A survey of hospital pharmacy research in Canada.

During the past two years, the CSHP Research Committee was given the tasks of evaluating the present status of hospital pharmacy research and developing positive recommendations for future action. In order to determine the specific needs and interests of Canadian hospital pharmacists, a survey of the CSHP membership was conducted in April of 1987. Two hundred and twenty-two members (13.1%) responded to the survey. Fifty-six percent (124) of the respondents had completed one or more research projects and 30 percent (66) served as supervisors of at least one research study. Clinical drug studies, particularly DUR and pharmacokinetic projects, were the focus of most of the present research efforts. In addition to DUR and pharmacokinetics, the most popular "wish to do" research topics included pharmaceutics, cost benefit/analysis and other pharmacy practice research topics. The survey respondents indicated a strong desire for CSHP to sponsor research similar to the Workload Measurement Study. The Canadian Society of Hospital Pharmacists was also requested to provide educational programs and other methods of information dissemination for training in the field of research methodology.     

The Canadian Oncology Pharmacy Research Network

Research in hospital pharmacy has been increasingly highlighted in recent years, with special attention focused by the Research Committee of the Canadian Society of Hospital Pharmacists (CSHP). In a first attempt to organize potential oncology pharmacist researchers, an invitation to join a research network was distributed to hospital pharmacists across Canada in late 1988. Data sheets, including personal demographic data, practice and research information, members' perceived roles in future research projects, experience and training, interest in multi-centre research projects, and specific areas of research involvement were used to create a roster of pharmacist researchers. Sixty-nine pharmacists submitted their names to the roster. Details on each respondent were then transferred to a standardized data spreadsheet which was distributed back to each network member. Members then had a listing of potential researcher colleagues to aid in their development or participation in multi-centre studies. Data provided by the respondents were analyzed to characterize the nature of this network. Twenty of 60 members reported qualifications beyond BSc and 11 members hold advanced degrees. There was a wide variation of time available for research activities. A weekly commitment of three to ten hours (reported by 25/48) is a reasonable amount of time for successful research involvement. Previous training and experience are also positive factors: 25/69 had postgraduate training, 25/68 had previous experience conducting a research project and 34/67 had collaborated on a study project. There were two cohorts of potential researchers in oncology pharmacy--those who are prepared to run a project, and those who wish to contribute to projects.(ABSTRACT TRUNCATED AT 250 WORDS)     

The development of a Canadian hospital pharmacy workload measurement system

The aim of the proposed study is to establish a national workload measurement system for hospital pharmacy in Canada. No reliable method presently exists to determine staffing requirements for hospital pharmacy. In order to establish staffing guidelines, a method of scientifically assessing and measuring hospital pharmacy workloads is needed. It is proposed to develop worlkload measurement data for hospital pharmacy according to the Canadian Workload Recording Method of Statistics Canada. The Canadian Workload Recording Method was developed to provide a scientific basis for measuring clinical laboratory workload, thus promoting effective laboratory management. This method is now being applied to other health professions. Data for hospital pharmacy will be collected from various hospital pharmacy departments across Canada based on standardized definitions of modern hospital pharmacy practice. The proposed study will be carried out over a period of two years by a research group located at the College of Pharmacy, University of Saskatchewan, Saskatoon, in cooperation with the Canadian Society of Hospital Pharmacists. Workload measurement data of pharmacy services in Canadian hospitals will serve as a valuable management tool for hospital pharmacy directors, hospital administrators and federal-provincial funding agencies in the determination of total manpower needs and resources for hospital pharmacy. Also, information obtained will be of administrative assistance in the areas of: (a) development of standardized methods of recording hospital pharmacy management information; (b) generation of valid and reliable data to allow comparative studies of hospital pharmacy departments in terms of productivity and utilization of manpower; (c) determination of the proper staffing ratio between pharmacists and supportive personnel; and (d) development of short and long-term planning goals for the hospital pharmacy department. The Canadian Workload Recording Method was designed to reflect current practice by a system of continuous monitoring and review by the user. As new pharmaceutical services develop, additional workload studies can be conducted to establish new standards demonstrating the impact of future programs on manpower requirements.     

我国医院药学服务及临床药学开展现状调查(三)——临床药学相关者态度意向调查

目的:了解我国医院相关人员对临床药学的态度意向。方法:采用信函式问卷调查,对通过分层、定距抽样选取的600家样本医院和42家临床药师制试点医院进行我国医院决策者、医师和药师对临床药学的态度、支持力度和可行措施调查,并对结果进行SPSS13.0统计分析。结果:医院领导对临床药学工作都有一定了解,支持率均大于60%;医院的临床医师对临床药学工作了解不深,但大部分医院支持率均大于59.5%;各级别医院药师对临床药学工作的开展的必然性都予认可,但对临床药学开展前景看法不同,64.2%的医院认为二级医院中开展临床药学工作难度很大。结论:当前推动临床药学发展,最为紧迫和重要的是采取措施培养临床药师人才;其次是使临床药学工作规范化,建立有效工作和管理模式;再次是改善国内用药环境,建立临床药学工作氛围;同时,对临床药学工作给予经济支持。     

Clinical pharmacy services, pharmacy staffing, and hospital mortality rates

OBJECTIVE: To determine if hospital-based clinical pharmacy services and pharmacy staffing continue to be associated with mortality rates. METHODS: A database was constructed from 1998 MedPAR, American Hospital Association's Annual Survey of Hospitals, and National Clinical Pharmacy Services databases, consisting of data from 2,836,991 patients in 885 hospitals. Data from hospitals that had 14 clinical pharmacy services were compared with data from hospitals that did not have these services; levels of hospital pharmacist staffing were also compared. A multiple regression analysis, controlling for severity of illness, was used. RESULTS: Seven clinical pharmacy services were associated with reduced mortality rates: pharmacist-provided drug use evaluation (4491 reduced deaths, p=0.016), pharmacist-provided in-service education (10,660 reduced deaths, p=0.037), pharmacist-provided adverse drug reaction management (14,518 reduced deaths, p=0.012), pharmacist-provided drug protocol management (18,401 reduced deaths, p=0.017), pharmacist participation on the cardiopulmonary resuscitation team (12,880 reduced deaths, p=0.009), pharmacist participation on medical rounds (11,093 reduced deaths, p=0.021), and pharmacist-provided admission drug histories (3988 reduced deaths, p=0.001). Two staffing variables, number of pharmacy administrators/100 occupied beds (p=0.037) and number of clinical pharmacists/100 occupied beds (p=0.023), were also associated with reduced mortality rates. CONCLUSION: The number of clinical pharmacy services and staffing variables associated with reduced mortality rates increased from two in 1989 to nine in 1998. The impact of clinical pharmacy on mortality rates mandates consideration of a core set of clinical pharmacy services to be offered in United States hospitals. These results have important implications for health care in general, as well as for our profession and discipline.     

Pharmaceutical services at Sint Radboud Hospital

This article describes a contemporary pharmaceutical and clinical pharmacy program at a major university medical center in The Netherlands. The service components described illustrate practice concepts on an international basis. The number of professional personnel and their training vary considerably among the nations, and this requires imagination in adapting practice concepts in various countries. Several types of technical persons are used to support the professional role of the pharmacist at Sint Radboud Hospital. Pharmaceutical research and international liaison are high priorities in the department of clinical pharmacy. Primary differences at Sint Radboud, as compared with U.S. hospitals, are the use of various supportive personnel and a continuing drug analysis/quality control program for commercial pharmaceuticals.     

Shared pharmacy services: a cost-effective programme for small hospitals.

A pilot project for shared pharmacy service was undertaken to investigate costs and benefits under an agreement established between University Hospital, London and South Huron Hospital, Exeter, Ontario. The programme involved the use of facsimile telecopiers to transmit direct copies of the physicians' orders to the Pharmacy Department at University Hospital where they were entered into the computerized pharmacy system. At South Huron Hospital therapy was initiated from floor stock while the drug, dispensed in unit-of-use packaging, was delivered to the Exeter Hospital by courier service. The shared service pharmacist visited South Huron Hospital once weekly for nursing orientations, inservice lectures, patient consultations, medical staff meetings and direct contact with physicians. With the approval of the Bureau of Dangerous Drugs the pharmacist delivered Narcotic and Schedule G medications once weekly. After three months the patient census and average number of medication orders per patient per day had increased. The hours of pharmacy operation were extended, while the medication costs per patient day were reduced from $2.16 to $1.64. A shared pharmacy service can result in an improved element of drug use control for smaller hospitals in a cost-effective manner.     

Clinical pharmacist staffing in United States hospitals

We evaluated hospital demographics (census regions, size, teaching affiliation, hospital ownership, hospital pharmacy director's degree, pharmacist location within the hospital) and clinical pharmacist staffing/occupied bed in United States hospitals. A database was constructed from the 1992 American Hospital Association's Abridged Guide to the Health Care Field and the 1992 National Clinical Pharmacy Services database. Simple statistical tests and multiple regression analysis were employed. The study population consisted of 1391 hospitals that reported information on clinical pharmacist staffing. The mean number of clinical pharmacists/100 occupied beds was 0.51 +/- 0.18. Factors associated with increased clinical pharmacist staffing were west north central region (slope = 0.0029439, p = 0.002), Pacific region (slope = 0.0032089, p = 0.004), affiliation with pharmacy teaching hospitals (slope = 0.0025330, p = 0.0001), teaching hospitals (slope = 0.0028122, p = 0.001), federal government ownership (slope = 0.0029697, p = 0.012), directors with Pharm.D. degrees (slope = 0.0335020, p = 0.002), directors with M.S. Pharmacy degrees (slope = 0.0028622, p = 0.003), pharmacists in a decentralized location (slope = 0.0035393, p = 0.0001), and pharmacy technician staffing (slope = 0.0517713, p = 0.0001). Statistically significant associations between demographic variables and decreased clinical pharmacist staffing/occupied bed were mid-Atlantic region (slope = -0.0028237, p = 0.002), small size (slope = -0.0028894, p = 0.001), pharmacy directors with B.S. degrees (slope = -0.0019271, p = 0.023), and pharmacy administrator staffing (slope = -0.0184513, p = 0.042). The R2 for this multiple regression analysis was 28.31% and adjusted R2 was 24.83%. Increased pharmacy technician staffing had the greatest association (slope = 0.0517713) with increased clinical pharmacist staffing. Significant differences were observed between clinical pharmacist staffing and hospital demographic factors. It appears that one of the most effective ways to increase clinical pharmacist staffing is to increase pharmacy technician staffing (slope). These findings will help future researchers determine specific reasons why some types of hospitals have higher and some lower levels of clinical pharmacist staffing.     

我国医院药学服务及临床药学开展现状调查(二)——临床药学工作开展状况调查

目的:了解我国医院临床药学工作的开展情况。方法:采用信函式问卷调查,对通过分层、定距抽样选取的600家样本医院、42家临床药师制试点医院进行我国医院临床药学工作开展状况调查,并对结果进行统计分析。结果与结论:在回收的310份调查问卷中,处方点评、药物不良反应监测及药物信息咨询服务等临床药学工作开展的比例均较高,而书写药嘱及药-食相互作用监测工作开展比例相对较小;试点医院临床药学工作优于一般医院,尤其在药物治疗监测和个体化给药方面。临床药学人员素质整体仍较低,数量较少;临床药学工作经费投入及临床药师作用仍有待加强。     

Shadowing program to increase student awareness of hospital pharmacy practice

A shadowing program designed to acquaint second-year pharmacy students with the professional responsibilities of a hospital pharmacist is described. The program developed by the Toledo Area Society of Hospital Pharmacists allowed second-year pharmacy students to "shadow" a staff pharmacist for three to four hours. The program required the cooperation of area hospital pharmacists to develop rotations at each site. Eight hospitals provided shadow rotations for 87 students during the program's first offering. Reactions were positive from both students and pharmacists. Direct pharmacist-student interaction, low cost, and flexibility were important factors in the program's success. The shadowing program has proven to be an effective method of introducing hospital pharmacy career options to prepharmacy students.     

Survey of 24-hour, 7-day/week hospital pharmacy service

Emergency after-hour pharmacy services in many hospitals have been replaced by 24-hour, 7-day/week pharmacy services. A survey questionnaire was published in Hospital Pharmacy, February 1983, to be completed by hospital pharmacies that provide a pharmacist in the hospital 24 hours a day, 7-days a week. Usable responses were received from 185 hospitals. The type of hospitals and the number of beds of these hospitals varied greatly. The differing responses concerning staffing, scheduling, hours of the post-midnight shift, arrangement of vacations and holidays, the factors used in selling the concept to administration, and the handling of compensation are presented.     

Hospital pharmacy practice in Saudi Arabia: Prescribing and transcribing in the Riyadh region

PurposeThe purpose of this survey is to outline pharmacy services in hospitals on a regional level in the Kingdom of Saudi Arabia.MethodsA modified-American Society of Health-System Pharmacists (ASHP) survey questionnaire as pertinent to Saudi Arabia was used to conduct a national survey. After discussing with the pharmacy directors of 48 hospitals in the Riyadh region over the phone on the survey’s purpose, the questionnaires were personally delivered and collected upon completion. The hospital lists were drawn from the Ministry of Health hospital database.ResultsTwenty-nine hospitals participated in the survey giving a response rate of 60.4%. Approximately 60% of the hospitals which participated in the survey required prior approval for the use of non-formulary medications. About 83.3% of hospitals reviewed compliance with clinical practice guidelines and 72.7% hospitals reported that pharmacists are also actively involved in these activities. Pharmacists in more than 95% of hospitals provided consultations on drug information. A staff pharmacist routinely answering questions was the most frequently cited (74.1%) method by which objective drug information was provided to prescribers. Electronic drug information resources were available in 77.7% of hospitals, although internet use is not widely available to hospital pharmacists, with only 58.6% of hospitals providing pharmacist access to the internet. About, 34.5% of hospitals had computerized prescriber order entry (CPOE) systems with clinical decision-support systems (CDSSs) and 51.9% of the hospitals had electronic medical record (EMR) system.ConclusionHospital pharmacists are increasingly using electronic technologies to improve prescribing and transcribing of medications in Saudi Arabia.     

基层综合性医院临床药师培育和激励机制探析

我国已经提出建立临床药师制度,但目前基层医院临床药学开展仍相对滞后,临床药师管理工作仍处于摸索阶段。本文从临床药师的培育、发展和激励三个阶段着手,总结我院在建立临床药师管理工作制度过程中取得的经验,尝试逐步摸索出一套适合基层综合性医院实际情况的临床药师管理工作制度。通过建立对临床药师的培育制度和临床药学工作激励体系,为推动临床药学在基层医院的深入发展提供参考。     

Checking of unit dose cassettes by pharmacy technicians at three Minnesota hospitals

A pilot project in which pharmacy technicians were trained to check unit dose cassettes filled by other technicians is described. With the approval of the state board of pharmacy, the Minnesota Society of Hospital Pharmacists (MSHP) conducted the nine-month project in three hospitals with different types of unit dose drug distribution systems. Twenty-seven technicians underwent didactic and practical training and were then validated as checkers if they scored 99.8% accuracy in checking carts into which errors had been deliberately introduced by the pharmacist auditor. The performance of validated technicians was audited monthly, and failed audits had to be repeated. Participating technicians did not check the preparation of first doses or extemporaneously prepared doses. In 100,000 doses audited, 60 errors by the validated checkers were identified. Of six technicians who failed a monthly audit, five passed a repeat audit. Pharmacists at the participating hospitals documented time they spent on clinical activities that would have been spent checking cassettes. In December 1990 a one-year extension of the project, expanded to 10 hospitals, began. With strict quality control measures, specially selected and trained pharmacy technicians performed unit dose cassette checking with an accuracy of at least 99.94%.     

ASHP national survey of pharmacy practice in hospital settings: monitoring and patient education--2006.

PURPOSE: Results of the 2006 ASHP national survey of pharmacy practice in hospital settings that pertain to monitoring and patient education are presented. METHODS: A stratified random sample of pharmacy directors at 1178 general and children's medical-surgical hospitals in the United States were surveyed by mail. SMG Marketing Group, Inc., supplied data on hospital characteristics; the survey sample was drawn from SMG's hospital database. RESULTS: The response rate was 39.0%. Virtually all hospitals (93.4%) had pharmacists regularly monitoring medication therapy in some capacity. Patient monitoring has improved since 2003; fewer respondents reported monitoring less than 25% of patients in the hospital. More than two thirds of hospitals had a process for routine monitoring of patient profiles by pharmacists, and 87.3% of hospitals provided pharmacists with computer access to laboratory data to facilitate this function. Nearly 60% of hospitals allowed the transfer of electronic information between inpatient and outpatient settings. Over 87% of hospitals routinely monitored serum medication levels or a surrogate marker. In these hospitals, pharmacists ordered serum medication levels (69.1%), adjusted dosages (73.2%), and were notified when a level was outside the therapeutic range (47.3%). The number of adverse drug events (ADEs) reported by hospitals internally and externally decreased from the numbers reported in 2003 (213 and 31 versus 271 and 45, respectively). Medication counseling by pharmacists continued to be infrequent, with only 7.6% of hospitals reporting that 26% or more of inpatients received medication counseling. Documentation of patient education decreased from 58.0% in 2003 to 51.7%. Medication reconciliation programs were implemented in 71.7% of hospitals. The vacancy rate for budgeted pharmacist positions increased from 4.3% in 2003 to 4.6%. CONCLUSION: Pharmacists have made significant strides to increase the number of patients whose drug therapy is monitored. Electronic access to laboratory data by pharmacists greatly increased, as did the availability of information transferred between the inpatient and outpatient settings. Therapeutic drug monitoring by pharmacists increased, as did pharmacists' ability to order serum medication levels and adjust dosages. More pharmacists were notified when medication levels fell outside the therapeutic range. Internal and external reporting of ADEs has decreased. Documentation of patient education declined. A significant percentage of hospitals developed and implemented medication reconciliation programs. The number of pharmacists per 100 occupied beds has increased, and the number of pharmacist vacancies remained stable.     

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.