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In the June 1983 issue of Hospital Pharmacy, I requested pharmacy directors in hospitals of less than 300 beds who had 168-hour a week pharmacy service to describe their service and how they obtained it. Below you will find a continuation of this feature. We plan to publish additional descriptions as they are received.
In the June 1983 issue of Hospital Pharmacy, I requested pharmacy directors in hospitals of less than 300 beds who had 168-hour a week pharmacy service to describe their service and how they obtained it. Seven such descriptions appeared in July 1983. Below you will find a continuation of this feature. We plan to publish additional descriptions as they are received.
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The development of a disaster plan for hospital pharmacy services in Hartford, CT, is described. In June 1978, directors of pharmacy from 12 hospitals in the Hartford, CT, area began a project designed to ensure an uninterrupted supply of drugs and an adequate supply of pharmacy personnel during and after any natural disaster. The project initially involved standardization of components of the individual hospital pharmacies' disaster plans. A questionnaire was then completed by each director of pharmacy regarding hours of operation, telephone numbers, and pharmaceutical products usually stocked (including blood derivatives, radiologic-contrast media, and intravenous solutions). Information on inventory levels was collected later. Pharmaceutical manufactures and wholesalers in the region were contracted, and a list of routine and emergency telephone numbers was compiled. The disaster plan was completed in July 1979. The plan has been tested in a mock catastrophe drill and one natural disaster that caused relatively few injuries.
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A hospital pharmacy-based patient-controlled analgesia (PCA) service is described. The pharmacy department at a 255-bed community hospital instituted a comprehensive PCA service in 1985. Pharmacists were given thorough training in the clinical aspects of pain management and were taught how to use the PCA device; nurses also received instruction. An order for PCA is issued by a physician, who may then delegate decisions about medication choice, duration of therapy, and device settings to a clinical pharmacist. The pharmacist reviews the order and evaluates the patient's status. If PCA is appropriate, the pharmacist selects the analgesic agent and PCA device settings and prepares a pharmacy monitoring card. Orders for syringes are filled in the central pharmacy or by the decentralized pharmacist. Each order is entered into the i.v. drug profile and the i.v. drug computer file, and a narcotics control card is completed. The nurse programs the device, instructs the patient, and records the patient's level of pain control on a PCA-monitoring record. The pharmacist observes patients daily and records observations and changes on the pharmacy monitoring card. Use of the PCA service has grown from an average of 56 patient days per month in 1985 to 919 in 1989, and pharmacy department revenue has increased accordingly. A moderate increase in workload has been absorbed without the need for an increase in staff. Surveys show broad acceptance of the service by physicians, nurses, and patients. A hospital pharmacy-based PCA service offered patients better control of pain, allowed pharmacists to demonstrate competence in non-distributive functions, increased the visibility of the pharmacy department, and was a source of revenue.
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The steps involved in preparing to implement a pharmacy computer system are described. Although the order in which the various steps have to be completed varies according to the hospital specifics, important elements of the preparation process include preparation of the site, organization of personnel, development of policies and procedures, developing and ordering forms, preparation of the implementation schedule, file development, and preparation of other departments. A well-designed plan and a realistic time schedule for the preparation process facilitates the actual implementation of a pharmacy computer system.