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PubMed1983

Hospital pharmacy in Portugal and its future trends.

The authors begin by presenting a brief historical summary of hospital pharmacists' activities in Portugal, especially since the 1950s. They state their views on the present situation of hospital pharmacy in various aspects, namely: general legislation; activities and premises of pharmacy services; pharmaceutical career and staff recruitment; the National Hospital Formulary of Medicines and Pharmacy and Therapeutic Committees; acquisition, production and distribution of medicines; and clinical pharmacy activities. Future trends of hospital pharmacy in Portugal are summarized, stressing the following points: evolution of production and information, unit dose distribution, and steady increase of other clinical pharmacy activities.

Formularies, Hospital as Topic↗
PubMed2000

Cost-analysis of high-dose chemotherapy and peripheral blood stem-cell support in patients with solid tumors.

BACKGROUND: The use of High-dose chemotherapy (HDC) with peripheral blood stem cells (PBSC) rescue in the treatment of solid tumors is controversial, and may be an important determinant of HDC and PBSC use in the future. Until the use of these procedures is proven through disease-free survival and overall survival compared with standard-dose chemotherapy, the associated cost is also under discussion. PATIENTS AND METHODS: We evaluate 27 consecutive patients with solid tumors who underwent HDC and PBSC rescue, through an accurate review of medical records and cost estimate for each patient. RESULTS: Median age was 45 years. Fifteen had breast cancer, six non-Hodgkin's lymphoma and six other solid tumors. The mean hospital length of stay was 21 days and mean cost was 21,445 US dollars (21,232 euro). Mean cost was clearly lower for the 9 patients treated within phase III trials, 17,571 US dollars (17,747 euro) than for the remaining 18 patients, treated in phase I-II trials, 22,747 US dollars (22,975 euro) (P < 0.001). The distribution of costs shows that wages and pharmacy account for 72% of total cost. The distribution of pharmacy costs per patient shows that chemotherapy (56% of pharmacy costs) and antibiotics (26%) account for most of the cost of medication. CONCLUSIONS: Our cost estimates agree with those of most countries with national health insurance programs, and are lower than those from the USA. As wages and pharmacy account for more than 70% of the costs, the great different among the costs estimates compared are due essentialy to doctors fees or salary and drugs utilization. Anyway, taking HDC with PBSC rescue as a model for a therapy that is more aggressive than standard, and that is associated to a possible survival improvement in indications such as relapsed high-grade non-Hodgkin's lymphoma, an adequate cost analysis is crucial both to measure cost-effectiveness and to establish payment to health care providers.

Adult↗
PubMed2003

Organization of a health-system pharmacy team to respond to episodes of terrorism.

The role of a pharmacy emergency response team (PERT) trained to respond to episodes of terrorism involving chemical, biological, radiological, and nuclear (CBRN) agents is described. Pharmacists must be prepared to support their health systems in responding to episodes of terrorism by detecting exposure to CBRN agents and mitigating, treating, and preventing casualties resulting from exposure to those agents. Maimonides Medical Center, whose pharmacists responded to the medical and pharmaceutical needs of victims of the World Trade Center attacks and anthrax exposures, has developed the PERT, modeled after the Health Emergency Incident Command System, to standardize the response of their pharmacists in the event of such an attack. Each team member has a specific role and can assume any other team member's role, if needed. Key players in the PERT include the pharmacy administrator, drug information pharmacist, intensive care unit pharmacist, infectious diseases pharmacist, nuclear pharmacist, management-information-system pharmacist, hazardous materials pharmacist, and auxiliary-site pharmacist. The most important features of this disaster response model include activating the PERT to establish command and control in the pharmacy department, conducting a disaster-needs analysis, deploying PERT members in support of the medical center during a public health emergency involving CBRN agents while maintaining normal operations in the pharmacy, and maintaining, mobilizing, distributing, and receiving a pharmaceutical stockpile while ensuring that timely antidotes are available and used appropriately when distributed. The PERT allows for a comprehensive pharmacy response within a health system to episodes of terrorism involving CBRN agents.

Disaster Planning↗
PubMed1990

Continuous quality assurance monitoring by staff pharmacists.

The article describes a system of continuous quality assurance monitoring which is accomplished by pharmacists at the medical center. This 856 bed Veterans Affairs facility is provided pharmacy services through a decentralized unit dose distribution system. Pharmacists are assigned to separate patient care areas and provide or coordinate all drug distribution functions and additionally provide clinically-oriented services including quality assurance intervention. Pharmacists are provided guidelines on selected medication therapy which warrant pharmacist monitoring to assure high quality of care. In addition to these guidelines, pharmacists are encouraged to intervene in other therapeutic areas where their expertise favorably impacts quality of patient care. A report of clinically significant intervention is prepared monthly and submitted to the Drug Use Evaluation Subcommittee for review. This report is distributed along with the Pharmacy and Therapeutic Committee minutes to all pharmacists, physicians, and supervisory nursing personnel. The system of continuous quality assurance monitoring encourages pharmacists to use their expertise in a manner which assures quality of medical care provided by the medical center. Documentation of pharmacist intervention meets many JCAHO requirements for quality assurance.

Concurrent Review↗
PubMed1980

Audit mechanism for hospital drug distribution.

The development and application of a pharmacy department audit of its unit dose drug distribution system is described. Criteria used in the program were based on broad drug distribution criteria developed by the Minnesota Society of Hospital Pharmacists' PSRO Liaison Committee, with subcriteria developed by the staff of the hospital pharmacy department. Month-long audits are based on one of three criteria. A committee consisting of two staff pharmacists, one administrative pharmacist and one technician audits a predetermined number of randomly selected medication orders, medication profiles, filled medication orders or medication drawers. Deficiency patterns are identified, and appropriate corrective action is taken. Audits require approximately eight hours of pharmacist time and three hours of technician time per month per criterion. Audit of the drug distribution system makes pharmacy staff more aware of the quality of service it provides.

Hospital Bed Capacity, 500 and over↗
PubMedDate not supplied

[The distribution of tuberculin allergy among students in their 5th and 6th years at the University of Medicine and Pharmacy Iaşi].

The authors studied the distribution of tuberculin allergy in a group of high TB risk, the students in last years of study of the Iaşi University of Medicine. They are already BCG vaccinated. An infection prevalence of 18.6% was found--reactions over 18 mm, also a reaction of 10-17 mm was found at 62.2% of the students having 2-3 BCG scars. In the time of the present national BCG vaccination program there is need for new criteria for separating the two types of allergy: post BCG and post infection.

Adult↗
PubMed2001

Nonprescription drug-related problems and pharmacy interventions.

OBJECTIVE: To document the number and types of drug-related problems (DRPs) identified in customers purchasing nonprescription products in Swedish pharmacies; describe the distribution of DRPs by customer's gender, age, underlying ailment, and class of drug; determine whether problems are identified to the same extent in pharmacies with staffed nonprescription self-service departments as in pharmacies with over-the-counter sales; and document the number and types of pharmacy interventions to prevent or resolve DRPs, including reasons for drug switches and referrals to physicians. METHODS: A computerized instrument for documentation of DRPs and pharmacy interventions was developed. The study was conducted in 45 volunteer pharmacies in Sweden during 10 weeks in late 1999. RESULTS: A total of 1,425 problems and 2,040 interventions were recorded by 308 pharmacy practitioners. Relatively fewer DRPs were documented in pharmacies with self-service departments. The most common DRPs were uncertainty about the indication for the drug (33.5%) and therapy failure (19.5%). Dyspepsia was the most frequently specified symptom (11.4%). Consumers of dermatologic products had significantly higher rates of problems than expected in relation to sales volume. The most common ways of responding to a problem were with consumer drug counseling (61.1%), switching of drugs (43.9%), and referral to a physician (27.5%). CONCLUSIONS: The study has demonstrated a need for more professional attention and intervention by pharmacy staff to prevent and rectify DRPs in nonprescription consumers. It seems especially important to make sure that consumers receive the appropriate drugs for their current ailments.

Adolescent↗
PubMed1988

Effective management strategy for establishing an operating room satellite pharmacy.

The steps involved in justifying and implementing an operating room (OR) pharmacy satellite are described. A hospital administrator's viewpoint on the project is included. Objectives of the satellite were to reduce inventory costs, improve control of distribution, reduce loss of revenue and improve patient charging, improve IV compounding and labeling, and significantly improve narcotic control and accountability. The satellite provides comprehensive services 12 hours a day, five days a week. Effective after-hours procedures have been developed to provide efficient drug distribution when the pharmacy is closed. Achieved benefits of the satellite include decreased drug inventory, improved patient charging, accurate labeling, improved IV compounding, and improved pharmacy/surgery relations. The OR pharmacy satellite is a successful cost-effective operation.

Centralized Hospital Services↗
PubMed1991

The effective pharmacy-nursing committee.

The Saint Joseph's Hospital Pharmacy-Nursing Committee sees a long list of pharmacy-nursing and drug distribution system problems still to be addressed and has no worry about running out of new business. In fact, increasing controlled substances accountability, creating a more reliable and timely process for moving intravenous fluid pumps through the inpatient system, and implementing a pharmacy-based, patient-controlled analgesia program across all of the hospitals' wards are three major issues now being addressed by the committee. At Saint Joseph's Hospital there is not a lot of unnecessary handwringing or undue stress over major pharmacy-nursing issues. Issues do exist, but there is also an experienced Pharmacy-Nursing Committee with a good track record of being able to resolve major issues. The committee takes on problems in a healthy and confident atmosphere of trust in both profession's skills and competencies. There is a respectful knowledge of each discipline's professional responsibilities and a full awareness that a quality patient drug system requires pharmacy and nursing elements working closely together. Wrestling with the heavy, modern-day, hospital pharmacy-nursing drug distribution system issues at this facility actually can be fun as a result of the confidence, camaraderie, and empathy that exists within the Pharmacy-Nursing Committee.

Clinical Pharmacy Information Systems↗
PubMed1981

A satellite pharmacy program in a community hospital.

A satellite (decentralized) pharmacy program in a medium-size community hospital is described. The hospital is a private institution consisting of three divisions: an acute-care division, a psychiatric division, and a long-term care division. Pharmacy services are provided on an around-the-clock basis, and the satellites are operational 16 hours daily. Pharmacy services include unit dose distribution, I.V. admixture services, and clinical pharmacy programs. Structurally, the department is divided into four satellite units and a central pharmacy unit to provide care to all areas of the health center. The professional staff is divided into several categories as a means to overcome the difficulties and take full advantage of all of the benefits of the satellite system. The Associate Director and the Assistant Director perform primarily administrative functions in order to maintain overall control, coordination, and quality assurance of the department. The Education Coordinator helps maintain the level of basic competence of the staff and coordinates the development and implementation of new departmental programs. Staff Pharmacists II provide both administrative and professional functions in their roles as team leaders of individual satellite units. Staff Pharmacists I serve the traditional staff functions in a satellite unit or in the central pharmacy.

Centralized Hospital Services↗
PubMed1982

Establishing priorities and distributing the request for proposal.

The process of establishing priorities for a prospective hospital pharmacy computer system and distributing the Request for Proposal (RFP) to computer vendors is described. Priorities are established through the creation of three documents: (1) a priority list, (2) a categorized RFP, and (3) a categorized RFP extension. The priority list outlines important elements in the selection of a vendor; quality of software, reliability of software and hardware, vendor stability, costs, site requirements, expansion capability, vendor support, and system performance. The categorized RFP ranks each specific RFP item as mandatory, highly important, important, or "luxury." The categorized RFP extension ranks the nonimplementation items and is used to grade vendors on items not addressed by the RFP. Each potential vendor should be called and asked the same set of questions in order to quickly eliminate those with unacceptable products. The RFP is then distributed to vendors that qualify. This process helps determine if the system being considered has all the required functions, has reliable software and hardware, and whether the vendor is stable and capable of providing assistance during implementation and throughout the life of the product.

Computers↗
PubMed2001

Private pharmacy practice and regulation. A randomized trial in Lao P.D.R.

OBJECTIVES: The objective of this study was to assess the effectiveness of government regulation of private pharmacy practice in a low-income country. METHODS: The intervention comprised inspections of the pharmacies, information, and distribution of documents to drug sellers and sanctions. It was implemented at two different intensity levels, active and regular intervention. The methods used to assess the effect of the interventions were interviews with the district drug inspectors, drug sellers and customers, inspection of drug purchases, and indicator surveys of pharmacies. Indicators for pharmacy-specific quality as well as for dispensing quality were developed. RESULTS: The main finding was one of strong overall improvements from initially low levels. The improvements were particularly marked by increases in the availability of essential materials for dispensing by 34% and in order in the pharmacy by 19%. Information given to customers increased from 35% to 51% and the mixing of different drugs in the same package went down from 17% to 9%. The pharmacies in the active intervention districts showed greater improvements for four of the six indicators, although statistically significant compared with the regular intervention districts only for the essential materials indicator. CONCLUSIONS: It was concluded that the regulatory activities have probably been an important factor behind the service quality improvements. It appeared feasible as well as effective to regulate private pharmacy practice in this particular low-income setting.

Developing Countries↗
PubMed1985

Pharmaceutical services in a United States Army field hospital.

Pharmaceutical services in a United States Army field hospital are described. The field hospital was deployed to Honduras to support United States troops during military exercises. Pharmaceutical services were provided from a large tent near the hospital, which consisted of an emergency treatment facility, two operating rooms, and a small medical-surgical ward. One pharmacist and four technicians provided outpatient pharmaceutical services 10 hours per day, seven days per week; pharmacy personnel were on call at other times. The majority of pharmacy time was spent prepackaging and labeling medications for use by medical teams visiting local villages to provide health care to Honduran natives. The pharmacy's drug distribution, inventory control, and intravenous admixture activities in light of limited personnel and storage space, long supply lines, and lack of an aseptic working area are described. Pharmacist-physician interactions regarding drug therapy and common ailments of United States troops and Honduran natives are also discussed. During a two-month period, the field hospital pharmacy dispensed approximately 24,000 prescriptions. Pharmaceutical services played an important role in the success of the field hospital's mission and provided aid to the population of an impoverished country that might not otherwise have received it.

Drug Prescriptions↗
PubMedDate not supplied

[Development of surgical antibioprophylaxis kits: evaluation of the impact on prescribing habits].

In our hospital, surgical antibioprophylaxis (ATBP) was too often administered too late, thus raising the infectious risk. Antibiotic stocks of the anaesthesia department were also systematically used, instead of nominal prescriptions of these drugs. The pharmacy could neither charge antibiotics to each surgical department nor quantify and differentiate ATBP from curative antibiotic therapy. The pharmacy and anaesthesia departments therefore set out to standardize surgical ATBP, in order to adapt this treatment to each surgical indication, and particularly in the case of allergy to beta-lactamase antibiotics (second line treatment kits). Consequently, prescription forms were developed and supplied to each surgery department, as well as ATBP kits. The kits were prepared and distributed by the pharmacy, and comprised boxes containing antibiotics in sufficient quantities to respect the protocols approved by the French Society of Anaesthesia and Resuscitation (SFAR). A protocol describing prescriptions, dispensation and administration has been presented to physicians and nurses. Fifteen surgical departments were included in our study and 30 different kits were prepared. From 1998 to 2001, 5586 surgical operations required administration of a kit (second line treatment kits in 5% of cases): 1848 (33%) in visceral surgery; 764 (13.8%) in urology; 802 (14%) in orthopaedics; 13 (0.2%) in vascular and thoracic surgery; 1236 (22%) in ear-nose-throat (ENT), periodontics and ophtalmology, and 923 (17%) in gynaecology and obstetrics. 93% of filled prescriptions forms were spontaneously returned to the pharmacy, the others were obtained during the renewal of kit stocks. The cost (over 4 years) of ATBP was quantified: 157,871 F for the 15 departments included, 26,123 F in visceral surgery, 13,520 F in urology, 73,741 F in orthopaedics, 569 F in vascular surgery, 39,720 F in ENT/ophthalmology/periodontics and 4,198 F in gynaecology and obstetrics. According to the Altemeier classification, 2226 class I, 3151 class II, and 209 class III surgical operations were performed. Since the kits have been brought into use, the committee for the protection against nosocomial infections (CLIN) has observed a reduction in the incidence of post-operative infections, according to the Altemeier classification: from 1.6% to 0.5% in class I, from 6.5% to 4.3% in class II, and from 11% to 8.5% in class III. The difference was statistically significant only for classes I (p < 0.01) and II (p < 0.001), and unchanged for class III (p = 0.3). No analysis was carried out for class IV (curative treatments). Both nurses and physicians have greatly appreciated the implementation of this organization. The advantage in terms of post-operative infections, administration exhaustiveness and stock management is obvious. The prescribed kits were systematically appropriate for the surgical interventions. In orthopaedics, cefamandole was used over 24 h (188 kits) in ligament plasty and osteotomy, or for 48 h (499 kits) in prosthetic surgery; 24 amoxicillin/clavulanic acid (first line) and 9 clindamycin/gentamicin (second line) single dose kits have been prescribed in traumatic indications. In ophthalmology, kits were only prescribed in endophtalmitis (24 ofloxacin/fosfomycin single amount kits), implant replacement or cornea graft (1076 ofloxacin 24 h kits) and cataract surgery in diabetic patients (12 ofloxacin single amount kits). In ENT and periodontics, 124 surgical operations required cefazolin single dose kits. In vascular surgery, 5 pefloxacin/gentamicin 48 h kits and 1 amoxicillin/clavulanic acid 48 h kit were used in contaminated limb amputation, 1 cefamandole 48 h kit in class I surgery and 1 vancomycin 24 h kit (betalactamase antibiotic allergy); in thoracic surgery, 1 cefamandole 24 h kit was used for a thoracic wound. In visceral surgery, 9 different kits have been used, depending on the opening (class II) or not (class I) of the digestive tract. 797 cefazolin (first line) and 68 clindamycin/gentamicin (second line) single dose kits were used in class I surgery, and 689 amoxicillin/clavulanic acid single dose (SD) kits in class II surgery. Specific protocols consisted of 18 ceftriaxone/metronidazole and 48 metronidazole/gentamicin SD kits in oesophagus surgery, 11 ceftriaxone and 17 gentamicin SD kits in biliary endoscopy, 137 metronidazole SD kits in proctology and 34 amoxicillin/gentamicin 6 h kits for prevention of endocarditis. In urology, 133 cefotaxime and 20 pefloxacin/gentamicin SD kits were precribed in renal lithiasis, 102 amoxicillin/clavulanic acid SD kits in cystectomy, 27 amoxicillin/gentamicin 6 h kits in endocarditis prevention and 58 cefamandole SD kits in all other indications. In gynaecology and obstetrics, 534 cefazoline and 19 clindamycin/gentamicin (second line) SD kits were used, and 370 doxycyclin SD kits were prescribed in pregnancy termination. Some departments (orthopaedics and visceral surgery) adapted the protocols to their needs, specifically with regard to treatment duration. However, these situations were quickly corrected. A constant follow-up and update of this system, associated with routine audits, should allow the maintenance and possibly the improvement of these results, hence shortening treatment duration.

Anti-Bacterial Agents↗
PubMed1990

Comparison of women pharmacy and nursing students.

The increasing number of women in pharmacy schools has had an impact on pharmacy manpower estimates. The nursing shortage has been used as an example of what may happen when women health professionals choose not to practice in their field. The purpose of this study was to determine whether the women students in these two health professions were similar with respect to demographics, career choice, career plans, and career commitment. A survey was distributed to undergraduate pharmacy students and baccalaureate nursing students at the University of Texas. The 168 women pharmacy students and 67 nursing students responding to the survey were included in the analyses. On average, the pharmacy students were younger, were more likely to be single, and had fathers of a higher socioeconomic status. When asked to indicate their primary reason for choosing their profession, the pharmacy students most often chose "want a career in the health field," whereas the nursing students chose "desire to help people" most often. When future plans of the two groups were compared, a higher percentage of the pharmacy students planned to work full time for the majority of their careers. Responses to Blau's Career Commitment Scale indicated that the women pharmacy students were more committed to their profession than were women nursing students. Although some may assume these groups are similar, results indicate that there are significant differences between them. Comparison of manpower issues between the two groups may not be justified.

Career Choice↗