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PubMed1999

Once- versus twice-daily gentamicin dosing in neonates >/=34 Weeks' gestation: cost-effectiveness analyses.

OBJECTIVES: To compare performance and cost analysis of two gentamicin regimens in infants >/=34 weeks' gestation requiring antibiotics for a 72-hour rule-out sepsis evaluation. A once-daily dosing (ODD) regimen of 4 mg/kg was compared with a standard twice-daily dosing (TDD) regimen of 2.5 mg/kg every 12 hours. SETTING AND DESIGN: Infants at two university-affiliated Level III nurseries were prospectively temporally allocated to receive ODD (n = 27) or TDD (n = 28) as part of their 72-hour empirical antibiotic regimen. Performance of dosing regimens was based on target serum gentamicin concentrations (SGC) established prospectively as a peak of 5 to 10 microgram/mL and a trough of </=2 microgram/mL. SGC were determined by fluorescence polarization immunoassay on day 3 of therapy. Cost data were obtained by distributing a questionnaire to 15 pediatric pharmacy practice sites. Inquiries were made regarding hospital cost of drug acquisition, drug supplies, drug preparation and administration, and serum concentration analysis. Performance and cost data were then used to do a cost-effectiveness analysis. RESULTS: Mean peak concentrations were higher with ODD (7.9 +/- 0.2 microgram/mL) than TDD (6.7 +/- 0.3 microgram/mL). Half of the patients in the TDD group had trough concentrations >2 microgram/mL, compared with none in the ODD group. Overall, 57% of the SGCs in the TDD group were outside the target concentration range versus 7% in the ODD group. Based on questionnaire results, a total 72-hour process cost of ODD versus TDD was compared for regimens with and without use of SGC analysis. If SGCs are obtained, more than 75% of the cost associated with gentamicin therapy is attributable to SGC analysis. Based on a cost-effectiveness analysis, ODD was the dominant dosing strategy in all categories analyzed. CONCLUSIONS: ODD of gentamicin at 4 mg/kg in neonates >/=34 weeks' gestation is the preferable treatment strategy based on: 1) significantly improved SGC performance compared with TDD; 2) elimination of the need for routine SGC collection in infants on short courses of therapy; and 3) significant antibiotic-associated hospital cost savings when compared with conventional therapy of TDD and SGC analysis.

Cost-Benefit Analysis↗
PubMed1999

Women and men managers in pharmacy: gender issues.

This paper examines the backgrounds, behaviours, and attitudes of a representative sample of male and female pharmacy managers in Ontario, Canada. It shows that the female managers are younger than their male colleagues, and spend significantly more time on childcare activities. There were no differences between the male and female managers in terms of work commitment and job responsibilities, but the female managers spent more time in direct patient contact, an activity that the qualitative analysis indicated was important to them. Female managers were also more supportive of strategies that would encourage additional patient counseling. For faculty in health administration programs, the results suggest that the importance that females place on the psycho-social aspects of their jobs as managers needs to be recognized and supported in the development and delivery of courses of study.

Administrative Personnel↗
PubMed2002

Understanding patient perceptions of asthma: results of the Asthma Control and Expectations (ACE) survey.

In spite of support among UK healthcare professionals for asthma guidelines, studies continue to show that many patients fail to reach the suggested management goals. Patient expectations and poor communication may be factors in this failure. This survey assessed patients' asthma control, expectations in respect of asthma and communication with healthcare professionals. A structured questionnaire, designed for self-completion, was developed and distributed to asthma patients at participating pharmacies. A total of 1031 questionnaires were returned. Most of the respondents, even among those feeling well, reported lifestyle restrictions because of asthma. These restrictions were not generally discussed with healthcare professionals. One-third did not perceive the benefits of inhaled corticosteroids. Low expectation may be a major contributor to the poor control seen in this survey. The failure to discuss lifestyle restrictions and symptom levels with healthcare professionals gives little scope for recommendation of appropriate and adequate treatment. Improved communication between healthcare professionals and patients may help such understanding and raise patient expectations.

Adolescent↗
PubMed1984

Applying for a certificate of need for unit dose and i.v. admixture services in a Connecticut hospital.

The process of obtaining regulatory-agency review of a proposal for unit dose and i.v. admixture services is described. In a 901-bed community hospital in Connecticut, a pharmacy department proposal for instituting unit dose distribution and expanding the i.v. admixture service was supported by the hospital administration and included in hospital budget projections. A state body that regulates hospital revenues, the Commission on Hospitals and Health Care (CHHC), rejected the proposal for these changes in pharmaceutical services. The pharmacy and hospital administration subsequently petitioned the Health Systems Agency in that jurisdiction for a certificate of need (CON); the procedure required that the application also be simultaneously submitted to CHHC. Implementation of the program over a three-year period was proposed. The CON application was submitted in July 1981; it required detailed information from pharmacy, nursing services, and hospital administration. During the nine months following application for the CON, further questions were asked and five hearings were held. In April 1982, CHHC approved the program and the capital expenditures but did not approve the proposed 10% increase in drug revenue needed to support the services. The hospital ultimately committed funding for implementation of the program over three years. The net result of the application procedure was a delay in implementation of expanded pharmaceutical services.

Certificate of Need↗
PubMed1981

Implementation of a modified decentralized drug distribution system with the use of master medication carts.

A decentralized drug distribution system with the use of master medication carts was implemented. This system was designed so that roving pharmacists could dispense new medication orders quickly and develop a more personal means of nurse-pharmacist interaction for the benefit of better patient care. The key to the system using roving pharmacists is a master medication cart, a pharmacy dispensing unit on wheels, which travels to each nursing unit. The pharmacy medication profiles are kept with the cart, and at each nursing unit patient medication profiles are reviewed, new drug orders are filled, missing medications and discrepancies are resolved, and nurse-pharmacist consultations can take place. There are two roving pharmacists who make simultaneous rounds of all nursing units in the hospital with two similarly stocked master medication carts from 9 A.M. to 9 P.M., seven days a week. All unit dose drawers are filled in the central pharmacy and are exchanged once daily at 2 A.M. by the night pharmacy technician. Each master medication cart carries about 300 different medications, which comprise nearly 95% of the drug needs of the 340 patients served by the two medication carts. The pharmacy department has added 1.4 Full-Time Equivalent (FTE) registered pharmacists and eliminated 2.8 FTE pharmacy messengers in implementing the decentralized drug distribution system. Currently, three registered pharmacists per day are assigned to the inpatient unit dose drug distribution system (two roving pharmacists and one unit dose filling pharmacist). Our roving pharmacists play a vital role in improving patient care. The overwhelming support by the nursing and medical staff represents an attempt by the hospital to continue to provide an optimal health care delivery system.

Colorado↗
PubMed1993

Continued cost justification of an operating room satellite pharmacy.

Cost justification for the establishment and continued operation of an operating room satellite pharmacy is described. Establishment of an operating room satellite pharmacy can be justified based on the need to recover lost revenue, regulate controlled substances, monitor inventory, and enhance communication between operating room personnel and the department of pharmacy. At a 510-bed community hospital, an internal audit performed before the satellite pharmacy was opened revealed an average loss of $14.53 in drug charges per surgical procedure; 16 months after the pharmacy opened, changes in the way drugs are distributed to the departments of surgery and anesthesia has resulted in a decrease in this loss to $9.61, or a 34% improvement. To regulate controlled substances, the pharmacy attaches a drug-use log to each dispensing kit, which has resulted in 98% agreement between recorded administration of controlled substances and actual amounts signed out and ultimately returned. Recommendations made by the department of pharmacy regarding the use of high-cost drugs during surgery has resulted in an annual savings of more than $100,000, and improvements in drug packaging reduced, and in some cases eliminated, wastage. Direct contact between operating room personnel and pharmacists has fostered discussions regarding cost-effective application of pharmacotherapy, and the potential for cost savings is substantial. Although the remaining loss of $9.61 per case must still be addressed, considerable progress has been made in a relatively short period of time. The satellite pharmacy in the operating room has led to increased revenue recovery, improved regulation of controlled substances and monitoring of drug inventory, and better communication among the involved personnel.

Cost-Benefit Analysis↗
PubMed1990

Distributive and clinical activity measurement using spreadsheet software.

Documentation of distributive and clinical activities is an important factor in maintaining and expanding pharmacy services. In order to illustrate the impact of pharmacists' efforts on risk management and the reduction of drug costs, the pharmacy must effectively monitor workload. This report describes a method to identify and estimate time required for both distributive and clinical functions. Tabulation of the distributive work units is automated through the hospital billing system. Clinical monitors are dependent on manual documentation by decentralized clinical pharmacists. The clinical coordinator and the pharmacy director review the documented clinical monitors to insure compliance and standardization. Productivity and workload calculations are performed automatically via the spreadsheet software once all the distributive and clinical units are entered. Identifying clinical functions and measuring the associated workload has aided in justifying new positions. Future considerations include calculating the impact of clinical services on revenues, expenses, and staffing.

Connecticut↗
PubMed1994

Clinical pharmacy services in an intermediate care facility for the mentally retarded.

The impact of a focused drug regimen review process based on clear objectives and of interdisciplinary team cooperation is described. By shifting from a pharmacy departmental focus, which was primarily on drug distribution activities, to a broader agenda that promotes pharmacists as clinicians, inroads were made in reducing medication doses per resident, decreasing nursing time spent in medication administration, and decreasing pharmacy expenses in this residential facility for the developmentally disabled.

Drug Costs↗
PubMed1985

Twenty-four hour emergency pharmaceutical services.

Operation of an emergency department satellite pharmacy in which the pharmacist provided clinical, educational, and drug distribution services during patient visits is described. In a Detroit trauma and ambulatory-care center, drugs were dispensed to outpatients 24 hours a day from a satellite pharmacy located in the 75-bed emergency department. Emergency department pharmaceutical services were expanded to include distributive, clinical, and educational activities by the pharmacist on a 24-hour basis. The pharmacist contributed to improved inventory control and billing for drug products. When reductions in the work force were necessary, the institution chose to retain 24-hour pharmacist coverage during emergency department patient visits and to eliminate 24-hour dispensing to outpatients. In this urban trauma center, the emergency department pharmacist's clinical, distributive, and educational services contributed substantially to delivery of patient care.

Education, Pharmacy↗
PubMed1984

Progressive pharmaceutical services in a small community hospital.

The pharmaceutical services in an 86-bed community hospital in rural Maine are described. With a staff of two full-time pharmacists, one hospital pharmacy resident, and 2.6 full-time equivalent technicians, the pharmacy department operates a 24-hour unit dose drug distribution system with complete i.v. admixture services. In addition, the department supervises nurses on medication administration and i.v. therapy teams. Clinical pharmacy services include patient-education programs, protocols giving pharmacists responsibility for initiating and monitoring specific drug therapies when authorized by a physician, and concurrent antibiotic review. The department publishes a bimonthly newsletter for physicians and nurses and a quarterly newsletter for hospital employees and patients; it also conducts continuing-education programs for nurses. By maintaining a delicate balance between creativity and practicality, pharmacists in small hospitals can develop progressive services.

Anti-Bacterial Agents↗
PubMed1986

Designing a modern hospital pharmacy.

Cooperation between the pharmacy director and the hospital's architects in planning a modern hospital pharmacy is described. The pharmacy director at an 870-bed voluntary nonprofit institution and the hospital's architects planned the design for a new 3250-square foot pharmacy department. They developed a preliminary floor plan based on the following functions that the pharmacy would perform: centralized unit dose drug distribution; compounding; bulk and unit dose prepackaging; preparation of sterile products; controlled substance storage; outpatient and employee prescription dispensing; reserve stock storage; purchasing, receiving, and inventory control; drug information services; and administrative services. A final floor plan was designed that incorporated these functions with structural and utility requirements, such as placement of the computer system and dispensing and lighting fixtures. By integrating modern material management concepts with contemporary hospital pharmacy practice, the pharmacy director and the hospital's architects were able to plan and construct a pharmacy that receives, processes, and dispenses medication efficiently.

Computers↗
PubMed1998

Enough sterile syringes to prevent HIV transmission among injection drug users in Montreal?

The HIV epidemic among injection drugs users in Montreal continues unabated. We wished to know whether sufficient syringes were being distributed to provide for the needs of injection drug users (IDUs) in Montreal. Using data from several sources, including the estimated number of active IDUs in 1994 and the injection frequency according to the drug consumed, we calculated the number of syringes required by IDUs. The number of syringes estimated was compared with the number of syringes distributed by needle exchange programs or sold in private pharmacies. Overall, we estimated that in 1994 about 10,683,000 syringes were required by the 10,000 IDUs in Montreal. Because about 338,000 syringes were distributed, <5% of the need was being met. The parameters in our analysis, particularly the number of IDUs in Montreal, drug use, and the frequency of injection, are subject to uncertainty. Nevertheless, because of the disparity between the small proportion of syringes distributed and the number required, it is unlikely that sufficient syringes are available to ensure access to clean needles and prevent HIV transmission. Measures should be taken to expand syringe distribution to Montreal IDUs.

Cocaine↗
PubMed2006

Geometric probability distribution for modeling of error risk during prescription dispensing.

PURPOSE: The relationship between the number of prescriptions dispensed by individual pharmacy staff during a single workday and the probability of committing at least one dispensing error during that same workday period was evaluated using a geometric probability distribution. SUMMARY: A cross-sectional descriptive study involving 50 pharmacies located in six cities across the United States was conducted. A pharmacist trained to detect dispensing errors recorded the number of prescriptions filled by each pharmacy staff member and noted which prescription represented the staff member's first dispensing error (defined as any deviation from the prescriber's order) made during the observation period. The Kolmogorov-Smirnov tests for discrete distributions revealed that the observed cumulative distribution of dispensing errors could have come from a geometric probability distribution that assumed dispensing error rates of 2-3%. In terms of risk analysis, this study's findings suggest that there can be a quantifiable statistical relationship between a measure of workload and the risk of committing at least one dispensing error. The ability to model dispensing errors using a geometric probability distribution enables the safety and health care practitioner to directly assess dispensing error risk as a function of a pharmacy's accuracy rate and the number of prescriptions a pharmacy staff member should dispense during a work shift. CONCLUSION: A geometric probability distribution effectively modeled the relationship between the number of prescriptions filled and the occurrence of the first dispensing errors.

Drug Prescriptions↗
PubMed1998

Patient satisfaction with delivery of products and information by an ambulatory care pharmacy.

A survey for assessing ongoing patient satisfaction with ambulatory care pharmaceutical services was developed for and tested in a veterans population; acquiescence response to survey items and desire for potential future services were measured. A questionnaire based on key aspects of patient satisfaction described in the literature was distributed to 1451 patients visiting an ambulatory care pharmacy prescription-pickup window during five consecutive days in 1994. Patients were asked about current services and the desirability of potential future services. Patients indicated their responses to statements about current services. Acquiescence response (the tendency to agree with statements regardless of content) was measured by using matched pairs of contradictory statements. The response rate was 48.3%. Patients' mean +/- S.D. overall satisfaction with current services was 3.7 +/- 1.1. The responses of 72.0% of patients exhibited no contradictions. The potential new service wanted most by respondents was availability of a pharmacist to talk with patients by telephone; seeing a pharmacist in the clinic instead of a physician for drug-related problems was wanted least by respondents. Veterans responding to a survey of satisfaction with ambulatory care pharmaceutical services had a low tendency to agree with statements regardless of content. The survey can be used to assess veterans' ongoing satisfaction.

Ambulatory Care Facilities↗
PubMed1998

Total and attributable costs of surgical-wound infections at a Canadian tertiary-care center.

OBJECTIVE: To determine the total and attributable costs of surgical-wound infections in a Canadian teaching hospital. DESIGN: Retrospective incidence series study with chart review and examination of resource utilization attributable to wound infection. The charts of inpatients with wound infections were examined using the Appropriateness Evaluation Protocol (AEP), a validated chart review instrument designed to determine appropriateness of care, modified for wound infections. SETTING: A university referral center in Canada. PATIENTS: Medical records were abstracted from patients with wound infections who underwent an inpatient clean or clean-contaminated procedure during 1991. MEASUREMENTS: During the wound-infection treatment period, the hospital costs associated with providing care were tabulated for all inpatient days and for outpatient and emergency visits. Costs taken into account included nursing salary and benefits, nonphysician professional services, operating room time, laboratory, pharmacy, supplies, ancillary tests, and hotel costs. RESULTS: We identified 108 wound infections. Twenty-two patients required 28 surgical procedures related to a wound infection. Inpatient days totalled 1,116, costing $394,337. Fifty-five emergency and 42 clinic visits occurred, costing $27,193. By applying the AEP to the inpatient days, 833 days, or 10.2 days per case, were directly attributable to the wound infection. The hospital costs for inpatient care attributable to wound infections were $321,533 in total, or $3,937 per infection. Costs were distributed as follows: nursing, 51%; hotel, 14%; pharmacy, 10%; laboratory, 9%; emergency and outpatient clinic, 6%; professional services, 5%; operating room, 3%; and ancillary tests, 2%. CONCLUSIONS: Wound infections contribute markedly to extra days of hospitalization and related costs. The AEP method is applied easily to determine attributable days of care and costs of wound infections, which are necessary to calculate the cost-benefit of infection control programs.

Hospital Bed Capacity, 300 to 499↗