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PubMed1994

Screening for coronary heart disease risk factors in retail pharmacies in Sheffield, 1992.

OBJECTIVE: To investigate the current and likely future provision of screening services for risk factors for coronary heart disease in retail pharmacies in Sheffield. DESIGN: This was a questionnaire survey asking about screening tests currently offered, price charged per test, likely future provision of screening tests, the action respondents would take upon finding an abnormal test result, whether the pharmacy was owner-run, franchised, or part of a commercial chain, and inviting open comments from respondents. SETTING: All retail pharmacy premises on the Sheffield Family Health Services Authority list. RESULTS: Seventy seven responses were obtained to 102 questionnaires distributed. Only nine of these currently offered any screening test other than pregnancy testing, although 37 indicated that they might offer tests in the future. Thirty nine were not offering screening and had no plans to do so. Pharmacies offering or likely to offer screening tests were mainly owner-run. All pharmacists who replied to the question asking about their action upon finding abnormal result (33) reported that they would advise the patient to see a doctor. The most frequent comments made by pharmacists were about the commercial viability of screening in pharmacies and the lack of space available to ensure patient privacy and confidentiality during screening. CONCLUSIONS: Screening in retail pharmacies would probably be a commercial failure unless doctors were able to contract for screening services from pharmacies. Evidence from this study and others, however, leads us to question the desirability of this option.

Attitude of Health Personnel↗
PubMed1986

Implementing a mainframe packaged pharmacy computer system in a 190-bed hospital.

The implementation of a pharmacy computer system in a 190-bed institution is described. A computer system was instituted in the pharmacy department as part of a hospitalwide conversion to an online information system. Planning for implementation began nine months before the actual live date (date of full computerization). Problems in the existing distribution and record-keeping systems that might be eliminated by computerization were identified, and changes in the layout of the pharmacy and department procedures were initiated to prepare for computerization. The events leading to computerization are presented in chronological order, and the advantages and shortcomings of the system are discussed. Because of careful planning, the cooperation of all pharmacy staff members, and frequent assistance from the computer vender, the nine-month conversion to a computerized system proceeded smoothly.

Computers↗
PubMed2004

[Evolution of Belgian hospital pharmacy].

During the last 30 years, Hospital Pharmacy has undergone a significant evolution. It has progressively evolved from a purchase, production and distribution oriented institutional logistical support activity towards a patient oriented activity through the application of the complementary skills acquired by the various pharmacists active in the field. This evolution, particularly marked during the seventies and eighties, was recognized in 1991 through the adoption by the health authorities of hospital pharmaceutical centers acceptance norms specifically targeting activities of multidisciplinary teams centered around the patient. All these new skills progressively became the object of practical and theoretical training sessions dispensed in the framework of a Hospital Pharmacy DES. The content of this DES is regularly adapted in accordance with the evolution of observed necessities.

Belgium↗
PubMed1985

The mobile medication cart as an adjunct to a centralized pharmacy service.

At Kingsbrook Jewish Medical Center, a mobile medication cart was used as an adjunct to a centralized unit dose drug distribution system. The system was instituted to study the possible decrease in turnaround time between the writing of the drug order and the administration of the first dose to the patient. The study showed that there was a 39% increase in doses administered in less than 60 minutes with the cart. Also, availability of medication at the first scheduled administration time improved 11%. The study concluded that turnaround time and nursing trips to the pharmacy were reduced. The system improved clinical contact with doctors and nurses, and this had a direct effect on improving job satisfaction among the pharmacists.

Hospital Bed Capacity, 500 and over↗
PubMed1989

Cooperative regional program for distribution of poison prevention information and syrup of ipecac.

A regional program to distribute poison prevention information and syrup of ipecac to families that have regular contact with young children is described. In December 1985 the department of pharmacy services at Bristol Hospital in Connecticut proposed implementation of a poison prevention program targeted to families with young children (less than 12 years of age) in the hospital's five-town service area. A planning committee was created to define program goals and oversee operations. The committee decided that poison prevention kits consisting of an instructional booklet and a one-ounce bottle of syrup of ipecac would be distributed to selected residents of the five-town area, with individual instruction provided in the correct use of syrup of ipecac. Funding was provided principally by the hospital, with some additional money from private foundations. The project was named CAP (Combating Accidental Poisoning) and ran initially from December 1, 1986, to June 30, 1987. Kits were distributed in cooperation with area health-care professionals with whom families had regular contact, including pediatricians, family-practice physicians, and community pharmacies. Apart from the hospital pharmacy service itself, the most effective participants were pediatricians; family-practice physicians were highly ineffective. During the course of the initial CAP program 6610 kits were distributed, with 48.7% going to families considered at high risk for the occurrence of an accidental child poisoning. An ongoing program to distribute these kits to all newly delivered mothers and to all area pediatricians free of charge has resulted in more than 15,000 kits being distributed.(ABSTRACT TRUNCATED AT 250 WORDS)

Connecticut↗
PubMed1986

Strategic planning for clinical services: panel discussion.

A panel of hospital pharmacy managers representing three institutions discussed issues related to planning for patient-oriented pharmacy services. The panelists discussed organizational benefits of strategic planning, ways to gain momentum for change among pharmacy staff members and from others within the institution, the need for setting realistic goals, and problems in differentiating roles for pharmacy staff. They also discussed the funding of strategic-planning programs. The panelists advocated an integrated approach to providing drug distribution and clinical services. Management must provide whatever support is necessary for integrating patient-oriented services into the daily activities of all pharmacists. That support may be in the form of additional personnel, better use of supportive personnel, staff development programs, or automation. Pharmacists, too, must recognize their combined responsibilities for drug distribution and clinical services. Only by having all pharmacists clinically trained can a department provide clinical services when needed. The experiences of these panelists may be useful to other institutions planning patient-oriented pharmacy services.

Medication Systems, Hospital↗
PubMed1999

ASHP guidelines on surgery and anesthesiology pharmaceutical services. American Society of Health-System Pharmacists.

Pharmaceutical services in surgery and anesthesiology should be the standard of practice in health care organizations across the United States. Although not essential, an onsite satellite pharmacy would help in the provision of these services. A majority of distribution-related activities should be done by technicians. The availability of automated devices and other technology may lessen, to some extent, the time devoted to drug distribution. It is important for the OR pharmacist to concentrate on the provision of clinical services, such as medication-use management, drug information services, medication-use evaluations, formulary management, and pharmacoeconomic analyses of anesthesia-related medications. These activities provide the best opportunity for the pharmacist to contribute to improving patient care and outcomes and containing costs. Finally, pharmaceutical services in surgery and anesthesiology should be periodically assessed for patient care and financial effectiveness.

Anesthesiology↗
PubMed2001

Practical approach to the use and monitoring of dofetilide therapy.

FDA's requirements for the use of dofetilide are described, and one hospital's strategy for meeting the requirements is discussed. Dofetilide is a specific class III antiarrhythmic agent approved for use in the conversion of atrial fibrillation and atrial flutter and the maintenance of normal sinus rhythm. It is available as an option for highly symptomatic patients who fail to respond to or do not tolerate other antiarrhythmic agents and patients with structural heart disease. Because of the risk of torsade de pointes associated with dofetilide, FDA has mandated in-hospital initiation of dofetilide therapy and has restricted its availability to hospitals and prescribers who have received appropriate education on dofetilide treatment initiation and dosing. Control of the drug's distribution is limited to a single wholesaler and a single mail-order pharmacy. These restrictions, along with the FDA labeling and the inherent risks associated with dofetilide use, have made this drug a complicated agent to use within an institution. When dofetilide was added to the formulary at Harper University Hospital, policies and procedures were developed to ensure appropriate use and monitoring. The use of dofetilide within health systems requires detailed procedures for prescribing, dispensing, and monitoring and thorough education of caregivers about those procedures. Pharmacists have a pivotal role in ensuring the appropriate use of dofetilide.

Anti-Arrhythmia Agents↗
PubMed1975

Unit dose innovations.

Four innovations in a unit dose drug distribution system are described. The innovations involve prefilling oral syringes, distribution of refrigerated doses, pharmacist verification of nurses' transcriptions of medication orders, and pharmacy preparation of dose administration schedules.

Drug Administration Schedule↗
PubMed2003

[Computerized physician order entry, a tool for added safety in the hospital].

DRUG-RELATED IATROGENIC NOSOCOMIAL ILLNESS: Remains a matter of concern in the public health area. Responsibility of hospitals is challenged by the ever increasing number of patients' claims. Dysfunction in the drug-prescribing and delivery system account, to a large extent, for medication errors, some of them resulting in adverse drug events. Most generally, medication ordering by the physician is handwritten, without nominative recapitulating prescriptions, and followed by nurse transcriptions and a global medication order is transmitted to the pharmacy. This system does not integrate the pharmaceutical analysis of the prescription, before distribution of the drugs. THE COMPUTERIZED DRUG ORDER ENTRY PROCESS: The prescription is entered directly and is displayed on the computer screen, together with the previous prescriptions for the same patient. Transcription is hence eliminated. Depending on the sophistication of the software, the prescription undergoes a series of tests; warnings and reminders can be displayed online before the physician validates the prescription. Moreover, various guidelines in some aspects of drug therapy may be presented online before the prescription is completed. POSSIBILITIES: The pharmacist's access to the complete prescriptions permits analysis of the quality and safety of the prescriptions and the adequation with eventual current applicable recommendations. Prospective drug utilization review, with immediate feedback to the prescribing physician in case of concern, may be undertaken, further improving the quality of drug therapy. Moreover, a work sheet is printed out for the nurses, further enhancing the safety of drug administration and validation. The computerized drug network also permits the development of other functions. A TOOL FOR SAFETY: Currently available reports in the literature suggest that computerized drug prescription reduces the incidence of prescribing errors, improves the appropriateness of drug choices, optimises therapeutic follow-up, and reduces the incidence adverse drug events and leads to substantial reduction in drug expenditures.

Computers↗
PubMed1993

Methods used by pharmacy departments to identify drug interactions.

The results of a survey evaluating the methods that pharmacy departments use to manage drug interactions, and their satisfaction with those methods, are reported. A random sample of 300 hospitals with more than 200 beds was selected, and a questionnaire was mailed in January 1991 to the directors of the pharmacy departments of these hospitals. Of the 300 questionnaires mailed, 167 were completed and returned. Thirty-seven percent of the hospitals offered pharmacy services through a central location only, whereas 63% offered such services through a combination of central and decentral locations. The majority of hospitals (83%) detected drug interactions through the knowledge of the pharmacist processing orders. Nearly all central pharmacies had AHFS Drug Information and Facts and Comparisons available for drug interaction information, but these resources were available in only slightly more than half of all decentral pharmacies surveyed. Fifty-four percent of the responding institutions had a computerized drug distribution system with a drug interaction component; 56% of these classified their system as "indispensable" or "helpful," while 44% classified their system as "somewhat helpful but sometimes a hindrance." Sixty-eight percent of all respondents believed that the availability of a drug interaction computer program increased the number of drug interactions identified. Sixty-eight percent of respondents perceived that pharmacists provided proper follow-up. Overall, 66% of respondents were not satisfied with their method for detection and follow-up of interactions. Of those who were satisfied, 79% had a computerized drug interaction program. Respondents who reported departmental audits or quality assessment procedures were also more likely to be satisfied.(ABSTRACT TRUNCATED AT 250 WORDS)

Drug Information Services↗
PubMed1988

Cost-benefit of a clinical services integrated with a decentralized unit dose system.

Clinical pharmacy services are believed to be beneficial to patient care and to have the potential to reduce drug costs. This study was designed to apply cost-benefit analysis techniques to selected clinical pharmacy services provided by staff pharmacists assigned to a mobile decentralized unit-dose drug distribution system. Pharmacists' interventions were identified and recorded by the pharmacists and the investigator over an eight-week period. Interventions, to which a monetary value could be assigned, included non-formulary drug use, drug regimen adjustments, and the duration of drug therapy. A total of 543 interventions were recorded or observed. Of these, 174 (32 percent) fit the criteria for inclusion in the study. Those interventions accepted by physicians (87 percent) were assigned a dollar value and tabulated. Costs to provide the service were the pharmacists' salaries. Benefit to cost ratios of 1.08 and 1.59 demonstrated that the benefits accrued from selected clinical pharmacy services exceeded the costs to the hospital.

Canada↗
PubMed1986

Burnout experienced by recent pharmacy graduates of Mercer University.

The degree of burnout experienced by graduates of the Mercer University Southern School of Pharmacy from 1973 to 1983 was studied. Questionnaires were mailed to 1000 alumni, representing 850 Bachelor of Science (B.S.) and 150 Doctor of Pharmacy (Pharm.D.) graduates. Three components of burnout--emotional exhaustion, depersonalization, and personal achievement--were measured using the Maslach Burnout Inventory to determine relationships between burnout and primary work setting, primary work activity, and type of degree (Pharm.D. or B.S.). The response rate was 41%. The respondents experienced a moderate degree of burnout. Those pharmacists working primarily in community chain store settings reported greater levels of burnout than those working in hospital or institutional pharmacies, independent community pharmacies, academia, and home health care. Respondents who performed primarily nondistributive duties (direct patient care, drug information, teaching or research, and management or administration) experienced lower levels of burnout than those involved primarily in drug distribution. Pharmacists holding the Pharm.D. degree were involved to a greater extent in nondistributive positions and experienced a lower degree of burnout than the pharmacists holding a B.S. degree only. Pharmacists in nondistributive roles appear to be less affected by burnout than pharmacists performing traditional distributive activities.

Burnout, Professional↗
PubMed2005

Development of a complementary and alternative medicine (CAM) pharmacy and therapeutics (P&T) subcommittee and CAM guide for providers.

OBJECTIVE: The objective was 2-fold: (1) to evaluate the feasibility and value of developing a Pharmacy and Therapeutics (P&T) subcommittee aimed at scientifically evaluating complementary and alternative medicine (CAM) products for an integrated managed care organization (IMCO) and (2) to assess provider acceptance and usefulness of a CAM guide. METHODS: Three factors drove the decision to form a CAM P&T subcommittee to evaluate current commonly used CAM products: (1) physicians, pharmacists, and dieticians expressed a desire for an easy-to-use, scientifically based mechanism for evaluating the ever-increasing number of CAM products; (2) Intermountain Health Care Health Plans (Health Plans), the insurance division of this IMCO, offers access to certain CAM products to its members at a discounted price in an effort to remain competitive with other IMCOs; and (3) this IMCO owns and operates more than a dozen community pharmacies that sell CAM products. Some IMCO clinicians believed an efficacy and safety review of the products offered through the organization was warranted. Subcommittee members included clinical pharmacists (IMCO and university), pharmacy directors, a community pharmacist, practicing physicians (from the drug P&T committee), a medical director, dieticians and nutritionists, and a representative from the Health Plans sales department. The primary outcome was the development of a CAM guide listing recommendations for use of CAM products. Outcome measures included survey results (survey sent with guide to physicians and (pharmacists) regarding acceptance and usefulness of the guide. RESULTS: The CAM P&T subcommittee met monthly to evaluate current commonly used CAM products. A CAM guide was developed in paperback and electronic versions. The electronic version was downloadable to handheld devices. Thousands of CAM guides were disseminated to IMCO-employed physicians, network pharmacies, dieticians, and nutritionists affiliated with this managed care organization. A survey that accompanied distribution of the first CAM guide in 2003 showed that 89% of physicians and pharmacists felt that the guide would be somewhat or very helpful as a counseling aide; the remainder was unsure. A second CAM guide was disseminated one year later, in 2004. The accompanying survey showed that 78% of physicians and 97% of pharmacists felt that the guide would be somewhat or very helpful as a counseling aide; 7% of physicians and 3% of pharmacists felt the guide would be unhelpful. CONCLUSION: A CAM guide developed through the work of a subcommittee of the P&T committee of this IMCO appears to be widely accepted by pharmacists and physicians. A CAM guide should be easy to use and available online with the ability to download to a handheld device.

Community Pharmacy Services↗