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PubMed1999

Transitions, part 1: beyond pharmaceutical care.

A systems view of the amalgamation of existing pharmacy practice models is proposed. Pharmacy's evolution is traceable as a series of stages. The stages in pharmacy's evolution have been manufacturing pharmacy, compounding, distribution, clinical pharmacy, and pharmaceutical care. Good pharmacy practice (GPP) represents an international attempt to unite various conceptualizations of practice, including pharmaceutical care. GPP in turn provides a foundation for a model to explain current and changing practice, the total pharmacy care (TPC) model. TPC combines five existing practice models: drug information, self-care, clinical pharmacy, pharmaceutical care, and distribution. TPC, as the sum of these models, asserts that there will be an ongoing need for all five existing models of practice, that the proportion of pharmacists employing each model will reflect the needs of a given health care environment at a given time, and that if changes in health care provide more opportunities for pharmaceutical care, pharmacists will shift increasingly toward that type of practice. Total pharmacy care is the delivery of a comprehensive range of services that result in the maximum possible contribution to the health of a nation's population within the limits of the health care delivery structure.

Forecasting↗
PubMed1980

Distribution and cost of drugs in a pharmaceutically decentralized health maintenance organization.

A private, free-standing health maintenance organization, Group Health of Arizona, was established with a decentralized pharmacy distribution system. A closed formulary and monthly peer review by pharmacists and physicians influence the number of prescriptions written as well as drug cost. A study was conducted to determine: the 50 most-prescribed items by number and cost; drug cost according to certain therapeutic categories; the average drug cost per prescription; the number of prescriptions dispensed per enrollee; and the cost of drugs dispensed as a percentage of wholesale cost. The objectives of the study were achieved but additional questions requiring future studies were raised.

Arizona↗
PubMed1991

Quality assurance of data collection in an aminoglycoside dosing service.

An aminoglycoside dosing service (ADS) has been in existence at the Hospital since 1984. As part of an overall Quality Assurance (QA) plan for the service, an audit was conducted to ensure that all necessary data were available to allow for proper interpretation of the serum aminoglycoside levels. The initial audit revealed complete documentation of required data in 75% of PRE-dose levels and 63% of POST-dose levels drawn. Several problems were identified: staff were not aware of procedures on how to complete the serum antibiotic level requisition forms; inaccurate assumptions of infusion times were made by pharmacists; and discrepancies were found to exist in the Hospital's Laboratory Manual and Pharmacy Intravenous Medication Manual. Corrective action was initiated through: education on proper documentation on the serum antibiotic level requisition forms through the hospital-wide distributed Pharmacy Bulletin; revision of the Hospital's Laboratory Manual and Pharmacy Intravenous Medication Manual; communication with head nurses to emphasize the need for documentation of infusion times; and active follow-up with nurses on missing information by the clinical pharmacist. A re-audit was initiated following implementation of the corrective actions. Complete documentation of required data increased to 93% with PRE-dose levels and 84% with POST-dose levels. This improvement was statistically significant (p less than 0.001).

Aminoglycosides↗
PubMed1980

Effectiveness of a cephalosporin education program--a pharmacy education program.

In October, 1977, a cephalosporin drug-use review and an educational program were initiated to maximize savings in the pharmacy budget at UCSF and to revise the formulatory to include only one parenteral cephalosporin. The results of the drug-use review were presented to the Pharmacy and Therapeutics Committee where our proposal for an education campaign to encourage appropriate dosing of cefazolin was approved. An explanatory document comparing cephalosporin costs and equivalency was developed for hospital-wide distribution. Pharmacy staffs were informed of program objectives to coordinate education efforts. Physician education was undertaken via document and personal contact with pharmacy personnel. A drug-use review one month after institution of the cephalosporin education program showed marked changes in physician prescribing habits, with greater impact on services where pharmacists were members of the medical rounding team. A change to appropriate dosage prescribing of cefazolin resulted in significant cost savings to the pharmacy budget. These findings resulted in formulary revision to cefazolin as the single cephalosporin available at UCSF. Because cefazolin is available from more than one manufacturer, we were able to obtain a lower bid price the following year, thus realizing an additional cost savings.

California↗
PubMed1990

Managing clinical pharmacy services by integrating drug information and dispensing.

Managing clinical pharmacy services in the 1990s will remain a challenge. Planning appropriate services, matching resources to workload and needs, and meeting the rapid changes in hospital diversification requires substantial pharmacy management knowledge and expertise. A key step in meeting these challenges is integrating the pharmacist's responsibilities for drug information and drug dispensing. This step ensures the provision of the highest quality clinical and distributive pharmacy services. Patient care demands it. Pharmacists will achieve their full potential if drug dispensing and information are provided as one comprehensive service.

Drug Information Services↗
PubMed1986

Patient acuity indicators as predictors of pharmacy workload.

The feasibility of using two workload indicators from a nursing patient-classification system as a means of predicting pharmacy workload was studied. Frequency data for 13 pharmacy distribution and clinical activities were recorded daily for 28 consecutive days and compared with daily data for acuity of patient illness and number of standard hours of nursing care required on nine nursing units. The strength of the associations between (1) pharmacy workload and patient acuity and (2) pharmacy workload and standard hours of nursing care was determined by linear regression analysis. Both same-day and one-day-lagged analyses were performed; the one-day-lagged analyses looked at pharmacy workload on a given day in relation to nursing workload on the previous day. A total of 252 observations were available for analysis. Pharmacy workload and same-day standard hours of nursing care were correlated most strongly, although all of the analyses yielded large coefficients of correlation. Analysis of data from individual nursing stations yielded smaller coefficients of correlation, especially for the one-day-lagged analyses. At least 73% of the variance in pharmacy workload could be attributed to variance in nursing workload. The index of patient acuity of illness and the number of standard hours of nursing care are good predictors of pharmacy workload of the same and the following days; the potential exists to use these nursing workload indicators in determining pharmacy staffing requirements.

Minnesota↗
PubMed1982

Controlled substances system change provides increased accountability.

The distribution and control systems for controlled substances were evaluated. A mail survey of other hospitals was conducted to obtain samples of control substance systems and the associated procedures. From these samples of existing programs and previous experiences with the current program, a system was designed to meet the needs of an 800-bed hospital with a decentralized pharmacy distribution system. The new distribution and control system completely replaced the prior system. Therefore, new forms and procedures were generated. The total system was implemented in a stepwise procedure in two-week increments over approximately 14 weeks until the entire hospital was converted. The new system has increased control as well as identified workload, inventory utilization, and problem areas.

Drug and Narcotic Control↗
PubMed1978

Training staff pharmacists for clinical positions.

A five-phase education and training program for establishing and maintaining the clinical competency of pharmacists in a 940-bed private, nonprofit hospital is described. In Phase 1 of the program, pharmacists are given selected textbook and journal materials in 15 study sections, each requiring 20--30 hours of the pharmacist's own time to complete. Phase 2 consists of two months of instruction in the daily clinical routine with emphasis on applying knowledge by investigating clinical problems through case presentation and by answering questions of health professionals. During Phase 3, the pharmacist is assigned to a patient-care area for two months to perform the duties of a clinical pharmacist. The pharmacist is assigned to the drug information center for two months during Phase 4. Phase 5, the year-round continuing education component of the program, consists of regularly scheduled clinical rounds, meetings and conferences. Upon completion of Phases 1--4, pharmacists selected for clinical positions provide clinical services for eight to 10 months and rotate to the pharmacy distribution area during the remaining two to four months per year. The education and training program described is important to the development and expansion of clinical services in this hospital.

Curriculum↗
PubMed1997

Using an anesthesia information management system as a cost containment tool. Description and validation.

BACKGROUND: Medical informatics provide a new way to evaluate the practice of medicine. Anesthesia automated record keepers have introduced anesthesiologists to computerized medical records. To derive useful information from the stored data requires programming that is not currently commercially available. The authors describe how they custom-programmed an automated record keeper's database to perform cost calculations, how they validated the programming, and how they used the data in a successful pharmaceutical cost-containment program. METHODS: The Arkive (San Diego, CA) automated record keeper database was programmed at Duke University Medical Center as an independent noncommercial project to calculate costs according to standard formulae and to follow adherence to Duke University Department of Anesthesiology's prescribing guidelines for anesthetic drugs. Validation of that programming (including analysis of discarded drugs) was accomplished by comparing database calculated costs with actual pharmacy distribution of drugs during a 1-month period. RESULTS: Validation data demonstrated a 99% accuracy rate for total costs of the drugs studied (atracurium, vecuronium, rocuronium, propofol, midazolam, fentanyl, and isoflurane). The study drugs represented approximately 67% of all drug costs for the period studied. CONCLUSIONS: Programming of an anesthesia automated record keeper's database yields essential information for management of an anesthetic practice. Accurate economic evaluation of anesthetic drug use is now possible. In the future, as definitive identification of best anesthetic practices that yield optimal patient outcomes and higher measures of patient satisfaction is pursued, large numbers of patients should be studied. This is only possible through database analysis and complete computerization of the perioperative medical record.

Anesthesiology↗
PubMedDate not supplied

Educating patients' families on their level.

OBJECTIVE: To provide well-written, easy-to-read, comprehensible education materials without losing sight of their medical accuracy. PARTICIPANTS AND THEIR DUTIES: Employees from all hospital departments develop first drafts. A multidisciplinary committee, patient-education program (PEP), composed of a pharmacist, dietitian, respiratory therapist, radiology technician, medical illustrator, and inpatient and outpatient nurses facilitate these handouts. Laypeople critique the readability and experts evaluate content. METHOD: Patient-education handouts are coded into one of seven divisions and tracked through the stages of writing, word processing, proofing by experts, proofing for readability, illustrating, printing, and distribution. PHARMACY PEP DESIGN: A medication template is used to standardize the format and general information that needs to be included in all medication education materials. CONCLUSIONS: Through better-written and more comprehensible educational materials, patients' families are able to understand the medical treatment being rendered, thereby easing stress and encouraging their participation in total care.

Educational Status↗
PubMed1990

Long-term care pharmacy services: a new dimension of pharmacy practice.

Pharmacists providing care to patients must have a commitment to quality patient care, have well-developed operations systems, possess refined clinical skills, and be able to effect excellent communication with the clinical and administrative staff. These attributes of pharmacy practice should exist in both the acute care and long-term care settings. Pharmacy practice in the long-term care setting, a unique position due to the everchanging definition of long-term care, may best be referred to as an alternative site for the application of contemporary pharmacy distribution and clinical systems for patient care over an extended period.

Drug Therapy↗
PubMed1986

Application of drug-use review principles to intravenous administration set use: a preliminary study.

A quantitative study of the use of intravenous administration sets in a 556-bed hospital was conducted as a first step in establishing a use-review program for administration sets. Central supply and pharmacy distribution points for i.v. administration sets were identified. Patient use of i.v. administration sets was recorded twice daily for seven-day periods on each of six patient-care units; data for all units were collected within a three-month period. Use of six common administration sets was studied. For each patient-care unit studied, the majority of sets used were of two of the six types; the specific set types differed by unit. More sets were used between the hours of 0801 and 2000. The number of sets per i.v. patient day (one patient receiving i.v. therapy on one day) was greatest in the intensive-care units. Through application of components of drug-use review, the numbers and types of i.v. administration sets used in various patient-care areas were identified.

Injections, Intravenous↗
PubMed1996

[Supervision of distribution and use of veterinary drugs in Schleswig-Holstein].

By means of drug related legislation the endowment and limits of veterinary medicines surveillance are demonstrated. The distribution of veterinary pharmaceutical products is organised in wide area structures, both in legal and illegal employment. Thus powerful monitoring can only be established by co-operation of all involved institutions. In advance, a concentration of duties in a few administrations with supraregional authorisation can take place, in particular shown here for the organisation of the recommended institutions in Schleswig-Holstein. A catalogue of typical violations und neglects indicates areas of problems at various levels of veterinary drug trade (production, distribution, pharmacy, veterinarian). A report about the performance and results of the surveillance of drug applications in animal production demonstrates the conjoint consummation of drug control in farms and specimen control on living and slaughtered animals.

Animals↗
PubMed1975

The spatial distribution of urban pharmacies.

Pharmacists are thought to play a central role in providing information and advice on health to lower income and other socially disadvantaged groups. However, recent evidence suggests that social biases exist in the spatial distribution of urban pharmacies. Such biases would severely limit the accessibility of the poor and the nonwhite to pharmacy services. To test the general nature of this evidence, we used multiple regression techniques to assess the simultaneous influence of several ecological and socioeconomic variables on the location of pharmacies in Pittsburgh and Omaha. After controlling for the influence of physicians, hospitals, commercial activity, population, and other variables thought to affect pharmacy location, we were unable to detect any evidence of a direct association between pharmacy location and the socioeconomic or demographic (other than total population) characteristics of areas in either city.

Delivery of Health Care↗
PubMed1976

Pharmacy personnel activities and costs in decentralized and centralized unit dose drug distribution systems.

Pharmacy personnel activities and labor costs directly associated with concurrent decentralized and centralized unit dose drug distribution systems in the same institution were compared. A work-sampling observation technique was used for the activity survey. Analysis of the data showed that: (1) the activities of pharmacy personnel vary significantly between the decentralized and centralized systems, (2) pharmacists in the decentralized area spent a significantly greater portion of their productive time performing therapy-related activities than did those pharmacists in the centralized system, (3) multiple staffing patterns associated with the centralized unit dose system afforded a significantly greater participation in educational activities by all pharmacy personnel staffing that area, (4) dispensing activities accounted for most nonpharmacist personnel time in both systems, and (5) based on cost/unit dose and existing staffing patterns, there was no appreciable difference in personnel labor costs associated with the two systems. However, it was determined that a considerable cost difference could be expected if the decentralized system's hours of service were equivalent to those associated with the centralized system.

Communication↗
PubMed1983

Pharmacy-based controlled substances distribution for a university campus.

A university-wide pharmacy-based controlled substances distribution system is described. The purchasing and control of controlled substances for the entire university campus is centralized in the hospital pharmacy department. The distribution system uses the concept of restricted versus nonrestricted drugs, where restricted drugs are all Schedule II controlled substances and other drugs needing restrictive control. The restricted or nonrestricted status of a drug is based upon suspected or observed abuse potential. After receipt by the pharmacy, all controlled substances and restricted drugs are stored in a vault. A 24-hour audit-disposition record system is used to control the inpatient distribution of restricted drugs, which are stored in locked cabinets on each nursing unit. In the outpatient pharmacy, a small supply of restricted drugs is stored in a locked cabinet; the inventory is reconciled weekly. Nonrestricted controlled substances, such as phenobarbital and chloral hydrate, are distributed to the inpatient satellite pharmacies and the outpatient pharmacy in the same manner as other prescription drugs. Campus practitioners and researchers order all controlled substances from the pharmacy using the appropriate order forms; each individual is responsible for maintaining a record and control system. A quality assurance program was established to review and improve the quality of service. The centralized pharmacy-based system improved the control, monitoring, and efficiency of controlled substances distribution for the entire university campus.

Academic Medical Centers↗