The surgical pharmacists provide pharmaceutical care to general adult surgery patients. Services provided include assistance with drug selection, pharmacokinetic dosing and monitoring, patient and team education, and drug information. Consultations are also provided to the SICU teams on issues of critical care management.
The pharmacists working with the Adult AIDS Patient Care Program provide inpatient and outpatient services. Specialized pharmacists function as team members on the inpatient HIV Service, providing patient specific and health care provider education and drug information on the pharmacotherapy of HIV and related diseases. They also assist in the coordination of home parenteral therapy. Pharmacists working at the Evelyn Jordan Center clinic review and update patient profiles, provide prescription counseling for patient education and adherence, as well as pharmacotherapeutic information to the health care team.
Pharmacists working in the Anticoagulation Clinic monitor outpatients on warfarin therapy. Patients are interviewed for signs and symptoms of bleeding or thromboembolic complications. Their INRs are measured and their warfarin dosages are adjusted accordingly. Pharmacists also check patients' blood pressures. Education and compliance, including referral to Dupont's Indigent Patient Program, are strongly emphasized. Appropriate over-the-counter medications are recommended as needed.
The pharmacists on this service attend rounds in the PCU/CCU where they assist with drug information, drug selection and dosing, pharmacokinetics, and adverse drug reaction reporting. In addition, pharmacists participate in discharge planning, such as simplification of medication regimens, with an emphasis on patient compliance, cost-effectiveness, and patient education. Ambulatory responsibilities include the Anticoagulation Clinic, where patient's warfarin and concomitant drug therapy are assessed.
This specialized service works with critical care physicians and other professionals in designing and implementing drug therapy in the Shock Trauma Center and the Medical Intensive Care Unit. The pharmacists provide information on pharmacodynamics, drug selection and administration, toxicities, and cost effective treatment options. A comprehensive pharmacokinetic service is provided for aminoglycoside and vancomycin dosing as well as other drugs upon request. In addition, the service is involved in development of multiple drug and disease state protocols, research and educational programs.
The University of Maryland Drug Information Center is open Monday-Friday from 9:00 am to 5:00 PM. The Center is staffed by full-time faculty, drug information residents, hospital pharmacy residents, and PharmD students. Services provided include answering drug information questions regarding new drug availability, adverse reactions, orphan drugs, foreign drugs and their equivalents, tablets/capsule identification, pharmacology, drug interactions, dosing and therapeutic related issues. Other services provided include: the Therapeutics Committee drug evaluation monographs; IV Push Guidelines; Guidelines for Use, Infusion Guidelines, training of students, residents, and newly hired pharmacists; and contributing articles to monthly newsletters such as Therapeutic Perspectives.
This specialized service provides consultations in the areas of antineoplastic drug therapy to include pharmacology, pharmacokinetics, drug administration, toxicities, compatibilities, and related supportive care management. A variety of references on these topics are also available. In addition, therapeutic monitoring including pharmacokinetics is provided for patients.
This comprehensive service prepares about 1500 doses a day which range from simple premixed bags to complex intravenous admixtures. All total parenteral nutrition bags are compounded here using automated technology. Technicians and pharmacists on this service assist in aseptic technique training of new staff members in the department.
The Investigational Drug Service is responsible for the development, distribution, and accounting procedures for all investigational drugs at UMMC. Assistance is also provided for protocol development, preparation of drug information materials, IND submission, randomization and blinding, and post-marketing surveillance studies.
The Pharmacy Leadership Team strives to create and maintain a pharmacy practice environment conducive to the provision of proficient, compassionate and standard setting direct patient care. This group consists of the Director of Pharmacy Services, the Manager of Clinical Services, Operations Managers, and Process Coordinators.
The Maryland Poison Center (MPC) is an emergency telephone service which provides health professionals and the general public with immediate, up to date information on exposures to toxic substances on a 24 hour per day basis. A division of the University of Maryland School of Pharmacy, the MPC is the official poison center for the state of Maryland. The center is staffed by specialists in poison information. Public and professional education programs are also available.
The medicine pharmacists work with physicians and other health care professionals to provide pharmaceutical care services to adult patients on Med 1, Med 2, and Med 4. Services provided include assistance with drug selection and dosing, cost-effective treatment options, drug information, patient counseling, team education, pharmacokinetic dosing and monitoring, renal dosing, and adverse drug reaction reporting.
The pharmacists in neurocare provide pharmaceutical care services to Neurology, Neurosurgery inpatient teams, and the Neurology ambulatory clinic. Services provided include the provision of patient specific or general therapeutic information with an emphasis on anticonvulsants, assistance with choice and dosing of drugs, and participation of discharge planning rounds. Monitoring of home patients and inservices are also provided upon request. The pharmacists also participate in clinical pathway development.
Pharmaceutical services are provided to the neonatal, pediatric, mother/baby, and labor & delivery inpatient teams in critical and non-critical areas. The pediatric clinical pharmacists provide patient specific and general pharmacotherapeutic information. This includes drug information, pharmacokinetics, and other drug-related problems. Assistance is also provided for questions related to Total Parenteral Nutrition.
Kidney and Pancreas
The pharmacists working with the Kidney/Pancreas Transplant Team provide pharmaceutical care services through immunosuppression adjustment, drug information, dosage recommendations, pharmacokinetic dosing, drug selection, and adverse drug reaction reporting. Medications used by this team are complicated and costly. Medication profile review helps to decrease unnecessary waste of drugs and preparation times.
Liver
Pharmaceutical care services are provided for both inpatients and outpatients. These services include dosing and monitoring of immunosuppressive agents, assistance with drug selection, drug interaction monitoring, patient education, and drug information. This service also provides assistance with protocol development and inservice education per request.
The Antimicrobial Use Program was established to work with the Antimicrobial Subcommittee of the Therapeutics Committee. The pharmacist in this area works with the subcommittee to review and evaluate antimicrobial use within UMMC. Classes of antimicrobials are reviewed with emphasis placed on therapeutic equivalency of the agents. The pharmacist monitors usage patterns of specific drugs along with the microbiology to look for patterns of resistance. Specific recommendations are then reported to the Therapeutics Committee for approval and implementation.
The Medication Use Evaluation Program (MUE) is a planned and ongoing process to monitor and evaluate the use of drugs at UMMC. The aim of the program is to help assure appropriate, safe and effective use of drugs. The program involves monitoring of drug usage patterns, adverse drug reactions, formal drug and disease state oriented reviews utilizing approved criteria, collection and analysis of data on drugs recently evaluated by the Therapeutics Committee, and outcomes research. Results and activities are reported to the Therapeutics Committee and to the Quality Improvement Committee. MUE results are disseminated to the medical staff through Therapeutic Perspectives.
Adverse Drug Event Advisory Council
The ADE Advisory Council functions as a multidisciplinary consulting body to the Therapeutics Committee. The Council is charged with analyzing data collected from the ADR Surveillance Program and the Medication Error Surveillance Program, collaborating on prevention projects, initiating quality improvement programs, and making recommendations for action.
Adverse Drug Reaction Surveillance Program
The definition of an adverse drug reaction (ADR) at UMMC is, "a detrimental response to a drug that is unintended or unexpected and occurs at doses used for prophylaxis, diagnosis or therapy." The ADR Surveillance Program, through the implementation of the ADR Hotline, has been developed to concurrently monitor for ADRs.
Three key features of the program include: routine feedback to healthcare providers concerning ADRs, compliance with The Joint Commission requirements, and prevention of known or suspected drug intolerances. Physicians, nurses, and other health professionals are able to report a possible ADR by calling the ADR Hotline. The hotline is operational 24 hours a day. All documented or suspected allergic and other significant reactions may be reported through the hotline. There is no paper work involved. All calls are strictly confidential. The data collected is analyzed for trends that could signify areas where ADR prevention can occur. Serious reactions are reported to the FDA MedWatch program.
Medication Error Surveillance Program
The definition of a medication error at UMMC is, "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in control of the health care provider, patient, or cnsumer." The Department of Pharmacy Services, in collaboration with the Department of Risk Management collects and analyzes medication errors at UMMC. The purpose of this program is to identify and correct system breakdowns believed to be causing errors. All medication errors should be reported to Pharmacy by filling out a Medication Error Report form.
ISMP Medication Safety Alert
The Institute for Safe Medication Practices (ISMP) is a nonprofit organization dedicated to educating the global healthcare community about methods to prevent adverse drug events. ISMP publishes its recommendations along with actual events reported to the USP Medication Error Reporting Program, operated in cooperation with ISMP. ISMP has given the Department of Pharmacy permission to reproduce the ISMP Medication Safety Alert in Therapeutic Perspectives for the medical system staff. This bi-weekly publication brings potentially life-saving information about medication and device errors and adverse drug reactions. The ISMP Medication Safety Alerts can be found each month as an insert in Therapeutic Perspectives.
The Medication Use Process Manual (Formulary) is a publication of the Department of Pharmacy in collaboration with the Medical Staff. It includes complete product descriptions of the formulary items available for use at UMMC. The manual also contains drug and treatment guidelines, a section on pertinent administrative information, and highlights from the Adverse Drug Reaction and Medication Error Programs.
The Therapeutics Committee is a standing committee of the medical staff responsible for assuring that the medications and therapeutic agents used at UMMC are of the highest quality. The Managed Care Team, in collaboration with the Drug Information Service and the Medical Staff, provides administrative support for the Therapeutics Committee including: setting monthly agendas, formulary reviews for requested medications, monitoring non-formulary drug use, medication use evaluations, adverse drug and medication error surveillance, pharmacoeconomic analyses, preparation of guidelines for use, dissemination of information from the Committee, and publication of Therapeutic Perspectives. Other administrative duties are performed as requested.
Therapeutic Perspectives is the official newsletter of the Therapeutics Committee, published by the Department of Pharmacy Services. This publication is distributed to all physicians at UMMC, as well as nurse managers, pharmacists, and hospital administrators. Each addition consists of a feature article, drug warnings and alerts, approved drug guidelines, and formulary updates. In addition, information for concerning medication use evaluations and adverse drug and medication error monitoring is presented.
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