Antineoplastic admixture service in a tertiary-care hospital

The rationale and decision-making processes involved in the development and implementation of an antineoplastic admixture service in a 1027-bed teaching hospital are described. Because of concerns expressed by nurses about the potential health hazards of handling antineoplastic drug products, the department of pharmacy was asked to prepare all injectable antineoplastic agents within the institution. At the time of the request, the pharmacy department operated 12 decentralized pharmacies and one central pharmacy; no i.v. admixture services were provided, except for total parenteral nutrient solutions. In developing the service, the pharmacy department considered the advantages and disadvantages of (1) a centralized versus decentralized organization, (2) various physical facilities, and (3) various staffing patterns. An ad hoc committee of the P & T committee was formed to develop multidisciplinary guidelines for the appropriate handling of these products. A centralized service open from 0800 to 1600 daily was established. A supervisor was hired to train and manage the rotation of the entire pharmacy staff through the area. A vertical laminar-airflow biologic safety cabinet and exhaust adapter were purchased, and policies and procedures for handling the antineoplastic agents were developed for all involved personnel. Since opening in July 1983, the antineoplastic admixture service has been positively received by health-care providers in this institution, and no major problems have been associated with the program.     

Applying for a certificate of need for unit dose and i.v. admixture services in a Connecticut hospital

The process of obtaining regulatory-agency review of a proposal for unit dose and i.v. admixture services is described. In a 901-bed community hospital in Connecticut, a pharmacy department proposal for instituting unit dose distribution and expanding the i.v. admixture service was supported by the hospital administration and included in hospital budget projections. A state body that regulates hospital revenues, the Commission on Hospitals and Health Care (CHHC), rejected the proposal for these changes in pharmaceutical services. The pharmacy and hospital administration subsequently petitioned the Health Systems Agency in that jurisdiction for a certificate of need (CON); the procedure required that the application also be simultaneously submitted to CHHC. Implementation of the program over a three-year period was proposed. The CON application was submitted in July 1981; it required detailed information from pharmacy, nursing services, and hospital administration. During the nine months following application for the CON, further questions were asked and five hearings were held. In April 1982, CHHC approved the program and the capital expenditures but did not approve the proposed 10% increase in drug revenue needed to support the services. The hospital ultimately committed funding for implementation of the program over three years. The net result of the application procedure was a delay in implementation of expanded pharmaceutical services.     

药师在肠内肠外营养支持中的作用及干预实例

目的促进药师在临床营养支持中积极发挥作用,提高药师专业形象和药学服务效率。方法介绍了浙江大学医学院附属第二医院药师在肠内肠外营养支持中的工作模式以及成效。结果临床药师通过参与临床查房和医嘱开立、咨询、讲座宣教、药品不良反应会诊处理等,提供全程药学监护。病区药剂作业的药师通过严格的收费前医嘱审核、与临床医生积极沟通、肠外营养液的集中配置、处方点评和流程管理,保证肠外肠内营养的合理性和使用安全性。不同岗位药师开展了相应的药学服务,互相合作取得了较高的临床满意度。结论肠内肠外营养的合理用药干预需要团队合作,临床药师和药剂作业的一线药师需要紧密合作,从不同的侧重点切入,点面结合,才能将药学服务做精做细。     

Implementing a stand-alone packaged pharmacy computer system in a 580-bed hospital

The problems experienced by a hospital pharmacy department in implementing a stand-alone packaged computer system are discussed, and recommendations for avoiding and managing these problems are presented. In 1984, a stand-alone packaged computer system was implemented in a 580-bed, tertiary-care institution that provides services from a central pharmacy and five satellite pharmacies. The department developed a request for proposal and contracted with a vender for a system that would support unit dose drug distribution and i.v. admixture services. During the implementation process, the following problems were experienced: The hardware was insufficient for the department's workload, the software design was limited, and personnel were frustrated with learning to use the system. These problems were intensified by the heavy workload and the large number of users. In the 18 months since implementation, the department has purchased more hardware, improved the software applications, and resolved many of the problems associated with employee frustration. Pharmacy departments at other large institutions might avoid some of these problems by training personnel adequately before implementation and by researching and estimating hardware and software needs in advance. In this large hospital, the efficiency of a stand-alone packaged pharmacy computer system has improved 18 months after implementation.     

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.     

Justifying additional pharmacist staff in an era of cost reductions

A proposal is described that justified adding one full-time equivalent (FTE) pharmacist in a 125-bed community hospital that already employed in its pharmacy department 2.5 FTE pharmacists and 5.2 FTE other personnel. The administrative steps taken included identifying the need for an additional staff member and documenting the cost effectiveness of various clinical activities. Literature references were used to justify the proposed ratio of pharmacists to technicians; to show the results of deficiencies in supervision, motivation, and scheduling; and to demonstrate the cost effectiveness of serum concentration monitoring, formulary review, and patient discharge-medication consultations. Results of formulary review, drug-use audits, dosing guidelines, and serum concentration monitoring performed by the pharmacy department were included in the proposal. Prospective drug-use reviews, computerized pharmacokinetic dose determinations, additional educational programs, and tighter purchasing policies were identified as other cost-saving activities that could be performed with an additional pharmacist. A 12-page proposal was submitted in July 1983 to the hospital administrator and the budget review committee, and the additional staff position was approved. The key to maintaining the new pharmacist position will be the continual documentation of cost-saving activities within the department.     

Word-processing system in a centralized intravenous admixture program

The application of a word-processing system to a centralized i.v. admixture service is described. The pharmacy department of a 560-bed private hospital developed its admixture service with a limited increase in staff and without compromising its clinical services by using a commercially available word-processing system. The system allows the user to type, edit, store, and print patient profiles and labels for total parenteral nutrition solutions, i.v. piggyback medications, and large-volume parenterals. The data for the admixture service are stored in three diskettes--one for piggybacks, one for TPNs, and one for other applications. Operational details regarding all applications are described. The word-processing system provides a relatively inexpensive method of coping with the large amount of data manipulation and label preparation inherent in a sophisticated i.v. admixture program.     

Establishing a pharmacy department for a large pediatric hospital: managerial problems, opportunities, and lessons

The process of planning and establishing a pharmacy department in a pediatric hospital is described, and lessons learned from the experience are summarized. Since its founding in 1954, Texas Children's Hospital (TCH) had shared pharmacy services with St. Luke's Episcopal Hospital. The decision to terminate the shared-services agreement in the mid-1980s made it necessary for TCH to establish an independent pharmacy department. A director of pharmacy was hired in March 1988, and November 30 of that year was set as the target for implementation of the TCH pharmacy. It was decided that six services--a decentralized unit dose distribution system, an i.v. admixture service, delivery services, ambulatory-care services, a formulatory system, and a drug information service--would be offered initially. Decisions concerning department organizational structure and staffing, space allocations, and a computer system were made. A multidisciplinary advisory committee was appointed; one of its responsibilities was to oversee inservice staff training. The pharmacy areas were to be opened on a staggered basis, beginning with the hematology-oncology clinic pharmacy. A number of problems arose immediately following the opening of the central pharmacy, including inaccurate computer profiles, lower-than-estimated productivity resulting from staff members' unfamiliarity with the new system, higher-than-estimated patient census, and orders for nonformulary drugs. Delays in drug delivery times were unacceptably high. A crisis-management plan was implemented to cover both short- and long-term problems, and within a few months operations had stabilized. The opening of the intensive-care and sixth-floor satellite pharmacies enhanced decentralized operations and had an important role in improving response times.(ABSTRACT TRUNCATED AT 250 WORDS)     

Mandating unit dose drug distribution and i.v. admixture services in New Jersey hospitals

Efforts by New Jersey hospital pharmacists that led to a state mandate for unit dose drug distribution and i.v. admixture services are described. The New Jersey Society of Hospital Pharmacists' proposal for revision of state board of pharmacy regulations for institutional practice had been rejected in 1977. In 1979, NJSHP began to work through the state health department to upgrade standards for institutional pharmacy practice. In 1981, NJSHP submitted to the health department a position paper to justify revised standards on the basis of patient safety and cost-effectiveness, and in 1982 NJSHP conducted a seminar for pharmacists, nurses, and hospital administrators on the cost-effectiveness of unit dose distribution and i.v. admixture programs. The standards were revised and were adopted in June 1984, and hospitals had two years to implement the mandated programs.     

Pharmacy and therapeutics committee review of the parenteral cephalosporins

The process by which a 530-bed university hospital reduced, from three to one, the number of parenteral cephalosporins in its formulary is discussed. In January 1975, cephapirin sodium was added to the formulary which already included cefazolin sodium and cephalothin sodium. Nine months later, the pharmacy and therapeutics committee decided to delete cephapirin and cephalothin from the formulary. The pharmacy department had supplied background information to the committee, and infectious disease specialists advised the committee. The decision was ratified by the executive committee of the medical staff. The rationale for the decision and its implementation, including staff communications, are discussed.     

Justification for a pediatric satellite pharmacy at a tertiary-care institution.

The justification for a pediatric satellite pharmacy is described. Of the 742 inpatient beds in a tertiary-care medical center, 150 are dedicated to pediatric patients. The pharmacy department provides services to both adult and pediatric patients from a central pharmacy. However, unit dose drug distribution services are not provided to the nurseries. Furthermore, the department lacks a core of pharmacists specializing in pediatric practice. As a result, the ability of the pharmacy to support pediatric drug use has been compromised, and medication errors and infection control problems have occurred that can be attributed to this situation. A pediatric satellite pharmacy was proposed to improve the quality of pediatric care. Service objectives were established, and benefits were identified. A financial analysis was included in the proposal that documented a total gain attributable to a pediatric satellite pharmacy of approximately $285,000 over five years. The satellite pharmacy was approved by hospital administration. The pharmacy department's quality assurance committee will monitor the satellite's impact. The justification for a proposed pediatric satellite pharmacy included indications that the satellite could correct medication-related problems and improve pediatric care and that implementation would have a positive effect on finances.     

Total formulary review--the easy way

In an effort to minimize drug costs, many hospital pharmacy services have limited their drug inventories through the development of a formulary. Evaluation of drug products for addition to the formulary is the responsibility of the Pharmacy and Therapeutics (P & T) Committee. The deletion of rarely used or outdated products is often overlooked. As a means to "clean up" the formulary, Hamot Medical Center (HMC) underwent a total formulary review. Drugs were separated into classes as defined by the American Hospital Formulary Service (AHFS). Approximately three drug classes were evaluated each month by the P & C Committee. Evaluation criteria was based on the following factors: current formulary status, usage statistics, negative comments appearing in six current publications, hospital acquisition cost, and number of formularies containing each product. A final compilation of all deletions and additions were distributed to all medical staff department and division chiefs. Following receipt of all their comments, a final draft of the formulary was made and prepared for publication. This system is a simple, uncomplicated means of either revising or beginning a formulary. It evaluates a drug based on efficacy, individual hospital usage, and cost of the drug while allowing for input of the medical staff. The end result is a formulary tailored to best fit each institution.     

Prospective-pricing strategies for hospital and departmental effectiveness: the pharmacist's response

Strategies a pharmacy department used to identify product costs and cost of drug therapy by case type are discussed. To define its intermediate products, the pharmacy identified 300 of 7500 line items on the formulary as representing 95% of its drug costs. This information, coupled with workload measures and component costs such as labor and supplies, was used to identify the cost of the pharmacy's products. A retrospective drug-therapy analysis conducted on total-hip-replacement procedures showed that drugs can be indicators of the severity of medical problems and hence good predictors of total hospital cost per case. Intermediate-product costing can be used to determine end-product profitability. Clinical pharmacists can help substantially in trying to determine the total cost of drug therapy, and they can help by developing standard treatment patterns with cost standards for treating patients in specific DRGs.     

品管圈在提高肠外营养液灌注速度方面的应用

目的：利用品管圈（QCC）方法,提高我院静脉用药调配中心（PIVAS）肠外营养液（TPN）的灌注速度。方法：按照PDCA循环理论（计划、执行、检查、控制）,运用鱼骨图法分析影响肠外营养液灌注速度的原因,采用头脑风暴法探讨解决问题的对策并加以实施,最终评价有形成果和无形成果,制定标准化工作流程。结果：肠外营养液的灌注速度由平均75.46袋/小时提高至106.02袋/小时。结论：品管圈活动在药学部的应用,具有明显的效果和积极作用,在改进工作、提高肠外营养液灌注速度的同时,降低了劳动强度,大大提高了临床满意度。     

建立静脉药物配置中心的必要性

目的探讨建立静脉药物配置中心的必要性。方法对静脉药物配置中心的概况、意义、存在的问题进行分析。结果静脉药物配置中心的建立能够最大限度的保证人体的安全性,节约药品,减轻工作量,保证合理用药。结论建立静脉药物配置中心为医院带来社会效益和经济效益。     

Drugman--a computerized supplement to a hospital's drug information newsletter

A computerized supplement to a hospital's drug information newsletter, called Drugman, is described. The pharmacy department of a 452-bed teaching hospital developed Drugman. The program uses the "Converse" software, which was developed by the hospital's computer medicine department. The program provides information on new drugs recently added to the formulary and updated information on current formulary drugs. It also provides information on investigational drugs. A staff pharmacist is responsible for coordinating the writing and review of each new-drug monograph in the system, as well as the computer entry and up-dating of existing monographs. The program is available to all medical, nursing, and pharmacy personnel via computer terminals located on each nursing unit and in the pharmacy department. Survey questions at the end of the program elicit user response to the program and suggestions for additions or changes. In the initial 14-month period, the general response to Drugman has been favorable. Drugman represents a new method of disseminating drug information via computer in an individual hospital. The program complements traditional drug information sources and has been received positively in our hospital.     

医院处方集应用中存在的问题及对策探讨

医院处方集是医院药学信息服务工作的一项重要内容,是提高医院药事管理水平、促进合理用药的重要工具和手段。处方集的编制和管理也成为医院药事管理中非常重要的一项工作内容,但依靠传统模式编制、管理的处方集,在应用中存在的不足或弊端已不能满足医院合理用药及药事管理发展的需要。本文分析了医院处方集目前的应用现状及存在问题,对医院处方集建设的发展思路进行探讨。     

品管圈用于降低静脉用药调配中心药品损耗的实 践简

目的 提高科室人员参与自我管理的意识和解决问题的能力,降低药品损耗.方法 2011年10月医院成立品管圈并确立降低药品损耗为主题,分析药品损耗居高不下的原因,制订相应的整改措施并组织实施.结果 药品损耗明显降低,由原来的每月2 404.12元降至1 151.96元,下降了52.08％.结论 开展品管圈活动不仅降低了静脉用药调配中心的药品损耗,还提高了科室人员参与管理的意识和解决问题的能力.     

Strategic planning for clinical services: St. Joseph Hospital and Health Care Center

A pharmacy department at a 340-bed community hospital based its strategic plan for developing patient-oriented services on a sound drug distribution system, a credible work-measurement program, and fiscal responsibility. In 1982 the department of pharmacy and i.v. therapy implemented a strategic plan for improving pharmaceutical services. The plan involved developing goals and objectives for the department; marketing the department's services and fiscal management to hospital administrators, medical staff, and nursing staff; building teamwork among the pharmacy staff; and improving the drug distribution system before instituting clinical services. Hiring of additional pharmacy staff was justified on the basis of work-measurement data. By adjusting staffing levels every two weeks based on work-measurement data, the department increased the efficiency of drug distribution activities; the pharmacy also implemented cost-saving programs like selection of therapeutic alternates and formulary restrictions. The savings were then reinvested in labor-intensive patient-oriented pharmaceutical services. A staff development program using staff pharmacists as preceptors expanded the breadth and depth of pharmacists' clinical skills. The planning efforts were successful because the needs of hospital administrators, the pharmacy department, and staff members were addressed.