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To determine whether randomly selected intravenous (IV) antimicrobial doses dispensed from an inpatient pharmacy were administered.
This was a prospective, cross-sectional study in which dose administration was confirmed by direct observation and by assessment of the medication administration record (MAR). A retrospective analysis of the return rate of unused IV antimicrobial doses was performed subsequently.
Medical and surgical intensive care units (ICUs) and non-ICUs of a 550-bed urban public teaching hospital.
Hospitalized patients with an order in the pharmacy database for an IV antimicrobial during 9 non-consecutive weekdays in June 1999.
Of 397 doses, 221 (55.7%) assessed by bedside observation and 238 (59.9%) assessed by MAR review were classified as administered; 139 doses (35.0%) were dispensed but changes in the drug order or the patient's status prevented their administration. In the subsequent assessment, of 745 IV antimicrobial doses dispensed during 24 hours, 322 (43.2%) were returned to the pharmacy unused; 423 (56.8%) of the doses—consistent with our prior observations—were presumably administered.
Because computerized pharmacy data may overestimate actual antimicrobial consumption, such data should be validated when used in studies of hospital antimicrobial use. Dispense-return analysis offers a simple validation method.
A multitude of life-threatening and nonlife-threatening processes cause chest pain and shortness of breath. Prehospital therapy for these patients may be lifesaving and includes pharmacologic interventions, as well as invasive procedures. Appropriate therapy depends on the diagnostic skills of the paramedic.
This study was undertaken to determine the accuracy of the paramedic diagnosis in patients transported with a chief complaint of pain or shortness of breath.
Multihospital, one large municipal hospital, one community hospital.
Prospective, cross-sectional study. Paramedics evaluated the patient and then completed a standard form indicating the diagnosis. The paramedic's and final emergency physician's diagnoses were compared to assess the accuracy of the paramedic diagnosis.
All patients who complained of chest pain or shortness of breath, transported to the study centers by the city of Denver paramedia, were eligible for the study. Ninety-nine of the 102 patients enrolled had complete records for analysis and were entered into the study.
Diagnostic concordance data were analyzed by organ system (e.g., cardiac, pulmonary, etc.) and for specific diagnoses using the kappa statistic and McNemar's chi-square analysis for discordant pairs. Using the kappa statistic, there was statistically significant concordance between the paramedic and emergency-physician diagnosis for cardiac (p = 0.0001; kappa value = 0.54) and pulmonary organ systems (p = 0.0001; kappa value = 0.61). Overall, for organ system diagnosis, the paramedics had an 82% accuracy (p = 0.05) rating. For specific cardiac and pulmonary diagnosis, paramedics had good concordance with emergency physicians.
Overall, paramedia have excellent diagnosis by organ system. They retained good agreement on specific cardiac diagnoses and pulmonary diagnosis.
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