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PubMed1997

Satisfaction among residents in ASHP-accredited pharmacy residency programs.

The level of work satisfaction among pharmacists in ASHP-accredited residencies was studied. In March 1996 a questionnaire designed to measure residency satisfaction was mailed to 697 individuals in ASHP-accredited pharmacy practice and specialty practice residencies. Subjects responded to 16 statements relating to intrinsic and extrinsic determinants of work satisfaction on a scale of 1 to 5, where 1 = strongly disagree and 5 = strongly agree. Questionnaires were returned by 413 (59%) of the residents. The respondents were predominantly women (76%), and most (86%) had at least a Pharm. D. degree. Hospitals were the primary work setting (88%). Of the 413 residents, 305 were in pharmacy practice residencies and 108 were in specialized residencies. None of the mean scores indicated disagreement (scores < 3) with the positively worded statements or agreement (scores > 3) with the negatively worded statements. The median and mode were equal to 2 (disagree) for the three negatively worded items and 4 (agree) for all but three positively worded items. Only 8% of the residents indicated that they would not accept the residency again if given the chance. Specialized residents tended to rate positively worded statements higher and negatively worded statements lower than pharmacy practice residents. Female residents indicated greater satisfaction than male residents. Pay and benefits were rated slightly better than neutral. Pharmacy residents appeared generally satisfied with their residencies. Specialized pharmacy residents were more satisfied than pharmacy practice residents, and women were more satisfied than men.

Education, Pharmacy↗
PubMed1997

Handling of gene-transfer products by the National Institutes of Health Clinical Center pharmacy department.

Policies and procedures for handling gene-transfer products at the National Institutes of Health (NIH) Clinical Center pharmacy department are described. The pharmacy at the Clinical Center is responsible for handling in vivo gene-transfer delivery systems, which are gene-transfer products that are prepared for direct administration to patients. The gene-transfer products currently handled by the pharmacy are investigational and are composed of viruses containing the gene encoding either of the melanoma antigens MART-1 and gp100. The pharmacy has prepared guidelines, based on the principles of aseptic technique and FDA guidelines for manufacturing facilities, intended to help pharmacy personnel safely dilute a concentrated gene-transfer product into a dose suitable for administration. Before a product is handled, the biological safety level is determined and a biohazard sign is posted. Worksheets detailing all supplies, calculations for dilutions, and procedures that will be required are prepared in advance; the worksheets are part of a drug fact sheet prepared for all investigational drugs dispensed. Personnel must be properly trained and dressed in protective clothing. Aseptic technique and decontamination procedures are used as specified in the guidelines, and all materials used are disposed of as biohazardous waste. All work is documented. If a worker is accidentally exposed, standard procedures are followed. The handling of gene-transfer products at the NIH Clinical Center pharmacy is based on the principles of aseptic technique, FDA guidelines, and experience.

Containment of Biohazards↗
PubMed1981

Preceptors' views of community pharmacy clerkships: a national survey.

A survey was administered to a random sample of community pharmacy practitioners who participate as preceptors in clerkship programs for colleges of pharmacy throughout the country. The purpose of this survey was to determine (1) in what ways, if any, students have affected the preceptors' practices; (20 whether the students served as a sources of continuing education to the preceptors; (3) whether the preceptors identified areas of students' strengths/deficiencies; and (4) roles of colleges of pharmacy and pharmacy associations in providing continuing education programs for pharmacists. Results of this survey are discussed. Data are cross-tabulated for types of pharmacy services provided, years in practice, length of clerkship rotations, and other essential demographic information needed for evaluation. Based on responses, recommendations are made that will provide guidance to colleges of pharmacy, pharmaceutical associations, and practitioners currently involved or those who are considering involvement in clerkship programs.

Attitude of Health Personnel↗
PubMedDate not supplied

Assessment of workflow redesign in community pharmacy.

OBJECTIVE: To assess the effect that workflow enhancements have on dispensing responsibilities and pharmacist-patient interaction in the community pharmacy setting. DESIGN: Pre-post comparison. Pre-assessment data were obtained from a multisite observational study. SETTING: Pharmacy within a regional pharmacy chain. STUDY PARTICIPANTS: 3 pharmacists and 110 patients. INTERVENTION: The pharmacy was physically remodeled to enable workflow changes, including defining dispensing responsibilities with an emphasis on patient counseling, providing an additional 6 feet of counter space, upgrading technology, installing a third computer, implementing tools to augment the filling process, and requesting that cashiers rephrase the offer to counsel to encourage patient acceptance. Patients and pharmacists were surveyed about the experiences and beliefs, and pharmacy activities were observed directly. MAIN OUTCOME MEASURES: Patient counseling and prescription dispensing. activities. RESULTS: The number of pharmacists who perceived that they had adequate time to counsel patients increased as a result of the intervention (0 of 3 responding pharmacists before the intervention, compared with 2 of 2 afterward). Patient satisfaction scores both before and after the intervention were predominantly favorable and did not differ significantly. The most relevant change in dispensing activities was pharmacist involvement with data entry into the computer, which decreased from 61% to 10%. Oral counseling offers to patients increased significantly, from 5% to 85%, but counseling rates remained low throughout the study and were not measurably affected by workload. CONCLUSION: Workflow redesign has positively affected the dispensing activities at the study site. Technicians took more responsibility for dispensing tasks. Given the drastic increase in counseling offers but lack of effect on counseling rates, patient behavior and expectations with regard to counseling likely need to change to further improve dynamics in the community pharmacy.

Architectural Accessibility↗
PubMed2003

White coat ceremonies in US schools of pharmacy.

BACKGROUND: Pharmacy and medical schools share similar concerns regarding the need to place greater emphasis on professional socialization. Many academic institutions of both professions have elected to establish a white coat ceremony to initiate the process of inculcating professional values. However, a recent literature search revealed little published information on pharmacy white coat ceremonies. OBJECTIVE: To determine the prevalence of white coat ceremonies in US schools of pharmacy and identify commonalities between ceremonies conducted at different schools. METHODS: In April 2002, a 25-question survey was sent via E-mail to the deans of the 83 accredited schools of pharmacy in the US. The survey solicited details about the nature of each school's white coat ceremony or reasons why the school does not conduct a ceremony. RESULTS: The first ceremony in pharmacy was held at the University of Kentucky in 1995. As of May 2002, 51 of the 83 schools had already conducted a white coat ceremony and another 10 indicated plans to initiate a ceremony by the end of the year. Telephone follow-up confirmed that, as of May 2003, the number had risen to 61 schools. Most schools conduct the ceremony during the first professional year. Common features include presentation of the coat, recitation of an oath, a speech by an honored guest, a class photograph, and a reception. CONCLUSIONS: The white coat ceremony is a growing phenomenon in pharmacy education that could play a pivotal role in the quest to better achieve professional socialization among students.

Clothing↗
PubMed2006

A comparative study of consumer participation in mental health pharmacy education.

BACKGROUND: People with mental illness have been recognized as key stakeholders in the development of mental health education. However, few studies have evaluated the impact of people with mental illness as participants in education programs for students studying to become health professionals. OBJECTIVE: To assess the impact of education provided by mental health consumer-educators on the attitudes of pharmacy students toward people with mental illness. METHODS: The study used a 2 group, nonrandomized, clustered, comparative design, with 4 tutorial classes allocated to receive standard pharmacist-led instruction (comparison group), and 5 tutorial classes to receive standard pharmacist-led instruction plus additional input from mental health consumer-educators (intervention group). All pharmacy students (N = 229) enrolled in the third year of a 4 year pharmacy degree program were invited to participate. Consumer-educators receiving ongoing treatment for illnesses including schizophrenia, bipolar disorder, and major depression participated in small-group work, case-study discussions, and role plays with pharmacy students in the intervention group. Pharmacy students' attitudes were assessed using a 39 item survey instrument derived from previously published instruments evaluating social distance, attribution, provision of pharmaceutical services, and stigmatization of people with schizophrenia and severe depression. RESULTS: Paired baseline and follow-up responses were obtained from 117 students in the intervention group and 94 students in the comparison group. Students who received the consumer intervention had decreased social distance scores (F(1209) = 5.30; p = 0.02). Students in the intervention group more strongly disagreed with 26 of 27 nonsocial distance statements that demonstrated a negative attitude toward people with mental illness (F(1209) = 13.58; p < 0.001) and more strongly agreed with all 4 nonsocial distance statements that demonstrated a positive attitude (F(1209) = 7.56; p = 0.014). CONCLUSIONS: Consumer participation in mental health education for pharmacy students improves students' attitudes toward people with mental illness.

Attitude of Health Personnel↗
PubMed1991

Survey of Canadian oncology pharmacy services--the emergence of a specialty.

The provision of pharmacy services to oncology is a substantial component of hospital pharmacy practice at several Canadian hospitals. To determine the scope of such pharmacy services a survey was developed and distributed to 103 hospital pharmacies and 11 ambulatory oncology pharmacies in 1988. There were 72 responses (65%), although only 96 centres were known to offer oncology services (adjusted response = 72 of 96 = 75%). Surveys were distributed and returned in reasonable proportion across the country. Inpatient and outpatient services were reported separately, for size of service offered, and categories of work in which staff were employed. Twenty-four of fifty-seven centres report large inpatient pharmacist services, and 21 of 57 had large inpatient technician services. The ratio of pharmacists to technicians appeared to be about equal, but technicians were less likely than pharmacists to be permanently assigned (one-third vs. one-half permanently assigned). About one-half of both large and small services indicate a desire for increased time for both pharmacists and technicians. Outpatient services were reported by fewer respondents, and the job assignments in this setting were mostly permanent. Manpower usage in both settings is primarily dedicated to drug preparation and distribution, although two-thirds of centres report small clinical services (most centres desired increased clinical services). Future planning topics ranked improved clinical services and standardization of practice highest. A 91% majority agree that there should be standards for pharmacy practice in oncology pharmacists in Canada. Many factors, including insufficient clinical services, impede specialty development and recognition, but are priority areas for future development.

Canada↗
PubMed1993

Hospital and community pharmacists' attitudes towards clinical pharmacy.

This longitudinal study compared the attitudes of the Class of 1983 at the University of Toronto toward clinical pharmacy seven years after graduation with those they expressed at the point of graduation in 1983. Over three quarters of the original class responded by indicating agreement or disagreement with statements (on a 5-point scale) about clinical pharmacy in 1983 and 1989. While there was little difference between those who became hospital pharmacists versus those who became community pharmacists at the point of graduation, seven years later, the hospital pharmacists were significantly more favourable than their colleagues toward drug consulting aspects of clinical pharmacy. The community pharmacists were significantly more favourable than their colleagues toward patient counselling aspects of clinical pharmacy. It is concluded that the work setting has influenced these different preferences for how the ideal of clinical pharmacy is interpreted. We offer a possible explanation for the consistently positive, if divergent, orientations towards the ideal of clinical pharmacy.

Attitude of Health Personnel↗
PubMed1983

The Pharmacy and Therapeutics Committee Part 1: overview.

The Pharmacy and Therapeutics (P & T) Committee is an important medical staff advisory group. As the primary, formal communication link between the pharmacy and medical staff, the P & T Committee is of particular importance to the department of pharmacy services. All matters pertaining to the use of medications within the institution, including pharmacy programs, must be reviewed and approved through the committee. In addition, medication formulary data is reviewed through the committee and recommendations are offered to the medical staff. Such a wide diversification of involvement and activity necessitates the effective communication between all committee members. An active involvement in the committee by the department of pharmacy services is vital in order to develop a contemporary and progressive institutional pharmacy program. This series of four articles will address several important aspects of the committee's operation, including committee formation, mechanics, operation, and problem solving.

Group Processes↗
PubMed2003

[Evidence-based pharmacology in community and hospital pharmacies--a vision of the future?].

Pharmacists are academically trained drug and medication specialists. Also in the eyes of the law, pharmacists are more than just specialised sales people for medication. As laid out in the regulations governing pharmacies, pharmacists see patients and experts in the fields of medicine, dentistry and veterinary science to whom they have to offer advice. The pharmacist's advisory activities, though, must not interfere with an existing doctor-patient relationship. All pharmaceutical activities in community and hospital pharmacies should therefore be based--similar to the medical faculty--on an evidence-based practice in the sense of an evidence-based pharmacy adopting all principles of Evidence-based Medicine. The challenge for pharmacists and doctors should therefore be to work together to increasingly develop common strategies in order to achieve optimal treatment for the benefit of the patient. Especially in the treatment of chronically ill patients, synergistic effects could be reached through open exchange and a closer linkage between medical and pharmaceutical activities. Such closer contacts between the two disciplines could be made at interdisciplinary colloquia or special subject-specific round table discussions. Pharmaceutical Care (PhC), i.e. the optimisation of medicational therapy of chronically ill patients through accompanying intensive pharmaceutical advice is desirable from the patient's point of view and could take some load off medical practitioners. Any questions as to the use of medication, potential side-effects or undesirable interaction with other medications, but also regarding additional preventive measures can be posed to qualified personnel by the patient collecting his/her medication in the pharmacy. Also, as community pharmacists see themselves as active medication specialists and valuable qualified advisors to the patient with regard of self-medication, increased investment in internal communication between colleagues and external communication with patients is desirable. In the hospital setting, the pharmacy is to be regarded as the central medication information office and should participate in interdisciplinary working groups for the development of clinical guidelines and substitution possibilities. Furthermore, hospital pharmacy should be consulted on pharmaco-economic questions and on planning and conducting clinical studies.

Evidence-Based Medicine↗
PubMed1990

Turbulence and tranquility in the new decade: pharmacy leader--managers in patient care.

Management challenges that face pharmacy in the 1990s are described. Tichy's rope metaphor--intertwined cultural, technical, and political strands of an organization--is applied to problems faced by pharmacy managers; effective managers keep the organization strong by preventing the strands from working at cross-purposes to unravel the rope. Pharmacy's culture--its shared beliefs and values--is changing as "altruistic" institutional pharmacists form home care businesses, pharmacists identify more strongly with the profession than with their institutions, clinical pharmacists identify more strongly with the medical team, and cost control becomes more important. Institutional pharmacy must identify its desired outcomes and apply technology to achieve them. The patient's bedside is the best place for pharmacists to influence prescribing and monitor drug therapy; technology could be used to process patient information at the bedside and to dispense medications there. Current unit dose distribution systems isolate the functions of physician, pharmacist, and nurse, which must be integrated to make the system efficient and responsive. Standardized doses and dosage forms could be developed that are consistent with patient-care protocols; use of protocols allows the effectiveness of treatment methods to be evaluated and eliminates unnecessary therapy. Pharmacy can further its patient-care goals through political success with the medical staff; a pharmacy practice plan developed for a specific clinical area and presented to the medical staff is an example. Collaboration of pharmacists and physicians in a unified institutional strategy for drug use helps ensure appropriate decisions about therapy and prevents manufacturers from attempting to isolate an institution's pharmacists from its medical staff.(ABSTRACT TRUNCATED AT 250 WORDS)

Drug Industry↗
PubMed1984

Diversification strategies for hospital pharmacies.

Several ways used by the pharmacy department of a large university hospital to generate revenue through diversification are described. The department offers its facilities and staff as a resource in training medical service representatives for several pharmaceutical manufacturers, which is projected to provide $85,000 in net income for fiscal year (FY) 1983-84. The pharmacy department also conducts a six-month program for training pharmacy technicians, which yields a small net profit. The pharmacy department actively participates in educational programs such as college courses and clerkships earning extra income. An apothecary-style outpatient pharmacy was set up under a for-profit corporation. Services have been expanded to include the preparation of i.v. solutions that support home care. A durable medical equipment (DME) business is planned. The ambulatory and home-care programs are expected to generate approximately $165,000 in net profit next year. Contract pharmaceutical services are provided to another hospital. The net income generated through diversification in this pharmacy department will exceed $250,000 in FY 1983-84.

Allied Health Personnel↗
PubMed1984

Observational study of job satisfaction in hospital pharmacy technicians.

Intrinsic and extrinsic factors contributing to job satisfaction of pharmacy technicians in two community hospitals were studied. A pharmacy student employed part-time as a pharmacy technician by one of the hospitals observed fellow technicians in a wide range of job activities for 22 months. In a second hospital, the same student conducted similar observations during one summer while posing as a social researcher. Both hospitals had technician training programs providing classroom instruction and on-the-job training. Data were gathered primarily from informal conversations with technicians and pharmacists and by recording activities through notetaking. Formal training programs, praise from pharmacists, opportunities to train other technicians, diversity of job activities, and autonomy in coordinating work with time demands were identified as factors contributing to job satisfaction of technicians. Negative aspects of the job that employers attempted to circumvent or clarify were the unchallenging nature of the work and the limited opportunities for advancement. Technicians' and pharmacists' attitudes toward job enrichment for technicians are discussed, and suggestions for improving technicians' intrinsic and extrinsic job satisfaction are provided. A reliable cadre of pharmacy technicians is necessary for further expansion of clinical pharmacy services under current hospital budgetary restraints. In addition to modifying job activities to promote technicians' intrinsic job satisfaction, pharmacy managers can improve extrinsic satisfaction by providing adequate salaries, job security, and flexible work schedules.

Humans↗
PubMed1978

Hospital pharmacy in Australia.

Hospital pharmacy practice in Australia is reviewed. Topics covered include pharmaceutical education, drug distribution, purchasing of pharmaceuticals, and hospital pharmacy staffing and services. Australia has a national health insurance system which directly affects both community and hospital pharmacy practice. While traditionally Australian hospital pharmacy practice has followed the British system of drug delivery, practitioners have tried to introduce innovations such as intravenous admixture services, unit dose drug distribution systems and drug information services. The limitations imposed by restricted governmental funds have inhibited the introduction of innovations. The Society of Hospital Pharmacists of Australia offers a continuing education correspondence course which leads to the granting of a Fellowship in Hospital Pharmacy.

Australia↗
PubMed1999

Pharmacovigilance of over-the-counter products based in community pharmacy: a feasible option?

PURPOSE: With the increasing range of potent medicines available for sale 'over-the-counter' (OTC) in community pharmacies, this feasibility study set out to develop and validate a method for the pharmacovigilance of OTC medicine, using ibuprofen as a model. METHOD: A trained network of community pharmacies (n=61) in Grampian, Scotland, tested different methods for recruiting people buying ibuprofen for their own use (pilot 1) and then used the 'best' method to test two methods of follow-up (pilot 2). RESULTS: Recruitment rates-method 1 (pharmacy staff inserted the patient information sheet and recruitment questionnaire in the shop bag of eligible subjects): 18% (41/227) of questionnaires issued; method 2 (staff explained the study and asked eligible subjects to complete the questionnaire outwith the pharmacy): 31% (61/194); method 3 (staff explained the study and asked eligible subjects to complete the questionnaire in the pharmacy): 52% (100/192). A further 200 subjects were recruited in pilot 2. The majority of recruits (n=402) were female (75%), mean age 43 years (range 18-84 years), 73% drank alcohol, 72% were non-smokers, and 56% were in the two most affluent socio-economic categories. There was a strong association between the drug dose data collected prospectively and that collected retrospectively. The average response to postal follow-up was 80% (315/392) at 1 week and 79% (308/390) at 2 months. CONCLUSION: The study has confirmed the support of pharmacy personnel in undertaking research and indicated the feasibility of a major pharmacovigilance project of OTC medicines.

Journal Article↗
PubMed2005

Prospective study of the incidence, nature and causes of dispensing errors in community pharmacies.

BACKGROUND: Each year over 600 million prescription items are dispensed in community pharmacies in England and Wales. Despite this, there is little published evidence relating to dispensing errors and near misses occurring in this setting. This study sought to determine their incidence, nature and causes. METHODS: Prospective study over a 4-week period in 35 community pharmacies (9 independent pharmacies and 26 chain pharmacies) in the UK. Pharmacists recorded details of all incidents that occurred during the dispensing process, including information about: the stage at which the error was detected; who found the error; who made the error; type of error; reported cause of error and circumstances associated with the error. RESULTS: 125,395 prescribed items were dispensed during the study period and 330 incidents were recorded relating to 310 prescriptions. 280 (84.8%) incidents were classified as a near miss (rate per 10,000 items dispensed=22.33, 95%CI 19.79-25.10), while the remaining 50 (15.2%) were classified as dispensing errors (rate per 10,000 items dispensed=3.99, 95%CI 2.96-5.26). Selection errors were the most common types of incidents (199, 60.3%), followed by labeling (109, 33.0%) and bagging errors (22, 6.6%). Most of the incidents were caused either by misreading the prescription (90, 24.5%), similar drug names (62, 16.8%), selecting the previous drug or dose from the patient's medication record on the pharmacy computer (42, 11.4%) or similar packaging (28, 7.6%). CONCLUSIONS: This study has demonstrated that a wide range of medication errors occur in community pharmacies. On average, for every 10,000 items dispensed, there are around 22 near misses and four dispensing errors. Given the current plans for reporting adverse events in the NHS, greater insight into the likely incidence and nature of dispensing errors will be helpful in designing effective risk management strategies in primary care.

Community Pharmacy Services↗
PubMed2006

Discrepancies between medication records of anticoagulation clinics and pharmacy records.

PURPOSE: To determine whether there were discrepancies between with coumarin anticoagulants interacting medications recorded in medical files of anticoagulation clinics (AC-records) and computerized records of community pharmacies (pharmacy records). METHODS: A descriptive study was conducted at two Dutch anticoagulation clinics (AC's). Records of with coumarin anticoagulants interacting drugs at the AC's were compared with the pharmacy records. A drug registered in the pharmacy records but not in the AC-records, was recorded as a discrepancy, while a drug registered in AC-records as well as in pharmacy records, was recorded as a match. RESULTS: Of the 117 identified interacting drugs registered in pharmacy records 32 (27%) were not registered in the AC-records. In four out of seven patients of whom the use of a pharmacokinetically interacting drug was not registered in the AC-records, several INR-values exceeded the upper therapeutic range. CONCLUSION: This study demonstrates that a substantial percentage of drugs of which an interaction with coumarin anticoagulants can be expected, is not registered in the medical files of anticoagulation clinics.

Aged↗
PubMed1991

Small-scale preparations in Sweden. Extemporaneous preparations and stock preparations at eleven community pharmacies.

Small-scale preparations, i.e. non-registered drugs that are extemporaneously prepared for each patient or made in larger batches for stock keeping, form a small but important group of drugs, especially for patients with rare diseases or allergies. Small-scale preparations are not included in the otherwise comprehensive statistics compiled by the National Corporation of Swedish Pharmacies and this makes knowledge of the use of these drugs limited. The occurrence of small-scale preparations was studied at eleven community pharmacies over a three-year period (1987-1989) by analysis of the orders from the pharmacies to the four production units of the National Corporation of Swedish Pharmacies in the first quarter of each study year. The number of small-scale preparations dispensed were compared with the total sales of drugs at each pharmacy. The proportion of small-scale preparations in the total drug sales was about 1.5% throughout the study period, but there were fluctuations over time at the individual pharmacies. The most common dosage forms were creams, liniments and mixtures. Dermatological drugs in different dosage forms were the most frequent (almost 50%). This was probably because of the necessity for a great variety of different strengths among these drugs.

Community Pharmacy Services↗