Clinical pharmacy should adopt a consistent process of direct patient care.

Although the application of a consistent process of care serves as a foundational principle for most health care professions, this is not true for the discipline of clinical pharmacy. Without an explicit, reproducible process of care, it is not possible to demonstrate to patients, caregivers, or health professionals the ways in which the clinical pharmacist can reliably contribute to improved medication-related outcomes. A consistent patient care process should describe the key steps that all clinical pharmacists will follow when they encounter a patient, regardless of the type of practice, the clinical setting, or the medical conditions or medications involved.

Factors associated with inappropriate inpatient prescribing of acid-suppressive therapy.

Objectives: Acid-suppressive therapy is used for 54-70% of inpatients, and is frequently prescribed for inappropriate indications. The objective of this study was to identify characteristics associated with inappropriate prescribing of acid-suppressive therapy.

Methods: A random sample of adult internal medicine inpatients admitted between 1 July 2005 and 30 June 2006 was screened for acid-suppressive therapy.

Role of student pharmacist interns in hospital-based standing orders pneumococcal vaccination program.

Objective: To describe the role of student pharmacist interns in supporting a standing orders program (SOP) for pneumococcal polysaccharide vaccination in hospitalized patients.

Setting: University of Pittsburgh Medical Center (UPMC) Presbyterian, an academic teaching hospital in Pittsburgh.

Practice Description: The hospital-based Drug Use and Disease State Management (DUDSM) program designs, implements, and promotes evidence-based practice guidelines to ensure safe and cost-effective drug therapy.

Designing and implementing a hospital-based vaccine standing orders program.

Purpose: An inpatient pneumococcal polysaccharide vaccine (PPV) vaccination program was designed and implemented to meet federal and state regulatory requirements and national vaccination goals.

Summary: In 2002, the Centers for Medicare and Medicaid Services published a final rule removing the federal requirement for an individual patient physician-signed order for the pneumococcal and influenza vaccines in Medicare- and Medicaid- participating hospitals. This statute authorized implementation of standing orders programs (SOPs) in health care institutions.

Overcoming barriers to establishing an inpatient vaccination program for pneumococcus using standing orders.

Objectives: To identify and classify barriers to establishing a standing orders program (SOP) for adult pneumococcal vaccination in acute care inpatient facilities and to provide recommendations for overcoming these roadblocks. Vaccination rates in hospitals with SOPs are generally higher than those in hospitals that require individual physician orders. The array of solutions drawn from our experience in different hospital settings should permit many types of facilities to anticipate and overcome barriers, allowing a smoother transition from initiation to successful implementation of an inpatient pneumococcal vaccination SOP.

Pharmacists' role in increasing pneumococcal and influenza vaccination.

Purpose: The role of the pharmacist in increasing pneumococcal and influenza vaccination rates and the clinical efficacy of pneumococcal and influenza vaccines are discussed.

Summary: Institutional pharmacists often play key roles on multidisciplinary committees and have the opportunity to make preventive therapies, such as vaccination, a priority. Standing-order programs authorize health care professionals to screen for vaccine eligibility and contraindications, administer vaccines, and monitor for adverse effects when following a physician- or institution-approved protocol.

Aminoglycoside-associated nephrotoxicity in the elderly.

Objective: To determine whether there was an increased incidence of nephrotoxicity in elderly patients (> or =65 y) prescribed single-dose (SD) versus multiple-dose (MD) aminoglycosides and whether aminoglycoside-induced nephrotoxicity was associated with length of therapy and other risk factors.

Methods: A prospective, observational audit at a university teaching hospital was conducted. Physician prescribing was used to stratify subjects according to dosing regimen: MD (n = 60) or SD (n = 26).

Intravenous immunoglobulin: appropriate indications and uses in hematopoietic stem cell transplantation.

Intravenous immune globulin (IVIG) therapy has been prescribed in many different disease states. Hyperimmune products are also available. Recently, routine use for many indications has come under scrutiny secondary to high cost, limited supply, and unclear benefit.