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PubMed1993

Limited availability of medications for cancer patients.

We surveyed both chain and independent pharmacies within 10 counties of central South Carolina to determine the availability of certain medications that are often prescribed for patients during cancer treatment. One hundred twenty (59%) of the 202 surveys distributed were returned. Results indicate that many of the 65 products included in the survey are not stocked on a regular basis by the majority of the pharmacies that responded. Limited availability of these medications not only may prevent a patient from receiving timely drug therapy, but may exacerbate the anxieties and frustrations experienced by patients as they deal with their disease as well. This limited accessibility to medications could directly influence patient compliance. Therefore, patients need to be informed that availability is often limited, and that prescribed medications may require special ordering by their pharmacist. Awareness of this potential problem and increased communication among physicians, nurses, pharmacists, and patients could alleviate delays in drug therapy and improve the continuity of patient care.

Analgesics↗
PubMed1983

Description of an experimental hospital pharmacy management information system.

The objectives, characteristics, and uses of hospital pharmacy work-measurement systems are discussed, and the development and operation of an experimental hospital pharmacy management information system (HPMIS) is described. Hospital pharmacy work-measurement systems are designed to measure and evaluate the productivity of a hospital pharmacy or group of pharmacies. Previous work-measurement systems used by hospital pharmacies have been too time consuming or imprecise for widespread use. A national hospital pharmacy work-measurement system known as HPMIS was developed to provide comprehensive and widely applicable information on pharmacy expenses, personnel use, and productivity. HPMIS converts data from participating hospitals into 17 indicators that enhance the comparability of the information between the hospitals. The 17 indicators relate to pharmacy production, clinical services, and administrative functions; also included are several gross department indicators that combine elements of all three areas. After analysis and categorization of the data according to characteristics such as bed size, geographical location, and type of drug-distribution system, results are reported to individual hospitals. A national work-measurement system such as HPMIS should enable hospitals to evaluate their pharmacy operations in relation to those of other hospitals and to track their department's relative management performance over time.

Efficiency↗
PubMed1975

Review of computer applications in hospital pharmacy practice.

A comprehensive literature review of the applications of computers in hospital pharmacy practice is presented. Articles are categorized as: accounting and drug usage review; purchasing and inventory control; controlled substances; outpatient services;drug distribution; drug information; and clinical services.

Accounting↗
PubMed1994

Relationship between severity, costs and claims of hospitalized patients using the Severity of Illness Index.

The results of the prospective application of Horn's 'Severity of Illness Index' in a teaching hospital during 1987, 1989, and 1990 constitute the basis of the present report. The average overall severity of illness scores for the three years were 1.42 in 1987, 1.65 in 1989, and 1.46 in 1990. Most of the processes evaluated in the three periods showed an overall distribution among severity levels 1 and 2, both overall and when the seven dimensions of the severity of illness index were analyzed. A statistically significant correlation between the overall severity of illness and average length of stay was found for patients in 1989 and 1990. The length of stay differed significantly in the different severity levels. When the four levels of the seven dimensions of the severity of illness index for 1987, 1989, and 1990 were compared, it was observed that figures were not uniformly distributed. There was a statistically significant association between severity of illness for hospital service and pharmacy charges per hospital stay for both 1989 and 1990, as well as a statistically significant inverse relationship between severity of illness and the number of claims per hospital service in both periods of time. Case-mix methods that account for the severity of patients constitute a useful indicator of quality for the management of different hospital services and of the hospital as a whole.

Adolescent↗
PubMed1999

Hospital drug distribution systems in the UK and Germany--a study of medication errors.

The aim of this study was to compare the incidence of medication errors and the stages of the drug distribution system at which they occur in a United Kingdom (UK) hospital using the ward pharmacy system, a German hospital using the unit dose system and a German hospital using their traditional system. Medication errors were identified by observing the preparation and administration of regularly scheduled solid oral medication. In the UK hospital using the ward pharmacy system, the medication error rate was 8.0% (95% confidence interval 6.2-9.8%). The majority of these errors occurred at the stage of medication administration. In the hospital using the traditional German system, the error rate was 5.1% (4.4-5.8%). With the German unit dose system, the error rate was 2.4% (2.0-2.8%). In both German systems the errors were mainly attributable to the stage of transcription. It was noted that patient turnover was much higher in the wards using the ward pharmacy system and therefore the study sites may not be comparable. However, recommendations can be made in order to reduce the error rate associated with each system. Errors associated with the ward pharmacy system may be reduced if medication is stored in individual patient medicine cabinets and patients' own drugs used. Errors occurring with the traditional system and the unit dose system may be reduced if the original prescription is used for medication administration.

Data Collection↗
PubMed1986

Joint pharmacy/nursing procedure for monitoring unit dose distribution and unadministered doses.

This article describes a procedure that uses a multidisciplinary approach to quality assurance in a unit-dose distribution system. The procedure described here uses an assigned nurse and one member of the pharmacy staff (pharmacist, technician/intern) on each nursing unit to check the physical contents of medication cassettes as well as compare pharmacy patient profiles with nursing medication administration records. In examining data from a 184 calendar day period, there was an average of 822 doses of medication per day, including IV admixtures and piggybacks, checked using this system. The time spent in the checking process was approximately 40 minutes per day for each of the three pharmacy staff members performing the check. The average daily census during this period was 60 patients, located on two medical/surgical nursing units, a combined short-procedure unit/detox unit, and an eight-bed critical care unit. The procedure presented also includes a mechanism for the nursing staff to easily document unadministered doses in a manner that provides the pharmacy department with this information. The procedure described makes it extremely difficult for certain types of medication errors to extend beyond a 24-hour period. It also controls missing doses. We found during the 184-day period that only 12 doses were reported missing from the cassettes after the check process. The low number of missing doses reported can be attributed to the fact that the assigned nurse and member of the pharmacy staff verify the presence of a 24-hour supply of medication.

Hospital Bed Capacity, 100 to 299↗
PubMed1979

Reference aids for developing policies and procedures for intravenous admixture services.

A table of literature citations designed to help hospital pharmacists develop a policy and procedure manual for i.v. admixture services is presented. The table is categorized according to literature that will aid in developing policies and procedures for specific aspects of admixutre services (e.g., distribution procedures, quality assurance). The citations were selected from two periodicals (American Journal of Hospital Pharmacy and Drug Intelligence & Clinical Pharmacy) and three other publications.

Bibliographies as Topic↗
PubMed1985

Control and accountability of controlled substance administration in the operating room.

Personnel working in the operating room complex may be at increased risk for chemical impairment. It has been proposed that this predisposition may be related to the frequency of use of controlled substances and the inadequate control over distribution of these medications, which frequently exists in the operating room. A system utilizing a pharmacy satellite in the operating room has increased the control and accountability of drug administration practices. Several other alternative systems are also reviewed. Emphasis is placed on the establishment of a quality assurance program to monitor compliance routinely.

Anesthesiology↗
PubMed2004

[Doubts and problems of phytotherapy].

Phytotherapy and pharmacotherapy are closely related. The mode of action of phytopharmaca with no strong effect is often explained cell biologically and pharmacologically in a too general way. The origin of some herb teas and herbal medicinal products, distributed by product distributor networks, is often uncertain, often originating from abroad. The imprecise denomination of drug components, as well as the unscientific description of indications make abuses possible and are harmful for the upsurge of phytotherapy. For these reasons more potential should be given to the preparation of herb tea mixtures and herbal medicinal products that can be prepared in pharmacies as well. Inland medicines, curative or illness-preventing products that are prepared from checked components and licensed for distribution should be favoured.

Phytotherapy↗
PubMedDate not supplied

Alcohol use, drug use, and sexual activity among pharmacy students at three institutions.

OBJECTIVE: To determine alcohol and drug use and sexual activity among pharmacy students at three colleges of pharmacy. DESIGN AND SETTING: A survey to obtain self-reported information on alcohol and drug use, and sexual activity was administered to professional pharmacy students at the University of Iowa (UI), Massachusetts College of Pharmacy, and Texas Southern University. MAIN OUTCOME MEASURES: Information on sexual activity and condom use, alcohol and drug consumption, and the effect of alcohol on unintended sexual activity. RESULTS: 848 students (50% response rate) completed the survey. Alcohol use was high at all three institutions, and most students had consumed five or more drinks on one or more occasions within the last three months. The extent of drug use among pharmacy students was similar to that reported in other college students. The majority of students were sexually active. More men than women reported having been sexually active with one or more partners. Most students reported having had sexual intercourse without a condom. Significant numbers of students had engaged in unintended sex after alcohol use, especially at UI (chi 2 = 12.6, p = 0.002). Sexual contact and drinking were strongly correlated (Pearson r = 0.31, p = 0.0001). CONCLUSION: Alcohol consumption among pharmacy students was high. Heavy drinking (five or more drinks on one occasion) was associated with unintended sexual contact. Given low condom use and increased sexual contact, pharmacy students are at an increased risk for HIV infection. Strategies should be developed to reduce alcohol intake and unprotected sexual activity among pharmacy students.

Adult↗
PubMed1999

Technicians or patient advocates?--still a valid question (results of focus group discussions with pharmacists).

New legislation went into effect in Iceland in March 1996 making it the first Nordic country to liberate their drug distribution system. The term liberalization implies the abolishment of the professional monopoly in that ownership was not tied to the pharmacy profession anymore. Focus group discussions with community pharmacists in the capital area Reykjavík and rural areas were employed to answer the research question: How has the pharmacists' societal role evolved after the legislation and what are the implications for pharmacy practice? The results showed firstly that the public image and the self-image of the pharmacist has changed in the short time since the legislative change. The pharmacists generally said that their patient contact is deteriorating due to the discount wars, the rural pharmacists being more optimistic, and believing in a future competition based on quality. Secondly, the results showed that the pharmacists have difficulties reconciling their technical paradigm with a legislative and professional will specifying customer and patient focus. This study describes the challenges of a new legislation with a market focus for community pharmacists whose education emphasized technical skills. This account of the changes in the drug distribution system in Iceland highlights some of the implications for pharmacists internationally.

Denmark↗
PubMed1996

Technology and automation in pharmaceutical care.

Pharmacy computer systems in the future will help pharmacists assess patients' medication needs, evaluate drug therapy, and manage patient information. Technology companies are developing systems for automatic dispensing and for distributing medications from nurses' stations in hospitals and long-term care facilities. Bar codes are being used in medication dispensing, verifying prescriptions, selecting patient brochures, and screening for drug interactions. Pharmacies in the future will rely on information networks to store, manage, and communicate patient information. Drug use review databases offer highly developed drug therapy screening.

Humans↗
PubMed1980

A statewide decentralized public drug information system.

A statewide drug information system designed to assist consumers and health professionals is described, with emphasis on the training of pharmacists in the system's satellites. The development of the system was initially funded by a 10-month, $12,500 grant from the Chemical Dependency Division of the State of Minnesota Department of Public Welfare. Twenty-one satellite drug information centers in community or hospital pharmacies are linked by a WATS telephone line to the library of the University of Minnesota College of Pharmacy. Consumers' questions are handled through the satellites with the pharmacists there referring to the central information source as needed. All the pharmacists in the system are trained in a one and one-half day program that covers (1) consultation skills, (2) communication skills, (3) drug information retrieval and distribution, (4) practical applications, (5) promotion, and (6) resources and referrals. The average amount of time devoted to the service for all pharmacy sites is 15-20 minutes per day. Percentage of time that specific resources are used include one's own knowledge and experience, 64.8%; a fellow pharmacist, 5.7%; another resource individual, 5.1%; a standard pharmacy reference book, 13.4%; the central clearinghouse at the college, 6.2%; and another resource facility, 4.8%. The authors believe that their system can be easily adapted to other areas.

Community Pharmacy Services↗
PubMed1979

Pharmacy practice in an operating room complex.

The steps involved in establishing a comprehensive pharmaceutical service in an operating and recovery room complex is described. Objectives of the operating room pharmaceutical satellite were to: (1) improve control of distribution, storage and charging for all drugs, especially Schedule II controlled substances; (2) reduce inventory costs and loss of revenue; (3) improve compliance with the drug formulary; and (4) establish patient-oriented pharmaceutical services. The pharmacy satellite improved inventory control and patient charging, assured continual access to all drugs and appropriate security for controlled substances, and expanded the pharmacy department's clinical, drug information and research activities.

Alabama↗
PubMed1961

Dangerous and Hypnotic Drug Act.

It is unprofessional conduct within the meaning of the Medical Practice Act to prescribe a dangerous drug without either a medical examination by a physician or other medical indications. Dangerous and hypnotic drugs are specifically defined by both state and federal law and distribution is strictly regulated.A physician may administer to his own patients such amounts of dangerous drugs as are necessary for the immediate needs of the patient. The physician may obtain such needed amounts of these drugs by an order placed with a pharmacist marked "for administration to immediate needs of patients." A licensed physician may also prescribe dangerous and hypnotic drugs for patients and such prescriptions may be refilled on the specific authorization of the physician.A physician who dispenses dangerous and hypnotic drugs to patients must obtain a hypnotic drug license; he must use specific purchase orders when purchasing; the drugs must be labeled in the manner provided by law; and all records of sale shall be open to inspection by authorized officers of the law and kept for three years. By the Principles of Medical Ethics physicians are bound to limit the source of their professional income to medical services actually rendered. Recent decisions of the Judicial Council answer questions concerning a physician's interest in a corporation which purchases, packages and sells medicines under a corporate name. Also answered are questions as to the measures that exist to prevent physicians from abusing the privilege of owning a pharmacy, and whether a physician can ethically rent space in a building owned by him to a pharmacist with a percentage of the income of the pharmacy as rental. The public welfare of California and the nation as determined by legislation strictly regulates the distribution of dangerous drugs. It is in the best interest of the medical profession and its patients that these laws be understood and carefully observed.

California↗
PubMedDate not supplied

[Cost-benefit analysis of a semi-automated process in the preparation of unit-doses by the Pharmacy Department].

OBJECTIVE: To determine in monetary terms the effect of implementing a semi-automated procedure for preparation of drugs for unit dose distribution. METHODS: The current net value was estimated for three different flows involved in the evaluation of semi-automated drug storage and retrieval systems used in the unit dose distribution area in a hospital: capital investment, staff costs and structural costs related to physical space occupied. RESULTS: Implantation of the new work procedure produced an annual saving of 32,390 euro in staff costs and 5,645 euro in structural costs. Global cash flow has been estimated in -96,565 euro for a five year amortization period, with a benefit/cost ratio of 2.19. CONCLUSION: Replacement of traditional unit dose cart filling systems by a semi automated procedure presents a positive benefit/cost ratio and initial investment is paid off in 44 months.

Automation↗
PubMed1983

Program to disseminate information on new hospital pharmacy practices.

A five-year program to stimulate interest in contemporary pharmacy practices and disseminate information to pharmacists and other health professionals in community hospitals throughout the State of Maine is described. Pharmacists from the New England Medical Center in Boston and the Maine Medical Center in Portland conducted a program from 1973 to 1978 that included consultative services, drug information, and continuing-education components. Pharmacy consultants visited about 50% of the hospitals in the state and met with the director of pharmacy, administrator, and director of nursing who received written reports of all findings and suggestions. Most frequently, hospitals requested recommendations on drug-distribution systems, design and use of medical profiles, and design of physician order forms. Surveys at the beginning and at the end of the program indicated that the number of hospitals with unit dose systems and i.v. admixture programs increased during the life of the program; pharmacy staffing levels also increased. The program successfully brought consultative services, drug information, and educational programs to pharmacists and other health professionals in community hospitals in Maine.

Boston↗
PubMed1995

Survey results of POPS use in United States and Canadian schools of medicine and pharmacy.

Recent initiatives calling for changes in medical education, such as the General Professional Education of the Physician and Robert Wood Johnson Reports, have recommended alternative teaching approaches to the lecture format. The Patient-Oriented Problem-Solving (POPS) exercises, sponsored by the Upjohn Company (Kalamazoo, MI) and made available for pharmacology in 1985, offer one of many possible alternatives to lectures. The technique involves group interactions between four students in a working group, each of whom must, with the aid of their colleagues, arrive at mutual solutions to simulated cases in clinical pharmacology. The exercises are intended to complement and enhance the learning of concepts from lectures, and to help students apply these concepts practically. The system is used extensively by medical, pharmacy, and other health profession schools throughout the United States and also abroad, and many thousands of exercise booklets have been distributed free of charge by the Upjohn Company. Currently, a committee of the American Medical School Pharmacology (AMSP) group, working with Upjohn Company personnel, is responsible for overseeing the writing and educational testing of new and revised exercises. The purpose of this paper is to report the results of a survey of POPS use in medical and pharmacy schools in the United States, Canada, and Puerto Rico, completed in March 1993. The returns indicate continued strong interest in the approach, and the acquired data affirm its value in teaching principles of clinical pharmacology to students in basic pharmacology courses. Detailed data were obtained on patterns of use, and a number of advantages and disadvantages were identified. Priorities for the writing of new POPS exercises were expressed by the respondents. The information acquired will form the basis for planning new and revised POPS exercises in the future.

Canada↗