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Methods used by pharmacy departments to identify drug interactions.

The results of a survey evaluating the methods that pharmacy departments use to manage drug interactions, and their satisfaction with those methods, are reported. A random sample of 300 hospitals with more than 200 beds was selected, and a questionnaire was mailed in January 1991 to the directors of the pharmacy departments of these hospitals. Of the 300 questionnaires mailed, 167 were completed and returned. Thirty-seven percent of the hospitals offered pharmacy services through a central location only, whereas 63% offered such services through a combination of central and decentral locations. The majority of hospitals (83%) detected drug interactions through the knowledge of the pharmacist processing orders. Nearly all central pharmacies had AHFS Drug Information and Facts and Comparisons available for drug interaction information, but these resources were available in only slightly more than half of all decentral pharmacies surveyed. Fifty-four percent of the responding institutions had a computerized drug distribution system with a drug interaction component; 56% of these classified their system as "indispensable" or "helpful," while 44% classified their system as "somewhat helpful but sometimes a hindrance." Sixty-eight percent of all respondents believed that the availability of a drug interaction computer program increased the number of drug interactions identified. Sixty-eight percent of respondents perceived that pharmacists provided proper follow-up. Overall, 66% of respondents were not satisfied with their method for detection and follow-up of interactions. Of those who were satisfied, 79% had a computerized drug interaction program. Respondents who reported departmental audits or quality assessment procedures were also more likely to be satisfied.(ABSTRACT TRUNCATED AT 250 WORDS)

Drug Information Services↗

[Hospital pharmacy: partner in the health care team].

The hospital pharmacy is responsible for providing each patient with the required drug treatment. This goal can be fulfilled by constant adaptation of the pharmaceutical services to the needs of the medical and nursing staff, hospital administration and other technical services. The goals and the functional relationship between the different activities of a hospital pharmacy are reviewed. The specific organisation of the Sierre-Loèche hospital pharmacy is presented. Centralisation of some services of the district hospital pharmacy within the central pharmacy of the "Institut Central des Hôpitaux Valaisans" provides the hospital with the required services. Pharmaceutical counseling based on a regular activity of the pharmacist within the health care team is a prerequisite to adapt organisation and services to the requirements of the clinical situation.

Drug Information Services↗

Preparation for Desert Storm: expansion of an overseas Air Force hospital pharmacy to handle casualties.

The planning and execution for contingency pharmacy services in support of Operations Desert Shield/Desert Storm in an overseas Air Force Medical Center are described. These operations presented the staff with far different challenges than the contingency support plan that had been in place for several years. That plan focused medical operations based on armed conflict in Central Europe. With conflict now imminent in the Persian Gulf, over 8 hours flying time away from our facility, our priorities and mission changed tremendously. This conflict demanded prompt action by the Department of Pharmacy to ensure comprehensive services in support of Operations Desert Shield/Desert Storm without interruption of services to the local military community. Pharmacy planning focused on four basic areas: (1) supply requirements, (2) contingency staffing requirements, (3) expansion of inpatient pharmacy services, and (4) modifications to outpatient pharmacy services. A modified contingency plan assured professional pharmaceutical services for over 3,000 patients suffering injuries in the 12 months American forces were deployed to the Persian Gulf.

Aerospace Medicine↗

[The participation of hospital pharmacy services in enteral nutrition].

We present the results of a study done in the departments of hospital pharmacy of our country with the aim of knowing their participation in the use and clinical follow up of patients with enteral nutrition. 293 questionnaires were sent out, and 121 were filled out and returned (41.3%). The responses were classified into three groups, according to the number of hospital beds, considering > or = 1000 (large), 500-1000 (medium), and < or = 500 (small). The data were analyzed by means of a statistical program (R-Sigma Horus). 79% (68) of the small hospitals have a unitary dose drug dispensation system, and the Enteral Nutrition was distributed through this system in 53% (50) of them; only 29% (27) of them have a stock of these preparations on the wards. 93% (14) and 65% (54) of the large and small hospitals respectively, prefer the use of enteral nutrition as opposed to parenteral nutrition. 85% (11) of the large hospitals have protocols for the use of enteral nutrition, this being 62% (10) and 59% (47) in medium and small hospitals. The committees for artificial nutrition are present in 75% of the large hospitals, in addition to which, in 66% of these there is a nutritional support team. A pharmacist from the department of pharmacy participates in both multidisciplinary groups. If it is necessary to manipulate the enteral nutrition preparations, in 30% of the departments of pharmacy of the smaller hospitals, this is centralized, being done by personnel of the department itself; in 59% of them (19) there is a specific area for the elaboration, which is not the case in large hospitals. Drugs are mixed with the enteral nutrition in 25% (1), 12% (1), and 9% (4) of the large, medium and small hospitals respectively. There is great, active participation of the hospital pharmacists in the activities of the multidisciplinary nutritional support systems, although at the present time, the involvement of the departments of pharmacy in the centralization of the manipulation of the enteral nutrition is reduced. It is necessary therefore, to implement the development of enteral nutrition programs with a quality guarantee from the departments of pharmacy.

Enteral Nutrition↗

Patterns of pharmacy participation in Medicaid: implications for enrollee access.

Little attention has been given to pharmacy participation in Medicaid and enrollee access to pharmacy services despite the potential for treatment problems if appropriate drug regimens are not followed. This study presents an economic model of pharmacy participation in Medicaid and descriptive and multivariate analyses of participation rates. A key variable was the adequacy of Medicaid payments for drugs dispensed to Medicaid enrollees. This was found to positively affect county-level pharmacy participation and, in turn, participation rates were a positive and significant determinant of the number of prescriptions per enrollee. Pharmacy location, size, and type also affected participation rates and enrollee utilization.

Health Services Accessibility↗

[Pharmacy and the great contribution of Arab-Islamic science to its development].

The differentiation and separation of two scientific disciplines, medicine and pharmacy begins during the 12th century. Each differentiation by itself brings certain improvement and upgrading but at any level, this happens only when proper conditions are met. Therefore, in order for pharmacy to appear as a profession and to promoted to the level of science, certain conditions had to be met, namely the society and cultural forces had matured to the level of differentiation of these two disciplines, which have begun existing as completely independent disciplines in that time. For the history of pharmacy, it is very important to note the fact that we find the first beginnings of professional pharmacy among Arabic population. The first drug stores in the world were established in Arabic world (Baghdad 754). Considering the fact that Arabs had brought a great deal to pharmaceutical science and the fact that their search included some 2.000 substances, the goal of this work was formulated and medicinal herbs used in the treatment listed. The forms used that period are still used in the therapy and some formulations of drugs can be found in pharmacopeas even today. If we add to these reports the fact that most of the literature appearing in the field was also of Arabic origin and that many editions and translations of the pharmaceutical works from Arabic to Latin had been published ever since, the obvious contribution of Arabic science in the development of pharmacy becomes even more obvious.

Arab World↗

1995 National Clinical Pharmacy Services Study.

To determine the extent of hospital-based clinical pharmacy services in 1995, we surveyed 1109 United States acute care, general, medical-surgical, and pediatric hospitals with 50 or more licensed beds. Fifteen clinical pharmacy services were assessed to determine pharmacists' specific patient care responsibilities. The percentage of hospitals offering services grew between 1992 and 1995: pharmacokinetic consultations (16% increase), drug therapy protocol management (15%), drug therapy monitoring (8%), drug counseling (13%), and parenteral-enteral nutrition team (6%). All other services increased 0-5%. Pharmacists conducted clinical research in 14% of hospitals, averaging 6.3+/-22.1 protocols/department annually; total budget $96,219+/-$262,026. Patient-focused care predominated in 20% of hospitals, although most pharmacists reported to directors of pharmacy through traditional pharmacy department channels. Clinical pharmacy services continue to expand, with pharmacists providing higher-level direct patient care activities related to drug therapy management and monitoring.

Ambulatory Care↗

End-of-life care education in United States pharmacy schools.

Hospice and palliative care have undergone dramatic changes in the past 30 years. Educational initiatives and certification programs for physicians (American Board of Hospice and Palliative Medicine) and nurses (National Board for Certification of Hospice and Palliative Nurses) have further delineated this area of practice as distinct from geriatrics, neurology, anesthesiology, or oncology. As other professions assess their own practices of hospice and end-of-life (EOL) care education in their respective schools and colleges, the pharmacy profession must also ensure that its future graduates are prepared to adequately participate in this type of care. This was a descriptive study in which all accredited schools and colleges of pharmacy in the US were queried regarding their level of curricular commitment to EOL care. Eighty-three questionnaires were mailed, and 60 schools responded (72 percent). Four primary informational items regarding EOL and palliative care education were targeted, including availability of didactic teaching, specialization of pharmacy faculty, availability and type of clerkships, and method of instruction. Sixty-two percent of respondents indicated EOL care education was provided didactically (3.89 +/- 1.91 lecture hours per year). Fifty-eight percent of respondents indicated that EOL care experiential clerkships were available (4.97 +/- 1.25 weeks in duration). These data indicate that over half of US pharmacy students receive some exposure to EOL care education.

Clinical Clerkship↗

Pharmaceutical education and the practice of pharmacy.

Community pharmacy has undergone a process of relative deprofessionalization; most community pharmacists are now and will continue to function primarily as drug distributors. More sophisticated professional services can and will be offered mainly in hospitals and clinics. There is need for a rigorous and objective assessment of future needs and career opportunities in pharmacy. Many of the expanded roles for pharmacists have not yet been justified by proper functional and economic evaluation. The acceptance of those who fill these new and nontraditional roles cannot be ascertained adequately as long as they are supported extensively by schools of pharmacy rather than by professional fees or by salaries from the institutions in which they practice. There has been an unwillingness or inability on the part of academic pharmacy to make objective and rigorous assessments of the career potential of the various new roles envisaged for pharmacists. Other important issues that have not been explored objectively include drug information leaflets for patients and the single professional degree (Pharm.D.). A good case can be made for having physicians rather than community pharmacists provide drug information literature to patients. There must be pharmacists with one of three different levels of training: the B.S., the Pharm.D., and the Ph.D. Of these, the most critically needed at the present time are Ph.D. pharmacists qualified for positions in drug discovery, formulation, pharmacokinetics and pharmacodynamics, and in the development and evaluation of new drug delivery systems.

Education, Pharmacy↗

Analysis of a survey of UHC hospitals--College of Pharmacy relationships.

The University HealthSystem Consortium (UHC) Pharmacy Advisory Council commissioned a survey of the methods and resources used to support pharmacy practice education. This article presents the results of the two-part survey, and presents a brief description and analysis of the results. Fifty-two of the UHC's member hospitals' pharmacies replied to the survey. An unblinded study sought to characterize the types and numbers of students and staff involved. A second blinded portion of the survey requested the opinions and comments of pharmacy managers.

Academic Medical Centers↗

Pharmacy formularies in integrated health systems.

Formulary management implications are described for an Oklahoma integrated health system comprising 14 acute care facilities, numerous owned medical practices, and a fledgling HMO. A systemwide pharmacy director has yet to be appointed; however, the position of pharmacy operations management for the Oklahoma City area has been created. A physician group has been formed that is expected to address system-wide pharmacy and therapeutics (P&T) committees and formulary strategies. Currently P&T committee activities take place at the individual hospital level. The hospitals do not have restrictive formularies. An overall formulary system would likely be patterned after the largest hospital's system, including a formal approval process in which a P&T subcommittee reviews drug use outside established guidelines and the P&T committee asks the appropriate medical department to address the problem. For ambulatory care, the HMO has contracted with a pharmacy benefit manager (PBM), and there is no coordination of formulary efforts between the PBM and health system entities. Although this and other problems remain to be resolved, some standardization of drug use has begun. Also, all entities in the system use the same purchasing group and plan to use the same information system. Drug use among hospitalized patients in this integrated health system is influenced by the usage guidelines established at the largest hospital, and drug use among ambulatory managed care patients is influenced by an external PBM.

Ambulatory Care↗

Training, utilization and motivation of pharmacy technicians--a five-year analysis.

A 600-hour-on-the-job training program for hospital pharmacy technicians is described. Qualified applicants who successfully pass a written examination are admitted to the program. Trainees receive both didactic and practical experience in all service areas of the pharmacy department. Opportunity for advancement through a technician specialist training program is available. Eighty percent of all applicant accepted into the program graduated, and 39% are currently employed by the pharmacy department with an average of 42 months work experience each. It is recommended that national guidelines are established for hospital-based pharmacy technician training program.

Education, Pharmacy↗

[Prosecution of Mélanie Hahnemann in 1847 at the court of Paris: illegal practise of pharmacy and medicine].

Recently married, the Hahnemanns came to Paris in 1835. The great man, 80, was authorised to practice in France. His wife Mélanie always assisted him in writing prescriptions, and in recruiting patients. When he died in 1843, she was continuing to practise assisted or not by a physician, Deleau or Croserio. A young pharmacist, Charles LeThiére, lived close to her as her adoptive son, grandson of the famous painter Guillaume Guillon-LeThière who was the director of the French Academy of Fine Arts of Rome at the Villa Medici, grandson as well of the Roman pharmacist Giuseppe Meli. Early Charles remained orphan and was educated by Mélanie. In 1844, he obtained his pharmaceutical graduation at the Ecole supérieure de Pharmacie de Paris. In 1847, she was accused of illegal practising of medicine and pharmacy. She claimed that she held the degree of doctor in homeopathy granted to her by the Academy of Pennsylvania. The court condemned her on the medical side considering that she earned money without legal certification in medicine. But as the drugs were prepared by a pharmacist, and delivered free of charge to the patients, no sentence was pronounced against her neither against LeThière. However, the court tempted to object that LeTière did not meet all the legal requirements for practising his pharmaceutical activity, especially aruging that he did not own an open shop of pharmacy, and that he did not declare his activity to the authorities in Paris. This point underline the fact that during the XIXth century the French law (21 germinal An XI- 1803), obliged the starting drug industry to be in dependence of the shops of pharmacy opened to the public, owned by a graduated pharmacist. As defender Mrs. Hahnemann chose the quite known solicitor Chaix d'Estange. Many testimonies came for justifying her capability of medical prescribing from artists, officers, writers and several aristocrats. From abroad came the supports of American doctors, Hempel, Hering and Hull. But the core question motivating her sentence came from the medical lobby acting in Paris led by the professor Orfila. Among the adepts of the homeopathy themselves, raised division and rivalry, but all considering that Mélanie Hahnemann's behavior was criticable. The court fined her for hundred francs that she paid. Then, she kept the circle of her friends and continued in medical counselling.

Ethics, Pharmacy↗

Promoting residencies to pharmacy students.

A program for promoting pharmacy residency training to pharmacy students at the University of the Pacific (UOP) is described. A residency club was started in 1982 to increase UOP students' interest in residency training and to provide them with relevant information. Some students needed to be convinced that residencies were primarily educational rather than staffing experiences. Students were made aware of pharmacists' practice in specialty areas, for which residency training is needed, and were taught how to prepare themselves for selection for residencies. The club was formed to encourage mutual support among the students, which would be less likely to occur if residencies were promoted only through work with individual students. Club meetings provide information about available residencies, the application process, and the value of residency training to a career in pharmacy. Students are taught how to prepare curricula vitae, how to interview, and how to select programs to which to apply. Applications for residencies increased. Although the rate of acceptance was low at first, it was expected to increase as more UOP students demonstrated their interest in and qualification for residency training. The promotion of residencies as part of a balanced career planning and placement program for pharmacy students is encouraged.

California↗

Hospital pharmacy in 1990: the year in review.

The accomplishments of hospital pharmacy in 1990 are reviewed, and external and internal factors affecting the profession are described. Six issues were identified as having a major impact on hospital pharmacy in 1990: cost containment, productivity and leadership, patient safety, medical-legal and ethical considerations, human resource management, and computers and new technologies. Highlights of activity in each of these areas, as reported primarily in the American Journal of Hospital Pharmacy, are reviewed. Hospital pharmacy remains a vibrant and growing profession that is responding positively to external and internal challenges.

Clinical Pharmacy Information Systems↗

Clinical pharmacy: the past, present and future.

Clinical pharmacy is discussed in terms of its historical basis, current status and future trends. Topics covered include the origins and current scope of clinical pharmacy practice, controversial issues in clinical pharmacy practice and education, and the quest for quality in clinical pharmacy practice.

Education, Pharmacy↗

1992 National Clinical Pharmacy Services Study.

STUDY OBJECTIVE: To determine the extent of hospital-based clinical pharmacy services in 1992. DESIGN: National survey with trend comparison to 1989. SETTING: All 1597 United States acute care, general medical-surgical and pediatric hospitals with 50 or more licensed beds and one or more full-time pharmacists (43% of all U.S. hospitals). MEASUREMENTS AND MAIN RESULTS: Fourteen clinical pharmacy services, carefully defined to indicate pharmacist proactive or concurrent patient care provision, were assessed to determine pharmacists' specific patient care responsibilities. The percentage of hospitals offering each of the services increased from 1989 to 1992, with greatest growth in management of adverse drug reactions (22% increase), pharmacokinetic consultations (14%), and drug therapy protocols (12%). The mean percentage of patients actually receiving clinical pharmacy services ranged from 0.2% for pharmacist participation on the cardiac arrest team to 36.1% for daily monitoring of drug therapy. Pharmacists conducted clinical research in 13% of all hospitals, averaging 3.9 +/- 4.3 protocols per year with a total budget of $79,765 +/- $128,641. CONCLUSIONS: Clinical pharmacy services continue to expand; however, even the most common direct patient care service is provided to a small number of inpatients.

Drug Utilization Review↗

Certification program in antineoplastic drug preparation for pharmacy technicians and pharmacists.

A formal training program for technicians who prepare cytotoxic agents and pharmacists who check the doses is described. To handle an overwhelming workload in an oncology satellite pharmacy and to enable the pharmacists there to increase their clinical involvement, a program was developed to train technicians to prepare antineoplastic doses and pharmacists to check the technicians' work. The program consists of two days of classroom instruction, three weeks of hands-on training, and a written examination. In addition to handling and preparation of antineoplastic drugs, other topics related to oncology are covered to give the participants a better understanding of cancer and its treatment. The technicians must complete a refresher program annually. From 1991 to 1993, 15 pharmacists and 14 technicians and pharmacy students completed the program. The technicians have taken on additional responsibilities in the satellite pharmacy, including managing the inventory of oncology drugs. Implementation of a comprehensive cancer chemotherapy training class for technicians and pharmacists has benefited the pharmacy in terms of labor and inventory control.

Antineoplastic Agents↗