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PubMed1990

Method for evaluating performance of clinical pharmacists.

A performance-evaluation process that satisfies Joint Commission on Accreditation of Healthcare Organizations criteria and state policies is described. A three-part, criteria-based, weighted performance-evaluation tool specific for clinical pharmacists was designed for use in two institutions affiliated with the University of Washington. The three parts are self-appraisal and goal setting, peer evaluation, and supervisory evaluation. Objective criteria within each section were weighted to reflect the relative importance of that characteristic to the job that the clinical pharmacist performs. The performance score for each criterion is multiplied by the weighted value to produce an outcome score. The peer evaluation and self-appraisal/goal-setting parts of the evaluation are completed before the formal performance-evaluation interview. The supervisory evaluation is completed during the interview. For this evaluation, supervisors use both the standard university employee performance evaluation form and a set of specific criteria applicable to the clinical pharmacists in these institutions. The first performance evaluations done under this new system were conducted in May 1989. Pharmacists believed that the new system was more objective and allowed more interchange between the manager and the pharmacist. The peer-evaluation part of the system was seen as extremely constructive. This three-part, criteria-based system for evaluation of the job performance of clinical pharmacists could easily be adopted by other pharmacy departments.

Employee Performance Appraisal↗

PubMed1990

Time and cost requirements for decentralized pharmacist activities.

Time and cost requirements for pharmaceutical services in patient-care areas at a 548-bed university hospital were studied. The study was conducted in 1987 and 1988 to (1) define the clinical and distributive activities of decentralized pharmacists, (2) develop time standards for each activity, (3) determine whether the time requirements of decentralized pharmacists depend on the type of patient involved, (4) determine the actual costs of decentralized pharmacist services for various types of patient, and (5) compare costs with reimbursement for clinical pharmacy services. Time standards were established based on data from seven patient categories representing a cross section of the institution's patients. The mean frequency of each activity and the total time and cost per patient day for all activities were determined. Pharmacist time spent daily in each patient-service category ranged from 2.3 hr for low-intensity medical care to 20.8 hr for trauma-burn intensive care. Decentralized pharmacists spent approximately 50% of their time on clinical activities in all patient-service categories. The daily cost per patient day for clinical activities was lowest for low-intensity medical care and highest for adult intensive care. The institution's daily charge for clinical activities ($10/admission and $10/day) exceeded the cost of clinical services during the study period. The decentralized pharmacist time requirement per patient day, and thus the costs of delivering pharmaceutical services, varied by patient-service category. The provision of clinical services generated a profit. A pharmacy workload analysis system that can identify costs and correlate them with patient types can be valuable in hospital pharmacy management.

Centralized Hospital Services↗

PubMed1990

Assessing the quality of pharmacist answers to telephone drug information questions.

A quality assurance (QA) program is described in which frontline pharmacists were asked test drug information questions via anonymous telephone calls. The program was instituted at a university hospital that began providing decentralized pharmaceutical services in 1985. Questions were developed on the basis of a pilot study conducted to determine the types and complexity of drug information questions received by frontline pharmacists at the hospital. Data on departmental clinical productivity were used to determine the number of questions that would be posed during each shift in the various service areas. The questions were posed during a 10-day period; the pharmacists were aware of the program, but the callers did not identify their affiliation with it. In response to 105 questions asked, 86 were judged to have been answered correctly, 13 answers were deemed incomplete, and 6 were judged incorrect. Pharmacists were more likely to respond incorrectly to complex questions and questions posed during the night shift. As a result of the audit, staff members with advanced clinical knowledge were asked to help less experienced pharmacists, the position of assistant director for drug information and staff development was created, and educational programs were instituted. The QA audit has been repeated twice. Posing test drug information questions via anonymous telephone calls is effective in assessing the quality of drug information provided by pharmacists in patient-care areas.

Drug Information Services↗

PubMed1990

Clinical pharmacists in family practice residency programs.

A project was undertaken to determine the number, specific activities, and demographics of clinical pharmacists directly involved with residency programs in family practice. A survey was mailed to the directors of all 381 family practice residencies, with a request either to forward it to the participating pharmacist or to return the survey if a pharmacist did not directly participate in the teaching program. With two mailings, responses were received from 85.3% of the residencies, with 80 pharmacists completing surveys. While the involvement of pharmacists in family practice residencies was similar to that reported in a survey 9 years ago, academic appointments and funding, in whole or in part by a college of medicine, had increased. This increased involvement may represent an acknowledgment by medical educators in family practice of the value of pharmacists participating in residency programs.

Adult↗

PubMed1989

Use of a path model to analyze factors that influence hospital pharmacists' salaries.

The direct and indirect effects of eight factors on Texas hospital pharmacists' salaries are described. Data for a path analysis (a method of examining relationships among specific variables while controlling for the effects of other variables) were collected by mail survey during the fall of 1985 from randomly selected hospital pharmacists residing in Texas. A path model was constructed to examine the effects of the following variables on the annual salary earned by full-time pharmacists: position, gender, seniority, academic degree, age, number of hours worked per week, size of hospital, and location of hospital. The relationships among the variables were evaluated using linear regression analysis. Of 1500 questionnaires mailed, 502 usable responses from full-time pharmacists were received. Six factors--gender, position, seniority, size of hospital, academic degree, and number of hours worked per week--had significant direct impact on financial compensation. Pharmacists' position also had an indirect effect on salary through the number of hours worked per week, with managers working more hours than nonmanagers. Position was influenced by seniority, gender, size of hospital, and academic degree. Male pharmacists earned more than their female counterparts. Age and hospital location had no significant influence on annual salary, position, or the number of hours worked per week. Overall, path analysis showed only 11 of 21 relationships among the nine variables to be significant. Seniority, gender, size of hospital, academic degree, position, and number of hours worked per week all had a significant effect on salary.

Data Collection↗

PubMed1988

Career patterns of pioneer clinical pharmacists.

The career paths of some early clinical pharmacists from their first positions during the years 1965-1974 to their current positions were studied. In August 1985 a group of pharmacists was surveyed to determine (1) the extent to which they had maintained a clinical practice (defined as direct patient contact, including evaluating and planning drug regimens), (2) the number of job-function changes, and (3) the degree of the pharmacists' commitment to public service, as measured by Hall's Belief in Public Service and Allport-Vernon-Lindzey Personality Values. The response rate for the 337 questionnaires was 73.5%. The average age of the group was 40 years; 83% were men, and 79% possessed Doctor of Pharmacy degrees. The respondents had changed job functions an average of 2.1 +/- 1.5 times over the last 13 years since the highest professional degree. The percentage in the job functions of hospital pharmacist and pharmacy faculty declined over time while those in hospital pharmacy administration, academic administration, and the pharmaceutical industry increased. Clinical-practice activity declined over time, with a twofold net increase in those reporting no direct patient-care responsibilities. Male respondents with fewer years after their highest professional degree, a greater belief in public service, higher theoretical values, and no residency experience were more likely to be currently involved in direct patient care than others. Although attrition among pioneer clinical pharmacists is not excessive for those who began their careers with a relatively small percentage of their time devoted to clinical practice, most pharmacists who began with substantial clinical commitments have reduced or eliminated clinical activities over time.(ABSTRACT TRUNCATED AT 250 WORDS)

Career Mobility↗

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↗

PubMed1987

Managing both members of a two-pharmacist couple: the employer's perspective.

Employer considerations in hiring and managing the two-pharmacist couple are discussed. In recruiting one member of a two-pharmacist couple, an employer may need to consider hiring the other spouse, especially if the employment requires relocation and if the institution is the only practice site in the area. Managers should be aware of potential difficulties associated with this practice, such as the potential for formal charges if illegal discrimination is perceived as a motive for selecting a candidate. If one spouse is not acceptable, the employer could provide assistance in locating another position. In some organizations, family members cannot supervise, or even work with, one another. Employers should review policies concerning organizational working relationships with two-pharmacist couples. In terms of scheduling, two-pharmacist couples may have work-schedule preferences that are difficult to accommodate. Although organizations have traditionally designed compensation packages for individuals, some nonsalary benefits may be handled more efficiently on a family basis. Problems can arise when individuals in two-pharmacist couples are promoted at different times and frequencies. This possibility should be discussed with both employees at the time of hiring and reviewed as promotions occur. The resignation or dismissal of one spouse may lead to the departure of the other. If this type of staff loss occurs frequently, other staff may perceive the hiring of two-pharmacist couples as a poor management practice. When hiring and managing both spouses in a dual-career couple, managers can minimize potential problems by maintaining good communication with the couple and other staff.

Employment↗

PubMed1987

Professional attitudes of Ohio pharmacists working in three practice settings.

The attitudes of pharmacists in three practice settings toward a set of attributes associated with professionalism were studied. A questionnaire that included the 40-item Shack and Hepler professionalism instrument was mailed to 1999 pharmacists in Ohio. Responses from 617 pharmacists who worked in hospital, independent community, or chain community pharmacy practice were used. There were significant differences between the responses of pharmacists who worked in the different practice settings (multivariate analysis of variance, p less than 0.01). However, the practice setting accounted for less than 10% of the variance in the responses. Statistically significant differences were also observed when the pharmacists were grouped according to sex, years since graduation, degree, and job position; however, less than 8% of the variance in the responses could be explained by the demographic variables. There did not appear to be any practical differences in beliefs about professional attributes among pharmacists working in hospital, independent community, and chain community practice settings.

Attitude of Health Personnel↗

PubMed1987

Work expectations and organizational attachment of hospital pharmacists.

Measures of expectations, organizational attachment, and job satisfaction were studied among hospital pharmacists. Pharmacists in 42 Chicago-area hospitals were asked to respond to 18 closed-ended statements designed to measure job and profession satisfaction and the degree to which the respondents' expectations of their work and profession had been met. From the sample of 529 pharmacists, 217 (41%) usable responses were received. Pharmacists generally agreed that their expectations toward work, salary, department standards, and use of professional abilities had been met. However, it was found that younger pharmacists and those performing primarily staff duties had lower ratings for met expectations and satisfaction than did their counterparts. Measures of expectations and satisfaction with current jobs consistently outranked similar measures of opinions toward the profession. Organizational attachment appeared to be highly correlated with age and with tenure of employment; younger pharmacists and those with one to seven years of concurrent employment were more predisposed to leaving the organization. It was noted in particular that the factors exerting a strong influence to leave the organization involved management-related activities and responsibilities. Managers can encourage organizational attachment by providing promotion opportunities and leadership in the structure and facilitation of job duties and by responding to individual needs.

Age Factors↗

PubMed1985

Monetary incentive for pharmacists to control drug costs.

An incentive program that paid hospital pharmacists at United Hospitals Incorporated (UHI) and Children's Hospital Incorporated (CHI) a percentage of the money saved by the pharmacy on drug and i.v. expenses in 1984 is described. Hospital administration, as part of a hospitalwide incentive program, approved the pharmacy department's proposal for a monetary incentive program. Pharmacy managers hoped that, by rewarding all pharmacists for their efforts to control costs, they could potentiate other cost-containment programs (stronger formulary control and improved purchasing and inventory control) and improve clinical services while maintaining quality of care. The incentive calculation was derived from the percentage of expenses saved on drugs and i.v. solutions and sets relative to budget. The payout, to be applied to 1984 salaries of pharmacists, could not exceed 10% of salary or more than 35% of the total savings to the hospital. A screening mechanism was established to protect the hospital from paying an incentive if the total pharmacy expenses exceeded budget. In fiscal 1984, drug and i.v. expenses per adjusted case decreased 1.55%, which led to each full-time pharmacist receiving an average payout of $500. This payout was less than had been anticipated because of a nursing strike at other hospitals, which resulted in an influx of intensive-care patients. The monetary incentive program for pharmacists is a useful tool for controlling drug and i.v. expenses and for rewarding pharmacists for successful cost-saving approaches.

Cost Control↗

PubMed1978

Evaluation of the professional communications of a pharmacist in a 45-bed rural hospital with comprehensive pharmaceutical services.

The professional communications of a pharmacist providing comprehensive services were studied to determine the accuracy of the information provided, its usefulness to patient care and the level of expertise needed to respond appropriately. Data were collected by a diary technique for a four-month period. Patient charts were reviewed to collect clinical data needed to evaluate the appropriateness of the pharmacist's responses and to ascertain evidence that the information provided was implemented. The analysis classified the communications as either "clinical" or "pharmaceutical" in content. Practitioner panels of pharmacists and a physician assessed the communications for accuracy, relevance to the patient episode and level of pharmacy expertise necessary to communicate. Most communications with physicians were "pharmaceutical" in content. The most frequent information asked concerned dose or dosage schedule. Approximately one-third of the "pharmaceutical" communications could have been handled adequately by a technician. Only one communication should have required an extensive literature search for the pharmacist to respond. Less than half of the pharmacist's communications were pertinent to the patient episode and of clinical importance. Information from half of the communications was implemented in patient care within 48 hours. There did not appear to be any relationship between accuracy of response and implementation of information. It is not known whether the deficiencies identified apply to a large number of pharmacists. Hence, the bearing of the study on the cost-benefit of clinical pharmacy services is not clear.

Communication↗

PubMed1983

Comparison of physician and pharmacist management of anticoagulant therapy of inpatients.

The management of anticoagulant therapy for hospitalized patients by seven certified pharmacist prescribers and one physician was compared. Eighty-one consecutive patients referred to the anticoagulation service were randomly assigned to two groups. For patients in the pharmacist-prescriber group, the physician independently monitored laboratory results and simulated heparin and warfarin doses. The roles of pharmacist and physician were reversed for patients in the physician-prescriber group. According to an established protocol, adjustments in heparin sodium infusion rate were based on activated partial thromboplastin time (PTT); warfarin sodium dosage was adjusted using a proconvertin and prothrombin (P&P) method. Heparin doses, warfarin doses, and clotting-test results were compared for patients in the two prescriber groups; simulated and actual doses also were compared. Patients were observed for complications of anticoagulant therapy. There were no significant differences in the mean heparin and warfarin doses administered to patients in the two prescribed groups. Similarly, PTT and number of days to reach therapeutic P&P were not significantly different. Within each group, the mean prescribed and simulated heparin doses were not significantly different. There were no episodes of major bleeding, but four patients in the pharmacist-prescriber group had minor bleeding. While the results are not applicable to all pharmacists or all settings, the certified pharmacist prescribers in this study adjusted anticoagulant therapy as well as an experienced physician.

Anticoagulants↗

PubMed1982

Job content and pharmacists' job attitudes.

The relationships between job content and hospital pharmacists' work attitudes are examined. A 152-item questionnaire was mailed to 507 hospital pharmacists in southeastern Michigan. The questionnaire included measures of job dimensions, psychological states, and personal and work outcomes. Mean scores for 34 subscales consisting of 2-5 related items were computed. Background characteristics were also assessed. Using factor analysis, the respondents were categorized as clinical, inpatient, outpatient, or generalists depending on their reported relative time spent performing 23 nonadministrative job functions. Analysis of variance was performed across the four groups for each subscale; the level of significance was set at 0.001. The response rate was 56%, representing 283 completed questionnaires. The clinical, outpatient, inpatient, and generalist pharmacist groups consisted of 43, 36, 70, and 134 respondents, respectively. There was a prevalent trend in the rank order in which pharmacists in the four groups responded to various subscales. The clinical group had the highest scores for 13 of the 14 subscales that were significantly different across pharmacist groups. Alternatively, in all but one of the significantly different subscales the inpatient group ranked lowest. Because pharmacists in the clinical group consistently scored higher than the other groups on scales measuring components of job enrichment, the authors concluded that the challenge of hospital pharmacy managers is to adapt the positive features of clinical practice to other areas of the profession.

Attitude of Health Personnel↗

PubMed1981

Effect of pharmacist intervention on the use of serum drug assays.

The results of an investigation to (1) evaluate the use of serum drug assays (SDAs), (2) study the influence of clinical pharmacist monitoring and educational programs on SDA use, and (3) perform drug-related patient-care evaluations for the medical audit committee are reported. The components of the five-month study were a retrospective audit, education of physicians prescribing SDAs, and a concurrent reaudit. The four SDAs audited were digoxin, theophylline, gentamicin, and phenytoin. Criteria for appropriate use were defined by the audit committee and a clinical pharmacist. The criteria specified the indication for each drug, performance data, and dosage adjustments with SDA results. The clinical pharmacist presented two housestaff conferences on the appropriate use of SDAs and distributed educational materials to the attending physicians. An SDA report form was completed each time an SDA was ordered, and, whenever possible, the pharmacist met with the prescribing physician. Appropriate overall use of SDAs increased significantly (p less than 0.05). A significant improvement (p less than 0.05) was noted for each of the criteria. An estimated $2500 in patient charges was saved during the study; the cost of the clinical pharmacist's time was approximately $260. The authors concluded that clinical pharmacists, in conjunction with patient-care evaluations, can provide a cost-effective service in improving therapeutic patient monitoring based on SDA results.

Costs and Cost Analysis↗

PubMed1981

Competency-based advancement program for pharmacists.

A competency-based advancement program for practicing pharmacists is presented. The criteria for selecting this method of providing incentives for pharmacists are outlined. Procedures for developing and implementing this competency-based program are described. Five competency levels for pharmacists were developed based on the pharmacist's educational background, training, and experience. Differentiated position titles and competency expectations for each level are summarized. Criteria for pharmacist placement and promotion from one completely level to another are outlined. The administration of the program is described, including budget considerations and methods for evaluating its effectiveness. This system recognizes and rewards accomplishments of staff pharmacists without removing them from patient care roles.

Budgets↗

PubMed1980

Physician attitudes toward pharmacists counseling patients on adverse drug reactions.

The attitudes of physicians in a university teaching hospital toward pharmacist counseling of patients regarding adverse reactions to prescribed medications were studied. A questionnaire mailed to 120 physicians in each of the three groups affiliated with the Medical College of Virginia Hospitals (teaching faculty, house staff, and community practitioners with attending privileges) listed 56 potential adverse reactions associated with commonly prescribed medications in 13 therapeutic categories. For each physician group, half of the questionnaires pertained to inpatient and half to outpatient situations. The physicians were asked whether their patients should be informed about the possible reactions and, if so, if the physician alone, the pharmacist alone, or both should do the counseling. When "pharmacists only" and "both" data were combined for the 199 responses, over 50% of the respondents accepted pharmacists as patient counselors for all listed reactions except the three pertaining to antipsychotic agents. Class of medication significantly influenced attitude (p less than 0.05), with pharmacist participation in counseling being most acceptable for reactions involving anticoagulants, antibiotics, and analgesics, and least acceptable for those involving antipsychotics, cardiac glycosides, and antianxiety agents. Acceptability also was influenced by physician type (p less than 0.05), being lowest among community physicians, and was slightly higher in outpatient versus inpatient situations (p less than 0.05). The study indicates that physicians will accept pharmacist counseling with respect to adverse drug reactions, especially on a partnership basis.

Attitude of Health Personnel↗

PubMedDate not supplied

[Community health pharmacists' situation in the framework of the Spanish State. Analysis of their functions and competence in the matter of food hygiene in the Community of Valencia].

BACKGROUND: We intend to show the Community Health pharmacists's situation in the different Autonomous Communities of the State, independently from their health. With regard to the Community of Valencia, we propose to integrate the Community Health pharmacists in the health structures of Health Areas, so that they can better fulfil their duties: specially Food Hygiene. METHODS: The information provided by the Health Services of each Autonomous Community has been used. Data from the Community of Valencia come from the Public Health General Direction and from Valencia Health Service of Generalidad Valenciana. Official criteria of periodical inspection in order to study needs have been put into practice. Data process has been computerized. RESULTS: Two kinds of Autonomous Communities have been identified depending on wether they have carried out or not the reorganization and/or the reassignment of duties of Community Health pharmacists. The distribution of Community Health pharmacists in the Autonomous Community of Valencia is shown in its health map, as well as the needs of surveillance for industries and food establishments within a pharmaceutic scope. CONCLUSIONS: The necessity of adapting the figure of the Community Health pharmacist to the Health General Law appears evident, particularly to health structures in the Areas; as well as the convenience of not making the chemist's shop possession compatible with the rest of duties assigned to this pharmacist's Body.

Community Health Services↗