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PubMed1987

The postindustrial decentralization of the hospital and the urban analogy.

The hospital in the United States as an institution, a community, an organizational form, and a social phenomenon shares many striking commonalities with the city. It has highly important technical functions which are accompanied, and at times overshadowed, by broader social purposes and roles. The hospital also has undergone a number of transformations over time and has experienced a distinct, if idealized, golden age fostered by key technological advances. It has been the site of significant political and social tensions and conflicts. And in recent years, it has begun to evidence a decline in social significance and standing, and a general deconcentration which further underscores the usefulness of the urban analogy. The application of an ecological perspective aids in framing this intriguing parallelism between these two great social institutions. This perspective emphasizes the interdependence and mutual causality which key contributory trends--such as technological and organizational developments, environmental change, and shifting population characteristics--have had on the forms and functions of both hospitals and cities. The urban ecologist Hicks has written: "The city is being redefined ... [t]he transforming city is a predictable response to changing demographic, economic and technological realities. While the image of the city's form is etched into our consciousness, it is the city's function that will always be its sine qua non; in time its form will adjust to the new roles that cities will come to society." In a like fashion, a similar ecological interpretation of the transformation of the hospital can and will be made. This article will propose that examining the modern hospital through the urbanization-deurbanization parallel can be an instructive way to explore and interpret its changing character and role in American society. It will suggest that the hospital evolved into a dominant central position--more in a functional than a territorial sense--in the health services sector with other service entities arrayed concentrically about it. However, powerful centrifugal forces in recent years have reversed this trend, and dispersion is becoming increasingly evident. These processes will be detailed and contrasted with those documented in urban decline and deconcentration of selected future trends from this perspective and some public policy implications in a ecological interpretation.

Community-Institutional Relations↗
PubMed1988

Source of missing doses in a decentralized unit dose system: a quality assurance review.

Unit dose drug distribution systems have become the prominent drug delivery system in healthcare institutions. Much of the success of the unit-dose concept can be attributed to the increased accountability of medications dispensed and administered. However, as a direct result of this added accountability the problem of "missing doses" has become more evident than under non-unit dose systems. A quality assurance audit was conducted to identify the reasons for missing doses and identify the responsibility for them. A missing dose record was developed through a collaborative effort of the pharmacy and nursing departments. Both staff nurses and pharmacists were invited to review and suggest modifications prior to using the form. All potential reasons for missing dose occurrences were listed on the form. When a missing dose occurred the pharmacist and the nurse completed form jointly to ensure agreement as to the cause. During the 25 day study period the pharmacy dispensed 54,082 doses of medications to patients on the study floors. During that period 227 incidents of missing doses were documented. This resulted in an overall incidence of missing doses of 0.4%. Of the 227 missing doses, a reason for the occurrence was identified for 170 (75%). Nine classes of medications accounted for 62% of all reported missing doses. When responsibility for the missing doses was examined 13.3% were pharmacy generated and 45.8% were nursing generated. The results of the audit generated several suggestions which may decrease the number of missing doses and further improve our drug distribution service.

Boston↗