The effects of computerized drug profiles and clinical pharmacist consultation in the internal medicine clinics at a Veterans Administration hospital were studied. Population included patients (n = 512) and physicians (n = 35) of three internal medicine clinics during an eight-week period. The first four weeks were the preintervention period. The second four weeks were the intervention period in which a clinical pharmacist attended one clinic (A) and provided drug profiles on all patients. Two other clinics (B and C) served as controls. During the intervention, patients in clinic A experienced a significant reduction in prescribing problems as identified by the pharmacist: 49 percent of patients before the intervention versus 9.4 percent after the intervention (p less than 0.001). Patients in clinic B had no significant change in prevalence in the number of problems identified (39 versus 40 percent; NS), and patients in clinic C had a significant but less dramatic decrease (35 versus 22 percent; p less than 0.05). The proportion of patients in clinic A with net decrease in the number of prescribed medications rose from 7.1 to 34.9 percent (p less than 0.001), with a mean decrease of 0.3 medications per patient. No significant differences in number of prescribed medications were noted in clinics B or C. Accuracy of physician medication charting improved for patients in clinic A from 54 percent of charts with accurate drug lists before the intervention to 78.3 percent after the intervention (p less than 0.001). No significant improvements were noted for clinics B and C. These results suggest that computerized drug profiles together with clinical pharmacist consultation can improve prescribing practices in a hospital outpatient department.

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The use of acetaminophen in young children has increased, in part due to concerns over the association of Reye's syndrome with aspirin. Accidental ingestion of acetaminophen in this age group has also increased, and treatment of overdose in children has been controversial. Recommendations for treatment of adolescents and young children are presented, based on the acetaminophen nomogram. It is recommended that children in the highest risk group (above the upper nomogram line) be treated with N-acetylcysteine, even though treatment may be unnecessary in many.