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Legal status and functions of hospital-based pharmacy technicians and their relationship to clinical pharmacy services.

The relationships among (1) laws and regulations governing hospital-based pharmacy technicians, (2) functions pharmacy technicians perform, and (3) pharmacists' provision of clinical pharmacy services were studied. A state-level technician-restriction score was developed, based on state rules and regulations in effect in 1989. Scoring included (1) type of supervision required for hospital-based pharmacy technicians, (2) ratio of technicians to pharmacists, (3) pharmacist-only reconstitution of injectable products, and (4) pharmacist-only counting and pouring. Actual use of hospital pharmacy technicians was measured with the technician-use index, and overall provision of clinical pharmacy services was measured with the pharmaceutical-care index. Based on the technician-restriction scores, 25 states and the District of Columbia were categorized as having less restrictive laws and 25 states as having more restrictive laws. Technician use varied with hospital size, teaching affiliation, owner-ship, type of drug delivery system, and education level of the director of pharmacy. Use of pharmacy technicians increased with the severity of hospital-patient illness treated. A fair correlation was found between the pharmaceutical-care index and the technician-use index. A positive association was found between pharmacy technician use and pharmacists' provision of clinical pharmacy services.

Certification

Pediatric pharmacy practice guidelines. Pediatric Pharmacy Administrative Group Committee on Pediatric Pharmacy Practice.

Pediatric patients are unique because of age-specific differences in metabolic capacity, disease processes that may make commercially available pharmaceutical preparations unacceptable for use, a lack of published information on the effects of many new pharmacotherapeutic agents in this population, and changes in population demographics caused by new diseases (e.g., AIDS) and new technologic applications. Comprehensive pharmaceutical services are essential for maximizing the benefits--while avoiding or minimizing adverse effects--of pharmacotherapy and new technologies. Comprehensive pharmaceutical services can help maximize the use of health-care resources in the pediatric population and assist in the development, implementation and evaluation of new methods of treatment that will benefit children everywhere.

Humans

Increasing pharmacy productivity by expanding the role of pharmacy technicians.

Efforts to meet growing clinical and distributive demands without increasing pharmacy staff are described. Real and expected increases in demands for services led pharmacists at a cancer center to seek ways of accommodating those demands within budgetary limits. Growth in the distributive workload was interfering with clinical consultation work. Research studies by the medical staff were resulting in complex dosage calculations and time-consuming compounding. Increasing requests for clinical services had to be met without compromising distributive services and teaching responsibilities and without raising costs. A plan of action was approved that included the use of a written test and a training manual to allow the hiring and retaining of skilled pharmacy technicians qualified to assume greater responsibilities. Technicians were assigned to enter drug orders into the computer, check other technicians, and dispense certain drugs. Greater use was made of commercially prepared i.v. solutions, and the floor stock was expanded. A comprehensive quality control program was concurrently put in place. The larger role for technicians not only enabled the pharmacy department to increase its distributive workload dramatically but reduced pharmacy medication errors and provided more time for clinical pharmacy practice. The number of pharmacist and technician full-time equivalents increased by only 1.5 in each category between 1985 and 1990. By making more use of pharmacy technicians, a pharmacy department was able to meet escalating demands for services with only a minor increase in personnel.

Allied Health Personnel

The structure and function of urban pharmacies: visits to community pharmacies in inner-city Chicago.

Visits were made to 21 pharmacies in two poor neighborhoods on the west side of Chicago and interviews conducted with pharmacists-in-charge. The objective of the study was to provide a comprehensive description of the function, capabilities, and problems of urban pharmacy. We present results on the structure and function of these inner-city pharmacies. The pharmacies fit one of three structural forms: chain, independent, or medical center. The majority of respondents viewed the function of the inner-city pharmacy as patient-centered but also identified several barriers to effective patient communication. The results suggest that inner-city physicians and pharmacists should communicate with patients more often and in ways that patients understand. Also, Medicaid and other drug insurance programs should develop patient information networks and coverage packages intended to maximize patient health status.

Chicago

Acceptance of a pharmacy-based, physician-edited hospital pharmacy and therapeutics committee newsletter.

OBJECTIVE: To assess the level of physician acceptance and perceived usefulness of a pharmacy-prepared, physician-edited pharmacy and therapeutics (P&T) committee newsletter. DESIGN: Two separate surveys conducted after 7 and 24 months of publication, respectively. SETTING: 500-bed, university-affiliated, tertiary-care hospital. MAIN OUTCOME MEASURES: The initial survey was mailed to physicians after 7 months of publication and they were requested to rate various aspects of the newsletter, including timeliness of articles, usefulness of articles, quality of writing and design, and overall value of the publication on a scale of 1-4: (1 = excellent, 2 = good, 3 = fair, 4 = poor). Physicians were also asked to rank different categories of articles (articles on new drugs, drug-class reviews, topical reviews, formulary news, and articles providing P&T committee information) and were encouraged to provide comments. A separate follow-up survey conducted at 24 months asked physicians to indicate whether they (1) regularly received the newsletter, (2) regularly read the newsletter, (3) found the information in the newsletter to be useful, and (4) desired to continue receiving the newsletter. RESULTS: Initial survey results yielded mean newsletter quality scores ranging from 1.54 to 1.66. Respondents preferred, in descending order, articles on new drugs, drug-class reviews, topical reviews, formulary news, and P&T committee information. The 24-month survey revealed that 96 percent of the physicians regularly receiving and reading the newsletter found the information useful and 97 percent felt that the newsletter should continue to be published. Favorable comments were also received from several prominent physicians. CONCLUSIONS: The results indicate strong physician acceptance of a pharmacy-prepared, physician-edited newsletter and provide information about the types of articles preferred by physicians in a university hospital setting.

Attitude of Health Personnel

Pharmacy services in a Federal extended care facility, as provided by a pharmacy student.

The objective of this study was to identify the role of the pharmacy student in providing health care to a Federal Nursing Home Care Unit. Under the supervision of a graduate pharmacy resident, the student was responsible for monitoring compliance in drug therapy, providing consultation services, and developing several research projects. A detailed study of allergy documentation in 78 patients showed that 25.6 percent of their records indicated drug allergies, but upon further investigation only 5.1 percent could be confirmed. Fourteen (41 percent) of the 34 reported allergy-producing substances had been administered again after the initial allergic incident, without ensuing difficulties. Evaluation of the self-medication program indicated that 71.4 percent of 14 study patients could not easily open their child-proof medicine container. A change to "tight" containers enhanced the patients' ability to open them. However, no significant conclusions could be drawn regarding improvement in the patients' compliance with prescription directions. Pharmacy students can be a valuable resource in improving documentation, testing drug prescription compliance, and participating in the general care of patients in long-term facilities.

Aged

The pharmacy college as a pharmacy service "corporation".

A program of providing contract pharmaceutical services to health care facilities by a college of pharmacy is described. Services are provided to ten facilities: five hospitals, three mental health centers, a free-standing cancer clinic and a primary care center. The initial development of the concept, the lines of authority between the college and the facilities, the nature of the contractual agreements, and the benefits of the program are discussed. Among the benefits are the development of advanced drug distribution systems and clinical services, secure positions for clinical faculty members, the availability of the college's resources to the health care facilities, training and employment opportunities for students, and the good will created by improved health services.

Education, Pharmacy

Duplicate prescription system to facilitate communication between a hospital pharmacy and community pharmacies.

A duplicate prescription system which enables a university hospital pharmacist to fill a copy of the prescription and return the original prescription to the patient for obtaining continuing supplies in his local community is described. The system is based on a prescription form and carbon duplicate with designated space for notations, and clarifications by the pharmacist. Instructions for use of the form and a statement that the prescription copy cannot be filled legally at any other pharmacy assures that the system will not be misused. The system helps assure that an initial quantity of medication is obtained by the patient before he leaves the hospital. Time spent by patients and prescribers in establishing initial and continuing supplies of medication is decreased under the system. The system is of substantial benefit to patients and health care providers.

Drug Prescriptions