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At least 19 recordsLinked to original sources
PubMed2002

Clinical pharmacy services, hospital pharmacy staffing, and medication errors in United States hospitals.

The direct relationships and associations among clinical pharmacy services, pharmacist staffing, and medication errors in United States hospitals were evaluated. A database was constructed from the 1992 National Clinical Pharmacy Services database. Both simple and multiple regression analyses were employed to determine relationships and associations. A total of 429,827 medication errors were evaluated from 1081 hospitals (study population). Medication errors occurred in 5.22% of patients admitted to these hospitals each year. Hospitals experienced a medication error every 22.04 hours (every 19.13 admissions). These findings suggest that at minimum, 90,895 patients annually were harmed by medication errors in our nation's general medical-surgical hospitals. Factors associated with increased medication errors/occupied bed/year were drug-use evaluation (slope = 0.0023476, p=0.006), increased staffing of hospital pharmacy administrators/occupied bed (slope = 29.1972932, p<0.001), and increased staffing of dispensing pharmacists/occupied bed (slope = 19.3784148, p<0.001). Factors associated with decreased medication errors/occupied bed/year were presence of a drug information service (slope = -0.1279301, p<0.001), pharmacist-provided adverse drug reaction management (slope = -0.3409332, p<0.001), pharmacist-provided drug protocol management (slope = -0.3981472, p=0.013), pharmacist participation on medical rounds (slope = -0.6974303, p<0.001), pharmacist-provided admission histories (slope = -1.6021493, p<0.001), and increased staffing of clinical pharmacists/occupied bed (slope = -9.5483813, p<0.001). As staffing increased for clinical pharmacists/occupied bed from the 10th percentile to the 90th percentile, medication errors decreased from 700.98 +/- 601.42 to 245.09 +/- 197.38/hospital/year, a decrease of 286%. Specific increases or decreases in yearly medication errors associated with these clinical pharmacy services in the 1081 study hospitals were drug-use evaluation (21,372 more medication errors), drug information services (26,738 fewer medication errors), adverse drug reaction management (44,803 fewer medication errors), drug protocol management (90,019 fewer medication errors), medical round participation (42,859 fewer medication errors), and medication admission histories (17,638 fewer medication errors). Overall, clinical pharmacy services and hospital pharmacy staffing variables were associated with medication error rates. The results of this study should help hospitals reduce the number of medication errors that occur each year.

Adverse Drug Reaction Reporting Systems↗
PubMed2000

Hospital pharmacy service provision in Australia--1998.

The results of a 1998 national survey of pharmaceutical services in hospitals throughout Australia are reported. A self-administered questionnaire was sent to all directors of hospital pharmacy services and senior hospital pharmacy managers to determine the extent of clinical and nonclinical pharmacy services provided by hospitals in Australia. Respondents chose the services their departments provide from a list of 26 commonly provided services. The response rate was 58.5%. Respondents were fairly evenly divided between teaching and nonteaching hospitals, but most of the respondents were from public (versus nongovernment) hospitals. The five most commonly provided services were imprest (a wordstock of frequently used medications that are regularly restocked by the pharmacy department), informal drug education for hospital staff, review of medication charts, control of drug purchasing, and inpatient dispensing. Review of medication charts and provision of drug education for the hospital staff were the most widely provided clinical pharmacy services. The most common services available from hospital pharmacies throughout Australia were imprest, informal drug education for hospital staff, review of medication charts, control of drug purchasing for the hospital, and inpatient dispensing.

Australia↗
PubMed1990

Hospital pharmacy services in the Great Lakes region.

The results of a spring 1987 survey of hospital pharmacy services in seven states of the Great Lakes region are reported. The study group (n = 1087) comprised all hospitals in seven states that employed at least one full-time or part-time pharmacist and that had 50 or more licensed beds. The survey had a 63% response rate (681 usable responses). Seventy percent of the hospitals were small (average daily census, less than 200), 20% were medium sized (200-399), and 11% were large (greater than or equal to 400). Some 33% of the hospitals were affiliated with a college of pharmacy. Pharmacy directors who held an advanced degree (master of science or doctor of pharmacy) were more likely to work in larger hospitals and in those affiliated with educational institutions. The extent of unit dose services differed based on hospital teaching affiliation and pharmacy director's education. Provision of i.v. admixture services differed based on hospital teaching affiliation and pharmacy director's education but not hospital size. Pharmacy preparation of six specialty i.v. products differed according to pharmacy director's education and hospital teaching affiliation; however, pharmacy preparation of only three of the specialty products differed based on hospital size. Larger hospitals that were affiliated with an educational institution were more likely to employ a clinical coordinator, drug information specialist, or clinical pharmacist. Home health-care services involving pharmacists were provided by 26% of the hospitals; the most common programs were antimicrobial therapy and total parenteral nutrition therapy. Pharmacists provided services in ambulatory-care clinics in 24% of the hospitals, with the most common services being patient education, pharmacokinetics consultation, and dosage regimen adjustment. Provision of 10 of 12 inpatient clinical pharmacy services differed based on hospital size and teaching affiliation; 11 of the 12 services differed based on education of the pharmacy director. Workload and pharmacist staffing data for the inpatient clinical pharmacy services varied widely. Eleven of these services were expected to undergo a positive net growth, while one service, provision of admission medication histories, was expected to decline. An extensive survey of hospital pharmacy services in the Great Lakes region showed that the provision and scope of many services were related to hospital size, hospital teaching affiliation, and the education of the pharmacy director.

Drug Information Services↗
PubMed1999

Staffing and the cost of clinical and hospital pharmacy services in United States hospitals.

A survey was mailed to pharmacy directors at all United States acute care medical-surgical hospitals that related to staffing and cost components of hospital pharmacies and clinical services. Cost information was evaluated as both unadjusted and adjusted for severity of illness using the Health Care Financing Administration's Medicare case mix index (CMI). Unadjusted drug costs/occupied bed/year were $13,350+/-6927, a 36% increase over 1992 and a 112% increase over 1989, with statistically significant differences observed by geographic region, hospital size, hospital ownership, and drug delivery system. Annual median pharmacist salary costs/patient associated with centrally based clinical pharmacy services were drug use evaluation $111, in-service education $20, drug information $117, poison information $24, and clinical research $35. Annual median pharmacist salary costs/patient associated with patient-specific clinical services were drug therapy monitoring $5, pharmacokinetic consultation $8, patient counseling $6, medical rounds $4, admission drug histories $7, and drug therapy protocol management (prescribing) $9. Drug costs continue to increase at double-digit rates. Substantial differences exist among various regions of the country with salary and specific cost components. Registered nursing staffing is increasing at twice the rate of pharmacists staffing increases.

Hospital Costs↗
PubMed1984

Survey of 24-hour, 7-day/week hospital pharmacy service.

Emergency after-hour pharmacy services in many hospitals have been replaced by 24-hour, 7-day/week pharmacy services. A survey questionnaire was published in Hospital Pharmacy, February 1983, to be completed by hospital pharmacies that provide a pharmacist in the hospital 24 hours a day, 7-days a week. Usable responses were received from 185 hospitals. The type of hospitals and the number of beds of these hospitals varied greatly. The differing responses concerning staffing, scheduling, hours of the post-midnight shift, arrangement of vacations and holidays, the factors used in selling the concept to administration, and the handling of compensation are presented.

Emergencies↗
PubMed1999

When should pharmacists visit their wards? An application of simulation to planning hospital pharmacy services.

This paper reports a pilot study of the use of simulation in planning hospital pharmacy services. The objectives were to create a simulation model of the hospital drug distribution system, to use the model to investigate a simple problem and to assess the potential for simulation to aid decision making in hospital pharmacy management. The problem chosen for investigation focused on the UK ward pharmacy system, where a pharmacist visits each ward daily to initiate the supply of newly prescribed non-stock medication. A simulation model was used to investigate how changing the time of the ward pharmacist's visit could affect the mean time delay between the prescription of a non-stock drug and the arrival of that drug on the ward. The simulation results suggest that the time of day at which pharmacists visit their wards can have a major impact on delay times, and that the relative benefit of different visit times is likely to vary between wards. Simulation was found to be a useful approach to investigating different service alternatives without the expense and disruption of assessing each in practice.

Computer Simulation↗
PubMed1995

Cost-evaluation model for clinical trials in a hospital pharmacy service.

A cost-evaluation model was applied to clinical trial protocols to estimate their cost for the hospital pharmacy service. The steps taken in the drug management of clinical research were identified. Fixed costs (common to all clinical trials) and variable costs (peculiar to each clinical trial) were determined for each step. The number of patients, the number of operations, the planned services (receptions, storage, drug dispensing), the timing and difficulty of the study (randomization) were included in the variable costs. The economic assessment of these items was based on the costs of the materials and means used, the cost of staff time and finally the cost of drug storage during the clinical trial. This model was applied to 24 clinical trials carried out in the University Clinic of Navarra. 83% of all pharmacy costs of a clinical trial were variable. Drug dispensing, stock management and return drugs account for 94% of the time expended. The approximate cost of the pharmacy providing investigational services was $1,766 per trial or $174 per patient. Drug storage costs were not an important source of expenditure among the variable costs (7.4%). The best way to determine the cost of a trial is to calculate the number of operations.

Clinical Trials as Topic↗
PubMed1978

Payment for nondistributive hospital pharmacy services--a regional survey.

Questionnaires were mailed to all (464) nongovernment, not-for-profit and investor owned for-profit hospital pharmacies in Washingon, Oregon and California. Responses were received from 350 institutions, a return rate of 75.4 percent. Pharmacists were asked to report data relating to the incidence of, the range of fees charged, and the extent of reimbursement received from third party carriers for the provision of nondistributive pharmacy services. The data received indicate that pharmacy consultation to physicians was provided by 77.9 percent of the respondents, drug therapy monitoring by 48.1 percent, generalized patient discharge consultation by 40.8 percent, CPR team participation by 27.2 percent, indepth patient discharge consultation by 17.5 percent and admitting medication history by 8.8 percent. Additionally, 12 institutions charged for providing 16 nondistributive pharmacy services. Directors of pharmacy from six hospitals indicated that they billed third party carriers for nondistributive pharmacy services as part of their total pharmacy charge via their usual billing procedure. All third party carriers billed in this manner paid for the nondistributive pharmacy service.

California↗
PubMed1987

The need for and methods of cost-justifying hospital pharmacy services.

The purpose of this paper is to introduce the interested reader to research priorities and needs for the effective management of hospital pharmacy services. Reference is first made to the new economic milieu for today's management along with the financial incentives for the delivery of cost-justifiable pharmaceutical services and products. The prerequisite for cost-justification is the documentation and collection of appropriate research data. Hence, the issue of a work measurement system as means to generate management data is highlighted. This system is needed to establish the costs of products and services provided; to improve efficiency of the operation; to identify potential managerial problems; and to justify staffing needs and budgeting. The newer trends in cost-justification studies of clinical services are discussed and their related research methods and means are emphasized.

Cost-Benefit Analysis↗