Topics in hospital pharmacy management最新文献

The management imperatives for pharmaceutical care concern themselves with complexity, while leadership imperatives are concerned with effecting change. Both "species" of action are needed to support the paradigm shift associated with pharmaceutical care. Pharmacy managers must be the architects and engineers of the new dimensions of complexity associated with pharmaceutical care while also serving as zealots of change for pharmaceutical care within their departments and hospitals. In the final analysis, departments of pharmacy do not practice pharmaceutical care. They are, however, the borne fruit of pharmacy managers and leaders who provide for an appropriate environment inclusive of resources and systems necessary for individual pharmacists to make the commitment to making pharmaceutical care a reality.

Continuous quality improvement methods have the potential to improve processes that cross several disciplines. The medication system is one in which coordination of activities between physicians, pharmacists, and nurses is essential for optimal therapy to occur. DUE services can play an important role in helping to ensure that patients receive high-quality pharmaceutical care. It is necessary for pharmacy managers to review the structure, goals, and outcomes of their DUE programs to ensure that they are consistent with a philosophy of continuous improvement in the quality of drug therapy.

We feel the reorganization has enabled us to position the department and, more importantly, the individual practitioner to achieve a practice model that approaches the pharmaceutical care paradigm. As a result of the reorganization, our department is now structured around patient care and has in place teams of pharmacists, technicians, and managers who have the potential to be proactive and collaborative with other health care professionals to improve the drug therapy outcomes of our patients.

Our department is committed to a process of continuous quality improvement focusing on delivering the best possible pharmaceutical care services. Three committees, each with representation from pharmacists and pharmacy technicians from all areas of the department, were convened in 1991 to 1992 to further identify areas for service enhancement and to plan for the future. Based on the recommendations of these committees, further expansion in ambulatory services is a priority. Other changes will include further automation of the drug-distribution system, examination of the role of the pharmacy technician, development of an automated patient-care system with direct physician order entry, computerized documentation of clinical interventions, and reaffirmation of the role of the pharmacist as the professional responsible for proper use of medications at UMHC.

To date, the stated program objectives have been met. There is a heightened awareness of ADRs, and the program has had a positive impact on patient care. More work is needed in the prevention of ADRs as opposed to their tabulation. Future educational efforts will focus on how reporting suspected ADRs can positively impact patient care.

A frequent complaint among health care professionals about ADE reporting programs is that they never know what happens to the information they took the time and effort to report. In the Mississippi ADE program, physicians appreciated the feedback they were provided--in letter form--indicating the ultimate disposition of the reported information. Also, a regular newsletter summarizing the number and types of reports and the drugs involved was well received. This vehicle was also used to educate physicians about new drugs on the market that warranted closer scrutiny. Reminder posters placed at strategic points around the hospital and periodic inservices on the program are effective in maintaining a level of awareness about the importance of ADE monitoring and its impact on the quality of care.

All health care professionals are responsible for reporting ADRs. The physician records these events in the patient's medical record. In the monitoring program at Meriter Hospital, pharmacy responsibilities include review and assessment of all reported ADRs. When appropriate, the ADR is reported to the FDA. The pharmacy department maintains ADR statistics, reports quarterly to the P&T committee, and disseminates information to appropriate hospital committees and departments. The P&T committee supports the ADR monitoring program and policy. This committee reviews all ADRs and recommends action plans. The ADR monitoring program has successfully increased the number of ADRs reported, and actions resulting from ADR reports have had a positive impact on patient care.

Crossfunctional teams can generate more new ideas, concepts, and possible solutions than does a department-based process alone. Working collaboratively can increase knowledge of teams using CQI approaches and appropriate tools. CQI produces growth and development at multiple levels resulting from involvement in the process of incremental improvement.

This research is intended to improve understanding of the leadership orientations of hospital pharmacy directors. The results of the study suggest that these pharmacy directors have not assumed leadership roles within the network of social relationships in the organization. One explanation is that descriptive theories are of little relevance to current practice. Another explanation is that these pharmacy directors are not prepared to value and to be competent at leadership roles. In the absence of measures of effectiveness, these results are difficult to evaluate in terms of the need to cultivate leadership skills in pharmacy directors. Nevertheless, cultivating such skills may be desirable because the pharmacy directors participating in this study perceive that they are less prepared to engage in relationships with people external to the pharmacy department than with members of the department. Enhanced competence would create the potential for higher perceived value and may yield shifts in actual behavior.