Topics in hospital pharmacy management最新文献

The design of institutional medication use programs that are effective and meet regulatory and accreditation standards is becoming increasingly dependent upon a thorough understanding of the principles and applications of continuous quality improvement (CQI) and total quality management (TQM). Both the Joint Commission on Accreditation of Healthcare Organizations and the federal government have recently begun to make significant attempts to transform our existing quality assurance programs into indicator-based quality improvement management systems that are based on the principles of CQI and TQM. The article outlines and illustrates an effective approach for developing and implementing a comprehensive CQI/TQM program for medication use monitoring.

Successful examples of teams and drug use evaluations explore communication strategies to enhance quality improvement of medication use. Topics highlighted include establishing contacts within key departments, creating committee connections, fostering physician and nurse participation, and increasing visibility and maintaining awareness. Multidisciplinary collaboration and linkage between the hospital and the managed care pharmacy are also reviewed. Medication use can be improved by integrating these communication tactics.

Total quality management techniques were used to lay the groundwork for and to implement procedural changes designed to improve compliance with the Joint Commission on Accreditation of Healthcare Organizations' medication use indicator for ordering and administering presurgical antibiotics. The effect of these procedural changes on patient outcomes (i.e., postsurgical infection rates and length of hospitalization) is described. In a study to assess compliance, 57 (30 percent) of 40 control patients received a presurgical antibiotic within 1 hour of incision compared with 65 (52 percent) of 126 study group patients, and 83 (44 percent) of the control group received a presurgical antibiotic within 2 hours of incision compared with 88 (70 percent) of 126 study group patients. Postsurgical infection rates and length of hospitalization were not significantly different (p = .407 and p = .885, respectively).

The development of critical pathways along with continuous quality improvement and patient-focused care represents one of the key initiatives in health care in the 1990s. The critical pathway defines the components of care, including treatments, diagnostic measures, and activities to be performed each day, to achieve the desired outcome for a patient with a given diagnosis. Indicators can then be used to define opportunities for improving the pathway. Participation in the critical pathway development process provides pharmacists with an opportunity to utilize their expertise in the medication use process to ensure optimal medication management.

Physician partnering, value-added relationships, and integrated delivery systems with risk/incentive arrangements are emerging in managed care. These arrangements require time-sensitive program information that can be used in continuous quality improvement programs. Components of any clinical intervention program designed to improve the quality of pharmacotherapy are on a continuum, from those that are primarily individual patient focused to those that are disease or system/process focused. Components include case management, patient profile review, brand to generic drug conversion, targeted therapeutic evaluations, provider profiling, and pharmacoeconomic analysis. All health care professionals involved in pharmacotherapy need to be involved in implementation of these quality improvement programs.

Critical pathways are multidisciplinary tools designed to improve patient care and efficiency. Almost every path requires some type of pharmacotherapeutic intervention, from selection of surgical prophylaxis to management of anticoagulation. Pharmacists should become involved with the critical pathway process because it offers an excellent opportunity to incorporate pharmaceutical care and to meet Joint Commission on Accreditation of Healthcare Organization compliance criteria.

Economic and competitive pressures in the health care market are causing hospitals and other health care providers to seek more effective ways to improve the quality of care and to decrease costs. Integrating total quality management and continuous quality improvement techniques into traditional drug use evaluation methodology allows for the development of critical performance indicators. These indicators integrate the selection, use, delivery methods, and outcomes of drug therapy with other operational therapeutic modalities. The article describes the development of medication system performance indicators using heparin dosing as a model.

The safe handling of cytotoxic agents is intimately related to the technical aspects of drug preparation, dispensing, and administration. The appropriate equipment, supplies, protective clothing, and waste disposal systems must be available to the health care worker who is called upon to prepare cytotoxic agents. In addition, the health care worker must be adequately trained in and familiar with the safe use of these products and equipment and the preparation techniques or manipulations necessary during cytotoxic drug compounding. The article describes in detail and reviews the technical considerations, such as aseptic technique, proper use of the biological safety cabinet, gowning and gloving, labeling, and waste disposal, that are essential to the safe preparation and dispensing of chemotherapy.

Providing complete and understandable information to patients about medicines is considered an integral component of high-quality medical and pharmaceutical care. With such information, not only can the level of general health increase, but costs associated with noncompliance, including polypharmacy and hospitalization, can decrease. Although patient information leaflets (PILs) have been available since the 1970s, their use is more relevant today because of the counseling requirements of the Omnibus Budget Reconciliation Act of 1990. A national survey of community pharmacists was conducted to determine their attitudes toward this patient education strategy. Results demonstrate that pharmacists believe PILs benefit patients, but that PILs need revision in terms of readability, understandability, and standardization.

The purpose of this study was to classify pharmacist-physician encounters in a family medicine center into three progressive levels of service in order to determine the physician's perception of the relative value of each level. The three levels of service were drug information, pharmacy consultation individualized to the patient, and pharmaceutical care-consultation with follow-up to monitor patient outcome. Physicians received a questionnaire with each encounter and were asked to rank questions regarding the quality of the information provided, the impact they perceived that the information had on patient care, and to assign a monetary value for each encounter. A total of 106 of 141 (75 percent) questionnaires suitable for analysis were stratified into drug information (25.5 percent), pharmacy consultation (49 percent), and pharmaceutical care (25.5 percent). Physicians' perceptions toward the quality, impact, and value of pharmacy services were favorable overall, but they perceived a significantly higher quality, impact, and value to pharmaceutical care encounters than for drug information and pharmacy consultation (p < 0.05).