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PubMedDate not supplied

Cost of drugs manufactured by the university hospital--role of the Central Pharmacy.

UNLABELLED: The hospital pharmacy in large and advanced institutions has evolved from a simple storage and distribution unit into a highly specialized manipulation and dispensation center, responsible for the handling of hundreds of clinical requests, many of them unique and not obtainable from commercial companies. It was therefore quite natural that in many environments, a manufacturing service was gradually established, to cater to both conventional and extraordinary demands of the medical staff. That was the case of Hospital das Clínicas, where multiple categories of drugs are routinely produced inside the pharmacy. However, cost-containment imperatives dictate that such activities be reassessed in the light of their efficiency and essentiality. METHODS: In a prospective study, the output of the Manufacturing Service of the Central Pharmacy during a 12-month period was documented and classified into three types. Group I comprised drugs similar to commercially distributed products, Group II included exclusive formulations for routine consumption, and Group III dealt with special demands related to clinical investigations. RESULTS: Findings for the three categories indicated that these groups represented 34.4%, 45.3%, and 20.3% of total manufacture orders, respectively. Costs of production were assessed and compared with market prices for Group 1 preparations, indicating savings of 63.5%. When applied to the other groups, for which direct equivalent in market value did not exist, these results would suggest total yearly savings of over 5 100 000 US dollars. Even considering that these calculations leave out many components of cost, notably those concerning marketing and distribution, it might still be concluded that at least part of the savings achieved were real. CONCLUSIONS: The observed savings, allied with the convenience and reliability with which the Central Pharmacy performed its obligations, support the contention that internal manufacture of pharmaceutical formulations was a cost-effective alternative in the described setting.

Brazil↗

PubMed2006

Epidemiological assessment of levodopa use in Cuba: 1993-1998.

PURPOSE: The purpose of this study is to describe and evaluate the use of levodopa in Cuba in order to provide a basis for intervention aimed at improving pharmacological treatment of individuals presenting with Parkinson's disease (PD). METHODS: We studied the amount of levodopa, both plain and combined, distributed by the central laboratory to hospital and community pharmacies in Cuba in the period 1993-1998. An internationally established drug-classification system and a reported method for epidemiological assessment of levodopa sales were applied. Sweden in 1994 served as the reference population. RESULTS: National crude rates of levodopa use basically remained stable since 1994, and in 1998 stood at 0.11 defined daily dose (DDD) per 1000 inhabitants/day, approximately 15 times lower than the corresponding figure for the reference population. Annual provincial use of levodopa showed considerable geographical variation, with the lowest rates in the eastern provinces and the highest rates in Havana City (Ciudad de La Habana). Adjustment for age reduced such differences by approximately 50%. CONCLUSIONS: Levodopa use in Cuba is low and consistent with the reported low prevalence of the diagnosis of PD. Results suggest that the diagnosis and treatment of PD can be improved, with emphasis on better detection of PD.

Cuba↗

PubMed1999

Relationship between tablet splitting and compliance, drug acquisition cost, and patient acceptance.

As managed care pharmacy continues to grow and medication costs increase, pharmacy managers are continually looking for ways to reengineer distributive services to provide the most cost-effective care. In an effort to save money, the San Diego Veterans Affairs Healthcare System (SDVAHS) and other health systems have implemented tablet-splitting programs targeted at high-cost and widely prescribed medications. Despite this growing practice, published research examining the effects on compliance rates, patient acceptance, and actual cost savings is lacking. A recent computer-assisted literature search revealed only one study of tablet splitting that addressed patient compliance and acceptance. In that study, patients taking lovastatin and using a tablet splitter were mailed a questionnaire to assess their impressions of tablet splitting. A majority of the patients found tablet splitters easy to use and reported that compliance was not hindered. However, compliance was subjectively evaluated through patients' responses to questions; actual tablet counts were not performed. Furthermore, actual cost savings (if any) were not determined.

Aged↗

PubMed2001

Automated medication distribution systems and compliance with Joint Commission standards.

One health care institution's experience with an automated medication distribution (AMD) system is described, along with how the system met standards of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). AMD units were implemented in nearly 50 patient care locations in a medical center with the goal of providing cartless distribution for over 90% of all medications. Planning for the system began in the fall of 1998; the system was fully implemented by mid-2000. In compliance with JCAHO requirements, the system provided medications in unit dose or single unit-of-use packaging, supplied drugs in a ready-to-administer form, ensured that drugs were available only near the time of administration, created a patient-specific medication profile, allowed for pharmacist review of medication orders before dispensing, provided proper storage conditions, prevented unauthorized use, allowed for access in emergencies, and met federal and state regulations. Implementation of the system improved drug distribution at the medical center and saved nursing and pharmacy time. Challenges included waits by nurses trying to access the AMD units and the extensive, ongoing education and training required for users of the system. An AMD system should be fully integrated with the health care institution's medication-use process and comply with applicable JCAHO standards.

Drug Utilization↗

PubMed2005

A university-sponsored home health nursing program in Karachi, Pakistan.

This article describes a university-sponsored home health nursing program in a large urban center in Pakistan and details the essential elements needed in implementing such a program in a developing country. Compared to in-hospital treatment, home healthcare reduced hospital stay from 12.8 days to 3.9 days, and resulted in a net savings of Pakistani rupees (PRs) 5,374,135 (USD 89,569). A cost-effective home treatment program in a resource-limited country can be successfully implemented by using the hospital pharmacy as the central point for the preparation and distribution of medications and specialty nursing services.

Community Health Nursing↗

PubMed1999

Benchmarking saves hospital $1 million.

UNLABELLED: Sarasota (FL) Memorial Health care System compared its pharmacy charges with peer hospitals and found it was $15 million below average. A quality improvement team found the pharmacy wasn't charging for all medications at the point of distribution, resulting in lost charges. THE SOLUTION: a simple process change that saved the hospital $1 million.

Benchmarking↗

PubMed1993

Challenge to clinical pharmacy practice in Malaysia.

OBJECTIVE: To report on the current status and future trends of clinical pharmacy practice in Malaysia. DATA SOURCES: Published conference reports and journal articles. DATA EXTRACTION: Data on areas related to clinical pharmacy practice in Malaysian hospitals were gleaned from various publications. DATA SYNTHESIS: Malaysia is capable of implementing clinical pharmacy services in hospitals and perhaps also in the community setting. The important factors in clinically oriented pharmacy practice include improvement of the drug-control process, development of physical and human resources, clinical pharmacy skills, and the training of practicing pharmacists. A number of Malaysian pharmacists have already developed a unit-dose drug distribution system, patient counseling, therapeutic drug monitoring, drug information, and total parenteral nutrition services. CONCLUSIONS: The pharmacy profession in Malaysia has many challenges ahead and it is hoped that every practicing pharmacist will be highly committed to future professional needs so that clinical pharmacy practice in Malaysia becomes a reality.

Drug Information Services↗

PubMed1991

Establishing a pharmacy department for a large pediatric hospital: managerial problems, opportunities, and lessons.

The process of planning and establishing a pharmacy department in a pediatric hospital is described, and lessons learned from the experience are summarized. Since its founding in 1954, Texas Children's Hospital (TCH) had shared pharmacy services with St. Luke's Episcopal Hospital. The decision to terminate the shared-services agreement in the mid-1980s made it necessary for TCH to establish an independent pharmacy department. A director of pharmacy was hired in March 1988, and November 30 of that year was set as the target for implementation of the TCH pharmacy. It was decided that six services--a decentralized unit dose distribution system, an i.v. admixture service, delivery services, ambulatory-care services, a formulatory system, and a drug information service--would be offered initially. Decisions concerning department organizational structure and staffing, space allocations, and a computer system were made. A multidisciplinary advisory committee was appointed; one of its responsibilities was to oversee inservice staff training. The pharmacy areas were to be opened on a staggered basis, beginning with the hematology-oncology clinic pharmacy. A number of problems arose immediately following the opening of the central pharmacy, including inaccurate computer profiles, lower-than-estimated productivity resulting from staff members' unfamiliarity with the new system, higher-than-estimated patient census, and orders for nonformulary drugs. Delays in drug delivery times were unacceptably high. A crisis-management plan was implemented to cover both short- and long-term problems, and within a few months operations had stabilized. The opening of the intensive-care and sixth-floor satellite pharmacies enhanced decentralized operations and had an important role in improving response times.(ABSTRACT TRUNCATED AT 250 WORDS)

Decision Making, Organizational↗

PubMed1978

Clinical pharmacy services in a community hospital.

An example is given of the implementation of clinical pharmacy service program in a community hospital. The need for establishing an efficient drug distribution system is discussed, and the feasibility of utilizing clinically motivated staff pharmacists is presented. A method of limiting the number of patients admitted to the clinical pharmacy service program is also given.

Aged↗

PubMed1984

Pharmacy practice in a small pediatric hospital.

Pharmaceutical services provided in a 72-bed pediatric hospital are described. One full-time pharmacist, one full-time technician, and a half-time pharmacy assistant staff the pharmacy, which is open 40 hours per week, and a pharmacist is on call when the pharmacy is closed. The technician makes hourly rounds to nursing units to pick up new orders and deliver medications. Unit dose carts are exchanged at 4 p.m. The pharmacy prepares individual doses of i.v. medications that are used Monday through Friday. More than 80% of new orders are filled during pharmacy hours; a night cabinet provides 75% of medications needed when the pharmacy is closed. The pharmacist provides drug information to physicians and nurses and counsels parents of discharged patients. Workload data and logs that reflected calls received and drugs obtained after hours were used to justify expansion of pharmacy hours, which is expected for 1984. Pharmacists in small hospitals must balance distributive, clinical, and administrative demands to provide reliable and consistent service during limited hours of operation.

Drug Labeling↗

PubMed1981

Staffing for comprehensive pharmaceutical services in a small hospital.

The use of licensed practical nurses as medication administration personnel under the administrative authority of the pharmacy department in a 140-bed hospital is described. The pharmacy department assumed responsibility for medication administration in its efforts to expand the scope and quality of its services and to control drug distribution more completely. A medication administration team (MAT) was developed that involves licensed practical nurses and technicians. The MAT members are trained through programmed instruction, on-the-job experiences, and a 32-hour pharmacology course taught by staff pharmacists. This medication administration team gives the pharmacy department control of the entire drug distribution system.

Drug Therapy↗

PubMed2003

The pharmacy cost of delivering postoperative analgesia to patients undergoing joint replacement surgery.

Few data exist on the distribution of pharmaceutical costs for inpatient surgical procedures across different drug categories (eg, analgesia, anti-infectives). The goals of this study were to categorize pharmaceuticals administered to patients after joint replacement surgery and then to take the hospital's perspective and quantify the pharmacy cost of delivering postoperative analgesia to these patients. Two hundred ninety-eight patients undergoing unilateral hip replacement (n = 145), unilateral knee replacement (n = 121), or bilateral knee replacement (n = 32) were studied retrospectively. For each patient, we determined what hospital resources (eg, supplies) were utilized by each patient in each of 12 different hospital departments. This was done to determine what fraction of overall hospital costs was incurred as a result of pharmacy. Then, we classified the hundreds of items (from acetaminophen to warfarin) included as pharmacy costs into 1 of the following categories: postoperative epidural analgesia, opioids, nonopioids, respiratory, gastrointestinal, naloxone, anti-infective, anticoagulant/antiplatelets, miscellaneous, cardiovascular, pharmacist clinical intervention, intravenous fluids, and benzodiazepines. The pharmacy costs for epidural analgesia, opioids, and nonopioids were summed to compute the fraction of pharmacy costs attributed to postoperative analgesia. The results showed that 3.3% (95% confidence interval CI, 2.7% to 3.6%) of total hospitalization costs were pharmacy costs, which averaged 560 US dollars (95% CI, 500 US dollars to 620 US dollars) for hip replacement, 595 US dollars (95% CI, 551 to 639 US dollars) for knee replacement, and 922 US dollars (95% CI, 588 US dollars to 1256 US dollars) for bilateral knee replacement surgery. An average of 9.9% (95% CI, 7.37% to 12.43%) of total pharmacy costs for the 3 surgery types were for postoperative epidural analgesia, whereas opioids averaged 19.9% (95% CI, 18.67% to 21.13%), and nonopioids averaged 0.8% (95% CI 0.65% to 0.95%) of pharmacy costs. Thus, analgesics accounted for approximately 31% of pharmacy costs. The pharmacy cost of delivering postoperative analgesia to patients undergoing joint replacement surgery represents 1% of the total costs of surgery. Almost two thirds of the analgesic costs were for opioids.

Adult↗

PubMed1988

ASHP national survey of hospital pharmaceutical services--1987.

The results of a fall 1987 national mail survey of pharmaceutical services in short-term hospitals are reported and compared with similar surveys conducted in 1975, 1978, 1982, and 1985. A sample of 875 hospitals was selected randomly from among the estimated 5600 U.S. short-term hospitals that employ a pharmacist on at least a part-time basis. The survey had a 71.1% response rate (617 usable replies). Nearly three-fourths of the respondents had complete unit dose drug distribution services (UDD), 68% reported complete i.v. admixture services (IVA), and 57% reported both complete UDD and complete IVA. Nearly 5% of respondents offered five specified clinical services (up from 1.8% in 1985); 24% reported having no clinical services (versus 38% in 1985). Nineteen percent said their departments had one or more clinical specialists. Overall, about one-third of pharmacy technicians had completed formal training. The number of respondents with programs to contain drug costs increased about 10% since 1985. Weekly hours of pharmacy operation averaged 102; 36.7% of respondents had pharmacy service around the clock. The percentage of hospitals with computerized drug distribution systems increased from 32% in 1985 to 52% in 1987. Prime vendors were used by 94.6% of respondents, and only 2% reported that they did not use a purchasing group. National expenditures for drugs and fluids for community hospitals were projected at $4.7 billion, personnel costs at $1.8 billion, and other pharmacy expenditures at $0.4 billion. The projected numbers of open positions nationally for pharmacists in community hospitals was 1950. The survey also collected data on the use of personal computers, inventory turnover, quality assurance, continuing-education philosophy, revenue-generating programs, and outpatient services. Drug control in community hospitals is improving, and clinical services are more widespread. Twenty percent of respondents had comprehensive pharmaceutical services, defined as complete UDD and complete IVA plus three or more clinical services.

Computers↗

PubMed1996

Work redesign and role restructuring in a pharmacy department with pharmacist assistants.

A new staffing model for decentralized pharmacists and support staff at a university hospital is described. A new technical support position--the pharmacist assistant--was created, and activities were reallocated among the pharmacists, pharmacist assistants, and pharmacy technicians according to the recommendations of two total quality management teams. Pharmacist assistants were to perform many of the drug distribution and record-keeping functions previously performed by pharmacists. The activities marked for reallocation accounted for about 50% of pharmacist time in the existing staffing model; they would not be performed by experienced pharmacy technicians who received brief training to be pharmacist assistants. Nine pharmacists and nine technicians tested the new staffing model on four patient care units over a four-week period. The reassignment of pharmacist tasks to pharmacist assistants theoretically gave pilot-unit pharmacists more time for providing and documenting patient-specific clinical activities and an additional 12 hours a week to participate in such global patient care activities as critical-pathway and quality improvement meetings. By the end of the study, the pharmacist assistants demonstrated that they could perform the reassigned activities; however, the pharmacists were not yet confident in the assistants' ability to do so. A pilot study of a new decentralized pharmacy staffing model demonstrated that technical support personnel can perform many distributive and record-keeping activities traditionally performed by decentralized pharmacists.

Hospital Restructuring↗

PubMed1991