Missing medications associated with centralized unit dose dispensing.

The reasons for missing medications in a centralized unit dose system were studied, and means of improving the situation were recommended. Reasons for missing medications included: insufficient or incorrect medications dispensed by the pharmacy, differences in interpretations of orders by pharmacists and nurses, administration of extra medication or incorrect doses, waste of medication, administration of medication to patients other than for whom it was dispensed, delivery to wrong nursing unit, pilferage, and requests by nurses for medication before the orders were received by the pharmacy. A procedure for checking medications in unit dose carts by pharmacy and nursing personnel was implemented. Before this procedure, the rate of missing medications was 0.93% of the doses dispensed; after the procedure, the rate was 0.33%. Other recommendations designed to prevent missing medications in this unit dose system are presented.     

COVID-19 pandemic: Response plan by the Johns Hopkins Aramco Healthcare inpatient pharmacy department

The coronavirus disease 2019 (COVID-19) is an ongoing pandemic having caused a major health care crises across the globe. Pharmacy professionals are considered vital in preparation for optimal response to the COVID-19 pandemic. Therefore, in response to the estimated potential impact of COVID-19 on Johns Hopkins Aramco Healthcare (joint venture between Saudi Aramco and Johns Hopkins Medicine International), several initiatives were taken by the hospital's inpatient pharmacy department with focus on infection control, staffing, meeting clinical operational challenges, ethics, increased utilization of automation, and maintenance of employee wellness to prepare for this challenge. The plan implemented by the inpatient pharmacy department was prepared while incorporating information and recommendations from leading pharmacy organizations, ministry of health, institute's experience in battling another similar coronavirus (the Middle East respiratory syndrome–coronavirus) previously, and updated scientific research. The key focus areas include development of an institutionalized COVID-19 protocol, measures to improve infection control when handling and dispensing medications, modified staffing plan, system changes in peri-operative areas, keeping pharmacy professionals updated about new and scientific researches, increased utilization of automation, clinical interventions by pharmacist ensuring appropriate utilization of medications while monitoring for drug-drug interactions, adverse drug event prevention, and preparing for handling drug shortages. By implementing a robust plan, pharmacy professionals continue to show that they are an integral member of inter-professional health care teams.     

Implementation of a modified decentralized drug distribution system with the use of master medication carts

A decentralized drug distribution system with the use of master medication carts was implemented. This system was designed so that roving pharmacists could dispense new medication orders quickly and develop a more personal means of nurse-pharmacist interaction for the benefit of better patient care. The key to the system using roving pharmacists is a master medication cart, a pharmacy dispensing unit on wheels, which travels to each nursing unit. The pharmacy medication profiles are kept with the cart, and at each nursing unit patient medication profiles are reviewed, new drug orders are filled, missing medications and discrepancies are resolved, and nurse-pharmacist consultations can take place. There are two roving pharmacists who make simultaneous rounds of all nursing units in the hospital with two similarly stocked master medication carts from 9 A.M. to 9 P.M., seven days a week. All unit dose drawers are filled in the central pharmacy and are exchanged once daily at 2 A.M. by the night pharmacy technician. Each master medication cart carries about 300 different medications, which comprise nearly 95% of the drug needs of the 340 patients served by the two medication carts. The pharmacy department has added 1.4 Full-Time Equivalent (FTE) registered pharmacists and eliminated 2.8 FTE pharmacy messengers in implementing the decentralized drug distribution system. Currently, three registered pharmacists per day are assigned to the inpatient unit dose drug distribution system (two roving pharmacists and one unit dose filling pharmacist). Our roving pharmacists play a vital role in improving patient care. The overwhelming support by the nursing and medical staff represents an attempt by the hospital to continue to provide an optimal health care delivery system.     

Personnel management for hospital pharmacists

This paper launches a seven-part series of articles on personnel management for hospital pharmacists. The series is designed to help hospital pharmacists who supervise other workers improve their skills in handling personnel matters. Methods of managing the pharmacy manager will be reviewed, including the establishment of goals and priorities, time management, and mechanisms for coping with stress. Techniques for recruiting, interviewing, and hiring and for training new employees will be presented. Several motivation theories will be examined and applied to professional and supportive personnel in the pharmacy department. Methods of evaluating performance and disciplining employees will be reviewed. Each article will include typical examples from hospital pharmacy practice to illustrate the concepts.     

Pharmacy intervention and the anesthesia drug exchange drawer.

We implemented an ED drug system for anesthesia carts at no net cost. Cooperation by the departments of pharmacy and anesthesia permitted the establishment of services without additional funds for new personnel or equipment. The system offers a number of important advantages over individual-cart drug stocking. Benefits include reduced costs, improved patient safety, improved drug handling, and better communication between anesthesia and pharmacy personnel. We conclude that when a satellite pharmacy is not feasible, or as an interim measure, an ED system can provide substantial benefits over individual anesthesia carts. We further observed that anesthetists' drug-handling behaviors improved when carts were common and standardized.     

Effects of bar coding on a pharmacy stock replenishment system

A bar-code stock ordering system installed in the ambulatory-care pharmacy and sterile products area of a hospital pharmacy was compared with a manual paper system to quantify overall time demands and determine the error rate associated with each system. The bar-code system was implemented in the ambulatory-care pharmacy in November 1987 and in the sterile products area in January 1988. It consists of a Trakker 9440 transaction manager with a digital scanner; labels are printed with a dot matrix printer. Electronic scanning of bar-code labels and entry of the amount required using the key-pad on the transaction manager replaced use of a preprinted form for ordering items. With the bar-code system, ordering information is transferred electronically via cable to the pharmacy inventory computer; with the manual system, this information was input by a stockroom technician. To compare the systems, the work of technicians in the ambulatory-care pharmacy and sterile products area was evaluated before and after implementation of the bar-code system. The time requirements for information gathering and data transfer were recorded by direct observation; the prevalence of errors under each system was determined by comparing unprocessed ordering information with the corresponding computer-generated "pick lists" (itemized lists including the amount of each product ordered). Time consumed in extra trips to the stockroom to replace out-of-stock items was self-reported. Significantly less time was required to order stock and transfer data to the pharmacy inventory computer with the bar-code system than with the manual system.(ABSTRACT TRUNCATED AT 250 WORDS)     

Managing training programs for pharmacy employees

Principles for managing training programs for supportive personnel and new pharmacist employees in hospital pharmacy departments are discussed, and ongoing staff development activities are described. General management objectives of training programs are outlined. Training programs for supportive personnel should include general theory, such as basic pharmacology and metric conversions, and practice in the specific skills required for the job. The practical component of the training program should be based on a job analysis, and behavioral objectives of the training program should be developed. Various approaches for structuring and monitoring training programs for supportive personnel are described. Besides mastering specific practice skills, new pharmacist employees must become thoroughly familiar with the pharmacy department's policy and procedure manual. Hospital pharmacy managers should implement ongoing activities for developing the decision-making, interpersonal, and practice skills of staff pharmacists. Well-organized training programs can effectively raise the performance standards of pharmacy departments and decrease the time spent in monitoring, evaluating, and correcting performance deficiencies of the staff.     

基于风险管理的智慧药房调剂差错预防体系的构建与实施

目的:构建基于风险管理的智慧药房调剂差错的预防体系,通过具体实施减少药房调剂差错的发生。方法:通过对药房管理中可能发生的风险因素进行识别和评估,从人员、设备、软件、处方以及人员与环境等构建差错预防风险管理体系,基于风险管理遏制差错的发生。结果与结论:通过构建风险管理体系、建立健全智慧药房各项规章制度,规范药房人员处方调配和管理,全方位的实施差错预防风险管理,有效减少智慧药房调剂差错和医患矛盾的发生,规范了药房的工作,确保了患者用药的安全性和合理性。