Topics in hospital pharmacy management最新文献

This article describes the successful implementation of a prospective drug dosage adjustment program that has achieved cost-containment, improved quality of patient care, and optimum usage of clinical pharmacy services. It has significantly reduced the number of unnecessary doses administered and lowered the possibility of adverse drug reactions.

This article defines a process to reconfigure and streamline patient care services in an acute care hospital. Multidisciplinary teams use quality improvement methods and team process to challenge and redefine current work activity in order to achieve financial savings and service improvements.

As health care reform takes shape, many challenges face hospital pharmacists. An opportunity exists to combine the principles of patient-focused care and pharmaceutical care to restructure the pharmacy department. The goal of restructuring is to increase the amount of time pharmacists spend providing pharmaceutical care to patients.

The patient-centered care model needs to retain a central focus on the patient. Process and system interfaces are key areas where alignment on behalf of the patient is required. Often, the current system is out of control. Departmental infrastructure and the need for resource reallocation must be assessed. No blueprint exists for implementing patient-centered care, although many incremental patient-focused initiatives are already underway. Impact on patients must be the balancing factor.

The use of automation in hospital pharmacies is essential to support the concept of patient-focused care. Patient-focused care principles are defined, and the positive effect automation can have on supporting these principles is discussed. Automated technologies supporting drug distribution, sterile product production, prescription filling, and point of care information systems are summarized. Drug distribution technologies include distribution to and from the patient care area, distribution of medication to the patient, inventory control, controlled substance systems, and documentation of medication administration. Finally, a comprehensive automated technology system at a university teaching hospital is described.

The pharmacy-based investigational drug service plays an important role in the clinical research process. Investigators and sponsors often rely on the research pharmacist to assure drug accountability and to assist in educating staff about drug studies, reporting adverse reactions, and providing drug information. While many pharmacy departments across the country have established investigational drug services, there is an increasing need to justify these services from a financial perspective. Our pharmacy department currently provides investigational drug services for over 100 protocols. We have established a fee-for-service billing mechanism, but only 61% of our protocols are drug-company or investigator-sponsored, which reimburse for pharmacy services. As a result, we are unable to collect all operating costs through our billing mechanism. Many protocols, however, are sponsored by the National Cancer Institute (NCI), which provides free drugs for cancer protocols. Some NCI drugs are also on the market, so the hospital experiences savings in drug costs when patients are placed on certain NCI protocols. When we combine direct costs recovered through billing with the indirect cost savings from dispensing "free drugs, we find that the total benefit of operating an investigational drug service more than outweighs the cost of operating the service.

Patient-focused care is a new way of doing business in hospitals. Work redesign initiatives can be an opportunity or a threat to established pharmacy structures. Seizing the opportunity, pharmacy departments can use redesign efforts to implement pharmaceutical care. Key features of a redesign initiative include vision development, objective setting, and defined operating strategy elements. This article describes the process used in a patient-focused care initiative at MultiCare Medical Center and its Department of Pharmacy Services, Tacoma, Washington.

Patient-centered care may have the pharmacists and technicians reporting either directly or in a matrix to other than pharmacy administration. The pharmacy administrative people will need to be both effective leaders and managers utilizing excellent human resource management skills. Significant creativity and innovation will be needed for transition from departmental-based services to patient care team services. Changes in the traditional methods of recruiting, interviewing, hiring, training, developing, inspiring, evaluating, and disciplining are required in this new environment.

Patient-centered work restructuring reduces costs and improves quality by helping hospitals make better use of high-skilled professionals in an environment that requires few non-valued activities in fulfilling patient clinical and support needs. Described in this article are the critical elements of core process reengineering, several principles of patient-centered care, the implications for pharmacy, and the pharmacist's role in the new environment. The goal is to increase the amount of time pharmacists spend in clinical decision making, education, and monitoring to help expedite patient recovery, shorten lengths of stay, and improve utilization effectiveness.

This article will describe our hospital's transition to a patient-centered care environment as a response to rising costs within the hospitals and a desire to improve the quality of patient care through systems improvement. The involvement of pharmacy managers in the new organizational structure will be detailed, as well as their new roles and responsibilities as care center leaders. The traditional pharmacy management structure has been replaced by a team approach to decision making and problem solving. Challenges exist to the pharmacy managers as they reorganize to accommodate new responsibilities within the care centers. Opportunities exist within this setting to support pharmaceutical care.