Integrated system for the purchase, distribution, and use of drugs in hospital.
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Costs and Cost Analysis↗
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Parenteral distribution in a 262-bed hospital.
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Anti-Bacterial Agents↗
[The distribution of medication in a hospital setting].
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Costs and Cost Analysis↗
Reducing the number of missing doses with the aid of a computer system.
Missing or extra medications in the unit dose drug distribution system have resulted in lost financial charges. At Kingsbrook Jewish Medical Center, the reasons why drugs were returned or missing in the unit dose system were not properly explained nor properly recorded. Enhanced programs in the computerized pharmacy management system were developed to include a mechanism for recording reasons why doses were missing and a method of documenting extra doses dispensed to the patient, while capturing current costs for these drugs. The system permits simple data entry which allows uninterrupted processing. The reports generated by the system are used to inform physicians of dosage problems of patients and to act as an educational aid in correcting a source of medication errors. The computerized reporting system has helped to reduce the number of missing medication doses by 36.8% and to improve pharmacy inventory control.
Computers↗
Relationship of productivity analysis to departmental cost-accounting systems.
Productivity assessment and its relationship to cost-accounting systems (CASs) is described. Hospital pharmacist managers need workload measurement-productivity assessment systems for evaluating their departments' scope of services and their impact on the total cost-quality balance in treating patients. Productivity is measured as the ratio of output (production units) to input (total personnel hours used) during a specified time. "Macro" production units represent a grouping of related tasks that, when combined, identify a service unit (e.g., patient day) or activity (e.g., drug-use review consultation); "micro" production units are derived by weighting macro units on the basis of resource consumption (standard time required). Macro production unit data should reflect both fixed and variable costs and should be easy to obtain. A productivity analysis system may need more than one macro production unit and also some micro production units. Both input and output units should be separated by service category (e.g., distributive, clinical, research) and by personnel category (pharmacist or supportive personnel). ASHP's PharmaTrend workload measurement system fits these criteria and facilitates national and regional comparisons, and data from PharmaTrend reports can be readily incorporated into a CAS. Pharmacy managers can best use workload measurement systems and CASs by observing trends in their ratios and indicator values over time.
Accounting↗
The state of clinical pharmacy practice in family practice residency programs.
BACKGROUND: Clinical pharmacists have been involved with family practice residencies for more than 20 years. This survey was designed to evaluate the current state of clinical pharmacy services in the family practice residency program (FPRP) in the United States. METHODS: All FPRPs were contacted to identify clinical pharmacists involved with their programs. These pharmacists were directed to a password-protected Web address where the survey was posted. Completed surveys were submitted on-line, and data were retrieved for analysis. RESULTS: Of the 579 residencies, 155 (26.7%) acknowledged 174 clinical pharmacists working within their program. Responses were received by 130 of the pharmacists (74.7% response rate). These pharmacists held academic appointments in both their institution's school of pharmacy (80%) and the school of medicine (53.2%). The mean age of the respondents was 36.5 +/- 8.2 years, and the mean salary was $66,000 (range $46,000-$125,000). A majority of the pharmacists received their funding from a single source, and 32.2% received full salary support from the FPRP. The respondents spent more than half of their time with the residency program. Overall, their time was divided into teaching responsibilities (42.7%), patient care activities (37.1%), research (12.1%), administrative functions (11.8%), and drug distribution (< 5%). CONCLUSIONS: Pharmacists are actively involved in 26.7% of FPRPs. This survey demonstrates increased salary support from the FPRP in comparison to past surveys. Additionally, more pharmacists hold academic appointments within schools of medicine.
Adult↗
Effectiveness of an antibiotic cost containment measure.
University Hospital, University of British Columbia (UBC) Site, a 600-bed teaching hospital in Vancouver, British Columbia, adopted several cost containment measures on August 2, 1988 in an attempt to limit the rise in antibiotic expenditures. One cost containment measure involved extending the dosing intervals of cefazolin, clindamycin and metronidazole by a pharmacy-based automatic dosing interval interchange. Cefazolin and clindamycin orders were changed to an every eight-hour dosing schedule, and metronidazole orders to an every 12-hour schedule. Data were retrospectively collected and tabulated from August 1987 to February 1988 (pre-implementation or PRE period) and August 1988 to February 1989 (post-implementation or POST period). During the POST period, the mean doses per course were significantly less for metronidazole. Estimated cost savings from the measure was $7,300 for the seven-month POST period. Annualized, the expected savings would be $12,600, which is 4.4% of 1988/1989 total antibiotic expenditures. This cost containment strategy achieved its goal of effective cost savings for University Hospital, UBC Site. Although a small reduction in total drug budget was seen, this study suggests that savings can be achieved through this cost containment measure.
Anti-Bacterial Agents↗
A longitudinal study of syringe acquisition by Puerto Rican injection drug users in New York and Puerto Rico: implications for syringe exchange and distribution programs.
Increasing access to sterile syringes and new drug preparation materials is an effective means of reducing HIV transmission among injection drug users (IDUs), and a fundamental component of harm reduction ideology. The purpose of this study is to examine changes during a three-year period in syringe acquisition by street-recruited Puerto Rican IDUs characterized by frequent drug injection and high HIV seroprevalence. At baseline (1998-1999) and 36-month follow-up, 103 IDUs recruited in East Harlem, New York (NY), and 135 from Bayamón, Puerto Rico (PR) were surveyed about syringe sources and HIV risk behaviors in the prior 30 days. A majority of participants in both sites were male (NY 78.6%, PR 84.4%), were born in Puerto Rico (NY 59.2%, PR 87.4%), and had not completed high school (NY 56.3%, PR 51.9%). Compared to PR IDUs at follow-up, NY IDUs injected less (3.4 vs. 7.0 times/day, p < .001), and re-used syringes less (3.1 vs. 8.0 times, p < .001). Between baseline and follow-up, in NY the proportion of syringes from syringe exchange programs (SEPs) increased from 54.2% to 72.9% (p = .001); syringes from pharmacies did not increase significantly (0.2% to 2.5%, p = .095). In PR, the proportions of syringes from major sources did not change significantly: private sellers (50.9% to 50.9%, p = .996); pharmacies (18.6% to 19.0%, p = .867); SEP (12.8% to 14.4%, p = .585). The study indicates that NY SEPs became more dominant, while NY pharmacies remained a minor source even though a law enacted in 2001 legalized syringe purchases without prescription. Private sellers in PR remained the dominant and most expensive source. The only source of free syringes, the SEP, permitted more syringes to be exchanged but the increase was not statistically significant. Implications for syringe exchange and distribution programs are discussed.
Adult↗
Penicillinase-producing Neisseria gonorrhoeae in Dade County, Florida: evidence of core-group transmitters and the impact of illicit antibiotics.
In 1985, 2,455 cases of infection due to penicillinase-producing Neisseria gonorrhoeae were reported from Dade County, Florida. These cases represent the largest concentration of PPNG infections reported to date in the United States. A zip code-based geographic analysis of morbidity caused by gonorrhea and PPNG identified a core area where the percentage of all gonorrhea cases due to PPNG was 31-36%. This percentage decreased in a radial pattern outward from the central core. A prospective study of patients presenting to the Dade County central clinic with gonorrhea found that men infected with PPNG were more likely to have medicated themselves with illicit antibiotics than were patients infected with penicillin-sensitive N. gonorrhoeae (odds ratio, 3.6; 95% confidence interval, 1.9-6.8). Of all self-medicated patients, 42% obtained antibiotics via illicit over-the-counter purchase at pharmacies in the hyperendemic area. In contrast to previous reports, PPNG infection was not associated with either narcotic- or prostitution-related activities. The results show that PPNG is endemic in Dade County and is arrayed in a core distribution. Antibiotic abuse may have played an important role in the Miami epidemic and in the establishment of PPNG as an endemic strain.
Adolescent↗
Medication carts--are they all the same?
Purchase of unit dose medication carts is one of the major capital expenditures in the development and maintenance of a unit dose distribution system. Critical factors in this selection process are the considerations of product reliability and durability. To develop an assessment of user satisfaction with the various brands of unit dose carts, a national survey of 500 randomly selected hospital pharmacies was developed and mailed. The questionnaire requested information on types of carts used, satisfaction with cart performance, types of repairs needed, frequency of repairs, providers of cart repairs, and frequency of cart maintenance inspections. Two hundred seventy responses (54%) were available for evaluation. Eighty-five percent of cart users have five or more carts. Although 60% of respondents have carts greater than or equal to 4 years old, comparative satisfaction did not decrease as a function of increasing age of carts. There were 11 brands of unit dose carts reported by 214 responders. One hundred and three of these 214 responders (48.1%) used MacBick as compared with 36, 22, 18, and 35 users of Trans Aid, Lionville, Ferno Forge, and seven other brands, respectively. MacBick's users reported less equipment failure rate compared with the other brands, but this difference did not reach statistical significance (p less than 0.2 greater than 0.05). It was also determined that only 29% of hospitals routinely inspect carts to insure proper functioning. Since the most frequent type of equipment failure reported (up to 61% of users) involved cart locking mechanisms, drug security can be compromised without routine inspections.
Attitude of Health Personnel↗
FDA, companies test RFID tracking to prevent drug counterfeiting.
The U.S. has an apparently growing problem with fake, counterfeit drugs entering the mainstream drug supply, and being fraudulently sold at full price in regular pharmacies and hospitals; some have no active ingredient, or too little, or substitute a cheap drug for an expensive one. The FDA has asked drug manufacturers to develop technology to track all shipments electronically as they move through the distribution chain; currently, RFID (radio frequency identification) is the preferred method for doing so. This article explains what is happening, and why we do not believe that this use of RFID is a privacy threat--though other privacy issues are among the most important questions we face today.
Anti-HIV Agents↗
Simple automated drug distribution system.
A simple automated drug distribution system is described. To reduce errors generated by a traditional system, a system was implemented which required (1) writing three computer programs, (2) installing a cathode ray tube terminal and a split-pattern character printer in the pharmacy, and (3) designing a new piggyback medication label. Under the new system reorders per order were reduced by 24% (indicating that the number of unnecessary orders had been minimized) and credits per order or reorder increased 7%.
Computers↗
Survey of clinical pharmaceutical services in Florida hospitals.
A survey of clinical pharmaceutical services in Florida hospitals is described. Questionnaires were mailed to the pharmacy departments of 210 hospitals containing 50 or more beds; 172 (82%) responded. Data were collected concerning the extent and types of clinical services provided; the reasons for not implementing the services were also obtained. Twenty (12%) hospitals employed a full-time clinical pharmacist. Inservice drug education, formalized drug information, cardiopulmonary resuscitation and patient medication histories were provided by 78%, 47%, 19% and 6% of the hospitals, respectively. Hospitals with a total or partial unit dose drug distribution system seemed more likely to provide clinical services than those with other types of distribution systems. Hospitals employing a clinical pharmacist were engaged in a wider range of clinical services and provided these services to a larger portion of their patient population. The reason most frequently cited for not implementing clinical services was inadequate staff.
Florida↗
Trends in full-time pharmacists' labor market characteristics.
OBJECTIVE: To provide a historical overview of the pharmacy profession for the past 30 years, using trends in full-time pharmacists' labor market characteristics. METHODS: A retrospective longitudinal sample of pharmacists from 1968 to 1996 was constructed from the March Current Population Survey data. A three-period centered moving average method was used to describe the labor market trends over time. Pharmacists' labor market was characterized by age, sex, race, education, geographic distribution, salary, working hours, and wage. RESULTS: The dominant age group among full-time pharmacists was 36-45 in the late 1960s and early 1970s, 26-35 between the mid-1970's and early 1990's, and 36-45 in the mid-1990's. Historically, a significant proportion of full-time pharmacists were white men, holding bachelor's degrees. The number of pharmacists has been highest in the South and lowest in the West. In general, pharmacists' annual salary and wage rates have grown steadily, whereas average hours worked per week have decreased from 50 hours to less than 45. CONCLUSION: Findings suggest a growing trend of three demographic groups: aged 36-45, women, and nonwhite. In addition, an increasing proportion of pharmacists holding "higher than bachelor" degrees was observed. The distribution of pharmacists was highest in the South and lowest in the West. The Midwest has the highest pharmacist/population ratio, the South the lowest. On average, full-time pharmacists in the 1990s work 40-45 hours per week, have an annual salary higher than $55,000 (in 1996 dollars), and an hourly wage rate above $25.
Employment↗
Prevalence of hepatitis B and C virus markers among the members of the medical-sanitary staff from the Faculty of Dentistry "Carol Davila" University of Medicine and Pharmacy, Bucharest.
This study was developed in an attempt to estimate the prevalence of hepatitis B and C virus markers in the sanitary personnel from dentistry clinics which represents a high risk group concerning both contamination and transmission of the infection. The results of the study showed a higher contamination by virus B than virus C. The distribution of contamination depending upon the position held by the staff members revealed a higher contamination incidence among medium level personnel than among high level personnel. The need to initiate this study is due to the high incidence of contamination with hepatitis B virus which calls for the implementation of prophylaxis measures to protect both the medical personnel and the patients.
Adult↗
Use of lithium, carbamazepine, and valproic acid in a state-operated psychiatric hospital.
OBJECTIVE: To examine the prescribing of mood stabilizers (lithium, carbamazepine, and valproic acid) in a 500-bed state-operated psychiatric hospital in New York. METHODS: All 129 inpatients receiving mood stabilizers were identified and their medical records reviewed using a standardized drug use evaluation form. Diagnosis, other indications, and prior experience with mood stabilizers were examined, as well as outcome and adverse effects. RESULTS: Approximately one-quarter of the inpatient population received a mood stabilizer. The frequency of carbamazepine use exceeded the use of lithium, with 72 patients receiving carbamazepine and only 62 receiving lithium. Twenty-eight patients received valproic acid. Indications found most frequently for carbamazepine use included assaultive or aggressive behavior (70% for those receiving carbamazepine as the only mood stabilizer). Of those patients with bipolar or schizoaffective disorder and receiving either lithium, carbamazepine, or valproic acid, 36% were prescribed carbamazepine (10% as a first-line agent) and 50% lithium (26% as a first-line agent). None of these indications for carbamazepine has been approved by the Food and Drug Administration. In general, positive outcomes were documented but without supporting objective measures. Significant adverse effects were documented in the medical record in one-quarter of the patients. CONCLUSIONS: There was widespread use of the three mood stabilizers examined, singly and in combination, for a variety of indications. Lithium and valproic acid remain more frequently prescribed for the treatment of bipolar and schizoaffective disorders. Monotherapy with carbamazepine or valproic acid results in statistically significantly fewer adverse effects than lithium or combination therapy (p values between p = 0.00038 and p = 0.006). Current clinical practice has endorsed the use of carbamazepine for aggressive or assaultive behavior, although there does not appear to be sufficient proof of effectiveness in the literature. Formal studies of carbamazepine's antiagressive effects should be conducted.
Aggression↗
Quality of health education during STD case management in Nairobi, Kenya.
Quality of health education during STD case management in Nairobi was assessed in 142 healthcare facilities, through interviews of 165 providers, observation of 441 STD patients managed by these providers, and 165 visits of simulated patients. For observations, scores were high for education on contact treatment (74-80%) and compliance (83%), but unsatisfactory for counselling (52%) and condom promotion (20-41%). The World Health Organization (WHO) indicator for STD case management Prevention Indicator 7 (PI7) (condom promotion plus contact treatment) was poor (38%). Public clinics strengthened for STD care generally performed best, whereas pharmacies and mission clinics performed worst. Compared with observations, scores were higher during interviews and lower during simulated patient visits, indicating that knowledge was not fully translated into practice. Interventions to improve the presently unsatisfactory service quality would be wide distribution of health education materials, ongoing training and supervision of providers, implementation of STD management checklists, and the introduction of pre-packaged kits for STD management.
Attitude of Health Personnel↗
The influence of information provided by patients on the accuracy of medication records.
OBJECTIVE: To assess two interventions for improving the accuracy of doctors' information about their patients' medication. DESIGN AND SETTING: A 12-month two-armed (parallel designed) prospective study among elderly patients of four general practitioners (GPs) in two local government areas of Sydney's North Shore. PATIENTS: 206 elderly, ambulant, self-caring patients (69 men, 137 women; median age, 75 year; range, 60-94 years). INTERVENTION: Patients were issued with a medication record card (MRC), filled in by their GPs with what they believed to be the patient's current medications, and were asked to produce it at all subsequent consultations. Patients of two of the GPs were additionally asked to bring their currently used medications to all scheduled appointments. MAIN OUTCOME MEASURE: Accuracy of the MRC, determined by confirmatory home visits and inspection of medications by a pharmacist. RESULTS: The proportion of patients with regimens recorded accurately on their MRCs improved significantly (from 25.9% to 42.0%) only in the group asked to bring their medications to consultations (P = 0.03). Most errors of recording were of omission, with patients taking a median of two medications (range, 0-10) of which their GPs were not aware. CONCLUSION: Requesting that patients bring their medications to consultations, in conjunction with the use of medication record cards, can improve information for doctors about their patients' medications.
Aged↗