Topics in hospital pharmacy management最新文献

In response to the current trends in health care utilization and provision, The UMHC Department of Pharmaceutical Services has as part of its mission the provision of comprehensive pharmaceutical services to its ambulatory patients. To achieve this, the Department began the process of identification of need and the provision of these services. Simultaneously, the Department is conducting research to document the impact that pharmacists can have on the cost and quality of care when they are actively involved in the therapeutic management of patients treated in the ambulatory setting.

The need to justify continued and expanded clinical services persists in the current climate of concern over the high costs of health care; thus, documentation of the clinical interventions of pharmacists is vital. Time is a limited commodity, and an intervention reporting system must be as efficient as possible. A system that can be integrated into departmental and institutional quality assurance activities is a necessity; the capability of sharing the information with other hospital committees and departments is also an important consideration.

There is a growing importance and need for the documentation of the clinical work done by the pharmacist in providing pharmaceutical care. The data provided by documentation of care are critical to the effective and efficient transition from a product-based profession to a patient-care, service-based profession, especially during a period of great scrutiny of resource utilization in the hospital industry. Intervention documentation can serve both to document the provision of pharmaceutical care to individual patients and to provide critical information to managers to justify and expand the level of service provided.

In conclusion, the development of an efficient system to document pharmacist-initiated drug therapy interventions has been successful. The system has been incorporated into the pharmacy quality assurance program and is being used to evaluate the provision of pharmaceutical care. Finally, the system has been incorporated into the clinical services drug-use evaluation program and is being used to evaluate individual physician prescribing practices.

Several important lessons were learned during this pilot project. First, the timely feedback of results, in the form of a concise report, to the pharmacists documenting the recommendations was very useful and aided in their future participation in the program. Second, the design of the database that restricted the data entry person to choose from a list of scrollable choices enhanced the utility of the database for reporting purposes. Future work is needed to facilitate data entry by the pharmacist recording the recommendation.

We have suggested that some pharmacotherapists may resist documentation because they view it as administrative intrusion rather than an essential component of continuity of care. In the final analysis, it is also a matter of the pharmacotherapist's belief. Pharmacists must understand what it is that they contribute, and must believe that it is both valuable and unique. It is not just an information management function--they are making patient-specific decisions and must be willing to be held accountable for their outcome. The pharmacy manager must also believe that such a responsible decision-making role represents that preferred future for the profession. Unfortunately, because many pharmacy managers have never truly functioned in such a role, developing such a belief system is difficult at best. The hospital administrator must also be made to believe that the contribution of the pharmacist to patient care not only extends beyond materials management but represents an entirely separate professional function. This will not occur simply through documentation of interventions. Yes, we believe that it is necessary to document pharmacotherapeutic interventions, however, not for the reasons that it is most frequently demanded.

In our hospital, the decentralized pharmacists, on a daily basis, are documenting their cost-saving and therapeutic interventions. The cost savings for the first six months in 1991 totaled $45,862. The therapeutic interventions for these six months totaled 2,087. These interventions have a direct impact on the quality of patient care, while at the same time providing input into economics of patient care. The pharmacist interventions at our hospital can be documented and measured, and they do have an impact on physician prescribing habits.

The clinical intervention reporting system that we are using at our facility provides pharmacy management, hospital management, and the quality improvement committee with valuable information. Pharmacy management can use the interventions to motivate, train, and evaluate pharmacists, as well as justify full-time equivalent employees. Hospital management can use the data in the budgeting process, in physician credentialing, and as a part of the medical center's cost containment efforts. The quality improvement committee can use the data in drug selection for DUEs, as well as for information in clinical privileging. Now pharmacy can say with confidence, "We are documenting it; we are doing it."

Pharmacists should incorporate and modify existing clinical intervention programs to document pharmacists' effects on patient care and quality drug-therapy management. We have already demonstrated the pharmacist's role in drug cost savings through the intervention programs, and now QIP can assist us in taking the next step in providing quality patient care. If we endorse the principles of pharmaceutical care, we must assume the responsibility for documenting our value as pharmacists in managing drug therapy in patients. The clinical intervention programs will deemphasize the value of drug cost analysis and emphasize effects on patient-care outcome. We believe that facilitating positive patient outcomes will decrease overall health care costs. As managers, we must assist our pharmacists in endorsing this concept by developing our programs to show the maximum benefit of their efforts in the patient-care arena.

The QARx program provides the necessary tools for organizing and effectively implementing a quality assurance program for a pharmacy department that truly offers the ever-elusive potential for creating an environment that promotes on-going quality improvement for the department. Eventually there will be a plethora of criteria sets available so that a pharmacist will be able to just choose the pertinent indicators from the shelf (if you choose not to create your own). There is an option to import criteria sets from the utilities menu, and the availability of pertinent sets should provide an attractive option for actually selecting certain readily available sets of indicators, monitors, and outcomes to be automatically imported into your existing quality assurance plan. This program is a must for any department manager trying to organize and orchestrate an effective quality assurance program in a health care institution. For more information about QARx, contact the American Society of Hospital Pharmacists, Special Projects Division, 4630 Montgomery Avenue, Bethesda, MD 20814, (301) 657-3000.