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Biomedical subjects

R T Smolarek

Publications and source records attributed to R T Smolarek.

12 recordsLinked to original sources
PubMed1997

Peer review and continuous quality improvement of pharmacists' clinical interventions.

A peer-review-based continuous quality improvement (CQI) program for improving pharmacists' clinical interventions at a hospital is described. With the implementation of pharmaceutical care at Detroit Receiving Hospital came the need for a CQI system to validate and improve this type of patient care. A peer-review group (PRG) was formed. The PRG decided to review 60 pharmacist interventions per month for clinical appropriateness, accuracy of entry into the computer, documentation in the medical record by the pharmacist, and implementation if accepted by the physician. Interventions are assigned to individual reviewers, and final decisions on the appropriateness and correctness of the selected interventions are made at periodic PRG meetings. In its first year the PRG met nine times and evaluated 409 interventions; 96% of the interventions were judged clinically appropriate, 62% were accurately entered into the computer, 62% were documented in the medical record by the pharmacist, and 92% were implemented if accepted by the physician. Meetings, additional reviews, and inservice sessions were used to address deficiencies in the interventions; these efforts led to improvements. The clinical appropriateness of documented interventions was included as a medication use indicator in the hospital CQI program. A peer-review-based CQI process allowed a hospital to effectively monitor and improve the quality and documentation of interventions recommended by pharmacists.

Hospital Bed Capacity, 300 to 499↗
PubMed1996

Outsourcing the preparation of parenteral nutrient solutions.

A hospital pharmacy's experience with using an outsourcing center to prepare parenteral nutrient solutions (PNs) is described. In 1994 the pharmacy at a 340-bed level 1 trauma center selected an outsourcing center located 20 miles away to provide PN-compounding services; the center is licensed as a manufacturer and has an extensive quality control program. The necessary telephone and computer links were established. When a PN order is received, the pharmacist simply dials into the outsourcing computer system and enters the order. At 1400, a pharmacist dials into the system to verify all PN orders entered for that day. After 1500, personnel at the outsourcing center print labels and compound the solutions, which are delivered by courier within a few hours. The net savings during the first year of outsourcing PNs were estimated at about $59,000. The savings were attributable to the elimination of a technician full-time equivalent (FTE), a reduction in pharmacist labor, and favorable contract provisions; money was saved even though the service's PN-preparation fees outweighed the savings from reductions in labor. The hospital's onsite inventory of PN supplies decreased by $5800, and storage space was freed for other uses. Very few problems were associated with the service provided. Outsourcing the preparation of parenteral nutrient solutions reduced personnel, inventory, and expenditures in a hospital pharmacy.

Contract Services↗
PubMed1996

Implementing comprehensive pharmaceutical services at an academic tertiary care hospital.

The implementation and impact of comprehensive pharmaceutical services at a hospital are described. Before 1992, pharmaceutical services at Detroit Receiving Hospital and University Health Center were comparable to those of many departments serving similar academic tertiary care institutions. A major conflict with the principles of pharmaceutical care existed in that specific tasks were assigned to pharmacists, so that up to four pharmacists may have been involved in one patient's drug therapy while other patients were ignored. Several steps were taken to solve this problem. The department's mission and vision statements were modified to embrace pharmaceutical care. The support of administration and department leaders was secured, pharmacist evaluations were adjusted to make pharmaceutical care skills baseline competencies, and staffing was reconfigured. A voluntary pharmaceutical care committee was formed to transform pharmaceutical services at the hospital. It was decided that all staff pharmacists would provide clinical and distributive services on a rotating basis. The drug distribution system was altered to free more pharmacist time for patient care, and two technician positions were added. The clinical program was made more patient focused. The program was implemented in a stepwise manner beginning in September 1992. Computerized systems for tracking workload and documenting clinical interventions and drug cost savings were established. Later changes included making pharmacists responsible for all patients on a medical service rather than for specific problems in a particular location and changing scheduling to enhance the continuity of care. The number of clinical interventions by pharmacists increased from 3,563 in 1993 to 15,476 (projected) in 1995, and drug cost savings and avoidance increased from $239,248 in 1992 to $562,402 (projected) in 1995. Major change was necessary to implement comprehensive pharmaceutical services at an academic tertiary care hospital.

Cost Savings↗
PubMed1992

Quality improvement in the use of medications through a drug use evaluation service.

Continuous quality improvement methods have the potential to improve processes that cross several disciplines. The medication system is one in which coordination of activities between physicians, pharmacists, and nurses is essential for optimal therapy to occur. DUE services can play an important role in helping to ensure that patients receive high-quality pharmaceutical care. It is necessary for pharmacy managers to review the structure, goals, and outcomes of their DUE programs to ensure that they are consistent with a philosophy of continuous improvement in the quality of drug therapy.

Adverse Drug Reaction Reporting Systems↗
PubMed1991

Facsimile machines for medication order transmission.

The use of facsimile machines for medication order transmission has improved turnaround time and provided benefits for the Department of Pharmacy Services and the hospital. As a result of this program pharmacists have more time and more opportunities to improve drug therapy because they no longer have to travel to patient care units or handle patient charts for the purpose of order entry. Pharmacists will have even more time when technicians have been fully trained to carry out medication order entry. Important also is the ability for nurses to FAX rather than hand carry urgently needed orders to the pharmacy satellites. The use of FAX machines in this manner lowers the cost of patient care and makes this technology available for other purposes as well. It is becoming increasingly clear that pharmacists, as well as others, can utilize modern technology such as this to maintain and improve services in the presence of a cost-containment environment.

Competitive Bidding↗
PubMed1989

An analysis of 1986 drug procurement practices in hospitals within the United States.

The purpose of this study was to statistically answer a set of predefined objectives concerning pharmaceutical procurement. The key indicators were assumed to be cost per patient day and turnover rate. Of the 5,911 surveys mailed, 709 surveys were returned for a 12% response rate. The following statements were based on attempts to answer the six predetermined objectives. Pharmaceutical purchasing is controlled by pharmacy departments to the extent that comparisons to pharmaceutical purchasing by materials management departments was not possible. Prime vendor purchasing is the procurement method of choice. Competitive bidding through a group process is so popular that a valid comparison to nongroup bidding could not be accomplished with the results of this survey. Certain variables of group purchasing such as group age, contract adherence, and volume commitment, do not appear to be correlated to purchasing outcomes in this study. When comparing government to private hospitals, the private sector seems to have an advantage in managing turnover rates. Cost per patient day results were less conclusive. As single and multiple hospital systems were compared for purchasing outcomes, the results were not totally conclusive. Although, multiple hospital systems had a significantly higher turnover rate. Finally, a comparison based on the use, or lack of use, of prime vendor arrangements demonstrated interesting results. The duration of contract did not significantly affect the purchasing outcomes. Other hospital variables such as size, type, ownership, and organization, demonstrated notable trends. The importance of examining hospitals based on case mix and mission seems to be most important. Also, the ability to relate purchasing outcomes with formulary management strategies needs further study before conclusive statements can be adopted.

Contract Services↗
PubMed1984

Types of selected security devices for hospital pharmacies.

Every pharmacist, whether in the hospital or in a community environment, faces the daily possibility of a holdup, burglary, or forged prescription. Statistics on drug-related crime are on the upswing as an increasing number of perpetrators recognize that wholesalers and hospitals are large depots of injectable narcotics and controlled substances. In response to this, many Federal drug crime laws and increased security have been proposed. This report identifies many types of security devices available to provide early warning or deter robberies. They include perimeter security systems, motion detectors, surveillance cameras, bullet-resistant windows, and key-lock systems. This report also suggests several considerations to be used in developing a security system in a hospital pharmacy. A basic understanding of security devices will enhance the manager's ability to choose the appropriate devices(s) for a particular service.

Equipment Design↗
PubMed1983

Evaluation of a cardiopulmonary-resuscitation training manual for pharmacists.

The development and evaluation of a training manual for pharmacists participating in cardiopulmonary resuscitation (CPR) efforts at an institution encompassing ambulatory-care, acute-care, and emergency-trauma facilities are described. The manual was developed to familiarize pharmacists who had little or no experience in CPR procedures with the equipment and medications used and the pharmacist's role on the CPR team. To evaluate the effectiveness of the manual, a 29-question multiple-choice test was administered to 35 staff pharmacists who were randomly assigned to study and control groups. Training manuals were issued to members of the study group, who were asked to document time spent studying them. Three weeks after the pretest, the same test was administered to all subjects. There was no control on the number of CPR events attended during the three-week period. The study group spent less than two hours (mean +/- S.D. = 97.5 +/- 34.22 min) using the manual. For the study group, posttest scores were significantly higher than pretest scores. The difference in pretest scores for the study and control groups was not significant, but for the posttest the study group scores were significantly higher. Because use of the manual appeared to improve knowledge of drug therapy and procedures used in CPR, the pharmacy department incorporated it into its orientation procedure.

Education, Pharmacy, Continuing↗
PubMedDate not supplied

A computerized system to improve documentation and reporting of pharmacists' clinical interventions, cost savings, and workload activities.

A major factor in delivering patient care is documenting activities by pharmacists. This documentation is not only essential to sustain existing programs but necessary to justify future growth of resources. A computerized documentation system for clinical interventions and workload activities was developed in a 340-bed university teaching hospital. With the expansion of its pharmaceutical care model, the department reworked its distribution process to allocate more pharmacist time for patient care. Manual documentation of these services, however, soon was identified as an obstacle. A software program was developed to alleviate the problems inherent with manual documentation. This "user-friendly" program tracks clinical recommendations and interventions by pharmacists, and calculates cost savings/avoidance. It also facilitates monthly and annual reporting for department managers.

Clinical Pharmacy Information Systems↗