Pharmacy services in a 240-bed Gordon Friesen-design hospital

This article describes a typical Gordon Friesen-design institution in which the facility design and systems design complement one another to make an efficiently run hospital. The basic concepts of the hospital are to keep the nurse with the patient and to maintain a steady supply flow by centralizing responsibility for materials. Problems that occur in pharmacies of facilities designed by Friesen usually are related to logistics. The design of the institution make delivery of medication and communication with staff nurses more difficult. Pharmacy programs such as unit dose and intravenous admixtures, excellent examples of products in "patient-ready units," complement the other supply delivery systems that are typical of a Friesen-design institution. Good written and verbal communications between nursing staff and pharmacy can bring about a smoothly flowing pharmacy service that blends with the overall concept.     

Implementing a mainframe packaged pharmacy computer system in a 190-bed hospital

The implementation of a pharmacy computer system in a 190-bed institution is described. A computer system was instituted in the pharmacy department as part of a hospitalwide conversion to an online information system. Planning for implementation began nine months before the actual live date (date of full computerization). Problems in the existing distribution and record-keeping systems that might be eliminated by computerization were identified, and changes in the layout of the pharmacy and department procedures were initiated to prepare for computerization. The events leading to computerization are presented in chronological order, and the advantages and shortcomings of the system are discussed. Because of careful planning, the cooperation of all pharmacy staff members, and frequent assistance from the computer vender, the nine-month conversion to a computerized system proceeded smoothly.     

A respiratory therapy unit dose system in a 500-bed hospital

A comprehensive unit dose distribution system for respiratory medications is described with emphasis on generalized design principles. This system may be tailored to meet the needs of any institution. Methods for receipt and interpretation of the physician's orders, the profiling system, handling of initial orders, monitoring medications, preparation of unit dose respiratory medications, and routine distribution of orders are covered. This unit dose system allows the pharmacy to assume full responsibility for the procurement, storage, and distribution of all respiratory medication. The pharmacist can provide the respiratory therapist with standardized, sterile quality-controlled medications that are ready to administer. Controlled cost and equitable charging procedures are also provided.     

Implementing a stand-alone packaged pharmacy computer system in a 580-bed hospital

The problems experienced by a hospital pharmacy department in implementing a stand-alone packaged computer system are discussed, and recommendations for avoiding and managing these problems are presented. In 1984, a stand-alone packaged computer system was implemented in a 580-bed, tertiary-care institution that provides services from a central pharmacy and five satellite pharmacies. The department developed a request for proposal and contracted with a vender for a system that would support unit dose drug distribution and i.v. admixture services. During the implementation process, the following problems were experienced: The hardware was insufficient for the department's workload, the software design was limited, and personnel were frustrated with learning to use the system. These problems were intensified by the heavy workload and the large number of users. In the 18 months since implementation, the department has purchased more hardware, improved the software applications, and resolved many of the problems associated with employee frustration. Pharmacy departments at other large institutions might avoid some of these problems by training personnel adequately before implementation and by researching and estimating hardware and software needs in advance. In this large hospital, the efficiency of a stand-alone packaged pharmacy computer system has improved 18 months after implementation.     

Pharmacy-initiated introduction of patient-controlled analgesia to a 400-bed community hospital

The pharmacist's role in the implementation of patient-controlled analgesia (PCA) in a 400-bed community hospital is described. PCA for postoperative patients was introduced on the recommendation of the pharmacy and therapeutics committee. A subcommittee selected a PCA pump, developed a physician order form and patient monitoring sheet, and in March 1987 initiated a two-month pilot study of PCA therapy in orthopedic-surgery patients. An orthopedic-service pharmacist developed an inservice-education program for the physicians, anesthesiologists, and nurses involved in the care of these patients. Because of the support of anesthesiologists for this program, PCA use during the two-month period rapidly expanded beyond orthopedics to include general and genitourinary-gynecologic patients. Nursing staff demand for PCA inservice education became so great that all staff pharmacists participated in the teaching. Pharmacists in the decentralized areas also provided one-on-one instruction to physicians, nurses, and patients. Positive evaluations of PCA therapy by patients and nurses and favorable patient pain assessment scores, in addition to the hospital-wide acceptance and use of PCA by medical staff, indicated that the program was a success. Active pharmacist participation was a major factor in PCA being well accepted by physicians, nurses, and patients as an effective alternative method of narcotic administration.