Distributing estrogen patient package inserts to institutional patients

A procedure for the distribution of patient package inserts (PPIs) for estrogens to outpatients (ambulatory and home health care) and inpatients (acute and long-term) was developed. The pharmacist dispenses the PPI to outpatients along with the prescribed drug. The name of the drug, the date, the pharmacist's initials and the fact that the PPI was issued are recorded in the patient's profile. The pharmacist then orally reinforces the information in the PPI. For inpatients, a preprinted double-tab label is adhered to the PPI which is distributed with the medication upon new estrogen orders. The portion adhered to the PPI lists instructions to the physician. The unadhered portion contains an area for recording the name of the drug product, the patient's name, the physician's signature and the date; this tab is affixed to the order sheet by the physician after he has provided and explained the PPI to the patient. Estrogens are not administered until physicians comply with the PPI procedure. While compliance with the PPI procedure has been satisfactory, this may be the result of a substantial decrease in the number of physicians ordering estrogens, along with a corresponding reduction in the number of estrogen products they now prescribe.