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Annotated Selected Bibliography on the Patient Record System
Patient Record Systems in Canada The Canadian Pharmaceutical Association has developed "CPhA Minimum Information Requirements for Patient Record Systems," and those systems and/or advertising of manufacturers who qualify may use this designation or a special logo upon approval ofCPhA. Canadian Pharmaceutical Association mInImUm requirements include family name and names of dependents, address, telephone , birth years, "third-party" con-
tract numbers, allergies and special information, date, prescription number, identification of prescriber, identification of pharmacist, name and strength of medication, quantity, directions for use, repeat information and charge (price). It is reported that considerable activity is under way in most provinces of Canada, and at least two of them- Alberta and Ontario- seem to be close to making the
Patient Record System a legislative requirement. The definition of "minimum requirements" differ from province to province. For example, Ontario requires the pharmacist to identify himself by a full signature, while other provinces only require the dispensing pharmacist to initial the record card. Some provinces go beyond the CPhA "minimums," and Quebec is presently establishing a different set of standards.
Annotated Selected Bibliography on the Patient Record System The following selected annotated bibliography on "Patient Record Systems" offers both an historical review of their development to date, as well as the " pros" and "cons" which have been expressed by many authors. 1962 _ __ _ , "His Rx Record System Pays In 8 Ways," American Druggist, p. 45 (May 28, 1962)Pharmacist Don Roach Jr. of Livon ia, Michigan, describes the Safeguard System, noting that "the family record card is the most essential part of the system."
1963 Eugene V. White, "The Maintenance of a Family Prescription Record System," Wiscon sin Pharmacist, pp 420-421, 435 (December 1963) -Pioneer innovator of family prescription record system describes format and advantages, and expresses hope that one day all of the nation's pharmacists will maintain such records. (Reprinted in Wisconsin Pharmacist, pp. 234, 236, June 1966)
1964 Roger Cain, "New Prescription Practices .•• Patient Record Systems," Journal of the American Pharmaceutical Association, pp. 164-168 (April 1964) -First survey of Patient Recor d Systems de scribes record cards of Eugene White, Lokato, ACA, Con R. Spainhour , Jack R. Thompson, Wilkens Harden, Hennin g En g mark and John Stadnik. Article suggests i nformation which should be included in any Patient Record System . Martin M. Rosner, "Attitudes Toward Maintaining Family Records on Drug Sensitivities, J ournal of the A mencan Pharmaceutical Association, pp 169-175 (April 1964)-Survey indicates that in 1963 only nine of 87 pharmacists interviewed maintained family drug reco r ds while 22 (28 percent) thou g ht it was a good idea; 26 (33 percent) thought it impractical, and 30 (38 percent) were opposed without qualification. On the other hand , physicians expressed approval of the concept by a three to two marg in. Opposition was based on unnecessary duplication of effort and the intrusion of the phar macist into the physic ian's professional domain. Dale W. Doerr and Russell F. Parke, "Prescription Record Keeping: Why?," I ndiana Pharmacist, pp. 111-112, 143 (April-May 1964)Referr ing to J APhA, April 1964 issue , authors d iscuss advantages of Patient Record Systems . Article mentions use of Royal -McBee Keysort cards, Criss-Cross Directory and "hybrid systems which supposedly selects the g ood points from a variety of set-ups now in use." In answering the question "will the
record system support itself," they respond, "how can anyone place a dollar value on the conven ience of such services."
1966 Herman O. Thompson, "Composite Prescription Records," American Professional Pharmacist, pp. 50-55 (March 1966)-Author lists ten benefits from patient record systems as well as data required on a complete patient record (he emphasizes need to monitor drug reactionspointing to study showing that over two percent of patients discharged from a hospital over a nine-month period experienced minor to very ser ious drug reactions. William S. Lackey, "Family Rx Records Help to Designate You as the Family RxMan," American Professional Pharmacist, pp. 56-57, 59-60
(March 1966)-The fami ly prescription system has not increased cost of operation, claims author. "Actually, the percentage of labor cost has been somewhat reduced," the author adds . The cost for the first year was slightly over one cent for each prescription; and even if it had been greater, the system would have been worth many times his investment in time and money, according to pharmacist Lackey of Tucson, Arizona. Vance Weidle, "Our Family Prescription Record System," J ournal of Kansas Pharmacy, pp. 8-9 (April 1966)-Designing record forms from those appearing in April 1964 issue of J A PhA, Weidle promoted serv ice via radio spots. Physicians complimented service, and patrons called it "splendid." The expense involved is nominal, and "we consider it the wisest investment we could make. . . You can be assured that once you have it in operation you will wonder how you ever operated without it," concluded the author. _ _ ___ , "Rx System Saves 10,000 Hours a Year," American D ruggist, pp. 47-48 (July 18, 1966)Wayne Berry and Frank Dannelley of Austin, Texas, describe system using triplicate forms and teletype between three pharmacies which saves 25 percent of pharmacist's time and " has already more than paid for itself." _____ , "Why Chains Are GOing For Patient Record Systems," Chain Sto re Age, pp. 68-69, 85 (August 1966)-Not only do patient records provide better service, but they also furnish valuable marketing data. Chains report that physicians have responded with "uniform approvaL" First chains to adopt system were Osco, Drug Fair and Dougherty Drug. Maven J. Myers, "Use This Special Record Card to Keep Tabs of Drug Control Numbers," American P rofessional Pharmacist, pp 56-60 (September 1966)-Author suggests a "pharmacy product card system" as an alternate to placing drug product control numbers on
the prescription label. System was initially designed for recall procedures, but subsequently adopted in certain patient record systems. _____ " "Miscellaneous Aids to Rx Practice," J ournal of the American Pharmaceutical A ssociation, pp. 639-640 (December 1966)-ln addition to "patron-medication record card," which includes non-prescription drugs, medication calendar is suggested and shown to permit pf'larmacists to provide patients with a medication calendar to simpllfy complicated dosage regimens. Other aids include renewal authorization postcards to ease pharmacist's problems in trying to contact prescriber.
1967 August P. Lemberger and William L Blockstein, "A Total Medication Record System," Wisco nsin Pharmacy Extension B ulletin, pp. 2-3 (January 1967)-Announces Family Medication Record at $9.00/M and Drug Control Record at $6.00/M from University of Wisconsin. Latter based on form proposed by Maven Myers, American Prof essional Pharmacits, pp. 56-60 (September 1966) August P. Lemberger, "Record Systems-A Growing Obligation," Wisconsin Pharmacist, pp. 71-72 (February 1967)-Perhaps part of the reason we have not identified the need for written, complete and total patient drug utilization records is that we have attempted to maintain them by memory. We must admit this is a poor form of record keeping The Patient Record System is a challenge and the key to a rebirth of our professional identity. Roger W. Cain, "Family Prescription Records: Present and Projected Utilization," W isconsin Pharmacy Extension B ulletin, pp. 2-4 (March 1967)-Keeping family prescription records is costly both in time and money. Keeping them requires changes in traditional practices of dispensing prescriptions but they do create patron loyalty which in most cases offsets the cost. Future utilization permits imagination to run wild. "Why aren't these records required by State Boards in every pharmacy? We don't know of any Board that is considering this now but it could be a future possibility ," prophetically concludes the author. "Cuts Rx Record-Keeping Chores By 67%," American Druggist, pp. 47-48 (July 31, 1967)-Pharmacist Jack Wells of Downey, California, describes use of Safeguard "onewrite" prescription record system as helping him to cut two-thirds of the time that he would normally spend in "doin g the tedious recordkeeping chores needed in today's economy."
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353
uations by the pharmacist regarding drug utilization or abuse. The drug history provided a reason and created the necessity for the pharmacist to personally approach his patient-no matter where he practiced- in the community, hospital or extended care facility. The patient developed an appreciation of the value of the pharmacist's services; it made the patient realize the pharmacist's role was more than a distributive and technical function. The family pharmacist became the one individual on the health care team who recorded all medications dispensed; patient loyalty was enhanced because of the realization of the importance of selecting one family pharmacist. The new role of monitoring drug usage reversed our direction from the selling of merchandise to the provision of pharmaceutical services for a fee. The attention of the patient was diverted from the prescription medication and its cost to the pharmacist and his knowledge. The new role upgraded our professional service and enhanced the pharmacist's professional stature in the eyes of the patient and the medical team. The record system provided new and in-
Annotated Bibliography (continued from page 353) _ _ _ __ , "Patient Records: Legal Shelter .•. Or a Peril?" SK&F Pharmacy News, pp 1012 (October-November 1967)-lf the pharmacist desires to expand his professional role, he must assume more responsibility. When he takes on a service like patient record keeping, he also takes on the responsibility to perform that service in a proper way. Not keeping patient records may no longer be an alibi for the pharmacist associated with a medication mishap.
creased responsibilities for the pharmacist and by becoming active in drug surveillance, the pharmacist gained a foothold in drug therapy involvement. A new source of information was provided for the physician, pharmacist and patient. I am convinced the new service had a desired side effect of "cushioning the blow" when I abandoned all of the commercial activities in the old pharmacy. One can readily see that the change in practice environment was not the principal component of the new concept of patient orientation in community practice. Without the patient drug history, in all likelihood the pharmacist would still have little need to approach his patient. • References 1. W hite, E .V., " An Interesting Pha rmacy," Va . Pharm., 36, 24 (M arch 1962 ) 2. W hite, E.V., "An Inter esting Pha rmacy," L a. Pharm. (M ay 1962) 3. " P harmacy I s M od eled After MD ' s Office," Amer. Druggist (July 23, 1962 ) 4 . " In the Professiona l M a nner, " J A PhA, NS3, 70 (F eb . 196 3) 5. " Pha rmacist Pra ises Family Prescription R ecord
1968)-The professional nature of the service demands a dignified explanation to the public. It should not be a circus-type announcement. The pharmacist should explain the system himself to his patient. Systems described by practitioners include ACA, WPhA and "Sav a Tax" sold by Safeguard of Lansdale, Pennsylvania. Latter cost $165.00 for first year (10,000 prescriptions) and $100.00 for second year (same number of prescriptions). "These costs are more than offset by the tremendous amount of conversation that is created," concludes practitioner.
1969
Linwood F. Tice, "Outpatient Pharmacy Services," J ournal of the American Pharmaceutical Association, pp. 622-623 (December 1967)-ln a statement before the Task Force on Prescription Drugs, the author emphasizes the importance of "a medication record on each patient including all drugs prescribed and those o-t-c products taken by the patient. Examples of therape.utic incompatibilities are listed.
_ _ _ __ , "Patient Record Card Systems," B ulletin oj the Ontario College of Pharmacy, pp. 1-16 (January 1969)-Survey of patient records in use and the literature leads author to conclude that "the use of patient record systems is both practical and economical and will help the pharmacist in his professional relationships and in projecting a better professional image."
Joseph D. McEvilla, "A Computerized Prescription Recording System," J ournal of the American Pharmaceutical Association, pp. 636-638 (December 1967)-1963 USPHS g rant provided funds to demonstrate the application of data processing equipment-including direct telephone communication, flexowriter, slow-scan television and oral dictation. Results emphasize importance of maintainin g patient records of prescribed medication to prevent a patient receiving therapeutically incompatible drugs or multiple quantities of dangerous drugs without knowledge of the prescriber.
David P. Vogel and Benjamin F. Holland, "Electronic Data Processing in Hospital Dispensing," American J ournal of H ospital Pharmacy, pp. 218-223 (April 1969)-Describes a pharmacy electronic data processing program in a 438bed community hospital. For each original medication order received by the pharmacy, a punched card is pulled giving drug description, drug number, cost per unit, fee code and a drug interaction code. Patient's number and quantity dispensed are punched into card, resulting in output data of label, reorder file, daily pharmacy audit and patient medicati~n profile.
1968 Victor Morgenroth, "The Prescription Record and Our Experience With Its Use,' Wisconsin Pharmacy Extension B ulletin, pp 2-4 (January 1968)"The value of the system has been so outstanding to us that whatever the cost may be, we would still have to use this system, even if we had to start all over again." William L. Blockstein, "The Professional and Public Promotion of Record Systems," Wis consin Pharmacy E xtension Bulletin, pp. 2-3 (February
System," APhA Newsletter, 2, 3 (Oct. 12, 1963 ) 6. White, E.V., "The Maintenance of a Family Prescription Record System," Proceedings of Program, ACA at the Greenbrier (Oct. 26-30, 1963) 7. White, E Y., "The Maintenance of a Family Prescription Record System," Wis. Pharm . (Dec. 1963) 8. White, E.V., "The Maintenance of a Family Prescription Record System," Carolina J. of Pharm./ 45,25 (Jan . 1964) 9 . ACA Secretary's N ewsletter, 22, 3 (Jan. 25,1964 ) 10. White, E.V., " The Maintenance of a Family Prescription Record System," Iowa Pharm. (April 1964) 11. Cain, R., "Patient Record Systems," JAPhA, NS4, 4 (April 1964) 12 . "The Eternal Triangle," Amer. Prof. Pharm. (June 1964) 13. ACA Secretary's N ewsletter (July 10, .1964 ) 14. "The Profession Overseas: 'prescription pharmacy' in the U.S.A. ," Pharm. J. of G. Br. (Sept. 12, 1964) 15 . White, E.V., " The Patient Prescription Record System-A Must in Modern Practice," Annual Spring Seminar, Howard College School of Pharmacy (March 17,1965) 16. " APhA, McKesson Offer New Rx 'Center'," Amer. Druggist, 151,13 (Mar . 29,' 1965) 17. White, E .V ., " The Maintenance of a Family Prescription Record System," The Ind. Pharm ., 47, 54 (Mar. 1966) 18. White, E.V., "The Maintenance of a Family Prescription R ecord System," Wis. Pharm. Extension Bull., 9, 6 (June 1966 ) 19 . White, E.V., " Tenue D es Fiches Familiales D ' Ordonnances," Chronique du Centre d'Etudes et d'Informations Pharmaceutiques, 25 , rue des Bourdonnais-Versailles, France; No. 4 (April 1966 )
1969)-ln addressing the Iowa Pharmaceutical Association, Allen Brands predicted that "uniform state laws might require the maintainance of patient records in the pharmacy, in order to prevent the use of contraindicated and incompatible drugs." He added, "if these new services are demanded by law, pharmacists might find it much easier to convince the public and government that charging for these services is justified." Daniel L. Wertz, Julian H. Fincher and Harry A. Smith, "Why Use a Prescription Record System?," Bulletin of Bureau of Pharmaceutical Services, School of Pharmacy, University of M ississippi, pp. 1-6 (June 1969)-Authors list 11 practicing pharmacists using patient record systems, suggest type of information required in such a system, and report that use of patient record cards do not add more than five cents to the cost of a prescription. "This is certainly not a major . expense for such a valuable tool in utilizing the pharmacist's knowledge and ability to provide the best protection possible to those he serves," the authors conclude. James Andrew Visconti, "Use of Drug Interaction Information in Patient Medication Records," American Journal of Hospital Pharmacy, pp. 378-387 (July 1969)-Author describes a patient time-flow drug profile and its actual use and benefits in a three-month study of drug reactions by a pharmacist-monitor stationed on the medical wards of a university teaching hospital. The method described may be implemented manually or computerized in small or large hospitals.
Robert M. Stevens and Reuben R. Wolfert, "A Random Filing System for Inpatient Medication Records," A merican Jou rnal of H ospital Pharmacy, pp. 290-293 (May 1969)-Authors describe the Randomatic system for filing and retrieving patient medication records. Described by authors as faster, more accurate and more versatile than the visible line file previously used at the Bryn Mawr Hospital, Bryn Mawr, Pennsylvania.
_ _ ___ , "His Rx Record System Is Designed for Computer Age," American Druggist, pp. 55-56 (July 28, 1969)-Walter Lettieri of West Trenton, New Jersey, states that his "family Rx record system not only saves time, but it provides total information, offers an extra dimension of professional service, and prepares the pharmacist for the day when his prescription records will be handled entirely by computer." (See also American Druggist, p. 43, November 30, 1970; p. 42 March 20, 1972.)
_ _ _ _ , "Make Patient Records Mandatory for RxMen," American Druggist, p. 4 (May 5,
(continued on page 374) Vol. NS13, No.7, July 1973
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VISlrecord Systems A pioneer developer of visiblevertical record keeping systems, VISlrecord has installed numerous prescription record systems nationally, but as yet has not aggressively promoted their system to pharmacists. The main features of the VISIrecord System are the speed of card location and the elimination of misfiling. Bows of cards may be scanned at the rate of more than 300 cards per minute to remove inactive accounts'. Many VISlrecord installations are used in conjunction with RecordA-scri P, Safeguard and Quik Chek. This involves the use of VISI record files to replace the trays for filing records. A variety of record cards have been produced by VISlrecord. One 6" X 8" record card used by Pekin Prescription Laboratory of Pekin, Illinois, provides for name, social ~ecurity number, I.D. number, birth date and "allergies & idiosyncrasies" at the top. The card provides for 34 prescription transactions (front and back) recording date, prescriber, prescription number, patient, price and medication. The Crest Pharmacy of Aliquippa, Pennsylvania, uses' a 61 / 2" X 8" card with family name, address, telephone, all family members, birth
Annotated Bibliography (continued from page 359) _ _ _ _ , "Why Darby Set Up Rx Card File," American Druggist, p. 70 (October 6, 19G9)-Joel Darby of Brooklyn, New York, states, "I started the Rx record plan because my patrons are so darned sophisticated." Pharmacist Edward Strauber adds, "the prescription record card file system is vitally important under today's conditions."
date, "sensitivity" and "reaction." The card provides for recording 42 prescription transactions with date, prescription number, prescriber, price and medication. Still another form, 6" X 10", combines features of both Pekin and Crest forms, with space for 46 prescription transactions. Price for the latter ranges from $37.65/M to $22.15/M for 15M. Open tray with locking caster movable stand, with capacity for 4,224 prescription record cards priced at
$346.40, but may be obtained separately at lesser cost for use on counter top. A flat, one-time original charge of $20.50 for custom-made record cards. Many other units available varying in size, capacity and degree of protection to meet requirements of pharmacy.
it is conceivable that the courts might rule that nonrecord keeping pharmacists are not exercising the care and prudence regarding public health which their peers are providing. ihis could be interpreted as negligence. "You can't get any professional satisfaction out of your work if you seek to escape all responsibility," concludes the author.
-Keeping a family record system has been an integral part of the operations at Sarnia Pharmacy, Ontario, since 1961. At first it was simply a 3/1 x 5/1 card file, but by 1969 the system had become elaborate and sophisticated. The cost is about 18 cents per prescription dispensed, but this out-of-pocket expense is offset by economic advantages, and patient loyalty more than covers the cost of maintain ing family medication records. Similar results, using different systems, are reported in two other Canadian pharmacies.
_ _ __ , "The Hazards in Family Record Keeping," Drug Topics, p. 38 (September 14, 1970)-Family medication records cannot be embarked upon as a promotional gimmick, and if they are maintained, they must be competently handled to prevent errors and to prove total lack of negligence in the way they are maintained.
1971
1970 _ __ _ , "Illinois Pharmacist Informs Physicians of Various Uses for Fam.ily Record System," American Druggist, p. 71 (April 6, 1970)George Scharringhausen qf Park Ridge, Illinois, advises physicians by letter, "we are discovering that there are other benefits from the use of this system than the originally intended usages." They become a valuable cross-reference file for the busy doctor and his patient. ' Carl Roberts, "Beware the Family Record System," Chain Store Age, pp. 74, 78 (August 1970)-lf a pharmacist chooses to maintain a family record system, he assumes a responsibility which must be exercised with due care. But as most pharmacies adopt this system,
374
Pharmacist Richard W. Sams at Pekin Prescription Laboratory , Pekin , Illinois, keeps his cabinet for the VISIrecord S ystem next to the receptionist's desk in his Pharmaceutical Center so that the patient profile card can accompany the prescription order throughout the entire operation. "Admittedly it was a monumental task to convert from family records to patient profiles, but after using the system for over a year we know it was worth the effort," writes Pharmacist Sams.
Roger S. Wilson and Hugh F. Kabat, "Pharmacist-Initiated Patient Drug Histories," American Journal of Hospital Pharmacy, pp. 49-53 (Jan-
uary 1971)-Studying the efficacy of pharmacists developing drug histories for newly admitted hospitalized patients at the Minneapolis Veterans Administration Hospital, authors interviewed 100 male patients over a 3~-day period. Only 57 percent of the medications found by the pharmacist were recorded by the attending physician. Over 90 percent of the patients were cooperative, and almost 40 percent of the patients revealed that they did not utilize their prescription drugs exactly as directed by their physician. _ _ _ _ , "Patient Record Systems," Canadian Pharmaceutical Journal, pp. 68-72 (March 1971)
Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION
VISIrecord Systems, Division of Barry Wright Corporation, Copiague, Long Island, New York. A. Mark Rudiger, Director, Systems Research and Development.
Daniel R. Toal, "Advantages of Pharmacy Drug Record," Louisiana Pharmacist, p. 13 (March 1971)-ln order for any pharmacist to practice patiented-oriented pharmacy, he must have and maintain adequate information about the patient. This is the purpose of the family record system or patient drug profile. Eugene V. White, "How the Family Medication Record was Originated," Pharmacy Times, pp. 34-37 (April 1971)-Berryville, Virginia, pharmacist tells how he introduced "clinical pharmacy in the community" with the Pharmaceutical Center and the patient drug history record which "provided the core of the concept and enabled the pharmacist to step up into a new role on the health care team." Tim R. Covington and Harvey A. K. Whitney Jr., "Patient-Pharmacist Communication Techniques," Drug Intelligence and Clinical Pharmacy, pp. 370-375 (November 1971)-ln a study to demonstrate the pharmacist's ability and
(continued on page 378)
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Like many other pharmacists, James Ramseth of Kent, Washington , has developed his own Family Medication Profile Card with family name, address, telephone, individual patient names, birth date , "sensitivity," "misc." and prescriber. A red dot in upper left hand corner calls attention to the fact that there are potentials for interactions or sensitivities. Card provides f or prescription number, patient, prescriber, fee , medication, renewals and dates dispensed.
easy to use record of medication utilization. Compared to other pharmacy drug records used for similar purposes, the patient drug profile provides several advantages. It can serve as an exact record of medication labels since a direct copy appears on the profile for each drug prescribed. This prevents mistakes when subsequent labels are typed for the same prescription. Because a label copy appears on the form it also contains the directions to the patient; for example, "Take one (1) tablet four (4) times a day." This type of inform ation is not usually contained on most other pharmacy drug records even though it is valuable information neces-· sary to follow p'l.tient drug therapy. Unlike other pharmacy drug record systems which can be placed on top of the prescription counter or in small drawers built into the prescription
counter, the patient drug profile system requires a place large enough to accommodate a standard two-drawer file. The drawer space supplied by a twodrawer file allows for easy storage of 4,500 profiles. A cost analysis of the patient drug profile system was performed relating the cost of forms and labor to the total number of prescription orders dispensed per day. The cost of maintaining this patient drug profile system was 3.2 cents per prescription order. This figure is inflated because of the small number of forms (5,000) and labels (5,000) printed for use in the study. The costs could be reduced considerably if larger numbers of forms and labels are manufactured.3 An efficient pharmacy drug record system is a must in order for the "patientoriented" community pharmacist to
adequately supply clinical services to his patrons. 4 This patient drug profile system provides a pharmacist with an easy-to-use, inexpensive tool with which to monitor drug therapy. Since this patient drug profile is presented in an organized manner, the information contained therein is readily accessible to the pharmacist each time a prescription order is dispensed, or whenever he desires information about his patient. 5 •
Annotated Bibliography
pharmacy." Story also notes that Delaware Pharmacy Board is also considering such a regulation.
52-54, 56, 58 (April 1972)-Nurse at Lenox Hill Hospital. New York City. reports on use of an I BM drug card in pharmacy corresponding with physician's medication order which is used as the patient record system in "deck form." Every morning the pharmacy issues a profile of all standin g orders for each patient and sends it to each nursing station where the physician can review it and the nurse use it for daily administration of drugs.
(continued from page 374) expertise in acquiring a patient medication history. 40 inpatients on medicine and surgery wards of a 500-bed municipal. acute-care general hospital were selected at random. Most patients were from the lower socio-economic strata. While physician-acquired histories n .)ted two patients with prior drug allergies. pharmacist-acquired medication histories revealed 12 prior allergies. including six to penicillin, one to sulfonamides and three to aspirin. The pharmacist-acquired medication record also detected five (12.5 percent) adverse drug reactions during hospitalization.
1972 "N.J. Is First State Requiring Pharmacies To Maintain Patient Medication Records," American Druggist, pp. 24-25 (January 24, 1972)-Report on anticipated action by New Jersey Board of Pharmacy regulation requiring a "patient profile record . . . be maintained in all pharmacies by family name . . . in alphabetical order for all persons for whom prescriptions are dispensed." Paul Pumpian is quoted as saying that "as the public becomes aware of the advantages of medication records, people will tend more and more to have all their prescriptions filled in one
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378
Robert F. Steeves, "Outdated Rx Record Keeping," American D ruggist, p. 8 (February 21, 1972)-AII prescription records for a given patient should be maintained under the patient's name so that the pharmacist can quickly check all medication "by leafing through the file when a new prescription was dispensed or when a refill was dispensed. Many man-hours of record transfer and wasted motion could be saved . .. and could have a beneficial effect on patient care with no additional cost to pharmacy."
References 1. C a in, R. vV., " P a(ie n t R ecord Sys :em s," J A PhA, NS4, 164 (196 4 ) 2. "Cu ts R x R ecord-Keeping Chores b y 67 %," Amer. Druggist, 156, 3, 47 (July 31, 1967 ) 3. P erson a l Commu nication , Briggs Prin ting C omp a n y, D es Moines, I owa 4 . T oal, 'D .R. , "Clinical C ommunity P h :1rm acy," L a. Pharm., 30, 3,12 (March 1971) 5. Toa l, D .R ., and Kann, D ., "A P atien t-Drug Profile," Iowa Pharm ., 27,4, 10 (April 1972)
Francis P. J. Slanina, "Outdated Record Keeping," American D ruggist, p. 66 (March 20, 1972)-Philadelphia pharmacist writes letter to editor claiming Steeves is 15 years behind time. "I opened my pharmacy in 1956 and started filing my prescriptions by patient name ... and have-continued to do so to this day."
Allen Dinnerstein, "The Perils of Patient Rx Profiles," Chain Store Age, pp. 99, 102 (July 1972) -Vice president in charge of pharmacy affairs for Rite Aid Corp., the author attacks the patient record system as too costly and with unknown lega I liabilities. Admitting that it is not new-"almost every pharmacist has worked in a store where a cross index or . record keeping system was kept for tax records or customer convenience"-he concludes by claimin g that "mandating family record cards by decree without full knowledge of a II its consequences can only result in disaster for the entire profession."
Daniel R. Toal and Duane Kann, "A PatientDrug Profile, I owa Pharmacist; pp. 10-11 (April 1972)-Author describes Patient-Drug Profile system which was the subject of thesis in partial fulfillment of MS degree at the University of Iowa. Describes a patient record system as "a storehouse of information to the patient, pharmacist and physician."
William Fogelson, "Message from the President," New J ersey Journal of Pharmacy, p. 6 (September 1972)-"1 cannot claim to be an early con vert" to the patient profile record card system." reports NJ PhA president. I n fact he writes that he asked many questions of those who utilize patient record systems. and found "without exception these pharmacists were
Carolyn Timmer, "Our Unit Dose System Cuts Medication Errors," Pharmacy Times, pp.
(continued on page 385)
Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION
c. It is no longer necessary to look up prescription orders in the files on renewals since the medication record can be used to renew prescription orders. d. The F.D.S.N. Prescription Number and the Drug Safety Number Service Mark insure professional integrity, accuracy and patient acceptance; e. It allows the filling out of any third-
Annotated Bibliography (continued from page 378) enthusiastic-even ecstatic-about the values of the patient record card system." "At last, in this past year, I took the plunge," reports Fogelson, and "one word sums up the profile record card system-that is, great." Pat Demers, -"Individual Patient Profiles are Housed in Same Manila Folder for Entire Family," Pharmacy T imes, pp. 42-46 (September 1972)-Pharmacist in Springvale, Maine, adopted idea for new patient profile system from a hospital pharmacist. A manila folder is kept for each family on which is recorded names of each family member. Included in each folder is a separate prescription record sheet for each individual family member. Different-colored inks are used to transcribe data on prescription record sheets so that each year can be ascertained at a glance by the color of the ink. Dan Kushner, "A Dissenting Vote," A merican Druggist , p. 15 (September 18, 1972)-ln an editoria I, Kushner objects to the patient medication file on the basis that he does not like to be monitored-"by the police, by bugged telephones, or by the pharmacists no matter how well meaning. I claim the right not to be data-banked, so far as I can avoid it." Editor Kushner also claims that patient medication records will not work anyway because "a lot of people will resist the notion of patronizing one, and only one pharmacy, whether or not it maintains comprehensive files. In fact some people may be 'ornery' enough to resist patronizing a pharmacy because it keeps those neat, prOfessional dossiers." Ray E. Marcrom and D. C. Huffman Jr., "Why-A Patient Record System?," T ennessee Pharmacist, pp. 16-18 (October 1972)-A survey of the use of a patient record system in "a small middle Tennessee town" revealed that 86 percent of the patients responding to a questionnaire felt that the pharmacist should provide the patient prescription record system; 90 percent said they would obtain all their prescriptions from a pharmacy that maintained such a service, and 49 percent said they would be willing to pay as much as 25 cents extra per prescription for the service. Of 396 patient record cards initiated during the study, 21 percent were found to have one or more chronic illnesses and 17 percent of the patients had some type of drug allergy. There was a 10 percent increase in the number of new prescriptions shown during the threemonth study over the same period a year prior. (See also Louisiana Pharmacist, pp. 25-26, 28, May 1973). Donald W. Moore, "A Badly Needed Service," American Druggist, p. 68 (October 16, 1972)-Read-
ing "with amazement" Kushner's editorial, this Wichita, Kansas, pharmacist writes, "I have found that in spite of the additional work and expense to the pharmacy and not withstanding the fact that they are not yet perfected, family patient records provide a badly needed pharmaceutical service to the patient ... We have never had a patron who felt so strongly as you do aoout 'invasion of privacy.' In fact, the usual pattern is the direct opposite, with the patient really appreciating the importance of these records." Joel Pollack, "He's Against Profiles," American Druggist, p. 69 (October 30, 1972)-Shokan, New York, pharmacist writes congratulating Kushner's editorial, calling patient record
party claim form expeditiously, only requiring the signature of the person receiving the medication; f. The alphabetical reception counter file is a real aid to the pharmacist or receptionist by indicating immediately that a family-patient prescription profile card has been initiated previously; and before the next prescription is dispensed or before an o-t-c medication is pur-
chased, it immediately alerts one that a person is allergic to a specific drug or medication. g. The writing or typing only once of the original or telephone prescription order on the family/patient prescription profile card will more than compensate the pharmacist for his time because he is not required to look up the prescription order on all successive renewals. •
systems "about the last insult to the individual patient-customer, and the pharmacist. . . . Our profession is not a system of index cards. .. The fact that all prescriptions do not come to one pharmacy exposes the system for what it really is : another Big Brother clamp on pharmacy."
ment. The report also mentions the legal, economic, professional and public health aspects of record systems, and concludes by noting that these questions with recommendations will be submitted to the NACDS board of directors upon completion of the study.
M.
Profiles,"
American Druggist , p. 59 (December 11, 1972)-
American Druggist, p. 69 (October 30, 1972)-Aus-
Coordinator for continuing education at Virginia Commonwealth University school of pharmacy sends his own editorial to Kushner, noting that "medication profiles, as they exist are not perfect. Has anything ever appeared on the scene in a state of perfection? Certainly your opinion does appeal to those who resist change and might even be construed as playing into the hands of those who have written pharmacy off the health care team. Leadership demands that medication records be given a fair trial."
Eugene
Rector,
"He's
For
tin, Texas, pharmacy student writes Kushner, "I feel that patient record keeping would give the pharmacist the opportunity to use his knowledge and experience by evaluating patient records for possible drug interactions." James T. Harrison, "Useless Information," A merican Druggist, p. 69 (October 30, 1972)-Villa
Rica, Georgia pharmacist supports Kushner 100 percent by asking, "Really, what do we accomplish when we spend our time compiling this useless information?" R. H. Waller and J. N. Hlynka, "Watchdog on Prug Control, Canadian Pharmaceutical J ournal, pp. 346-354 (November 1972)-Study based on patient drug record plans used in two pharmacies for six and nine years, respectively, supports the effectiveness of such plans in identifying and preventing potential problems related to drug use at the ambulatory patient 1evel. Of 955 prescriptions for tetracycline surveyed, there was a potential interaction in 56 cases, and 37 (66 percent) were due to nonprescription drugs. Abstract in A cademy / GP, pp. 1-2 (January 1973). William R. Bacon, "Record System Defended," A merican Druggist, p. 76 (November 13, 1972)-APhA Academy of General Practice of Pharmacy president writes Kushner, "A patient-oriented pharmacist needs the patient profile, and you need re-orientation . .. You extend the concept of monitoring drug use into a science fiction fantasy." K. Joe Di Maggio, "Confidentiality," A merican Druggist, pp. 76-77 (November 13, 1972)-San Austine, Texas, pharmacist writes Kushner, "The profile is neither useless nor an invasion of privacy. .. I am sorry this type of article came from your desk and you used a poison pen to help knock one of the beneficial tools pharmacy is fighting for. You will probably not even know whose health you have hurt because a pharmacist did not initiate family records due to your editorial ." Leavitt C. Parsons, "Those Patient Records," The Apothecary, p. 6 (December 1972)-"Good patient records are not only an important link in the chain of relationships that bind the thinking patient to his friendly pharmacist; but the thinking physician who writes the prescriptions soon learns that the pharmacist's customer records may offer certain image insurance for him too . . . Therefore, don't let anyone talk you out of keeping patient records as too much work for the benefits you get. Compulsory patient records are on the horizon ... Be prepared." A P,e/iminary Report of the Task Force on Pharmacy Record Systems (National Association of Chain Drug
Stores, Inc., 1972); see also "Chain Drug Task Force Evaluates Pharmacy Record Systems," Pharmacy Times, pp. 64-65 (December 1972)-Task Force appointed in April 1972 by president of NACDS reported on 13 manual single use systems, six manual multiple use systems, and three EDP systems, establishing tentative requirements for all medication record systems into four areas-administrative, professional, patient and operation/manage-
Norman L. Hilliard, "A Dissenting Vote,"
1973 Harry A. Smith, "Application of Cost-Effectiveness Analysis to Patient Record Systems," Journal of the American Pharmaceutical Association, pp. 13-14 (January 1971)-Using a costeffectiveness analysis, it was found that the implementation of a patient medication record system cost $971.00 for the first year, but that the calculated increase in net income attributable to the Pfltient prescription record system was $2,467.00. Thus the cost·effective· ness ratio was one to 2.54. Neil M. Davis, "Let's Inform the Public About Prescription Records," Hospital Pharmacy (January 1973)-Editorial commenting Patient Record Systems, but criticizing lack of organized efforts to "educate public to demand this service." "I believe an intensive public education campaign is long overdue. This is something members of the ASHP, APhA, and NARD could surely agree upon and work together to initiate," concludes Editor Davis. J. W. Dorsey, "Blame It On Me," American D ruggist M erchandising, p. 74 (January 1, 1973) -Pharmacist from Albuquerque, New Mexico, writes in letter to the editor, "perhaps it is time for me to add a few words to the Patient Profile controversy. It is very possible that I am one of those responsible for launching the idea, since I started my patient profile system on January I, 1947." Paul Guthrie, "Like It Or Not, Those Profile Cards Are Looming Larger Now," Drug Topics, pp. 21, 33 (January 15, 1973)-Pharmacists who already use record cards find them very advantageous, primarily for the familiar interaction and abuse checks. Secondary benefits often cited include-aid in finding a prescription, tax records, health care diary and an image-building service. On the other side of the fence, some pharmacists feel that their patients would regard profiles as an invasion of their privacy. Then too, there is the specter of added expenses. As for the liability threat, pharmacists seem to underestimate what they could be letting themselves in for if patient profiles were to become the law of the land. "Leave it to the lawyers," seems to be their general retort. Put into perspective , patient profiles are just a minute aspect 'of the evolving health-care paper work scene. Crystal bailers say that the only thing that will save the record keeping day will be statewide computer systems. Karl Neumann, M.D., "Medication Profiles Help RxMan, MD, the Patient," American Druggist M erchandising, p. 11 (January 15, 1973)-The
Vol. NS13, No.7, July 1973
385
changing medical scene lends itself to the pharmacist's keeping medical profiles. With the gradual demise of the general practitioner and the increasing availability of medical specialists, the public increasingly lacks a primary physician. Unfortunately specialists tend to treat not patients, but specific organs and often do not adequately question about symptoms outside their sphere of interest. Frequently, specialists are not well-informed about drugs that are not used in their field.
-=--=--=-=-=-----=:' "Drugstore Profile,"
Time (March 5, 1973)-Editors of Time magazine inform public on the value of the patient record system, pointing out that many pharmacists are keeping such profiles so that each time they dispense a prescription or sell an over-thecounter drug product, they can prevent the possibility of a harmful reaction.
"The Challenge of Patient Profiles," Chain Store Age, pp. 73-74 (April 1973)There is, at present, no really efficient method of maintaining prescription profiles in a highvolume prescription department. But profiles can be fought with other arguments as well. Pharmacists throughout the nation are raising the always pertinent question of pharmacist liability, and the always practical one of consumer shopping habits. How, the second question goes, can a profile help the consumer who shops prescriptions at a variety of different stores? But the primary argument against profiles is the paper work. ~
=:------c:-::--::-c--"
Proponents of patient profiles counter these arguments with one of their own-the public needs the protection afforded by a pharmacist who is in the position to monitor the prescriptions written by more than one physician.
Joan Cook, "Druggists Compile Customer Profiles," New York Times (May 28, 1973)-The profile serves as a backstop for drug monitoring and usage and is particularly effective in preventing harmful drug interaction.
David Pinto, "Time For A New Stand On Patient Profiles," (Editorial), Chain Store Age '( June 1973)-The nation's drug chains have too long hidden behind words like "impractical," "expensive,'" "unnecessary" and unfeasible" when discussing patient profiles. One way or another, patient profiles will become an integral part of all prescription dispensing within the next few years. The smart thing' to do-and the right thing to do-is to speed that day. • •
Drug Recalls The following data have been compiled from the Federal Food and Drug Administration Weekly Recall Report covering the period March 29, 1973, to April 18, 1973. Pharmacists and others possessing drug inventories are reminded to check their stock again to be certain that they do not have any of the products on the list. Anyone who has additional facts on any of the listed recalls which he leels will assist in completing the recall is urged to send such data to the editurof this JOURNAL.
Manufacturer or Distributor
Product Aristomin Capsules (triamcinolone 1 mg, chlorpheniramine maleate 2 mg, ascorbic acid 75 mg), 30's and 100's Cutter parenteral solutions
Quantity
Recall Reason
Lederle Labs (Pearl River, N.Y.)
All lots
10,000,000 capsules
NAS/N RC drug efficacy study implemer;ltation
National
Cutter Labs (Chattanooga, Tenn.)
All lots with prefix T 7206069
Unknown
No assurance of sterility
National I nternationa I
Unknown
Premature disintegration
Florida
Continental Distributors (Hialeah, Fla.) Bell Pharmacal Corp. (Greenville, S.C.)
Thyroid tablets, enteric coated, 1 Gr, container size unknown
Product Distribution
Lot Number
Respiratory problems?
Get out of the house! If IPPB or nebulization are prescribed, the patient can get out of the house and use the
G.T. SERIES V (12-VOLT) IPPB Use it in an automobile, in the park, most anywhere ... with the
Rechargeable battery pack Also available with 115-volt compressor
~
• Lightweight • Patented • Guaranteed • Made by the Pioneer in inexpensive IPPB Units • Available on Prescription Only
PULMO-VENT ,
~® MEDICAL SERVICES, INC. PO BOX 1185 TULSA, OKLAHOMA 74101
I
386
Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION
PHONE , (918 ) 584-5247
tract numbers, allergies and special information, date, prescription number, identification of prescriber, identification of pharmacist, name and strength of medication, quantity, directions for use, repeat information and charge (price). It is reported that considerable activity is under way in most provinces of Canada, and at least two of them- Alberta and Ontario- seem to be close to making the
Patient Record System a legislative requirement. The definition of "minimum requirements" differ from province to province. For example, Ontario requires the pharmacist to identify himself by a full signature, while other provinces only require the dispensing pharmacist to initial the record card. Some provinces go beyond the CPhA "minimums," and Quebec is presently establishing a different set of standards.
Annotated Selected Bibliography on the Patient Record System The following selected annotated bibliography on "Patient Record Systems" offers both an historical review of their development to date, as well as the " pros" and "cons" which have been expressed by many authors. 1962 _ __ _ , "His Rx Record System Pays In 8 Ways," American Druggist, p. 45 (May 28, 1962)Pharmacist Don Roach Jr. of Livon ia, Michigan, describes the Safeguard System, noting that "the family record card is the most essential part of the system."
1963 Eugene V. White, "The Maintenance of a Family Prescription Record System," Wiscon sin Pharmacist, pp 420-421, 435 (December 1963) -Pioneer innovator of family prescription record system describes format and advantages, and expresses hope that one day all of the nation's pharmacists will maintain such records. (Reprinted in Wisconsin Pharmacist, pp. 234, 236, June 1966)
1964 Roger Cain, "New Prescription Practices .•• Patient Record Systems," Journal of the American Pharmaceutical Association, pp. 164-168 (April 1964) -First survey of Patient Recor d Systems de scribes record cards of Eugene White, Lokato, ACA, Con R. Spainhour , Jack R. Thompson, Wilkens Harden, Hennin g En g mark and John Stadnik. Article suggests i nformation which should be included in any Patient Record System . Martin M. Rosner, "Attitudes Toward Maintaining Family Records on Drug Sensitivities, J ournal of the A mencan Pharmaceutical Association, pp 169-175 (April 1964)-Survey indicates that in 1963 only nine of 87 pharmacists interviewed maintained family drug reco r ds while 22 (28 percent) thou g ht it was a good idea; 26 (33 percent) thought it impractical, and 30 (38 percent) were opposed without qualification. On the other hand , physicians expressed approval of the concept by a three to two marg in. Opposition was based on unnecessary duplication of effort and the intrusion of the phar macist into the physic ian's professional domain. Dale W. Doerr and Russell F. Parke, "Prescription Record Keeping: Why?," I ndiana Pharmacist, pp. 111-112, 143 (April-May 1964)Referr ing to J APhA, April 1964 issue , authors d iscuss advantages of Patient Record Systems . Article mentions use of Royal -McBee Keysort cards, Criss-Cross Directory and "hybrid systems which supposedly selects the g ood points from a variety of set-ups now in use." In answering the question "will the
record system support itself," they respond, "how can anyone place a dollar value on the conven ience of such services."
1966 Herman O. Thompson, "Composite Prescription Records," American Professional Pharmacist, pp. 50-55 (March 1966)-Author lists ten benefits from patient record systems as well as data required on a complete patient record (he emphasizes need to monitor drug reactionspointing to study showing that over two percent of patients discharged from a hospital over a nine-month period experienced minor to very ser ious drug reactions. William S. Lackey, "Family Rx Records Help to Designate You as the Family RxMan," American Professional Pharmacist, pp. 56-57, 59-60
(March 1966)-The fami ly prescription system has not increased cost of operation, claims author. "Actually, the percentage of labor cost has been somewhat reduced," the author adds . The cost for the first year was slightly over one cent for each prescription; and even if it had been greater, the system would have been worth many times his investment in time and money, according to pharmacist Lackey of Tucson, Arizona. Vance Weidle, "Our Family Prescription Record System," J ournal of Kansas Pharmacy, pp. 8-9 (April 1966)-Designing record forms from those appearing in April 1964 issue of J A PhA, Weidle promoted serv ice via radio spots. Physicians complimented service, and patrons called it "splendid." The expense involved is nominal, and "we consider it the wisest investment we could make. . . You can be assured that once you have it in operation you will wonder how you ever operated without it," concluded the author. _ _ ___ , "Rx System Saves 10,000 Hours a Year," American D ruggist, pp. 47-48 (July 18, 1966)Wayne Berry and Frank Dannelley of Austin, Texas, describe system using triplicate forms and teletype between three pharmacies which saves 25 percent of pharmacist's time and " has already more than paid for itself." _____ , "Why Chains Are GOing For Patient Record Systems," Chain Sto re Age, pp. 68-69, 85 (August 1966)-Not only do patient records provide better service, but they also furnish valuable marketing data. Chains report that physicians have responded with "uniform approvaL" First chains to adopt system were Osco, Drug Fair and Dougherty Drug. Maven J. Myers, "Use This Special Record Card to Keep Tabs of Drug Control Numbers," American P rofessional Pharmacist, pp 56-60 (September 1966)-Author suggests a "pharmacy product card system" as an alternate to placing drug product control numbers on
the prescription label. System was initially designed for recall procedures, but subsequently adopted in certain patient record systems. _____ " "Miscellaneous Aids to Rx Practice," J ournal of the American Pharmaceutical A ssociation, pp. 639-640 (December 1966)-ln addition to "patron-medication record card," which includes non-prescription drugs, medication calendar is suggested and shown to permit pf'larmacists to provide patients with a medication calendar to simpllfy complicated dosage regimens. Other aids include renewal authorization postcards to ease pharmacist's problems in trying to contact prescriber.
1967 August P. Lemberger and William L Blockstein, "A Total Medication Record System," Wisco nsin Pharmacy Extension B ulletin, pp. 2-3 (January 1967)-Announces Family Medication Record at $9.00/M and Drug Control Record at $6.00/M from University of Wisconsin. Latter based on form proposed by Maven Myers, American Prof essional Pharmacits, pp. 56-60 (September 1966) August P. Lemberger, "Record Systems-A Growing Obligation," Wisconsin Pharmacist, pp. 71-72 (February 1967)-Perhaps part of the reason we have not identified the need for written, complete and total patient drug utilization records is that we have attempted to maintain them by memory. We must admit this is a poor form of record keeping The Patient Record System is a challenge and the key to a rebirth of our professional identity. Roger W. Cain, "Family Prescription Records: Present and Projected Utilization," W isconsin Pharmacy Extension B ulletin, pp. 2-4 (March 1967)-Keeping family prescription records is costly both in time and money. Keeping them requires changes in traditional practices of dispensing prescriptions but they do create patron loyalty which in most cases offsets the cost. Future utilization permits imagination to run wild. "Why aren't these records required by State Boards in every pharmacy? We don't know of any Board that is considering this now but it could be a future possibility ," prophetically concludes the author. "Cuts Rx Record-Keeping Chores By 67%," American Druggist, pp. 47-48 (July 31, 1967)-Pharmacist Jack Wells of Downey, California, describes use of Safeguard "onewrite" prescription record system as helping him to cut two-thirds of the time that he would normally spend in "doin g the tedious recordkeeping chores needed in today's economy."
=----::=-:c::--::-:-'
(continued on page 359) Vol. NS13 , No.7, July 1973
353
uations by the pharmacist regarding drug utilization or abuse. The drug history provided a reason and created the necessity for the pharmacist to personally approach his patient-no matter where he practiced- in the community, hospital or extended care facility. The patient developed an appreciation of the value of the pharmacist's services; it made the patient realize the pharmacist's role was more than a distributive and technical function. The family pharmacist became the one individual on the health care team who recorded all medications dispensed; patient loyalty was enhanced because of the realization of the importance of selecting one family pharmacist. The new role of monitoring drug usage reversed our direction from the selling of merchandise to the provision of pharmaceutical services for a fee. The attention of the patient was diverted from the prescription medication and its cost to the pharmacist and his knowledge. The new role upgraded our professional service and enhanced the pharmacist's professional stature in the eyes of the patient and the medical team. The record system provided new and in-
Annotated Bibliography (continued from page 353) _ _ _ __ , "Patient Records: Legal Shelter .•. Or a Peril?" SK&F Pharmacy News, pp 1012 (October-November 1967)-lf the pharmacist desires to expand his professional role, he must assume more responsibility. When he takes on a service like patient record keeping, he also takes on the responsibility to perform that service in a proper way. Not keeping patient records may no longer be an alibi for the pharmacist associated with a medication mishap.
creased responsibilities for the pharmacist and by becoming active in drug surveillance, the pharmacist gained a foothold in drug therapy involvement. A new source of information was provided for the physician, pharmacist and patient. I am convinced the new service had a desired side effect of "cushioning the blow" when I abandoned all of the commercial activities in the old pharmacy. One can readily see that the change in practice environment was not the principal component of the new concept of patient orientation in community practice. Without the patient drug history, in all likelihood the pharmacist would still have little need to approach his patient. • References 1. W hite, E .V., " An Interesting Pha rmacy," Va . Pharm., 36, 24 (M arch 1962 ) 2. W hite, E.V., "An Inter esting Pha rmacy," L a. Pharm. (M ay 1962) 3. " P harmacy I s M od eled After MD ' s Office," Amer. Druggist (July 23, 1962 ) 4 . " In the Professiona l M a nner, " J A PhA, NS3, 70 (F eb . 196 3) 5. " Pha rmacist Pra ises Family Prescription R ecord
1968)-The professional nature of the service demands a dignified explanation to the public. It should not be a circus-type announcement. The pharmacist should explain the system himself to his patient. Systems described by practitioners include ACA, WPhA and "Sav a Tax" sold by Safeguard of Lansdale, Pennsylvania. Latter cost $165.00 for first year (10,000 prescriptions) and $100.00 for second year (same number of prescriptions). "These costs are more than offset by the tremendous amount of conversation that is created," concludes practitioner.
1969
Linwood F. Tice, "Outpatient Pharmacy Services," J ournal of the American Pharmaceutical Association, pp. 622-623 (December 1967)-ln a statement before the Task Force on Prescription Drugs, the author emphasizes the importance of "a medication record on each patient including all drugs prescribed and those o-t-c products taken by the patient. Examples of therape.utic incompatibilities are listed.
_ _ _ __ , "Patient Record Card Systems," B ulletin oj the Ontario College of Pharmacy, pp. 1-16 (January 1969)-Survey of patient records in use and the literature leads author to conclude that "the use of patient record systems is both practical and economical and will help the pharmacist in his professional relationships and in projecting a better professional image."
Joseph D. McEvilla, "A Computerized Prescription Recording System," J ournal of the American Pharmaceutical Association, pp. 636-638 (December 1967)-1963 USPHS g rant provided funds to demonstrate the application of data processing equipment-including direct telephone communication, flexowriter, slow-scan television and oral dictation. Results emphasize importance of maintainin g patient records of prescribed medication to prevent a patient receiving therapeutically incompatible drugs or multiple quantities of dangerous drugs without knowledge of the prescriber.
David P. Vogel and Benjamin F. Holland, "Electronic Data Processing in Hospital Dispensing," American J ournal of H ospital Pharmacy, pp. 218-223 (April 1969)-Describes a pharmacy electronic data processing program in a 438bed community hospital. For each original medication order received by the pharmacy, a punched card is pulled giving drug description, drug number, cost per unit, fee code and a drug interaction code. Patient's number and quantity dispensed are punched into card, resulting in output data of label, reorder file, daily pharmacy audit and patient medicati~n profile.
1968 Victor Morgenroth, "The Prescription Record and Our Experience With Its Use,' Wisconsin Pharmacy Extension B ulletin, pp 2-4 (January 1968)"The value of the system has been so outstanding to us that whatever the cost may be, we would still have to use this system, even if we had to start all over again." William L. Blockstein, "The Professional and Public Promotion of Record Systems," Wis consin Pharmacy E xtension Bulletin, pp. 2-3 (February
System," APhA Newsletter, 2, 3 (Oct. 12, 1963 ) 6. White, E.V., "The Maintenance of a Family Prescription Record System," Proceedings of Program, ACA at the Greenbrier (Oct. 26-30, 1963) 7. White, E Y., "The Maintenance of a Family Prescription Record System," Wis. Pharm . (Dec. 1963) 8. White, E.V., "The Maintenance of a Family Prescription Record System," Carolina J. of Pharm./ 45,25 (Jan . 1964) 9 . ACA Secretary's N ewsletter, 22, 3 (Jan. 25,1964 ) 10. White, E.V., " The Maintenance of a Family Prescription Record System," Iowa Pharm. (April 1964) 11. Cain, R., "Patient Record Systems," JAPhA, NS4, 4 (April 1964) 12 . "The Eternal Triangle," Amer. Prof. Pharm. (June 1964) 13. ACA Secretary's N ewsletter (July 10, .1964 ) 14. "The Profession Overseas: 'prescription pharmacy' in the U.S.A. ," Pharm. J. of G. Br. (Sept. 12, 1964) 15 . White, E.V., " The Patient Prescription Record System-A Must in Modern Practice," Annual Spring Seminar, Howard College School of Pharmacy (March 17,1965) 16. " APhA, McKesson Offer New Rx 'Center'," Amer. Druggist, 151,13 (Mar . 29,' 1965) 17. White, E .V ., " The Maintenance of a Family Prescription Record System," The Ind. Pharm ., 47, 54 (Mar. 1966) 18. White, E.V., "The Maintenance of a Family Prescription R ecord System," Wis. Pharm. Extension Bull., 9, 6 (June 1966 ) 19 . White, E.V., " Tenue D es Fiches Familiales D ' Ordonnances," Chronique du Centre d'Etudes et d'Informations Pharmaceutiques, 25 , rue des Bourdonnais-Versailles, France; No. 4 (April 1966 )
1969)-ln addressing the Iowa Pharmaceutical Association, Allen Brands predicted that "uniform state laws might require the maintainance of patient records in the pharmacy, in order to prevent the use of contraindicated and incompatible drugs." He added, "if these new services are demanded by law, pharmacists might find it much easier to convince the public and government that charging for these services is justified." Daniel L. Wertz, Julian H. Fincher and Harry A. Smith, "Why Use a Prescription Record System?," Bulletin of Bureau of Pharmaceutical Services, School of Pharmacy, University of M ississippi, pp. 1-6 (June 1969)-Authors list 11 practicing pharmacists using patient record systems, suggest type of information required in such a system, and report that use of patient record cards do not add more than five cents to the cost of a prescription. "This is certainly not a major . expense for such a valuable tool in utilizing the pharmacist's knowledge and ability to provide the best protection possible to those he serves," the authors conclude. James Andrew Visconti, "Use of Drug Interaction Information in Patient Medication Records," American Journal of Hospital Pharmacy, pp. 378-387 (July 1969)-Author describes a patient time-flow drug profile and its actual use and benefits in a three-month study of drug reactions by a pharmacist-monitor stationed on the medical wards of a university teaching hospital. The method described may be implemented manually or computerized in small or large hospitals.
Robert M. Stevens and Reuben R. Wolfert, "A Random Filing System for Inpatient Medication Records," A merican Jou rnal of H ospital Pharmacy, pp. 290-293 (May 1969)-Authors describe the Randomatic system for filing and retrieving patient medication records. Described by authors as faster, more accurate and more versatile than the visible line file previously used at the Bryn Mawr Hospital, Bryn Mawr, Pennsylvania.
_ _ ___ , "His Rx Record System Is Designed for Computer Age," American Druggist, pp. 55-56 (July 28, 1969)-Walter Lettieri of West Trenton, New Jersey, states that his "family Rx record system not only saves time, but it provides total information, offers an extra dimension of professional service, and prepares the pharmacist for the day when his prescription records will be handled entirely by computer." (See also American Druggist, p. 43, November 30, 1970; p. 42 March 20, 1972.)
_ _ _ _ , "Make Patient Records Mandatory for RxMen," American Druggist, p. 4 (May 5,
(continued on page 374) Vol. NS13, No.7, July 1973
359
VISlrecord Systems A pioneer developer of visiblevertical record keeping systems, VISlrecord has installed numerous prescription record systems nationally, but as yet has not aggressively promoted their system to pharmacists. The main features of the VISIrecord System are the speed of card location and the elimination of misfiling. Bows of cards may be scanned at the rate of more than 300 cards per minute to remove inactive accounts'. Many VISlrecord installations are used in conjunction with RecordA-scri P, Safeguard and Quik Chek. This involves the use of VISI record files to replace the trays for filing records. A variety of record cards have been produced by VISlrecord. One 6" X 8" record card used by Pekin Prescription Laboratory of Pekin, Illinois, provides for name, social ~ecurity number, I.D. number, birth date and "allergies & idiosyncrasies" at the top. The card provides for 34 prescription transactions (front and back) recording date, prescriber, prescription number, patient, price and medication. The Crest Pharmacy of Aliquippa, Pennsylvania, uses' a 61 / 2" X 8" card with family name, address, telephone, all family members, birth
Annotated Bibliography (continued from page 359) _ _ _ _ , "Why Darby Set Up Rx Card File," American Druggist, p. 70 (October 6, 19G9)-Joel Darby of Brooklyn, New York, states, "I started the Rx record plan because my patrons are so darned sophisticated." Pharmacist Edward Strauber adds, "the prescription record card file system is vitally important under today's conditions."
date, "sensitivity" and "reaction." The card provides for recording 42 prescription transactions with date, prescription number, prescriber, price and medication. Still another form, 6" X 10", combines features of both Pekin and Crest forms, with space for 46 prescription transactions. Price for the latter ranges from $37.65/M to $22.15/M for 15M. Open tray with locking caster movable stand, with capacity for 4,224 prescription record cards priced at
$346.40, but may be obtained separately at lesser cost for use on counter top. A flat, one-time original charge of $20.50 for custom-made record cards. Many other units available varying in size, capacity and degree of protection to meet requirements of pharmacy.
it is conceivable that the courts might rule that nonrecord keeping pharmacists are not exercising the care and prudence regarding public health which their peers are providing. ihis could be interpreted as negligence. "You can't get any professional satisfaction out of your work if you seek to escape all responsibility," concludes the author.
-Keeping a family record system has been an integral part of the operations at Sarnia Pharmacy, Ontario, since 1961. At first it was simply a 3/1 x 5/1 card file, but by 1969 the system had become elaborate and sophisticated. The cost is about 18 cents per prescription dispensed, but this out-of-pocket expense is offset by economic advantages, and patient loyalty more than covers the cost of maintain ing family medication records. Similar results, using different systems, are reported in two other Canadian pharmacies.
_ _ __ , "The Hazards in Family Record Keeping," Drug Topics, p. 38 (September 14, 1970)-Family medication records cannot be embarked upon as a promotional gimmick, and if they are maintained, they must be competently handled to prevent errors and to prove total lack of negligence in the way they are maintained.
1971
1970 _ __ _ , "Illinois Pharmacist Informs Physicians of Various Uses for Fam.ily Record System," American Druggist, p. 71 (April 6, 1970)George Scharringhausen qf Park Ridge, Illinois, advises physicians by letter, "we are discovering that there are other benefits from the use of this system than the originally intended usages." They become a valuable cross-reference file for the busy doctor and his patient. ' Carl Roberts, "Beware the Family Record System," Chain Store Age, pp. 74, 78 (August 1970)-lf a pharmacist chooses to maintain a family record system, he assumes a responsibility which must be exercised with due care. But as most pharmacies adopt this system,
374
Pharmacist Richard W. Sams at Pekin Prescription Laboratory , Pekin , Illinois, keeps his cabinet for the VISIrecord S ystem next to the receptionist's desk in his Pharmaceutical Center so that the patient profile card can accompany the prescription order throughout the entire operation. "Admittedly it was a monumental task to convert from family records to patient profiles, but after using the system for over a year we know it was worth the effort," writes Pharmacist Sams.
Roger S. Wilson and Hugh F. Kabat, "Pharmacist-Initiated Patient Drug Histories," American Journal of Hospital Pharmacy, pp. 49-53 (Jan-
uary 1971)-Studying the efficacy of pharmacists developing drug histories for newly admitted hospitalized patients at the Minneapolis Veterans Administration Hospital, authors interviewed 100 male patients over a 3~-day period. Only 57 percent of the medications found by the pharmacist were recorded by the attending physician. Over 90 percent of the patients were cooperative, and almost 40 percent of the patients revealed that they did not utilize their prescription drugs exactly as directed by their physician. _ _ _ _ , "Patient Record Systems," Canadian Pharmaceutical Journal, pp. 68-72 (March 1971)
Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION
VISIrecord Systems, Division of Barry Wright Corporation, Copiague, Long Island, New York. A. Mark Rudiger, Director, Systems Research and Development.
Daniel R. Toal, "Advantages of Pharmacy Drug Record," Louisiana Pharmacist, p. 13 (March 1971)-ln order for any pharmacist to practice patiented-oriented pharmacy, he must have and maintain adequate information about the patient. This is the purpose of the family record system or patient drug profile. Eugene V. White, "How the Family Medication Record was Originated," Pharmacy Times, pp. 34-37 (April 1971)-Berryville, Virginia, pharmacist tells how he introduced "clinical pharmacy in the community" with the Pharmaceutical Center and the patient drug history record which "provided the core of the concept and enabled the pharmacist to step up into a new role on the health care team." Tim R. Covington and Harvey A. K. Whitney Jr., "Patient-Pharmacist Communication Techniques," Drug Intelligence and Clinical Pharmacy, pp. 370-375 (November 1971)-ln a study to demonstrate the pharmacist's ability and
(continued on page 378)
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Like many other pharmacists, James Ramseth of Kent, Washington , has developed his own Family Medication Profile Card with family name, address, telephone, individual patient names, birth date , "sensitivity," "misc." and prescriber. A red dot in upper left hand corner calls attention to the fact that there are potentials for interactions or sensitivities. Card provides f or prescription number, patient, prescriber, fee , medication, renewals and dates dispensed.
easy to use record of medication utilization. Compared to other pharmacy drug records used for similar purposes, the patient drug profile provides several advantages. It can serve as an exact record of medication labels since a direct copy appears on the profile for each drug prescribed. This prevents mistakes when subsequent labels are typed for the same prescription. Because a label copy appears on the form it also contains the directions to the patient; for example, "Take one (1) tablet four (4) times a day." This type of inform ation is not usually contained on most other pharmacy drug records even though it is valuable information neces-· sary to follow p'l.tient drug therapy. Unlike other pharmacy drug record systems which can be placed on top of the prescription counter or in small drawers built into the prescription
counter, the patient drug profile system requires a place large enough to accommodate a standard two-drawer file. The drawer space supplied by a twodrawer file allows for easy storage of 4,500 profiles. A cost analysis of the patient drug profile system was performed relating the cost of forms and labor to the total number of prescription orders dispensed per day. The cost of maintaining this patient drug profile system was 3.2 cents per prescription order. This figure is inflated because of the small number of forms (5,000) and labels (5,000) printed for use in the study. The costs could be reduced considerably if larger numbers of forms and labels are manufactured.3 An efficient pharmacy drug record system is a must in order for the "patientoriented" community pharmacist to
adequately supply clinical services to his patrons. 4 This patient drug profile system provides a pharmacist with an easy-to-use, inexpensive tool with which to monitor drug therapy. Since this patient drug profile is presented in an organized manner, the information contained therein is readily accessible to the pharmacist each time a prescription order is dispensed, or whenever he desires information about his patient. 5 •
Annotated Bibliography
pharmacy." Story also notes that Delaware Pharmacy Board is also considering such a regulation.
52-54, 56, 58 (April 1972)-Nurse at Lenox Hill Hospital. New York City. reports on use of an I BM drug card in pharmacy corresponding with physician's medication order which is used as the patient record system in "deck form." Every morning the pharmacy issues a profile of all standin g orders for each patient and sends it to each nursing station where the physician can review it and the nurse use it for daily administration of drugs.
(continued from page 374) expertise in acquiring a patient medication history. 40 inpatients on medicine and surgery wards of a 500-bed municipal. acute-care general hospital were selected at random. Most patients were from the lower socio-economic strata. While physician-acquired histories n .)ted two patients with prior drug allergies. pharmacist-acquired medication histories revealed 12 prior allergies. including six to penicillin, one to sulfonamides and three to aspirin. The pharmacist-acquired medication record also detected five (12.5 percent) adverse drug reactions during hospitalization.
1972 "N.J. Is First State Requiring Pharmacies To Maintain Patient Medication Records," American Druggist, pp. 24-25 (January 24, 1972)-Report on anticipated action by New Jersey Board of Pharmacy regulation requiring a "patient profile record . . . be maintained in all pharmacies by family name . . . in alphabetical order for all persons for whom prescriptions are dispensed." Paul Pumpian is quoted as saying that "as the public becomes aware of the advantages of medication records, people will tend more and more to have all their prescriptions filled in one
-=-:-_ _ _ ,
378
Robert F. Steeves, "Outdated Rx Record Keeping," American D ruggist, p. 8 (February 21, 1972)-AII prescription records for a given patient should be maintained under the patient's name so that the pharmacist can quickly check all medication "by leafing through the file when a new prescription was dispensed or when a refill was dispensed. Many man-hours of record transfer and wasted motion could be saved . .. and could have a beneficial effect on patient care with no additional cost to pharmacy."
References 1. C a in, R. vV., " P a(ie n t R ecord Sys :em s," J A PhA, NS4, 164 (196 4 ) 2. "Cu ts R x R ecord-Keeping Chores b y 67 %," Amer. Druggist, 156, 3, 47 (July 31, 1967 ) 3. P erson a l Commu nication , Briggs Prin ting C omp a n y, D es Moines, I owa 4 . T oal, 'D .R. , "Clinical C ommunity P h :1rm acy," L a. Pharm., 30, 3,12 (March 1971) 5. Toa l, D .R ., and Kann, D ., "A P atien t-Drug Profile," Iowa Pharm ., 27,4, 10 (April 1972)
Francis P. J. Slanina, "Outdated Record Keeping," American D ruggist, p. 66 (March 20, 1972)-Philadelphia pharmacist writes letter to editor claiming Steeves is 15 years behind time. "I opened my pharmacy in 1956 and started filing my prescriptions by patient name ... and have-continued to do so to this day."
Allen Dinnerstein, "The Perils of Patient Rx Profiles," Chain Store Age, pp. 99, 102 (July 1972) -Vice president in charge of pharmacy affairs for Rite Aid Corp., the author attacks the patient record system as too costly and with unknown lega I liabilities. Admitting that it is not new-"almost every pharmacist has worked in a store where a cross index or . record keeping system was kept for tax records or customer convenience"-he concludes by claimin g that "mandating family record cards by decree without full knowledge of a II its consequences can only result in disaster for the entire profession."
Daniel R. Toal and Duane Kann, "A PatientDrug Profile, I owa Pharmacist; pp. 10-11 (April 1972)-Author describes Patient-Drug Profile system which was the subject of thesis in partial fulfillment of MS degree at the University of Iowa. Describes a patient record system as "a storehouse of information to the patient, pharmacist and physician."
William Fogelson, "Message from the President," New J ersey Journal of Pharmacy, p. 6 (September 1972)-"1 cannot claim to be an early con vert" to the patient profile record card system." reports NJ PhA president. I n fact he writes that he asked many questions of those who utilize patient record systems. and found "without exception these pharmacists were
Carolyn Timmer, "Our Unit Dose System Cuts Medication Errors," Pharmacy Times, pp.
(continued on page 385)
Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION
c. It is no longer necessary to look up prescription orders in the files on renewals since the medication record can be used to renew prescription orders. d. The F.D.S.N. Prescription Number and the Drug Safety Number Service Mark insure professional integrity, accuracy and patient acceptance; e. It allows the filling out of any third-
Annotated Bibliography (continued from page 378) enthusiastic-even ecstatic-about the values of the patient record card system." "At last, in this past year, I took the plunge," reports Fogelson, and "one word sums up the profile record card system-that is, great." Pat Demers, -"Individual Patient Profiles are Housed in Same Manila Folder for Entire Family," Pharmacy T imes, pp. 42-46 (September 1972)-Pharmacist in Springvale, Maine, adopted idea for new patient profile system from a hospital pharmacist. A manila folder is kept for each family on which is recorded names of each family member. Included in each folder is a separate prescription record sheet for each individual family member. Different-colored inks are used to transcribe data on prescription record sheets so that each year can be ascertained at a glance by the color of the ink. Dan Kushner, "A Dissenting Vote," A merican Druggist , p. 15 (September 18, 1972)-ln an editoria I, Kushner objects to the patient medication file on the basis that he does not like to be monitored-"by the police, by bugged telephones, or by the pharmacists no matter how well meaning. I claim the right not to be data-banked, so far as I can avoid it." Editor Kushner also claims that patient medication records will not work anyway because "a lot of people will resist the notion of patronizing one, and only one pharmacy, whether or not it maintains comprehensive files. In fact some people may be 'ornery' enough to resist patronizing a pharmacy because it keeps those neat, prOfessional dossiers." Ray E. Marcrom and D. C. Huffman Jr., "Why-A Patient Record System?," T ennessee Pharmacist, pp. 16-18 (October 1972)-A survey of the use of a patient record system in "a small middle Tennessee town" revealed that 86 percent of the patients responding to a questionnaire felt that the pharmacist should provide the patient prescription record system; 90 percent said they would obtain all their prescriptions from a pharmacy that maintained such a service, and 49 percent said they would be willing to pay as much as 25 cents extra per prescription for the service. Of 396 patient record cards initiated during the study, 21 percent were found to have one or more chronic illnesses and 17 percent of the patients had some type of drug allergy. There was a 10 percent increase in the number of new prescriptions shown during the threemonth study over the same period a year prior. (See also Louisiana Pharmacist, pp. 25-26, 28, May 1973). Donald W. Moore, "A Badly Needed Service," American Druggist, p. 68 (October 16, 1972)-Read-
ing "with amazement" Kushner's editorial, this Wichita, Kansas, pharmacist writes, "I have found that in spite of the additional work and expense to the pharmacy and not withstanding the fact that they are not yet perfected, family patient records provide a badly needed pharmaceutical service to the patient ... We have never had a patron who felt so strongly as you do aoout 'invasion of privacy.' In fact, the usual pattern is the direct opposite, with the patient really appreciating the importance of these records." Joel Pollack, "He's Against Profiles," American Druggist, p. 69 (October 30, 1972)-Shokan, New York, pharmacist writes congratulating Kushner's editorial, calling patient record
party claim form expeditiously, only requiring the signature of the person receiving the medication; f. The alphabetical reception counter file is a real aid to the pharmacist or receptionist by indicating immediately that a family-patient prescription profile card has been initiated previously; and before the next prescription is dispensed or before an o-t-c medication is pur-
chased, it immediately alerts one that a person is allergic to a specific drug or medication. g. The writing or typing only once of the original or telephone prescription order on the family/patient prescription profile card will more than compensate the pharmacist for his time because he is not required to look up the prescription order on all successive renewals. •
systems "about the last insult to the individual patient-customer, and the pharmacist. . . . Our profession is not a system of index cards. .. The fact that all prescriptions do not come to one pharmacy exposes the system for what it really is : another Big Brother clamp on pharmacy."
ment. The report also mentions the legal, economic, professional and public health aspects of record systems, and concludes by noting that these questions with recommendations will be submitted to the NACDS board of directors upon completion of the study.
M.
Profiles,"
American Druggist , p. 59 (December 11, 1972)-
American Druggist, p. 69 (October 30, 1972)-Aus-
Coordinator for continuing education at Virginia Commonwealth University school of pharmacy sends his own editorial to Kushner, noting that "medication profiles, as they exist are not perfect. Has anything ever appeared on the scene in a state of perfection? Certainly your opinion does appeal to those who resist change and might even be construed as playing into the hands of those who have written pharmacy off the health care team. Leadership demands that medication records be given a fair trial."
Eugene
Rector,
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For
tin, Texas, pharmacy student writes Kushner, "I feel that patient record keeping would give the pharmacist the opportunity to use his knowledge and experience by evaluating patient records for possible drug interactions." James T. Harrison, "Useless Information," A merican Druggist, p. 69 (October 30, 1972)-Villa
Rica, Georgia pharmacist supports Kushner 100 percent by asking, "Really, what do we accomplish when we spend our time compiling this useless information?" R. H. Waller and J. N. Hlynka, "Watchdog on Prug Control, Canadian Pharmaceutical J ournal, pp. 346-354 (November 1972)-Study based on patient drug record plans used in two pharmacies for six and nine years, respectively, supports the effectiveness of such plans in identifying and preventing potential problems related to drug use at the ambulatory patient 1evel. Of 955 prescriptions for tetracycline surveyed, there was a potential interaction in 56 cases, and 37 (66 percent) were due to nonprescription drugs. Abstract in A cademy / GP, pp. 1-2 (January 1973). William R. Bacon, "Record System Defended," A merican Druggist, p. 76 (November 13, 1972)-APhA Academy of General Practice of Pharmacy president writes Kushner, "A patient-oriented pharmacist needs the patient profile, and you need re-orientation . .. You extend the concept of monitoring drug use into a science fiction fantasy." K. Joe Di Maggio, "Confidentiality," A merican Druggist, pp. 76-77 (November 13, 1972)-San Austine, Texas, pharmacist writes Kushner, "The profile is neither useless nor an invasion of privacy. .. I am sorry this type of article came from your desk and you used a poison pen to help knock one of the beneficial tools pharmacy is fighting for. You will probably not even know whose health you have hurt because a pharmacist did not initiate family records due to your editorial ." Leavitt C. Parsons, "Those Patient Records," The Apothecary, p. 6 (December 1972)-"Good patient records are not only an important link in the chain of relationships that bind the thinking patient to his friendly pharmacist; but the thinking physician who writes the prescriptions soon learns that the pharmacist's customer records may offer certain image insurance for him too . . . Therefore, don't let anyone talk you out of keeping patient records as too much work for the benefits you get. Compulsory patient records are on the horizon ... Be prepared." A P,e/iminary Report of the Task Force on Pharmacy Record Systems (National Association of Chain Drug
Stores, Inc., 1972); see also "Chain Drug Task Force Evaluates Pharmacy Record Systems," Pharmacy Times, pp. 64-65 (December 1972)-Task Force appointed in April 1972 by president of NACDS reported on 13 manual single use systems, six manual multiple use systems, and three EDP systems, establishing tentative requirements for all medication record systems into four areas-administrative, professional, patient and operation/manage-
Norman L. Hilliard, "A Dissenting Vote,"
1973 Harry A. Smith, "Application of Cost-Effectiveness Analysis to Patient Record Systems," Journal of the American Pharmaceutical Association, pp. 13-14 (January 1971)-Using a costeffectiveness analysis, it was found that the implementation of a patient medication record system cost $971.00 for the first year, but that the calculated increase in net income attributable to the Pfltient prescription record system was $2,467.00. Thus the cost·effective· ness ratio was one to 2.54. Neil M. Davis, "Let's Inform the Public About Prescription Records," Hospital Pharmacy (January 1973)-Editorial commenting Patient Record Systems, but criticizing lack of organized efforts to "educate public to demand this service." "I believe an intensive public education campaign is long overdue. This is something members of the ASHP, APhA, and NARD could surely agree upon and work together to initiate," concludes Editor Davis. J. W. Dorsey, "Blame It On Me," American D ruggist M erchandising, p. 74 (January 1, 1973) -Pharmacist from Albuquerque, New Mexico, writes in letter to the editor, "perhaps it is time for me to add a few words to the Patient Profile controversy. It is very possible that I am one of those responsible for launching the idea, since I started my patient profile system on January I, 1947." Paul Guthrie, "Like It Or Not, Those Profile Cards Are Looming Larger Now," Drug Topics, pp. 21, 33 (January 15, 1973)-Pharmacists who already use record cards find them very advantageous, primarily for the familiar interaction and abuse checks. Secondary benefits often cited include-aid in finding a prescription, tax records, health care diary and an image-building service. On the other side of the fence, some pharmacists feel that their patients would regard profiles as an invasion of their privacy. Then too, there is the specter of added expenses. As for the liability threat, pharmacists seem to underestimate what they could be letting themselves in for if patient profiles were to become the law of the land. "Leave it to the lawyers," seems to be their general retort. Put into perspective , patient profiles are just a minute aspect 'of the evolving health-care paper work scene. Crystal bailers say that the only thing that will save the record keeping day will be statewide computer systems. Karl Neumann, M.D., "Medication Profiles Help RxMan, MD, the Patient," American Druggist M erchandising, p. 11 (January 15, 1973)-The
Vol. NS13, No.7, July 1973
385
changing medical scene lends itself to the pharmacist's keeping medical profiles. With the gradual demise of the general practitioner and the increasing availability of medical specialists, the public increasingly lacks a primary physician. Unfortunately specialists tend to treat not patients, but specific organs and often do not adequately question about symptoms outside their sphere of interest. Frequently, specialists are not well-informed about drugs that are not used in their field.
-=--=--=-=-=-----=:' "Drugstore Profile,"
Time (March 5, 1973)-Editors of Time magazine inform public on the value of the patient record system, pointing out that many pharmacists are keeping such profiles so that each time they dispense a prescription or sell an over-thecounter drug product, they can prevent the possibility of a harmful reaction.
"The Challenge of Patient Profiles," Chain Store Age, pp. 73-74 (April 1973)There is, at present, no really efficient method of maintaining prescription profiles in a highvolume prescription department. But profiles can be fought with other arguments as well. Pharmacists throughout the nation are raising the always pertinent question of pharmacist liability, and the always practical one of consumer shopping habits. How, the second question goes, can a profile help the consumer who shops prescriptions at a variety of different stores? But the primary argument against profiles is the paper work. ~
=:------c:-::--::-c--"
Proponents of patient profiles counter these arguments with one of their own-the public needs the protection afforded by a pharmacist who is in the position to monitor the prescriptions written by more than one physician.
Joan Cook, "Druggists Compile Customer Profiles," New York Times (May 28, 1973)-The profile serves as a backstop for drug monitoring and usage and is particularly effective in preventing harmful drug interaction.
David Pinto, "Time For A New Stand On Patient Profiles," (Editorial), Chain Store Age '( June 1973)-The nation's drug chains have too long hidden behind words like "impractical," "expensive,'" "unnecessary" and unfeasible" when discussing patient profiles. One way or another, patient profiles will become an integral part of all prescription dispensing within the next few years. The smart thing' to do-and the right thing to do-is to speed that day. • •
Drug Recalls The following data have been compiled from the Federal Food and Drug Administration Weekly Recall Report covering the period March 29, 1973, to April 18, 1973. Pharmacists and others possessing drug inventories are reminded to check their stock again to be certain that they do not have any of the products on the list. Anyone who has additional facts on any of the listed recalls which he leels will assist in completing the recall is urged to send such data to the editurof this JOURNAL.
Manufacturer or Distributor
Product Aristomin Capsules (triamcinolone 1 mg, chlorpheniramine maleate 2 mg, ascorbic acid 75 mg), 30's and 100's Cutter parenteral solutions
Quantity
Recall Reason
Lederle Labs (Pearl River, N.Y.)
All lots
10,000,000 capsules
NAS/N RC drug efficacy study implemer;ltation
National
Cutter Labs (Chattanooga, Tenn.)
All lots with prefix T 7206069
Unknown
No assurance of sterility
National I nternationa I
Unknown
Premature disintegration
Florida
Continental Distributors (Hialeah, Fla.) Bell Pharmacal Corp. (Greenville, S.C.)
Thyroid tablets, enteric coated, 1 Gr, container size unknown
Product Distribution
Lot Number
Respiratory problems?
Get out of the house! If IPPB or nebulization are prescribed, the patient can get out of the house and use the
G.T. SERIES V (12-VOLT) IPPB Use it in an automobile, in the park, most anywhere ... with the
Rechargeable battery pack Also available with 115-volt compressor
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• Lightweight • Patented • Guaranteed • Made by the Pioneer in inexpensive IPPB Units • Available on Prescription Only
PULMO-VENT ,
~® MEDICAL SERVICES, INC. PO BOX 1185 TULSA, OKLAHOMA 74101
I
386
Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION
PHONE , (918 ) 584-5247