Using telemedicine technology for pharmaceutical services to ambulatory care patients.
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Ambulatory Care Facilities↗
Biomedical subjects
J A Jorgenson
Publications and source records attributed to J A Jorgenson.
Creating a team approach to hospital and college of pharmacy relationships: a strategy to integrate missions to enhance education and patient care.
Academic medical centers continue to bear the burden of the additional costs of professional education. Such institutions and their affiliated colleges of pharmacy are challenged to sustain the degree of professional staffing required to deliver quality education and patient care services. Historically, these relationships have not always proven to be cooperative and mutually beneficial. As managers and deans attempt to maximize the productivity of their financial and human resources, they will need to creatively structure relationships that effectively meet those diverse professional missions that sometimes seem to exist in conflict or that each seem to be successful only at the expense of the other. Pharmacists who act as both faculty, delivering experiential education, and clinical staff providing patient care, are significantly stressed in their attempts to meet the sometimes conflicting objectives of these multiple missions. The survival of precepted experiential education in pharmacy and of pharmaceutical care in academic medical center hospitals will likely depend upon a model of cooperative relationship, such as the venture described by Jorgenson, et al.
Academic Medical Centers↗
Work activities before and after implementation of an automated dispensing system.
The impact of an automated dispensing system (ADS) on medication-related work activities by nurses and pharmacists was studied. A point-of-care ADS (Baxter Sure-Med) was installed on two nursing units (the surgical intensive care unit [SICU] and a medicine unit [4NMU]) of a 400-bed university hospital as part of a pilot project. A self-reported work-sampling study was used to collect observations of medication-related work activities by nurses, health unit coordinators (nursing support staff), and pharmacists for a seven-day period before ADS implementation and a seven-day period after implementation. There were 7797 observations of nurse work activities, 1408 observations of health unit coordinator work activities, and 4236 observations of pharmacist work activities. The percentage of nurse work activities that were medication related decreased from 20.7% before ADS implementation to 18.4% afterward on 4NMU and increased slightly from 10.8% to 11.0% on the SICU. Medication-related health unit coordinator work activities increased from 17.5% to 25.3% of total activities on 4NMU and decreased from 16.6% to 10.7% on the SICU. None of these changes was significant. For decentralized pharmacists supporting 4NMU, the percentage of work activities classified as clinical increased significantly from 36.5% to 49.1%. For decentralized pharmacists supporting the SICU, clinical activities increased from 27.9% to 35.1%. There were no significant changes on either unit in pharmacist activities classified as technical. An overall measure of the efficiency with which pharmacists used their time for patient care-related activities increased. A point-of-care ADS did not affect the proportion of time spent by nurses on medication-related activities and seemed to give pharmacists more time for clinical work.
Automation↗
Justification and evaluation of an aminoglycoside pharmacokinetic dosing service.
This article reviews the administrative and clinical processes and alternatives involved in justifying and implementing an aminoglycoside pharmacokinetic dosing service in a 500-bed community hospital. The methods used to document the initial problem areas and gain medical staff and administrative approval to propose alternative solutions are described. The financial and quality considerations used to justify a new clinical service to hospital administration are reviewed and the procedures employed to implement the new service are presented. Finally, the methods used to document performance of the new service are discussed.
Aminoglycosides↗
Dealing with substance abuse in the workplace.
Substance abuse within the workplace affects both the employer and the employee. A decrease in morale and an increase in accidents and sick calls can contribute to significant financial losses for an institution. This article discusses ethical and legal considerations in developing substance abuse policies and employee assistance programs. A proactive approach intended to prevent substance abuse and exert greater control over the problem with resulting decreases in the waste of valuable human resources is presented.
Drug and Narcotic Control↗
Maximizing profitability in a hospital outpatient pharmacy.
This paper describes the strategies employed to increase the profitability of an existing ambulatory pharmacy operated by the hospital. Methods to generate new revenue including implementation of a home parenteral therapy program, a home enteral therapy program, a durable medical equipment service, and home care disposable sales are described. Programs to maximize existing revenue sources such as increasing the capture rate on discharge prescriptions, increasing "walk-in" prescription traffic and increasing HMO prescription volumes are discussed. A method utilized to reduce drug expenditures is also presented. By minimizing expenses and increasing the revenues for the ambulatory pharmacy operation, net profit increased from +26,000 to over +140,000 in one year.
Ambulatory Care↗
Accuracy and efficiency of three methods of preparing piggyback admixtures.
The efficiency and accuracy of three methods of preparing i.v. admixtures in small-volume plastic bags were compared. One hundred individual 1-g doses of cephalothin sodium in 50-ml minibags were prepared by each of three methods; the PharmAide Fluid Dispensing System (PAFDS), the Valleylab IV Formulator, and the Viavac vacuum unit, using 20-g, 20-g, and 1-g vials of cephalothin sodium, respectively. For each method, preparation time and cost were recorded. To determine accuracy, a random 10% sample of minibags prepared by each method was assayed for cephalothin concentration by microbiologic assay. The IV Formulator required the least time to prepare 100 doses, followed by the PAFDS and the vacuum unit. Cost data for the three methods were nearly identical, with a difference of only $0.07 per dose between the least and most expensive. The minibags prepared using the vacuum pump and unit-of-use vials were more accurate than those prepared with 20-g vials and the other two methods. However, the initial concentration of the cephalothin sodium vials before transferring to the minibags was not tested. Each method studied was found to have advantages and disadvantages. No one system could be judged best for all situations.
Cephalothin↗
Advances in hospital pharmacy computing.
These brief descriptions of hospital pharmacy computer applications only scratch the surface of the many different areas in which they have the potential of being used. As the pharmacy profession becomes more knowledgeable in the application of computers, these systems will be used to the fullest degree. The computer is a very important tool for the pharmacy. A whole new vision of hospital pharmacy can be seen in which pharmacy personnel must master existing systems and instigate a wide variety of new programs in order to create more efficient and wide-ranging services.
Clinical Pharmacy Information Systems↗