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Biomedical subjects

J N Bair

Publications and source records attributed to J N Bair.

At least 19 recordsLinked to original sources
PubMed1995

Work activities of pharmacy teams with drug distribution and clinical responsibilities.

The time spent by satellite pharmacists and technicians on various activities was measured by using work sampling to evaluate the pharmacists' use of time for patient care. Between December 1992 and April 1993, pharmacists and technicians on satellite pharmacy teams at a tertiary care teaching hospital reported their work activities on forms. A total of 11,485 observations of pharmacist work activities and 7,626 observations of technician work activities were made. Pharmacists on teams with fewer support staff members spent less time on patient care-related work activities, and vice versa. As measured by an institution-specific index, the efficiency with which pharmacists used the available work time for patient care ranged from 60% to 83% for the various teams (100% would mean that pharmacists spent all their work time on patient care tasks). Changes were made in technician staffing that enabled the pharmacists to devote more time to patient care. Measuring the time pharmacists and technicians spent on various work activities provided a means of identifying and correcting organizational inefficiencies in order to give the pharmacists more time for patient care.

Efficiency, Organizational↗
PubMed1991

Pharmacist salaries and hiring practices in teaching hospitals.

A survey of selected teaching hospitals was conducted in early 1990 to determine salary ranges for pharmacist positions, salaries at which pharmacists were typically hired for these positions, differences in salary between clinical practitioner and managerial positions, and geographic differences in these salaries. Surveys were mailed to 50 members of the University Hospital Consortium (UHC) and 50 other university-affiliated and non-university-affiliated hospitals believed to be comparable to the investigators' hospital. Hospital capacity and census data, numbers of pharmacist and support staff positions, qualifications preferred and required for those positions, and salary information were requested. Data from 22 UHC hospitals and 23 non-UHC hospitals were evaluated. Relative to average daily census, UHC hospitals indicated higher pharmacist staffing levels and non-UHC hospitals reported higher support staff levels. More non-UHC hospitals than UHC hospitals (69.2% versus 43.5%) used an integrated model for delivery of clinical and distributive services. Nationally, the reported annual salaries were as follows: staff pharmacist, $34,881 to $47,906; clinical pharmacist, $37,768 to $51,564; clinical specialist, $38,905 to $55,282; supervisor, $39,905 to $54,416; assistant director, $43,554 to $58,758. Overall, typical hire rates (THRs) exceeded mean minimum salaries by about 10%. The percentages by which THRs exceeded mean minimum salaries were greatest in the West for staff pharmacist, clinical pharmacist, and clinical specialist positions and greatest in the Midwest for supervisor and assistant director positions. THRs for supervisors and assistant directors exceeded those for clinical specialists. Respondents' preferences varied regarding advanced education and training, and their actual requirements did not match their stated preferences.(ABSTRACT TRUNCATED AT 250 WORDS)

Data Collection↗
PubMed1990

Strategic planning for patient-specific clinical pharmacy services.

Planning for the development, implementation, or redirection of new or existing clinical pharmacy services necessitates that several key issues be addressed. Managers must submit to critical subjective and objective evaluation of their departmental practices as a first step to the development of a strategic plan to meet goals for pharmacy practice. Strategic plans must address the mission of the department and clearly define the management systems and practice model that will achieve that mission. The strategic plan must be structured for the purpose of obtaining organizational commitment to the strategic goals and to the programs and resources that will allow those goals to be realized.

Organizational Objectives↗
PubMed1990

Modified processing of prescriptions for discharged patients.

A process for designing and implementing a new procedure for handling discharge prescriptions is described. Hospital administration requested that the pharmacy department develop a new procedure to handle discharge medications. The old procedure, in which discharge prescriptions were filled by decentralized pharmacy personnel and delivered to patients' rooms, resulted in lost revenues from third-party payers and in delays for patients leaving the hospital. Under the new procedure, prescriptions are given to patients at the time of discharge; these prescriptions then may be filled either at the central ambulatory-care pharmacy or at a community pharmacy. This new procedure was designed and implemented according to a planned approach: (1) reviewing the problem, (2) evaluating the arguments for and against change, (3) using strategies to minimize resistance, and (4) evaluating the results. Resistance of pharmacy personnel, physicians, nurses and patients to the new procedure was managed by allowing pharmacy personnel to participate in the design of the new procedure; educating all affected hospital staff members about the procedure; structuring the procedure to address the problems of delayed discharge and patient ability to pay for medications; and negotiating with ambulatory-care pharmacists and technicians about the increased workload. The new procedure was implemented on July 1, 1987. The new procedure was evaluated to determine how well it worked and whether continuity of care had been compromised. As a result of this evaluation, the level of staffing and hours of operation of the ambulatory-care pharmacy were increased. A planned approach to implementing a change in the procedure for handling discharge medications was successful in identifying and overcoming resistance to that change.

Aftercare↗
PubMed1990

Using pharmacists' perceptions in planning changes in pharmacy practice.

Pharmacists' perceptions of and goals for clinical pharmacy services, as well as the proportion of time devoted to clinical services, were studied at one hospital as part of the process for establishing departmental goals. Three methods were used in evaluating pharmacists' perceptions of clinical pharmacy services. The first was a departmental survey. Second, staff members were asked to generate and prioritize a list of goals for clinical pharmacy services; this was done by means of an interactive, small-group process. Finally, a work-sampling study was performed that indirectly measured use of staff pharmacist and technician time. Staff pharmacists perceived that clinical pharmacy services were being provided to individual patients; however, support for these services from upper management was perceived as inadequate. Staff development had the highest priority for the further development of clinical pharmacy services. Only 19.7% of pharmacists' time was devoted to clinical services. Data from all three studies were incorporated into the development of a strategic plan that set forth long-term departmental goals and objectives. The plan includes a statement of commitment to develop management systems to eliminate deficiencies identified in the study. Among the changes in pharmacy operations introduced as a result of the survey were (1) a career-ladder system, (2) new opportunities for staff development, and (3) improved documentation systems. Surveying staff perceptions of existing services, joint goal setting and prioritization, and work-sampling studies formed the basis for the development and implementation of a new model of integrated pharmacy services at this institution.

Attitude of Health Personnel↗
PubMed1990

Self-reported work-sampling methods for evaluating pharmaceutical services.

The steps involved in designing a self-reported work-sampling study of pharmacy department operations are described. Traditional methods of work measurement include subjective evaluation, time-and-motion studies, and analysis of departmental statistics and are appropriate when the research question concerns repetitive work and when data about single activities at single points in time are sought. When institution-wide changes are being considered, a more global measurement approach is needed. Work sampling allows a manager to measure indirectly the amount of time spent by employees on work activities during a specified period. Many instantaneous observations are taken randomly or systematically to estimate the proportion of time spent on any activity. Data may be collected by trained observers or may be self-reported; self-reporting facilitates a large number of short-interval observations and allows for the reporting of cognitive activities. In designing a self-reported work-sampling study, the manager must (1) identify the study objective, (2) define the service area and staff to be studied, (3) inform all staff members to be involved, (4) define temporally relevant workload measures, (5) decide how many observations are needed, (6) decide for how long data will be collected, (7) choose between randomized and systematic sampling times, (8) define categories of work representative of staff activities, (9) design data collection forms and communicate procedures, and (10) conduct a pilot study. To interpret the results, an analysis of simple summary statistics may be more appropriate than a sophisticated statistical analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Data Interpretation, Statistical↗
PubMed1987

Compatibility and stability of clindamycin phosphate-aminoglycoside combinations within polypropylene syringes.

The stability and compatibility of clindamycin phosphate admixed separately with gentamicin sulfate, tobramycin sulfate, and amikacin sulfate in polypropylene syringes under specific storage conditions were studied. In duplicate syringes, clindamycin phosphate 900 mg was admixed with sterile NaCl 0.9% l ml and with either gentamicin sulfate 120 mg, tobramycin sulfate 120 mg, or amikacin sulfate 750 mg. In duplicate polypropylene syringes, control solutions of clindamycin phosphate and each aminoglycoside were prepared separately and stored under the same conditions. The clindamycin control consisted of clindamycin phosphate 900 mg in 6 ml. The gentamicin and tobramycin controls consisted of gentamicin sulfate and tobramycin sulfate 120 mg in 3 ml plus 1 ml of sterile NaCl 0.9%. The amikacin control consisted of amikacin sulfate 750 mg in 3 ml plus 1 ml of sterile NaCl 0.9%. Drug concentrations were determined at the time of preparation and 1, 4, 8, 12, 24, and 48 hours thereafter. Aminoglycosides were assayed by fluorescence polarization immunoassay and clindamycin was assayed by high performance liquid chromatography. Visual inspections and pH determinations of each combination and control solution were performed at each assay time. For the clindamycin, gentamicin, tobramycin, and amikacin control solutions, changes in concentration were within ten percent of the original concentration. Concentrations of clindamycin and gentamicin when admixed together also remained within ten percent of the original concentration. Similar results were found with concentrations of clindamycin and amikacin when admixed together. Tobramycin and clindamycin formed a lasting precipitate upon initial contact when admixed under the study conditions.

Amikacin↗
PubMed1985

Cost comparison of two systems for intermittent intravenous administration of small-volume injections.

Pharmacy department costs for preparing and administering intermittent i.v. drug doses using a piggyback bottle system and a syringe pump system were predicted and compared. Centralized i.v. admixture service personnel time for preparation of small-volume injections in piggyback bottles was recorded for 14 days. After a four-week orientation of personnel to the syringe pump system, personnel time for preparation of doses in this system was recorded for 14 days. Material costs were itemized for each system and annual costs were predicted. Costs were calculated on the basis of the previous year's purchasing data, assuming that 80% of intermittent i.v. drug doses could be given by the syringe pump system. Syringe pump system costs were calculated for administration of one to eight drug doses through each secondary infusion set; 5-mL and 10-mL syringes were used. Preparation time was slightly longer for the syringe pump system than for the piggyback bottle system; the annualized personnel cost difference was $0.012 per dose. Based on one dose per secondary infusion set, material costs were higher for the syringe pump system. Based on administration of four doses through each secondary infusion set, overall costs were lower for the syringe pump system. Lower material acquisition costs for the syringe pump system could result in pharmacy department cost savings if at least four intermittent i.v. drug doses were administered through each secondary administration set.

Costs and Cost Analysis↗
PubMed1985

Compatibility of clindamycin phosphate with cefotaxime sodium or netilmicin sulfate in small-volume admixtures.

The stability and compatibility of clindamycin phosphate plus either cefotaxime sodium or netilmicin sulfate in small-volume intravenous admixtures were studied. Admixtures containing each drug alone and two-drug admixtures of clindamycin phosphate plus cefotaxime sodium or netilmicin sulfate were prepared in 100 mL of 5% dextrose injection and 0.9% sodium chloride injection in both glass bottles and polyvinyl chloride (PVC) bags. Final concentrations of clindamycin, cefotaxime, and netilmicin were 9, 20, and 3 mg/mL, respectively. All solutions were prepared in duplicate and stored at room temperature (24 +/- 2 degrees C). Samples were visually inspected, tested for pH, and assayed for antibiotic concentration using stability-indicating assays at 0, 1, 4, 8, 16, and 24 hours for admixtures in glass bottles and at 0, 8, and 24 hours for admixtures in PVC bags. No substantial changes in color, clarity, pH, or drug concentration were observed in any of the solutions. Clindamycin phosphate is compatible with cefotaxime sodium or netilmicin sulfate in 5% dextrose and 0.9% sodium chloride injections in glass bottles or PVC bags for 24 hours.

Cefotaxime↗
PubMed1984

Developing a hospital pharmacy purchasing system.

Suggestions for developing or modifying a pharmacy purchasing system are presented and discussed. To achieve an optimal purchasing system, pharmacy managers must understand the development and operation of their current systems and enlist the participation of other hospital departments in planning the new or modified system. A pharmacy purchasing system should ensure that drug products and supplies of the highest quality are obtained at the lowest price, that these items are available when needed, and that the financial investment in drug and supply inventory is appropriate. The job requirements, activities, and responsibilities of pharmacy purchasing personnel are described, and the recording and retrieving of purchasing data are discussed. Various order-placement alternatives are compared, and order-shipment alternatives are described. Equipment and supply requirements for the purchasing function are also presented. An efficient, productive purchasing system can produce cost savings for the pharmacy department and the institution.

Inventories, Hospital↗
PubMed1983

Pharmacy-based controlled substances distribution for a university campus.

A university-wide pharmacy-based controlled substances distribution system is described. The purchasing and control of controlled substances for the entire university campus is centralized in the hospital pharmacy department. The distribution system uses the concept of restricted versus nonrestricted drugs, where restricted drugs are all Schedule II controlled substances and other drugs needing restrictive control. The restricted or nonrestricted status of a drug is based upon suspected or observed abuse potential. After receipt by the pharmacy, all controlled substances and restricted drugs are stored in a vault. A 24-hour audit-disposition record system is used to control the inpatient distribution of restricted drugs, which are stored in locked cabinets on each nursing unit. In the outpatient pharmacy, a small supply of restricted drugs is stored in a locked cabinet; the inventory is reconciled weekly. Nonrestricted controlled substances, such as phenobarbital and chloral hydrate, are distributed to the inpatient satellite pharmacies and the outpatient pharmacy in the same manner as other prescription drugs. Campus practitioners and researchers order all controlled substances from the pharmacy using the appropriate order forms; each individual is responsible for maintaining a record and control system. A quality assurance program was established to review and improve the quality of service. The centralized pharmacy-based system improved the control, monitoring, and efficiency of controlled substances distribution for the entire university campus.

Academic Medical Centers↗
PubMed1983

Implementing an operating room pharmacy satellite.

Implementation of an operating room (OR) pharmacy satellite is described, and its impact on cost-effectiveness and efficiency of drug distribution is analyzed. The OR satellite provided pharmacy coverage for 30-35 patients per day in 10 centralized surgical suites, 2 obstetric suites, and 1 burn-unit suite in a 401-bed teaching hospital. Objectives of the satellite were to consolidate accountability for drug distribution and control, reduce controlled substance loss and waste, reduce inventory costs, and improve recording of patient charges. Stock on the OR supply cart was reduced, controlled substances were dispensed to anesthesiologists from the satellite, and a system of standardized anesthesiology exchange trays was developed. A new billing form served as both the charging document and replacement list. Reduction in the medication cart stock resulted in smaller discrepancies in patient charges. For the five most commonly used controlled substances, accounting discrepancies were reduced. Inventory turnover increased and inventory dollar value and cost per patient were reduced. The percent of nurses who believed that a pharmacist should work in the area increased from 31% before implementation of the satellite to 95% after. The pilot OR pharmacy satellite was a financial success. Efficiency and effectiveness in drug distribution and control were improved, and communication between pharmacists and other medical personnel working in the OR areas was enhanced.

Anesthesia↗
PubMed1982

Alternative to the traditional discount method of wholesaler purchasing.

A program of purchasing drugs from wholesalers at the wholesaler's exact invoice cost plus a percentage is described and compared with the traditional method of average wholesale price (AWP) less a discount. The comparison was conducted by the pharmacy department of a 310-bed, teaching hospital that awarded a one-year contract to a wholesaler offering its items at the exact cost plus a pre-established percentage. Data collected from monthly wholesaler computer printouts gave the following information on each product: (1) list price per item, (2) actual cost to pharmacy per item, (3) percentage discount from AWP, and (4) quantity ordered. The net percentage discount from AWP for 12 months was calculated and compared to the former (traditional) discount rate. The net discount from AWP was 15.6% for purchases made by the hospital during the first 12 months of the program. When compared with the smaller discount the hospital traditionally received, the new program saved the hospital $5758 on annual purchases of $136,419. The actual dollar savings to an institution that changes from a traditional discount program to a cost-plus-percentage program depends on: (1) the negotiated percentage added to wholesaler cost, (2) the discount from AWP that the institution was previously receiving, and (3) the volume of wholesale purchases.

Pharmacy Service, Hospital↗
PubMed1981

Structured competency-based hospital pharmacy internship program.

A structural competency-based internship program involving terminal behavioral objectives (TBOs) is described. The program is set up for three levels of interns; junior, senior grade B, and senior grade A. Each level has specific learning requirements and a minimum number of experience hours and TBOs to fulfill. Upon completion of the minimum hours for each level, the intern is evaluated by a committee of pharmacists and examined on his attainment of the TBOs. The order followed in the program allows the interns to progressively build a foundation for professional practice by exposing them to all areas of the pharmacy. All level advancements are accompanied by a salary increase. The program provides departmental staff coverage to the hospital all year. The student interns work approximately 40 hr/wk during the summer and 18 hr/wk during the academic year. The TBO-based program allows the students to gain 3300 hours of experience before they are licensed. This program is an essential complement to a student's scholastic work in his professional training as a hospital pharmacist.

Competency-Based Education↗
PubMed1980

Analysis of dispensing activities before and after decentralization of pharmaceutical services.

Changes in drug handling activities, revenue, and telephone communications were documented during a conversion from a centralized unit dose system to decentralized pharmacists and unit dose services in a 310-bed university teaching hospital. All decentralized services were mobile; no physical satellites were utilized. Computer programs were used to collect and analyze drug handling and revenue data during a prestudy control period and three equal-length study periods after decentralization of pharmaceutical services for five patient care areas of the hospital. All telephone calls to the central pharmacy were recorded and classified by type during 21 days of the prestudy period and were compared with 21 days of the second postimplementation period. The mean number of doses handled decreased for all patient care areas. After decentralization the number of telephone calls to the central pharmacy requesting clinical drug information, as well as distributive information, decreased sharply. Moving the pharmacist to the patient care unit decreased the time that pharmacists spent handling drugs and improved communication with the medical and nursing staffs.

Centralized Hospital Services↗
PubMed1979

Effect of filtration on complications of postoperative intravenous therapy.

The incidence of intravenous complications (phlebitis) and the length of hospital stay in postoperative patients whose infusions were filtered through inline final filters were compared with those in patients whose infusions were not filtered. Identical i.v. solutions were administered to 150 postoperative orthopedic patients randomly assigned to three study groups: control (no filter), 5-micrometers membrane filter and 0.45-micrometers membrane filter. An i.v. therapy team of seven nurses inspected patients for phlebitis. The phlebitis rate of the control group (27%) was significantly greater (p less than 0.05) than that of the 0.45-micrometers filter group (6%) but not significantly different (p less than 0.9) from that of the 5-micrometers filter group (22%). In a subgroup of 104 patients undergoing total hip replacement, the mean reduction in length of postoperative hospital stay compared with the control group (13.6 days) was: 5-micrometers filter group--3.4 days (p less than 0.01); and 0.45-micrometer filter group--3.3 days (p less than 0.01). The results suggest that final filters can be used to reduce the incidence of phlebitis-related i.v. complications and thereby reduce the length of hospital stay.

Cephalothin↗