In August 2005, Woodland Heights Medical Center (Lufkin, Texas) pharmacy technician Fred Poage, CPhT, was taking a computer programming course while pursuing a mathematics degree at nearby Stephen F. Austin State University. Staff pharmacist Eddie Purifoy, R.Ph., challenged Poage to put the course to good use. "Why don't you do something really useful—tackle this Xigris problem?"

The "problem" is the amount of time it takes to calculate proper dosing for infusing the life-saving Xigris (drotecogin alfa, Eli Lilly)—indicated for serious sepsis—to reduce waste. Said pharmacy director Craig Brown, R.Ph., "Lilly provided a manual dosing calculator with its original product; it incurred a considerable amount of waste. You had to run it back and forth, then decide what size bags you were going to do, or how long you were going to run them."

Lilly's table can waste between $400 and $1,000 per patient, said Brown. But doing the manual calculations to cut that waste can take a pharmacist 15 to 45 minutes, he explained.

So Poage worked on the program as time permitted through the end of the year. He also had pharmacists from other Texas hospitals testing it and making suggestions. His finished program, Xigris Dose Calculator 1.0, determined the proper dosage in seconds, with an average waste of $35. In addition, he expanded patient weights to include 18 kg to 700 kg. "The Lilly dosing table covers patient weights from 40 kg to 135 kg. With patients smaller and larger than that, manual calculations were still necessary." In January 2006, Poage contacted Lilly about his calculator. "Basically, they said they were not interested. The original dosing table disappeared from their Web site in March. In April they posted a new one that cut the amount of waste in half, but still much higher than my calculator—and still within the narrower patient weight range."

Frustrated by Lilly's lack of interest, Poage posted his calculator on a free Web page so the medical community at large could take advantage of it. In only weeks, physicians and pharmacists from several states, India, France, Germany, and the United Kingdom had downloaded the calculator. A Portuguese physician suggested adding fields for patient name, attending pharmacist, and ordering doctor. The calculator has since been added to GlobalRPh.com listings.

Why is Poage offering the tool free of charge? Poage said he had only been trying to make his pharmacy department's work easier at the pharmacy. "When I realized what a jewel it is, I thought that if I could get other hospitals to start using it, it would look good on my applications to optometry and pharmacy schools in September." Lilly's reaction was another incentive. "I wanted to show them this is really going to save hospitals and patients money. And even if they weren't interested, it's going to get used anyway."

Pharmacists whom Drug Topics talked to suggested that the calculator would be most useful for smaller hospitals but still helpful at larger facilities. Jaye Weston, M.S., R.Ph., clinical coordinator in infectious diseases at St. Luke's Episcopal Hospital, Houston, who had used it while he was with East Texas Medical Center in Tyler, explained, "Larger institutions often have protocols in place to guide pharmacists in dosing and dose rounding. But a protocol does allow the pharmacist to make certain decisions, whereas Fred's calculator always gives a consistent output of how many vials to use. With consistency you could track your savings better."

At Memorial Medical Center of East Texas in Lufkin, clinical pharmacist Robin Flournoy, Pharm.D., said her hospital uses the 5-mg vials to make the last bag. "Therefore, our wastage is minimal. The dosing calculator follows the same method and is a great way to verify your calculations." Cautioning that there is always the risk of error when doing manual calculations, she added, "This program reduces that risk. It is user friendly and a great tool for the busy pharmacist."

Mike Kasper, R.Ph., consulting pharmacist, Nacogdoches, Texas, emphasized the time savings. "Now-adays, if a pharmacist spends any more than 20 minutes on one particular drug order, it's a waste of time. The way these calculations were originally set up was exceptionally time-consuming for a pharmacist to handle—especially in a life-and-death situation."

Epocrates Inc., the on-line retailer of mobile medical references, is interested in a PDA version of the calculator. Poage said he will probably work on that following graduation; but for now he's simply leaving the calculator available for free use on the Internet.

To access the Xigris Dose Calculator 1.0, here are some links:

• http://xigrisdosecalculator.bravehost.com/
• http://www.globalrph.com/medcalcs.htm

Lilly did not return calls from Drug Topics to discuss the calculator.

THE AUTHOR is a writer based in New Hampshire.