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The original purpose of this survey was to obtain sufficient salary information on residency programs to assist us in evaluating our residents' annual stipend. The data reported are intended to assist other hospital pharmacists and administrators in their efforts to maintain a fair and equitable stipend for residents in hospital pharmacy.

A decentralized pharmacy-team concept of delivering pharmaceutical services in a 719-bed hospital complex is described. The approach is called the Pharmacy Service Unit (PSU). Each PSU, which functions in the patient care areas, consists of a supervisor, two staff pharmacists, a technician specialist and a technician. Five PSUs provide daily 12-hour pharmaceutical services. Initial medication doses are provided from satellite stores maintained for each PSU; subsequent doses are dispensed from the central pharmacy in unit dose form. Other functions of the PSUs, including clinical and administrative responsibilities are described. The PSU concept has resolved previous logistical problems in the distribution of drugs at this hospital and has integrated the distributive, clinical and administrative roles of the pharmacists.

A management seminar miniseries for training hospital pharmacy residents is described. A series of lectures and workshops on the administrative aspects of hospital pharmacy practice are an integral part of a 2400-hour residency training program. Hospital pharmacy practice, clinical pharmacy practice, communication skills, and pharmacy administration and personnel management are the four major areas covered by the program. The section on pharmacy administration and personnel management is initiated in the middle of program after the residents have gained an appreciation of the intricacies of the department. The management workshops emphasize role playing and actual case-study analyses. The program's faculty members are members of the professional staff who have received formal training in the topics they teach. Twenty-two of this program's 53 graduates have assumed management positions. The management miniseries described can provide residents with the managerial skills they need to become effective pharmacy leaders.

The approaches of teaching hospitals toward limiting the number of cephalosporin drug products on formularies were studied in a mail survey. Pharmacy department directors of 128 teaching hospitals with 200 beds or more responded to teh survey. Forty-two of 128 (33%) hospitals had established formal restriction policies (FRPs) for cephalosporins (CS). Cephalexin and cephradine were the predominant formulary oral CS. Few hospitals had established "therapeutic equivalents" policies, yet the majority of hospitals had a single oral CS on the formulary. Cefazolin was the predominant injectable CS on all formularies; cefamandole and cefoxitin were the predominant restricted CS. In hospitals without restriction policies, these newer CS were on the formulary in 55% of the cases; in FRP hospitals, the figure was 15%. The occurrence of a single, formulary, unrestricted CS was much more likely in FRP hospitals (38%) than in hospitals with no restriction policy (NRP) (8%). FRP hospitals tended to have fewer unrestricted formulary CS. Eighty-three percent of FRP hospitals and 41% of NRP hospitals monitored CS use.

A survey of pharmacy directors in teaching hospitals was conducted in March 1983 to ascertain policies for management of cephalosporin use. Surveys were sent to 298 institutions in each of the United States except Alaska. Respondents were asked various questions regarding hospital policies on cephalosporin use. Responses were received from 179 hospitals that had formularies; 99 of these had formal restriction policies, more frequently for second- and third-generation agents than for first-generation agents, and 13 planned to institute restriction policies. In 68% of hospitals with restriction policies, restricted drugs were released only after consultation with the infectious disease service. Chart review was the most frequently reported method of monitoring use of restricted cephalosporins. Approximately 40% of respondents had therapeutic equivalence policies, and more than 40% had recently deleted one or more cephalosporins from the formulary. The percentage of hospitals with formal restriction policies (55%) was greater than in a 1979 survey (32%). Many teaching hospitals have initiated policies to curb rising drug costs associated with the use of cephalosporin antibiotics.

A comprehensive program to monitor and regulate the activities of medical service representatives (MSRs) in a large teaching hospital is described. The MSR program consists of written policies and procedures for regulating the activities of MSRs within the hospital, an orientation program for MSRs, and quarterly MSR committee meetings. In addition, MSRs are involved in planning and implementing an annual drug fair for all hospital personnel and biannual continuing-education sessions for physicians. Compliance with policies and procedures is monitored using a MSR visitation roster in the pharmacy department. This organized program has resulted in an optimum exchange of information between the hospital and the pharmaceutical industry.

The newer beta-lactam antimicrobials offer an expanded spectrum of activity and a similar safety profile compared to their older counterparts. The penicillins appear to be useful in the combination treatment of systemic Pseudomonal infections, and cefuroxime and the third generation cephalosporins may be valuable in the management of meningitis caused by susceptible organisms. However, to avoid the emergence of resistance and to help contain the cost of antimicrobial therapy, these newer agents should be reserved for those clinical situations where older beta-lactams would not be indicated.

Committees serve as an ideal forum for members of an organizaton to exchange views and information. If managed effectively, they can be utilized to generate ideas and to provide sound recommendations to the pharmacy manager. This article describes a personnel management program in which all levels of pharmacy personnel are provided with several opportunities to actively participate and contribute to the establishment and attainment of departmental objectives. The involvement of the staff in serving on committees and attending meetings is outlined. Various intradepartmental and interdepartmental committees as well as continuing education conferences are described. The comprehensive program permits each member of the pharmacist staff to spend approximately 5-10% of their time participating in the three above-mentioned activities. This personnel management approach has had a positive effect on the role of the entire staff and has enabled all levels of employees to get involved and contribute to departmental services and hospital issues. Most importantly, it has successfully provided a stimulus to the staff to pursue avenues of professional specialization.

The physiologic importance of trace element supplementation to total parenteral nutrition solutions is discussed. The trace elements discussed are copper, zinc, manganese and iodide.

A pharmacy-conducted digoxin pharmacokinetic consultation service was implemented to determine the influence of the service on patient serum digoxin concentrations. Changes in digoxin dosages and serum levels during a three-week period were compared with a three-week control period in which the consultation was not offered. Of 47 patients evaluated, there was no statistically significant (P > 0.05) difference between the control and the study group in terms of population variables. The study group receiving pharmacokinetic consultations showed a significantly greater (P > 0.05) number of dosage changes resulting in therapeutic serum drug levels than did the control group whose physicians received a report of serum drug level by itself. The number of patients with steady-state serum digoxin levels in the therapeutic range of 1-2 ng/ml increased from 45.5% to 80% as a result of the clinical pharmacokinetic consultations. This study demonstrated that a pharmacy-based clinical pharmacokinetic consultation service can provide potential benefits to the patient by aiding clinicians in optimizing serum drug concentrations.

Personal and professional characteristics of men and women hospital pharmacy residents were studied to identify differences that could affect future hospital pharmacy practice. Residents in 111 ASHP-accredited pharmacy residency programs received a survey containing questions on demographic information, reasons for selecting a residency, areas of professional interest, postresidency career goals, responsibilities to home and family, and advantages and disadvantages associated with gender. Of 286 residents receiving questionnaires, 226 responded; the percentages of men and women responding corresponded to the ratio of men and women in hospital pharmacy residencies. While men and women expressed educational goals that were not significantly different, more men than women had earned or were in the process of earning advanced degrees. No significant differences were evident between men's and women's plans for marriage and children, but 73% of the women indicated that they would take time out from their practice to raise children, compared with only 9% of the men. The majority of residents did not think their gender affected them in their residency programs, but in professional interactions more men saw gender as an advantage and more women as a disadvantage. Significantly more than women aspired to be hospital pharmacy directors. The results suggest that men are obtaining advanced training closer to the time they graduate from pharmacy school and that in the future women competing for promotions may be older than men competing for comparable positions. Those planning pharmacy staffing should consider the needs of women, and men, who expect to take time out from their careers for family responsibilities and possibly seek part-time positions when they return to the work force.

Two methods for estimating body surface area (BSA) in adult amputees were developed. BSA in sq m was determined in 42 healthy, nonamputee men and women by summing the surface areas of individual body parts obtained using geometric measurements (BSAmeas) and by an equation using height and weight (BSAcalc). Linear regression analysis was used to determine correlations between BSAmeas and BSAcalc and between BSAmeas and surface-area measurements of individual body parts (SApart). The percentages of total BSA contributed by individual body parts in each subject were determined by the ratio of SApart to BSAmeas, and these percentages were compared with the corresponding percentages for body parts using the "Rule of Nines." BSAcalc and BSAmeas were significantly correlated, as were SApart and BSAmeas. Regression analysis of SApart versus BSAmeas yielded an equation for each measured body part that allowed calculation of SApart without direct measurement. SApart expressed as a percentage of total BSA differed from the percentage of BSA used in the "Rule of Nines" by a mean of 12.4-32% depending on the body part. Two methods of estimating BSA in amputees were proposed based on deduction of the surface area of the amputated part (calculated from the regression equation for SApart or as a percentage of total BSA) from total BSAcalc in adult amputees. The two methods developed in this study for estimating BSA may be useful in determining drug dosages in adult amputees and may provide more accurate information in burn therapy. Further studies are needed to validate the clinical application of these methods.

A 600-hour-on-the-job training program for hospital pharmacy technicians is described. Qualified applicants who successfully pass a written examination are admitted to the program. Trainees receive both didactic and practical experience in all service areas of the pharmacy department. Opportunity for advancement through a technician specialist training program is available. Eighty percent of all applicant accepted into the program graduated, and 39% are currently employed by the pharmacy department with an average of 42 months work experience each. It is recommended that national guidelines are established for hospital-based pharmacy technician training program.

A program designed to improve patient care by assuring the quality of medications stored in patient care areas is described. A questionnaire covering six major areas--medication room, controlled substances, refrigerator, emergency medication kit, other storage areas and miscellaneous--designed to assist in gathering information during medication quality assurance rounds was developed. Rounds are conducted every four months by a pharmacist and a nurse. To ensure that any deficiencies are corrected, copies of the findings are sent to the appropriate pharmacy and nursing personnel.

The pharmaceutical services at Rhode Island Hospital integrate the decentralized distribution role of the pharmacist with the provision of patient-specific drug information. This service is backed up by a Drug Information Center (DIC). A study to analyze the inquiries addressed to pharmacists assigned to a decentralized unit (PSU) was conducted over a 30-day period. The survey tabulated what kind of requests were made, if they could be answered with the information available on the patient care unit, and what action was taken as a result of the information provided. When the requests were categorized according to the type of information, the PSUs and the DICs top three categories were the same. Only 3.8% of the requests for information on the PSU could not be answered using the references available on the unit. Fifty one per cent of the requests received by the PSU were acted upon by the inquirer exactly according to the information provided by the pharmacist.