Hospital pharmacy and the patient: Proceedings of a symposium held at the University of York, England, 7–9 July 1982

181 Pages·1983·3.435 MB·English

by  R. W. Anderson (auth.), Tom Bradley (eds.)

Hospital
phannacy
and the
patient
Travenol Laboratories are pleased to have been associated
both with this symposium and the publication of these
Proceedings.
The team approach to patient care, and the growing role of
the hospital pharmacist as a member of the team are
evident from the papers presented.
The publication of these Proceedings emphasises this
company's continuing belief in the importance of
co-operation between medicine and industry in order to
promote an increase in knowledge and improve the care
and treatment of the patient.
m
TRAVENOL
Hospital
phannacy
and the
patient
Edited by
Tom Bradley
Proceedings of a symposium held at
the University of York, England, 7-9 July 1982
MT
PRESS LIMITED
International Medical Publisher
LANCASTER' BOSTON ·THE HAGUE
Published in the UK and Europe by
MTP Press Limited
Falcon House
Lancaster, England
British Library Cataloguing in Publication Data
Hospital pharmacy and the patient.
1. Self medication-Great Britain-Great Britain
Congresses
I. Bradley, T.
615.5'8 RM103
ISBN 978-94-011-9725-0 ISBN 978-94-011-9723-6 (eBook)
DOl 10.1007/978-94-011-9723-6
Published in the USA by
MTP Press
A division of Kluwer Boston Inc
190 Old Derby Street
Hingham, MA 02043, USA
Library of Congress Cataloguing in Publication Data
Main entry under title:
Hospital pharmacy and the patient.
Bibliography: p.
Includes index.
1. Hospital pharmacies-Congresses. 2. Chemotherapy
-Congresses. 3. Parenteral therapy-Congresses.
I. Bradley, T. [DNLM: 1. Pharmacy service, Hospital
Congresses. 2. Drug therapy-Congresses. WX 179
H82651982)
RS152.H67 1982 615.5'8 83-744
Copyright © 1983 MTP Press Limited
Softcover reprint of the hardcover 1s t edition 1983
All rights reserved. No part of this publication may be
reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical,
photocopying, recording or otherwise, without prior
permission from the publishers.
Contents
List of Contributors viii
Preface x
Opening address xi
T.D. Clarke
SECTION ONE
Parenteral Therapy for the Patient at Home
Chairman: J.E. Lennard-Jones
Chairman's introduction 3
1 Cytotoxic therapy - developing a home intravenous 7
service
R. W. Anderson
2 Current therapeutic role of continuous insulin delivery 17
systems
J. Birtwell
3 Care of the home parenteral nutrition patient 27
S.R. Wood
4 Is providing the regimen sufficient? 35
H.Doery
Discussion 42
v
vi HOSPITAL PHARMACY AND THE PATIENT
SECTION TWO
Hazards, Risks and Responsibilities
Chairman: S. Ellis
Chairman's introduction 57
5 Handling cytotoxic drugs-health and safety hazards 59
R. W. Anderson
6 Microbiological risks for the compromised patient at 75
home
P. Noone
7 Home parenteral therapy and the general practice 83
pharmacist
J. Kirby
8 Home parenteral therapy and the hospital pharmacist 89
F. Gibson
Discussion 93
SECTION THREE
New Approaches in Practice
Chairman: D.R. Knowles
9 An evaluation of the use of case studies in 99
clinical pharmacy training
E.A. Aston and S. Hudson
Discussion 103
10 An integrated approach to ward pharmacy 105
R.D. Swallow
Discussion 111
11 Ward and clinical pharmacy - a comparison with Holland 113
D.R. Forbes
Discussion 117
CONTENTS vii
12 The stability of diluted betamethasone 17- valerate 121
topical preparations
K.R. Middleton and R.F. Haines-Nutt
Discussion 125
13 A case study in nutritional support 127
D.A. Bolton
Discussion 131
14 The introduction of a cytotoxic reconstitution and 135
additive service in a regional chemotherapy centre
M. Earnshaw, C. Tate and H. Harris
Discussion 140
SECTION FOUR
Drug Selection and Evaluation
Chairman: F. Fish
Chairman's introduction 145
15 Hospital pharmacy and clinical pharmacokinetics-is 147
academia in touch?
w.J. Tilstone
16 Theophylline therapy: the need for pharmacy 153
involvement
R.A. Wolf
17 Pharmacokinetics in the hospital pharmacy 159
R. T. Calvert
18 Practising drug evaluation 165
S. Hudson
Discussion 176
Closing address 179
T.J. Bradley
Index 183
List of Contributors
Dr R.W. ANDERSON Mr M. EARNSHAW
Director Pharmacy Department
Department of Pharmacy Newcastle General Hospital
The University of Texas Westgate Road
Anderson Hospital and Tumor Institute Newcastle-upon-Tyne NE4 6BE, UK
at Houston
Houston, TXs 77030, USA Dr S. ELLIS
Regional Pharmaceutical Officer
East Anglia RHA
Mrs E.A. ASTON
Union Lane
Drug Information Centre
Chesterton
Leicester Royal Infirmary
Cambridge CB4 1R F, UK
Infirmary Square
Leicester LE1 5WW, UK Dr F. FISH
Dean
Dr J. BIRTWELL The School of Pharmacy
Registrar University of London
Department of Medicine 26/39 Brunswick Square
University Hospital of Wales London WC1N 1AX, UK
Cardiff, UK
Mr D.R. FORBES
Pharmacy
Mr D.A. BOLTON Bristol Royal Infirmary
District Pharmaceutical Officer Marlborough St
Pharmacy Department Bristol BS1 3NP, UK
Bangour General Hospital
Broxburn, West Lothian EH52 6LR, UK Dr F. GIBSON
Pharmaceutical Consultant
3 Greville Place
Dr. T.J. BRADLEY
London NW6 5JS, UK
Regional Pharmaceutical Officer
West Midlands Regional Health Authority
Dr R.F. HAINES-NUTT
Newland House
Regional Quality Control Laboratory
139 Hagley Road
Torbay Hospital
Birmingham B16 8UA, UK Torquay
Devon TQ2 7AA, UK
OrR. CALVERT
Pharmacy Miss H. HARRIS
Leeds General Infirmary Pharmacy Department
Great George Street Cookridge Hospital
Leeds LS1 3EX, UK Leeds, UK
Mr S. HUDSON
Miss H. DOERY Drug Information Centre
Staff Pharmacist Leicester Royal Infirmary
St Mark's Hospital Infirmary Square
City Road Leicester
London EC1V 2PS, UK LE1 5WW, UK
viii
LIST OF CONTRIBUTORS IX
MrJ. KIRBY Mr R.D. SWALLOW
Superintendant Pharmacist and Director Staff Pharmacist, Clinical Services
Joins and Kelynack Ltd Pharmacy Department
31, Cole Green Lane St James's University Hospital
Welwyn Garden City AL7 3PP, UK Beckett Street
Leeds LS9 7TF, UK
Mr D.R. KNOWLES
District Pharmaceutical Officer Miss C. TATE
Dean Clarke House Pharmacy Department
Southern Hay East Cookridge Hospital
Exeter, Devon, UK Leeds, UK
Professor W.J. TILSTONE
Professor J.E. LENNARD-JONES
Forensic Science Unit
Consultant Gastroenterologist
School of Pharmacy
St Mark's Hospital
University of Strathclyde
City Road
Glasgow G1 1XW, UK
London EC1V 2PS, UK
MissS. WOOD
Dr K.R. MIDDLETON Clinical Nutrition Sister
Department of Pharmacy St Mark's Hospital
Northwick Park Hospital City Road
Watford Road London EC1V 2PS, UK
Harrow
Middlesex HA1 3UJ, UK Dr. R.A. WOLF
Assistant Professor
Dr P. NOONE Department of Pharmacy Practice
Medical Microbiology College of Pharmacy
Royal Free Hospital University of Arizona
London NW3 2QG, UK Tucson, AZ 85724, USA
Preface
The development of new technology means that compromised patients
previously confined to hospital may now be treated at home. Those
patients receiving intravenous feeding, cytotoxic drugs and new insulin
therapy, are fully trained by the health-care professionals (doctors,
pharmacists and nurses) to encourage self-reliance and understanding
which are vital to success.
There are hazards in treating these patients in the home environment,
e.g. microbiological risks which are currently being evaluated, failure of
equipment, and social problems as patients adjust to a new life in the
community. Neverthless, the balance of benefits favour restoration of the
patient to a self-reliant positive life at home.
The delivery of this important new dimension in therapy was described
at a symposium held in the University of York by innovators in the field.
Discussion enabled the core of knowledge and experience developed by
multi-disciplinary teams to be shared. The problems of supplying
parenteral nutrition and medication for the compromised patient in the
home and the family situation were aired and solutions presented.
The special care for hospital out-patients receiving cytotoxic drug
therapy and safe procedures for staff handling these agents was presented
and together with responses to questions indicated the direction for UK
hospital pharmacists to follow.
More information is needed and it is hoped that this account of these
proceedings will stimulate interest in these aspects of health care.
T. J. Bradley
x
Opening Address
T D Clarke
I would like to welcome you to Yorkshire and to this symposium in York
University. Having looked over the shoulder of the Chairman and
speakers, I can promise you a full and stimulating programme. This sym
posium, as previous Travenol symposia have done, points the way to
change. In the past, pharmacy has been labelled as a drug-orientated
profession, both in its education and practice. The next 2 days will be
devoted to confirming that pharmacy is becoming a patient-orientated
profession, that hospital pharmacy is opening the doors of the hospital and
carrying complicated therapies previously described as hospital only into
the patient's home. It has happened with home haemodialysis and more
recently with CAPD.
Now is the time to review the possibilites, the problems, the dangers and
advantages of all forms of parenteral therapy for patients at home. The
more difficult of these therapies concern the use of cytotoxic drugs, and
parenteral nutrition, particularly away from the controlled environment of
the hospital. The development of these techniques in the home will be dis
cussed in the first session and the hazards, risks and responsibilities in the
second. Consideration of the responsibilities for these services includes a
discourse of the juxtaposition between hospital and community pharma
cists, and here today are 230 hospital pharmacists and one community
pharmacist.
An evening session will be devoted to the presentation by the '1981
Travenol Fellow' of his paper on the application of freeze-thawing. The
extension of i. v. drug additive services within unchanged resources will re
quire developments in technology of this nature and we look forward to
xi