Hospital Pharmacy - June 2018 - 191
191
Hammond et al
Table 3. Correct Responses for Relative Costs of Intravenous and Oral Dosage Forms.
Medicationa
Nurse
(n = 17)
Medical student
(n = 3)
Medical resident
(n = 66)
Fellow
(n = 7)
Attending
(n = 5)
Total
(n = 98)
P value
Acetaminophen 1000 mg
Linezolid 600 mg
Pantoprazole 40 mg
Levofloxacin 750 mg
Average correct, n (out of 4)
9 (56)
2 (13)
3 (19)
1 (6)
0.9 (22)
1 (33)
2 (67)
0 (0)
1 (33)
1.3 (33)
33 (51)
17 (26)
14 (22)
1 (2)
1 (25)
2 (29)
4 (57)
0 (0)
0 (0)
0.9 (22)
3 (60)
1 (20)
3 (60)
0 (0)
1.4 (35)
48 (49)
26 (27)
20 (20)
3 (3)
1 (25)
.775
.096
.164
.101
.596
a
All data are number of correct responses (%), except for P values.
Table 4. Perception of Practice and Knowledge.
Statementsa
Consider medication cost when
ordering/using
Cost of medication discussed
on rounds
Medication benefits and efficacy
versus cost discussed on
rounds
Pharmacists limit use of
expensive medications
Consider myself knowledgeable
on medication costs
Nurse
(n = 17)
Medical student
(n = 3)
Medical resident
(n = 66)
7 (44)
0 (0)
33 (50)
6 (35)
1 (33)
5 (29)
Fellow
(n = 7)
Attending
(n = 5)
Total
(n = 98)
P value
3 (43)
4 (80)
47 (48)
.161
14 (21)
1 (14)
3 (60)
25 (26)
.624
1 (33)
22 (33)
2 (29)
2 (40)
32 (33)
.669
8 (47)
1 (33)
38 (58)
6 (86)
5 (100)
58 (59)
.007
2 (12)
1 (33)
9 (14)
0 (0)
3 (60)
15 (15)
.174
a
All data are number of agree responses (%), except for P values.
Perceptions of Practice and Knowledge
Slightly less than half (48%) of respondents indicated that
they consider a medication's cost when ordering or using a
medication in a critically ill patient. Approximately
one-quarter (26%) of respondents reported that the costs of
medications were discussed during patient care rounds.
One-third (33%) of nonpharmacist health care professionals
felt that medication benefits and efficacy in conjunction with
medication cost were discussed on patient care rounds. Only
15% of these individuals believed themselves to be knowledgeable about the costs of medications. The majority (59%) of
nonpharmacist health care professionals believed pharmacists try to limit the use of expensive medications in critically ill patients. More attending physicians felt this way
than nurses (100% vs 47%, P = .007; Table 4).
Discussion
Cost-effective care emphasizes preserving and utilizing
finite resources in the most optimal way in accordance with
the best available evidence.8,9 Half of the nonpharmacist
health care professionals who practice in the medical ICU at
our institution consider a medication's cost when ordering or
using that medication in a critically ill patient; however, only
15% consider themselves knowledgeable about medication
costs. Participants knew on average 41% of the most and
63% of the least expensive medications in therapeutic
classes, less than 40% of the relative costs for commonly
used medications, and less than 50% of the relative costs
between intravenous and oral dosage forms for commonly
used medications. Physicians who are aware of the price of a
medication are more likely to support cost-effective prescribing policies.10-12 Each health care professional working
in an ICU can play a vital role in decreasing the rising expenditures in critical care medicine; however, increasing this
responsibility begins with identifying perceptions and deficits
in knowledge.13,14
Our findings are similar to those in other studies. In a
study of medical students, residents, and intensive care
physicians, only 29% of their estimates for costs of medications
used in critically ill patients were within 50% of the actual
medication cost.15 In 2 studies that evaluated physicians'
knowledge of costs of medications used in acutely ill patients,
the estimated medication cost was within 25% of the actual
cost in less than 15% and 31% of instances.16,17 When costs
of medications were evaluated upon a transition of care from
the hospital setting to home, nonpharmacist health care
professionals accurately assessed the relative price of a
medication less than half of the time.18
Hernu and colleagues surveyed medical students, residents,
and intensive care physicians regarding the costs of medications, blood products, laboratory tests, and procedures that
Table of Contents for the Digital Edition of Hospital Pharmacy - June 2018
Ed Board
TOC
USP <800>
Oct-Dec 2017 Boxed Warning Highlights approved by the FDA
Zoster Vaccine Recombinant, Adjuvanted
Multifactorial Causes of Tacrolimus Errors: Confusion With Strength/Formulation, Look-Alike Names, Preparation Errors, and More
New Medications in the Treatment of Nonalcoholic Steatohepatitis
One Chance for Your Best First Impression: Tips for New Pharmacists
Implications of Statin Use on Vasopressor Therapy in the Setting of Septic Shock
Intravenous Push Administration of Antibiotics: Literature and Considerations
The Role of Computerized Clinical Decision Support in Reducing Inappropriate Medication Administration During Epidural Therapy
Health Care Professionals Toward Adverse Drug Reaction Reporting in Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia: A Cross-sectional Study
Nonpharmacist Health Care Providers’ Knowledge of and Opinions Regarding Medication Costs in Critically Ill Patients
Detection of HBV, HCV, and Incidence of Febrile Neutropenia Associated With CHOP With or Without Rituximab in Diffuse Large B-Cell Lymphoma–Treated Patients
Hospital Pharmacy - June 2018 - Cover1
Hospital Pharmacy - June 2018 - Cover2
Hospital Pharmacy - June 2018 - Ed Board
Hospital Pharmacy - June 2018 - TOC
Hospital Pharmacy - June 2018 - 131
Hospital Pharmacy - June 2018 - USP <800>
Hospital Pharmacy - June 2018 - 133
Hospital Pharmacy - June 2018 - Oct-Dec 2017 Boxed Warning Highlights approved by the FDA
Hospital Pharmacy - June 2018 - 135
Hospital Pharmacy - June 2018 - Zoster Vaccine Recombinant, Adjuvanted
Hospital Pharmacy - June 2018 - 137
Hospital Pharmacy - June 2018 - 138
Hospital Pharmacy - June 2018 - 139
Hospital Pharmacy - June 2018 - 140
Hospital Pharmacy - June 2018 - 141
Hospital Pharmacy - June 2018 - Multifactorial Causes of Tacrolimus Errors: Confusion With Strength/Formulation, Look-Alike Names, Preparation Errors, and More
Hospital Pharmacy - June 2018 - 143
Hospital Pharmacy - June 2018 - 144
Hospital Pharmacy - June 2018 - 145
Hospital Pharmacy - June 2018 - New Medications in the Treatment of Nonalcoholic Steatohepatitis
Hospital Pharmacy - June 2018 - 147
Hospital Pharmacy - June 2018 - One Chance for Your Best First Impression: Tips for New Pharmacists
Hospital Pharmacy - June 2018 - 149
Hospital Pharmacy - June 2018 - 150
Hospital Pharmacy - June 2018 - 151
Hospital Pharmacy - June 2018 - Implications of Statin Use on Vasopressor Therapy in the Setting of Septic Shock
Hospital Pharmacy - June 2018 - 153
Hospital Pharmacy - June 2018 - 154
Hospital Pharmacy - June 2018 - 155
Hospital Pharmacy - June 2018 - 156
Hospital Pharmacy - June 2018 - Intravenous Push Administration of Antibiotics: Literature and Considerations
Hospital Pharmacy - June 2018 - 158
Hospital Pharmacy - June 2018 - 159
Hospital Pharmacy - June 2018 - 160
Hospital Pharmacy - June 2018 - 161
Hospital Pharmacy - June 2018 - 162
Hospital Pharmacy - June 2018 - 163
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Hospital Pharmacy - June 2018 - 165
Hospital Pharmacy - June 2018 - 166
Hospital Pharmacy - June 2018 - 167
Hospital Pharmacy - June 2018 - 168
Hospital Pharmacy - June 2018 - 169
Hospital Pharmacy - June 2018 - The Role of Computerized Clinical Decision Support in Reducing Inappropriate Medication Administration During Epidural Therapy
Hospital Pharmacy - June 2018 - 171
Hospital Pharmacy - June 2018 - 172
Hospital Pharmacy - June 2018 - 173
Hospital Pharmacy - June 2018 - 174
Hospital Pharmacy - June 2018 - 175
Hospital Pharmacy - June 2018 - 176
Hospital Pharmacy - June 2018 - Health Care Professionals Toward Adverse Drug Reaction Reporting in Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia: A Cross-sectional Study
Hospital Pharmacy - June 2018 - 178
Hospital Pharmacy - June 2018 - 179
Hospital Pharmacy - June 2018 - 180
Hospital Pharmacy - June 2018 - 181
Hospital Pharmacy - June 2018 - 182
Hospital Pharmacy - June 2018 - 183
Hospital Pharmacy - June 2018 - 184
Hospital Pharmacy - June 2018 - 185
Hospital Pharmacy - June 2018 - 186
Hospital Pharmacy - June 2018 - 187
Hospital Pharmacy - June 2018 - Nonpharmacist Health Care Providers’ Knowledge of and Opinions Regarding Medication Costs in Critically Ill Patients
Hospital Pharmacy - June 2018 - 189
Hospital Pharmacy - June 2018 - 190
Hospital Pharmacy - June 2018 - 191
Hospital Pharmacy - June 2018 - 192
Hospital Pharmacy - June 2018 - 193
Hospital Pharmacy - June 2018 - Detection of HBV, HCV, and Incidence of Febrile Neutropenia Associated With CHOP With or Without Rituximab in Diffuse Large B-Cell Lymphoma–Treated Patients
Hospital Pharmacy - June 2018 - 195
Hospital Pharmacy - June 2018 - 196
Hospital Pharmacy - June 2018 - 197
Hospital Pharmacy - June 2018 - 198
Hospital Pharmacy - June 2018 - 199
Hospital Pharmacy - June 2018 - 200
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