Third-party Payer Reimbursement for Patient Education
`and Pharmacokinetic Dosing Services
`The Ohio State University Hospitals was being reimbursed
`by Blue Cross of Central Ohiofor five’ patient-training pro-
`grams.' As of September 1, 1978, there are two additional
`reimbursement programs: a steroid administration training
`program and a pharmacokinetic dosing service.
`Pharmacists, upon a written order by a physician, train pa-
`tients with adrenalinsufficiency to administer steroids intra-
`muscularly. A total of 18 patients have been instructed within
`-the last six months. Blue Cross of Central Ohio has approved
`a $25 charge for this training program.
`The pharmacokinetic dosing service provides for the phar-
`. macist to do the following:
`
`1. Reviewall relevant patient data.
`-2. Planinitial plasma samplingif required.
`3. Interpret and make recommendationsfor drug doses based
`upon the plasma concentration.
`4. Assess the resultant serum drag concentrations,
`5. Prepare a writlen.report.
`6. Prepare a computer-generated plot of drug ‘concentration
`versus time.
`
` Letters
`
`Blue Cross of Central Ohio will reimburse the hospital $20
`for each dosing consult (one per patient). This chargeis rendered
`by the pharmacy and does not include anycosts or fees associ-
`ated with the laboratory tests.
`The approval for both programsresulted from meetings with |
`Blue Cross of Central Ohio officers, Myles P. Lash, Adminis-
`trator, University Hospitals, and me. Both programswill be
`required to demonstrate cost effectiveness using previously
`agreed uponstandards ofperformance,
`1, Nold EG and Pathak DS: Third-party reimbursement for clinical
`pharmacyservices: philosophy and practice, Am J Hosp Pharm
`34:825-826 (Aug) 1977.
`Edward G, Nold, M.S., Associate Director
`Department af Pharmacy
`University Hospitals
`410 W. 10th Avenue
`Calumbus, OH 43210
`
`Mannitol Crystallization in Plastic Containers
`Several months ago I had an unexpected experience while
`using mannitol 25%injection. I would like to bring this to the
`attention of hospital pharmacists as it poses a pee prob-
`lem,
`Anorder was received for mannitol 25 g to be given over 30
`minutes. This necessitated placing 100 ml of mannitol 25%into
`an emptyViaflex bag. Administration was delayed one hour, by
`which time a very heavy, white flocculent precipitate appeared.
`I repeated the events using new materialand found the pricip-
`itate formed in 12 minutes.
`Using a fresh vial of mannitol I placed some into the Con-.
`tinuflo tubing and had the same results. Placing another sample
`inte a plastic 20-ml syringe again gave the precipitate.
`I am aware that mannitol commonlycrystallizes when ex-
`posed to low temperature. This could not be the case in these
`instances since at ne time was the mannitol exposed to tem-
`peratures below75 F, Furthermore, the flocculent precipitate
`observed in no. way resembled the more commonlarge crys-
`tals.
`I realize that usually mannitolis given over a short period of
`time and this problem may be minimized. It is myintention to”
`report.this occurrence in casethere is somesignificance Lo it.
`
`
`
`Edward Epperson, Pharm, D,
`Assistant Director of PharmacyAffairs
`Woodland Memarial Hospital
`1325 Cattantwood Street
`Wuodland, CA 95695
`
`The observations reported by Dr. Epperson relative to crys-
`tallization of supersaturated solutions of mannitol when ex-
`temporaneously packagedin or allowed to contact plastic par-
`enteral containers, plastic administration tubing and plastic
`syringes are accurate.
`The aqueous room temperature solubility of mannitol is in
`the neighborhood of18%w/v. Supersaturatedsolutions of 20%
`‘and 25% w/v are commercially available. Such products fre-
`quentlycontain the long, needle-like crystals typical of mannitol
`which has ‘undergone slow,
`relatively undisturbed crystal
`growth. In cases where such crystal growth has occurred, the
`mannitol may be resolubilized by the aid of heat as described
`in the product's labeling. Recrystallization normally does not
`oecur during the time required for administration to the pa-
`tient.
`Plastic container or plastic administration device surface
`characteristics frequentlydiffer from those of the glass container
`originallyutilized to package the product. These surfaces may
`actas nuclei for crystallization to occur at a rapid rate, thereby
`providing atypically small crystals when supersaturated man-
`nitol injections are utilized. Resolubilization of these crystals
`with the aid ofheat will not prove fruitful because the material
`may recrystallize within a short time period.
`Where solution volume intake is not a major concern, this
`problem may be overcome by aqueous dilution of the super-
`saturated injection to 18% w/vor less priorto contact with the
`plastic container or administration device. In all cases, however,
`it is our recommendation thatafiltration device be used during
`the administration of the fluid.
`_R.L. Nedith, Ph.D., Senior Manager, Pharmaceutical Development
`Travenol Lohorataries, [ne
`630) Lincaln Avenue
`Morton Grove, 1L 60054
`
`Salary Survey of Hospital Pharmacy Residency Programs
`The Rhode Island Hospital Department of Pharmacy con-
`ducted a salary survey of pharmacy residency programs in
`hospitals in March 1978. Questionnaires were mailed to each
`ofthe 89 training programs accredited hy the American Society
`of Hospital Pharmacists at that time. Fighty-two (88%)ofthe
`questionnaires were completed and returned. Similar surveys
`were conducted in 1975,! 1976? and 1977.8
`The salary range, based on an annual stipend, for the 12-
`month nonacademic, nongovernmental programs (IN = 48) was
`- $6,800-$15,932. The mean was $10,796 and the median $10,670.
`The 1977 survey revealed a mean and medianof $10,231 and
`$10,320, respectively.
`The salary range for nonacademic, governmental programs
`(N = 11) was $13,000-$20,652 with a mean of $15,640 and a
`median of $14,712. These programsare 12 months in duration,
`In analyzing the data from the programs surveyed which were
`offered by the various governmentalservices one must consider
`other criteria since in manyinstances financial remuneration
`
`Continued on page 1340
`
`Vol35 Nov 1978 American Journal of Hospital Pharmacy
`
`1337
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