Using an action research process in pharmacy practice research—A cooperative project between university and internship pharmacies

BackgroundAction research (AR) is a common research-based methodology useful for development and organizational changes in health care when participant involvement is key. However, AR is not widely used for research in the development of pharmaceutical care services in pharmacy practice.ObjectivesTo disseminate the experience from using AR methodology to develop cognitive services in pharmacies by describing how the AR process was conducted in a specific study, and to describe the outcome for participants.MethodsThe study was conducted over a 3-year period and run by a steering group of researchers, pharmacy students, and preceptors. The study design was based on AR methodology. The following data production methods were used to describe and evaluate the AR model: documentary analysis, qualitative interviews, and questionnaires.ResultsExperiences from using AR methodology and the outcome for participants are described. A set of principles was followed while the study, called the Pharmacy-University study, was being conducted. These principles are considered useful for designing future AR studies. Outcome for participating pharmacies was registered for staff-oriented and patient-oriented activities. Outcome for students was practice as project leaders and enhancement of clinical pharmacy-based skills. Outcome for researchers and the steering group conducting the study was in-depth knowledge of the status of pharmacies in giving advice to patient groups, and effective learning methods for students.ConclusionDeveloping and implementing cognitive pharmaceutical services (CPS) involves wide-reaching changes that require the willingness of pharmacy and staff as well as external partners. The use of AR methodology creates a platform that supports raising the awareness and the possible inclusion of these partners. During this study, a set of tools was developed for use in implementing CPS as part of AR.     

Implementing a Pharmacy System: Facilitators and Barriers

To describe facilitators and barriers to the implementation of an inpatient pharmacy system at two pediatric hospitals. Interviews, pre- and post-implementation, were conducted with pharmacy and clinical managers. Key findings from the pre-implementation survey were included in the post-implementation survey to further assess facilitators and barriers to the adoption of a pharmacy system. The majority of pharmacy participants and all clinical leaders believed that project goals were being met. Pharmacist’s described staff readiness-to-change as the most significant facilitator to adoption and concerns with the usability of information in the pediatric drug file as the most significant barrier. Clinical managers described system training and education as the most significant facilitator to adoption and adjustment to new work processes as the most significant barrier. We described major facilitators and barriers to the adoption of an inpatient pharmacy system at two pediatric hospitals. Strategies identified by our informants to overcome barriers may promote successful pharmacy implementations at other pediatric facilities.     

Neonatal intensive care nurses’ perceptions of implementing parent discharge preparation tools

BackgroundStandardized tools for discharge education can facilitate transitions from the neonatal intensive care unit to home. Perceptions of nurses regarding parental discharge preparation and relevant tools can inform implementation.PurposeTo describe nurses’ perceptions of discharge preparedness and implementation of a standardized tool to facilitate nurse-parent engagement in discharge education.MethodsWe conducted semi-structured interviews with seven nurses meeting eligibility criteria. Interviews were conducted using an interview guide developed for this study and were audio-recorded, transcribed verbatim, and thematically analyzed.ResultsThree major themes emerged: 1) Discharge Education is an Ongoing and Evolving Process; 2) Nurse-Parent Partnerships; and 3) Importance of Context to Implementation of Standardized Tools. Sub-themes emerged from the data to support each major theme.ConclusionStandardized tools can improve parent discharge preparedness and implementation of these tools is facilitated by well-described processes, partnerships between nurses and parents, and tailoring to the unit context.     

Addicted to discovery: Does the quest for new knowledge hinder practice improvement?

Despite the billions of dollars spent on health-focused research and the hundreds of billions spent on delivering health services each year, relatively little money and effort are directed toward investigating how best to connect the two. This results in missed opportunities to assure that research findings inform and improve quality across healthcare in general and for addiction prevention and treatment in particular. There is an asymmetrical focus that favors the identification of new interventions and neglects the implementation of science-based knowledge in actual practice. The consequences of that neglect are severe: significantly diminished progress in research on how to implement treatments that could improve the lives of persons with addiction problems, their families, and the rest of society. While the advancement of knowledge regarding effective implementation is lagging, it is clear that existing systemic incentives in the conduct of science inhibit rather than facilitate widespread adoption of evidence-based practices. This commentary proposes three interrelated strategies for improving the implementation process. First, develop scientific tools to understand implementation better, by expanding investigations on the science of implementation and broadening approaches to the design and execution of research. Second, nurture and support a collaborative implementation workforce comprised of scientists and on-the-ground practitioners, with an explicit focus on enhancing appropriate incentives for both. Third, pay closer attention to crafting research that seeks answers that are most relevant to clinicians' actual needs, primarily by ensuring that the anticipated users of the evidence-based practice are full partners in developing the questions right from the start.     

加强医院采购管理工作的思考与实施

医院采购管理工作是否能适应医院发展的需要,关系到医院的社会效益和经济效益的实现。本文就目前医院采购管理工作中存在的一些问题,结合我院实际提出相应的解决办法,通过健全内部管理制度,提升医院综合实力和医院竞争力,使医院能积极应对医疗市场的竞争与发展。     

重庆市基本药物和绩效考核制度的实施现况调查

目的了解重庆市基本药物和绩效考核制度的实施现况,为政府相关部门科学决策提供依据。方法采用立意抽样方法抽取重庆市实施基本药物和绩效考核制度的19个社区卫生服务中心,采用问卷调查和小组访谈方法调查其机构负责人。结果 19个机构全部实施基本药物和绩效考核制度,47.4%的机构配全基本药物,42.1%的机构非基本药物全部下架;15.8%的机构门诊量增加,大医院转回社区的患者有78.9%不能在社区开到所需药品;84.2%的机构收入减少,68.4%的机构职工收入减少;84.2%的职工对绩效考核不满意。结论基层卫生急需综合配套改革。基本药物目录的制订需要充分调研并进行动态调整,大医院与基层同步推进,以保证服务连续性。应在落实基层卫生机构补偿基础上实施绩效考核,同步推进人事制度改革。     

结构化电子病历的实施策略

结构化电子病历作为医改的重要内容,正在全国范围内积极推广。本文从实地考察慎重选择、专人负责分工合作等5个方面阐述了我院结构化电子病历的实施策略,并介绍了该项目实施后方便医师工作,提高病案质量等功能,探讨了实施结构化电子病历的经验,提出了对于实施过程的建议。     

医院电子病案的实施

电子病案在基层医院的实施,通过资金投入和人员培训,循序渐进地建立经济适用的电子病案系统,实现了异地医疗信息资源共享,使广大患者在基层医院得到更好的医疗服务;基层医院工作量明显加大,收到的不仅是经济效益、社会效益,更有助于改善医疗服务项目,扩大医院影响,使医疗资源分布不均衡的现状得到明显改善;高效、低耗、节能提高了基层医院医疗工作效率,加快信息化发展速度,从而使医疗资源得到充分的利用。电子病案系统帮助医务人员迅速、直观、准确地了解相关病例的医疗信息,迅速建立有效的诊疗方案,在提高医疗效率的同时,节约有限的医疗资源,控制减少医疗消耗。     

医学影像技术专业高职学生职业规划教育的实施与思考

依据社会、市场、学校和学生的实际情况,北京卫生学校对医学影像技术专业高职学生实施全程化职业规划教育,从新生入学和一年级的职业引导和入职前教育,多种多样的日常活动贯穿职业意识的渗透教育,到融入专业课程教学过程职业规划教育的行为教育,实时有效、针对性的求职应聘的技巧教育等,实现全程化的有计划、有侧重的职业指导,使学生真正了解职业、准备职业、选择职业、适应职业和转换职业,树立正确的价值观、择业观,培养良好的职业素养,规划未来的职业生涯,在思想、知识、能力、素质等方面做好从业前的准备.实践表明,全程化的职业规划教育是行之有效的方法.