PharmaTrend as a management tool: evaluation of the program

A critical evaluation of PharmaTrend, a personal computer-based program for the analysis of pharmacy workload and productivity, is presented. The use of PharmaTrend is facilitated by a number of support features. A tutorial program instructs first-time and infrequent users on how to negotiate PharmaTrend's data-entry screens. The manual is well written and organized, and a toll-free number is available should more technical questions arise. However, some of PharmaTrend's definitions are confusing, as is the program's method of capturing workload data on the preparation of intravenous solutions. Some of the data currently maintained in pharmacies will need considerable modification before they can be used as PharmaTrend entries. A few minor changes would transform PharmaTrend from a good to an exceptional program. In addition to clearer definitions, an option allowing the user to edit the definitions shown on the screen is needed. A line should be added to the data-entry screen to remind the user that F1 is the help key. Reporting would be facilitated if deadlines were changed to reflect standard quarters. PharmaTrend is advantageous for the analysis of departmental operations because it provides regional and national standards for comparison. It can also help justify proposals and defend existing services and staffing. The monthly and quarterly reports generated with PharmaTrend are useful in analyzing pharmacy operations, and the user can modify work-load times on the basis of local circumstances. These difficulties notwithstanding, the current cost of PharmaTrend appears to be a bargain. Although some aspects of PharmaTrend need refinement, its basic features make it a valuable management tool.     

PharmaTrend as a management tool: implementation in a university hospital

The implementation of ASHP's hospital pharmacy management information system, PharmaTrend, in a university hospital is described. The pharmacy department at the University of Wisconsin Hospital and Clinics (UWHC) is a decentralized operation with 63.5 pharmacist full-time equivalents (FTEs) and 81.6 supportive staff FTEs. The multipharmacy capability of PharmaTrend, which allows workload and productivity data for several pharmacies (usually satellites) to be combined into total departmental data for a given period, was used by UWHC to describe the pharmacy department's major cost centers individually. These centers were inpatient services, outpatient services, home health i.v. services, and two offsite pharmacies. Data were divided into elements collected by computer, elements not previously collected or requiring new procedures, and elements requiring manual collection. Data entry forms specific to each cost center were developed. With these forms, collected data can be categorized appropriately by technical staff members. Work hour allocation for each cost center was determined on the basis of PharmaTrend definitions and institution-specific considerations; only those hours reflecting direct fiscal burden of the department on the hospital were included. A manual process for collecting and categorizing data on hours worked and hours paid was automated and adapted for use in PharmaTrend. Finally, some preliminary experience with the system was obtained so that information could be collected for the development of policies, procedures, and training methods and on the use of forms and categorization methods. In particular, the time requirements for collecting, categorizing, and entering selected PharmaTrend data by cost center were determined. Optimal use of PharmaTrend requires creativity and a commitment of time and effort.     

PharmaTrend as a management tool: introduction

Use of the PharmaTrend computerized management information system to document workload and productivity in hospital pharmacy departments is described. PharmaTrend provides indicators in the areas of revenue, cost, drug distribution, clinical services, research, education, and management support; examples are total direct cost per admission, total drug cost per drug distribution work unit, and comparisons between cost and revenue, supportive staff and pharmacist work hours, and total staff work and paid hours. The key information provided by PharmaTrend is not specific indicators or values, however, but the display of trends. PharmTrend files can be downloaded to other spreadsheet and database management programs; the sophisticated user can recalculate values for indicators or develop new indicators. Information about revenue and the cost of drug distribution is easily obtained from reports; this information, combined with data on hours worked to provide drug distribution services, can provide access to all the key PharmaTrend indicators. Institution-specific data are made available to managers elsewhere by submitting them for use in the PharmaTrend national report, which is organized so that users can compare values for their indicators with those reported by hospitals of various size in various geographic regions. PharmaTrend can be a valuable tool in hospital pharmacy management and provides a basis for developing accurate and meaningful workload standards for pharmacy practice.     

PharmaTrend as a management tool: experience with the program

A hospital's experiences with two pharmacy workload measurement systems, PharmaTrend and the pharmacy productivity unit (PPU) system it replaced at the institution, are compared. In 1976 a 352-bed general acute-care hospital implemented the locally developed PPU system. Typical drug distribution-related activities were defined and were assigned standard times per work unit; miscellaneous activities were assigned constant times per month. The PPU system served the institution well but had three important limitation: (1) new pharmaceutical services were not adequately represented, (2) the data collected had to be manually manipulated in order to calculate indicators, and (3) it was not possible to compare the data with those of similar institutions. In January 1988 the hospital implemented PharmaTrend. PharmaTrend was found to be a useful management tool because of the relative ease of data collection and the system's report-generation capabilities. By combining pharmacy workload data (including non-drug-distribution-related components) with data on finance, personnel hours, and patient admissions, PharmaTrend calculated indicators that were used for determining staffing and other needs and for financial reporting. The limitations of the PPU system were eliminated, except that it was still not possible to make valid comparisons with other hospitals because of the small number of participating hospitals that consistently report data to the PharmaTrend database. PharmaTrend offers advantages over previous pharmacy workload-monitoring systems by allowing for the expanded analysis and application of data.     

Relationship of productivity analysis to departmental cost-accounting systems

Productivity assessment and its relationship to cost-accounting systems (CASs) is described. Hospital pharmacist managers need workload measurement-productivity assessment systems for evaluating their departments' scope of services and their impact on the total cost-quality balance in treating patients. Productivity is measured as the ratio of output (production units) to input (total personnel hours used) during a specified time. "Macro" production units represent a grouping of related tasks that, when combined, identify a service unit (e.g., patient day) or activity (e.g., drug-use review consultation); "micro" production units are derived by weighting macro units on the basis of resource consumption (standard time required). Macro production unit data should reflect both fixed and variable costs and should be easy to obtain. A productivity analysis system may need more than one macro production unit and also some micro production units. Both input and output units should be separated by service category (e.g., distributive, clinical, research) and by personnel category (pharmacist or supportive personnel). ASHP's PharmaTrend workload measurement system fits these criteria and facilitates national and regional comparisons, and data from PharmaTrend reports can be readily incorporated into a CAS. Pharmacy managers can best use workload measurement systems and CASs by observing trends in their ratios and indicator values over time.     

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.     

Adjustments of distributive and clinical pharmacy services to financial constraints

The effects of hospital budget constraints on a pharmacy department's ability to provide distributive and clinical services are described, and the development and use of workload-monitoring systems to match resources with demand is discussed. In 1980, the pharmacy department at Grace Hospital, a 402-bed community hospital in Detroit, Michigan, began quantifying workload by using five drug distribution indicators. After the pharmacy began providing clinical services in 1981, workload elements were measured in a pilot program for ASHP's Hospital Pharmacy Management Information System. Hospitalwide staff reductions occurred in 1985, eliminating most clinical pharmacy services. From 1985 to 1986, drug costs increased more than expected; also, turnaround time for medication orders increased. In 1986, 1.4 full-time-equivalent positions were added, and the pharmacy instituted use of decentralized carts and a pharmacist on the patient-care units to provide first doses. The hospital's management engineering department had selected patient days as the single indicator for pharmacy workload, but pharmacy used the ASHP Pharma Trend monitoring system to present data that convinced management engineering that patient days was an inadequate indicator of pharmacy workload. Also, drug costs decreased after the drug distribution changes and the reinstitution of patient drug therapy monitoring. Pharmacy managers need workload monitoring systems that are responsive to changes and include departmental expense information; these systems should be able to interrelate to hospital cost-accounting systems.     

Patient acuity indicators as predictors of pharmacy workload

The feasibility of using two workload indicators from a nursing patient-classification system as a means of predicting pharmacy workload was studied. Frequency data for 13 pharmacy distribution and clinical activities were recorded daily for 28 consecutive days and compared with daily data for acuity of patient illness and number of standard hours of nursing care required on nine nursing units. The strength of the associations between (1) pharmacy workload and patient acuity and (2) pharmacy workload and standard hours of nursing care was determined by linear regression analysis. Both same-day and one-day-lagged analyses were performed; the one-day-lagged analyses looked at pharmacy workload on a given day in relation to nursing workload on the previous day. A total of 252 observations were available for analysis. Pharmacy workload and same-day standard hours of nursing care were correlated most strongly, although all of the analyses yielded large coefficients of correlation. Analysis of data from individual nursing stations yielded smaller coefficients of correlation, especially for the one-day-lagged analyses. At least 73% of the variance in pharmacy workload could be attributed to variance in nursing workload. The index of patient acuity of illness and the number of standard hours of nursing care are good predictors of pharmacy workload of the same and the following days; the potential exists to use these nursing workload indicators in determining pharmacy staffing requirements.     

Workload measurement of a clinical pharmacy residency program

The types of activities performed by four clinical pharmacy residents and the amount of time spent on each activity were studied using a workload measurement system. A workload measurement system was developed to record all activities performed by pharmacy residents. The system included 50 activities that were grouped under 11 general headings; residents' time was divided among 10 major areas of service. The following data were collected and analyzed each month during the six-month study period: units of work, weighted units of work, total productive hours, total service hours, and productivity. The residents participated in 39 of 50 clinical pharmacy activities. Activities performed most frequently included nursing-home-care-unit drug reviews, drug monitoring, and rounds. The most time-consuming activities were clinical education, administration, and drug-use review. Productivity ranged from 80 to 115% and was influenced by residents' assigned rotations. A workload measurement system for quantifying the time spent by residents performing various clinical pharmacy activities provided objective data that were used to restructure a clinical pharmacy residency program.     

Correlation of employees' perception of workload with workload indicators

In this study, the measurement of perception of pharmacists' workload did not correlate well with any workload indicators studied. Generally, census on the study date correlated well for pharmacy technicians working in various areas of the pharmacy. If it is agreed that perception of workload is the real measure of activity--that is, how busy the employees believe it is--then the indicators used in this study are not useful. Similar research using other indicators is warranted.     

Finding and Using Readily Available Sources of Assessment Data

This paper provides the rationale for, examples of, and the collection and general uses of currently available, potentially underutilized academic program assessment data. Academic program assessment is essential for program improvement and accreditation, but commonly used assessment methods may not fully meet these needs. General assessment references, pharmacy education literature, and prior experiences were used to identify and discuss sources of potentially underutilized assessment data. Pre-course assessments, graded assignments, examinations, pharmacy experience evaluations, scoring rubrics, portfolios, progress testing, self-assessments, and classroom assessment techniques are potential sources of assessment data. Course evaluations and grades may also be useful. Selection should be based on need, availability, strength, and concerns. Challenges in data management may be best met through a centralized, integrated database. Careful selection of specific embedded and other assessments can be utilized to complete the development of a comprehensive, meaningful, and efficient program assessment plan.     

National test of an experimental hospital pharmacy management information system

An experimental hospital pharmacy management information system (HPMIS) was evaluated in a national pilot test. Approximately 250 information and materials packets were distributed to hospitals that had inquired about the project. Monthly data on pharmacy expenses, personnel use, and productivity were collected for a six-month period by participating hospitals. This information was processed quarterly and converted into the HPMIS indicators; results were categorized according to hospital characteristics and locations. A questionnaire soliciting opinions about the system was sent to participants at the end of the data-collection period. One hundred six hospitals agreed to participate; 84 hospitals submitted data for at least one quarterly period. The range of values for most indicators varied 100-fold; this was attributed to misinterpretation of data item definitions. Based on indicator values, drug and personnel expenses and supportive-personnel use were greater in unit dose hospitals than in hospitals without total unit dose drug distribution systems. Both drug and fluid costs and the extent of supportive-personnel use increased with increasing hospital size. Data-collection time was less in hospitals with computerized pharmacy operations. Responses to the questionnaire indicated that the clinical services indicators were favored the least; however, only a few changes in the data-collection format of the system were suggested. HPMIS appears to be a useful work-measurement tool but needs to be simplified if it to serve as the standard for these systems.     

运用工时测定法测算某大型综合医院门诊药房人员配置

目的：通过对门诊药房工作量的系统测算得出门诊药房人员配置方案,给合理配置门诊药房人力资源作参考。方法：运用工时测定法对2013年1~4月在某院门诊药房工作的18名药学专业技术人员每日的工作内容进行跟踪观察与计时。将测算结果录入EXCEL软件建立数据库,对各个岗位的工作量进行分类汇总。将相关参数带入人力编制公式计算所需人数。结果：确定了9项门诊药房工作项目平均操作时间,对其中调配药品和发药两项操作时间进行了细化。根据工作量计算所需药师人数为13.29人,加上门诊药房组长、工勤人员,共15.29人,约16人。结论：运用工时测定法能科学的测算每项工作的耗时。门诊药房的工作人员资质、数量等应以工作量为依据合理配置。     

Patient-specific total parenteral nutrient formulas.

A method of formulating total parenteral nutrient (TPN) solutions to meet specific patient requirements is discussed. A series of calculations is presented which results in a specific formula that provides the required nutrients. The input data for the calculations are the patient's 24-hour requirements for protein, calories and electrolytes. To serve as a starting guideline, baseline nutrient requirements for patients of different weights are provided. Although individualizing TPN solutions may increase the pharmacy workload, such a program can assure that patients receive optimal nutritional support.     

Beyond the numbers: Utilising existing textual data for qualitative research in pharmacy and health services research

IntroductionQualitative research is a well-established branch of scientific enquiry that draws insights from experiences.^{1, 2}Within social and administrative pharmacy research, interview and focus group methods are a mainstay of collecting data. However, other disciplines such as sociology, psychology and anthropology, use existing data that is routinely to provide a substance for qualitative inquiry. Drawing on our experiences of using interdisciplinary research methods, this paper presents three case studies where textual data was qualitatively analysed and critically examines the strengths and weaknesses of these method in relation to pharmacy practice.MethodsThree case studies were selected that access different types of existing, routinely collected data from pharmacy practice. This included 1) a study utilising boardroom meeting minutes, 2) a study using incident reports and 3) a study using WhatsApp messages as data. Each case study is described and critically examined. The strengths and weaknesses of this approach are based on our own reflections of completing the studies.ResultsRelationships between people, products and organisations can be examined in documents, records and text that is routinely collected. Existing data can also provide insights into culture, working patterns, education and errors. Practical advantages of using existing data include faster data collection and access to first-hand, accounts of experiences of human relationship with pharmaceutical products and practice. Drawbacks of using existing data are that some data may be missing, participants may no longer be accessible for participant checking and the context of language may have changed.ConclusionThis paper critically examined the use of methods rarely used in pharmacy practice research which draw on existing, routinely collected data. Adopting a wider range of data collection methods may will provide new understanding and insights into social and clinical pharmacy practice.     

Pharmacist-managed drug therapy helps meet requirements for drug-use evaluation.

Pharmacist-managed drug therapy at a 205-bed nonprofit, general medical and surgical hospital is described. The pharmacy department provides a drug therapy management service in which clinical pharmacists initiate and adjust drug therapy and order laboratory tests according to criterion-based protocols. A physician requests initiation of the protocol and cosigns all orders written by pharmacists. The protocols for pharmacy-managed drug therapy are developed primarily by the clinical pharmacists and approved by the hospital's pharmacy and therapeutics and executive committees. They delineate specific indicators of the process (e.g., timely initiation of therapy) and outcome (e.g., clinical efficacy) of drug therapy management. These indicators are included in the record kept by the pharmacist for each patient treated in this program, and this documentation is reviewed daily. The same documentation is used in the drug-use evaluation (DUE) process. (Drugs for which drug therapy management protocols have been developed are among those selected for DUE.) In 1990, pharmacists managed 3616 courses of drug therapy by using approximately 100 drug protocols. The criterion-based drug therapy management service helps to fulfill the hospital's drug-use evaluation responsibilities by establishing specific process and outcome indicators, proposing drugs for DUE inclusion, and collecting data.     

Multidisciplinary drug-use evaluation for stress ulcer prophylaxis.

A process for creating a multidisciplinary approach to quality assurance within an intensive-care unit is described. A drug-use evaluation program for stress ulcer prophylaxis in the neurosurgical intensive-care unit (NSICU) was developed by a pharmacist with the cooperation of physicians and nurses at the institution. First, the pharmacist worked with the gastrointestinal medicine division to develop indicators for appropriate prophylaxis and monitoring of stress ulcers in patients admitted to the NSICU. The physicians in the neurosurgical division were then given an opportunity to modify or approve the indicators. Before the indicators went into effect as the standard of care, inservice education was provided and pocket cards outlining the criteria were developed. Data were collected on all patients admitted to the NSICU over one year. The data are being reviewed to determine the clinical efficacy and safety of all regimens used, and this information will be used to revise the criteria and influence subsequent prescribing practices in the unit. The program has led to changes in nursing, medical, and pharmacy practice in the unit. Pharmacists can work with other health-care professionals in developing a program to obtain clinically relevant data for a specific group of patients and thus help to improve patient care.     

A mid-sized hospital's experience in indicator data collection

A hospital pharmacy department's experience in selection and use of indicators for measuring quality of care is described. At a 410-bed community teaching hospital, indicators were selected that would use data the department was already collecting. For the first indicator, "Patients on total parenteral nutrition (TPN) experiencing acid-base disorders," the goal was for no more than 20% of patients on TPN to have blood pH values outside the normal range, but 35% of patients were found to be outside the range. The standard TPN formula was examined and changed, after which only 16% of patients had pH values outside the normal range. For the second indicator, "Patients on TPN having negative nitrogen balance results," and the next two indicators, based on data available from the department's pharmacokinetics service, a similar process was followed. The department next examined incident reports and adverse drug reaction reports, categorized the drug-related problems represented, and established the indicator, "Patients on [nursing unit X] experiencing category 4 drug-related errors." Problems with indicator use included determining how an indicator relates to the quality of care and knowing how to analyze the data once they are collected. To maintain stature within their institutions by helping with the overall quality improvement effort, pharmacy departments need to expeditiously institute the use of indicators.     

探讨医护人员药事服务工作量评定的研究

目的：探索医护人员药事服务工作量的评定方法,为新医改公立医院增设药事服务费提供数据支持。方法通过查阅文献及专家咨询确定药事服务工作量评定参数和评定方法,采用自制问卷调查表调查临床医师及护士获取数据,使用SPSS18.0整理数据并进行统计学分析。结果本研究统计了1621份调查表,其中有766例临床医师,855例护士,临床医师的药事服务工作量点数为0.3737±0.1538,而护士为0.2171±0.0802,临床医师的药事服务工作量点数明显高于护士（P＜0.05）,对职称分类进行比较发现职称对药事服务工作量点数影响较小（P＞0.05）。结论医护人员的药事服务工作量受职称的影响不大,而与工作类别关系较大。     

Clinical services provided by staff pharmacists in a community hospital

A program for developing staff pharmacists' clinical skills and documenting pharmacists' clinical interventions in a large community teaching hospital is described. A coordinator hired in 1984 to develop clinical pharmacy services began a didactic and experiential program for baccalaureate-level staff pharmacists. Fourteen educational modules are supplemented by journal and textbook articles and small-group discussions of clinical cases, and the clinical coordinator provides individual training on the patient-care units for each pharmacist. Monitoring of clinical pharmacy services began in June 1987; each intervention provided by a pharmacist is recorded on a specially designed form. A target-drug program is used to document cost avoidance achieved through clinical services. Information collected through these monitoring activities is used to educate the pharmacy staff, shared with the pharmacy and therapeutics committee, and used to monitor prescribing patterns of individual physicians. The data are used in the hospital's productivity-monitoring system. All pharmacists who were on staff in 1984 have completed the educational modules, and all new employees are in the process. Since monitoring began, the number of clinical interventions has averaged 2098 per month. Cost avoidance has averaged $9306 per month. Over a five-year period, the development of staff pharmacists' clinical services raised the level of professional practice, produced substantial cost avoidance, and increased the number of pharmacist interventions in medication use.