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PubMed2004

Impact of a face-to-face educational intervention on improving the management of acute respiratory infections in private pharmacies and drug shops in Uganda.

BACKGROUND: In Uganda, although private retail pharmacies and drug shops are the most common sources of drugs for the majority of the population, the quality of care received from these outlets has been reported as suboptimal. It is believed that lack of adequate knowledge is an important underlying factor to such practices. OBJECTIVES: In this study, we investigated the impact of a face-to-face educational intervention on counter attendants' dispensing behaviour for mild and severe acute respiratory infections (ARI) in children at private pharmacies and drug shops. STUDY DESIGN AND SETTING: We used a quasi-experimental research design with comparison groups to analyse counter attendants' management of ARI before and after an intervention. The study was conducted in Kampala District, and used a sample of 191 registered drug outlets (27 pharmacies and 164 drug shops), stratified into two groups: 1) An experimental group that received training; 2) A control group unexposed to training. Data on the practices in the drug outlets from both groups were collected at two time-points: seven months before the intervention, and at one-month after the intervention. OUTCOME MEASURES: Two main outcome measures were considered: a) Assessment of the child's condition. b) The dispensing practices of counter attendants. RESULTS: The study found that despite the training, the assessment of the child's condition remained inadequate in both groups, where the child's age was the only question asked in more than 90% of cases. High levels of inappropriate dispensing practices for both mild and severe ARI were still persistent in both groups after the intervention. Antibiotic prescribing for both conditions was very common, and barely any advice or instruction was given with dispensed drugs. Client demand for particular drugs, competition among drug outlets, and inability of most clients to afford the recommended treatments were the main reported barriers that emerged from the focus group discussions with the counter attendants. CONCLUSIONS: The evaluation of the practices one month after the face-to-face educational intervention showed that the management of ARI did not improve in the drug outlets. While study design issues may have contributed to such findings, there are many other factors not related to knowledge and education that may indirectly hamper the promotion of appropriate dispensing in the private pharmacies and drug shops in Uganda. It is possible that a combination of interventions may contribute to improved management of ARI by counter attendants in the private drug shops and pharmacies in Uganda.

Acute Disease↗

PubMed1990

Outpatient pharmacy redesign to improve work flow, waiting time, and patient satisfaction.

An outpatient pharmacy redesign in which a pharmacist located outside the dispensing area speaks with each patient before the prescription is processed is described, and the effect of patients' waiting time and satisfaction is reported. Adoption of an open pharmacy plan at a Veterans Administration outpatient pharmacy allows patients to present their prescriptions to pharmacists in consultation booths equipped with computer terminals. The pharmacist promptly identifies and resolves any problem associated with a prescription or medication profile. The prescription then enters the dispensing work area, which was also redesigned to improve efficiency; patients now pick up their medications at a window on the opposite end of the dispensing area from where the pharmacist initially receives the prescription. Workload data and waiting times before and after implementation of the open pharmacy showed that prescriptions could be processed more quickly under the new system; average waiting times decreased from more than one hour to 30 minutes. Interviews of randomly selected patients indicated that the reduced waiting times led to increased patient satisfaction. The open pharmacy design appeared to improve work flow and to improve patient satisfaction by decreasing waiting times.

Consumer Behavior↗

PubMed1989

Use of the strategic-planning process by hospital pharmacy directors.

The extent to which hospital pharmacy directors use strategic planning was assessed. The strategic-planning process was divided into six steps: (1) specification of goals and objectives, (2) identification of threats and opportunities and strengths and weaknesses, (3) generation of alternatives, (4) evaluation of alternatives, (5) alternative selection and implementation, and (6) monitoring and obtaining feedback. Eight questions about these steps made up one part of a questionnaire mailed to the pharmacy directors of 1100 hospitals. In another part of the questionnaire, each director was asked to rate on a scale of 0 (low) to 100 (high) the level of the pharmacy department's performance in the areas of patient, employee, physician, and hospital administrator satisfaction; financial management; professional image; employee turnover and productivity; and clinical programs. The questionnaire was mailed on July 1, 1987, with a second mailing on August 1, 1987. A total of 343 questionnaires were returned with usable responses, for a response rate of 31.2%. Based on responses to the eight strategic-planning questions, hospital pharmacy directors were classified into seven levels of planning sophistication. Results indicated that the number of directors classified in each level increased significantly as the level of planning sophistication increased. The majority of respondents considered the scope and quality of services and the department character, quality, and reputation during the strategic-planning process, whereas less than 50% considered profitability and future needs. Pharmacy directors with a high level of planning sophistication rated their departments significantly higher in terms of hospital administrators' satisfaction, professional image among hospital administrators, number of clinical programs, and quality of clinical programs.(ABSTRACT TRUNCATED AT 250 WORDS)

Pharmacy Service, Hospital↗

PubMed1989

Justification and implementation of a cancer center pharmacy satellite.

The justification, establishment, and evaluation of a full-service cancer center pharmacy satellite for a university hospital are described. Providing efficient and effective pharmaceutical services was difficult because (1) the cancer center is housed in a freestanding building adjacent to the hospital and (2) there are special considerations inherent in the ordering and preparation of antineoplastic medications. Data collected and presented by the pharmacy, along with letters of support from nursing and medical staff, provided justification of the need to establish an oncology satellite pharmacy. The satellite, open 8.0 hours per day Monday through Friday, is primarily responsible for preparing antineoplastic agents and dispensing first doses of other intravenous and oral medications for the cancer center. Satellite staffing consists of 1.2 full-time-equivalent (FTE) pharmacists and 2.0 FTE technicians. A technician works in the satellite the same number of hours as the pharmacist but is also available to prepare antineoplastic drugs in the central pharmacy on weekends. Pharmacist activities also include providing drug and dosing information to the medical and nursing staff, as well as handling investigational drugs. The satellite pharmacy has decreased medication turnaround time by one-half and has improved pharmaceutical services to the nursing staff.

Antineoplastic Agents↗

PubMed1989

Management consultant review of three departments of pharmacy to identify cost-reduction opportunities.

A review by a management consulting firm to identify cost-reduction opportunities at three hospital pharmacy departments is described. A multihospital corporation hired a management consulting firm to review the operating procedures of several departments, including pharmacy, and recommend measures for reducing costs. A team approach was adopted to enable the pharmacy department managers and the consultants to freely contribute their expertise; input was also solicited from staff members. A review of each pharmacy department's operating costs showed that drugs and i.v. supplies consumed 60-67% of the expenses, and salaries and wages 27-36%. Estimates of the full-time equivalents allocated to inpatient, clinical, support, and ambulatory and outside contract service activities were compared. The relative costs of personnel allocated to all inpatient drug distribution activities were also compared. Cost-reduction recommendations were divided into short- and long-term measures. Short-term measures involved decreasing drug expenditures, decreasing the number of personnel, and limiting decentralized services in one of the departments; savings of $500,000 were projected. Long-term recommendations involved increasing the use of technology, expanding the use of technicians, and consolidating the management staffs among the hospitals. Management consultants, in cooperation with pharmacy department managers and staff members, can identify cost-reduction opportunities without compromising patient care.

Centralized Hospital Services↗

PubMed1988

Effects of simulated facility-design changes on outpatient pharmacy efficiency.

The potential effects of using the Baker drug counter or the Systamodule pharmacy fixture, or both, on the efficiency of the current outpatient pharmacy system at the National Institutes of Health were evaluated by computer simulation. It was hypothesized that the use of these two devices would reduce (1) the prescription-filling time (RxFT) and (2) the distance traveled (DT) by pharmacists in filling individual prescriptions. The sample used was 20% of two weeks' prescriptions, randomly selected. All theoretical estimations of RxFT were done by a computer program; DT was calculated based on measurements from the architect's schematic drawings. The effect of the application of the Baker drug counter alone, the Systamodule pharmacy fixture alone, and the Baker drug counter in combination with the Systamodule pharmacy fixture was to reduce the prescription-filling time by 0.123, 0.159, and 0.280 minutes per prescription, respectively. The average DT per prescription, 102 feet, was identical in the current NIH pharmacy and with use of the Baker counter. It was reduced by 86.3% (to 14 feet) with use of the Systamodule feature, both alone and in combination with the Baker counter. The use of the Baker drug counter and the Systamodule together promises improved efficiency of the prescription dispensing operation.

Computer Simulation↗

PubMed1986

Using a nursing-workload index to validate hospital pharmacy productivity.

The use of a nursing-workload-index indicator generated by the Medicus patient classification system was explored as a means of simplifying and validating a manual pharmacy-workload-reporting system. The pharmacy department of this 290-bed hospital monitors 14 activities in its productivity-measurement process. In an effort to validate this process, a 20-week study was conducted to evaluate the relationship between the nursing-workload-index data and the number of hours required to provide pharmaceutical services. Number of patient days and the nursing index were compared with respect to their reliability in predicting pharmacy workload. A significant correlation was found between the nursing index and the number of hours earned for pharmacy activities (with or without hours earned for processing admissions and discharges). Significant correlations were also found when the patient-days indicator was used, but those relationships were not as strong. The nursing-workload-index indicator studied was useful in validating the workload data generated by the pharmacy department.

Efficiency↗

PubMed1986

Implementing a stand-alone packaged pharmacy computer system in a 580-bed hospital.

The problems experienced by a hospital pharmacy department in implementing a stand-alone packaged computer system are discussed, and recommendations for avoiding and managing these problems are presented. In 1984, a stand-alone packaged computer system was implemented in a 580-bed, tertiary-care institution that provides services from a central pharmacy and five satellite pharmacies. The department developed a request for proposal and contracted with a vender for a system that would support unit dose drug distribution and i.v. admixture services. During the implementation process, the following problems were experienced: The hardware was insufficient for the department's workload, the software design was limited, and personnel were frustrated with learning to use the system. These problems were intensified by the heavy workload and the large number of users. In the 18 months since implementation, the department has purchased more hardware, improved the software applications, and resolved many of the problems associated with employee frustration. Pharmacy departments at other large institutions might avoid some of these problems by training personnel adequately before implementation and by researching and estimating hardware and software needs in advance. In this large hospital, the efficiency of a stand-alone packaged pharmacy computer system has improved 18 months after implementation.

Computers↗

PubMed1985

Pharmacy-based distribution system for enteral nutrition products.

A hospital pharmacy department's implementation of enteral nutrition product distribution and its proposal for an enteral nutrition product admixture service are described. Responsibility for the distribution of enteral nutrition formulations was transferred from the central distribution department to the pharmacy after problems with inventory control, billing procedures, and inappropriate administration of enteral nutrition products were recognized by personnel from the central-distribution area and nutrition services. After additional problems were identified using a multi-disciplinary approach, the pharmacy department implemented an enteral nutrition product distribution system and developed an enteral nutrition product formulary. A proposal was developed for a pharmacy-based enteral nutrition admixture service, but implementation of this service was deferred because data from a cost-effectiveness evaluation and random bacteriologic monitoring did not justify adding the service. Pharmacy-based distribution and formulary control of enteral nutrition products alleviated problems with inaccurate patient charges and accumulation of stock on the nursing units. Pharmacists at this hospital hope to develop an enteral nutrition product admixture program that will result in cost savings for the institution.

Costs and Cost Analysis↗

PubMed1984

Developing a hospital pharmacy purchasing system.

Suggestions for developing or modifying a pharmacy purchasing system are presented and discussed. To achieve an optimal purchasing system, pharmacy managers must understand the development and operation of their current systems and enlist the participation of other hospital departments in planning the new or modified system. A pharmacy purchasing system should ensure that drug products and supplies of the highest quality are obtained at the lowest price, that these items are available when needed, and that the financial investment in drug and supply inventory is appropriate. The job requirements, activities, and responsibilities of pharmacy purchasing personnel are described, and the recording and retrieving of purchasing data are discussed. Various order-placement alternatives are compared, and order-shipment alternatives are described. Equipment and supply requirements for the purchasing function are also presented. An efficient, productive purchasing system can produce cost savings for the pharmacy department and the institution.

Inventories, Hospital↗

PubMed1984

National survey of pharmacy-coordinated investigational drug services.

A national survey of 703 pharmacy departments was conducted to obtain information on the status and scope of investigational drug services (IDS). Questionnaires were mailed to the directors of pharmacy departments of general medical and surgical hospitals with 300 or more beds and a university affiliation. The survey consisted of 27 questions that were primarily based on the ASHP guidelines for the use of investigational drugs in institutions. A total of 403 questionnaires were returned, 386 of which could be evaluated, 386 of which could be evaluated. Only 33% of the pharmacy departments adopted a minimal subset (7 of 11) of the recommended procedures based on the ASHP guidelines. All pharmacy departments with more than 40 protocols reported having a research pharmacist or a need for one. Of all of the protocols, 43% were sponsored by the National Institutes of Health, 34% by pharmaceutical companies, 16% by investigators and physicians, and 7% by various other sponsors. Drug information, monetary reimbursement for services,a dn coordination and communication were the most frequently cited areas in need of improvement by the drug sponsors. The most common types of protocols involved cancer research (56%) and infectious disease and cardiovascular studies (12% and 13%, respectively). Directors of pharmacy departments should review their investigational drug policies and procedures for compliance with ASHP guidelines as the first step in developing the IDS concept.

Drug Information Services↗

PubMed1982

Hospital pharmacy computer systems--1982.

Results of a survey of hospital pharmacy computer systems vendors are reported. A questionnaire was mailed to 317 possible vendors of hospital pharmacy computer systems in August 1982. Of the 89 companies responding, 30 stated that they marketed a hospital pharmacy system. The results are tabulated in this paper according to general system information, system hardware, system software, and system features. The most common classification of the responding companies was the health-system corporation; second most common was pharmacy computer system companies. Twenty companies have marketed their systems for two years or longer. Sixteen companies now claim to have contracts with more than 20 health-care institutions. The survey results are offered as a guide for comparing the similarities and differences among various vendors of hospital pharmacy computer systems.

Computers↗

PubMed1982

Regional disaster planning for hospital pharmacies.

The development of a disaster plan for hospital pharmacy services in Hartford, CT, is described. In June 1978, directors of pharmacy from 12 hospitals in the Hartford, CT, area began a project designed to ensure an uninterrupted supply of drugs and an adequate supply of pharmacy personnel during and after any natural disaster. The project initially involved standardization of components of the individual hospital pharmacies' disaster plans. A questionnaire was then completed by each director of pharmacy regarding hours of operation, telephone numbers, and pharmaceutical products usually stocked (including blood derivatives, radiologic-contrast media, and intravenous solutions). Information on inventory levels was collected later. Pharmaceutical manufactures and wholesalers in the region were contracted, and a list of routine and emergency telephone numbers was compiled. The disaster plan was completed in July 1979. The plan has been tested in a mock catastrophe drill and one natural disaster that caused relatively few injuries.

Connecticut↗

PubMed1982

Unique needs of women pharmacy residents.

The needs of women residents in hospital pharmacy programs are discussed with respect to the responsibilities of preceptors to help residents prepare for a successful career. Women were a small minority within the profession of pharmacy until recently. More than half of the current hospital pharmacy residents are women, while over 95% of the preceptors of residency training programs are men. Hospital pharmacy preceptors can help meet the unique needs of women residents, so that women pharmacists can achieve the career successes of which they are capable. Preceptors can help women residents make career decisions and develop career goals and strategies. Preceptors should ensure that women residents develop the broad base of knowledge and skills necessary for advancement. Women residents should be encouraged to get involved in pharmacy organizations, and the importance of networking should be stressed. It is important that women residents develop a business style so that they are perceived as confident and competent. Preceptors must recognize that most women will have conflicts in their roles of career woman, wife, and mother. Preceptors can also help women residents by making managerial changes (e.g., offering part-time positions and flexible scheduling) that will facilitate integration of the professional and personal responsibilities of women.

Day Care, Medical↗

PubMed1981

Pharmacy's societal purpose.

The changing societal purpose of pharmacy is discussed. Historically, the societal purpose of pharmacy has been to make drugs and medicines available. While this core function of pharmacy remains unchanged, the profession's purpose has evolved with new medical and pharmaceutical knowledge and technological advancements. The traditional role of dispensing medications has been expanded to include developing and managing drug distribution systems that provide access points to consumers and assure drug safety and compliance with legal and professional standards. These new responsibilities have required pharmacists to acquire expertise in the storage of data, distribution, and inventory control functions, and the management of data for drug histories, patient records, quality assurance programs, and drug information services. Pharmacists and support personnel who are qualified to perform the physical and scientific aspects of drug distribution and control must also be able to handle the interpersonal relationships required at the interface of the pharmacy system and the ultimate consumer. Today's pharmacists must provide services that transmit the knowledge and skills they have at their command to physicians, other pharmacists, and patients. The service component of pharmacy should supplement and complement its core function.

Delivery of Health Care↗

PubMed1980

Hospital pharmacy in Canada.

The status of Canadian hospital pharmacy and the impact of national hospital insurance on its development are discussed. The provision of health care services for Canadians is shared by the federal and provincial governments. The federal government enacts protective and regulatory legislation, compiles health statistics, promotes research, and provides direct health care for those citizens for whom it is directly responsible. Each province is responsible for hospitals, the education and training of health care professionals, public health, and the financing and administration of health insurance for all its citizens. Largely because of line-item budget allocations and a bureaucratic tendency to equalize services for the whole population, funds for existing pharmaceutical services have been assured but the introduction of upgraded or innovative programs has been difficult to achieve. The result has been an even quality of health care services, including pharmacy, throughout the country and a deficiency in clinical pharmacy programs and the trained personnel to run them. The last decade has brought advances, however, as allocation methods have changed and both hospital and insurance administrators have recognized the patient benefits and cost effectiveness of many of the newer pharmacy programs. The main challenges facing Canadian hospital pharmacy are to upgrade clinical services and education and to improve managerial and bureaucratic competence among department directors.

Canada↗

PubMed1980

Pharmacy and health planning: a national survey of health planners.

The extent of pharmacy involvement in area health planning, and the perception of health planners on pharmacy and drug-related issues, were assessed. Health Systems Agencies (HSAs) (135, or 66%) and State Health Planning and Development Agencies (SHPDAs) (25, or 45%) responded to a 34-item mail questionnaire on pharmacy planning issues. Pharmacists were involved in developing health plans in 39% of the HSAs and 18% of the SHPDAs. Pharmaceutical services were mentioned in 50% of the local and 58% of the state plans. Thirty-two percent of the HSAs and 42% of the SHPDAs believed there was a poor distribution of pharmacies in health service areas. The respondents also answered questions on the need for pharmaceutical services in given areas and among special populations, drug reimbursement procedures, and the kinds of data health planners need when planning pharmaceutical services. Numerous respondents noted that increased participation by pharmacy groups in health planning would be desirable and welcomed.

Health Planning↗

PubMed1994

Primary health-care services with a functional ambulatory care clinical pharmacy in a low-income housing project clinic.

This article describes the establishment of clinical pharmacy services at a primary health-care clinic in a low-income housing area in New Orleans. The St Thomas Health Care Services Outpatient Clinic was established in 1987 by the Catholic Sisters of Charity. The clinic provides care for 4500 ambulatory patients who otherwise have inadequate health care. Xavier University College of Pharmacy established pharmacy services in the clinic as a site for its ambulatory clerkship students. The pharmacy provides training for students on the principles and practice standards of ambulatory care pharmacy services, which include taking medication history and performing drug therapy review. A computer-generated medical record was developed to provide access to patients' demographic and drug profiles. The system was designed to help the pharmacist preceptor and students detect, resolve, and prevent drug-related problems, and to aid in learning to monitor the progression of disease(s) and whether the patient is experiencing the desired therapeutic outcome. Direct contact with patients allows the pharmacist and the students to become familiar with patient compliance problems, adverse drug reaction monitoring, patient counseling techniques, and providing patient education.

Community Health Centers↗