[Use of electron computers for the distribution of pharmaceutic supplies].
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Computers↗
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Results for “Pharmacy Distribution”
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[On the selection, distribution and education of pharmaceutical personnel in the pharmaceutical establishments of the Donets district].
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Education, Pharmacy↗
Improving drug therapy for patients with asthma--part 1: Patient outcomes.
OBJECTIVE: To evaluate the effects of a therapeutic outcomes monitoring (TOM) program on selected process and outcome measures. DESIGN: Prospective, controlled, multicenter study. SETTING: Community pharmacies throughout Denmark (16 intervention, 15 control). PATIENTS: Five hundred patients with asthma aged 16 to 60 years and treated in primary care. INTERVENTION: TOM is a community-based program for pharmaceutical care. Using a structured, seven-step, cyclical outcome improvement process, TOM pharmacists identify and resolve (or refer) problems with drug therapy that, if not addressed, might result in therapeutic failure or adverse effects. Equal emphasis is placed on the patient's perspective (e.g., coping, control, and empowerment) and the professional's perspective (e.g., adherence, patient knowledge, and therapeutic problems). TOM requires cooperation among pharmacists, patients, and physicians. MAIN OUTCOME MEASURES: Asthma symptom status, days of sickness, health-related and asthma-specific quality of life, use of health care services and resources, and satisfaction with health care and pharmacy. INTERMEDIATE OUTCOME AND PROCESS MEASURES: Peak expiratory flow rate (PEFR), knowledge of asthma and asthma medications, inhalation errors, and drug therapy problems in the TOM group. RESULTS: The mean individual differences for TOM and control patients were tested. Beneficial effects were found for the following outcome measures: asthma symptom status, days of sickness, and health-related and asthma-related quality of life. Satisfaction with health care and pharmacy varied throughout the course of the project, with no significant difference between groups at the final evaluation. Although not statistically significant, differences in use of services were considered to be clinically significant and encouraging. Beneficial effects were found for knowledge of asthma and medications, inhalation errors, drug use and drug therapy problems. No significant differences were found for PEFR. CONCLUSION: The project demonstrated that therapeutic outcomes monitoring by community pharmacists is an effective strategy for improving the quality of drug therapy for asthma patients in primary health care.
Adolescent↗
Clinical career ladders: Hamot Medical Center.
The clinical career ladder program for pharmacists at Hamot Medical Center (HMC), a 500-bed not-for-profit community teaching hospital, is described. Between 1980 and 1989 a career ladder at HMC evolved from an idea to an established program with parallel administrative, business, and clinical tracks. The development of the career ladder mirrored the growth of clinical programs and the diversification of pharmaceutical services. A formal plan for a clinical ladder was developed when the first satellite pharmacy opened in 1984. An entry-level pharmacist at HMC starts with a six-month period during which he or she learns the drug distribution system and prepares for several certification tests. The employee is then promoted to staff pharmacist. Staff pharmacists are promoted to clinical pharmacist II (CP II) upon meeting requirements for competence in a broad range of clinical skills and knowledge. Candidates for the position of clinical pharmacist specialist (CP I) must have either a minimum of three years of experience as a CP II or a Pharm.D. degree and have established an area of clinical expertise. A CP I can progress to assistant and associate director positions as vacancies occur. The clinical ladder has enhanced job satisfaction and encouraged the development of clinical practitioners who provide improved care. Problems have included time constraints, competition for positions, and management of incentives. A parallel career ladder program with a clinical track has enhanced the growth of pharmacy practice at HMC and improved the quality of pharmaceutical care.
Career Mobility↗
Drug information pharmacists at health-care facilities, universities, and pharmaceutical companies.
A national survey was conducted to provide a profile of drug information pharmacists. Questionnaires were mailed to 436 drug information pharmacists whose names were obtained from directors of drug information centers (DICs) at health-care facilities, universities, and pharmaceutical companies. The net response rate was 64% (278 usable replies). Most respondents were 30 to 39 years of age and had practiced in drug information for four years or less. There were equal numbers of male and female respondents. More than half had a doctor of pharmacy (Pharm.D.) degree, and about half had completed a postgraduate residency or fellowship. Respondents with a Pharm.D. degree or postgraduate training reported a more favorable professional outcome, including position, income, and job satisfaction. Respondents reported a high level of professional involvement, including faculty appointment, publishing, and professional membership. Common reasons cited for choosing a career in drug information were an opportunity to continually learn, job satisfaction, and regular work hours. More than 70% of respondents were either very satisfied or extremely satisfied with their current job position. The most frequently reported income range was $40,000-44,999; distribution of income differed significantly among geographic regions. Drug information pharmacists report a high level of job satisfaction and involvement in professional activities; they often have completed advanced pharmacy education or postgraduate training.
Adult↗
Development and benefits of a pharmacy technician career ladder.
The development and benefits of a career ladder for pharmacy technicians are described. A career ladder for technicians was implemented at a 575-bed community hospital in 1989 to provide incentives for technicians to improve their skills and take on additional responsibilities. The ladder consisted of four steps, each requiring additional years of experience, proficiency at specific skills, and involvement in specific departmental activities (e.g., maintaining floor-stock medications, preparing i.v. admixtures, and implementing new policies and procedures). Pay increases were given with each move up the ladder. At the start of the program, eight technicians were placed at level 2 and the remaining 16 were placed at level 1. Three years after the ladder was implemented, annual technician turnover had decreased from 33% to 15%. Employee surveys suggested increased job satisfaction among the technicians. Reassignment of tasks to technicians (e.g., maintaining narcotic distribution and coordinating daily purchasing activities) increased scheduling flexibility and helped provide an additional eight hours per week for pharmacist involvement in patient care activities. A pharmacy technician career ladder was associated with lower technician turnover, expansion of technicians' job responsibilities, and an increase in pharmacists' time for clinical activity.
Career Mobility↗
The Role of the Practice of Nuclear Pharmacy in Positron Emission Tomography.
As nuclear medicine evolved from an obscure research tool to a mainstream clinical diagnostic and therapeutic modality, so has the role of the practice of pharmacy in nuclear medicine also evolved. A similar evolution is unfolding today in the practice of positron emission tomography (PET). The skills of many diverse professionals, including pharmacists, are essential for the safe and efficient operation of a modern PET facility. The importance of the role of pharmacists in PET has been increasing as the use of PET radiopharmaceuticals has matured from research to clinical to commercial arenas. While it is clear that pharmacists can contribute clinical and technical skills to the operation of a PET center, perhaps one of the most important factors influencing the increased role of pharmacists in PET is their expertise and experience in the drug regulatory process. The commercial distribution of PET radiopharmaceuticals, primarily [18F]2-fluorodeoxyglucose (FDG), is currently being performed by a variety of corporate and institutional facility partnerships, with the likelihood of several new players entering the marketplace in the near future. This factor has served to dramatically increase the role for nuclear pharmacy in PET. The practice of nuclear pharmacy is a well-established component of PET. The role of nuclear pharmacists in PET is complementary to the many other professionals currently practicing in this specialty. With the rapidly increasing clinical demand for FDG imaging, it is likely that the number of facilities and institutions entering into the commercial distribution of PET radiopharmaceuticals will also increase. Such growth will also serve to solidify and expand the role for the practice of nuclear pharmacy in PET.
Journal Article↗
The pharmacist's role in controlling bloodborne infections with emphasis on procuring safe injection systems.
The hospital's department of pharmacy plays an important role in lessening the risk of bloodborne disease transmission through its influences in the coordination and control of the hospital's drug distribution system, intravenous (IV) admixture service and purchasing decisions with regard to injectable drug products. A review of drug distribution systems has shown that the unit-dose system is the most advantageous in terms of accuracy, safety, time savings and overall costs to the institution. Needlestick injuries are an occupational hazard for healthcare workers. Today, the need for safety in medication administration is a priority in injectable medication systems. Pre-filled cartridges offer a number of advantages, one of which is their safety in preventing needlesticks, through facilitating administration of medication quickly and easily and disposal of the needle immediately thereafter.
Drug Packaging↗
Pharmacy computerization: a rational step forward.
The decision was made and the Travenol computer system was installed and has since assisted the department of pharmacy in capping current labor expenditures, while increasing operating efficiencies. Technicians perform conditional order entry while pharmacists review and validate the orders. The resulting efficiencies have been readily translated into the benefits mentioned above. The enhanced services also include numerous clinical activities and the often neglected distribution responsibility. Another noteworthy benefit is the increase professionalism brought about by computerization of the department.
Computers↗
Contraindicated medications dispensed with cisapride: temporal trends in relation to the sending of 'Dear Doctor' letters.
PURPOSE: 'Dear Doctor' letters alert the prescribing community of drug labeling changes that contain new contraindications, warnings, adverse reactions, and precautions. There has been little assessment of the impact of these letters. We quantified the impact of two 'Dear Doctor' letters concerning interactions between cisapride and a series of drugs. A letter in 1995 described a risk of prolonged QT intervals and serious ventricular arrhythmia in patients who received macrolide antibiotics and imidazole antifungals in conjunction with cisapride. A June 1998 letter that expanded the list of contraindicated comedications had wider distribution than an earlier one, was accompanied by substantial Internet and media coverage, and was complemented by an effort to inform large pharmacy dispensing information organizations of the warnings against concurrent use of the named drugs. METHODS: Health plan members with one or more outpatient pharmacy claims for cisapride during the period 1 January 1995 through 31 May 1999 were identified among members of a large New England health insurer. A retrospective review of concurrent and nearly concurrent dispensings of cisapride and contraindicated comedications was undertaken in the automated pharmacy claims data using both graphical and statistical time-series analysis. We tabulated by month the fraction of cisapride dispensings that occurred in close temporal relation to dispensings of contraindicated comedications. Codispensings that occurred on the same day were taken as the most direct measure of prescriber responsiveness to the letters. Codispensings that occurred in windows of plus or minus 2 weeks (29 day window) and plus or minus 4 weeks (57 day window) were taken as measures of possible simultaneous consumption. Among overlapping dispensings, we counted the proportion dispensed by the same pharmacy. Time series regression analysis of secular, seasonal, and step-effects was conducted. RESULTS: There was a steady decline in codispensing of cisapride and contraindicated medicines, and a pronounced seasonal effect, arising principally from the seasonal use of macrolide antibiotics. Against this background, the isolated Dear Doctor letter of October 1995 had no discernible effect on prescribing practices. The 1998 letter and surrounding activity, by contrast, were followed by a 66% decline in same-day dispensings and a smaller, but still pronounced decline in dispensings in the wider time windows. For most codispensings of contraindicated medications with cisapride, both medications came from the same pharmacy. CONCLUSIONS: Publicity and direct intervention with dispensing pharmacies may be an important supplement to Dear Doctor letters when the goal is to eliminate the codispensing of drugs that should not be taken together.
Adolescent↗
Stability and compatibility assessment techniques for total parenteral nutrition admixtures: setting the bar according to pharmacopeial standards.
PURPOSE OF REVIEW: The stability and compatibility of total parenteral nutrition mixtures compounded for patients requiring nutritional support is paramount to their safety on intravenous infusion. The most significant pharmaceutical issues associated with mixing total parenteral nutrition formulations affecting their safety involve the stability of lipid-injectable emulsions and the compatibility of calcium and phosphate salts. Methods of analysis for stability and compatibility have varied, and the assessments have mostly been largely qualitative. RECENT FINDINGS: Although pharmacopeial standards have been primarily applicable to pharmaceutical manufacturers, recent efforts by the United States Pharmacopeia have been directed at standardizing pharmacy practices involved in the safe mixing of compounded sterile preparations. The adoption of chapter 797 entitled 'Pharmaceutical compounding - sterile preparations' on 1 January 2004 has had a dramatic impact on pharmacy practice in the United States. More recently, the United States Pharmacopeia has also proposed a new chapter 729 entitled 'Globule size distribution in lipid-injectable emulsions', setting specific limits on the sizes and concentrations of lipid droplets in the formulation, which may have implications for all-in-one mixtures. Finally, new efforts are under way to establish limits on the level of acceptable amounts of particulates intrinsically introduced by the manufacturer, and thus may have ramifications for particulates extrinsically introduced or initiated during compounding by the pharmacist. SUMMARY: With careful monitoring and the development of appropriate pharmacopeial-based specifications that limit the size and concentration of large-diameter fat globules and eliminate the possibility of dibasic calcium phosphate precipitates, improved patient outcomes may be achieved.
Drug Compounding↗
Home parenteral nutrition programs.
The technique of home parenteral nutrition (HPN) is becoming a more widely used method to treat patients who cannot eat for prolonged periods; to date, more than 500 patients have been trained nationwide. Training has been limited for the most part to larger centers which have more experience in providing this complex patient education. As this technique becomes more widely accepted, however, other less experienced health care professionals will be called upon to develop HPN training programs. For this reason, it is important to simplify these training programs, with initial attention directed toward the procedures used to prepare the total parenteral nutrition solution. The chance of potential errors can be reduced by using amino acid solutions with electrolytes included in the formulation. When possible, complexity can be reduced by administering vitamins and extra electrolytes orally. The teaching program can be simplified by developing or using existing training manuals, which standardize procedures so that consistent methods are taught and performed. The manual can serve as a reference for patient and teacher alike. Distribution of supplies can be simplified by employing commercially available shipment programs; but, while these are very convenient for the patient and pharmacy, the costs of such programs could be a limitation. Finally, the extensive work required to arrange reimbursement for services and supplies also can be simplified. Often a social worker can facilitate this process because of experience and training in dealing with payment problems. In addition, training fees should be negotiated with third party payors early in the development of HPN programs. By simplifying these basic elements in an HPN, the task of training patients is less imposing and can be made more widely available to those who need this treatment modality.
Adult↗
Building an image automatically--Madigan Army Hospital, Fort Lewis, Washington.
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Automation↗
Clinical distribution services. The big push.
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Centralized Hospital Services↗
Effect of decentralized computer order entry on medication turnaround time.
The medication order turnaround times of two drug-distribution systems in the same hospital using either centralized or decentralized computer order entry were compared. A decentralized medication order entry satellite pharmacy equipped with a pharmacy computer terminal and a small supply of medications typically requested to be administered without delay was implemented on one floor of a 518-bed hospital. Pharmacist-verified medication orders for five of the hospital's 22 nursing units were entered into the satellite computer terminal and transmitted to the central pharmacy for processing. Initial doses of medication dispensed from the satellite's drug supply were noted in the central pharmacy. Pharmacy personnel recorded time they spent in various steps of the medication delivery cycle for routine medication orders handled by the decentralized pharmacy. The same measurements were made for the centralized pharmacy system before implementation of the pharmacy satellite. The mean turnaround time for routine medication orders in the decentralized system was 79.5 minutes, which was 52% less than that of the centralized system (167.3 minutes). Decentralized computer order entry appears to be an effective way of decreasing turnaround time for routine medication orders.
Computers↗
Health personnel needs and attitudes to rural service in KwaZulu-Natal.
OBJECTIVES: To ascertain the urban/rural distribution of health personnel and the opinions of the medical fraternity in KwaZulu-Natal on compulsory rural service for medical practitioners. DESIGN: Cross-sectional analysis of geographical distribution of health personnel in KwaZulu-Natal based on 1991/92 South African Medical and Dental Council, South African Nursing Council and Pharmacy Council registration data. Opinion survey by administration of a structured questionnaire to a simple, random sample of private practitioners, academic consultants, postgraduate and undergraduate medical students and key informants in senior health service management in KwaZulu-Natal. RESULTS: Peripheral rural areas had health personnel/population ratios higher than or equivalent to those of urban areas, whereas the ratios were 15-40 times lower in deep rural areas. The key finding of the opinion survey was that the majority of all sectors except fifth-year medical students felt that rural service should be compulsory, either post-internship, prior to specialisation or prior to entry into private practice. However, respondents were significantly more likely to agree to rural service that would not affect them personally. The majority (54-87%) of all sectors felt that an option of 'buying out' of rural service should not be permitted. Respondents identified a range of financial, health service, academic, infrastructural and social incentives for rural practice. It is recommended that post-internship rural service be compulsory for a period of 6 months to 1 year provided that academic, health service and infrastructural deficiencies are ameliorated and appropriate financial incentives are provided.
Attitude of Health Personnel↗
Expanding clinical pharmacy services in a VA hospital.
The pharmacy staff at the VA Medical Center, Biloxi, Mississippi, has increased direct patient care activities for the Medical Center's inpatients by converting 139 beds from a manual system of unit dose to a computerized unit dose distribution system. Expanded clinical programs were primarily developed, implemented, and operated by staff pharmacists.
Drug Therapy, Computer-Assisted↗
Drug information centers as bases for continuing education programs in Kuwait.
Over the past few years, there has been a modernization of pharmaceutical services in Kuwait. In 1983 a drug information center was opened. A one-year postgraduate, long-distance program leading to a diploma in clinical pharmacy was started in October 1987 in cooperation with Queen's University of Belfast, Ireland. Pharmacist and physician tutors were assigned to supervise students in the major hospitals in Kuwait. A questionnaire was developed and distributed to 50 practicing pharmacists to assess the feasibility of using the Drug Information Center at Adan Hospital (DICAH) as a base for continuing education programs. Although certain difficulties were identified, it was concluded that the DICAH has the potential to be used as a base for future continuing education for pharmacists in Kuwait, especially as there is no school of pharmacy in the country.
Attitude of Health Personnel↗