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Purpose To evaluate the effect of bedside barcode medication administration (BCMA) on specific tasks performed by nurses during medication administration in an intensive care unit (ICU). Methods A prospective observational study was conducted on paper-based medication administration (PBMA) and BCMA in an ICU. A prevalidated time and motion observation instrument was used to measure time spent by nurses on tasks associated with PBMA and BCMA. Frequency of each task performed and mean duration of time dedicated to each task were obtained using descriptive statistics. Analysis of covariance was conducted to assess the difference in time spent with various nursing tasks between 2 periods. Factors considered as covariates were age, gender, body weight, length of stay of the patients in the ICU, number of drugs administered, and number of nurses involved. Results A total of 101 PBMA and 151 BCMA were analyzed. The mean duration of total medication administration time was found to be significantly higher during BCMA(377.8 ± 232.8 s) than during PBMA(313.3 ± 224.3 s). During BCMA, nurses spent more time on the following medication administration tasks: drug preparation(159.4 vs 27.3 s; P < .05), assisting physician(5.2 vs. 0.4 s; P < .05), universal precautions(3.6 vs 0.0 s; P < .05), and conversing with patients(21.6 vs 15.0 s; P < .05). During BCMA, nurses spent less time on the following medication administration tasks: giving medications(24.7 vs 35.0 s; P < .05), documenting medications(11.3 vs 17.3 s; P < .05), and cross-checking drugs with orders(7.4 vs 7.6 s; P =.04). Conclusion During PBMA, nurses spent more time on documenting medications and less time conversing with patients. This changed significantly after implementation of BCMA. BCMA resulted in nurses spending less time on documentation and more time conversing with patients during medication administration process.

Background: Diabetes is the third most expensive physical health condition for US employers. Thus, there is a need for employers to engage in disease management programs for their diabetic employees in order to ensure long-term benefits. Objective: To evaluate the clinical outcomes of successful implementation of an employer-initiated pharmacist-based disease management program for diabetic patients. Methods: This was a longitudinal retrospective study analyzing clinical indicators in diabetic employees after a community pharmacist-based diabetes disease management (DDM) program in a rural setting. The program involved comprehensive drug therapy assessment and individualized disease management education. Outcomes measured in this study were fasting serum glucose (FSG) levels, glycated hemoglobin (A1C) levels, diastolic blood pressure (DBP), systolic blood pressure (SBP), body mass index (BMI), and complete lipid profiles including high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride (TG), and total cholesterol (TC) levels. Results: A total of 137 patients were enrolled in this program. Significant improvement in mean clinical outcome scores was achieved for FSG (p = 0.004), DBP (p = 0.018), and SBP (p = 0.044). At the end of the 1-year intervention, targeted FSG and A1C goals were attained by 39.1% (p = 0.029) and 39.4% of patients, respectively. Also, targeted DBP, SBP, BMI, LDL, HDL, TG, and TC levels were achieved by 54.8% (p < 0.001), 38.5%, 38.3%, 56.8%, 38.2%, 37.5%, and 52.4% of patients, respectively. Conclusions: This study establishes a need for implementation of long-term employer-initiated pharmacist-based DDM programs that improve clinical outcomes for employees. Further studies evaluating outcomes for a longer time period would provide more conclusive results.

Purpose The purpose of this study was to evaluate the impact of commercial computerized prescriber order entry (CPOE) on efficiency outcomes in an 864-bed community hospital. Methods A retrospective study was developed to measure medication errors and medication order turnaround time in St. Luke's Episcopal Hospital located in the Texas Medical Center. The study data were collected by stratified random sampling through a review of medication orders submitted to the pharmacy using a paper-based order system and the CPOE system. Descriptive frequencies, chi-square test, Wilcoxon matched-pairs sign rank test, and logistic regression and multiple regression analyses were conducted to examine the relationship among variables. Results Of the 1,110 total orders reviewed (563 paper-based and 547 CPOE), a total of 135 medication errors were found, with 10.5% in paper-based versus 1.6% in CPOE. The most prevalent errors in paper-based orders were inappropriate abbreviations (24.4%), incorrect doses (15.6%), occurrences of allergy (13.3%), and wrong administration frequency (9.6%). In CPOE orders, the errors were occurrences of allergy (10.4%), incorrect doses (2.2%), and drug interaction (0.7%). CPOE resulted in a 50% reduction of medication order turnaround time (median = 24 minutes CPOE vs 48 minutes paper orders). A potential medication error, unidentified prescribers within medication orders, urgency of medication order, and implementation of CPOE were the significant ( P < .05) determinants of medication order turnaround time. Conclusion The implementation of a commercial CPOE system reduced medication errors and improved medication order turnaround times.

The purpose of this study was to evaluate and compare various Generic Drug Discount Programs (GDDPs) offered by large chain pharmacies in the United States to understand similarities and differences within them. Data collected included questions such as whether the pharmacy offered any GDDP, discounted amount, total number of generic drugs and drug classes included in the GDDP, and whether the discounted amount was differentiated by the term ‘insured’ or ‘uninsured’. Comparison of GDDPs was conducted by matching drugs covered under each GDDP with top-100 generics consumed in the United States in 2007. Of the 37 pharmacies evaluated, 22 offered GDDPs. GDDP offered by Pathmark pharmacy contributed the highest number of top-100 drugs both in dollar amounts and in number of units sold. In conclusion, more than half of the large chain pharmacies in the United States offered some form of GDDPs, which were different across pharmacies. These GDDPs offered consumers an option to reduce their health-care costs. Most programs varied by number of drugs covered, days' supply, enrollment requirements and the discounted amounts for generic drugs.

Background: Over-the-counter (OTC) medication use has increased among HIV-infected patients. Inappropriate use of OTC drugs may increase the risk of potential adverse drug events (ADEs), thus decreasing health-related quality of life (HRQL). Objective: To examine the effect of OTC medication misuse and associated ADEs on HRQL of HIV-infected patients. Methods: A cross-sectional field study with HIV-infected patients from an HIV clinic in Houston, Texas, was conducted from April 1, 2005, to June 30, 2005. A validated questionnaire (including questions on OTC medications used; ADEs experienced; and HRQL, Short Form-12, version 2 scale) was administered using self-administered and personal interview techniques. Cronbach's α was estimated to evaluate internal consistency for HRQL scores and χ2 and t-test analyses were performed to evaluate the effect of OTC misuse on ADEs and on HRQL. Results: Of the 215 respondents, 80 (37.2%) misused OTC medications. Thirty-six participants (16.7%) experienced ADEs due to OTC use or misuse. ADE incidence was significantly higher in patients misusing OTCs. Significantly lower HRQL scores for the physical component summary score domains were observed in patients reporting ADEs versus those who did not. Conclusions: HIV-infected patients had lower HRQL scores when they experienced an OTC-associated ADE. Patients misusing OTC medications had a higher incidence of associated ADEs. Interventions by healthcare providers and patients aimed at reducing misuse and ADEs due to OTC medications would improve care and the quality of life for HIV-infected patients.

Background: Heallh-relaled quality or lire (HRQL) is an important outcome, especially for chronic diseases with no cure such as cardiovascular diseases. Objective: To investigate the comparability of 2 HRQL instalments, the Short Form-12 (SF-12) survey and the MacNew Heart Disease HRQL survey (MacNew) in patients with cardiac diseases. Methods: A nonexperimental cross-sectional study was conducted in a lipid clinic in the Houston metropolitan area. Patients with a prior cardiac disease were requested to complete the SF-12 and the MacNew scales while waiting to see the physician during their regular clinic visit, Cronbach's u values were estimated to evaluate internal consistency. Spearman's correlation was performed to examine the correlation between the SF-12 and the MacNew scale domains, Results: A total of 118 patients were enrolled in this study. High Cronbach's a (from 0.89 to 0.94) were observed from all component scores in the MacNew scales. Physical component scores from the SF-12 and from the MacNew were highly correlated (r = 0.74; p < 0.001), as were the mental component score from the SF-12 and the emotional component score from the MacNew (r = 0.68; p < 0.001). Conclusions: The SF-12 and the MacNew appeared to be strongfy correlated to each other for predicting a patient's HRQL in patients with a cardiac disease.

Background: On March 17, 1999, the FDA mandated a new standardized format called “Drug Facts” and a minimum font size of 6 points for the labeling of over-the-counter (OTC) medications. Yet, some text legibility studies report consumer preference for font sizes of at least 10 points. The possibility therefore exists that the minimum font size mandated by the FDA might be too small for certain consumers to read. Objective: To compare the effectiveness of 3 labeling formats—old, new, and simulated labels (SLs)—using the OTC medication Label Evaluation Process Model (LEPM). Methods: A within-subjects experimental design was used. SLs designed for this study contained similar information as the new labels plus a larger font size. English-speaking consumers viewed these label formats and completed a questionnaire that requested consumer demographic information and measured their responses on 5 domains of the LEPM: ease of use, product knowledge, attitude toward product label, product evaluation, and purchase intention. These 5 domains were the dependent variables for this study. The independent variable was the label format. Data were analyzed using the SAS 9.1 software. A multivariate analysis of variance (ANOVA) followed by a univariate ANOVA determined the effect of label format on the dependent variables. Results: Each label format differed significantly from the others in terms of ease of use, attitude, product evaluation, and purchase intention, with the highest mean scores reported for SLs. SLs were the only label format that significantly improved consumers' product knowledge. Conclusions: Although the new standardized OTC labels are an improvement from the old unstandardized label format, there is a need for further improvement in OTC medication labeling, especially regarding the font size on these labels.

Objective: Job satisfaction is the favorableness with which employees view their work. Two main factors that affect job satisfaction are intrinsic and extrinsic job characteristics. Intrinsic factors lead to satisfaction,whereas extrinsic characteristics prevent dissatisfaction. The objective of this study was to determine the level of job satisfaction among hospital pharmacists at the Texas Medical Center by looking specifically at intrinsic and extrinsic factors that managers may use to promote a higher level of job satisfaction. Methods: A survey about intrinsic and extrinsic job characteristics was administered to hospital pharmacists. The survey employed a 5-point "strongly agree" (5) to "strongly disagree" (1) scale; satisfaction was measured using two previously validated scales abbreviated as JS1 and JS2. Eighty-five completed surveys were received for a response rate of 26%. Results: The mean age of the respondents was 40 years (′ 9.7); the majority of respondents were female (64.3%). In general, pharmacists were satisfied with their job. The mean job satisfaction scores on the two scales were 3.32 ′ 0.86 for JS1 and 3.43 ′ 0.84 for JS2. Job satisfaction was significantly correlated with intrinsic (r J S 1 = 0.61, r J S 2 = 0.54, P < 0.05) and extrinsic factors (r J S 1 = 0.64, r J S 1 = 0.61, P < 0.05). Furthermore, intrinsic and extrinsic factors were significantly correlated with each other (r = 0.48, P < 0.05). Conclusion: Hospital pharmacists at the Texas Medical Center were satisfied with their current jobs and liked their jobs. Intrinsic and extrinsic factors were significantly correlated with job satisfaction and with each other, indicating their importance when measuring job satisfaction.