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At least 793 records · Page 44Linked to original sources
PubMed1997

Pharmaceutical services in the United States Air Force.

The status of pharmaceutical services in the United States Air Force medical service is described. Air Force pharmacy is adopting new programs, staffing standards, inventory methods, and roles for pharmacists and technicians. One of the most visible changes is TRICARE, an interservice program that provides improved access to care. Many Air Force medical treatment facilities have been closed; prescription mail-out programs and networks of community pharmacies are filling the gap. The Air Force pharmacy team consists of more than 1300 pharmacists and technicians. Air Force pharmacists are military officers first. Great emphasis is placed on medical readiness training and continuing education. Some Air Force pharmacies are very small outpatient operations filling fewer than 300 prescriptions per day; others fill well over 4000. Many hospitals are being considered for more outpatient-focused operations. Because of anticipated minor reductions in pharmacist staffing, Air Force pharmacists will have to maximize efficiencies to maintain or improve current levels of service. More and better patient information will be provided and distributive processes streamlined. A greater role for technicians is anticipated. The future includes pharmacists serving in a wide variety of leadership and staff positions, improving the use of computers, and incorporating new technologies. Air Force pharmacy is changing to ensure uninterrupted fulfillment of its responsibilities.

Automation↗
PubMed1996

Distribution of emergency department costs.

STUDY OBJECTIVE: To report the distribution of emergency department costs by category of expense and level of patient urgency. METHODS: Cost-to-charge and relative-value methods were used to determine direct and indirect physician, facility, supply, pharmacy, laboratory, radiology, and miscellaneous costs for 24,010 ED patients. Explicit criteria were used to classify patient visits as nonurgent, semiurgent, or urgent. RESULTS: For all patients, the average costs were physician, $64; facility, $84; laboratory, $21; radiology, $24, and total, $209. Laboratory and radiology costs accounted for 5% of the total costs for nonurgent visits and 23% of the total costs for urgent visits. CONCLUSION: The distribution of ED costs varies significantly according to the urgency of the medical condition. For nonurgent patient visits, most costs are represented by the hospital facility and ED physicians' costs. Ancillary services represent a much greater proportion of costs for patients with urgent conditions. Although reduced test-ordering might result in some savings among patients with urgent conditions, overall improved cost efficiency can be achieved only through reductions in the fixed costs of operation of hospital EDs.

Ancillary Services, Hospital↗
PubMed1996

Hypnotic drug use in Spain: a cross-sectional study based on a network of community pharmacies. Spanish Group for the Study of Hypnotic Drug Utilization.

OBJECTIVE: To investigate how hypnotic drugs are used in Spain, specifically, (1) to characterize the user population in some simple demographic (e.g., sex, age) and clinical (e.g., type of insomnia, type of physician who prescribed the drug) variables; (2) to estimate the proportion of long-term users (> 3 mo); (3) to determine the frequency of different administration schedules; (4) to determine whether the kind of hypnotic drug prescribed according to the duration of its effect correlates with the type of sleep disorder or patient age; and (5) to compare the dosage used by the elderly with that used by adults. DESIGN: Cross-sectional pharmacy-based study. SETTING: A network of 318 community pharmacies throughout Spain. SUBJECTS: Patients (n = 5324) requesting a hypnotic drug for insomnia who agreed to take part in the study. MAIN OUTCOME MEASURES: Distribution of the use of hypnotic drugs by age, sex, type of insomnia, type of physician, specific hypnotic drug, daily dosage, treatment schedule, and duration of treatment. RESULTS: Women (67%) and the elderly (58%) constituted the largest subgroups in the sample. Difficulties in sleep onset and in sleep maintenance as single disorders were reported by 38% and 37% of users, respectively. Prescriptions were written by general practitioners in 80% of cases. Daily use was reported by 88% and long-term use (> 3 mo) by 72% of the users. Long-term treatment was two- to threefold more frequent in the elderly than in middle-aged subjects. Intermediate-action hypnotic drugs were used by 59% of subjects, short-action drug by 24%, and long-action drugs by 17%. The type of hypnotic drug prescribed was not related to the kind of sleep disorder or the age of patients. Specialists prescribed long-action hypnotic drugs more often than did general practitioners. No relevant differences were observed between dosages used by the elderly and those used by adults. In both groups the dosage taken by most patients, regardless of the drug, corresponded to the available strength. Substitution drugs for triazolam belonged to the intermediate-action class in 53% of the cases. CONCLUSIONS: Recommendations on hypnotic drug use are largely not followed in Spain. Most patients are taking hypnotic drugs daily, over long time periods, and without an adequate dosage titration according to age. Measures should be taken to correct this situation.

Administration, Oral↗
PubMed2004

[Religious and pharmacie in France after the french révolution].

The Germinal an XI law is supposed to close a period of time where several people were allowed to prepare and deliver drugs. Concerning clergy, this law will not be totally applied. Several priests and religious, during the XIXe century, will create and distribute pharmaceutical products. Oudin, Cottance and Chaupitre, all priests, are a few of key examples. L'abbé Perdrigeon was a priest that discover his calling to cure by treating Napoleon III's soldiers during 1870 war. It remains form it the so-called "Contrecoups de l' Abbé Perdrigeon ", product still commercialized. The present publication describes the legal and cultural feature in which illegal exercise of Pharmacy and Medicine took place by clergy, and the reasons why priests and nuns wanted to pursue this usage until the 1941 law.

Clergy↗
PubMed2001

Computerized controlled-substance surveillance: application involving automated storage and distribution cabinets.

A secondary data-reporting system used to scan the archives of a hospital's automated storage and distribution cabinets (ASDCs) for indications of controlled-substance diversion is described. ASDCs, which allow access to multiple doses of the same medication at one time, use drug count verification to ensure complete audits and disposition tracking. Because an ASDC may interpret inappropriate removal of a medication as a normal transaction, users of ASDCs should have a comprehensive plan for detecting and investigating controlled-substance diversion. Monitoring for and detecting diversion can be difficult and time-consuming, given the limited report-generating features of many ASDCs. Managers at an 800-bed hospital used report-writing software to address these problems. This application interfaces with the hospital's computer system and generates customized reports. The monthly activity recapitulation report lists each user of the ASDCs and gives a summary of all the controlled-substance transactions for those users for the time period specified. The monthly summary report provides the backbone of the surveillance system and identifies situations that require further audit and review. This report provides a summary of each user's activity for a specific medication for the time period specified. The detailed summary report allows for efficient review of specific transactions before there is a decision to conduct a chart review. This report identifies all ASDC controlled-substance transactions associated with a user. A computerized report-generating system identifies instances of inappropriate removal of controlled substances from a hospital's ASDCs.

Analgesics, Opioid↗
PubMed1975

Distribution accuracy of a decentralized unit dose system.

Unit dose medication carts in a 500-bed university hospital were monitored for accuracy and completeness after delivery to the nursing station. The contents of the cart were compared with the nurse's patient medication record. Discrepancies were recorded for evaluation. All medication cart distribution errors found were analyzed to identify the source and were tabulated to determine error rate. Three major categories of errors were discovered: pharmacy technician errors not corrected by the pharmacist, errors associated with nurse's patient medication records, and errors resulting from lost orders.

Medication Errors↗
PubMed1988

Nurses' attitudes toward pharmaceutical services before and after decentralization.

Nurses' attitudes toward the quality of pharmaceutical services were assessed before and after the implementation of decentralized pharmaceutical services at a tertiary-care teaching hospital complex. The same multiple-choice questionnaire was distributed to nurses at the University of Michigan Hospitals 18 months before decentralized services were implemented (November 1982) and again after two satellite pharmacies had been established and a clinical pharmacist had begun providing first-dose dispensing services using a movable medication cart (March 1985). The questionnaire measured nurses' satisfaction with aspects of pharmaceutical services most likely to be affected by decentralization of services (e.g., number of missing medications, accessibility of pharmacists). Nurses' overall satisfaction with pharmaceutical services increased only slightly after services were decentralized. Significant positive changes in nurses' satisfaction occurred in areas served by the satellite pharmacies and the clinical pharmacist; no significant change s in satisfaction occurred in the other areas. Nurses' perceptions of increased helpfulness of pharmacy personnel were a better predictor of increased satisfaction than were changes in the number of missing medications, waiting time for medication delivery, or number of incorrectly dispensed medications. Respondents remained anonymous; therefore, changes in personnel, rather than changed opinions of nurses, may account for the differences in responses between 1982 and 1985. Nurses' attitudes toward pharmaceutical services improved in areas of the hospital served by satellite pharmacies or by a clinical pharmacist using a movable medication cart.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗
PubMed1993

Capability of hospital computer systems in performing drug-use evaluations and adverse drug event monitoring.

A survey to determine the extent of computerization in key areas of hospitals, the information being collected in the databases, and the capabilities of the computer systems for performing adverse drug event monitoring and drug-use evaluations was conducted. The questionnaire was distributed to clinical pharmacists in the 500 hospitals composing the Drug Surveillance Network. In the majority of the 166 responding hospitals (> 85%), the pharmacy department, clinical chemistry and hematology laboratories, patient admissions, and microbiology laboratory were computerized for data acquisition and management. The medical records and purchasing departments were computerized in a smaller proportion of hospitals (75% and 74%, respectively). In the majority of hospitals with a computerized pharmacy department (> 78%), there was ready access to computer databases in other departments, but simultaneous querying of multiple databases was possible in only 30%. Patients could be identified according to diagnosis in 82% of the hospitals and according to medication received in 83%. More than 85% of responding hospitals had implemented spontaneous reporting systems for the identification of adverse drug events. Computers are widely used in hospitals participating in the Drug Surveillance Network, but a substantial effort is necessary to make these resources more useful and to standardize processes so that data may be pooled across institutions to deal with important public health concerns.

Adverse Drug Reaction Reporting Systems↗
PubMedDate not supplied

Media coverage of controlled substance diversion through theft or loss.

OBJECTIVES: To determine the frequency of media reports of controlled substance diversion. DESIGN: Quantitative search of news articles from LexisNexis Academic, using search strings related to four different types of controlled substance diversion. SETTING: Not applicable. PATIENTS OR PARTICIPANTS: Not applicable. MAIN OUTCOME MEASURES: Number of media reports about diversion of controlled substances at the prescriber or dispenser levels, through pharmacy robberies or thefts, and through hijackings or robberies of shipments. RESULTS: Media reports of controlled substance diversion indicate that theft and loss are important problems and that inappropriate prescribing and dispensing are substantial problems as well. Leaks of controlled substances from the closed system of distribution seem to be increasing as rapidly through theft and loss as through inappropriate prescribing and dispensing. During the five biennia between 1993 and 2002, these percentage increases in media reports were observed for the different types of diversion: 200% for prescribers; 350% for dispensers; 133% for pharmacy robberies and thefts; and 1,800% for thefts from shipping channels. CONCLUSION: A balanced approach to the prevention of controlled substance diversion, aimed at reducing illicit acquisition of drugs from theft and loss as well as from prescribing and dispensing, may produce the greatest success without adversely affecting the quality of patient care.

Drug Prescriptions↗
PubMed1994

Pharmacy-based automated medication records: methods, application, and a survey of use.

A literature review of articles describing the development and implementation of automated medication administration records is summarized, and the results of a survey undertaken of all hospitals in Missouri to determine the extent of an automated medication administration record (MAR) are reported. For hospitals with an automated MAR, the survey compiled information about the demographics of responding facilities and production and distribution, design, implementation, and procedures for use of automated MARs. The most frequently reported advantages of an automated MAR were a more legible document, increased accuracy, savings in nursing personnel time, and fewer medication errors. The most frequently reported disadvantages were increases in pharmacy personnel time, different interpretation of orders by pharmacy and nursing, and multiple entries required for a medication order to appear correctly on the MAR.

Clinical Pharmacy Information Systems↗
PubMed2005

Surface contamination of cyclophosphamide packaging and surface contamination with antineoplastic drugs in a hospital pharmacy in Sweden.

Workplaces, e.g. hospital pharmacies and hospital departments, where antineoplastic drugs are handled might be contaminated with these drugs, and pharmacy personnel and health care workers may be exposed. In this study potential sources for exposure of antineoplastic drugs were investigated. Unbroken drug vials and tablet blister packages, both containing cyclophosphamide (CP) and their outer packaging were wipe sampled. Analysis was performed by liquid chromatography combined with tandem mass spectrometry (LC-MS/MS). The result showed that almost every part of the primary packaging was contaminated with CP and ifosfamide (IF). However, the amounts of CP and IF were low, and most likely not harmful for the personnel handling these packaging in association with drug preparation. The contamination must originate from the pharmaceutical manufacturer. Different surfaces in the preparation unit of a Swedish hospital pharmacy were also investigated at two different occasions by wipe sampling. In the preparation unit CP and IF were found as contaminants on the majority of the investigated surfaces. After the first measurement the hospital pharmacy improved its routines. Lower amounts of CP and IF were detected at the second measurement. A low degree of contamination with CP and IF was also detected on the floor outside the preparation unit and this indicated a small distribution of antineoplastic drugs to the surroundings.

Antineoplastic Agents↗
PubMed1988

Economic consequences of two drug-use control systems in a teaching hospital.

Length of stay (LOS), total cost per admission (TCA), and pharmacy cost per admission (DCA) were determined for two drug-use control systems in a 1058-bed university hospital; a centralized unit dose drug distribution system served as a control. The two study systems were (1) pharmacist monitoring of drug therapy in the patient-care area and (2) centralized pharmacist monitoring of computerized patient profiles. LOS data were collected retrospectively for 659 patients admitted during a seven-month control interval. LOS, TCA, and DCA data were collected prospectively for 496 patients admitted during a five-month experimental interval. Each study system was assigned to one of three teams making rounds among intact patient groups. LOS differences were compared between intervals and by month. After corrections were made for differences in patient mix, the drug-use control system in which pharmacists were assigned to the patient-care area yielded a 1.5-day-shorter average LOS, $1293 lower average TCA (p less than 0.05), and $155 lower average DCA than under the unit dose system. The drug-use control system in which pharmacists were assigned to monitor patients' drug therapy from a central location was associated with a 0.13-day-shorter average LOS, $235 lower average TCA, and $55.13 lower average DCA than under the unit dose system. No systematic differences between teams, other than drug-use control system, appeared to explain the differences in LOS, TCA, and DCA. A drug-use control system based in a patient-care area, overseen by clinically experienced pharmacists, may result in shorter LOSs and lower total costs than centralized systems for general-medical inpatients of teaching hospitals.

Contraceptives, Oral, Combined↗