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A computer-assisted practitioner-response system was used to review cimetidine use in one hospital. All patients receiving cimetidine from April 1, 1981, through May 15, 1981, were identified daily using a computerized medication-profile system. A practitioner-response form, which asked the physician to indicate the reason for prescribing cimetidine, was placed in the chart of all patients receiving the drug. When these forms were collected, the reviewer scanned the chart for patient demographic information, duration of cimetidine therapy, and other drugs prescribed that potentially could interact with cimetidine. If the physician did not complete the form, the reviewer checked the chart for prescribing information. Cimetidine was prescribed for 10% (247) of all patients admitted during the study period. Seventy percent of the practitioner-response forms were completed; the indication for cimetidine use was obtained for an additional 20% through chart review. Seventy-five percent of the patients were exposed to a potential drug interaction. The most common reason for prescribing cimetidine was to prevent stress ulcers; only 15% of cimetidine orders were for FDA-approved uses. The computer-assisted practitioner-response system was an efficient method for reviewing cimetidine use. The computerized medication profile facilitated identification of patients receiving the drug, and the practitioner-response form provided the indication-for-use data more quickly than conventional chart review.

Legal issues associated with the use of pharmacokinetic computer software are discussed. One issue involves the physician's reliance on the pharmacist, as a drug therapy expert, to provide consultation on drug dosages. Another issue is the problem of liability associated with the software and how this relates to the physician, the pharmacist, and those who designed, manufactured, and sold the software. The legal concept of negligence as it relates to medical computer software is discussed. Although the programmer and the manufacturer are responsible for verifying that the program does what it purports to do, the user must exercise due care in identifying any program limitations that might influence the accuracy of a consultation. Clinical perspective, effective validation techniques, and critical selection will help to ensure that pharmacokinetic computer software is developed, purchased, and used safely and effectively.

The use of a tabletop computer for controlled substances distribution is described. The self-contained system uses programs stored on discs to maintain records for floor stock, individual patient orders, and ambulatory patient prescriptions. Three reports are generated daily: (1) a listing of all floor supplies issued on the current date, (2) a listing of all individual patient supply transactions for the current date, and (3) an alphabetical listing of the inventory for controlled substances, including an alert system to identify any item that has fallen below a preselected minimum stock level. The tabletop computer allowed the pharmacy to take advantage of the accuracy and speed of electronic data processing at its own pace, independent of the hospital's main computer system. Because the tabletop computer and the main system both use a common programming language, any programs developed on the tabletop computer can be converted to the main system.