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PubMed1986

Achieving excellence.

The concept of achieving excellence in pharmacy through development of effective leadership is discussed. The majority of hospital pharmacy directors have had very little education and training in management and effective leadership. Yet, excellent leadership skills will be needed to transform pharmacy more completely into a health profession. The management style most likely to be effective in this era of change is one that encompasses a high regard for both people and production through shared responsibility, high participation, involvement, and commitment. The following recommendations are offered to help achieve excellence through effective leadership: the ethic of self-development must be instilled in aspiring managers; courses in human behavior, leadership, and management should be added to undergraduate pharmacy curricula; pharmacy technicians should be educated in college-based programs that focus on drug distribution; Master of Science programs in hospital pharmacy should be deleted or restructured to focus on leadership and management; regional "centers for excellence" in leadership education should be developed; general residency training should be incorporated in undergraduate education so that more advanced residencies can be offered to graduates; high-level, self-study programs in management and leadership need to be developed, and substantial research funds need to be dedicated to the study of hospital pharmacy management.

Drug Industry↗
PubMed1976

Computerized pharmacy services in a large community hospital.

A computerized pharmacy system dealing with drug distribution, clinical services and administrative services is described. Present systems, implemented for 50% of the institution's beds, are discussed fully. Future applications of the system are outlined.

Computers↗
PubMed1981

Pilferage of controlled substances in hospitals.

The incidence of pilferage of controlled substances and the systems of monitoring and surveillance of controlled substances in hospitals were studied. A questionnaire was mailed to a random samples of 285 pharmacy directors in short-term medical and surgical hospitals nationwide. Of the 162 respondents, 103 (64%) reported at least one documented or suspected case of pilferage in the past year. These 103 hospitals reported 352 separate incidence of controlled substances theft involving 11,285 dosage units. Drug diversion occurred in 76% of the hospitals with more than 100 beds and in only 28% of the hospitals with less than 100 beds. Nurses were implicated in 69% of the incidents; pharmacists and pharmacy technicians in 12%; housekeeping personnel in 4.7%; unit-ward clerks in 3.5%; and physicians in 2.4%. These incidents most frequency involved: meperidine, morphine, cocaine, oxycodone, hydromorphone, propoxyphene, pentazocine, diazepam, and codeine products. Larger hospitals, those with more frequent inventory audits, those that disperse controlled substances throughout their drug stock, and those that have more pharmacy personnel involved in the distribution of controlled substances all had a relatively higher incidence of pilferage. It was concluded that a substantial amount of pilferage of controlled substances occurs in hospitals and that more stringent methods of control and surveillance are needed.

Drug and Narcotic Control↗
PubMedDate not supplied

Effects of restricting levothyroxine dosage strength availability.

We conducted a prospective, randomized, controlled trial to assess whether hospital formulary restrictions involving limiting dosage strengths of levothyroxine affect physicians' ability to manage patients effectively and provide pharmacy cost savings in a tertiary care federal government research hospital. Thirty-three endocrinologists were randomly assigned to prescribe levothyroxine from a restrictive (dosage strengths of 25, 50, 100, 125, and 150 micrograms) or a nonrestrictive (dosage strengths of 25, 50, 75, 100, 112, 125, 150, 175, 200, and 300 micrograms) formulary through a central computer system. Their 241 respective outpatients' laboratory results and drug compliance were outcome measures. Achievement of treatment objectives was measured by thyroid function tests (free and total thyroxine, total triiodothyronine, thyrotropin), number of clinic visits, and compliance (survey method). Additional measures were drug distribution patterns, drug costs, and pharmacy inventory costs. Restriction of levothyroxine's dosage strength did not significantly alter therapeutic outcomes. However, the restricted formulary was associated with more complex dosing regimens, and resulted in no significant cost savings. It is not known whether such restriction would adversely affect the care of patients of nonspecialists. Prospective studies are required to verify presumed cost-containment measures before such measures are adopted for widespread application.

Adult↗
PubMed1989

[The pharmacy: a health resource].

In Guatemala, as is the case in many of the other Central American countries, the pharmacy is often the only health resource used outside the household. This paper analyzes knowledge, attitudes and practices of the personnel from seven pharmacies located in marginal-urban areas of Guatemala. It also studies their interaction with 3,277 users related to all diseases, specifically those related to diarrheal disease and its treatment. Findings revealed that the pharmacies' personnel handle diarrheal disease in an empirical way, using medicines to treat the cause of the diarrhea, instead of trying to prevent dehydration. There are limitations and deficiencies of knowledge and practices related to the use and abuse of non-indicative medicines, insofar as the pharmacies' personnel and users are concerned. Findings also revealed that the Oral Rehydration Salts (ORS) are not used, and prepared oral serum is used in very small amounts, because these do not fit in popular expectations of a medicine that reduces diarrheic evacuations.

Diarrhea↗
PubMed1993

Development of a pharmaceutical care system in a neonatal intensive care satellite pharmacy.

The development of a pharmaceutical care system for a neonatal intensive care unit satellite pharmacy from existing integrated clinical, distributive, and quality assurance activities is described. Components of practice already in place included pharmacotherapeutic monitoring, evaluations for childhood immunizations, monthly medication summaries, and daily follow-up on scheduled doses returned in the unit dose exchange carts. Pharmacists documented patient drug therapy consultations on a standard form. New elements of practice emphasized organization of patients' clinical data by problem, development of specific outcome-oriented standards of care for common neonatal conditions and disease states, and quality improvement activities that evaluated the appropriateness of patient monitoring and patient outcomes. Written standards of care for specific disease states improved clinical decision-making, documentation of pharmacists' performance, and communication about patient care with other health care professionals. Elements of pharmacy practice already in place may provide a good foundation for a structured pharmaceutical care system.

Documentation↗
PubMed1980

Design and implementation of a quality-assurance program for pharmaceutical services.

The design and implementation of a quality-assurance program for hospital pharmaceutical services provided by a hospital pharmacy management corporation, and the applications of this program to other hospitals are discussed. The quality-assurance program measures performance of the pharmacy department's multidisciplinary, drug distribution, sterile products, purchasing and inventory control, management, and clinical activities. Standards are defined for each area of pharmaceutical services, based on regulatory and professional standards. Each department's compliance with the quality-assurance standards is assessed annually using uniform report forms. Corrective actions are planned and implemented by the department's director based on the assessment. Consultation and peer review are provided by the management corporation. The quality-assurance program allows documentation and improvement of the quality of pharmaceutical services and assures a consistent level of services among hospitals.

Contract Services↗
PubMed1983

Pharmaceutical services in family practice medical residency training programs.

The extent and nature of pharmacists' involvement in family practice medical residency training programs was assessed using a national survey. Department chairmen of all 386 approved family practice residency training programs in the United States were contacted and asked to provide the names and addresses of pharmacists in charge of pharmaceutical services in the centers. A 46-item, six-page questionnaire was mailed to each pharmacist with a follow-up mailing, then a telephone call, to nonresponders. Department chairmen of 68 (18%) of the programs reported having at least one pharmacist in the center. Responses to the questionnaire were obtained from 53 (78%) of the pharmacists, four of whom were no longer involved with family practice centers. Most of the remaining 49 pharmacists were men (76%) between 30 and 40 years old (59%) with an academic appointment (67%) and a doctor of pharmacy degree or some type of postgraduate training. Drug-distribution services were provided in 37% of the centers. All pharmacies offered clinical services. Almost all pharmacies (92%) offered educational services to both medical and nursing staffs, and pharmacists in 74% of the centers were involved in research. Few family practice medical residency training centers have pharmaceutical services conducted by a pharmacist; centers with pharmacists have a wide variety of distributive and clinical services.

Family Practice↗
PubMed1989

National survey of critical-care pharmaceutical services.

The results of a national survey of critical-care pharmaceutical services are reported. A questionnaire was mailed on March 8, 1988, to 1500 of the 6800 U.S. hospitals with more than 100 beds. The questionnaire was divided into four sections: (1) critical-care pharmaceutical services; (2) critical-care clinical pharmacy activity; (3) critical-care pharmacy standards; and (4) general information on the hospital, including pharmaceutical services provided to patients who are not critically ill. A total of 613 usable questionnaires were returned, for a response rate of 41%. Respondents from 124 hospitals reported having a critical-care satellite pharmacy. Critical-care beds served by satellite pharmacies were more likely to have unit dose drug distribution services than were critical-care beds not served by satellite pharmacies. The level of clinical and educational services provided to critical-care patients was significantly lower for intensive-care unit (ICU) pharmacists practicing in satellite pharmacies than it was for ICU pharmacists not associated with satellite pharmacies. There were no differences between satellite and nonsatellite ICU pharmacists in either the percentage of a typical day spent providing clinical services to critical-care patients or the percentage of critical-care patients receiving those services. Respondents expected their hospitals to add 301 full-time-equivalent critical-care pharmacists to their staffs during the next two years, for a 39% increase. Respondents strongly favored establishing 24-hour unit dose drug distribution and i.v. admixture services, providing inservice education to nurses and physicians, and providing written pharmacokinetic consultations.(ABSTRACT TRUNCATED AT 250 WORDS)

Critical Care↗
PubMed1977

Health care and hospital pharmacy in Sweden.

Health care and hospital pharmacy in Sweden are discussed. The system of drug distribution in Sweden is reviewed, and the following functions of hospital pharmacies are discussed; drug and hygiene committees, inspection activities, drug information and educational services, radiopharmacy, and research activities. Pharmacy education, drug manufacturing, and Apoteksbolaget--The National Corporation of Swedish Pharmacies--are also discussed. Future developments in hospital pharmacy are expected to include increased sales to outpatients, a restructuring of the drug supply within outpatient care and recommendations from the hospital drug committees on outpatient care.

Delivery of Health Care↗
PubMed1989

Pharmacy dispensing practices for Sudanese children with diarrhoea.

In order to study the dispensing practices of Khartoum and Khartoum North pharmacies with respect to the management of infantile diarrhoea, a Sudanese woman presented pharmacists with a brief description of an infant with acute diarrhoea. Sixty-three pharmacies were visited; only 3 (5%) recommended oral rehydration salts (ORS) alone. An additional 4 pharmacies (6%) recommended ORS plus either an antimicrobial agent or a physician visit. 39 pharmacies (62%) recommended antimicrobial therapy alone, 9 (14%) recommended a physician visit alone and 7 pharmacies (11%) had no available treatment. On average, antimicrobials cost four times more than two packets of ORS. In order to increase pharmacists' recommendation of ORS, health professional training may be required, perhaps in association with dispensing subsidies. Increased public awareness of ORS should also be encouraged.

Adult↗
PubMed1998

Disease management in the alternate-site health care setting.

The role of pharmacies that specialize in the treatment of specific chronic diseases in the alternate-site health care setting is discussed. The optimal use of medications through disease management programs can improve patient outcomes and lower overall health care costs. The increase in disease management programs has spawned the growth of disease-specific pharmacies in the home care and other alternate-site health care settings. These pharmacies usually operate from a single location or are regionalized operations that deliver pharmaceutical products to patients throughout the United States. The pharmacies employ clinicians who specialize in a particular disease. These clinicians conduct comprehensive patient education programs, drug-use review, and compliance monitoring. Disease management pharmacies focus on chronic, expensive diseases; costs related to inventory, equipment, and storage can be very high. Many disease management pharmacies are involved in preferred-distribution or closed-distribution arrangements with pharmaceutical manufacturers. Pharmacists involved in disease management programs routinely send compliance information about their patients to pharmaceutical companies, managed care organizations, or prescribing physicians. Disease management pharmacies act as advocates for patients with particular chronic diseases. Various foundations and patient advocacy and research groups have created their own disease management pharmacies. Disease management has also reached the community pharmacy practice setting. Pharmacies specializing in the treatment of specific chronic diseases in the alternate-site health care setting can improve health care and promote efficient use of health care dollars.

Chronic Disease↗
PubMed2004

Quality safeguards and regulation of online pharmacies.

Using econometric evidence, this article confirms that distribution of medicines online is split into two market segments of very diverse quality, and identifies the factors that drive quality and quality assurance in this activity. Unlike fraudulent, 'rogue,' websites, which offer scant guarantees and usually sell just a few medicines without prescription, online pharmacies offering insurance coverage and linked to conventional pharmacies typically sell a whole range of drugs, require third-party medical prescriptions and provide abundant information to patients. It is shown that, where online pharmacies are allowed to act legally, market forces enhance quality, as private insurers require professional standards, and specialized third parties make a business of certifying them. Furthermore, older online pharmacies and those running conventional operations offer higher quality, probably because of reputational investments. Overall, this evidence supports licensing online pharmacies, especially considering that prohibiting them is ineffective against fraudulent sites.

Commerce↗