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Establishing a pharmacy and nursing committee.

The development of a pharmacy and nursing committee to improve communication and interdepartmental relations is described. Too often pharmacists and nurses avoid talking about concerns or procedures until they become problems that must be resolved quickly. The purpose of the committee is to resolve issues using a cooperative approach. 1. To discuss the problems in an objective manner, in an attempt to diffuse the emotional component of the problem. 2. To permit discussion from each department's perspective. 3. To identify methods to resolve the problems that would be mutually agreeable. Both the departments of pharmacy and nursing are usually represented on many hospital committees and thus it would be mutually beneficial for both departments to work as a team rather than as adversaries. The logistics in committee formation is discussed. It is also suggested that other departments such as education and risk management may assist the pharmacy and nursing committee in its implementation and assessment of procedures. Since its development, the pharmacy and nursing committee has identified numerous problems and proposed solutions. The establishment of the pharmacy and nursing committee at our institution has assisted in improving the relationship between the two departments. Other hospital pharmacies are encouraged to develop a committee similar to the one described in this article.

Communication↗

PHARMIS: a national pharmacy workload and productivity reporting system.

PHARMIS represents the first easily usable database for review of pharmacy workload and productivity. While many large institutions have been successful in developing and using their own programs for reviewing this type of information, PHARMIS represents a desirable alternative for those hospitals that lack the ability to develop their own system. While the current version of PHARMIS lacks the flexibility to address separation and categorization of activities within the pharmacy, it represents the current state of the art. As an experience base develops and changes and trends in indicator values become explainable, PHARMIS will become a valuable tool for all hospital pharmacy managers. It is an excellent starting point for the collection and review of management information. When used in tandem with a sound quality assurance program and DRG-based review of resource utilization, PHARMIS will allow the pharmacy manager and his or her institution to review and develop excellent, cost-effective pharmacy services. The imprimatur of ASHP and the potential for a national reporting program should make PHARMIS a part of every pharmacy manager's analysis of department activities.

Efficiency↗

Adoption of a pharmacist conscience clause by Professional Associations and Boards of Pharmacy in the United States.

OBJECTIVE: To determine the number of professional associations and boards of pharmacy in the United States that have adopted or are considering to adopt a conscience clause as part of their codes of ethics, rules, laws or regulations. BACKGROUND: Pharmacists are often exposed to ethical dilemmas in their day-to-day practice and their response depends on a number of factors, including the personal beliefs and values of those involved. This has lead some professional associations to address whether their members have the right to refuse to participate in procedures which are contrary to their conscience or moral convictions. The outcome of these discussions is usually the development and adoption of a conscience clause. METHODS: A one-page self-administered questionnaire was sent by Fax to the highest ranking officer of 108 pharmacy organizations in the United States. RESULTS: Thirty-five completed questionnaires were received for a 32.4% response rate. In general, it was found that there is a lack of knowledge as to what a conscience clause is. Only two state associations and one board of pharmacy responded that they have a conscience clause as part of their code of ethics or regulations. Reasons given for not having a conscience clause included lack of interest and low priority. Nevertheless, four state associations, one national association and one board of pharmacy responded that they are considering developing a pharmacist conscience clause. More professional associations than boards of pharmacy expressed interest to obtain information about conscience clauses. CONCLUSION: Although many state associations and boards of pharmacy that responded do not have a conscience clause as part of their codes of ethics, laws or regulations, this survey shows an increasing interest to learn about it. This is expected as the pharmacist assumes increasing responsibility in patient care.

Ethics, Pharmacy↗

[Sixty years of studies on history of Chinese pharmacy].

This paper is presented in studies on the following subtopics: 1. General history of Chinese pharmacy; 2. Study and systematization of ancient herbological works; 3. History of individual drugs; 4. History of commercial and industrial aspects of Chinese and Western drugs; 5. Unearthed historical materials of pharmacy; 6. History of pharmacy of national minority; 7. Education on pharmacy; 8. History of special subjects in pharmacy; 9. Figures of pharmacy.

China↗

[Ottomane's pharmacies in Istanbul].

In the middle of the XIXth century, we notice that the pharmacies in Istanbul are the same as European pharmacies. The French scientific influency is very important: French language is officially used for the medicines, the instruction at school, in the publications and the business meetings. Until 1890, the owners of pharmacies are generally foreigners or persons of minorities with Ottomane nationality. After this date, pharmacies belonging to Turkish people are more numerous. We notice that military and public hospital pharmacies were quite well organized. There is two imperial pharmacies inside of Topkapï Palace and Yïldïz Palace, created by the Sultan Abdülhamid. The teachers in pharmaceutical science were very famous: Bonkowsi Pacha, Giorgio Della Sudda, Antoine Calleja.

Europe↗

Identifying at-risk patients through community pharmacy-based hypertension and stroke prevention screening projects.

OBJECTIVE: To demonstrate whether a community pharmacist can be successful in identifying and referring patients with elevated blood pressure and/or increased risk of stroke. SETTING: An independent community pharmacy and well-elderly housing facility in rural Iowa. PRACTICE DESCRIPTION: The pharmacy had dedicated space for patient care activities, had a community pharmacy practice resident, and served as a clerkship site for a local school of pharmacy. One of three well-elderly housing facilities in the same community was used as a screening site for the stroke prevention program. PRACTICE INNOVATION: All adults entering the pharmacy duringthe time the blood pressure project was underway were offered a free blood pressure screening. If readings were elevated, patients were referred to their primary care provider. For stroke prevention, a screening using the American Heart Association stroke risk assessment protocol was held at the pharmacy and the well-elderly housing facility. MAIN OUTCOME MEASURES: Blood pressure categories and stroke risk (normal, mild, moderate, and high) categories obtained during the screening. RESULTS: A total of 351 patients werescreened for hypertension. Of these, 216 (62%) had readings greater than 140/90 mm Hg. Of the 121 patients referred to their physician, 43 (36%) had a regimen change. A total of 50 patients were screened for stroke risk. Results of the risk assessments for patients screened were normal, 4%; mild, 26%; moderate, 32%; high, 38%. CONCLUSION: These projects demonstrated that, through ongoing screening programs, community pharmacists are in an ideal position to screen patients at risk for cardiovascular and cerebrovascular disease and refer patients to their physicians for further evaluation.

Adult↗

[An overview of the development of pharmacy education in Slovakia].

Before 1777, the pharmacist in Slovakia gained their professional qualification by practising in a pharmacy. From the establishment of the University of Trnava to 1777, they attended lectures and took examinations at its Faculty of Medicine, then from 1784 onwards in Budapest. After the establishment of Czechoslovakia, the candidates of pharmacy studied in Prague, and after the closing of Czech universities (1939) in Bratislava. Between 1940 and 1948 there existed a three-year course, and later a four-year course at the Faculty of Medicine, the contents of which were close to the level of the development of sciences and the requirements of pharmaceutical practice. A logical completion of the development of the course of studies was the establishment of independent Faculties of Pharmacy in Bratislava and Brno and the prolongation of the course to five years. Commencing with the academic year 1977/78, the course of studies was divided into three specializations, General Pharmacy, Clinical Pharmacy and Technological Pharmacy. Since the academic year 1990/91 the course is uniform again, with possible differentiations in the profile of the graduate during the course according to the interests and options of the student.

Czechoslovakia↗

[Hospital Pharmacy Departments on the internet. An unfinished business?].

OBJECTIVE: To establish the percentage of Pharmacy Departments with a web site on the Net, and to analyze whether their contents are focused on the development of pharmaceutical care activities for outpatients. METHODS: Cross-sectional study based on multiple Internet searches using the Copernic version 6.0 software, as well as on directories listing hospital- and pharmacy department-owned web sites. RESULTS: Amongst 452 hospitals with 100 or more beds, 198 (43.8%) hospital web pages and 52 (11.52%) pharmacy department web sites were found. The contents of pharmacy department sites were usually deficient, and only rarely was interaction with outpatients envisaged. CONCLUSION: The presence of pharmacy departments on the Internet is scarce. Telepharmacy or pharmaceutical care for outpatients using novel information technologies remains underdeveloped by Spanish pharmacy departments.

Ambulatory Care↗

[Pharmacy-managed drug supply may reduce drug expenditure in hospitals].

BACKGROUND: In order to reduce the cost of drugs and the time nurses spend on them, a six-month collaboration project was carried out between the hospital pharmacy and a ward unit. The ward unit had a yearly drug expenditure of 5.9 million NOK. MATERIALS AND METHODS: Pharmacy technicians stocked up the unit twice a week according to an agreed standard. Hospital pharmacists checked the need of other drugs ordered. A comparison between periods before and during the project was done on the value of the drug stock, credited returned drugs, nurses' time spent on drug handling and the number of telephone orders to the pharmacy. The value of avoided deliveries was calculated. RESULTS: The value of the drug stock was halved and calculated at a value of NOK 22,000. The value of drugs credited by the pharmacy was NOK 52,000. The savings from avoided deliveries were NOK 90,000. Total savings were NOK 164,000, 5% of the value of total purchases. In addition, nurses spent 11 hours less a week on drug handling. The number of telephone orders to the pharmacy was halved. INTERPRETATION: Pharmacy-managed drug supply to hospital wards may reduce drug expenditure and the risk of medication errors.

Cost Savings↗

Measuring population health risks using inpatient diagnoses and outpatient pharmacy data.

OBJECTIVE: To examine and evaluate models that use inpatient encounter data and outpatient pharmacy claims data to predict future health care expenditures. DATA SOURCES/STUDY DESIGN: The study group was the privately insured under-65 population in the 1997 and 1998 MEDSTAT Market Scan (R) Research Database. Pharmacy and disease profiles, created from pharmacy claims and inpatient encounter data, respectively, were used separately and in combination to predict each individual's subsequent-year health care expenditures. PRINCIPAL FINDINGS: The inpatient-diagnosis model predicts well for the low-hospitalization under-65 populations, explaining 8.4 percent of future individual total cost variation. The pharmacy-based and in patient-diagnosis models perform comparably overall, with pharmacy data better able to split off a group of truly low-cost people and inpatient diagnoses better able to find a small group with extremely high future costs. The model th at uses both kinds of data performed significantly better than either model alone, with an R2 value of 11.8 percent . CONCLUSIONS: Comprehensive pharmacy and inpatient diagnosis classification systems are each helpful for discriminating among people according to their expected costs. Properly organized and in combination these data are promising predictors of future costs.

Adolescent↗

Use of cytogenetic methods to determine mutagenic changes in the blood of pharmacy personnel and nurses who handle cytotoxic agents.

Lymphocytes of subjects from throughout the United Kingdom were studied over a two-year period beginning in January 1985 to determine the level of chromosomal damage produced by environmental exposure to cytotoxic agents. A small pilot study was conducted to determine the expected background level of chromosomal aberrations. Four groups of subjects were then recruited: pharmacy personnel who reconstituted the drugs under recommended conditions, nurses who did not reconstitute the drugs but worked on units where patients received cytotoxic chemotherapy, unexposed office workers from the same geographic location as the pharmacy personnel and nurses (negative control), and patients receiving cytotoxic drugs (positive control). Subjects completed questionnaires about smoking, viral illnesses, radiation exposure, and medication use in the past 12 months; pharmacy personnel were asked the numbers of times (1) they had handled specific drugs and (2) spills had occurred with these drugs. Lymphocytes from subjects were incubated for 48 hours, and first-division metaphases were examined for chromosome and chromatid aberrations; damage was measured as the number of aberrations per 100 cells. For a blood sample to be included in the analysis, at least 100 metaphase divisions had to be examined. Data were analyzed for 50 pharmacy staff members, 11 nurses, 12 controls, and 6 patients. Metaphase divisions in cells of the pharmacy personnel and nurses indicated no significant difference in chromosomal damage compared with the unexposed office workers. When the pharmacy, nurse, and control groups were pooled into a nonpatient group and compared with the patient group, significantly greater damage was observed in the patient group.(ABSTRACT TRUNCATED AT 250 WORDS)

Antineoplastic Agents↗

Electronic data interchange for pharmacy inventory control.

The use of electronic data interchange (EDI) for controlling pharmacy inventory at a 303-bed hospital is described. The hospital, which belongs to a group purchasing consortium, uses EDI to exchange information with its primary drug wholesaler. The pharmacy's personal computer and software provided by the wholesaler are used. EDI enables the pharmacy to (1) select and order items by using hand-held bar-code scanning devices, (2) upload this information into the pharmacy's computer, (3) review the order before transmission, and (4) access the wholesaler's inventory. The pharmacy also uses EDI with its primary i.v. supplier. Using EDI for placing the daily pharmaceutical and i.v.-supply orders reduces by one half the daily time expenditure for purchasing. In addition, EDI provides various inventory-related reports. EDI provides an efficient and effective way to control pharmacy inventory.

Computer Communication Networks↗

Computerized ambulatory-care pharmacy information system for direct order entry by prescribers.

A computer system that links prescribers in a diabetes center to an ambulatory-care satellite pharmacy is described. In 1988 an ambulatory-care center serving the diabetic patients of a 437-bed university teaching hospital moved to a new location. To maintain efficient communication of prescription information from the diabetes center to a designated ambulatory-care satellite pharmacy, a program that enables diabetes center prescribers to enter their orders directly into the satellite pharmacy computer system was implemented. The pharmacy department's prescription-entry screen was reprogrammed so that it could be more easily used by prescribers, and a "default" list of the most frequently prescribed drugs was generated to simplify direct order entry. Prescription information entered at the diabetes center is transmitted to the satellite pharmacy; the filled prescriptions are usually ready by the time patients arrive. The average number of prescriptions entered into the computer per week remained steady during the first 14 weeks that the system was in use but increased substantially after diabetes center personnel were given a summary of use data and other information pertaining to the new system. However, because of the availability of only one terminal for order entry and the inherent ease and speed of writing prescriptions on paper, use of the system has not met expectations despite the benefits it offers. Prescribers in a diabetes center did not frequently enter prescription information into a computer system linked to the hospital's ambulatory-care pharmacy because the traditional method of writing prescriptions remained available and convenient.

California↗

Effects of bar coding on a pharmacy stock replenishment system.

A bar-code stock ordering system installed in the ambulatory-care pharmacy and sterile products area of a hospital pharmacy was compared with a manual paper system to quantify overall time demands and determine the error rate associated with each system. The bar-code system was implemented in the ambulatory-care pharmacy in November 1987 and in the sterile products area in January 1988. It consists of a Trakker 9440 transaction manager with a digital scanner; labels are printed with a dot matrix printer. Electronic scanning of bar-code labels and entry of the amount required using the key-pad on the transaction manager replaced use of a preprinted form for ordering items. With the bar-code system, ordering information is transferred electronically via cable to the pharmacy inventory computer; with the manual system, this information was input by a stockroom technician. To compare the systems, the work of technicians in the ambulatory-care pharmacy and sterile products area was evaluated before and after implementation of the bar-code system. The time requirements for information gathering and data transfer were recorded by direct observation; the prevalence of errors under each system was determined by comparing unprocessed ordering information with the corresponding computer-generated "pick lists" (itemized lists including the amount of each product ordered). Time consumed in extra trips to the stockroom to replace out-of-stock items was self-reported. Significantly less time was required to order stock and transfer data to the pharmacy inventory computer with the bar-code system than with the manual system.(ABSTRACT TRUNCATED AT 250 WORDS)

Electronic Data Processing↗

Cost analysis of a satellite pharmacy.

The cost-effectiveness of a satellite pharmacy that serves 100 beds in a 550-bed community teaching institution was determined. On one day six months before and one day six months after the satellite pharmacy was implemented, 30 patients were randomly selected for study from the 50-bed surgical-trauma unit and the 50-bed medical oncology unit served by the satellite. Data for the cost analysis were collected from the medical charts of these 60 patients; each patient's entire hospital stay was used for all calculations. Data collected included costs per patient day for drugs, i.v. therapy, and laboratory tests; total hospital costs per patient day; number of doses per patient day; and length of hospital stay. There were no significant differences in patient age or sex, length of hospital stay, or patient mix among patients studied before and after the satellite pharmacy was implemented. The cost per patient day for drugs was significantly less after the satellite pharmacy was implemented. A cost analysis based on this decrease in drug costs per patient day of $5.77 showed that an annual savings of $134,927 could be realized as a result of satellite pharmacy implementation. Implementation of a pharmacy satellite proved to be cost-effective, largely because of decreased drug costs.

Cost-Benefit Analysis↗

Design and implementation of a cost-accounting system in hospital pharmacy.

The design and implementation of a cost-accounting system in a hospital pharmacy department is described. Pharmacy resource use (labor, drugs, supplies, and overhead), or pharmacy's intermediate products, was clearly defined in terms of dosage forms (10 groupings representing variable labor and supplies) and drug products (more than 100 categories that incorporate cost and volume of use for 3000 line items). Costs were defined as variable or nonvariable (fixed), based on whether they were related to a specific medication order. Labor was divided into variable and fixed components. Time standards were developed using time and motion studies. Variable labor hours were determined as follows: specified hours (the volume of each dosage form multiplied by the standard time for each dosage form); nonspecified hours (time not directly associated with production); hours worked (specified plus nonspecified hours); and hours paid (hours worked plus sick leave and vacation). A standard cost for each drug product was based on the weighted average of volume and cost of the individual line items. The total drug budget was constructed by multiplying the standard cost for each drug product times the projected volume for each drug product. The pharmacy budget was developed by calculating the number and mix of pharmacy products used in association with the projected number and type of cases for the fiscal year. The monthly pharmacy budget reports were assembled with data from the payroll, billing, and cost-accounting systems.(ABSTRACT TRUNCATED AT 250 WORDS)

Accounting↗

National survey of hospital pharmacy facilities: planning and design experience.

Recent major renovation or construction programs of hospital pharmacy facilities and pharmacists' involvement in the planning process for those new facilities are described. A 12-page questionnaire was sent in July 1982 to the chief pharmacists in a random sample of 1846 hospitals in the United States stratified by 10 hospital types. The percentage of hospitals of each type involved in an ongoing or recent (within the preceding 10 years) major renovation or construction project of all or part of the pharmacy was determined. Of those respondents having an ongoing or recent major project, the extent and timing of pharmacists' involvement in the planning process were determined for hospitals of each type. The response rate was 45.6%, and the respondents were representative of the population. Thirty percent of all hospitals had not altered their pharmacy facilities within the preceding 10 years. Nonprofit general medical-surgical hospitals and federal hospitals had the highest percentages of recent projects (78% and 79%, respectively); projects were more likely to involve a new pharmacy facility than remodeling. In 1982, 27% of all respondents had a major pharmacy facilities project under way. Of respondents with an ongoing or recent project, 38% were asked to propose needs for new pharmacy facilities, 45% served on the planning team, and 20% anticipated the need for new facilities; space and location were predetermined without pharmacist involvement in 25% of all cases. Two percent of the respondents had no notice of the deadline for finalizing plans for the new facilities; 22% had one to six months' notice, and 48% had over a year.(ABSTRACT TRUNCATED AT 250 WORDS)

Data Collection↗

Statistical and research quality of the medical and pharmacy literature.

The statistical and research quality of reports published in two U.S. medical journals and two U.S. pharmacy journals over a 12-month period was determined. A 50% random sample of issues of New England Journal of Medicine, Annals of Internal Medicine, American Journal of Hospital Pharmacy, and Drug Intelligence and Clinical Pharmacy published in 1979 was reviewed, and all citable items were classified as one of nine types of communications. Items classified as original evaluative research reports were evaluated for experimental design and research goals and rated for appropriateness of statistical testing and overall research quality according to a set of objective criteria. Reports that were not immediately classifiable were reviewed by one additional person, and classifications or ratings were assigned by mutual consent. Of a total of 1506 citable items, 120 met the criteria for original evaluative research reports. The two medical journals had the highest percentages of reports for which statistical methods were rated as correct but also had the most reports for which statistical methods could not be rated as a result of incomplete documentation or publication errors. Reports in the medical journals had conclusions based on a logical progression of hypothesis, methods, and analysis of results more frequently than did reports in pharmacy journals. Reports in the medical and pharmacy journals differed greatly according to research design and research goals. Improvement is needed in the statistical quality and research quality of original research reports published in the pharmacy literature.

Pharmacy↗