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PubMed1986

A drug distribution system to supply a detached ambulatory surgery center from the main hospital's central pharmacy.

Ambulatory surgery centers (ASCs) and other outpatient service facilities are becoming more prevalent throughout the country. The development and implementation of a drug distribution system to supply a detached ambulatory surgery center is described. The method proposed to provide all the medication needed for the ASC uses a unit-dose cart with lockable doors. The cart is delivered to the ASC each morning by nonpharmacy hospital transportation personnel. A locked case method similar to the system described by McClure-Zola et al. is employed for schedule II controlled substances. Specific formularies were developed for the anesthesia and the operating/recovery rooms. Medications for both areas are arranged separately in the cart. The cart is returned to the pharmacy at the end of each ASC day to be replenished on the night shift by the pharmacy staff. Additional full-time equivalents are not required in the pharmacy budget to provide this service. The system described provides a simple method for efficiently and effectively meeting the medications needs of a free-standing satellite of the hospital.

Centralized Hospital Services↗
PubMed2004

[Access to hospitalization in Brazilian municipalities in 2000: territorial distribution in the Unified National Health System].

This article investigates the effect of external factors on hospitalization patterns in Brazilian municipalities (or counties): supply, spatial configuration, socioeconomic aspects, and political context. Inpatient data from 2000 for individuals 15 years and over and most frequent hospital procedures, obtained from the National Hospital Information System (SIH-SUS), were aggregated by place of residence at the municipal level. Nested generalized additive mixed models were fitted using Bayesian inference. Probability of hospitalization is shown to increase with hospital bed supply and with primary care and local capacity, and to decrease with increasing distances and in larger and wealthier municipalities. Inclusion of random, State, and spatial patterns effects reveals regional differences in the probability of hospitalization and the main factors explaining such different patterns.

Adolescent↗
PubMed1983

Effect on drug costs of implementing decentralized drug distribution.

The drug costs associated with a centralized drug-distribution system were compared with those of a newly implemented decentralized unit dose and i.v. admixture system in a university teaching hospital. Three months before and three months after implementation and stabilization of the new drug-distribution system, the mean drug cost per patient day was determined for each of 22 nursing stations. Variations in drug use were monitored to eliminate the influence of patient mix or treatment protocol. Data from 2 of the 22 nursing stations were excluded from analysis because of large variations in drug use. Twelve nursing stations demonstrated lower drug costs per patient day with the new drug-distribution system. Overall, an 18% reduction in drug costs per patient day was achieved. In this hospital, a decentralized drug-distribution system was associated with lower drug costs than the traditional distribution system.

Costs and Cost Analysis↗
PubMed1985

Pharmaceutical services in hospitals treating pediatric patients.

A survey was conducted of pharmaceutical services in 120 of the 325 short-term hospitals associated with accredited pediatric residency training programs, 52 pediatric hospitals, and 68 adult hospitals with pediatric units or floors. The mail survey conducted in 1983 had a 70% response. Centralized pharmaceutical services were offered by the majority of the hospitals. Seventy-two percent of the respondents indicated that either a complete or partial unit dose drug-distribution system was used for most of their pediatric patients, while 25% indicated that they used either the traditional individual patient-fill system or some combination of drug-distribution systems. A total of 80% of the hospitals provided either complete or partial i.v. admixture services. The preparation of total parenteral nutrient solutions was the most common admixture service provided. Clinical services were provided, to some extent, by 63% of the respondents. Computers were used for multiple functions, such as generating patient profiles, organizing the formulary, and providing labels for unit dose and i.v. admixture services, by 33% of the respondents. Selection of therapeutic alternates was performed by pharmacists in 51% of the responding hospitals, and the majority of institutions had formulary systems. Modern drug-distribution systems and clinical services have been established in many hospitals treating pediatric patients.

Computers↗
PubMed2001

Systemic Candida infection in University hospital 1997-1999: the distribution of Candida biotypes and antifungal susceptibility patterns.

A total of 102 Candida species were isolated from blood cultures from January 1997 to October 1999. Using assimilation of carbohydrate test, 52 (51.0%) of the Candida sp. were identified as C. parapsilosis, 25.5% (26) were C. tropicalis. C. albicans made up 11.8% (12), 6.9% (7) were C. rugosa, 3.8% (4) C. glabrata and 1% (1) C. guilliermondii. No C. dubliniensis was found in the study. In vitro antifungal susceptibility tests showed that all Candida species were sensitive to nystatin, amphotericin B and ketoconazole. Although all isolates remained sensitive to fluconazole, intermediate susceptibility was found in 3 C. rugosa isolates. Antifungal agents with high frequency of resistance were econazole, clotrimazole, miconazole and 5-fluorocytosine. Candida species found to have resistance to these antifungal agents were non-C. albicans.

Antifungal Agents↗
PubMed2006

ASHP national survey of pharmacy practice in hospital settings: dispensing and administration--2005.

PURPOSE: Results of the 2005 ASHP national survey of pharmacy practice in hospital settings that pertain to dispensing and administration are presented. METHODS: A stratified random sample of pharmacy directors at 1173 general and children's medical-surgical hospitals in the United States was surveyed by mail. RESULTS: The response rate was 43.5%. Most hospitals had a centralized drug distribution system; however, there is evidence of growth in decentralized models compared with data from 2002. Automated dispensing cabinets were used by 72% of hospitals and robots by 15%. The percentage of doses dispensed in unit dose form increased, as did the use of two-pharmacist checks for high-risk drugs and high-risk patient groups. However, the percentage of medication preparation and dispensing quality-improvement programs declined over the past six years. Medication administration records (MARs) have become increasingly computerized over the past six years. Consequently, the use of handwritten MARs has declined substantially. Technology implemented at the administration step of the medication-use process is continuing to grow. Bar-code technology was implemented by 9.4% of hospitals, and 32.2% of hospitals had smart infusion pumps. Pharmacy hours of operation were stable, with 30% of hospitals providing around-the-clock services. About 12% of hospitals are using off-site medication order review and entry after hours. Pharmacy staffing has steadily increased over the past three years; however, hospital pharmacies reported a 5.6% vacancy rate. CONCLUSION: Safe systems continue to be in place in most hospitals, but the adoption of new technology is changing the philosophy of medication distribution. Pharmacists are continuing to improve medication use at the dispensing and administration steps of the medication-use process.

Drug Compounding↗
PubMed1998

Digital networking and archiving with ACOM T.O.P.

The international DICOM 3 standard for a single patient record exchange media (CD-R) provided the necessary definition for digital recording and distribution of cardiac angiographic patient data. The medical industry developed archive and review stations that allow the replacement of the 35 mm cine film. SIEMENS launched ACOM. T.O.P. in late 1995. The benefits and technical solution are presented in this paper. Today, the solution for networked real-time image data distribution within the hospital has become reality. Further integration of hemodynamic data, connectivity of hospital information systems, easy access and distribution of such high volume data from and to remote locations is well under way. ACOM. net is used as an example for the realization of commercial products to fulfill the demands of cardiologist and hospital administrators.

Cardiac Catheterization↗
PubMed1984

Improvement of pharmacy services at Melfort Union Hospital.

Approval for capital equipment funding and appropriate staffing was granted in August, 1982 for conversion to a unit dose drug distribution system at Melfort Union Hospital. All necessary packaging equipment, kardexes, forms and supplies were ordered in September and had arrived by November 1982, the same time a second pharmacist was hired. Prepackaging began in December for the proposed unit dose starting date of January 6, 1983. Inservices were performed to nursing three times prior to the implementation of unit dose on our 30 bed medical floor on January 6, 1983. During implementation one pharmacist spent a great deal of time with the nurses to ensure proper use of the system. Numerous meetings were held to correct the minor flaws inherent in any new system. Normal resistance to change was experienced, taking about 3 weeks to subside. Clinical services such as patient counselling, a monthly drug information bulletin and a formulary have been developed. These changes were not difficult and have provided a superior pharmacy service at a reasonable cost.

Hospital Bed Capacity, under 100↗
PubMedDate not supplied

[Status of feeding services at Spanish hospitals with dietetic and clinical nutrition unit].

Nutrition at the hospital is substantial to the evolution of the disease. The number of diets in the surveyed hospital ranged between 15 and 70 and was not influenced by the hospital number of beds. The proportion of basal and therapeutic diets is similar (about 50% each), although the number of "special" diets increase with the hospital size. The average periodicity of menus is 14 days, while the optional "menu" is lower in bigger hospitals. The knowledge of the Diet Code in different hospitals is how between physicians and nurses in relation to other health and service professionals. The computerized ordering of diets is higher in those hospitals with more than 1500 beds (66%) and the manual request ranges between 65% and 80% in those with 200 to 1500 beds. Most hospitals have a centralised distribution system with a isothermal tray.

Food Service, Hospital↗
PubMed1990

Disinfection of water distribution systems for legionella: a review of application procedures and methodologies.

Hospital-acquired legionella pneumonia is emerging as a major problem; potable water distribution systems have been shown to be the primary reservoirs for the legionella organisms. As a result, disinfection measures have been developed to eradicate the organism from the hospital water supply. Each disinfection modality differs in its design and application such that choosing an appropriate cost-effective control measure requires careful analysis and planning. We assess in comparative fashion the disinfection modalities of thermal eradication ("heat-and-flush"), instantaneous steam-heating system, chlorination, ultraviolet light irradiation, ozonation and metal ionization. The theoretical bases, the actual procedure or system, the logistics of implementation, the costs and personnel requirements and the advantages and disadvantages are presented for each modality. Criteria for selection of a method, the use of combinations of methods, parameters for installation, pitfalls in implementation and a plan for subsequent environmental surveillance are discussed in detail.

Cross Infection↗
PubMed1994

Evaluation of UltraSTAR: performance of a collaborative structured data entry system.

The UltraSTAR structured data entry system is now in routine use for reporting ultrasound studies at Brigham and Women's Hospital, having been used for 3722 reports in its first ten months of service. Reports entered through GUI-based forms are uploaded via HL7 to a radiology information system and distributed through a hospital network. UltraSTAR introduces collaborative reporting, in which nonmedical and medical staff collaborate to produce a single report for each patient visit. Performance of UltraSTAR was measured as user satisfaction, data entry time, report completeness, free text annotation rate, and referring-physician satisfaction with reports. Results show high satisfaction with UltraSTAR among radiologists and acceptance of the system among ultrasound technicians. Data entry times averaged 5.3 minutes per report. UltraSTAR reports were slightly more complete than comparable narrative reports. Free text annotations were needed in only 25.2% of all UltraSTAR reports. Referring physicians were neutral to slightly positive toward UltraSTAR's outline-format reports. UltraSTAR is successful at structured data entry despite somewhat long reporting times. Its success can be attributed to efficiencies from collaborative reporting and from integration with existing information systems. UltraSTAR shows that the advantages of structured data entry can outweigh its difficulties even before problems of data entry time and concept representation are solved.

Attitude to Computers↗
PubMed1995

[Eradication of Legionella from warm water systems--documentation of our own experiences with thermal disinfection].

A nosocomial case of Legionellosis in a recently built hospital was the reason for an investigation and thermal disinfection of the complete warm water distribution system. Furthermore weak points in the tubing of the warm water system, which promoted the contamination of potable water, were eliminated as far as technically possible. A lasting reduction of the numbers of Legionella spp. isolated could be measured (factor 10-1000), but a complete decontamination of the warm water distribution system was not possible. As Legionella spp. may cause serious infections in immunodeficient patients, additional measures for the disinfection of the hospital water distribution system must be taken into consideration.

Cross Infection↗
PubMed1997

Towards a component driven infrastructure for integrated healthcare systems.

A high level summarised description of the distributed clinical information system implemented in the hospital of the free university of Brussels (AZ-VUB) is described. It evolves towards a component based clinical distributed system that consists of a set of co-operating middelware software components running on a number of computers connected by a network that will foster the integration of applications, data servers and other resources in the medical field. This system is implemented in the University Hospital of Brussels (AZ-VUB) a full-service 800-bed university hospital that provides care for 23,000 inpatients, supports over 300,000 outpatient visits and receives 32,000 emergency patients a year.

Belgium↗
PubMed1994

The patient care component: patient-centered horizontal integration in a vertical world.

This paper describes the structure and operational properties of the Patient Care Component, a patient care data system developed by the Indian Health Service to support primary care in a multi-site, decentralized, health care organization. Sharing the same technology base as the Department of Veterans Affairs Distributed Hospital Computer Program, the system requires a minimal level of investment in technology compared to alternative approaches and is in operation at 140 sites. The Indian Health Service and historical aspects of the system are described briefly; the paper focuses on the design objectives for the system and lessons learned from development and several years of operational experience.

Humans↗
PubMed2000

[Internet technology for clinical applications in a digital radiography department].

PROBLEM: To provide an overview and to assess the clinical feasibility of Internet technology-based systems for hospital-wide image and report distribution as well as for video conferencing. METHODS: The paper describes the theoretical concept behind, the various technical approaches and the experience gained from different systems. RESULTS: Image and report distribution: Advantages include the universal availability of images and reports inside and outside hospitals; ease of use; security features; image and report integration; cost savings by reducing support and training efforts and by optimising available hardware. The main critical issues are performance and workflow integration with RIS and PACS. Video conferencing: main advantages are the standardised, software-based approach and the low investments for hard- and software. Depending on the desired usage the communication performance can be seen as inappropriate. CONCLUSION: Today, Internet technology-based systems appear to satisfy the main clinical needs in radiology. The mentioned drawbacks could be eliminated by means of modified software implementation and focused standardisation efforts. Considering the numerous advantages of these systems a further distribution can be expected for the future.

Communication↗
PubMed2003

Medication errors in hospitals: computerized unit dose drug dispensing system versus ward stock distribution system.

AIM: The aim of this study was to evaluate the rates and types of drug prescription and administration errors in one pediatric nephrology ward, comparing two dispensing schemes: the first one defined as handwritten prescription plus ward stock distribution system (WSDS), and the second one as computerized prescription plus unit dose drug dispensing system (UDDDS). METHOD: Data were collected over an 8-week period, from 1 February to 31 March 1999. Two fifth-year pharmacy students photocopied prescription and administration documents on the ward each day, under the supervision of a senior pharmacist. The medical record analysis was used to compare the prescription with the administration report. Prescribing and administration medication errors were classified according to the American Society of Health-System Pharmacists. RESULTS: Prescribing errors: overall, for both dispensing schemes, a total of 511 prescriptions, resulting in 4532 prescribed drugs (an average of 9 drugs per prescription) were prescribed. The total prescription error rate was 20.7% (937 of 4532), resulting in 1.9 errors per patient per day. The computerized prescription error rate was 10.6% (419 of 3943), the handwritten prescription error rate was 87.9% (518 of 589). This difference was very significant (P < 0.0001). ADMINISTRATION ERRORS: The total opportunity of administration errors was 4589 (sum of administered and omitted drugs). The total administration error rate was 23.5% (1077 of 4589) including wrong administration time, and 11.7% (538 of 4589) excluding administration time. The administration error rate, including administration associated with time errors, was only 22.5% (888 of 3943) for computerized prescription + UDDDS, compared with 29.3% (189 of 646) for handwritten prescriptions plus WSDS (P < 0.001). Excluding administration associated with time errors, the administration error rates were 9.7% and 24.3%, respectively (P < 0.0001). CONCLUSION: The drug prescription and administration error rates were significantly decreased using computerized prescription plus UDDDS as compared with handwritten prescription plus WSDS in a pediatric unit (even with potential biases taken into account).

Child↗