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Hospitals are not known for automating labor-intensive tasks but robots are just beginning to make inroads in health-care. The first--and still only--robot grew from a class assignment to use an established technology in a new growth industry. The established technology was bar coding; the industry health-care; and the result a robotic device for the hospital pharmacy.
An interview survey of 129 UK National Health Service doctors, nurses, pharmacists and managers at eight acute care hospitals was conducted in 1994. The survey examined several topics including whether the introduction of the internal market had affected hospital pharmacy services and what those effects had been. An internal market has been introduced and it has had significant effects on the nature and structure of hospital pharmacy services. Directorate pharmacy services were available at six sites. Contracts for specific, usually novel, services had been implemented at one site and contracts had been introduced widely at another hospital. However, all the features of a market were not present at any site. Market orientation also has implications for the equity of service provision, primarily because decision-making regarding service provision is increasingly in the hands of the clinical directors, rather than pharmacy managers. The effects of this change are not yet clear.
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Centralized intravenous additive services (CIVA) are becoming an essential component of hospital pharmacy services in the U.K. This review explores the background to their development, indicating how aseptic services commenced with total parenteral nutrition, developed further with cytotoxic drug preparation and is now progressing, in an increasing number of hospitals, to a full range of parenteral drug services. The benefits of pharmacy-operated provision of injections in ready-to-administer forms are described. The operation of such services is then considered in detail. A brief discussion of the types of service that can be operated is followed by consideration of staffing, facilities, methods of operation, technical support and documentation. National guidelines in the U.K. and U.S.A. are compared, since these have a major influence of the nature of CIVA service operation. The issues associated with the stability of reconstituted and repackaged injectables are discussed, together with how our knowledge can be used in the assignment of shelf lives to pharmacy-prepared intravenous additives. The review concludes with a brief assessment of future trends and changes likely to affect intravenous services provided under pharmacy control.
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