Direct Patient Care Roles Research Articles

An Information Paper on the Role of the Pharmacy Technician

INTRODUCTION CSHP endorses the concept of the direct patient care role of the pharmacist.1,2 One of the challenges to realizing this vision is providing pharmacists with the time to focus on direct patient care activities. An element required to achieve this is the increased utilization of pharmacy technicians in activities traditionally performed by pharmacists and/or in activities that directly support pharmacists providing direct patient care services. In some areas of Canada, a shortage of pharmacists has also sparked a review of expanded responsibility and authority for pharmacy technicians.

A clinical advancement program: creating an environment for professional growth.

Clinical ladders help maintain expert, motivated, and effective nurses in direct patient care roles. While many institutions were phasing out clinical ladders for registered nurses, Miami Valley Hospital was proactively evaluating the original version. The authors describe their clinical advancement program, based on Benner's model, with program evaluation results. The program participation rate has increased overall. Participants perceive their work and environment more positively than nonparticipants.

Gene therapy: Current and future implications for oncology nursing practice

To provide oncology nurses with the basic concepts of gene therapy related to cancer and to outline their practice roles. Published professional articles, clinical protocols, and textbooks. Oncology nurses will need to become knowledgeable about the methods and applications of gene therapy for cancer to participate in clinical trials and to develop relevant nursing development plans. Advances in genetic testing and gene therapies will extend oncology nursing roles in direct patient care, education, advocacy, provision of genetic services, and nursing research. Oncology nurses will also participate in dialogue and development of social policies with regard to the safety, ethical, and social issues related to cancer gene therapy.

Pharmaceutical services in the United States Army.

The status of pharmaceutical services in the United States Army is described. The Army Medical Department (AMEDD) has 157 commissioned pharmacy officers and 399 civilian pharmacists working in the United States and overseas. Pharmaceutical services are provided from fixed medical treatment facilities on Army installations and, during war and other field operations, field hospitals. Reductions in personnel and facility closures have helped align the AMEDD with the size of the Army's activeduty force, but there has been only a 15% reduction in the number of eligible beneficiaries. Measures such as the interservice TRICARE program have been implemented to help meet the continued high demand for pharmaceutical services cost-effectively. Army pharmacy is similar to civilian pharmacy, except that Army hospitals often include high-volume outpatient pharmacies not usually found in civilian institutions. Pharmacists are being given direct patient care roles on multidisciplinary teams. Army pharmacists participate in field exercises so that they will be prepared to provide services under combat conditions. The AMEDD trains its own pharmacy technicians in a highly structured 18-week course. A triservice Pharmacoeconomic Center (PEC) has been established with the goal of providing prescribers with the tools for making cost-effective decisions about drug therapy, including a formulary. Army pharmacy officers have broad opportunities to further their education and training. In preparing for the next century, Army pharmacists need to continue to prove their value to the AMEDD, the Army, and the Department of Defense.

Retention Can Be Improved!

A unique program has been developed to encourage retention of nurses who prefer to remain in direct patient care roles. Both recognition and monetary reward are available to nurses who join the "Professional Excellence in Nursing" (PEN) program. The underlying philosophy is that stable employment, clearly defined and attainable goals and recognition for a higher level of performance are keys to job satisfaction--and thus to retention. Evaluative data on this young program are not available but informal surveys indicate a positive outcome.

Clinical career ladders: Application to hospital pharmacy practice

The reasons for job dissatisfaction among hospital pharmacists are reviewed, and an option for ameliorating the problem by offering clinical career ladders is advanced. Not enough new pharmacists are being trained to replace those leaving the profession, and hospital pharmacy managers seeking to recruit and retain quality pharmacists are facing stiff competition from retail outlets, academia, and the pharmaceutical industry. Hospital staff pharmacists report less of a sense of accomplishment than other workers and are more likely to change jobs. Although inadequate pay and benefits are frequently cited, one investigator found that the greatest source of dissatisfaction was the lack of opportunity for advancement. Other professions facing similar problems have experimented with a system of parallel career ladders in which alternatives to the traditional managerial advancement track are offered. Staff nurses on a clinical ladder remain in a direct patient-care role while ascending a hierarchy of clinical practice levels; each level brings greater responsibility and rewards. Outcomes have included improved recruitment, decreased turnover, and increased interest in educational programs. In pharmacy, each level of a clinical career ladder would be defined by explicit criteria for knowledge and skill in patient care and drug therapy. As in nursing, such a ladder would create advancement opportunities and reward the acquisition of knowledge and skills. Several hospital pharmacy departments now offer clinical career ladders. Implementation of clinical career ladders has the potential to enhance the job satisfaction of hospital pharmacists and improve their recruitment and retention.

Plasmapheresis operations in the United States--1968.

The AMA Committee on Transfusion and Transplantation identified 173 facilities conducting plasmapheresis in the United States during 1968. Nearly 389 million ml of plasma were obtained from over 90,000 individual donors at 560,000 donor visits to these facilities. Incidence of donor reactions was in the range of 2% to 3%. In approximately 28% of the establishments providing data, there may be no physician present during the procedure of withdrawing whole blood from the donor, and separating and reinfusing the erythrocytes. Blood fractions obtained from the separated plasma will play an increasingly important role in direct and indirect patient care. Development of uniform criteria for donor selection and standards for donor care appears desirable.

Plasmapheresis Operations in the United States—1968

The AMA Committee on Transfusion and Transplantation identified 173 facilities conducting plasmapheresis in the United States during 1968. Nearly 389 million ml of plasma were obtained from over 90,000 individual donors at 560,000 donor visits to these facilities. Incidence of donor reactions was in the range of 2% to 3%. In approximately 28% of the establishments providing data, there may be no physician present during the procedure of withdrawing whole blood from the donor, and separating and reinfusing the erythrocytes. Blood fractions obtained from the separated plasma will play an increasingly important role in direct and indirect patient care. Development of uniform criteria for donor selection and standards for donor care appears desirable.