[Tasks and functions of the hospital pharmacy service].
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Health services and community and hospital pharmacy practice in Denmark are discussed. Topics covered include the education and training of pharmacists and technicians, pharmaceutical manufacturing by community and hospital pharmacies, hospital drug distribution, and drug information services. Pharmacy is unique in Denmark inthe 40% of the drug products on the market are manufactured by pharmacies, under the auspicies of the pharmacy proprietors' association. As in other Scandinavian countries, the number and location of community pharmacies are controlled by the state. Ninety pharmacists are employed in 13 hospital pharmacies; half of the pharmacists are occupied bb drug product manufacturing.
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The development of a programmed training manual to teach basic skills to hospital pharmacy technicians is described. Steps in the development of the manual included reviewing pertinent literature, writing a job description for a pharmacy technician position, performing a task analysis, writing learning objectives and sequencing course content into a programmed format. Five units of the manual cover dosage forms and routes of administration, drug nomenclature, abbreviations, calculations and medication orders. The programmed format should help to provide quality, economic and efficient training for technicians.
Medication delivery time requirements in centralized and decentralized unit dose drug distribution systems were compared. Four stages in the receipt of medication orders and the delivery of doses were identified, and the time required to perform each stage was recorded by pharmacist observers for seven days in each system. In the centralized system, it required 138--220 minutes to deliver doses after orders were ready to be collected at the nursing station, with the time varying according to order type. The same cycle required 1--40 minutes in the decentralized system. Delays in medication delivery were shorter in the decentralized system.
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A survey of nongovernment, nonprofit and for-profit hospitals in Washington, Oregon and California was conducted to determine the incidence of selected hospital pharmacy services (1) directly related to drug distribution and (2) not directly related to drug distribution. Questionnaires were mailed to all qualifying hospitals in the three states; the return rate was 75.4%. Unit dose drug distribution was used in combination with other delivery systems by 58.3% of the respondents; 26.5% used unit dose exclusively. Over half of the respondents provided i.v. admixture programs, outpatient and inpatient discharge prescriptions, and inpatient medication profiles. Additionally, 77.9% provided pharmacy consultation to physicians. Nonprofit hospitals had significantly higher pharmacy staffing levels (both pharmacists and supportive personnel) than for-profit hospitals in the categories, "open seven days per week," "open nine to 16 hours per day," "open 17 to 24 hours per day, "101 to 200 beds" and "201 or more beds." Hospitals that provided the following services had significantly higher pharmacy staffing levels than those that did not provide the serices: unit dose drug distribution, i.v. admixture services, inpatient discharge prescriptions, inpatient medication profiles, drug therapy monitoring, and cardiopulmonary resuscitation team participation (difference of supportive staff only).
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A pharmacy internship that offers graduated levels of hospital experience, with an emphasis on nursing assistant and medication administration programs, is described. Students work full time in the summer and part time during the academic year in the three-year program. The progression of duties is as follows: nursing assistant; inpatient drug distribution and control; sterile and nonsterile product production; patient education, monitoring and medication history-taking activities; drug information services; and medication administration. Interns are selected by the pharmacy department and trained and supervised by the nursing staff in nursing assistant and medication aide roles. The program provides the pharmacy department with a highly trained corps of interns who understand and appreciate the full range of systems required to deliver patient care and provides interns with patient-oriented work experiences valuable in their future roles as pharmacists.
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A nine-month on-the-job training program for hospital pharmacy technicians is described. The first three months of the program are devoted to didactic training and the remaining six months to acquiring practical experience. Candidates for the program are provided through state-sponsored public assistance or manpower training programs. A minimum of six individuals are needed to begin a program to ensure that during at least three complete it. Forth technicians have completed the program during the past six years, and eight are currently employed by the hospital. Thirteen others are known to be employed at other institutions or in health-related occupations.