Examining motives for opposition to the sole entry-level Pharm.D. degree.
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Curriculum↗
Biomedical subjects
R M Guerrero
Publications and source records attributed to R M Guerrero.
Reasons for the trend toward Pharm.D. education.
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Education, Pharmacy, Graduate↗
Pharmacist salaries and hiring practices in teaching hospitals.
A survey of selected teaching hospitals was conducted in early 1990 to determine salary ranges for pharmacist positions, salaries at which pharmacists were typically hired for these positions, differences in salary between clinical practitioner and managerial positions, and geographic differences in these salaries. Surveys were mailed to 50 members of the University Hospital Consortium (UHC) and 50 other university-affiliated and non-university-affiliated hospitals believed to be comparable to the investigators' hospital. Hospital capacity and census data, numbers of pharmacist and support staff positions, qualifications preferred and required for those positions, and salary information were requested. Data from 22 UHC hospitals and 23 non-UHC hospitals were evaluated. Relative to average daily census, UHC hospitals indicated higher pharmacist staffing levels and non-UHC hospitals reported higher support staff levels. More non-UHC hospitals than UHC hospitals (69.2% versus 43.5%) used an integrated model for delivery of clinical and distributive services. Nationally, the reported annual salaries were as follows: staff pharmacist, $34,881 to $47,906; clinical pharmacist, $37,768 to $51,564; clinical specialist, $38,905 to $55,282; supervisor, $39,905 to $54,416; assistant director, $43,554 to $58,758. Overall, typical hire rates (THRs) exceeded mean minimum salaries by about 10%. The percentages by which THRs exceeded mean minimum salaries were greatest in the West for staff pharmacist, clinical pharmacist, and clinical specialist positions and greatest in the Midwest for supervisor and assistant director positions. THRs for supervisors and assistant directors exceeded those for clinical specialists. Respondents' preferences varied regarding advanced education and training, and their actual requirements did not match their stated preferences.(ABSTRACT TRUNCATED AT 250 WORDS)
Data Collection↗
Using pharmacists' perceptions in planning changes in pharmacy practice.
Pharmacists' perceptions of and goals for clinical pharmacy services, as well as the proportion of time devoted to clinical services, were studied at one hospital as part of the process for establishing departmental goals. Three methods were used in evaluating pharmacists' perceptions of clinical pharmacy services. The first was a departmental survey. Second, staff members were asked to generate and prioritize a list of goals for clinical pharmacy services; this was done by means of an interactive, small-group process. Finally, a work-sampling study was performed that indirectly measured use of staff pharmacist and technician time. Staff pharmacists perceived that clinical pharmacy services were being provided to individual patients; however, support for these services from upper management was perceived as inadequate. Staff development had the highest priority for the further development of clinical pharmacy services. Only 19.7% of pharmacists' time was devoted to clinical services. Data from all three studies were incorporated into the development of a strategic plan that set forth long-term departmental goals and objectives. The plan includes a statement of commitment to develop management systems to eliminate deficiencies identified in the study. Among the changes in pharmacy operations introduced as a result of the survey were (1) a career-ladder system, (2) new opportunities for staff development, and (3) improved documentation systems. Surveying staff perceptions of existing services, joint goal setting and prioritization, and work-sampling studies formed the basis for the development and implementation of a new model of integrated pharmacy services at this institution.
Attitude of Health Personnel↗
Integrated patient-specific model of pharmacy practice.
The deficiencies of traditional models for the provision of clinical pharmacy services are discussed, and a patient-specific model that integrates drug distribution and clinical pharmacy functions is proposed. Traditional models have either designated specific individuals as providers of clinical pharmacy services or have combined distributive and supportive services with clinical services. In both cases, clinical services have been of secondary importance. Such models have resulted in inconsistent clinical services for which the patient is not necessarily the primary focus and have made it difficult for pharmacists to understand their mission. The lack of a well-defined primary clinical role for pharmacists has confused health-care providers and created problems for managers attempting to evaluate pharmacists and justify clinical services. The integrated patient-specific model is based on the ethical imperative that the patient must be central to any health-care endeavor. Under this model, clinical pharmacy services are of central importance and distributive services are integrated as a secondary but still very important aspect of comprehensive institutional pharmacy services. Critical elements of the integrated model include a patient-centered philosophy of practice, a definition of clinical pharmacy work, and a managerial framework. The integrated patient-specific model of pharmacy practice puts pharmacists in a professional relationship with patients and explicitly defines clinical services and priorities.
Institutional Practice↗
Self-reported work-sampling methods for evaluating pharmaceutical services.
The steps involved in designing a self-reported work-sampling study of pharmacy department operations are described. Traditional methods of work measurement include subjective evaluation, time-and-motion studies, and analysis of departmental statistics and are appropriate when the research question concerns repetitive work and when data about single activities at single points in time are sought. When institution-wide changes are being considered, a more global measurement approach is needed. Work sampling allows a manager to measure indirectly the amount of time spent by employees on work activities during a specified period. Many instantaneous observations are taken randomly or systematically to estimate the proportion of time spent on any activity. Data may be collected by trained observers or may be self-reported; self-reporting facilitates a large number of short-interval observations and allows for the reporting of cognitive activities. In designing a self-reported work-sampling study, the manager must (1) identify the study objective, (2) define the service area and staff to be studied, (3) inform all staff members to be involved, (4) define temporally relevant workload measures, (5) decide how many observations are needed, (6) decide for how long data will be collected, (7) choose between randomized and systematic sampling times, (8) define categories of work representative of staff activities, (9) design data collection forms and communicate procedures, and (10) conduct a pilot study. To interpret the results, an analysis of simple summary statistics may be more appropriate than a sophisticated statistical analysis.(ABSTRACT TRUNCATED AT 250 WORDS)
Data Interpretation, Statistical↗
Diagnosis and treatment of neuroleptic malignant syndrome.
A patient who developed neuroleptic malignant syndrome (NMS) from the use of several neuroleptic agents and the therapeutic interventions used to reverse the syndrome are described, and the clinical presentation and treatment of NMS are reviewed. Fever, leukocytosis, seizures, delirium, and elevated serum creatine phosphokinase levels developed in a 17-year-old girl who was receiving perphenazine and haloperidol. The patient was admitted to a hospital for treatment of atypical psychosis and received haloperidol and, later, thioridazine. Autonomic disturbances, altered consciousness, and muscular rigidity developed. Thioridazine was discontinued in favor of perphenazine because of anticholinergic adverse effects. Symptoms persisted despite treatment with benztropine and diphenhydramine. After the diagnosis of NMS was made, all neuroleptics were discontinued, and the patient began therapy with dantrolene sodium and bromocriptine. Dramatic improvement in the patient's condition followed. NMS has four characteristic signs: hyperthermia, muscular rigidity, altered consciousness, and autonomic dysfunction. Mechanisms believed to cause NMS include alteration of central neuoregulatory mechanisms and neuroleptic-induced imbalance between central dopaminergic and gamma-aminobutyric acid neurotransmitter systems. Bromocriptine, amantadine, dantrolene sodium, and electroconvulsive therapy have been used effectively in the treatment of NMS. NMS is a rare but potentially fatal adverse drug reaction that occurs in situations that make diagnosis difficult. Dramatic, favorable responses can be achieved with early diagnosis and appropriate treatment.
Adolescent↗