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PubMedDate not supplied

Computer simulation as a basis for pharmacy reengineering.

Using computer simulation can enhance the management decision-making process. Simulations can predict the effects on cost and quality of services. This article discusses the use of computer simulation to assist in planning the reengineering process to change a hospital's drug distribution from a decentralized pharmacy satellite system to a centralized robotic drug dispensing system. Because computer simulation was based on a fixed set of circumstances, circumstances changed before system implemented. Nursing and pharmacy staff and line managers were involved in the review, planning, and implementation that resulted in positive economic and quality outcomes for this project. For organizations to achieve successful change, administrators must play an active and essential part.

Computer Simulation↗
PubMed1981

Guidelines for safe handling of cytotoxic drugs in pharmacy departments and hospital wards.

The Specialty Practice Committee on Parenteral Services is one of a number of subcommittees of the Federal Council of The Society of Hospital Pharmacists of Australia (SHPA) having responsibility for development of professional practice in particular areas, such as drug distribution, drug information, clinical pharmacy, radiopharmaceuticals, and a number of others. Parenteral Services has been, perhaps, the major area of growth in Australian hospital pharmacy over the last three years. The pattern of growth of Australia has deviated somewhat from that which has emerged in the United States. Whereas the typical I.V. admixture service is relatively uncommon in Australian hospitals, the emphasis is towards specialization into Parenteral Nutrition and Oncology Support Services. Developments in Oncology Support have been particularly rapid, with many pharmacists becoming exclusively involved in this specialty. Concern is felt that operators intensively reconstituting and preparing cytotoxic drugs may be at risk from a variety of factors. Australian hospital pharmacists share the growing international opinion that this work is potentially hazardous and that safety guidelines governing every aspect of handling these substances are urgently required. The Specialty Practice Committee on Parenteral Services has conducted a study of safety aspects of this work as its major project for 1980 and has produced the document presented below. This is an official statement of the Society of Hospital Pharmacists of Australia.

Accident Prevention↗
PubMed1996

The role of commercial nuclear pharmacy in the future practice of nuclear medicine.

It has been estimated that today 70% to 80% of all radiopharmaceutical doses are dispensed through commercial nuclear pharmacy channels. These services are provided by the approximately 250 facilities in the United States, with some multisite corporations dispensing in excess of 20,000 unit-dose prescriptions per day. As pressures mount within health care institutions to reduce manpower, increase cost-effectiveness, increase participation in managed care contracts, and to seek outside vendors for many services that were previously provided in-house, the future role of the commercial nuclear pharmacy in the practice of nuclear medicine will only continue to increase. The essence of nuclear pharmacy practice is the dispensing of a full range of high quality radiopharmaceuticals in patient-specific unit doses. These doses must be delivered in a timely and cost effective manner, without compromising quality or patient safety. Commercial nuclear pharmacies have expanded to provide such varied functions as radiation safety and waste management, as well as consultative and marketing activities directed towards clinicians within a nuclear medicine practitioners own facility. In-service continuing education programs directed towards physicians and technologists are frequently offered by many commercial nuclear pharmacies. Changes in health care economics, merging and down-sizing in the hospital industry, and the overall impact of managed care on the viability of hospitals in general has resulted in slow growth, or even a small decline in the number of institutionally based nuclear pharmacists. As a result, nuclear medicine practitioners will be looking to the commercial nuclear pharmacies to meet a larger portion of their radiopharmaceutical needs, as well as to value added services, such as education and research and development. Specialized practice settings, such as nuclear cardiology and free-standing nuclear medicine clinics, are especially well suited to the services provided by commercial nuclear pharmacies. Involvement in the distribution of positron-emission tomography radiopharmaceuticals will continue to increase regardless of the results of current regulatory debates on this issue. In the future, nuclear medicine practitioners will look to the commercial nuclear pharmacies for an increasing portion of their radiopharmaceutical needs and the industry should be ready and able to meet these demands in a safe, timely, and cost efficient manner.

Costs and Cost Analysis↗
PubMed1988

Interdisciplinary committee on infusion-control devices: managing product use.

The development of an interdisciplinary approach to the management of infusion-control devices (ICDs) in a university teaching hospital is described. An ICD committee composed of staff from the pharmacy, nursing, bioinstrumentation, and materiel management departments was created to identify and solve problems with the existing system of ICD management. These problems included untimely delivery of malfunctioning ICDs to the bioinstrumentation department for repairs, chronic shortages of ICDs, inappropriate use of these devices, and lost charges for ICDs and cassettes. The committee decided on joint control of the ICD program by the pharmacy and nursing departments. Guidelines for appropriate use of ICDs were developed and distributed to all nursing units and pharmacy satellites. The pharmacist was responsible for screening requests for ICDs to determine whether they conformed to those guidelines. New policies for delivery of malfunctioning ICDs to the bioinstrumentation department resulted in improved turnaround time for repairs. Responsibility for billing was shared by the pharmacy and nursing departments. These changes resulted in increased availability of ICDs for patient use and an increased charge capture of $247,000 per year. Through the combined efforts of the pharmacy and nursing departments in this institution, the distribution and collection of ICDs has been made more efficient and lost patient charges have decreased.

Chicago↗
PubMed1995

Comprehensive services in an ambulatory care pharmacy.

The development of a comprehensive model of pharmacy practice in an ambulatory care setting is described. From 1991 to 1994, the department of ambulatory care pharmacy services at The University of Illinois at Chicago Medical Center converted its main outpatient pharmacy into a Pharmaceutical Care Center to serve as a model for community and hospital-based ambulatory care pharmacy services. The Pharmaceutical Care Center includes a waiting area, five private patient-assessment rooms, an examination room, a place for reviewing patient profiles and reference materials, space for storage and automation, an i.v. admixture area, a conference room, and office space. It serves 120-150 patients per day (10% just discharged from the hospital, 90% seen in the clinic system). Pharmacy clerkship students and residents, under the oversight of faculty, conduct patient assessments, educate patients and family, monitor outcomes, and intervene when drug-related problems are detected. Patient assessments and therapeutic interventions are documented in the patient's medical record. Computers, automated medication filling, and technical support are used to enable pharmacists to concentrate on patient care. A model ambulatory care pharmacy provides both drug distribution and direct patient care services.

Academic Medical Centers↗
PubMed2003

Diagnosis and treatment of presumed STIs at Mexican pharmacies: survey results from a random sample of Mexico City pharmacy attendants.

OBJECTIVES: People in developing countries often seek medical advice for common ailments from pharmacies. As one example, pharmacists routinely diagnose and treat symptomatic sexually transmitted infections (STIs). We aimed to assess the quality of advice provided in Mexico City pharmacies by presenting hypothetical STI related syndromes and recording pharmacy attendants' suggested diagnoses and treatments. METHODS: We interviewed the first available attendant in each of a 5% random sample of Mexico City's pharmacies. We inquired about the training, age, and experience of the attendant and about the typical number of clients coming for treatment of suspected STIs. After considering three hypothetical case studies, attendants recommended diagnoses, treatments, and, sometimes, physician follow up. RESULTS: Most Mexico City "pharmacists" are actually clerks, with trained pharmacists rarely available on the premises. The average pharmacy attendant was 32 years old, with a median of 5 years' experience at that pharmacy, but very limited (if any) training. 62% reported seeing 10 or more clients with genital or vaginal infections per month. Depending on the case study, attendants provided appropriate diagnoses in 0-12% of cases, recommended appropriate treatments in 12-16% of cases, and suggested physician follow up for 26-67% of cases. CONCLUSIONS: In general, surveyed pharmacy personnel were unable to diagnose accurately or offer appropriate treatment advice when presented with classic, common STI symptoms. Given the volume of clients seeking advice from this source, training pharmacy attendants could significantly help to reduce the burden of disease associated with STIs in Mexico City.

Adolescent↗
PubMed1999

[The organization of pharmaceutical supply in Wielkopolska in the period from 1945 to 1998].

The Archive of the Poznan CEFARM, located in a three-story building at 15 Mostowa St. in Poznan, comprises a collection, difficult to assess in terms of its size, which documents the operations of pharmacies in Wielkopolska within nearly 50 years. A small part of this collection, i.e. only approximately 8-10 running meters of archives, constitutes the documents of management boards (which appear under different names) of entities which acted as a head-office for the pharmacies. Archives filed in portfolios and paginated documents are of diverse historical value. Numerous balance sheets indicating the execution of plans above the expected limits are less valuable. However, the minutes from the meetings of the boards of directors and the boards of the Trade Unions of the Medical Care Organization's employees as well as as post-audit reports of the Chief Board of Supervision are quite useful for a historian. The statistical data presenting the development of this entity and the reporting pharmacies sometimes Missing documents on the operations of the Independent and Autonomous Trade Union "Solidarity" from the periods 1980-1981 and 1989-1990 are a characteristic phenomenon. They were lost in unexplained circumstances. The organization of pharmaceutical supply in Poland in 1945-1998 is an interesting issue for research, since the State's political and economic system changed twice in this period. The abolition of private ownership in pharmacy and in the wholesale distribution of medicines, medical materials and sanitary goods in 1951 and the democratic changes commenced with the Round Table Negotiations in 1989 significantly influenced the system of pharmaceutical supply, which proves its strong dependence on politics. In 1945-1951 the system was characterised by excessive development of central and provincial administration, comprehensive reporting and, following the Soviet Union, the application of principles of central planning and central management. The establishment of the state's monopoly in the area of wholesale and retail distribution of medicines did not result in the considerable development of the network of pharmacies and increased availability of medicines expected by the society and proclaimed by the authorities. It was typical that the State-owned pharmaceutical wholesalers, existing in 1951-1989, aimed at indoctrinating their staff through a broad offer of social benefits available in a wider range for those persons who participated in welfare work and other profession unrelated activities of ideological nature.

Archives↗
PubMed2004

Patients' use of GPs and community pharmacists in minor illness: a cross-sectional questionnaire-based study.

BACKGROUND: Despite pharmacists having increased involvement in managing minor illness, many patients continue to attend their GP with problems that could be managed by community pharmacists. OBJECTIVE: Our aim was to investigate the prevalence of visits to the GP that GPs felt could be managed by a pharmacist, and to explore patients' reasons for such visits. METHODS: This cross-sectional questionnaire study was conducted at 13 general practices in West Sussex, UK. A questionnaire was given to all patients attending appointments with their GP in these practices over a 1-week period, asking what the presenting problem was and whether the advice of a pharmacist had been sought. If patients had not sought the advice of a pharmacist, they were asked why not. The GP was then asked to indicate whether, in their opinion, the patient's problem could have been managed by a community pharmacist. RESULTS: The response rate was 94% (3984), representing 87% of all patients consulting their doctor during the week of the study. GPs felt that only 7% (260) of these visits could have been managed by a community pharmacist. The proportion of 'unnecessary' visits was significantly higher (P < 0.001) amongst young adults, those presenting with new medical problems and those consulting about a child's health. Skin and musculoskeletal problems were the most common causes of 'unnecessary' visits to the GP. The majority of patients making 'unnecessary' visits (59%) disagreed with the GP and felt that the pharmacist would not have been appropriate for their problem. CONCLUSIONS: GPs and patients were, on the whole, in agreement over which conditions were appropriate for GP attention. There is, however, a need for education to increase awareness of the roles of pharmacists, aimed particularly at young adults and at those with children.

Adult↗
PubMedDate not supplied

A community-based clinical pharmacy teaching, research, and service program in Zimbabwe.

In an effort to optimize limited resources, a community-based clinical pharmacy program was initiated to promote service, teaching, and research. This program sponsored the recruitment of pharmacy personnel to carry out distributive and clinical functions. This service enabled the development of new clinical attachment sites for pharmacy students. Students on these attachments carried out supervised projects that enhanced their learning while providing essential services to the community. This program resulted in the enhancement of stock levels of drugs and medical equipment, improvement in the drug budget through on-site manufacturing and proper stock management, and the creation of a favorable working partnership with other health professionals as well as the community. A number of research projects were initiated and completed, and a teaching program was established. This program demonstrated that integration of the triple functions of clinical pharmacy service, teaching, and research is feasible in a rural setting and can achieve goals that are mutually beneficial to all facets of the pharmacy profession.

Education, Pharmacy↗
PubMed1978

Hospital pharmacy in Australia.

Hospital pharmacy practice in Australia is reviewed. Topics covered include pharmaceutical education, drug distribution, purchasing of pharmaceuticals, and hospital pharmacy staffing and services. Australia has a national health insurance system which directly affects both community and hospital pharmacy practice. While traditionally Australian hospital pharmacy practice has followed the British system of drug delivery, practitioners have tried to introduce innovations such as intravenous admixture services, unit dose drug distribution systems and drug information services. The limitations imposed by restricted governmental funds have inhibited the introduction of innovations. The Society of Hospital Pharmacists of Australia offers a continuing education correspondence course which leads to the granting of a Fellowship in Hospital Pharmacy.

Australia↗
PubMed2003

The use of pharmacy immunization services in rural communities.

Pharmacies have been recommended as alternative sites for the delivery of immunization services, especially to medically underserved adults and children in inner cities and rural areas. Currently, 35 of 50 states in the USA have legalized the administration of vaccines by pharmacists on the basis of certain training requirements and specific protocols. Since the role of pharmacists is expected to expand, it is important to assess the factors that would enable them to improve the delivery of immunization services and the acceptance of these services by communities. It is particularly important for pharmacists to have knowledge of community circumstances and be able to respond to community needs. This case study of a pharmacy immunization programme (PIP) in rural West Virginia assessed how well pharmacists were aware of community circumstances and which community factors affected the utilization of pharmacy-delivered immunizations. Our findings suggest that although pharmacists played important roles as facilitators, hosts and motivators in PIP, they overestimated the trust placed in them by community members. The convenient locations of pharmacies and the convenient times when they offered immunization services were found to be the determining factors of mothers' decisions to take their children to these places for their vaccinations. The study concludes that as the use of pharmacies as sources of immunization is expected to continue to expand, pharmacists should take these factors into consideration when they decide to offer immunizations.

Chi-Square Distribution↗
PubMed1999

Acute isoniazid exposures and antidote availability.

BACKGROUND: Over the past 10 years the reported incidence of acute isoniazid (INH)-related poisonings has increased, with 507 cases reported in 1996. Parenteral pyridoxine is the antidote for INH-induced seizures, but 5-g aliquot recommended to treat an ingestion of unknown quantity of INH is not always readily available to emergency physicians. OBJECTIVE: To determine the hospital availability of pyridoxine. METHODS: One hundred thirty questionnaires were distributed nationwide to the pharmacies and emergency departments (ED) of hospitals containing pediatric emergency medicine (PEM) fellowships and/or emergency medicine (EM) residencies. Questions were posed regarding the availability, quantity, location, and deemed importance of pyridoxine at each institution. RESULTS: Responses were received from 81% of the hospitals with fellowships and 80% of the hospitals with residencies. Half of the former and one third of the latter reported not having the recommended 5-g aliquot available. Eighty percent of the hospitals with PEM programs and 71% with EM residencies with an adequate stock store it in the hospital's pharmacy, as opposed to in the ED. Thirty-four states were represented, 18 of which have experienced an increase in tuberculosis (TB) from 1993 to 1994; 6/18 (33%) of those did not have the pyridoxine available, and 7/18 (39%) did not deem it necessary. CONCLUSIONS: Our results imply that between one third and one half of the respondents would be ill-equipped to treat acute INH neurotoxicity. Establishing regional distribution centers may alleviate this deficiency, specifically in urban areas with a high incidence or a positive percent increase in TB.

Acute Disease↗
PubMedDate not supplied

Predicting tobacco sales in community pharmacies using population demographics and pharmacy type.

OBJECTIVE: To determine whether the population demographics of the location of pharmacies were associated with tobacco sales in pharmacies, when controlling for pharmacy type. DESIGN: Retrospective analysis. SETTING: Iowa. PARTICIPANTS: All retailers in Iowa that obtained tobacco licenses and all pharmacies registered with the Iowa Board of Pharmacy in 2003. MAIN OUTCOME MEASURE AND INTERVENTIONS: Percentage of pharmacies selling tobacco (examined by pharmacy type using chi-square analysis); median income and distribution of race/ethnicity in the county for pharmacies that did or did not sell tobacco (t tests); predictors of whether a pharmacy sold tobacco (logistic regression using the independent variables county-level demographic variables and pharmacy characteristics). RESULTS: County gender composition, race/ethnicity make-up, and income levels were different for tobacco-selling and -nonselling pharmacies. Logistic regression showed that whether a pharmacy sold tobacco was strongly dependent on the type of pharmacy; compared with independent pharmacies (of which only 5% sold tobacco products), chain pharmacies were 34 times more likely to sell tobacco products, mass merchandiser outlets were 47 times more likely to stock these goods, and grocery stores were 378 times more likely to do so. Pharmacies selling tobacco were more likely to be located in counties with significantly higher numbers of multiracial groups. CONCLUSION: The best predictor of whether an Iowa pharmacy sells tobacco products is type of pharmacy. In multivariable analyses, population demographics of the county in which pharmacies were located were generally not predictive of whether a pharmacy sold tobacco.

Commerce↗
PubMed2006

Pharmacy access to emergency contraception in California.

CONTEXT: California is one of eight states that allow a woman to obtain emergency contraceptives from a pharmacy without a physician prescription. Because many women do not know about emergency contraception or direct pharmacy access, it is important to understand barriers to getting the method and women's reasons for choosing the pharmacy option. METHODS: In a 2004 survey at 25 predominantly independent pharmacies across California that offered pharmacy access, 426 women completed questionnaires after obtaining emergency contraceptives. They were asked about their reasons for seeking the method, the time of unprotected intercourse, barriers to access, how they learned about pharmacy access and their reasons for choosing it. Chi-square tests and analysis of variance were used to assess differences between subgroups. RESULTS: Eighty-six percent of women wanted emergency contraceptives for immediate use, and women obtained the method an average of 36 hours after unprotected intercourse. Those younger than 16, those who had had unprotected sex on the weekend and those who were embarrassed to ask for the method or who did not know about it all took a longer time to get the medication than did their respective comparison groups. Women who chose pharmacy access did so because they thought it was faster (54%) and more convenient (47%) than seeking a physician prescription. The majority reported that talking to a pharmacist was very helpful (84%) and that it was very important to be able to get the method directly from a pharmacy (81%). CONCLUSIONS: Increasing women's knowledge about emergency contraception and its availability directly from pharmacies has the potential to improve the effectiveness of this contraceptive method by reducing the time interval between unprotected intercourse and initiation of treatment.

Adolescent↗
PubMed1985

National survey of hospital pharmaceutical services--1985.

The results of a 1985 national mail survey of pharmaceutical services in short-term hospitals are reported and compared with similar surveys conducted in 1975, 1978, and 1982. A sample of 809 hospitals was selected randomly from among the estimated 5480 U.S. short-term hospitals that employ a pharmacist on at least a part-time basis. The survey had an 84.6% response. Fewer than 10% of respondents did not have and were not planning for unit dose systems. The percentage of hospitals with complete or partial pharmacy-based i.v. admixture services increased since 1982 from 67.4% to 80.6%. More than half the respondents said floor-stock i.v. solutions were distributed by a department other than pharmacy. Only about half the respondents had both unit dose drug distribution and i.v. admixture services. Prime vendors were used by 87% of small hospitals, 75% of medium hospitals, and 51% of large hospitals. The percentage of pharmacies involved in patient monitoring increased from 27% in 1982 to 44% in 1985. The survey also collected data on other clinical services, computerization, inventory turnover, use of prime vendors, and selection of therapeutic alternates. Drug distribution services are improving, but the distribution of injectable drugs often is not under pharmacy control. Only 10% of respondents had comprehensive pharmaceutical services, defined as complete unit dose drug distribution and i.v. admixture services plus three or more clinical services.

Computers↗