Pharmacy costs associated with nonformulary drug requests.

Pharmacy costs associated with handling nonformulary drug requests were studied. Data for all nonformulary drug orders received at a university hospital between August 1 and October 31, 1999, were evaluated to determine their outcome and the cost differential between the nonformulary drug and formulary alternative. Two sets of data were used to analyze medication costs: data from nonformulary medication request forms, which allowed the cost of nonformulary drugs and their formulary alternatives to be calculated, and data from the pharmacy computer system, which enabled actual nonformulary drug use to be captured. Labor costs associated with processing these requests were determined through time analysis, which included the potential for orders to be received at different times of the day and with different levels of technician and pharmacist support. Economic analysis revealed that the greatest cost saving occurred when converting nonformulary injectable products to formulary alternatives. Interventions were least costly during normal business hours, when all the satellite pharmacies were open and fully staffed. Pharmacists' interventions in oral product orders resulted in a net increase in expenditures. Incremental pharmacy costs associated with processing nonformulary medication requests in an inpatient setting are greater than the drug acquisition cost saving for most agents, particularly oral medications.     

Potential economic effets of a brand standardization policy in a 1000-bed hospital.

The potential economic effects of a brand standardization policy on 50 multiple source, nonproprietary drugs in a 1000-bed hospital which uses a unit dose drug distribution system were studied. Inpatient drug usage cost and inpatient drug inventory cost for the year 1974 were compared under the existing nonformulary system and a simulated formulary system of brand standardization. Drug usage cost was defined as expenditures made by the study hospital for drugs which were administered. Drug inventory cost was defined as the dollar value of drug inventory being stored for use in the hospital. Potential saving in excess of $35,000 for drug usage cost and $9,000 for drug inventory cost could have been realized with a brand standardization policy on 50 nonprietary drugs. The differences in costs were significant at the 0.005 level. It is concluded that a brand standardization policy can be effective means of reducing drug usage cost and drug inventory cost in a large hospital.     

Evaluating a restrictive formulary system by assessing nonformulary-drug requests

Nonformulary-drug requests were used to evaluate a restrictive formulary system in a large university hospital, and a telephone survey of eight similar hospitals was conducted to assess the restrictiveness of their formulary systems. Nonformulary-drug requests were evaluated by two drug information pharmacists over a 12-month period (January-December 1984) to assess the frequency with which nonformulary items were ordered, the costs associated with the procurement of nonformulary drug products, and the rationales given by physicians when ordering nonformulary products. Of all nonformulary requests, 65% were for drugs previously evaluated by the pharmacy and therapeutics committee and denied admission to the formulary. A cost savings of $1887 would have resulted if formulary alternates had been used instead of nonformulary products. Excluding 22% of nonformulary items that were requested for the continuation of preadmission drug therapy, only 13% of the rationales for the remaining requests were appropriate. Although the eight other hospitals surveyed said they had restrictive formularies, all had frequent requests and procedures for procuring nonformulary items and some formularies included most available drugs. The formulary system at the study hospital was considered restrictive, but procedures for nonformulary-drug requests limited the effectiveness of the system. If any benefit is to result from formulary systems, hospitals must strengthen their enforcement of formulary restrictions.     

Effect of pharmacists' clinical interventions on nonformulary drug use

The effect on drug costs of pharmacists' interventions in reducing the use of nonformulary medications was studied in a private teaching hospital. During a four-month period, nonformulary medication request forms and pharmacist consultation logs were reviewed to determine physicians' actions taken on requests for nonformulary medications. Cost avoidance of interventions (nonformulary medication cost) and the cost of pharmacist cost) and the cost of pharmacist time for the interventions were determined. The pharmacist was able to contact The pharmacist was able to contact the physician in 388 of 394 instances in which the use of a nonformulary medication was considered. Of 230 recommendations by pharmacists to change a nonformulary drug order to one for a formulary alternative, 64.8% (149) were accepted by physicians. Of pharmacists' recommendations that were accepted, 75.8% (113/149) were from decentralized areas, which was a significantly higher acceptance rate than that for the centralized areas (24.7% or 36/149). Cost avoidance resulting from acceptance of pharmacists' recommendations during the four-month study was $2,645, or $13,573 per year; this was more than the cost of pharmacist time required to perform interventions. Pharmacist interventions to decrease use of nonformulary drugs can be cost-effective and appear to be more successful in decentralized pharmacy service areas than in areas served by a central pharmacy.     

Electronic data interchange for pharmacy inventory control

The use of electronic data interchange (EDI) for controlling pharmacy inventory at a 303-bed hospital is described. The hospital, which belongs to a group purchasing consortium, uses EDI to exchange information with its primary drug wholesaler. The pharmacy's personal computer and software provided by the wholesaler are used. EDI enables the pharmacy to (1) select and order items by using hand-held bar-code scanning devices, (2) upload this information into the pharmacy's computer, (3) review the order before transmission, and (4) access the wholesaler's inventory. The pharmacy also uses EDI with its primary i.v. supplier. Using EDI for placing the daily pharmaceutical and i.v.-supply orders reduces by one half the daily time expenditure for purchasing. In addition, EDI provides various inventory-related reports. EDI provides an efficient and effective way to control pharmacy inventory.     

药库零库存成本效益分析

目的:用药物经济学评价的方法综合评价药库零库存带来的收益和成本,为药库零库存管理提供参考。方法:利用药物经济学成本效益分析方法对我院药库零库存成本和效益情况进行分析,以2018年数据测算零库存条件下医院资金周转成本、库房成本、人员成本、房屋经济效益等,并测算同等条件下非零库存模式时的理论成本效益,并进行敏感度分析。结果:零库存和非零库存药库成本分别为4 081.07万元和4 739.79万元,其中医院资金周转成本最高,二者占比分别91.64%、87.47%。采用药库零库存预计每年可为医院节约成本658.72万元。而随着药品采购时间延长2 d、4 d时,成本将增加至4 475.93万元和4 870.79万元。结论:绝对零库存是一种理想状态,零库存只是一种降低成本的策略,不应该成为医院刻意追求的目标。医院应该根据自身的条件、制定一个全面的、科学的、合乎自身的经营需求的储备药品方案,在保证药品供应前提下提高药品周转率、优化库存,降低成本提高医院经济效益。     

Monitoring a primary wholesaler depot program

Techniques for monitoring a primary wholesaler depot program used by a university hospital pharmacy department are described. One year after the program began, data from the past four months, obtained from monthly management reports provided by the wholesaler, were reviewed. Attention was focused on the drugs and drug categories that represented the bulk of purchases (in dollar value). Summary purchase orders showed that approximately half the drugs were purchased at the most favorable prices (usually contract bid prices). Most drugs not purchased at the most favorable bid prices were accounted for by sole-source items, inadequate computer documentation by the wholesaler, and atypical orders. A study of ordering patterns revealed that 16 of the top 40 drugs ordered (by volume and dollar expenditures) were ordered less than once per month; the inventory management goal was to order a two-week supply. The wholesaler could not completely fill orders for 18% of the contract drugs, often because of back orders from manufacturers. Although the computerized management reports used in this study did not allow evaluation of all aspects of the primary wholesaler depot program, they provided a convenient mechanism for concurrent assessment of the program's effectiveness. The program appeared to be advantageous to the pharmacy department, and most problems encountered were easily remedied. Several performance measures for institutions considering depot programs are recommended.     

Improving a pharmaceutical purchasing and inventory control system

A method by which a pharmacy department improved its purchasing and inventory control system is described. System changes to the computerized inventory control system included implementation of a formulary, affiliation with a group purchasing association, and transfer of specified purchasing and inventory control functions to the technical staff of the purchasing department. Pharmacy maintained the decision-making authority over all vendors and dosage forms of drug products. Optimal results were achieved when the purchasing department's pharmacy buyer position was staffed with an employee who had previous experience as a clerical worker in the pharmacy. The authors state that this system has proved to be an effective, cost efficient method of purchasing and inventory control of pharmaceuticals in their hospital.     

Clinical pharmacists as allied health care providers to psychiatric patients

The effect of clinical pharmacy services on the quality and economy of health care provided to psychiatric patients at a Veterans Administration outpatient clinic was evaluated. Twenty-one patients were selected from the Day Treatment Center, of these, 19 patients completed the study. In providing health care to these psychiatric patients, the clinical pharmacist used a systemized approach including data gathering, evaluation, plan of action, and follow-up. In addition, medication groups and weekly staff meetings were incorporated into the patient treatment plan. Following a 3-month study period, the impact of clinical pharmacy services was evaluated. The provision of allied health care to psychiatric patients by clinical pharmacists resulted in a decreased incidence and severity of adverse drug effects, fewer drug use problems, a reduction in the total number of drugs prescribed, improved patient drug knowledge, and reduced expenditures for health care without compromising the patient's mental functioning.     

两种门诊库存管理方法的对比分析

目的：将ABC分析法和排序分析法进行对比分析,选择适合于我院的方法,以降低药品的管理成本。方法：通过医院His系统对我院门诊药房2014年1月~12月药品入库数据和实际销售数据进行统计分析,分别运用ABC法和排序法对药品进行分类,计算库存周转天数,设置每类药品的库存上下限。结果：根据ABC法进行分类,A类药品71个品种,实行重点管理;B类药品70个品种,实行一般管理;剩余的331个品种为C类,适当宽松管理;A、B、C分类分别占药品总品种数的15.04%、14.83%、70.13%。根据排序法进行分类,重点管理的品种数为163种,占药品总品种数的34.53%,剩余的309种药品实行非重点管理。ABC法划分的A类、B类药品的库存周转天数均在15天以内,库存上下限设置为A类为3~7天、B类为7~15天、C类在此基础上适当延长;排序法划分的重点管理品种98%以上药品的库存周转天数在15天以内,库存上下限设置为7~15天,剩余部分的重点管理品种以及非重点管理品种库存上下限适当延长至20天或1个月。结论：以两法对比分析结果为依据,综合两法的优点,取长补短,建立适合我院门诊药房的药品分类管理方法,保证药品供应,降低药品管理成本,实现药品库存的科学化管理。     

National survey of selected hospital pharmacy practices.

The incidence of 10 selected hospital pharmacy programs in short-term hospitals which contained a pharmacy was surveyed. A short questionnaire was mailed to a national sample of 738 hospitals. The 10 programs surveyed were: unit dose drug distribution; pharmacy-prepared i.v. admixtures; pharmacy-controlled drug administration; radiopharmaceutical dispensing; drug usage review; use of computers in the dispensing process; 24-hour pharmacy service; participation in group purchasing; pharmacy operation of central supply; and pharmacists' authority to select the brand or supplier of drugs. In addition, the volume of drug and supply purchases was determined. A large number of pharmacies (41%) belonged to a group purchasing plan, and a high percentage (67%) reported that pharmacists had authority to select the source of supply for all drug orders unless noted otherwise by the prescriber. Less than 10% of the hospitals had both complete unit dose drug distribution and intravenous admixture programs; an additional 10% had implemented such programs partially. Only 17% of the pharmacies in large hospitals were open 24 hours a day. Computer-assisted medication dispensing was used by 13% of the large hospitals and 5% of the small hospitals. Total pharmacy purchases for all short-term hospitals in 1974 was estimated to be 1.5 billion dollars.     

Comprehensive therapeutic interchange program in a community hospital

The implementation of a comprehensive therapeutic interchange program is described. The need to reduce the number of telephone calls to physicians about nonformulary drug orders, reduce drug costs, and maximize the effectiveness of drug therapy prompted the development of an automatic therapeutic interchange program at a 273-bed nonteaching community hospital. Pharmacists and physicians agreed that a telephone call to discuss every nonformulary drug order was unnecessary. The pharmacy department presented the automatic interchange program to the pharmacy and therapeutics committee. The program was reviewed by the committee, the hospital attorney, and medical staff members and was instituted in 1986 for drug products, such as vitamins and antacids, for which interchanges are noncontroversial. A newsletter describing the program was distributed, and inservice education sessions were held. A reminder was placed on order forms that an interchange for nonformulary drugs would be made unless the nonformulary agent was deemed "medically necessary" by the physician. In such cases, the physician is contacted to discuss the therapeutic alternative. As acceptance of the program and cost efficiencies were demonstrated, more controversial agents were phased in during subsequent years. It was difficult to obtain approval to add some agents, such as third-generation cephalosporins, to the program, but noncompliance and confusion have been minimal. An automatic therapeutic interchange program has worked well at this institution since 1986.     

ASHP national survey of hospital pharmaceutical services--1987

The results of a fall 1987 national mail survey of pharmaceutical services in short-term hospitals are reported and compared with similar surveys conducted in 1975, 1978, 1982, and 1985. A sample of 875 hospitals was selected randomly from among the estimated 5600 U.S. short-term hospitals that employ a pharmacist on at least a part-time basis. The survey had a 71.1% response rate (617 usable replies). Nearly three-fourths of the respondents had complete unit dose drug distribution services (UDD), 68% reported complete i.v. admixture services (IVA), and 57% reported both complete UDD and complete IVA. Nearly 5% of respondents offered five specified clinical services (up from 1.8% in 1985); 24% reported having no clinical services (versus 38% in 1985). Nineteen percent said their departments had one or more clinical specialists. Overall, about one-third of pharmacy technicians had completed formal training. The number of respondents with programs to contain drug costs increased about 10% since 1985. Weekly hours of pharmacy operation averaged 102; 36.7% of respondents had pharmacy service around the clock. The percentage of hospitals with computerized drug distribution systems increased from 32% in 1985 to 52% in 1987. Prime vendors were used by 94.6% of respondents, and only 2% reported that they did not use a purchasing group. National expenditures for drugs and fluids for community hospitals were projected at $4.7 billion, personnel costs at $1.8 billion, and other pharmacy expenditures at $0.4 billion. The projected numbers of open positions nationally for pharmacists in community hospitals was 1950. The survey also collected data on the use of personal computers, inventory turnover, quality assurance, continuing-education philosophy, revenue-generating programs, and outpatient services. Drug control in community hospitals is improving, and clinical services are more widespread. Twenty percent of respondents had comprehensive pharmaceutical services, defined as complete UDD and complete IVA plus three or more clinical services.     

Developing and implementing a statewide formulary system: one state's experience

Prior to the Pennsylvania Department of Public Welfare (DPW) implementing a statewide formulary for its 21 mental health hospitals and mental retardation facilities, each facility had its own drug use policy. In many facilities, drugs were ordered with little or no cost-containment or drug-management consideration. To change drug purchasing and usage policies, a task force was created to develop a state formulary system. The task force appointed a formulary subcommittee to research and make recommendations on issues such as drug selections, formulary substitutions, and nonformulary drug use. The step-by-step process of developing and implementing the Pennsylvania DPW state formulary--including pitfalls and successes--is presented.     

Challenges in purchasing and inventory control

In this concluding installment in a multipart series, issues that should be considered in the improvement of hospital pharmacy purchasing and inventory control systems are presented. Pharmacists must be aware of possible variation in bioavailability among different formulations of the same drug and evaluate new vendors critically. Hospital pharmacists and industry representatives should strive for a cooperative relationship by fostering ongoing dialogue. Pharmacists must continue to demand competitive bid prices on generically equivalent products of equal quality. Firm contact prices cannot be expected if product use estimates are unreliable. It is unethical to encourage additional price reductions on competitive products after a formal bid has been received. Institutions should limit their participation to one group purchasing organization or wholesaler for the competitive bid process. Inventory management through methods such as ABC analysis, economic-order quantities, calculated optimum reorder points, and other quantitative measurements should become commonplace. The use of data processing systems and devices can enable pharmacists to become more proficient at pharmaceutical purchasing and inventory control. The acquisition and distribution of pharmaceuticals in health-care institutions require good management to capture the opportunities in this area for pharmacy to contribute to fiscally sound health care.     

Nonformulary drug requests at an academic hospital in Germany – the role of general practitioners' long-term medication

Objective: To determine the influence of general practitioners' outpatient medication on nonformulary drug requests in university hospitals. Methods: During a period of 1 year every nonformulary drug request at the Göttingen University Hospital was analysed (reason for request, drug class). A second analysis examined whether the introduction of a new order form that allowed the prescribing physician to mark a box to declare that this request is due to general practitioner's outpatient therapy influenced the rate of requests. Results: During 12 months a total of 6,281 nonformulary drugs were ordered from the pharmacy, 1,077 (17.1%) of them because of outpatient medication. The percentage of requests according to general practitioners' outpatient medication was about 11% in both the medical and the surgical departments. The rate was rather high in the departments of psychiatry and orthopaedic surgery (39% and 60%, respectively). With the introduction of the new order form, there was a significant increase in the general practice based rate of nonformulary requests on the general surgical wards (from 10.8% to 19.9%). Only a minority of requests (14%) represented drugs of unproven efficacy. Conclusion: Since nonformulary requests attributable to previous outpatient medication accounts for less than 20% and since only a minor portion of them lack scientific proof of efficacy we suggest that hospital doctors and clinical pharmacologists should avoid a drug policy, which is too restrictive, and support maintenance of chronic medication initiated by general practitioners. Especially in the department of psychiatry, nonformulary requests seem to be justified by patient needs.     

Computer-generated reports for monitoring variances in the drug budget

A computerized pharmaceutical-purchasing cost-management system that can be used to monitor variances in the drug budget is described. Variance reports on inflation, volume of drugs used, and changes in inventory are generated monthly to determine whether the pharmacy is operating within its budget. The reports are processed on an IBM personal computer with the use of a dBASE-III management software package. The price and quantity of each drug, as specified in the standard drug budget, are entered into the system; using approximately four hours per month is required for entry of the quantities and prices of drugs received as noted on the invoice. Variances in the budget are reviewed, and drug-use data are assessed to determine trends. Demand intensity (use per 1000 cases) is also tracked to determine the effects of educational programs on the proper use of drugs. Variance reports generated by a computerized budget-monitoring system provide the pharmacy with timely cost data that can be used to monitor the effects of drug-use guidelines and educational programs on the budget.     

Controlling financial variables--purchasing, inventory control, and waste reduction

Purchasing, inventory control, and waste reduction techniques designed to minimize nonpersonnel expenditures are reviewed. Cost-saving purchasing mechanisms described include competitive bidding, contract negotiation, group purchasing, and primary wholesaler purchasing. The relative benefits of basic inventory management methods, including the ABC method, minimum and maximum levels, economic order quantity and value, and volume discount evaluation, are described. Waste and pilferage reducing methods discussed are unit dose drug distribution, i.v. admixture systems, and policies for use of i.v. sets and infusion pumps. Pharmacy departments in all institutions can reduce costs.     

基于医院中药饮片实施“相对零库存”优化管理的研究

目的研究特定的中药库存控制策略,为医院药品的库存与使用优化管理提供参考。方法改造中药房与周转库的仓储硬件设施;优化人力资源配置,强化管理机制;科学制订采购计划;开展对饮片供应商的遴选和评价;发挥“药品质量管理小组”对中药供应与质量的监督作用。结果中药周转加快,库存积压减少;效期药品循环良好,减少资金与空间的占用,;管理人员素质与工作效率得到提高;完善了饮片供应商遴选和评价的一体化协作体系,有效保证了临床供应。结论通过实施“相对零库存”基本实现医院中药库存成本的最低化、效用的最大化。