Assessing user satisfaction and hospital pharmacy practice: application to an individualized dispensing system in a French military teaching hospital

Rationale and aims Hospital pharmacy aims at optimizing pharmaceutical care practice. Classically, assessing patient's satisfaction is required. Same manner, for a service provider such as a hospital pharmacy, it is necessary to evaluate the satisfaction of its customers: physicians, nurses and pharmacy staff. The aim of this paper was to assess user satisfaction with an individualized dispensing system. Method A survey including 14 close‐ended and 1 open‐ended questions was repeated at several years' distance in a French military teaching hospital. Questionnaires were administered anonymously to the different actors involved: physicians, nurses, pharmacy staff. Results Fifty‐seven users of an individualized dispensing system (29 nurses, 18 physicians and 10 pharmacy staff) were included in the survey. At the level of the establishment, users' opinion about the system was positive. None of the dimensions studied concerning the pharmaceutical service was rated negatively. Overall user opinion about the computer system was the only parameter rated negatively. In total, most dimensions were judged satisfactory: confidence in the individualized dispensing system, time of delivery at the care unit, impact on cost control, quality of the presentation of unit doses and performance of respondents. The benefit for the patients was judged very satisfactory. The workload involved, the frequency and severity of errors, the serviceability of the information processing system and its impact on patient safety were judged fairly satisfactory. Finally, the quality of pharmaceutical information was rated average. Conclusions An evaluation of a service or a practice should include an assessment of how well the service meets the needs of the user and how well the service is provided. A comprehensive, reliable and valid instrument for assessing user's satisfaction with individualized dispensing system is then available in our hospital. This paper demonstrated the interest of using simple and robust tools in professional practice.     

Clinical pharmacy in a South Indian teaching hospital

OBJECTIVE: To describe how clinical pharmacy is helping to improve medication use at a South Indian teaching hospital by addressing medication use problems, which are commonly encountered in India. SUMMARY: Clinical pharmacy is practiced in many countries and makes a significant contribution to improved drug therapy and patient care. India is a country with significant problems with medication use, but until recently Indian pharmacists have not been educated for a patient-care role. Postgraduate pharmacy practice programs have been established at 2 pharmacy colleges in South India as a result of a joint Indo-Australian program of cooperation. At a teaching hospital associated with the colleges, clinical pharmacy services such as drug information, medication counseling, drug therapy review, adverse drug reaction reporting, and the preparation of antibiotic guidelines are assisting clinicians to improve drug therapy and patient care. Seven hundred twenty-seven requests for drug information were received from July 1997 to February 2001, and 543 suspected adverse drug reactions were evaluated from November 1997 to February 2001. The most common drug classes causing adverse drug reactions were antibiotics, nonsteroidal antiinflammatory drugs, and antitubercular agents. Physician opinion and service utilization have also been surveyed: 82% of respondents had sought drug information from the Clinical Pharmacy Department and 71% of respondents had sought advice on individual patient management. The success of this program is raising awareness of clinical pharmacy among pharmacy educators elsewhere in India and has led to the introduction of clinical pharmacy services at other Indian hospitals.     

The impact of clinical pharmacy intervention in a psychiatric hospital

One hundred and nine physician‐initiated consultations were directed to a clinical pharmacist over a 1‐year period. Two hundred and three (88·2%) recommendations out of 229 were adopted. Major question types included preventive measures, non‐response, side‐effects and mixed factors. The global effectiveness of pharmacist interventions suggests that 67·9% of patients exhibited a very satisfactory or satisfactory response. While our study suggests that a clinical pharmacist may favourably contribute to the quality of patient care, a control‐group study is required to confirm our results.     

Acceptance of a pharmacy-based, physician-edited hospital pharmacy and therapeutics committee newsletter.

OBJECTIVE: To assess the level of physician acceptance and perceived usefulness of a pharmacy-prepared, physician-edited pharmacy and therapeutics (P&T) committee newsletter. DESIGN: Two separate surveys conducted after 7 and 24 months of publication, respectively. SETTING: 500-bed, university-affiliated, tertiary-care hospital. MAIN OUTCOME MEASURES: The initial survey was mailed to physicians after 7 months of publication and they were requested to rate various aspects of the newsletter, including timeliness of articles, usefulness of articles, quality of writing and design, and overall value of the publication on a scale of 1-4: (1 = excellent, 2 = good, 3 = fair, 4 = poor). Physicians were also asked to rank different categories of articles (articles on new drugs, drug-class reviews, topical reviews, formulary news, and articles providing P&T committee information) and were encouraged to provide comments. A separate follow-up survey conducted at 24 months asked physicians to indicate whether they (1) regularly received the newsletter, (2) regularly read the newsletter, (3) found the information in the newsletter to be useful, and (4) desired to continue receiving the newsletter. RESULTS: Initial survey results yielded mean newsletter quality scores ranging from 1.54 to 1.66. Respondents preferred, in descending order, articles on new drugs, drug-class reviews, topical reviews, formulary news, and P&T committee information. The 24-month survey revealed that 96 percent of the physicians regularly receiving and reading the newsletter found the information useful and 97 percent felt that the newsletter should continue to be published. Favorable comments were also received from several prominent physicians. CONCLUSIONS: The results indicate strong physician acceptance of a pharmacy-prepared, physician-edited newsletter and provide information about the types of articles preferred by physicians in a university hospital setting.     

Autologous donation error rates in Canada

BACKGROUND: Although certain transfusion risks are eliminated by the use of autologous blood, clerical errors may still occur. In addition, because of differences in donor selection criteria and donor-patient expectations, the consequences of certain errors may be different in autologous and allogeneic donations. STUDY DESIGN AND METHODS: In January 1996, autologous donation error rates in Canada from 1989 to November 1995 were estimated by 1) a detailed questionnaire sent to hospitals supplied by the Canadian Red Cross, Blood Services, Transfusion Center of Quebec at Montreal autologous donation program (n = 31), 2) a review of that institution's quality assurance non- compliance reports, and 3) a detailed questionnaire sent to other Canadian Red Cross centers with autologous donation programs (n = 16) and hospital-based autologous programs in Canada (n = 3). The total number of autologous donations collected was determined from Canadian Red Cross annual reports and information supplied by hospital-based programs. RESULTS: There were 113 errors reported for 16,873 units collected by the Montreal center (1/149 units) based on collection center and hospital data. The most frequent errors were the late receipt of units for surgery (25% of errors) or the receipt of units in the wrong hospital (23%). Other Canadian programs reported 166 errors for approximately 53,500 units collected (1/322 units). However, this figure was based mainly on collection center, and not hospital, data. The most frequent errors were in labeling (48%) and component preparation (25%). One unit of autologous fresh-frozen plasma was transfused to the wrong recipient. Errors were more frequent if components were produced, if units were drawn in hospitals for interhospital transfer, or it units were shipped between Red Cross centers. CONCLUSION: Errors are not infrequent in autologous donation programs. Autologous transfusion should not be considered as being without risk.     

Evaluating process changes in a pediatric hospital medication system

This article describes a process change designed to increase the safety of prescribing and interpreting complex order sets. All chemotherapy orders written for pediatric oncology patients at a major teaching hospital in the Eastern United States and the affiliated ambulatory clinic from June 1998 through February 2000 (n = 1792) were reviewed to evaluate a new process for communication of chemotherapy orders. The multidisciplinary check (MDC) is a forum where all disciplines simultaneously review and change complex order sets. Evaluation of the MDC included monthly completion rate and classification of changes made to orders at MDC. Over the study period, 96% of eligible orders received a multidisciplinary check, and 44% were changed. The most common change was to clarify discrepancies between the order and the protocol. Changes were made to avoid medication errors in 99 of 451 orders. Changes to avoid medication errors were more likely to involve nonchemotherapy medications. The MDC is an efficient and feasible process to increase safety at the beginning of the medication system.     

Evaluating improvements in nursing staff at a state psychiatric hospital

In response to federal intervention in 1990, Hawaii initiated a number of changes at the state's psychiatric hospital. The process of change that was undertaken by the hospital's department of nursing from 1990 through 1994 to meet federal mandates was described in an earlier article in this journal. The present study evaluated the degree to which court-ordered improvements in nursing staff at the hospital were actually achieved between 1995 and 1997. Seven quantitative measures of compliance with federal mandates were evaluated, based on the court orders. Significant improvements were found on six of the seven measures during the 30-month study period. These included increases in nursing staff as measured by (1) the number of staff and (2) full-time equivalents, as well as increases in (3) the hours of nursing care per patient, (4) the number of staff per patient on each shift, and (5) the percent of RNs per shift. Use of agency personnel decreased significantly, as ordered, but overtime use increased significantly, contrary to court orders.