Benefits of clinical pharmacy services in a community hospital

The purpose of this analysis was to itemize the long term cost-avoidance and benefits of the Clinical Pharmacy Program at York Hospital and compare them to the cost of the program. It was assumed that the major actual reduction in drug cost would occur within the first year of clinical activities. Therefore, to determine the long term benefits, the hypothetical cost-avoidance of drug expenditures were calculated for the subsequent years after the clinical programs were instituted. For fiscal year 1991 these significant benefits amounted to an estimated monetary cost-avoidance of $416,000, a reduction in numerous hours in preparations and administration of 39,000 IVs, and numerous non-quantifiable benefits. The cost of the program in fiscal year 1991 for the pharmacist and administrative salaries related to the Pharmacy Clinical Program was approximately $140,000. Thus, the Clinical Pharmacy Program was cost-effective at York Hospital.     

Cost-benefit analysis of clinical pharmacy services in a community hospital.

A cost-benefit analysis of clinical pharmacy services in a 250-bed, acute-care hospital is described. Over a 3-year period, the total net benefit to the hospital and patients has totaled $125,648.     

Clinical pharmacy services in a community hospital

An example is given of the implementation of clinical pharmacy service program in a community hospital. The need for establishing an efficient drug distribution system is discussed, and the feasibility of utilizing clinically motivated staff pharmacists is presented. A method of limiting the number of patients admitted to the clinical pharmacy service program is also given.     

Analysis of cost avoidance from pharmacy students' clinical interventions at a psychiatric hospital

Objective

To analyze the cost avoidance resulting from clinical interventions made by pharmacy students completing an advanced pharmacy practice experience (APPE) at a psychiatric hospital.

Methods

A retrospective database review of documented clinical interventions by pharmacy students was conducted to classify interventions by type and significance. Interventions were assigned a cost avoidance value determined by an evaluation of the literature.

Results

Three hundred-twenty interventions were documented by 15 pharmacy students during the 1-year study period. The majority of interventions were related to psychiatric medication classes and most (n = 197; 61.6%) were classified as being of moderate significance. The most common interventions included patient education (13.1%), order clarification (11.6%), therapeutic dosing adjustments (10.9%), and laboratory order monitoring (8.8%). The estimated cost avoidance from all interventions made by pharmacy students was approximately $23,000.

Conclusions

Pharmacy students completing APPEs at a psychiatric hospital contributed to a variety of significant clinical interventions and provided considerable cost avoidance value to the institution.     

Documentation of patient care services in a community pharmacy setting.

OBJECTIVE: To assess the types of patient care documentation systems currently being used by community pharmacists and determine the preferred characteristics of an ideal patient care documentation system. DESIGN: Mailed survey. SETTING: United States. PARTICIPANTS: One pharmacist from each of 125 targeted community pharmacies. INTERVENTION: Survey mailed in February 2003, followed by a second mailing to nonrespondents in March 2003. MAIN OUTCOME MEASURES: Responses to survey items about (1) patient care services provided at the pharmacy, (2) characteristics of the current documentation system, and (3) characteristics of an ideal documentation system. RESULTS: A total of 48 usable responses were received from 106 pharmacies to which surveys were delivered (45.3%). Independent pharmacies accounted for 50% of survey respondents. More than 80% of respondents were providing patient screening or management services associated with a chronic disease such as diabetes, hypertension, or dyslipidemia. Approximately 54% of the pharmacists were using a paper documentation system. However, challenges identified with a paper system included documentation time, retrieval of patient data, tracking patient outcomes, and storage. Respondents indicated that an ideal documentation system would be comprehensive, easy and efficient to use, and affordable. CONCLUSION: Pharmacists recognize the importance of documenting patient care services. While the majority of respondents are using paper charts to document patient care services, computerized systems appear to offer advantages over paper charts. This information offers community pharmacists a summary of previous experiences and a starting point when trying to identify or modify a documentation system that would better meet the pharmacies' needs.     

Computerized pharmacy services in a large community hospital.

A computerized pharmacy system dealing with drug distribution, clinical services and administrative services is described. Present systems, implemented for 50% of the institution's beds, are discussed fully. Future applications of the system are outlined.     

Implementation of mobile decentralized pharmaceutical services in a community teaching hospital

Administrative strategies that were used to justify mobile decentralized pharmaceutical services in a community teaching hospital are discussed. The report describes the problems prompting the pharmacy's review of its centralized unit dose drug distribution and i.v. admixture services, the evaluation of alternative solutions, the proposal submitted to hospital administrators, the implementation process, and an analysis of fiscal impact. A decentralized system using mobile medication carts was considered the best alternative because it integrated distributive and clinical functions and offered efficiencies in drug distribution; anticipated capital expenditure costs and personnel costs were also lower than the costs of alternatives. The conversion to the new system increased the pharmacy personnel budget by $174,455 annually, representing the addition of 13.8 full-time equivalent (FTE) pharmacists and elimination of 10.4 FTE technicians and interns. The increased personnel budget was offset in fiscal year (FY) 1982-83 by documented savings of $47,000 from pharmacists' clinical activities and by calculated savings of $132,400 in nursing time. Excluding capital expenditures of $19,800 for the medication carts, implementing mobile decentralized services saved the hospital $4945 in FY 1982-83. Mobile decentralized services is a cost-effective approach for providing integrated drug distribution and clinical pharmacy services.     

Evaluation of mobile decentralized pharmaceutical services in a community teaching hospital

Mobile decentralized pharmaceutical services were compared with the previous centralized unit dose drug distribution services in a community teaching hospital. Medication order turnaround time, pharmacist workload activities, number of drug information requests, dose-activity index, and quality of drug distribution and drug administration record keeping were compared under the two systems. The number of drug therapy problems identified and resolved by decentralized pharmacists also was determined. Medication order turnaround time decreased from a mean of 198 minutes to 64 minutes in the centralized and decentralized systems, respectively. The number of drug information requests increased from 0.0055 to 0.05 requests per patient day. The percentage of requests related to adverse drug reactions, drug interactions, therapeutics, pharmacokinetics, and pharmacology increased in the decentralized system. The dose-activity index was 63.5% and 56.9% for centralized and decentralized systems, respectively, with the mean number of doses handled per patient day at 14.4 and 10.7. Decentralized pharmacists spent substantially more time than centralized pharmacists performing educational, therapy-related, and dispensing activities and less time performing clerical and verification activities. Decentralized pharmacists detected a large number of drug therapy problems that probably would have gone undetected in the previous system. The decentralized system met 31 of the 32 quality assurance standards, compared with 20 standards met for the centralized system. The implementation of mobile decentralized services provided greater opportunities for use of the pharmacists' clinical skills and reduced the time allocated to traditional functions.     

Expanding clinical pharmacy services in a VA hospital

The pharmacy staff at the VA Medical Center, Biloxi, Mississippi, has increased direct patient care activities for the Medical Center's inpatients by converting 139 beds from a manual system of unit dose to a computerized unit dose distribution system. Expanded clinical programs were primarily developed, implemented, and operated by staff pharmacists.     

Maintaining clinical pharmacy services during cost containment

As new hospital reimbursement schemes are rapidly introduced into the hospital industry, the impact of cost containment measures will be felt by all departments of pharmacy. This paper describes how the pharmacy department at one community teaching hospital justified the continuation of clinical pharmacy programs when faced with an immediate 18% reduction in pharmacist staff. Various written communications and recommendations are provided to assist other hospital pharmacy departments that are facing or may face this dilemma.     

Impact of a pharmacy technician on clinical pharmacy services in an Australian hospital

International Journal of Clinical Pharmacy - Background There is increasing recognition for the role of pharmacy technicians in obtaining medication histories and performing administrative tasks...     

Introducing clinical pharmacy services to cardiovascular clinics at a university hospital in Northern Cyprus

Background Clinical pharmacists are the primary source of scientifically valid information and advice on the safe, rational, and cost-effective use of medications. However, ward-based clinical pharmacy services are not well optimized in Northern Cyprus. Objective Ward based clinical pharmacy services were introduced and evaluated in cardiovascular clinics. Setting Cardiology and cardiovascular surgery departments in a tertiary university hospital. Methods A prospective interventional study introduced and documented clinical pharmacy services for 120 days. Drug-related problems were classified using the Pharmaceutical Care Network Europe PCNE DRP classification tool V6.2. Main outcome measure Interventions proposed and acceptance rate of recommendations. Results A total of 133 patients were reviewed, and, 81 patients had drug-related problems. Only 402 (93.1%) of the 432 suggested interventions were accepted and regarded as clinically relevant. Drug-related problems primarily involved antihypertensive, diuretic, and antithrombotic agents. Treatment effectiveness was the major type of drug-related problems (107; 49.3%) followed by adverse drug reactions (74; 34.1%). Drug dose and selection were the most frequent causes of drug-related problems. Add/change/stop medications were the most common types of intervention at the prescriber level. A total of 171 (78.8%) of the identified 217 drug-related problems were solved, 4 (1.8%) of the problems were partially solved, 32 (14.7%) problems were unsolved, and 10 (4.6%) problems had unknown outcomes. Conclusion Clinical pharmacy services may have optimized therapy effectiveness and prevent adverse effects. The pharmacist interventions were highly accepted by cardiologists; this may indicate the presence of a great opportunity and need to optimize and implement CPS in other hospitals in Northern Cyprus.     

Staffing and the cost of clinical and hospital pharmacy services in United States hospitals.

A survey was mailed to pharmacy directors at all United States acute care medical-surgical hospitals that related to staffing and cost components of hospital pharmacies and clinical services. Cost information was evaluated as both unadjusted and adjusted for severity of illness using the Health Care Financing Administration's Medicare case mix index (CMI). Unadjusted drug costs/occupied bed/year were $13,350+/-6927, a 36% increase over 1992 and a 112% increase over 1989, with statistically significant differences observed by geographic region, hospital size, hospital ownership, and drug delivery system. Annual median pharmacist salary costs/patient associated with centrally based clinical pharmacy services were drug use evaluation $111, in-service education $20, drug information $117, poison information $24, and clinical research $35. Annual median pharmacist salary costs/patient associated with patient-specific clinical services were drug therapy monitoring $5, pharmacokinetic consultation $8, patient counseling $6, medical rounds $4, admission drug histories $7, and drug therapy protocol management (prescribing) $9. Drug costs continue to increase at double-digit rates. Substantial differences exist among various regions of the country with salary and specific cost components. Registered nursing staffing is increasing at twice the rate of pharmacists staffing increases.     

Establishment of surgery satellite pharmacy services in a large community hospital.

Implementation of a satellite pharmacy serving the operating rooms (OR) and recovery areas in a nonteaching, 676-bed community hospital is described. Justification for proposed services are listed. Objectives and the steps taken in the implementation and maintenance of the services are described. Objectives were: (1) increased accountability of drug distribution and control; (2) improved accuracy in recording of patient charges; (3) improved accuracy in charting of medications administered; (4) adoption of a standardized anesthesiology medication system implemented on a kit-per-case basis; (5) enhancement of the pharmacy image through the improved provision of cost containing pharmacy services; and (6) promotion of improved patient care through a health care team approach.