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PubMed1988

Multidisciplinary cost-containment program promoting oral metronidazole for treatment of antibiotic-associated colitis.

A multidisciplinary cost-containment program for promoting oral metronidazole in place of oral vancomycin as initial therapy of antibiotic-associated colitis (AAC) is described. The pharmacy department and the division of infectious diseases implemented the program in two phases. In the first phase, a one-year retrospective drug-use review in patients with AAC treated with oral vancomycin was conducted to determine the average cost of therapy per treatment course. In the second phase, the use of oral metronidazole instead of oral vancomycin for initial treatment of AAC was promoted using inservice-education programs and distribution of pocket-size brochures containing AAC treatment guidelines to medical staff. The pharmacy and therapeutics committee supported the program by endorsing metronidazole as the drug of choice for AAC and by distributing follow-up progress reports of the program to medical staff. Pharmacists on the nursing units were responsible for enforcing the program stipulations regarding vancomycin and metronidazole use and for collecting data on patient-specific drug use. Six months after implementation of the program, the average cost of drug therapy for AAC had decreased by 89%, from $343.24 per patient to $37.50 per patient. The projected annual savings resulting from the program was $38,829.02. All prescribing physicians and dispensing pharmacists complied 100% with the program stipulations regarding drug use. The multidisciplinary program described here was successful in promoting the use of oral metronidazole for initial therapy of AAC.

Administration, Oral↗
PubMed1990

ASHP national survey of hospital-based pharmaceutical services--1990.

The results of a national mail survey of pharmaceutical services in community hospitals conducted by ASHP during May through July 1990 are reported and compared with the results of earlier ASHP surveys. A sample of community hospitals (short-term, nonfederal) was selected randomly from the population of community hospitals registered by the American Hospital Association. Questionnaires were mailed to each director of pharmacy. The adjusted gross sample size was 881. The net response rate was 66% (582 usable replies). The average number of hours of pharmacy operation per week reported by the respondents was 96. Complete unit dose drug distribution was offered by 89% of the respondents (up from 74% in 1987). About 70% offered complete, comprehensive i.v. admixture programs (essentially unchanged from 1987). Most of the hospitals (70%) had centralized pharmaceutical services. A computerized pharmacy system was present in 64% of the departments, and 75% had at least one microcomputer. More than 90% reported participation in adverse drug reaction and drug-use evaluation programs. Some 80% participated in drug therapy monitoring. Almost half of the respondents regularly provided written documentation of pharmacist interventions in patients' medical records. Approximately one third provided patient education or counseling, and one third provided drug management of medical emergencies. A well-controlled formulary system was in place in 58% of the hospitals; therapeutic interchange was practiced by 49%. A total of 98% of the respondents participated in group purchasing, and 96% used a prime vendor. Half of the departments served as training sites for pharmacy students. Less than half had a staff development program, but about two thirds supported continuing-education activities for pharmacists. The 1990 survey revealed a continuation of the changes in many hospital-based pharmaceutical services documented in earlier surveys and identified static areas that merit the attention of pharmacy leaders.

Centralized Hospital Services↗
PubMed1985

Implementation and evaluation of a decentralized pharmacy service.

The implementation of a decentralized pharmacy service on a 59 bed acute patient care area was evaluated. Over a ten-month period four criteria were used to evaluate the decentralized service: (1) reported medication errors, (2) reported medication discrepancies, (3) drug costs per patient day and (4) availability and utilization of drug information. Data was collected over the ten month period for all criteria except for drug information interactions in which a self reporting data card was utilized over a six week period. Medication errors and medication discrepancies decreased by 12.5% and 80% respectively on the pilot floor as compared to the hospital (+14.8%, -18.0% respectively). Drug costs per patient day increased the least on the pilot floor (+9.1%) as compared to other areas in the hospital (range: 10.8% to 49.3%). Seventy-six percent of drug information interactions occurred on the pilot floor as compared to the central pharmacy accounting for 24% of interactions for all other hospital areas combined. It is concluded that a decentralized pharmacy service can make a significant impact on a unit dose drug distribution system by reducing medication errors, discrepancies, drug costs and by increasing the utilization of drug information resources.

Centralized Hospital Services↗
PubMed1981

Delivery time in a decentralized pharmacy system without satellites.

The time required for pharmacy to deliver medications to the nursing unit under centralized and decentralized unit dose drug distribution (without satellites) systems was compared. Routing slips were attached to physicians' drug orders generated at a surgical nursing unit. Under the centralized system, the ward clerk sent the order to the pharmacy via pneumatic tube; the pharmacist received the order, transcribed it, and prepared the medication; and supportive personnel delivered the drug to the nursing station. The time required to perform each step was recorded on the routing slip for a five-week period. Under the decentralized system, the ward clerk placed the physicians' orders in the pharmacy box on the nursing unit. The pharmacist picked up the orders, filled them from a decentralized master medication cart, and placed the drug in the nurses' medication cart. Time required to complete the medication process was significantly less under the decentralized system than under the centralized system (54.15 +/- 42.82 versus 83.80 +/- 48.16; p less than 0.05).

Humans↗
PubMed1995

ASHP national survey of hospital-based pharmaceutical services--1994.

The results of a national survey of pharmaceutical services in federal and nonfederal community hospitals conducted by ASHP during summer 1994 are reported and compared with the findings of earlier ASHP surveys. A simple random sample of community hospitals (federal and nonfederal) was selected from hospitals registered by the American Hospital Association. A questionnaire was mailed to each director of pharmacy. The adjusted gross sample size was 896. The net response rate was 44% (393 usable replies). The mean number of hours that respondents' pharmacies were open per week for inpatient services was 107.5. An increasing number of pharmacy directors were managing other departments within the institution. Of respondents, 18% indicated that a patient-focused-care model was in place. Complete unit dose drug distribution was offered by 92% of respondents, and 67% provided complete, comprehensive i.v. admixture services. A total of 29% provided decentralized inpatient pharmaceutical services. Automation of some type to support drug distribution was used by 55%. Provision of ambulatory care pharmaceutical services was indicated by 82% of nonfederal hospitals and by 98% of federal hospitals. Home infusion therapy services were offered by 27% of respondents. Some 89% had a computerized pharmacy system. The most commonly offered clinical pharmacy services for inpatients were drug-use evaluations and programs to monitor drug therapy, adverse drug reactions, and drug-food interactions. About half of respondents indicated that they did not provide pharmaceutical care. One third indicated that pharmacists had the authority to write drug orders or prescriptions. Pharmacokinetic consultations were provided by 65% and nutritional-support consultations by 35%. Of nonfederal respondents, 86% participated in quality assurance for inpatient dispensing and 28% did so for ambulatory care dispensing. A well-controlled formulary system was in place at 60% of the hospitals. About 74% of inpatient pharmacy expenditures went for drugs and fluids, 20% for staff activities, and 6% for other noncapital expenditures. Almost half of respondents indicated that staff reductions had occurred. About 9% of nonfederal hospitals had an ASHP-accredited residency program. The 1994 ASHP survey revealed a continuation of growth in some areas of hospital pharmacy (clinical services, computerization, formulary management techniques, and residency programs) and identified static areas (ambulatory care services, scope of drug distribution services, and quality assurance programs) that should be addressed by pharmacy leaders.

Ambulatory Care↗
PubMed1984

Education and experience of pharmacy directors in large hospitals.

The education and experience of pharmacy directors in large hospitals are described. Questionnaires were sent in September 1981 to pharmacy directors of all hospitals in the United States having at least 300 beds. The questionnaire elicited background characteristics, postgraduate degrees, and administrative experience of the pharmacy director and descriptive information about the hospital. Of the 1483 questionnaires distributed, 609 (41%) were returned. Sixty percent of the respondents had an entry-level degree as their highest degree; 26%, 6%, and 7% of the respondents had M.S., M.B.A., and postgraduate Pharm .D. degrees, respectively. M.B.A. and postgraduate Pharm .D. degrees were more common for younger respondents. Only 6% of directors with entry-level degrees and 10% with M.B.A. degrees had completed an ASHP-accredited hospital pharmacy residency compared with 53% and 46% of directors with postgraduate Pharm .D. and M.S. degrees, respectively. Of directors with M.B.A. or postgraduate Pharm .D. degrees, 73% and 77%, respectively, had less than 11 years of administrative experience; just over 50% of directors with M.S. and entry-level degrees had less than 11 years of administrative experience; just over 50% of directors with M.S. and entry-level degrees had less than 11 years of experience. The majority of directors with postgraduate degrees had been in their current position for five years or less. Additional research is needed to evaluate the relationship of these variables more fully.

Education, Pharmacy↗
PubMed1976

Improved pharmacy services through pharmacist participation in medical rounds.

The participation by pharmacists in medical rounds in a 250-bed pediatric hospital with centralized unit dose drug distribution and i.v. admixture programs is discussed. A redistribution of responsibilities enabled pharmacists to attend physician work rounds on each medical service. Nursing-pharmacy rounds were set up for services which had no scheduled physician work rounds. As a result, the amount of medication waste due to late order changes, which had previously been a problem, was reduced by 0.54 cents per patient day. Pharmacist participation in medical rounds increased his clinical expertise and supplied him with the clinical data necessary to make more informed recommendations to physicians.

Costs and Cost Analysis↗
PubMed1980

A simple work measurement system that can aid in effective production planning.

With the advent of increased controls in the hospital field has come the mandate for more efficient use of available resources. Production planning is the mechanism by which these efficiencies can be gained. Ongoing measurement of various work components must be conducted and retrospectively compared to make meaningful use of production planning techniques. The pharmacy department at Brokaw Hospital, which utilizes a unit dose drug distribution system combined with intravenous admixture and monitoring services, has developed an internal measurement system based on key variable weighted units of service. Each component is assigned a value depending on time needed (in minutes) for completion. The units are tabulated daily, with the monthly sum being divided by departmental manhours to yield a monthly productivity ratio. This ratio is used as an aid in making decisions related to work assignments and staff scheduling. Compared against the productivity ratio of a benchmark month of known departmental efficiency (derived by measuring all activities for the month divided by man-hours consumed), projections can be made for future manpower requirements.

Efficiency↗
PubMed1990

Restructuring pharmacy services to reduce expenses without eliminating services.

The manner in which pharmaceutical services in a 719-bed teaching institution were restructured to reduce expenses without eliminating services is described. Before the department was restructured, the labor-intensive nature of the drug distribution system and high personnel costs hindered the introduction of upgraded services. Drugs were dispensed from a central pharmacy and 14 pharmacy satellites located throughout the hospital campus. A traditional floor stock system was used in the critical-care units, the operating suites, and the pediatric facility; i.v. admixture services were provided to only two patient-care units. Under a three-year strategic plan, the organizational structure of the department was changed to regroup existing functions and to give more autonomy to the managers. The 12 small pharmacy satellites in the main hospital building were replaced by two larger and more efficiently designed satellites. An automated medication order entry system with bar-code-reading capabilities was installed; automation was also used to increase the efficiency of the nutritional support and oncology services and to create an online file of all statistical, fiscal, and purchasing records. Fax machines that were installed on five critical-care units and the oncology unit decreased turnaround time for new medication orders. These changes enabled the department to eliminate 17 positions while adding 5 clinical pharmacist specialist positions and 6 technician group leader positions. By integrating automation technology with controlled downsizing and restructuring of drug distribution services, the department was able to reduce expenses while improving existing pharmaceutical services.

Automation↗
PubMed1991

A systems approach to the problem of missing medications.

Overall, the systems approach employed in this study has significantly decreased the frequency of missing medication requests on one pharmacy satellite by 38 percent. The most dramatic impact came from the systems-change phase of the study. While the pharmacy personnel-change phase did not contribute to the overall reduction in missing medications, there was a large decrease in missing medications due to discrepancies between the nursing MAR and the pharmacy profile. This study has prompted further investigation into the p.r.n. drug-distribution subsystem.

Evaluation Studies as Topic↗