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PubMed1977

Comprehensive pharmaceutical services in an 85-bed hospital: a one-year evaluation.

The economics of a comprehensive pharmaceutical service in a small hospital was evaluated. The pharmacy program includes total unit dose drug distribution, centralized compounding of intravenous admixtures, and clinical involvement. Data were collected for two fiscal years prior to the development of formal pharmaceutical services (FY 72-73 and FY 73-74), the fiscal year during the implementation phase (FY 74-75) and the fiscal year following full development (FY 75-76). The total cost of the pharmaceutical services for FY 75-76 was $5.66 per patient day, a 106% increase over the previous year. The revenue per patient day in FY 75-76 was $7.77, a 72% increase over FY 74-75. Inventory costs decreased during and after implementation of comprehensive pharmaceutical services. The evaluation emphasizes the need for assessing pharmacy programs as an integrated system representative of the service of pharmacy. The need for an equitable method of third party payment for pharmaceutical services is discussed.

Costs and Cost Analysis↗
PubMed1992

A simplistic approach to restocking crash carts.

An organized crash cart can bring a sense of structure to a potentially chaotic situation. By standardizing every crash cart, time and confusion can be saved, which in turn may save a life during an emergency situation. This article describes one hospital's solution to the design and restocking of crash carts. This approach streamlined the process of restocking the medication component of the crash carts by the pharmacy department. No matter what time of day or night a code was called, the pharmacy could have the medications replaced within minutes.

Cardiopulmonary Resuscitation↗
PubMed2006

Structural features of pharmacy function--the analysis using structural equation modeling.

In order to examine the structural features of community pharmacy function and to clarify areas meriting priority in efforts to expand pharmacy functions in the home care field, a questionnaire survey was conducted. Using the distribution of responses regarding the actual conditions entailed in the 16 categories of pharmacy services, factor analysis was carried out. Structural equation modeling was performed and the fitness of the path model constructed to study the interrelatedness of the individual factors extracted by factor analysis was considered. Four factors comprised pharmacy services "dispensing", "supply of goods", "offering home care", and "cooperation in community health and medical programs". The interrelatedness of four pharmacy functions by the result of structural equation modeling indicated the following insights. 1) By strengthening "cooperation in community health and medical programs", it is possible to directly improve the functions of "dispensing", and "offering home care". An improvement in "collecting and utilizing patient information", "providing appropriate instruction", "providing introductions to medical institutions and physicians", and "supplying over-the-counter drugs" can be expected as a result of direct benefits accrued by "cooperation in community health and medical programs". 2) By strengthening "offering home care", it is possible to directly improve "supply of goods". An improvement in "stocking long-term care goods and sanitary goods" can be expected as a result of direct benefits accrued by "offering home care". In conclusion, this study indicated that the areas meriting priority in the expansion and upgrading of pharmacy functions is stronger "cooperation in community health and medical programs".

Community Pharmacy Services↗
PubMed1990

Analysis of workload and staffing requirements for a critical-care satellite pharmacy.

A study to determine the workload and the staffing requirements of a proposed critical-care satellite pharmacy is reported. Data for all patients admitted to the adult surgical intensive-care units (SICUs) of an acute-care teaching hospital were recorded for 30 days. Both clinical and distributive data were collected, such as the number and times of patient admissions to the SICUs, the times medication orders were written and their nature, the number and types of drugs administered per patient per day, the number of medication profile reviews per day, and the number and types of interventions. Productivity standards were determined for specific clinical and distributive tasks and used to project the staffing requirements of the new satellite pharmacy. It was determined that proposed changes in distributive services, including expansion of the i.v. admixture program and implementation of a syringe-pump infusion system, would increase the pharmacist and technician staffing requirements by 1.91 and 6.77 hours per day, respectively. Expansion of clinical services, such as pharmacokinetic monitoring, would increase the pharmacist staffing requirements by 8.68 hours per day. It was estimated that the SICU satellite pharmacy could save the hospital more than $200,000 per year. Hospital administration approved a request to increase staffing by 3 full-time-equivalent (FTE) pharmacists and 1.6 FTE technicians. Workload analyses and projections of staffing requirements must incorporate measurements for clinical as well as distributive services.

California↗
PubMed1983

National test of an experimental hospital pharmacy management information system.

An experimental hospital pharmacy management information system (HPMIS) was evaluated in a national pilot test. Approximately 250 information and materials packets were distributed to hospitals that had inquired about the project. Monthly data on pharmacy expenses, personnel use, and productivity were collected for a six-month period by participating hospitals. This information was processed quarterly and converted into the HPMIS indicators; results were categorized according to hospital characteristics and locations. A questionnaire soliciting opinions about the system was sent to participants at the end of the data-collection period. One hundred six hospitals agreed to participate; 84 hospitals submitted data for at least one quarterly period. The range of values for most indicators varied 100-fold; this was attributed to misinterpretation of data item definitions. Based on indicator values, drug and personnel expenses and supportive-personnel use were greater in unit dose hospitals than in hospitals without total unit dose drug distribution systems. Both drug and fluid costs and the extent of supportive-personnel use increased with increasing hospital size. Data-collection time was less in hospitals with computerized pharmacy operations. Responses to the questionnaire indicated that the clinical services indicators were favored the least; however, only a few changes in the data-collection format of the system were suggested. HPMIS appears to be a useful work-measurement tool but needs to be simplified if it to serve as the standard for these systems.

Data Collection↗
PubMed1988

Attitudes of pharmacists and nurses toward interprofessional relations and decentralized pharmaceutical services.

Pharmacists' and nurses' attitudes toward pharmacist-nurse relations and pharmaceutical services were surveyed before and after the implementation of satellite pharmacies at a 600-bed teaching hospital. The same questionnaire was distributed two months before decentralization (phase 1) and nine months after decentralization was completed (phase 2). Sixty questions about the pharmacy services and the drug treatment process were to be answered using a seven-point, Likert-type scale. Overall response rates for the two phases were 62% and 45%, respectively. Pharmacists' satisfaction with all measured aspects of pharmaceutical services increased after decentralization of services; nurses' satisfaction increased for all measures except pharmacist-conducted medication histories. Pharmacists' satisfaction with the nursing department was greater after decentralized services were implemented. Most aspects of role conflict, one of four measured antecedents to interdepartmental conflict, improved subsequent to decentralization of services. Because of changes in personnel between the two phases of the study, the results may represent the opinions of different people, rather than actual changes in satisfaction. The attitudes of nurses and pharmacists toward overall distributive pharmaceutical services and toward certain aspects of interprofessional relations improved after pharmaceutical services were decentralized.

Attitude of Health Personnel↗
PubMed1992

Evolving to provide pharmaceutical care without additional resources in a university hospital.

Our department is committed to a process of continuous quality improvement focusing on delivering the best possible pharmaceutical care services. Three committees, each with representation from pharmacists and pharmacy technicians from all areas of the department, were convened in 1991 to 1992 to further identify areas for service enhancement and to plan for the future. Based on the recommendations of these committees, further expansion in ambulatory services is a priority. Other changes will include further automation of the drug-distribution system, examination of the role of the pharmacy technician, development of an automated patient-care system with direct physician order entry, computerized documentation of clinical interventions, and reaffirmation of the role of the pharmacist as the professional responsible for proper use of medications at UMHC.

Centralized Hospital Services↗
PubMed1986

Strategic planning for clinical services: the University of Texas M.D. Anderson Hospital and Tumor Institute.

A formal, hospitalwide strategic-planning process provides structure for the pharmacy's plans for implementing clinical services. The state-supported clinical cancer and research center began a formal strategic-planning process in 1981. The institution's planning report, prepared every two years and covering three two-year periods, drives the institution's budget through the state's biennial budget process. The report focuses on each department's responsibilities, areas of service, and relationship to the mission of the institution. Through the long-range planning process, upper-level administrators learned that pharmacy was eager not only to provide high-volume drug distribution services but also to assume direct patient-care and research responsibilities. This prompted an organizational change for pharmacy from a hospital department to a clinical division. The division of pharmacy now consists of three professional departments (patient care, pharmacy research, and pharmacy academic programs) and an administrative support service area. Services offered by each of the three departments are discussed, along with specific initiatives planned for the years 1987-1993. Within the next few years, all managers will come from the ranks of clinical practitioners; nonpharmacists will oversee financial and human resource functions. The division encourages existing pharmacy staff members to enhance their clinical skills through staff development programs. Strategic planning serves the dual purposes of structuring plans for implementing clinical pharmacy services and communicating pharmacy's goals within the institution.

Cancer Care Facilities↗
PubMed1984

Medication-related nursing time in centralized and decentralized drug distribution.

The amount of time spent by nursing personnel in medication-related activities was evaluated in a centralized and a decentralized drug-distribution system. A work-sampling study was used to measure the amount of time spent by nursing personnel in various work activities before and after establishing a satellite pharmacy. Random observations of three nurses and a transcriber were made daily for five-day periods one month before and two months after the satellite pharmacy became operational. The actual number of hours worked by nursing personnel and the patient census during both study periods were also recorded. The lag time for order processing and distribution of initial doses and the accuracy of filling unit dose cassettes were measured in both drug-distribution systems. Nurses' attitudes toward the decentralized system were surveyed three months after implementation of the satellite pharmacy. The percentage of time nurses spent in medication-related activities was significantly less in the decentralized system. Actual hours spent in medication-related activities per patient day were also less in the decentralized system. Lag time for order processing decreased from 55.3 minutes in the centralized system to 15.2 minutes in the decentralized system. The number of unit dose dispensing errors per patient day also decreased after implementing the pharmacy satellite. All nurses surveyed favored the decentralized system. Decentralized drug distribution using a satellite pharmacy was associated with more efficient use of nursing time compared with centralized drug distribution.

Attitude of Health Personnel↗
PubMedDate not supplied

Paradigm shifts in clinical trials enabled by information technology.

The use of the world wide web for clinical trials changes the processes of performing clinical research in several fundamental ways. Greatly improved security, monitoring capability, and accuracy and timeliness of study conduct can be achieved while lowering cost. Data quality is enhanced while co-ordinating centre effort is reduced. The web provides a natural environment for linking the various components of clinical research, leading to new levels of simplicity and efficiency. It also enhances opportunities for recruitment of study investigators and patients. Other information technology tools and databases can be used to assist in this regard as well. Web-based trials change the relationship of the investigator site to the study and the site to the co-ordinating centre. Different roles and responsibilities lead to simplified processes and more and higher quality data. Many standard co-ordinating centre activities, such as randomization, protocol implementation and amending, document tracking, adverse event reporting, site monitoring, report generation and data analysis are all fundamentally changed in a web-based trial. Opportunities are enhanced to identify potential investigators and support their successful study conduct. As the role of investigator sites is changed in web-based research, more primary care medical providers can be attracted to research, providing more typical patients to studies than those sometimes available through more traditional research sites, especially those at academic study sites. Other activities can now be co-ordinated electronically with the advent of the web. The Institutional Review Board (IRB) can use online tools to control investigator participation, resulting in improved study efficiency and patient safety. A web-based research pharmacy provides tremendous efficiencies in managing and distributing study medications. Financial payments to the sites can be performed and recorded electronically, or even administered based on timeliness and quality of the data. Our early experience with web-based trials indicates that there can be tremendous gains in study efficiency and accuracy by restructuring processes, roles and responsibilities through a comprehensive centralized, web-based trial. The future appears bright for web-based clinical trials.

Clinical Trials as Topic↗
PubMed2000

Syringe availability as HIV prevention: a review of modalities.

This review examines recent research into modalities for improving access to sterile syringes for injection drug users (IDUs) as a means to reduce human immunodeficiency virus (HIV) transmission. English language studies with empirical data were collected through Uncover reports and MedLine searches from 1998 to 2000. Although syringe-exchange programs are the most established and well-evaluated means of improving access to sterile syringes, research on alternative modalities-such as pharmacy sale, injector-specific packs, mass distribution, and vending machines-and on coverage of special populations suggests the need to pursue multiple avenues of increasing syringe availability simultaneously and, in particular, to explore modalities other than syringe-exchange programs when HIV incidence is under control. The impacts on HIV transmission of cocaine injection and sex with IDUs need to be explored further. Finally, any evidence of declining hepatitis C incidence among young IDUs might serve as a surrogate for a sharp drop in injection-related HIV risk behaviors in that population.

Developed Countries↗
PubMed1996

Attitude of physicians toward patient package inserts for medication information in Belgium.

In Belgium, the distribution of medications to outpatients in community pharmacies is almost exclusively by branded unit-of-use packages, with a package insert inside every package. At the time of the study (spring 1990), the implementation of legislation that mandated a shift from highly technical documents to patient package inserts (PPIs), understandable by the lay person, had begun. This study explores the attitude of practising physicians toward written medication information for patients. A mail questionnaire was sent to 1500 (8% random sample) Belgian general practitioners and to 500 (22% random sample) internal medicine specialists. A total of 543 usable questionnaires were returned (27.5% return rate). Ninety-two percent of the physicians stated that their patients seldom or never requested additional information on drug efficacy or side effects, during routine consultation; 30% estimated that more than half of their patients read the PPI; 75% expect that a patient would experience side effects after reading about them in the PPI; 59% agreed that the PPI could help the patient react more adequately in unforeseen situations. It was possible to cluster the respondents in a stable segmentation of three clusters: moderately positive physicians (20%), ambiguous to neutral physicians (44%), physicians overtly negative to written drug information (36%). The low response rate to this extensive postal questionnaire limits the conclusions to a qualitative description of relevant clusters of respondents. In contrast with the opinion of physicians about patient readership, results from other studies indicate that the vast majority of patients read the package inserts.

Adult↗
PubMed1984

Renal insufficiency associated with nonsteroidal anti-inflammatory agents.

In an attempt to characterize the clinical spectrum of renal insufficiency associated with nonsteroidal anti-inflammatory agents, 26 patients with 27 episodes of renal insufficiency secondary to these agents are described. These patients were seen over a 27-month period during which the inpatient distribution of these drugs by our hospital pharmacy was sufficient for approximately 92,000 patient-days of therapy. During these 27 episodes, serum creatinine increased from a mean value of 1.6 +/- .1 mg/dL to a mean maximum value of 3.3 +/- .3 mg/dL with a return to 1.7 +/- .1 mg/dL after discontinuation of the drug. Serum urea nitrogen increased from a mean of 27.8 +/- 2.5 mg/dL to 54.5 +/- 4.0 mg/dL and returned to 31.0 +/- 2.5 mg/dL. The mean duration of therapy in 25 patients was 4.2 +/- .7 days, and time to return to baseline renal function was 5.3 +/- .7 days. Five patients were briefly oliguric. No patient required dialysis. Only one patient had findings suggestive of interstitial nephritis. Patients were generally characterized by hemodynamic stress. In spite of only modest increases in serum creatinine, six patients had hyperkalemia with one sustaining a cardiac arrest secondary to a serum potassium of 7.9. We conclude that (1) the incidence of significant insufficiency in the general patient population is low but may be significant in a group characterized by hemodynamic stress; (2) the most common form of renal insult associated with nonsteroidal anti-inflammatory agents is mild renal insufficiency, which rapidly reverses when the agent is discontinued; and (3) hyperkalemia is relatively frequent, can be out of proportion to the degree of renal insufficiency, and can be life threatening.

Acute Kidney Injury↗
PubMed2001

Self-medication in Germany.

We introduce the legal background of self-medication with OTC-drugs in Germany with regard to the pharmacy, drug store and health food shop distribution channels and the qualifications of the sales personnel. We give an overview of the frequency of self-medication and discuss risk/benefit in a pharmacoepidemiological context.

Drug Utilization↗
PubMed2005

Changes in antibiotic use in Dutch hospitals over a six-year period: 1997 to 2002.

OBJECTIVE: To analyse trends in antibiotic use in Dutch hospitals over the period 1997 to 2002. METHODS: Data on the use of antibiotics and hospital resource indicators were obtained by distributing a questionnaire to all Dutch hospital pharmacies. Antibiotic use was expressed as the number of defined daily doses (DDD) per 100 patient-days and as DDD per 100 admissions. RESULTS: Between 1997 and 2002, the mean length of stay decreased by 18%. The mean number of admissions remained almost constant. Total antibiotic use significantly increased by 24%, from 47.2 in 1997 to 58.5 DDD per 100 patient-days in 2002 (p<0.01), whereas expressed as DDD per admissions it remained constant. Antibiotic use varied greatly between the hospitals. Moreover, the mean number of DDD per hospital of amoxicillin with clavulanic acid, clarithromycin, cefazolin, clindamycin and ciprofloxacin increased by 16, 38, 39, 50 and 52%, respectively. Total antibiotic use was higher in university hospitals than in general hospitals. CONCLUSIONS: Between 1997 and 2002, patients hospitalised in the Netherlands did not receive more antibiotics but, since they remained in the hospital for fewer days, the number of DDD per 100 patient-days increased. For macrolides, lincosamides and fluoroquinolones increases in both DDD per 100 patient-days and in DDD per 100 admissions were observed. It is arguable whether these trends result in an increase in selection pressure towards resistance in the hospitals. Continuous surveillance of antibiotic use and resistance is warranted to maintain efficacy and safety of antibiotic treatment.

Anti-Bacterial Agents↗
PubMed1990

National survey of syringe exchange schemes in England.

This report gives information from an England wide survey of syringe exchange carried out in early 1989. A postal questionnaire was sent to 74 agencies, responses received from 65 (88%), of which 55 were agencies operating syringe exchanges. The development of syringe exchanges has been marked by lack of central coordination, supervision and direction, allowing for local autonomy sensitivity to local conditions and a resulting diversity of practices. Four service models were identified: schemes run by drug agencies; pharmacy-based schemes; specialist stand-alone schemes; and schemes based in non-drug agencies. The average number of different clients per week was 21 and it is estimated that they distributed about one million syringes in the year 1988/89. Pharmacy based schemes presented fewer barriers in terms of access but offered limited services on site, while drug agency schemes presented more barriers in terms of access, but offered more services. The significance of these differences is related to the aims of syringe exchange. In a public health orientation, ease of access to sterile injecting equipment would be the priority and the question of individual help in other areas less important. From a drug problems orientation, the ability to offer clients more services to respond to their wider needs would be a priority. It is estimated that by the end of 1989 there were approximately 120 syringe exchange schemes in England.

England↗
PubMed1989

Marketing strategy adjustments in the ambulatory care center industry: implications for community pharmacy.

Each stage of a product's life cycle requires marketing strategy modifications in response to changing demand levels. The purpose of this study was to investigate changes in ambulatory care center (ACC) operational characteristics indicative of product, market, and distribution channel adjustments that could have a competitive impact upon community pharmacy practice. A questionnaire was mailed to a national sample of 325 ACC managers. Evidence of new product feature additions includes increased emphasis on continued care and increased prevalence of prescription drug dispensing. Expansion into new market segments and distribution channels was demonstrated by increased participation in HMO and employer relationships. The observed adjustments in ACC marketing strategies present obvious challenges as well as less obvious opportunities for community pharmacy practice.

Ambulatory Care Facilities↗