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PubMed1991

National survey of state psychiatric hospital pharmacies.

The results of a winter 1990 nationwide mail survey of pharmaceutical services provided in state psychiatric hospitals are reported and discussed. The survey universe consisted of all 207 state psychiatric hospitals registered by the American Hospital Association. Private and federal and other government-operated psychiatric hospitals were not included. Questionnaires were mailed to the director of pharmacy at each institution. Two questionnaires were not deliverable. There were 117 usable replies, for a net response rate of 57.1%. Compared with community hospitals, state psychiatric hospitals had pharmacy departments that were open fewer hours per week, occupied more floor space, were less likely to have a complete unit dose distribution system and i.v. admixture program, had lower inventory turnover rates, and had fewer full-time positions. About 28% of the respondents employed pharmacists who spent at least two thirds of their time providing clinical services. Differences in the provision of pharmaceutical services between state psychiatric hospitals and community hospitals may be due in part to the fact that most of the former are long-term-care institutions rendering a specific class of therapies.

Formularies, Hospital as Topic↗
PubMed2006

ASHP national survey of pharmacy practice in hospital settings: dispensing and administration--2005.

PURPOSE: Results of the 2005 ASHP national survey of pharmacy practice in hospital settings that pertain to dispensing and administration are presented. METHODS: A stratified random sample of pharmacy directors at 1173 general and children's medical-surgical hospitals in the United States was surveyed by mail. RESULTS: The response rate was 43.5%. Most hospitals had a centralized drug distribution system; however, there is evidence of growth in decentralized models compared with data from 2002. Automated dispensing cabinets were used by 72% of hospitals and robots by 15%. The percentage of doses dispensed in unit dose form increased, as did the use of two-pharmacist checks for high-risk drugs and high-risk patient groups. However, the percentage of medication preparation and dispensing quality-improvement programs declined over the past six years. Medication administration records (MARs) have become increasingly computerized over the past six years. Consequently, the use of handwritten MARs has declined substantially. Technology implemented at the administration step of the medication-use process is continuing to grow. Bar-code technology was implemented by 9.4% of hospitals, and 32.2% of hospitals had smart infusion pumps. Pharmacy hours of operation were stable, with 30% of hospitals providing around-the-clock services. About 12% of hospitals are using off-site medication order review and entry after hours. Pharmacy staffing has steadily increased over the past three years; however, hospital pharmacies reported a 5.6% vacancy rate. CONCLUSION: Safe systems continue to be in place in most hospitals, but the adoption of new technology is changing the philosophy of medication distribution. Pharmacists are continuing to improve medication use at the dispensing and administration steps of the medication-use process.

Drug Compounding↗
PubMed1988

No cost software for microcomputers: a shareware or public domain MS-DOS data manager for adverse drug reaction tracking.

IBM PC, XT, AT compatible computers have created a small revolution in the way we work, pharmacy procedures notwithstanding. In many instances the microcomputer software packages used are expensive and often difficult for inexperienced users to learn within reasonable periods of time. Public domain software, or shareware concept of software distribution, is an alternate means of obtaining good quality programs that are free to PC users, or cost very little upon final registration. This article describes a high efficiency, easy to use data management system that can serve a great variety of purposes within the pharmacy including tasks such as adverse drug reaction tracking, patient profiles, or inventory control. The flexibility and ease of operation makes this and other similar programs often wise choices as compared to expensive, fully relational commerical microcomputer data management systems.

Computers↗
PubMed1988

Source of missing doses in a decentralized unit dose system: a quality assurance review.

Unit dose drug distribution systems have become the prominent drug delivery system in healthcare institutions. Much of the success of the unit-dose concept can be attributed to the increased accountability of medications dispensed and administered. However, as a direct result of this added accountability the problem of "missing doses" has become more evident than under non-unit dose systems. A quality assurance audit was conducted to identify the reasons for missing doses and identify the responsibility for them. A missing dose record was developed through a collaborative effort of the pharmacy and nursing departments. Both staff nurses and pharmacists were invited to review and suggest modifications prior to using the form. All potential reasons for missing dose occurrences were listed on the form. When a missing dose occurred the pharmacist and the nurse completed form jointly to ensure agreement as to the cause. During the 25 day study period the pharmacy dispensed 54,082 doses of medications to patients on the study floors. During that period 227 incidents of missing doses were documented. This resulted in an overall incidence of missing doses of 0.4%. Of the 227 missing doses, a reason for the occurrence was identified for 170 (75%). Nine classes of medications accounted for 62% of all reported missing doses. When responsibility for the missing doses was examined 13.3% were pharmacy generated and 45.8% were nursing generated. The results of the audit generated several suggestions which may decrease the number of missing doses and further improve our drug distribution service.

Boston↗
PubMed1992

Computers in healthcare: overview and bibliography.

OBJECTIVE: The objective of this article is to provide an overview of computer technology and an associated bibliography, emphasizing institutional-based healthcare applications and pharmacoinformatics. DATA SOURCES: References were selected from the authors' files and from a computerized search over the last five years on computers in healthcare/medical informatics and in pharmacy. STUDY SELECTION: Articles selected for review and discussion were considered to be important contributions to the respective areas listed in the bibliography and representative of advancements in computer applications in healthcare and pharmacy. DATA SYNTHESIS: The computer has become an important support tool for healthcare professionals. Medical informatics and the discipline related to pharmacy, called pharmacoinformatics, have evolved from the cognitive underpinnings of medicine, pharmacy, and computer science. Recent developments in computer technology have resulted in computers that are fast, increasingly portable, and user friendly. Hospital information systems employ computers in various ways to deal with the vast amount of information used by various departments. Standards for electronic data exchange are being developed to increase the integration potential of these systems. Hospital pharmacists have used computers for drug distribution, financial analysis and inventory control, drug interaction detection, pharmacokinetic dosing, drug information, and drug therapy monitoring. Expert systems are being developed in several areas of drug therapy. Pharmacy educators have developed interactive courseware to help students learn problem-solving skills in the areas of calculations, therapeutics, and drug information. CONCLUSIONS: Pharmacists need to become more involved with applications of technology to pharmacy. Properly implemented, computers can provide more time for pharmacists to use their cognitive skills in the delivery of pharmaceutical care.

Clinical Pharmacy Information Systems↗
PubMedDate not supplied

The implementation of comprehensive critical care pharmacy services through the development of a 24-hour satellite pharmacy.

This report details the evolution of pharmacy services within the critical care areas of a large general hospital. The program began with the assignment of a clinical pharmacist to the intensive care unit and now includes a staff of six pharmacists operating from a 24-hour satellite pharmacy dedicated to critical care services. In the process a system has been developed which allows all staff to function in an integrated distributive-clinical role, eliminating the distinction between pharmacists performing these two separate functions. The system provides for total unit dose and IV admixture services as well as in-depth clinical monitoring, drug information and research responsibilities. Early impressions validate the success of this approach and objective evaluation, including the auditing of clinical input, is underway.

Critical Care↗
PubMed1986

Activity analysis of decentralized pharmacists in a unit dose dispensing and drug-administration program.

The relative amount of time spent by pharmacists on specific activities related to a pharmacy-coordinated drug administration and dispensing program in a 1000-bed tertiary-care teaching hospital was determined. Discrete activities of decentralized pharmacists involved in the program were defined using information from published reports and a short pilot study. Using a work-sampling technique, two pharmacy residents who had been trained to work as decentralized pharmacists performed instantaneous observations of the activities of pharmacists on five patient-care floors over a one-month period. Neither weekend nor night-shift activities were observed. Approximately 26% of a pharmacist's time was spent coordinating drug administration activities, and another 25% was spent providing clinical consultation or drug information services or performing research. The remainder of pharmacists' time was spent in activities related to drug distribution, interprofessional communication, or miscellaneous tasks. A work-sampling method proved useful in quantifying the amount of time associated with pharmacists' activities in a pharmacy-coordinated drug administration program.

Hospital Bed Capacity, 500 and over↗
PubMedDate not supplied

Mechanism for national distribution of delta 9-tetrahydrocannabinol (NSC-134454).

The National Cancer Institute (NCI) is initiating a national THC distribution program by applying to the FDA for its classification as a Group C investigational agent. Since THC is also a Schedule I drug, the distribution system requires strict adherence to Drug Enforcement Agency (DEA) security and safety regulations. Contrary to the usual distribution of Group C drugs, THC will not be available directly to physicians. THC will be made available to hospital pharmacies which are: (1) an NCI recognized Cancer Center (P-30 grant supported), (2) an NCI designated New Drug Study Group, (3) a member of the Council of Teaching Hospitals. Hospital pharmacies that are located in inadequately represented geographic areas when certain criteria are met by them will also be considered. Physicians desiring to prescribe THC need not have Schedule I registration, but should (1) have experience in cancer chemotherapy, (2) have a current DEA registration number, (3) agree to abide by the Guidelines for Use of THC, and (4) be registered with a participating pharmacy. A registered physician may prescribe THC by writing a Research Order for Medication on a usual prescription blank, including, in addition to normal required information, confirmation that patient consent has been obtained and the name of the hospital at which the physician is registered to prescribe THC.

Antineoplastic Agents↗
PubMed2003

A multi-agent system approach for monitoring the prescription of restricted use antibiotics.

Hospitals have a specified set of antibiotics for restricted use (ARU), very expensive, which are only recommended for special pathologies. The pharmacy department daily checks the prescription of this kind of antibiotics since it is often the case that, after a careful analysis, one can get the same therapeutic effects by using normal antibiotics which are much cheaper and usually less aggressive. In this paper, we describe a multi-agent system to help in the revision of medical prescriptions containing antibiotics of restricted use. The proposed approach attaches an agent to each patient which is responsible of checking different medical aspects related to his/her prescribed therapy. A pharmacy agent is responsible for analyzing it and suggesting alternative antibiotic treatments. All these agents are integrated in a hospital distributed scenario composed by many different kinds of software and human agents. This patient-centered multi-agent scenario is specified using the design methodology of Electronic Institutions.

Anti-Bacterial Agents↗
PubMed2003

Faculty turnover within academic pharmacy departments.

BACKGROUND: Pharmacy faculty manpower has been debated within the academic pharmacy community over the last several decades. Previous investigations studied job satisfaction among faculty members, but have not evaluated faculty retention and turnover among academic pharmacy departments. OBJECTIVE: To evaluate retention and turnover rates in the departments of Pharmacy Practice and Basic Science (Pharmacology/Toxicology, Pharmaceutics, Medicinal Chemistry) over the last 5 years. METHODS: Individual instructors and assistant, associate, and full professors across 80 colleges of pharmacy in the US were tracked between the years 1996 and 2001 using the American Association of Colleges of Pharmacy published rosters. Differences between departments were analyzed by year-stratified cross-tabulation table analysis. RESULTS: A greater percentage of Pharmacy Practice faculty resigned (10.6%) compared with Basic Science faculty (6.0%; percent ratio 1.76; 95% CI 1.58 to 1.95; p < 0.001), which remained constant across each academic year. Approximately 2.7 faculty members left their academic institutions per year in Pharmacy Practice compared with 1.1 faculty members in the aggregate of Basic Science departments. A higher percentage of women resigned in Pharmacy Practice (13.2%) than did men (8.7%; percent ratio 1.5; 95% CI 1.34 to 1.68; p < 0.001), despite a 1.3-fold male to female ratio. Likewise, regardless of a 4.1-fold male to female ratio in the Basic Science group, a higher percentage of women resigned (8.0%) than men (5.5%; percent ratio 1.45; 95% CI 1.18 to 1.78; p < 0.001). CONCLUSIONS: Over a 5-year period, Pharmacy Practice exhibited a higher turnover compared with Basic Science. Women displayed significantly higher turnover than men across all pharmacy academic departments. New retention approaches, especially for female faculty members, should be explored.

Education, Pharmacy↗
PubMed1992

Overcoming unit dose drug distribution system logistical problems on a 32-acre campus.

The literature contains numerous articles regarding the implementation of unit dose drug distribution systems, but little has been written concerning the logistical problems sometimes encountered with such systems. This article describes the implementation of a drug distribution system at a psychiatric institution at which the inpatient units are scattered throughout a 32-acre campus.

Hospital Bed Capacity, 100 to 299↗
PubMed2004

Open versus endovascular repair of abdominal aortic aneurysms: what does each really cost?

Endovascular repair (EVAR) of abdominal aortic aneurysm (AAA) has emerged as an alternative to open repair (OR). The aim of this study was to compare the clinical outcomes and specific costs of these procedures since commercialization.A retrospective analysis of 119 consecutive infrarenal AAA repaired via an EVAR or an OR between July 2000 and September 2001 was performed. Patient charts were reviewed. Diagnostic-related group (DRG) classification and payer mix were identified. The hospital cost accounting system was accessed to obtain actual variable direct cost (AVDC) for the two groups. Percentages of the mean AVDC for the two groups were compared in the following cost categories: graft, operating room, radiology procedures and supplies, pharmacy, respiratory therapy, clinical laboratories, surgical floor, and monitored unit. Hospital profit margins were determined. Fifty-five patients underwent EVAR and 64 patients underwent OR. Mean aneurysm size was 5.5A cm (EVAR) and 6.1A cm (OR). Mean intensive care unit (ICU) stay was 0.09 days for EVAR vs. 3.5 days for OR ( p < 0.05). Mean length of stay (LOS) was 1.96 days for EVAR vs. 7.3 days for OR ( p < 0.05). Reimbursement was based on DRG 110, 47.3% in the EVAR and 79.7% in the OR group ( p < 0.05), and DRG 111, 50.9% in the EVAR group and 12.5% in the OR group ( p < 0.05). The payer mix showed no significant differences between the two groups. Mean AVDC for EVAR was 1.74 times that of OR. Significant differences in the distribution of costs were found in the following: graft costs (58% vs. 6.3%, p < 0.05), radiology procedures and supplies (3.9% vs. 0.1%, p < 0.05), pharmacy (1.9% vs. 10.5%, p < 0.05), and monitored unit (7.3% vs. 24.65%, p < 0.05) comparing EVAR vs. OR, respectively. Median cost of an endovascular graft was 22.4 times that of the standard graft for OR. Average hospital profit margins for an EVAR case was 49.5% vs. 88.6% for OR. Despite significant differences in monitored unit utilization, pharmacy services, and respiratory therapy services by the OR group, the cost of EVAR is appreciably more expensive. Furthermore, increased DRG reimbursement, and decreased ICU use and LOS do not compensate for the cost of EVAR. The main cost of EVAR is the cost of the graft itself. Hospital profit margins are acceptable with both the EVAR and OR procedures at this time; however, with proposed reductions in reimbursement, the ability to cover the cost of this new technology may be threatened.

Aged↗