, anesthesia services, room and board, and pharmacy charges. The laparoscopic hysterectomy group had lower dollar charges for operating room time (N.S.), anesthesia fee (N.S.), laboratory charges, room and board charges, and total bills were significantly lower. The abdominal hysterectomy group had significantly less in operating room supplies. I conclude that, overall, laparoscopic hysterectomy represents cost-savings in the hospital environment.

Cyclosporin: a pharmacoeconomic evaluation of its use in renal transplantation.

Cyclosporin is a powerful immunosuppressive agent which has markedly improved the outcome of renal transplantation, a technique now well established as the treatment of choice for patients with end-stage renal disease (ESRD). Comparison of cyclosporin-based regimens with a regimen of azathioprine and a glucocorticoid (conventional immunosuppression) indicates an improved clinical course and increased long term graft survival rate with cyclosporin which is most apparent in the recipients of a kidney from a living related donor (human leucocyte antigen mismatched) or cadaver donor source. Cyclosporin has also improved the clinical outcome in patient subgroups previously associated with a higher risk of graft failure with conventional immunosuppression, namely older patients and those with diabetes mellitus. Cost-of-treatment studies conducted over the first post-transplant year in the US have found that higher pharmacy charges with cyclosporin-based regimens are associated with lower hospitalisation charges and total billed charges compared with conventional immunosuppression. Lower hospitalisation charges reflect an improved post-transplant clinical course with cyclosporin and this has been associated with an improved quality of life in the recipients of a cadaver donor kidney. Longer term, the direct cost to society of using cyclosporin-based dual therapy (in combination with a glucocorticoid) may be higher than that with conventional immunosuppression, although the difference is likely to be small compared with the ongoing cost of dialysis. Clinical research continues to focus on modified regimens which maximise the clinical benefits of cyclosporin while minimising the associated adverse events, in particular the potential for nephrotoxicity. Sequential drug therapy (induction with globulin, azathioprine and a glucocorticoid followed by delayed administration of cyclosporin) has been associated with an improved clinical course compared with dual therapy, as well as cost containment to a level comparable to that for conventional immunosuppression. Compared with sequential therapy, triple drug therapy (cyclosporin, azathioprine plus a glucocorticoid) has been associated with a similar clinical course and lower acquisition cost during the first post-transplant year, although its overall impact on the longer term cost of transplantation has yet to be assessed. Elimination of cyclosporin from the immunosuppressive protocol of carefully selected patients can be safely achieved during the first post-transplant year. However, it remains to be established whether savings in the long term acquisition cost of immunosuppression are more than offset by the cost of treating a potentially less favourable clinical course.(ABSTRACT TRUNCATED AT 400 WORDS)

Hospital drug formularies and use of hospital services.

Many hospitals have introduced formularies to reduce hospital pharmacy expense, among other reasons. This study provides empirical evidence of the influence of hospital formulary restrictions on pharmacy charges, all other hospital charges, and on length of stay, using a survey of hospital drug policies and hospital discharge data from Washington State in 1989. Limiting the number of drugs in particular therapeutic categories reduced total charges incurred for gastrointestinal disease and asthma patients, increased total charges for cardiovascular disease patients, and had no effect on charges for infectious diseases patients. Restricting availability of drugs reduced pharmacy charges, but these savings tended to be offset by increases in other charges. Combining the categories, we found that restricting availability of drugs did not affect charges. We conclude that across-the-board restrictions do not result in cost savings, although savings may be realized for particular drug categories.

Effect of pharmacist participation on a medical team on costs, charges, and length of stay

The financial impact of pharmacist participation on a medical team in a tertiary-care teaching hospital was studied prospectively. Two medical teams, one with and one without a pharmacist, operated simultaneously for 11 months. Physicians and a pharmacist on the teams rotated monthly during the first five months of the study. Subsequently, the hospital administrator, who was unaware that the controlled study was under way, permanently assigned an attending physician to the team that did ot have a pharmacist. After patients' discharge, pharmacy costs, pharmacy charges, hospital charges, and length of stay (LOS) were compared for the two teams. Data analysis was separated into four phases: phase 1, during which attending physicians rotated monthly; phase 2, with a permanent attending physician; phase 3, which encompassed the entire 11 months; and phase 4, which encompassed the 11-month period but omitted patients whose LOS exceeded 30 days. Data were analyzed for a total of 619 patients on the two teams. In phase 1, the team with a pharmacist had significantly lower per-patient pharmacy costs, pharmacy charges, hospital charges, and LOS. In phase 2, no significant differences were found between the teams. In phase 3, the only significant difference was that the team with a pharmacist had lower pharmacy costs and pharmacy charges. In phase 4, the team that included a pharmacist had significantly lower pharmacy costs ($105 difference), pharmacy charges ($368 difference), hospital charges ($2065 difference), and LOS (1.3-day difference). Participation of pharmacists on the medical team can significantly reduce pharmacy costs and charges, hospital charges, and LOS.

Contaminant Blood Cultures and Resource Utilization

To determine whether contaminant blood cultures increase resource utilization, we studied charge and length of stay data for episodes in which blood cultures were obtained from hospitalized adults. Compared with 1097 negative episodes, 94 false-positive episodes were associated with increased subsequent length of stay (median, 12.5 vs 8 days) and subsequent total charges (median, $13,116 vs $8731), pharmacy charges (median, $1456 vs $798), and laboratory charges (median, $2057 vs $1426). In multivariate analyses, contaminants were independently correlated with 20% and 39% increases in total subsequent laboratory charges and intravenous antibiotic charges, respectively. Thus, the true costs of contaminants may greatly exceed those of the test itself. Identifying patients at very low risk of bacteremia and attention to sterile technique may reduce costs by decreasing the frequency of contaminants.

Justification of an operating-room satellite pharmacy

The pharmacy department's documentation of medication handling and control in a 24-suite operating room (OR) complex to justify implementation of an OR pharmacy satellite is described. At a 937-bed hospital, medication inventory, charge capture, and procedures for handling controlled substances were assessed to justify an OR pharmacy both financially and in terms of patient safety. Actual medication charges to patients using the OR billing system were compared with theoretical pharmacy charges based on medication administration records; results indicated that an OR pharmacy would increase gross revenue by $671,606 annually. New collectible revenue from increased charge capture was projected to be $71,926, considering payer mix, reimbursement rates, and current payment methods. The cost of medication inventory in the OR complex was $75,576; a $55,000 inventory reduction and $50,000 annual decrease in drug wastage was projected. First-year personnel costs associated with an OR pharmacy were estimated at $79,872 and equipment and renovation costs at $5,000. New collectible revenue to the institution, after expenses, was projected at $79,959 from the first year of operation and $277,569 after five years. Controlled-substance documentation was incomplete; 19% of fentanyl and 31% of sufentanil removed from inventory were not recorded as administered, returned, or wasted. The results indicated that, at this institution, approximately three OR complex full-time equivalents could be relieved from medication-related activities. Based on the potential for improved patient safety and new revenue generation, implementation of an OR satellite pharmacy was recommended to the hospital administration.

Multidisciplinary approach to improving documentation of medications used during surgical procedures

A multidisplinary approach to improving medication documentation in the operating room (OR) of a 350-bed teaching hospital is described. A committee composed of the OR pharmacy supervisor, the assistant director of nursing in charge of the ORs, and a review coordinator from the auditing department developed a medication accountability system for the OR. The system consisted of a medication use record created by the pharmacy member of the committee for each of the hospital's two ORs (main OR and eye and ear infirmary OR). The nonsterile nurse in each OR suite would complete these forms by placing check marks next to the names of the medications used. A separate medication use record was created by the chief perfusionist for use in cardiopulmonary bypass cases; this form would be completed by the perfusionist at the end of each major heart case. Once the forms were approved by the form committee, inservice-education programs were conducted for nursing and perfusion staff members; the system was implemented in both OR areas in November 1986. Errors made in completing these forms were addressed by further inservice education and individual instruction. The new accountability system was effective in improving medication documentation in the OR. Immediately after implementation of the system, 83% of medications were accounted for on the forms; after six months that figure was 90%. Before the system was implemented, only 23% of patient charts reviewed contained no errors in documentation; after six months that figure had improved to 71%. The improved medication documentation allowed for more consistent collection of the assessed pharmacy charges on bills audited by third-party payers.(ABSTRACT TRUNCATED AT 250 WORDS)

The nonvalue of retrospective peer comparison feedback in containing hospital antibiotic costs.

Antibiotics have accounted for an increasing percentage of hospital pharmacy charges. Recently, an inexpensive method, automated peer comparison feedback, has been developed to influence physician use of resources. The documented success of several implementations of this strategy led to a one-year experiment to influence hospital antibiotic utilization. Each month, attending physicians in the top 50 percentiles for expenditure were notified of their status in relation to their peers. Expenditures by feedback and control groups were compared to determine whether feedback would result in reduced expenditures by individuals, or whether there would be a generalized reduction in expenditure by the entire group (Hawthorne effect). Over the year, no significant reduction in expenditure was noted. However, some important utilization patterns were identified. Although more surgical patients received antibiotics than did nonsurgical patients, surgical antibiotic costs were less. Surgical therapy was typically of shorter duration and involved the use of less expensive antibiotics. Multiple-antibiotic prescribing was less frequent on surgical services. Thirty percent of attending physicians were responsible for 80 percent of all antibiotic costs; 60 percent of those in this top group were members of the medical cohort. (1) As implemented in the current study, automated peer comparison feedback was not an effective method for reducing antibiotic utilization; (2) Differences in prescribing patterns between services may dictate the best strategies for improving antibiotic utilization; (3) More attention should be directed toward the relatively small "reference group" of physicians responsible for most hospital antibiotic prescribing.