The unit dose drug-distribution system.
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Medication Systems, Hospital↗
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The choice between centralized and decentralized unit-dose drug distribution.
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Cost-Benefit Analysis↗
[Organization of reliable drug distribution to the population].
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Pharmaceutical Preparations↗
Marketing concepts for pharmaceutical service development.
Marketing concepts as a mechanism to help pharmacy develop, communicate, and sell future pharmaceutical services to consumers are discussed. Pharmacy as a profession must define itself broadly to take advantage of future growth opportunities. These growth opportunities will be realized from unmet health-care needs and changing consumer life style trends and values. New services must therefore be oriented toward consumers (i.e., patients, health professionals, and third-party agencies) to gain acceptance. Dispensing and drug-knowledge-distribution pharmaceutical services are reviewed by a product life cycle analysis of sales profits versus time. A marketing mix for new pharmaceutical services is developed consisting of service, price, distribution, and promotion strategies. Marketing can encompass those key elements necessary to meet the organizational goals of pharmacy and provide a systematic, disciplined approach for presenting a new service to consumers.
Marketing of Health Services↗
Errors remaining in unit dose carts after checking by pharmacists versus pharmacy technicians.
The accuracy of pharmacists and pharmacy technicians in checking unit dose carts was compared. One-half of the unit dose patient medication drawers, for a 92-bed medicine service in a 450-bed teaching hospital, were checked by pharmacy technicians and the remaining by pharmacists. These drawers then were checked again to determine the number and type of checking errors committed by technicians and pharmacists. During the 10-day study, carts checked by pharmacists contained over twice as many errors (1.85%) as similar carts checked by technicians (0.87%). The results suggest that pharmacy technicians could probably be trained to perform the cart-checking task in unit dose drug distribution systems. Time-extended studies should be done to determine if technician performance is maintained after the novelty of the task wears off.
Drug Packaging↗
Effect of a pharmacist-education initiative on ketorolac use and costs in a Medicaid program.
The effects of a pharmacist-education initiative on the use and costs of ketorolac in a state Medicaid program are reviewed. An intervention letter describing changes in the manufacturer's prescribing guidelines for ketorolac and providing suggestions for interacting with physicians regarding the use of ketorolac was sent to 150 of the 301 pharmacies that participate in New Mexico's Medicaid program. The remaining 151 pharmacies served as a control group. Ketorolac claims records for three months before and after the intervention were reviewed. The mean quantity of ketorolac tablets, total days' supply, and number of prescriptions filled per pharmacy per month were calculated for both periods. The number of prescriptions not filled as a result of the intervention as well as the number that could have been avoided, the number of cases of peptic ulceration (ketorolac's major adverse effect) that would be avoided, and the associated cost savings if all the state's Medicaid pharmacies had been included in the intervention were estimated. A total of 167 pharmacies (90 intervention and 77 control) dispensed ketorolac for Medicaid patients during the study period. Ketorolac dispensing rates declined during the postintervention period in both the intervention group and the control group, but the reduction was greater in the intervention group. It was predicted that if all pharmacies were included in an intervention, 135.6 fewer prescriptions for ketorolac would be filled each year; as a result, 1.14 cases of peptic ulceration would be avoided and net Medicaid costs would be reduced by $1638. Sending educational letters to pharmacists was associated with a modest reduction in ketorolac use in a state Medicaid program; a net reduction in Medicaid costs if the intervention were extended to all pharmacies that participate in the state's Medicaid program was projected.
Analysis of Variance↗
Survey of sterile product compounding practices in Canadian hospital pharmacies.
Improper preparation of sterile products by hospital or community pharmacies may have serious consequences. Recent reports of deaths or injury to patients as a result of receiving products that were contaminated during their preparation in a pharmacy have highlighted the importance of maintaining good sterile compounding practices. Efforts are now underway to develop revised guidelines for the compounding of sterile products in order to minimize the potential for future recurrence of similar incidents. This survey study was undertaken to provide background data on current sterile products compounding practices and procedures in Canadian hospital pharmacies. It was also anticipated that these data would be helpful in identifying issues that needed to be addressed in the new guidelines. Surveys were distributed to 700 Canadian hospitals with 50 or more beds. Responses from returned surveys were entered into and analyzed using the database program RBase. A total of 306 hospital pharmacies responded, with 200 indicating that sterile products were compounded within their department. The information provided by respondents provides insight into the types of sterile products being prepared in Canadian hospitals, the training background of staff involved in sterile product preparation, the type of facilities and equipment used for compounding these preparations, and the quality control/quality assurance procedures that are in place in hospital pharmacies. The information arising from this survey underscores the need for comprehensive guidelines or standards with respect to sterile product compounding, and the need for improved training of personnel involved in sterile product compounding. The results should be of interest to hospital pharmacy administrators, pharmacy regulatory bodies, and government agencies responsible for assuring the safety of pharmaceutical products used in patient care.
Canada↗
Drug handling and patient compliance in an outpatient paediatric trial.
New routines for drug handling were used in a 24-week outpatient double-blind trial of naproxen versus acetylsalicylic acid in 80 patients with juvenile rheumatoid arthritis. The clinician ordered tablets from the pharmacy for each patient by stating name, weight and randomization number. The pharmacy dispensed the drugs in sealed and labelled 1-week medication containers. Totally, 2176 containers were packed and distributed to the patients. Two errors in ordering of drugs were detected. Patient compliance was studied by tablet count in used containers returned by 25 of the patients. The calculated compliance was 95%. The procedures for drug handling seem useful and may increase the validity of clinical trials. The staff at the local pharmacy can be valuable partners in the planning and performance of clinical drug trials.
Adolescent↗
Mandating unit dose drug distribution and i.v. admixture services in New Jersey hospitals.
Efforts by New Jersey hospital pharmacists that led to a state mandate for unit dose drug distribution and i.v. admixture services are described. The New Jersey Society of Hospital Pharmacists' proposal for revision of state board of pharmacy regulations for institutional practice had been rejected in 1977. In 1979, NJSHP began to work through the state health department to upgrade standards for institutional pharmacy practice. In 1981, NJSHP submitted to the health department a position paper to justify revised standards on the basis of patient safety and cost-effectiveness, and in 1982 NJSHP conducted a seminar for pharmacists, nurses, and hospital administrators on the cost-effectiveness of unit dose distribution and i.v. admixture programs. The standards were revised and were adopted in June 1984, and hospitals had two years to implement the mandated programs.
Drug Compounding↗
Automated decentralized pharmacy dispensing systems.
Automated decentralized pharmacy dispensing systems (ADPDSs) are medication management systems that allow hospitals to store and dispense drugs near the point of use. These systems, which can be compared with the automated teller machines used by banks, provide nurses with ready access to medications while maintaining tight control of drug distribution. In this study, we evaluated three ADPDSs from two suppliers, focusing on whether these systems can store and dispense drugs in a safe, secure, and effective manner. When rating the systems, we considered their applicability to two different implementation schemes: The use of a system with a pharmacy profile interface. This feature broadens the capabilities of the system by allowing more information to be provided at the dispensing cabinet and by providing better integration of the information from this cabinet with the pharmacy's information system. Two of the evaluated systems have this feature and were rated Acceptable. The use of a system without a pharmacy profile interface. We rated all three of the evaluated systems Acceptable for such implementations. To decide which scheme is most appropriate for a particular hospital, the facility will need to determine both how it intends to use the ADPDS and what it hopes to achieve by implementing the system. By performing this type of analysis, the facility can then determine which ADPDS features and capabilities are needed to accomplish its goals. To help facilities make these decisions, we have provided an Equipment Management Guide, "Improving the Drug Distribution Process-Do You Need an Automated Decentralized Pharmacy Dispensing System?," which precedes this Evaluation. In addition, readers unfamiliar with the roles of both the pharmacy and the pharmacist within the hospital can refer to the Primer, "Functions of a Hospital Pharmacy," also published in this issue.
Automation↗
[Analysis of automedication with antibiotics in Spain].
BACKGROUND: The aim of this study was to determine the incidence of automedication with antibiotics in Spain, analyzing the magnitude, importance and possible consequences of this problem. METHODS: A quantitative study was carried out in the pharmacies by personal interview with people who had acquired a pharmaceutical speciality. The study was performed according to territorial distribution proportional to the population of different autonomic communities and urban and rural environments. The questionnaires were done over one year with four cut offs, each coinciding with one of the annual seasons. RESULTS: Automedication with antibiotics was observed in 32.1% of the people who had acquired an antibiotic in a pharmacy, being 28.8% with pharmaceutical specialities acquired. In 20% of the cases (18.1% of the specialities), automedication was produced by direct request of the user, while in 12.1% of the cases (10.7% of the specialities) this was by recommendation by the pharmacist/ pharmaceutical auxillary. Of the people obtaining an antibiotic by self-medication, two out of three acquired a wide-ranging semisynthetic penicillin, while 23% acquired a macrolide. The remaining therapeutic subgroups acquired were tetracyclins (3.3%) and cephalosporins, quinolones and cotrimoxazoles being 1.6% each. Automedication was most frequent in people from 30 to 39 years of age (36.1%) followed by those from 40 to 49 years (29.5%). Men showed a slightly greater incidence than women with 39% of the women acquiring an antibiotic directly doing so for someone other than themselves. Pharyngoamigdalitis was the most frequent process for which an antibiotic was acquired by automedication (34.5% of the cases). The most frequent therapeutic schedule was three times a day for one week. There was little correspondence between the dosage schedule and length of treatment and the number of doses contained in the drug acquired. CONCLUSIONS: Antibiotic automedication is a widespread practice in Spain, specially in the treatment of infectious respiratory and bucal processes. Together with therapeutic unfulfillment and storage of antibiotics in the homes, automedication is currently one of the most serious problems in antibioticotherapy since it is frequently accompanied by bad usage. Health care education programs should be developed with the aim of making the public aware of the negative effects of automedication and orienting patients as to the rational use of antibiotics.
Adolescent↗
Accuracy of technicians versus pharmacists in checking syringes prepared for a dialysis program.
The accuracy of pharmacy technicians versus pharmacists in checking drug doses prepared in syringes for a dialysis program was studied. Three pharmacy technicians from the pharmacy of a regional kidney disease program in Minnesota participated in the study after completing a training program and after common preparation errors had been identified by pharmacists. From November 1995 to April 1996, the technicians used labels printed from a database of pharmacist-verified orders to prepare and label i.v. syringes. Four medications were used-epoetin alfa, calcitriol, heparin prepared from beef lung, and heparin prepared from porcine intestinal mucosa. Each syringe was checked by one of nine pharmacists for accuracy of dose and medication, and all errors were recorded. The technicians checked syringes prepared by other technicians and also recorded errors. Accuracy rates (percentages of syringes correctly evaluated) for pharmacists and technicians were compared. A total of 10,608 syringes were checked. Accuracy rates for pharmacists and pharmacy technicians were 99.86% and 99.83%, respectively. Accuracy rates in checking syringes did not differ significantly between pharmacists and technicians in this study setting.
Chi-Square Distribution↗
Pharmacists' knowledge of and attitudes toward opioid pain medications in relation to federal and state policies.
OBJECTIVE: To assess Wisconsin pharmacists' knowledge of and attitudes toward the use of opioid analgesics in the management of chronic cancer and noncancer pain, and to explore the potential for these beliefs to interfere with pharmacist dispensing, the last link of the distribution chain of controlled substances to patients. DESIGN: Mail survey. SETTING: Urban and rural pharmacies, long-term care facilities, hospitals, and outpatient clinics in Wisconsin in 1998. PATIENTS OR OTHER PARTICIPANTS: Representative sample of Wisconsin pharmacists. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Responses to self-administered questionnaires. RESULTS: Although most respondents were knowledgeable about the issues addressed in this study, there were important exceptions. Not all pharmacists knew what constitutes legitimate dispensing practices for controlled substances under federal or state policy in emergencies or for patients with terminal illnesses, and many were unaware of the important distinctions among addiction, physical dependence, and tolerance. Many respondents did not view the chronic prescribing/dispensing of opioids for more than several months to patients with chronic pain of malignant or nonmalignant origin as a lawful and acceptable medical practice; this was especially true when the patient had a history of opioid abuse. CONCLUSION: Pharmacists play a pivotal role in ensuring patient access to medications. Viewed in the context of federal and state controlled substances policies, our findings suggest that the incorrect knowledge and inappropriate attitudes of some pharmacists could contribute to a failure to dispense valid prescriptions for opioid analgesics to patients in pain.
Adult↗
Basing pharmacy counselling on the perspective of the angina pectoris patient.
AIM OF THE STUDY: A participatory action research study design was developed and tested in 40 Danish internship pharmacies as part of a 3-year study supported by the Research Centre for Quality in Medicine Use. The aim of the study was to create a foundation for improving the quality of counselling practice in pharmacies by comparing the pharmacy staff's views on, knowledge of and behaviour towards a specific patient group with the knowledge, perceptions and medication use of the same patients. METHOD: Pharmacy students in their fourth year collected data for the study. In 1999, the students carried out 123 qualitative interviews with angina pectoris patients and collected 569 questionnaires from pharmacy staff in 40 internship pharmacies. RESULTS: The results indicate that discrepancies exist between the patients' and pharmacy staff's perspectives on important issues such as knowledge about medicines (patients)/provision of information about medicines (pharmacy staff), experienced side effects (patients)/information about side effects (pharmacy staff), knowledge on prevention and lifestyle (patients)/information on lifestyle and prevention (pharmacy staff) and expectations of pharmacies (patients)/initiatives started in pharmacies (pharmacy staff). CONCLUSION: The study gives reason to believe that angina pectoris patients might benefit if pharmacies provided more information on the relationship between lifestyle factors and angina pectoris, the possible side effects of medicines and the function of medicines.
Angina Pectoris↗
New roles for wholesalers in hospital drug distribution.
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Competitive Bidding↗
Perceived interprofessional barriers between community pharmacists and general practitioners: a qualitative assessment.
BACKGROUND: There have been calls for greater collaboration between general practitioners (GPs) and community pharmacists in primary care. AIM: To explore barriers between the two professions in relation to closer interprofessional working and the extension of prescribing rights to pharmacists. DESIGN OF STUDY: Qualitative study. SETTING: Three locality areas of a health and social services board in Northern Ireland. METHOD: GPs and community pharmacists participated in uniprofessional focus groups; data were analysed using interpretative phenomenology. RESULTS: Twenty-two GPs (distributed over five focus groups) and 31 pharmacists (distributed over six focus groups) participated in the study. The 'shopkeeper' image of community pharmacy emerged as the superordinate theme, with subthemes of access, hierarchy and awareness. The shopkeeper image and conflict between business and health care permeated the GPs' discussions and accounted for their concerns regarding the extension of prescribing rights to community pharmacists and involvement inextended services. Community pharmacists felt such views influenced their position in the hierarchy of healthcare professionals. Although GPs had little problem in accessing pharmacists, they considered that patients experienced difficulties owing to the limited opening hours of pharmacies. Conversely, pharmacists reported great difficulty in accessing GPs, largely owing to the gatekeeper role of receptionists. GPs reported being unaware of the training and activities of community pharmacists and participating pharmacists also felt that GPs had no appreciation of their role in health care. CONCLUSION: A number of important barriers between GPs and community pharmacists have been identified, which must be overcome if interprofessional liaison between the two professions is to be fully realised.
Attitude of Health Personnel↗
Creating an enterprise-wide allergy repository at Partners HealthCare System.
A significant fraction of medication errors and preventable adverse drug events are related to drug-allergy interactions (DAIs). Computerized prescribing can help prevent DAIs, but an accurate record of the patient's allergies is required. At Partners HealthCare System in Boston, the patient's allergy list is distributed across several applications including computer physician order entry (CPOE), the outpatient medical record, pharmacy applications, and nurse charting applications. Currently, each application has access only to its own allergy data. This paper presents details of a project designed to integrate the various allergy repositories at Partners. We present data documenting that patients have allergy data stored in multiple repositories. We give detail about issues we are encountering such as which applications should participate in the repository, whether "NKA" or "NKDA" should be used to document known absence of allergies, and which personnel should be allowed to enter allergies. The issues described in this paper may well be faced by other initiatives intended to create comprehensive allergy repositories.
Boston↗
Nailing Jell-O to a wall: regulating Internet pharmacies.
The growth of the Internet pharmacy industry is challenging the ethical and regulatory systems that govern the sale and distribution of prescription drugs. New forms of regulation are necessary to prevent abuse and minimize mistakes by consumers, doctors, and pharmaceutical companies. Unfortunately, the mercurial nature of the Internet makes trying to regulate it "like trying to nail Jell-O to a wall." Effective regulation will require greater coordination among state, national, and international regulatory bodies. In addition, consumereducation programs are necessary to inform the public of the problems that are caused by the impersonal and commercial nature of marketing drugs over the Internet. At a minimum, the author suggests that states should uniformly adopt laws that prohibit a physician from prescribing drugs without any face-to-face communication between the physician and the patient, and the United States should work to make this a uniform international standard.
Ethics↗