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Biomedical subjects

K N Barker

Publications and source records attributed to K N Barker.

At least 19 recordsLinked to original sources
PubMed1995

Design and evaluation of a sterile compounding facility.

The design and evaluation of a sterile compounding center for a large community teaching hospital are described. The new sterile products area was redesigned to improve efficiency by minimizing staff travel and to incorporate recommendations of the ASHP Technical Assistance Bulletin on Quality Assurance for Pharmacy-prepared Sterile Products. The design approach combined strategic planning with master facilities planning. The process began with a systems analysis, followed by the development of a functional program (a comprehensive list of design specifications). Travel studies were performed before and after renovation to determine gains in efficiency; technician travel decreased 29% and pharmacist travel, 42%. The new facility design met the specifications in the functional program and appeared to comply with all recommendations in the ASHP document for all risk levels of preparations.

Drug Compounding↗
PubMed1991

Illumination and errors in dispensing.

The relationship between the level of illumination and the prescription-dispensing error rate in a high-volume Army outpatient pharmacy was investigated. The prescription error rate was determined by direct, undisguised observation and retrospective prescription review under three levels of illumination (45, 102, and 146 foot-candles) during 21 consecutive weekdays. Illumination was controlled in the prescription-checking area of the pharmacy by using additional fluorescent lamps and filters. The three levels of illumination were randomly assigned to the 21 days to provide a total of 7 days of observations per level. The final sample consisted of 10,888 prescriptions dispensed by five pharmacists. The overall prescription error rate (including both content and labeling errors) was 3.39% (369 prescriptions). An illumination level of 146 foot-candles was associated with a significantly lower error rate (2.6%) than the baseline level of 45 foot-candles (3.8%). There was a linear relationship between each pharmacist's error rate and that pharmacist's corresponding daily prescription workload for all three illumination levels. The effect of the observer was minimal. The rate of prescription-dispensing errors was associated with the level of illumination. Ergonomics can affect the performance of professional tasks.

Ambulatory Care↗
PubMed1990

Fundamentals of medication error research.

Types of medication errors are defined, error detection techniques are described, and the validity of several medication error studies is evaluated. A medication error is generally defined as a deviation from the physician's medication order as written on the patient's chart. In hospitals, medication errors occur at a rate of about one per patient per day. A dispensing error is one made by pharmacy staff when distributing medications to nursing units or directly to patients in an ambulatory-care pharmacy; the error rates for doses dispensed via the cart-filling process range from 0.87% to 2.9%. Categories of medication errors should be operationally defined before an investigation, and any allowable deviations from the physician's order should be clearly stated. Fourteen error category definitions are presented. Methods for detecting medication errors include anonymous self-reports (questionnaires), incident reports, the critical-incident technique (analyses of a large number of individual errors to identify common causal factors), and direct observation (including the disguised-observation and participant observer techniques). Observation is the best error detection method in terms of accuracy. Results of medication error studies were examined for validity and classified into one of four categories: (A) results should be accepted as reported, (B) results overestimate or underestimate the truth by a known amount, (C) results overestimate the truth by an unknown amount, and (D) results should not be accepted. All studies examined for validity used observation as the error detection technique. The following guidelines for observation-based medication error studies were established: The observer should follow the subject to the patient's bedside, the observer should witness patient consumption of each dose, the observer should not be familiar with patient drug regimens before observation, operational definitions must be used, and having an error validation committee can be advantageous. Future studies are needed that focus on the identification and testing of new error prevention methods that use the techniques described.

Data Collection↗
PubMed1988

Effects of simulated facility-design changes on outpatient pharmacy efficiency.

The potential effects of using the Baker drug counter or the Systamodule pharmacy fixture, or both, on the efficiency of the current outpatient pharmacy system at the National Institutes of Health were evaluated by computer simulation. It was hypothesized that the use of these two devices would reduce (1) the prescription-filling time (RxFT) and (2) the distance traveled (DT) by pharmacists in filling individual prescriptions. The sample used was 20% of two weeks' prescriptions, randomly selected. All theoretical estimations of RxFT were done by a computer program; DT was calculated based on measurements from the architect's schematic drawings. The effect of the application of the Baker drug counter alone, the Systamodule pharmacy fixture alone, and the Baker drug counter in combination with the Systamodule pharmacy fixture was to reduce the prescription-filling time by 0.123, 0.159, and 0.280 minutes per prescription, respectively. The average DT per prescription, 102 feet, was identical in the current NIH pharmacy and with use of the Baker counter. It was reduced by 86.3% (to 14 feet) with use of the Systamodule feature, both alone and in combination with the Baker counter. The use of the Baker drug counter and the Systamodule together promises improved efficiency of the prescription dispensing operation.

Computer Simulation↗
PubMed1988

Quality and comprehensiveness of the National Drug Code Directory on magnetic tape.

The quality and comprehensiveness of the FDA's National Drug Code Directory (NDCD) in magnetic tape form was evaluated. The internal quality of the tape was measured by performing cross-checks of the four record types found on the tape and by checking for the presence of "illegal" characters. The comprehensiveness of the tape was evaluated by determining the extent to which a sample of items from nine community and hospital pharmacies could be matched with code numbers on the NDCD tape. A second test of comprehensiveness measured the match rate between the shelf stock sample and National Drug Code (NDC) numbers in a magnetic tape supplied by a regional wholesaler. External quality was measured by comparing the NDC numbers on the containers of items from the shelf sample with the corresponding information in the NDCD tape. More than 300 discrepancies among the four types of records were discovered, and more than 100 "illegal" characters were present in each of the four record types. Matches on the NDCD tape could be found for 80% of the items in the shelf stock sample and 69.5% of the items in the tape supplied by the wholesaler. A total of 156 errors were discovered when the codes on containers in the shelf sample were matched with the NDCD tape information, yielding an error rate of 6.5%. Because of the 6.5% error rate, the usefulness of the NDCD tape is questionable. Since only 80% of an off-the-shelf sample of drugs had matches on the NDCD tape, about 20% of drug products would have to be matched with some other information source. How these figures for the NDCD tape compare with figures for proprietary tapes is not known.

Drug Information Services↗
PubMed1987

Hospital diversification: bibliography on pharmaceutical services.

A pharmacy diversification bibliography is presented. The bibliography includes a selection of references to descriptive reports, research papers, editorials, letters, and commentaries on diversified pharmaceutical services. This bibliography represents important literature from the past 12 years on diversification strategies as well as specific diversified services. For additional information, references have also been included to articles that suggest opportunities for diversification, describe pharmacists' roles in specific services, discuss legal or reimbursement aspects of a service, or could be used to help justify the implementation of a service or "sell' a service to hospital administrators or consumers. The bibliography can be helpful to pharmacy managers and clinicians who are interested in becoming involved in diversification of pharmaceutical services.

Bibliographies as Topic↗
PubMed1986

National survey of hospital pharmacy facilities: introduction.

This paper introduces three articles that report results of a national survey of hospital pharmacy facilities conducted in July 1982. A historical perspective of pharmacists' involvement in facilities planning and examples of internal and external factors influencing the optimal design of hospital pharmacies are presented. The survey aimed to identify and describe existing hospital pharmacy facilities, the adequacy of existing facilities, the anticipated need for facilities, and the processes used for planning facilities. These baseline data can be used in the future as a starting point for developing updated model plans for hospital pharmacies and recommending improvements in the planning process.

Data Collection↗
PubMed1986

National survey of hospital pharmacy facilities: planning and design experience.

Recent major renovation or construction programs of hospital pharmacy facilities and pharmacists' involvement in the planning process for those new facilities are described. A 12-page questionnaire was sent in July 1982 to the chief pharmacists in a random sample of 1846 hospitals in the United States stratified by 10 hospital types. The percentage of hospitals of each type involved in an ongoing or recent (within the preceding 10 years) major renovation or construction project of all or part of the pharmacy was determined. Of those respondents having an ongoing or recent major project, the extent and timing of pharmacists' involvement in the planning process were determined for hospitals of each type. The response rate was 45.6%, and the respondents were representative of the population. Thirty percent of all hospitals had not altered their pharmacy facilities within the preceding 10 years. Nonprofit general medical-surgical hospitals and federal hospitals had the highest percentages of recent projects (78% and 79%, respectively); projects were more likely to involve a new pharmacy facility than remodeling. In 1982, 27% of all respondents had a major pharmacy facilities project under way. Of respondents with an ongoing or recent project, 38% were asked to propose needs for new pharmacy facilities, 45% served on the planning team, and 20% anticipated the need for new facilities; space and location were predetermined without pharmacist involvement in 25% of all cases. Two percent of the respondents had no notice of the deadline for finalizing plans for the new facilities; 22% had one to six months' notice, and 48% had over a year.(ABSTRACT TRUNCATED AT 250 WORDS)

Data Collection↗
PubMed1986

National survey of hospital pharmacy facilities: space allocations and functions.

Space allocations for hospital pharmacies and the demand on these facilities in terms of the external environment and functions performed are described. A 12-page questionnaire was sent in July 1982 to the chief pharmacists in a random sample of 1846 hospitals in the United States stratified by 10 hospital types. The respondents in each hospital type were categorized by variables characterizing the external environment. The mean total amount of existing pharmacy space was computed for hospitals categorized by type and number of beds, and the mean space per bed in nonprofit, for-profit, and government (federal and nonfederal) hospitals was compared. The mean space for specific pharmacy functions was determined. The response rate was 45.6%, and the respondents were representative of the population. The majority of all hospitals served only one building (67%) and had no teaching affiliation agreement (63%). Forty-eight percent of the hospitals administered medications using medication nurses; another 48% used primary or team nursing. There was little relationship between the number of beds and total space allocated for pharmacy facilities. Pharmacies had a mean of 6.9, 5.0, 7.0, and 10.6 gross square feet per bed, respectively, in nonprofit, for-profit, nonfederal government, and federal government hospitals. Space for selected pharmacy functions in the three types of general medical-surgical short-term hospitals are described. Further studies examining the relationships between space and other variables described in this article are needed to explain apparent differences in the amount of space allocated to the pharmacy department among hospital types.

Hospital Bed Capacity↗
PubMed1986

National survey of hospital pharmacy facilities: adequacy of facilities and changes planned.

The adequacy of existing space allocations for hospital pharmacy facilities and planned changes are described. A 12-page questionnaire was sent in July 1982 to the chief pharmacists in a random sample of 1846 hospitals in the United States stratified by 10 hospital types. The respondents in each hospital type and size were categorized by their perceived adequacy of existing space for pharmacy facilities and their plans for adding pharmacy functions and staff. Changes in pharmacy facilities that would improve pharmaceutical services were identified, as were planned changes in facilities. The amount of proposed space approved and not approved for pharmacies in hospitals of each type were determined. The response rate was 45.6%, and the respondents were representative of the population. Forty-nine percent of the respondents reported having adequate space. Only 35% of the respondents indicated that no changes could be made in facilities to improve pharmaceutical services. Forty-one percent of respondents planned one or more changes of some kind in pharmacy facilities; this ranged from 14% for long-term, nonprofit hospitals to 50% for long-term, for-profit hospitals. Sixty-six (8%) of the 843 hospitals had additional floor space approved and funded for the pharmacy; 71% had proposed space that was not approved. Sixty-three percent of all respondents planned new pharmaceutical functions; 56% and 42% planned an increase and no change, respectively, in the number of pharmacy staff members. Adding more space may be one way to improve hospital pharmacy facilities, but more attention also should be directed toward better use of existing space, equipment, and fixtures.

Data Collection↗
PubMed1984

Effect of an automated bedside dispensing machine on medication errors.

The effect of an automated bedside dispensing machine on medication errors was studied on a 32-bed surgical unit of an 848-bed hospital. The experimental system (McLaughlin Dispensing System) included at each patient's bedside a locked medication cabinet that was electronically programmed to allow the nurse access to doses due at a particular time. The control system was a decentralized unit dose system. A crossover study design with random assignment of subjects and treatments was used. In the 14-day study period, nurses were observed by a pharmacist for 28 five-hour periods as they administered medications on the day and evening shifts. The mean error rates were significantly different--10.6% for the experimental system and 15.9% for the control system. Wrong time errors were the most common type. No significant differences were found between day and evening shifts or workloads of individual nurses. There was no treatment order effect. The error rate was significantly lower for the automated dispensing system than for the system using unit doses dispensed from a satellite pharmacy. Automated dispensing systems may be useful in reducing errors in administration time and dose omissions.

Computers↗
PubMed1984

Consultant evaluation of a hospital medication system: analysis of the existing system.

A consultant team's evaluation of a system for distributing and controlling medications in a large teaching hospital is described. Through interviews with key personnel from administration, pharmacy, nursing, and the medical staff, an interdisciplinary research group identified problems in the reliability and response times of the hospital's existing medication system. After assessing staff expectations regarding acceptable standards for medication errors and response times and their attitudes toward proposed changes in the medication system, medication-error rates were determined using a pharmacist-observer method. Observations during 34 five-hour periods on four nursing units were conducted over a 17-day period. Medication-error rates were calculated as the frequency of medication errors during the observation period divided by the total opportunities for error (OE), which were defined as doses ordered plus unauthorized doses given. Response times for processing "now," "stat," and routine orders were also determined using work-sampling methods. The total medication-error rate for the nursing units studied was 9% excluding wrong-time errors; more than a third of doses were given more than 30 minutes before or after their scheduled administration times. Response times for "now" and "stat" orders averaged about 23 minutes, in conformance with the desired standard of 30 minutes. However, processing of routine orders required an average of two hours and seven minutes, much of which was attributed to delays in the messenger service. The basic design of the existing unit dose medication system contributed to problems in the reliability and efficiency of the system.

Attitude of Health Personnel↗
PubMed1984

Consultant evaluation of a hospital medication system: synthesis of a new system.

Recommendations of consultants for the implementation of a new medication system at a large teaching hospital are described. Based on a previous analysis of the hospital's existing drug distribution and control system that revealed problems in reliability and response time, an interdisciplinary consultant group offered 14 recommendations, which included implementation of a computerized unit dose delivery system and selected clinical pharmacy services. Functions identified for which computerization would produce the greatest benefits included maintenance of patient census data, medication order entry and retrieval, and preparation of a medication administration record for nursing. Recommendations for improving the unit dose system in the hospital consisted of increasing the number of medications packaged in true unit dose form, increasing the frequency of daily deliveries of scheduled medications, sending p.r.n. medications on an on-call basis, decreasing the lead time for preparation of i.v. solutions, and using a pharmacist-manned portable medication cart to reduce workload on the central pharmacy during peak workload periods. Clinical pharmacy services identified as having the greatest cost-benefit ratio were discharge consults, drug therapy monitoring, and drug-use review. Using information from published studies and cost data from the hospital, a net annual savings of over +152,000 was projected with implementation of these services. Improvements in the unit dose system and implementation of clinical pharmacy services were expected to result in substantial cost savings in the study hospital.

Computers↗
PubMed1984

Consultant evaluation of a hospital medication system: implementation and evaluation of the new system.

The effects of consultant-recommended modifications in a hospital medication system on medication-error rates and response times were evaluated. Fourteen recommendations for improving the medication system in a large teaching hospital were implemented to varying extents over a period of 1.5 years. The response times and medication-error rates of the newly implemented system were then measured using pharmacist-observers as was done in the old medication system. Medication-error rates were then compared on one medical-nursing unit and two surgical-nursing units both before and after implementation of the new system on the medical unit alone. Response times for routine medication orders decreased by 55% compared with the previous system; for "now" and "stat" orders, response times were reduced by 57% for orders filled from the central pharmacy and by 70% for orders filled from medication carts on the nursing units. No significant differences in medication-error rates were found when the old and new medication systems were compared. This finding was attributed primarily to the hospital's failure to implement recommendations related to computer printing and sorting of orders, use of dispensing envelopes for delivering medications in true unit dose form, and packaging of all medications in unit dose form. This study illustrates how the benefits of a unit dose system can be compromised in implementation and the need for close monitoring to ensure that performance standards are maintained.

Consultants↗
PubMed1982

Pseudopharmacy practice and the future.

From the perspective of a researcher, the practice of hospital pharmacy is observed and future trends are discussed. Society is changing rapidly, and hospital pharmacy must seek innovative responses. In the past, hospital pharmacy has sometimes responded with pseudopharmacy--a term coined for paying lip service to implementing innovative pharmacy programs. Unit dose dispensing is used as an example of an innovative response that has been implemented in a manner that is inconsistent with the results of original study. Visions of several aspects of hospital pharmacy in the future are presented. Hospital outpatient pharmacies may be designed and run like chain drug stores, or by them. The emphasis will be upon marketing of pharmacy services to the consumer and providing information on self-medication. Pharmacy practice may be physically disassembled or completely decentralized. Prescription dispensing will be completely automated. Hospital pharmacy must prepare itself to deal with such new developments quickly with positive proposals that will withstand the closest scrutiny. Pseudopharmacy can be avoided if objective feedback in the form of a continuing critical review and analysis of ASHP policies and programs is provided. It is proposed that ASHP create, fund, and operate an independent Policy Analysis Laboratory for this purpose.

Forecasting↗