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The environments of hospital pharmacies and the preparations made in these pharmacies were examined for Pseudomonas aeruginosa. This organism was widely distributed in the pharmacies and was isolated from 9% of preparations. In 11 instances strains of Ps aeruginosa from the preparations bore a close resemblance to strains previously found in the pharmacy environments.
BACKGROUND: In the UK the National Reporting and Learning System (NRLS) is designed to coordinate the reporting of patient safety incidents nationally and to improve the ability of the health service to learn from the analysis of these events. Little is known about levels of engagement with the NRLS. OBJECTIVE: To examine the likelihood of community pharmacists and support staff reporting patient safety incidents which occur in community pharmacies. METHODS: Questionnaire survey containing nine incident scenarios. In the scenarios two factors were orthogonally manipulated: the outcome for the patient was reported as good, bad or poor, and the behaviour of the pharmacist was described as either complying with a protocol, not being aware of a protocol (error), or violating a protocol. Respondents were asked to rate whether they would report the incident (1) locally within the pharmacy and (2) nationally to the National Patient Safety Agency (NPSA). RESULTS: 275 questionnaires were returned (79% response rate) from 223 community pharmacists and 52 members of support staff. There were significant main effects for both patient outcome (F(2,520) = 18.19, p<0.001) and behaviour type (F(2,520) = 93.98, p<0.001), indicating that pharmacists and support staff would take into account both the outcome of the behaviour and whether or not it follows a protocol when considering to report an incident within the pharmacy. Likewise, both pharmacists and support staff considered patient outcome (F(2,524) = 12.59, p<0.001) and behaviour type (F(2,524) = 34.82, p<0.001) when considering to report to the NPSA. Both locally and nationally, the likelihood of reporting any incident was low, and judgements on whether to report were more affected by the behaviour of the pharmacist in relation to protocols than the resulting outcome for the patient. CONCLUSIONS: Community pharmacists and their support staff would be unlikely to report adverse incidents if they witnessed them occurring in a community pharmacy. They remain to be convinced that the advantages to them and their patients outweigh the consequences of blame.
OBJECTIVE: To assess the impact of a nationally coordinated pharmacy-based educational intervention on self-management behaviour and markers of asthma control in self-referred patients with asthma. DESIGN: An asthma clinic day was set up by a national chain of community pharmacies whereby pharmacists used a structured questionnaire to assess asthma control and self-care among self-referred patients with doctor-diagnosed asthma. In a one-on-one counselling session, each patient's educational needs were identified and the appropriate education offered. A telephone follow-up 30 days later assessed the impact of teaching. SETTING: Community pharmacies across Canada. OUTCOME MEASURES: The follow-up questionnaire quantified the number of wheezing episodes or other symptoms per week, the number of night-time awakenings per week, and the frequency of use of reliever and preventive medications. RESULTS: Of 4080 patients assessed, 22.2% used an inadequate inhaler technique, 16.4% used a short acting beta2-agonist excessively and 21.0% were not using an inhaled corticosteroid daily despite a frequency of symptoms that would suggest that it was needed. Common educational interventions included a review of inhaler technique (41.9%), a recommendation for regular inhaled corticosteroids (31.5%) and a referral to the primary care physician (21.0%). Thirty days after the educational intervention, patients reported significant decreases in the frequency of daytime asthma symptoms, the frequency of nocturnal symptoms and the frequency with which short acting beta2-agonists were used, while reporting significant increases in their use of preventive medication. CONCLUSIONS: A brief assessment and an educational intervention in the community pharmacy can produce significant short term improvements in patient-reported symptom control and appropriate self-management behaviour.
This article assesses changes over 10 years in the role of pharmacies in the care of drug misusers--needle/syringe provision and methadone treatment supervision--in the Swiss French-speaking Canton of Vaud (636,000 inhabitants, 238 pharmacies). A review of data collected in four surveys (1991, 1994, 1996, 2003) on the provision of sterile material (and methadone treatment supervision in 2003) including all the pharmacists of the Canton of Vaud was conducted, as well as a review of data of the monitoring of needle exchange programmes introduced since 1996 in this canton, and of methadone treatment statistics. In 2003, interviews with pharmacists complemented the survey. Pharmacies play an important role in the 'frontline' services to drug misusers: the provision of needles/syringes to drug users by pharmacies remains important in spite of a decrease in the provision of sterile material by them since the advent of needle exchange programmes, and they are included in the supervision of two thirds of the methadone treatments. However, they do not feel integrated enough in the network of care to drug misusers and ask for more training and better recognition of their role.
An interview survey of 129 UK National Health Service doctors, nurses, pharmacists and managers at eight acute care hospitals was conducted in 1994. The survey examined several topics including whether the introduction of the internal market had affected hospital pharmacy services and what those effects had been. An internal market has been introduced and it has had significant effects on the nature and structure of hospital pharmacy services. Directorate pharmacy services were available at six sites. Contracts for specific, usually novel, services had been implemented at one site and contracts had been introduced widely at another hospital. However, all the features of a market were not present at any site. Market orientation also has implications for the equity of service provision, primarily because decision-making regarding service provision is increasingly in the hands of the clinical directors, rather than pharmacy managers. The effects of this change are not yet clear.
For over 30 years, the content and form of the pharmacy curriculum and the title of the degree to be awarded have been subjects of controversy among pharmacy educators and practitioners. Scores of articles have been written about a universal Pharm .D. degree, all of which present different angles and opinions. Those who favor a universal Pharm .D. desire an improved image for the profession, greater employment opportunities, preparation for future pharmacy roles, the elimination of the multi- tiered structure, and decreasing costs for services. Those who oppose the entry-level Pharm .D. degree stress a need for multiple levels of education to meet the varying demands of practice, emphasize the oversaturation of the job market and increased costs to schools to adopt the new curriculum, and protest bestowing a doctoral title for reasons of self-esteem. The authors of this article consider it timely to present and evaluate these arguments, to provide the reader with a comprehensive review of the debate, and to call for unity within the profession as it considers the future educational needs of pharmacy practitioners.
A multi-faceted approach was used to study the impact of clinical pharmacy services on the cost of drug therapy on a cardiothoracic and vascular surgical service. Physician and nursing attitudes about the usefulness and likely effect of clinical pharmacist recommendations were also assessed. A cross-sectional design with a temporal factor was used to study physician prescribing of all pharmacologic classes, and particularly of antibiotics. Measurements were taken for nine months before the institution of clinical pharmacy services, 12 months during a clinical pharmacy service period, and for six months after the cessation of the services. A trend toward reduction in drug costs per patient day was observed on both services. This was observed for all pharmacologic classes, and when antibiotics were analyzed alone. The difference was significant when antibiotics were specifically analyzed on the vascular surgical service. The pharmacist's log and a survey of physicians' and nurses' attitudes toward clinical pharmacy services supported the above results.
A nationwide study investigated the attitudes of family practice residents toward: interdisciplinary health care teams in family practice; the clinical pharmacist as a member of the health care team; and the utility of clinical pharmacist involvement in private family practice offices. A random sample of 174 family practice residency programs was selected for study. First-year residents comprised the sample population. Based on the response of the directors, programs were assigned to experimental (programs offering clinical pharmacy services) or control (no clinical pharmacy services) groups. Completed attitudinal instruments were received from 158 resident respondents in the experimental group and 153 resident respondents from the control group. The reliability coefficient of the returned questionnaires was 0.901 by the split-halves method. Residents in the experimental group had significantly more favorable attitudes than those residents in the control group on several scales. These scales included the clinical pharmacist's participation on the health care team, utility of a clinical pharmacist in a private practice setting, desirability of hiring a clinical pharmacist, and the desirability of practicing with a multidisciplinary health care team. These results support the hypothesis that exposure to clinical pharmacy services can significantly affect physician resident's attitudes toward clinical pharmacy.
This study assessed the impact of physician exposure to clinical pharmacy services on the appropriateness of physician prescribing and on medication costs. Two study sites were used: FPC (primary resident training office without clinical pharmacist) and PMC (satellite office with clinical pharmacist). The same physicians provided care at both study sites. Exposed patient encounters were selected from encounters during each resident's rotation at the PMC satellite. Unexposed patient encounters were selected from encounters at the FPC immediately prior to each resident's exposure to clinical pharmacy services. A blind review panel evaluated case abstracts of the patient encounters for appropriateness of drug choice, daily dosage, dosing interval, duration of treatment, clarity of instructions, and monitoring data; potential severity of the patient problem; and difficulty of the clinical decision. After adjusting for covariables (potential severity, difficulty, patient age, sex, Medicaid status, therapeutic category, and type of medical problem), physician-patient encounters in which family practice residents were exposed to clinical pharmacy services were rated significantly more appropriate for choice of drug prescribed, daily dosage chosen, dosing interval selected, clarity of prescription instructions, and monitoring data. Costs of acute medications, as measured by average wholesale price per day, per dose, and per treatment course, were also significantly lower for clinical pharmacy-exposed physician-patient encounters.
There are always high expectations for a new year--and certainly we will have even higher expectations for a new century. To continue leadership in the 21st century, the American pharmaceutical industry must make a stronger commitment to new product research and development and the profession of pharmacy must commit to development of services needed for new, high-technology products and devices that will often be parenterally administered, bulky, nontraditional, patient-tailored, infrequently administered, and device-oriented. It is suggested that pharmacy must initiate efforts to include drug administration as a pharmaceutical service. Other actions are suggested to modify the curricula preparing pharmacists and to recruit a wider variety of students. A number of other professional initiatives are recommended and discussed to position pharmacy for enhanced clinical services. The issue of subperformance by pharmacists is discussed by pointing out that there is a significant difference in what often is, what should be, and what could be pharmacy service.
The Purdue Stepped Approach Model (PSAM) of service delivery is applied to pharmacy practice. The PSAM offers a method to organize interventions in a systematic and sequential manner according to the amount and type of resources required to achieve optimal patient health status. The model also provides an approach to integrating the expertise of other healthcare professionals into the provision of pharmacy services (e.g., health educators, psychologists, nurse practitioners, exercise physiologists), addresses economic costs and differential modes of reimbursement, and provides suggestions for future research. Examples are included to facilitate application of the PSAM in pharmacy and implications for holistic healthcare or health promotion in pharmacy practice are discussed.
Management of acute illness has been increasingly shifted to community practitioners. Expansion of community pharmacy into home healthcare has brought new opportunities and responsibilities to community practitioners. These practitioners are gaining expertise in total parenteral nutrition, intravenous infusion systems, intravenous catheters, parenteral antibiotics, and clinical pharmacokinetics--areas historically managed by hospital and long-term care facility pharmacists. This shift to community pharmacy-based care has brought with it the need for community pharmacists to develop expertise in therapeutic monitoring of chronic disease states. Dose adjustment of medications based upon careful analysis of blood concentrations is no longer limited to institutional pharmacy practice. Community pharmacists now must master basic infectious disease principles and possess internal medicine knowledge to ensure appropriate monitoring of their patients. This article discusses several disease states currently managed with community pharmacy-based home healthcare, summarizing basic monitoring parameters for comprehensive patient care, and provides sample supply lists and documentation forms for home healthcare providers.
Recent advances in Department of Veterans Affairs (VA) health care data systems have greatly increased access to operational pharmacy information. This article presents a brief guide to VA pharmacy data sources: the Veterans Health Information Systems and Technology Architecture files, the Pharmacy Benefits Management database, Decision Support System (DSS) National Data Extracts for inpatient and outpatient care, the planned DSS National Pharmacy Extract, DSS databases at local VA facilities, and the Non-VA Fee Basis files. Depending on the source, available data elements include patient demographics, clinical care information, characteristics of the medication and of the prescribing physician, and cost. Access policies are detailed for VA and non-VA researchers. Linking these sources to VA databases containing data on inpatient and outpatient services offers a comprehensive view of health care within several VA populations of general interest, including people over age 65 and those with physical and psychiatric disabilities.
A visiting nurse association (VNA) and a college of Pharmacy sought cost-effective models by which consultant pharmacy services could be offered at a rural branch office to improve medication management for high-risk patients. Through a collaborative relationship with the Albany College of Pharmacy, the Eddy VNA used the structure and support of the Partners In Care Foundation (The Model) Medication Management Model to simultaneously provide patient services and train Doctor of Pharmacy candidates. The Model brings the pharmacist into the homecare team to provide pharmaceutical care and can provide the framework by which pharmacist preceptors and interns can effectively provide services to high-risk patients identified through the agency's CQI process. Results from program implementation with 100 Medicaid waiver patients indicate positive staff response and an overall 43% acceptance rate with prescribers and suggest that this is a cost-effective medication management service with implications for adaptation by other HHAs.
This study examines the relationships between department values, service user closeness and marketing effectiveness as perceived by hospital pharmacy directors. Data from 171 hospital pharmacy directors, representing a cross-section of hospitals, revealed that departments of pharmacy characterized as having superior perceived marketing effectiveness also have shared department value profiles. However, no significant relationship was found between perceived level of marketing effectiveness and perceived service user closeness. More years of experience as a director and the larger the size of pharmacist staff each positively influence the director's perception of marketing effectiveness. The results of the study indicate that hospital pharmacy directors generally perceive the services offered by their respective departments are marketed effectively.
The physical layout of a retail pharmacy can play a significant role in the development of the customers' perceptions which can have a positive (or negative) impact on its sales potential. Compared to most general merchandise stores, pharmacies are more concerned about safety and security issues due to the nature of their products. This paper will discuss these aspects as well as the physical and professional environments of retail pharmacies that influence the perceptions of customers and how these vary whether chain, independent, or hospital pharmacies.
OBJECTIVE: To identify whether prior experiences, ideal referents, or market-based expectations affect patients' satisfaction with pharmacy services. DESIGN: Ambulatory pharmacy patients were randomly assigned to groups receiving one of three surveys. Each survey varied by the type of expectation (independent variable) used to measure expectations for satisfaction with pharmacy services. We used regression analysis to evaluate the three different expectation measures in the satisfaction model. Each regression consisted of the same dependent variable (patient satisfaction). Each survey contained one type of expectation measure (independent variable): prior experiences, ideal referents, and market-based expectations. RESULTS: We received 315 evaluable surveys by mail (47% response rate). All three regression models were statistically significant; however, the independent variables in the models differed. CONCLUSION: Cognitive services are best evaluated from the patient's perspective by asking him or her how the services compare with what they should be (i.e., ideal referent). Tangible aspects of the services, such as informational leaflets or wait time, are best evaluated by asking patients how recent experiences compare with past experiences. Therefore, satisfaction surveys should be designed to specifically assess the type of services provided by the pharmacy.
OBJECTIVE: To describe a pharmacist-operated program to help people stop smoking. SETTING: Community chain (mass-merchandise) pharmacy practice sites in Virginia. PARTICIPANTS: Faculty at the Virginia Commonwealth University School of Pharmacy (VCU) and 15 practicing pharmacists. PRACTICE DESCRIPTION: Smoking cessation clinics within the pharmacy departments of seven Target stores. PRACTICE INNOVATION: With input from the practicing pharmacists and using the most current strategies reported in the literature, faculty at VCU developed a training manual for smoking cessation counseling. This manual was used to facilitate a 4-hour training session and also served as a resource for pharmacists in the smoking cessation clinics. Pharmacists were taught about behavioral modifications, the Transtheoretical Model of Change as applied to smoking cessation, documentation, the Fagerström Test for Nicotine Dependence, smoking cessation therapies, patient counseling techniques, physical assessment skills, and how to develop an individualized action plan for smoking cessation. As pharmacists established smoking cessation clinics, issues such as workflow, continuous quality improvement, and marketing were addressed by the faculty members and practitioners. RESULTS: Using the process and tools described in this article, pharmacists successfully established and operated smoking cessation clinics. CONCLUSION: The process and materials developed for this demonstration project can serve as templates for other pharmacy faculty members and community pharmacists who wish to offer smoking cessation clinics.