Topics in hospital pharmacy management最新文献

Intervention documentation continues to be a valuable tool for both documenting pharmacist impact on patient care and justifying new clinical pharmacy services. Utilizing TQM principles to improve documentation has yielded many long-term benefits. Not only has intervention documentation been streamlined, but pharmacists at the staff level were an integral part of the changes that were made and the improvements to come. Their familiarity with the pitfalls of the former system provided solutions to the problems that might have been overlooked without their input.

The implementation of this documentation system has been a success. The SPF pharmacists' participation has been excellent. All of the original objectives have been met. The results collected have been responsible for more than validating the clinical functions of the pharmacists. They have been used to create CQI indicators, improve the work flow in the IV room, and enhance the evaluation process. The pharmacists work as a team to ensure that all interventions are documented. The results obtained, including numbers and trends, are reported on a monthly basis to the NSCPS, the sterile product formulation manager, and the director of Pharmacy Services. Although the documentation is considered to be a requirement for the pharmacists, they are continually encouraged through constant feedback from the managers. This feedback included individual recognition for exceptional interventions and reports of the impact of the interventions on pharmacy service. The biggest problem with the present system was the time-consuming task of entering the data into the Paradox computer database. This will soon be resolved by the implementation of a bar code system to automate this process. The pharmacists will be able to document the information from the interventions with a hand-held bar code wand. At the end of each day, the information can be automatically downloaded into the Paradox computer database.

The customer survey was a useful tool for marketing the IDS. It provided guidelines for making decisions about the best use of limited human and material resources. Analyzing the results of the survey provided new priorities and directions for the IDS. These results were then used in conjunction with pharmacy financial and operational data to focus on areas of greatest importance to the customers and the pharmacy. Physicians should not be reluctant to pursue compassionate use treatments because of the administrative programs responsibilities that accompany such programs. Every patient should have the opportunity to benefit from alternative therapies that are investigational. For the quality of patient care to be maintained or even enhanced when studies are conducted, nurses must be well trained. The marketing survey fulfilled its purpose of identifying service gaps and allowing us to improve our services.

At the end of the survey, respondents were asked whether their departments planned to make changes affecting the IDS within the next one to two years. Fifty-nine percent had made plans, and most of these plans included an expansion or streamlining of investigational services. Thirty-five percent planned to increase the scope of services offered, or extend present services to cover areas previously not reached, such as a specific medical service, or an outpatient clinic. More than 39 percent planned to begin using computers in the operation of the IDS, or expand their present use of computers. Twenty-six percent planned to increase staffing in some way; these plans included designating a staff pharmacist to handle study drugs and budgeting a few hours per week, hiring a pharmacist, nurse, technician, or student, or adding clerical help. Five institutions (less than 2%) planned to scale back services; this was due to budgetary cuts in three hospitals and one hospital closure, but in one case, plans were to limit enrollment of new patients to hours when a pharmacist is available. Clearly, many factors are involved in the operation of an IDS. The information obtained from this survey is by no means a complete list of the services that may be provided; however, the information and ideas gathered from this survey were useful in planning for service expansion at St. John's Hospital. It is hoped that this information might be useful to other pharmacists and pharmacy administrators as well.

The focus of much performance appraisal in the coming decade or so will likely be on the level of customer satisfaction achieved through performance. Ultimately, evaluating the evaluator--that is, appraising the supervisor--will likely become a matter of assessing how well the supervisor's department meets the needs of its customers. Since meeting the needs of one's customers can well become the strongest determinant of organizational success or failure, it follows that relative success in ensuring these needs are met can become the primary indicator of one's relative success as a supervisor. This has the effect of placing the emphasis on supervisory performance exactly at the point it belongs, right on the bottom-line results of the supervisor's efforts.

The increasing prevalence of pharmacy-based IDSs is raising the awareness of sponsors to the value of involving pharmacists in the design and conduct of drug studies. We have participated in several privately sponsored multicenter studies that required pharmacy participation as a condition of site participation. Government agencies (i.e., NIAID) now require and fund pharmacy involvement in their research.