静脉药物配置中心不合理用药分析

随机抽取本院静脉药物配置中心2008年长期医嘱12210份,对用药情况进行统计.其中376份医嘱存在用药与诊断不符、重复用药、配伍禁忌、溶媒不当、间隔时间不合理、用法用量不当等情况：提示药师需加强对临床用药的审核与监控.     

ASHP national survey of hospital-based pharmaceutical services--1990

The results of a national mail survey of pharmaceutical services in community hospitals conducted by ASHP during May through July 1990 are reported and compared with the results of earlier ASHP surveys. A sample of community hospitals (short-term, nonfederal) was selected randomly from the population of community hospitals registered by the American Hospital Association. Questionnaires were mailed to each director of pharmacy. The adjusted gross sample size was 881. The net response rate was 66% (582 usable replies). The average number of hours of pharmacy operation per week reported by the respondents was 96. Complete unit dose drug distribution was offered by 89% of the respondents (up from 74% in 1987). About 70% offered complete, comprehensive i.v. admixture programs (essentially unchanged from 1987). Most of the hospitals (70%) had centralized pharmaceutical services. A computerized pharmacy system was present in 64% of the departments, and 75% had at least one microcomputer. More than 90% reported participation in adverse drug reaction and drug-use evaluation programs. Some 80% participated in drug therapy monitoring. Almost half of the respondents regularly provided written documentation of pharmacist interventions in patients' medical records. Approximately one third provided patient education or counseling, and one third provided drug management of medical emergencies. A well-controlled formulary system was in place in 58% of the hospitals; therapeutic interchange was practiced by 49%. A total of 98% of the respondents participated in group purchasing, and 96% used a prime vendor. Half of the departments served as training sites for pharmacy students. Less than half had a staff development program, but about two thirds supported continuing-education activities for pharmacists. The 1990 survey revealed a continuation of the changes in many hospital-based pharmaceutical services documented in earlier surveys and identified static areas that merit the attention of pharmacy leaders.     

Strategic planning for clinical services: St. Joseph Hospital and Health Care Center

A pharmacy department at a 340-bed community hospital based its strategic plan for developing patient-oriented services on a sound drug distribution system, a credible work-measurement program, and fiscal responsibility. In 1982 the department of pharmacy and i.v. therapy implemented a strategic plan for improving pharmaceutical services. The plan involved developing goals and objectives for the department; marketing the department's services and fiscal management to hospital administrators, medical staff, and nursing staff; building teamwork among the pharmacy staff; and improving the drug distribution system before instituting clinical services. Hiring of additional pharmacy staff was justified on the basis of work-measurement data. By adjusting staffing levels every two weeks based on work-measurement data, the department increased the efficiency of drug distribution activities; the pharmacy also implemented cost-saving programs like selection of therapeutic alternates and formulary restrictions. The savings were then reinvested in labor-intensive patient-oriented pharmaceutical services. A staff development program using staff pharmacists as preceptors expanded the breadth and depth of pharmacists' clinical skills. The planning efforts were successful because the needs of hospital administrators, the pharmacy department, and staff members were addressed.     

Use of benchmarking techniques to justify the evolution of antibiotic management programs in healthcare systems.

OBJECTIVE: To apply basic benchmarking techniques to hospital antibiotic expenditures and clinical pharmacy personnel and their duties, to identify cost savings strategies for clinical pharmacy services. DESIGN: Prospective survey of 18 hospitals ranging in size from 201 to 942 beds. Each was asked to provide antibiotic expenditures, an overview of their clinical pharmacy services, and to describe the duties of clinical pharmacists involved in antibiotic management activities. Specific information was sought on the use of pharmacokinetic dosing services, antibiotic streamlining, and oral switch in each of the hospitals. RESULTS: Most smaller hospitals (< 300 beds) did not employ clinical pharmacists with the specific duties of antibiotic management or streamlining. At these institutions, antibiotic management services consisted of formulary enforcement and aminoglycoside and/or vancomycin dosing services. The larger hospitals we surveyed employed clinical pharmacists designated as antibiotic management specialists, but their usual activities were aminoglycoside and/or vancomycin dosing services and formulary enforcement. In virtually all hospitals, the yearly expenses for antibiotics exceeded those of Millard Fillmore Hospitals by $2,000-3,000 per occupied bed. In a 500-bed hospital, this difference in expenditures would exceed $1.5 million yearly. Millard Fillmore Health System has similar types of patients, but employs clinical pharmacists to perform streamlining and/or switch functions at days 2-4, when cultures come back from the laboratory. CONCLUSIONS: The antibiotic streamlining and oral switch duties of clinical pharmacy specialists are associated with the majority of cost savings in hospital antibiotic management programs. The savings are considerable to the extent that most hospitals with 200-300 beds could readily cost-justify a full-time clinical pharmacist to perform these activities on a daily basis. Expenses of the program would be offset entirely by the reduction in the actual pharmacy expenditures on antibiotics.     

Activities, functions, and structure of pharmacy and therapeutics committees in large teaching hospitals.

The results of a survey on the activities and functions of hospital-based pharmacy and therapeutics (P&T) committees are presented. Questionnaires were mailed to the pharmacy director or the person responsible for the pharmacy's drug information service at 267 teaching hospitals throughout the United States in 1994 and 1995. The survey questions covered P&T committee composition, functions, roles of members, policies and procedures, and formulary-maintenance activities. The overall response rate was 70%. The mean number of members on the P&T committees was 19.3, of whom 91% were allowed to vote. There was an average of 12.3 physicians on the committees. Each P&T committee had at least one pharmacist member, with an average of 3.2 pharmacist members; 69.5% of the institutions reported having a committee secretary, who was almost always a pharmacist. On almost all committees, pharmacists wrote the minutes, prepared the formulary review documents, and were responsible for monitoring formulary activities outside the meeting. The P&T committee functioned in a very formal manner. Most (87.7%) of the respondents reported that their institutions had a closed formulary. At all hospitals, the attending medical staff could request additions to the formulary, but at only 62.4% of the hospitals could pharmacy staff make a similar request. The committees were active in changing the formulary. P&T committees in large teaching hospitals are active in formulary management, are large and diverse, and consist mainly of physicians, although pharmacists play an important role in the meetings.     

Pharmacy involvement in formulary development: community pharmacists' views

A postal survey was carried out in the Eastern health and social services board in Northern Ireland to evaluate the views of community pharmacists (n= 100) on pharmacy involvement in formulary development. There was one mailing, with a response rate of 66 per cent. Most respondents (78.7 per cent) agreed or strongly agreed that pharmacist involvement in formulary development was important. Almost two thirds of responding pharmacists said they would be prepared to approach a GP in relation to such collaborative work and 27 per cent had had previous contact with GPs on the subject. Respondents considered that their input would be particularly useful in improving prescribing, providing cost advice and developing a closer working relationship with GPs. Evaluation of current levels of interprofessional liaison in relation to prescribing issues showed that 33.3 per cent of the pharmacists were already contacted by a GP regularly and 45.4 per cent contacted a GP regularly. Most (80 per cent) rated their working relationship with the GP as useful or very useful. The results suggest that community pharmacists in the Eastern health and social services board are willing to become involved in formulary development, thereby extending the use of practice formularies in general practice and integrating community pharmacy more fully into the primary health care team.     

Fighting against COVID-19: Innovative strategies for clinical pharmacists

BackgroundClinical pharmacists’ routine task is carrying out pharmaceutical care to ensure patients' safe and reasonable medication use. However, under public health emergencies, such as the outbreak of COVID-19, the work strategies of clinical pharmacists need to be modified according to the rapid spread of the disease, where information and resources are usually lack to guide them.ObjectiveTo retrieve and investigate the prevention and control measures of clinical pharmacists during the outbreak of novel coronavirus, summarize the roles and responsibilities of clinical pharmacists, and to propose innovative strategies for developing pharmacy services under the epidemic.MethodsThe Chinese and English databases, self-media network, website of professional society or medical institution, and clinical trial center platforms were searched, and clinical pharmacists involved in the work against COVID-19 were surveyed and interviewed. Investigate the challenges and needs of frontline medical staffs for treating patients, and formulate strategies based on the actual medical environment.ResultsClinical pharmacists play a vital role in leading the industry to formulate work instructions, provide frontline medical staff with drug information, and develop innovative pharmacy services to promote the rational use of medicines with collaborative teamwork and close communication according to the epidemic situation of COVID-19. Anti-epidemic work indeed has driven the development of remote pharmacy services.ConclusionFacing public health emergencies, clinical pharmacists can give full play to their professional expertise, analyze the current situation rationally, formulate telehealth strategies swiftly, and work in a united and efficient manner to provide innovative pharmacy services to ensure medication safety and rational use of medicine.     

Educational opportunities and anti-doping roles and responsibilities for pharmacists

Drug use and abuse by athletes has become a common problem. Pharmacists can assist by managing the legitimate medication needs of athletes to prevent them from accidentally using a banned substance. Pharmacists can also educate athletes and the public about the health consequences of using performance-enhancing substances. Pharmacists can play a variety of roles to assist with anti-doping. Such roles include educating, advising, dispensing and monitoring medications and supplements; and working with anti-doping agencies. There are few established educational opportunities for pharmacists and pharmacy students. Educational programs in sports pharmacy and doping control need to be developed for instruction in the classroom, for post-graduate training and for experiential programs. Classroom instruction should include information about performance-enhancing substances and general principles of doping control. Student activities for an established advanced pharmacy practice experience include education on performance-enhancing substances and assay technologies, preparing and providing presentations to athletes and others regarding these substances, performing literature research on drugs and dietary supplements used to improve athletic performance, writing a monograph on these substances, and participating in doping control programs.     

Time and cost requirements for decentralized pharmacist activities

Time and cost requirements for pharmaceutical services in patient-care areas at a 548-bed university hospital were studied. The study was conducted in 1987 and 1988 to (1) define the clinical and distributive activities of decentralized pharmacists, (2) develop time standards for each activity, (3) determine whether the time requirements of decentralized pharmacists depend on the type of patient involved, (4) determine the actual costs of decentralized pharmacist services for various types of patient, and (5) compare costs with reimbursement for clinical pharmacy services. Time standards were established based on data from seven patient categories representing a cross section of the institution's patients. The mean frequency of each activity and the total time and cost per patient day for all activities were determined. Pharmacist time spent daily in each patient-service category ranged from 2.3 hr for low-intensity medical care to 20.8 hr for trauma-burn intensive care. Decentralized pharmacists spent approximately 50% of their time on clinical activities in all patient-service categories. The daily cost per patient day for clinical activities was lowest for low-intensity medical care and highest for adult intensive care. The institution's daily charge for clinical activities ($10/admission and $10/day) exceeded the cost of clinical services during the study period. The decentralized pharmacist time requirement per patient day, and thus the costs of delivering pharmaceutical services, varied by patient-service category. The provision of clinical services generated a profit. A pharmacy workload analysis system that can identify costs and correlate them with patient types can be valuable in hospital pharmacy management.     

青运会医疗中心药学服务工作探讨

目的：探讨青运会期间青运村医疗中心药房工作并分析药学服务情况,为今后大型体育活动药学保障工作提供建议。方法：总结医疗中心药学服务准备工作及管理流程,按照时间节点分类统计每日处方信息,汇总用药咨询指导建议并对药学服务结果进行分析。结果与结论：通过精心的筹备、认真的学习及专业的培训,建立了医疗中心药房管理制度及保障运动员用药安全流程,完成处方调剂1664张,用药咨询50余次。针对运动员自备药品的合理使用和生理期选药等问题给予个体化的药学指导,对类似体育赛事药品的供应、储备及使用管理具有一定的指导意义。     

2010年广州亚运城运动员村医疗门诊部药房团队药学服务情况介绍

目的:分享广州亚运城运动员村医疗门诊部药房的药学服务工作经验。方法:建立药房服务理念和全面质量管理体系。结果与结论:通过精心准备、严格培训、团队合作,药房团队以高度的政治责任感、使命感和饱满的工作热情、熟练的业务技能和英语交流水平,为亚运会的体育健儿、中外贵宾、残障人士以及亚运村的工作人员、志愿者提供了全方位细致、周到的个体化药学服务。     

Educational differentiation of the pharmacy work force

A model of the pharmacy work force in which pharmacists are differentiated and quantified on the basis of their professional education is described, and the model is used to analyze work force data for 1978 and 1987. The educational differentiation of the pharmacy work force was represented by a three-tiered pyramid in which the base, second, and third levels comprised pharmacists with a B.S. degree, a Pharm.D. degree, and residency or fellowship training, respectively. The number of pharmacists at each level was tabulated for 1978 and 1987 by using data from the National Center for Health Statistics, the American Association of Colleges of Pharmacy, ASHP, and other sources. In 1987, as in 1978, more than 90% of pharmacists had no formal training beyond the B.S. degree. However, the proportion of pharmacists with Pharm.D. degrees did increase from 1 in 30 to 1 in 16, and proportionately more pharmacists were receiving post-Pharm.D. training. Large state and regional differences were seen in the number and educational level of pharmacists. Differentiation in the physician and nursing work forces was examined; the physician work force was highly specialized, but nurses showed a more balanced differentiation. An increase in the demand for postgraduate training of pharmacists was projected. The educational differentiation model shows that the pharmacy work force is highly undifferentiated and that education at the Pharm.D. level should be emphasized. Such emphasis will increase the demand for residency and fellowship programs and improve the image of pharmacy as a profession.     

Monetary incentive for pharmacists to control drug costs

An incentive program that paid hospital pharmacists at United Hospitals Incorporated (UHI) and Children's Hospital Incorporated (CHI) a percentage of the money saved by the pharmacy on drug and i.v. expenses in 1984 is described. Hospital administration, as part of a hospitalwide incentive program, approved the pharmacy department's proposal for a monetary incentive program. Pharmacy managers hoped that, by rewarding all pharmacists for their efforts to control costs, they could potentiate other cost-containment programs (stronger formulary control and improved purchasing and inventory control) and improve clinical services while maintaining quality of care. The incentive calculation was derived from the percentage of expenses saved on drugs and i.v. solutions and sets relative to budget. The payout, to be applied to 1984 salaries of pharmacists, could not exceed 10% of salary or more than 35% of the total savings to the hospital. A screening mechanism was established to protect the hospital from paying an incentive if the total pharmacy expenses exceeded budget. In fiscal 1984, drug and i.v. expenses per adjusted case decreased 1.55%, which led to each full-time pharmacist receiving an average payout of $500. This payout was less than had been anticipated because of a nursing strike at other hospitals, which resulted in an influx of intensive-care patients. The monetary incentive program for pharmacists is a useful tool for controlling drug and i.v. expenses and for rewarding pharmacists for successful cost-saving approaches.     

Formulary-control procedures in a staff-model health maintenance organization

Efforts to promote cost-effective drug prescribing in a health maintenance organization (HMO) through (1) revision of the formulary, (2) education, and (3) drug-use evaluations (DUEs) are described. New programs and procedures to promote more cost-effective prescribing were implemented in 1987 at a staff-model HMO with seven health-care centers and 40,000 members. Support to the pharmacy and therapeutics committee in developing formulary recommendations was enhanced, the formulary was revised and the number of listed drugs reduced by half, the focus of pharmacists was changed from purchasing and inventory control to education of physicians about cost-effective prescribing, and the most expensive drug categories were identified and educational efforts instituted. During the next two years substantial changes in the prescribing of oral contraceptives, nonsteroidal anti-inflammatory drugs, antiulcer agents, and anti-infectives, but not antihypertensive drugs, were identified through DUEs. Evaluation of cost savings was limited by the lack of an automated, integrated patient database, and it was difficult to assess the effect of changes in patient population. Revision of the formulary coordinated with enhanced educational efforts and DUEs resulted in more cost-effective prescribing in an HMO without placing severe restrictions on physicians or patients.