Pharmacy Facilities Research Articles

Expanding participation to non-group members in phase III cooperative group treatment trials

6533 Background: The NCI initiated the Cancer Trials Support Unit (CTSU) Independent Clinical Research Site (CICRS) Program at the ASCO Annual meeting in 2002. Building upon the CTSU's initial aim to expand participation of any NCI-sponsored Cooperative Group (Group) phase 3 trial to all Group and Community Clinical Oncology Program (CCOP) members, the CICRS initiative has enabled unaffiliated sites to enroll patients in a wide variety of Group trials. Methods: Interested oncology practices submitted applications that were reviewed by a committee, including external reviewers, to select the most qualified sites. They had to meet standards similar to those for Group members and were assessed for the quality of investigator credentials and site preparedness. Sites were required to demonstrate functioning IRBs, pharmacy facilities, and data management standard operating procedures to ensure a high level of clinical trials practice. A CTSU research nurse mentor was added to address challenges faced by the sites. Sites were required to enroll at least 5 patients per year to remain active participants. Results: Via the CTSU, a trial menu of over 60 Group phase 3 studies, and selected phase 2 trials, were made available to CICRS participants. Active CICRS sites are distributed over 19 states and 6 of the 7 highest accruers are in population areas with less than 300,000 persons. Participating sites were surveyed in January 2006 to better understand barriers to clinical trials enrollment and 68% percent reported the main barriers were dedicated staff, time, adequate IRB and financial support for research. Conclusions: Obstacles for participation in the CICRS program have been defined and strategies to overcome them are being implemented. Results of these efforts will be updated, including provision of survey results, updated accrual, audit results and a review of successful enrollment strategies. No significant financial relationships to disclose. [Table: see text]

Medication safety infrastructure in critical-access hospitals in Florida

The medication safety infrastructure of critical-access hospitals (CAHs) in Florida was evaluated. Qualitative assessments, including a self-administered survey and site visits, were conducted in seven of nine CAHs between January and June 2003. The survey consisted of the Institute for Safe Medication Practices Medication Safety Self-assessment, the 2003 Joint Commission on Accreditation of Healthcare Organizations patient safety goals, health information technology (HIT) questions, and medication-use-process flow charts. On-site visits included interviews of CAH personnel who had safety responsibility and inspections of pharmacy facilities. The findings were compiled into a matrix reflecting structural and procedural components of the CAH medication safety infrastructure. The nine characteristics that emerged as targets for quality improvement (QI) were medication accessibility and storage, sterile product compounding, access to drug information, access to and utilization of patient information in medication order review, advanced safety technology, drug formularies and standardized medication protocols, safety culture, and medication reconciliation. Based on weighted importance and feasibility, QI efforts in CAHs should focus on enhancing medication order review systems, standardizing procedures for handling high-risk medications, promoting an appropriate safety culture, involvement in seamless care, and investment in HIT.

A Survey of Drug Information Resources in Alabama Pharmacy Facilities

The primary purpose of this study was to evaluate the availability and usage of drug information (DI) resources in Alabama pharmacy facilities licensed by the Alabama State Board of Pharmacy. A survey consisting of questions regarding accessible DI resources and their usage was mailed to 1,430 pharmacy facilities, of which 604 (42%) were returned. The survey also consisted of other questions concerning personal data/digital assistant (PDA) usage, computer resources, types of DI questions answered, and other DI-related questions. Drug Facts and Comparisons was the most available and used resource for all pharmacy types; the PDR (Physician’s Desk Reference) and OTC (over-the-counter) references were second and third, respectively. PDA usage was relatively low (19.5%) among all pharmacies, but hospital/mental health pharmacies had the highest usage (32.4%). The primary drug questions answered by pharmacists for all pharmacy types concerned drug interaction, adverse reactions, and OTC questions.

Retrospective study of the costs of care during the first year of therapy with etanercept or infliximab among patients aged ≥65 years with rheumatoid arthritis

The aim of this work was to retrospectively examine the costs of therapy with etanercept and infliximab, among patients aged > or = 65 years with rheumatoid arthritis (RA), from a health-care system perspective. Data from 2 large, automated US health-care claims databases (Constella COMPASS and Ingenix LabRx) were pooled for the analyses. Each database is comprised of paid facility, professional service, and retail (ie, outpatient) pharmacy claims from participating health plans. Using the 2 databases, all RA patients aged > =65 years were identified who began therapy with etanercept or infliximab between July 1, 1999 (Constella COMPASS), or January 1, 2001 (Ingenix LabRx), and December 31, 2002. Costs of RA-related care (including study drugs, selected medications, and outpatient encounters for RA) and non-RA-related care (all other medications and services) for patients in the 2 treatment groups were assessed, in US dollars, over a 1-year period after therapy initiation. A total of 280 RA patients aged > or = 65 years initiated therapy with etanercept (n = 99) or infliximab (n = 181) and met all other selection criteria. Etanercept patients were younger than infliximab patients (mean [SD] age, 70.5 [4.6] vs 71.8 [4.6] years; P = 0.04), were less likely to be enrolled in a managed care organization (76.7% vs 87.8%; P < 0.01), and had fewer pretreatment rheumatologist visits (mean [SD], 1.3 [2.3] vs 2.2 [3.8]; P = 0.04). Other characteristics, including pretreatment levels of other types of health-care utilization, were generally similar. Mean (95% CI) total cost of RA-related care was lower for etanercept patients in both databases (US 12,159 dollars [US 10,795 dollars-US 13,380 dollars] for etanercept vs US 22,347 dollars [US 20,808 dollars-US 23,912 dollars] for infliximab in one, and US 14,297 [US 12,238 dollars-US 16,326 dollars] for etanercept vs US 22,154 dollars [US 19,688 dollars-US 24,703 dollars] for infliximab in the other), primarily due to lower costs of anti-tumor necrosis factor therapy (US 10,015 dollars [US 8754 dollars-US 11,224 dollars] for etanercept vs US 18,611 dollars [US 17,169 dollars-US 20,023 dollars] for infliximab in one database; US 11,917 dollars [US 10,128 dollars-US 13,480 dollars] for etanercept vs US 16,759 dollars [US 14,551 dollars-US 19,062 dollars] for infliximab in the other). Mean (95% CI) costs of non-RA-related care were similar among etanercept and infliximab patients in both databases (US 13,100 dollars [US 8956 dollars-US 18,377 dollars] for etanercept vs US 11,789 dollars [US 8326 dollars-US 16,001 dollars] for infliximab in one, and US 16,665 dollars [US 10,329 dollars-US 25,690 dollars] for etanercept vs US 13,959 dollars [US 10,216 dollars-US 18,168 dollars] for infliximab in the other). These results suggest that costs of RA-related care during the first year of therapy may be lower among RA patients aged > or =65 years receiving etanercept versus infliximab, a difference attributable primarily to lower costs of drug acquisition.

Improvement of hazardous medication ordering practice by physician and nurse education and pharmacist intervention

Purpose Demonstrate a reduction in frequency of hazardous medication ordering practices by a quality improvement process of education and pharmacist intervention. Methods: Three ordering practices with potential to cause a 10-fold overdose according to the Institute of Safe Medication Practices were targeted for improvement at a 280 bed community hospital: 1. failure to use a leading 0 before the decimal point in doses <1; 2. use of trailing 0 after a decimal point; and 3. use of a handwritten “U” for “units” which can be misinterpreted as a “0”. Pre-intervention data revealed a frequency of 6.8 hazardous orders per day, with nurses responsible for 30% during the transcription of verbal/telephone orders, and physicians responsible for 70%. Problem-associated medications included digoxin (omission of leading 0), warfarin (use of trailing 0) and insulin (use of “U” for units). Educational materials discouraging these practices were distributed by the facility Pharmacy & Therapeutics Committee and the hospital pharmacist contacted order writers during concurrent order review as indicated. Results: After intervention, hazardous ordering decreased to 0.79 orders/day. Physicians were responsible for 92% and nurses 8% of the remaining errors. Discussion: The potential for 10-fold overdose errors caused by hazardous order writing practices may be effectively reduced through communication and concurrent pharmacist review. Nurses appear very responsive as a group to these efforts. Clinical Pharmacology & Therapeutics (2004) 75, P44–P44; doi: 10.1016/j.clpt.2003.11.164

Developing a Quick Reference Formulary

The establishment of the Department of Defense Basic Core Formulary was an attempt by the Department of Defense to equilibrate its pharmacy benefit among military treatment facilities. Department of Defense military treatment facilities are required to make available to beneficiaries items on the Basic Core Formulary. Military treatment facilities may augment the Basic Core Formulary through local pharmacy and therapeutic committee actions that result in different formularies among military treatment facilities. Formulary differences among military treatment facilities also arise because the Coast Guard, which is under the jurisdiction of the Department of Transportation in peacetime, is not required to adhere to the Basic Core Formulary at present. Because of formulary differences, most military treatment facilities make available abbreviated, quick reference versions of their formularies to patients. This article describes the development of a quick reference formulary at a Coast Guard military treatment facility pharmacy.

Altered mentation and seizure

Dr. Rick Kulkarni: Today’s case is that of a 41-year-old mentally retarded man who presented to the Emergency Department (ED) with a change in mental status. The patient was transferred to our ED from an outside psychiatric facility, where he was a longstanding resident. According to his records, he was in his usual state of health until two days prior to presentation when he was noted to be less cooperative. On the morning prior to transfer a staff psychiatrist evaluated the patient. She noted him to be more irritable and confused than usual. There was no history of fever, chills, vomiting, or complaints of pain. Transfer to the ED was arranged. His past medical history was significant for schizophrenia, mental retardation, and dilated cardiomyopathy. The patient was taking risperidone, clozapine, and multivitamins. He had an allergy to penicillin, but the specific reaction was unknown. He did not have access to alcohol or tobacco. Dr. Eric Nadel: Are there any questions regarding the history? Dr. Andrew MacAfee: What was his baseline level of functioning? Dr. Kulkarni: The patient’s usual level of functioning was noted on the transfer paperwork. He was apparently able to interact with others and perform some activities of daily living, including eating and drinking without assistance. He was unable to speak fluently and follow verbal commands. Dr. Stephen Thomas: Was there any recent trauma? And did he have access to his own medications? Dr. Kulkarni: There was no known or suspected trauma. The medications were kept in the facility pharmacy where he would have had no access to them. On physical examination, the patient was lying uncomfortably on the paramedic stretcher. He was uncooperative and agitated. Vital signs were as follows: temperature 99.6°F (37.6°C) orally, pulse 86 beats/min, blood pressure 134/86 mm Hg, respirations 16 breaths/min, and oxygenation saturation of 98% on room air. The head was atraumatic. Pupils were 4 mm, round, equal and reactive to light. Extra-ocular movements could not be formally assessed due to lack of cooperation but there were no apparent deficits. The oropharynx was clear with moist mucosa. Gag reflex was intact. The neck was supple with no masses or tenderness. The heart and lung examinations were unremarkable. The abdomen was soft, nontender and nondistended. There were no masses, organomegaly, or guarding. The back was nontender. Pulses were full and symmetric in all extremities. There was no edema or clubbing. The skin was dry and warm with no evidence of a rash or other lesions. On neurologic examination, the patient was not oriented, could not speak fluently, and did not follow commands. There was full strength in all extremities and he appro-

Revised USP standards for product dating, packaging, and temperature monitoring.

Revisions in the standards of the United States Pharmacopeia (USP) related to product dating, packaging, and temperature monitoring are discussed. USP has revised product dating specifications as they relate to pharmacy practice. Pharmacists are required to affix beyond-use dates and not expiration dates to the prescription or repackaged vial. With respect to beyond-use dates for nonsterile products that are repackaged into unit dose or single-unit containers, the requirement has been changed from the previous period of six months from the date of repackaging or 25% of the time remaining until the expiration date, whichever is less, to one year. The type of packaging container, the material used in packaging, and the permeability of the container to moisture are important issues for pharmacists to consider. USP requires that the pharmacy facility where dispensing or repackaging occurs be maintained at controlled room temperature such that the calculated mean kinetic temperature does not exceed 25 degrees C. USP standards for product dating, packaging, and temperature monitoring have changed, and pharmacists must educate themselves about these revisions.

The OBRA-87 nursing home regulations and implementation of the Resident Assessment Instrument: effects on process quality.

To characterize changes in key aspects of process quality received by nursing home residents before and after the implementation of the national nursing home Resident Assessment Instrument (RAI) and other aspects of the Omnibus Budget Reconciliation Act (OBRA) nursing home reforms. A quasi-experimental study using a complex, multistage probability-based sample design, with data collected before (1990) and after (1993) implementation of the RAI and other OBRA provisions. Two independent cohorts (n > 2000) of residents in a random sample of 254 nursing facilities located in metropolitan statistical areas in 10 states. OBRA-87 enhanced the regulation of nursing homes and included new requirements on quality of care, resident assessment, care planning, and the use of neuroleptic drugs and physical restraints. One of the key provisions, used to help implement the OBRA requirements in daily nursing home practice, was the mandatory use of a standardized, comprehensive system, known as the RAI, to assist in assessment and care planning. OBRA provisions went into effect in federal law on October 1, 1990, although delays issuing the regulations led to actual implementation of the RAI during the Spring of 1991. MEASUREMENTS AND ANALYSES: Research nurses spent an average of 4 days per facility in each data collection round, assessing a sample of residents, collecting data through interviews with and observations of residents, interviews with multiple shifts of direct staff caregivers for the sampled residents, and review of medical records, including physician's orders, treatment and care plans, nursing progress notes, and medication records. The RNs collected data on the characteristics of the sampled residents, on the care they received, and on facility practices. The effect of being a member of the 1990 pre-OBRA or the 1993 post-OBRA cohort was assessed on the accuracy of information in the residents' medical records, the comprehensiveness of care plans, and on other key aspects of process quality while controlling for any changes in resident case-mix. The data were analyzed using contingency tables and logistic regression and a special statistical software (SUDAAN) to assure proper variance estimation. Overall, the process of care in nursing homes improved in several important areas. The accuracy of information in residents' medical records increased substantially, as did the comprehensiveness of care plans. In addition, several problematic care practices declined during this period, including use of physical restraints (37.4 to 28.1% (P < .001)) and indwelling urinary catheters (9.8 to 7% (P < .001)). There were also increases in good care practices, such as the presence of advanced directives, participation in activities, and use of toileting programs for residents with bowel incontinence. These results were sustained after controlling for differences in the resident characteristics between 1990 and 1993. Other practices, such as use of antipsychotic drugs, behavior management programs, preventive skin care, and provision of therapies were unaffected, or the differences were not statistically significant, after adjusting for changes in resident case-mix. The OBRA reforms and introduction of the RAI constituted an unprecedented implementation of comprehensive geriatric assessment in Medicare- and Medicaid-certified nursing homes. The evaluation of the effects of these interventions demonstrates significant improvements in the quality of care provided to residents. At the same time, these findings suggest that more needs to be done to improve process quality. The results suggest the RAI is one tool that facility staff, therapists, pharmacy consultants, and physicians can use to support their continuing efforts to provide high quality of care and life to the nation's 1.7 million nursing home residents.

An effective computer-based tardive dyskinesia monitoring system.

To promote early recognition and treatment of neuroleptic-induced tardive dyskinesia we used our facility's pharmacy and appointment data bases to develop an automated reminder system that significantly improved physician monitoring of patients receiving antipsychotic drug therapy. The system prompts staff to perform regular examinations for abnormal involuntary movements and to review patients' consent to therapy with antipsychotic medication. The average prevalences in the 15 months after automated reminders began, in a population of over 800 patients, increased from 53% to 85% for an annually completed abnormal involuntary movement scale in medical records and from 38 to 74% for a statement of informed consent. Now, 45 months later, prevalences of both measures approaches 100%. The integrated design of the Department of Veterans Affairs computer system allowed linking pharmacy and appointment scheduling data and facilitated the project. The reminder system effectively promoted rapid, marked, and sustained change in physicians' documentation of antipsychotic drug therapy.

Impact of a multidisciplinary, collaborative approach to implement and enforce an automatic stop order policy.

Although an automatic stop order (ASO) policy is mandated by the Joint Commission on Accreditation of Healthcare Organizations, the policy remains unenforced or exists only "on paper" in some hospitals. Strict enforcement of an ASO can lead to improvement of patient care by requiring physicians and other healthcare professionals to periodically review a patient's drug regimen. Following the approval of an ASO policy by our facility's pharmacy and therapeutics (P&T) committee, an audit of 160 orders of controlled substances revealed that 75 orders (47 percent) were continued for more than one dose without a physician's renewal order. This problem was then brought to the attention of the P&T committee where a decision was made to resolve the situation using a multidisciplinary, collaborative approach. With the help of all of the healthcare professionals involved in this issue, as well as our computer network, a system for strict enforcement of the ASO policy was subsequently implemented and has proven to be successful.

Pharmacoepidemiologic program for identifying patients in need of vaccination

The feasibility of identifying candidates for vaccination by analyzing patients' use of prescribed drugs as recorded in a computerized database was investigated. Pharmacists at a 45-bed hospital serving U.S. Armed Forces in Germany developed a list of drugs used to treat patients with diagnoses that warrant influenza or pneumococcal pneumonia vaccination. In December 1988 and April 1989, the facility's pharmacy database was searched for patients who had received the infection-risk-indicating drugs during September 1, 1988-March 30, 1989. Medical records of patients identified were screened to verify the indications for vaccination. Patients at risk were sent letters and prescriptions written by a pharmacist to inform and remind them of their need for vaccination. Of 109 patients for whom records were screened, 80 (73.4%) had valid indications for immunization. Of these 80 patients, 48 (60%) accepted the invitation to be immunized. The 80 patients in need of vaccination received 151 individual prescriptions; 77 doses (51%) were administered to 48 patients. Screening by pulmonary, cardiovascular, and hypoglycemic drug use identified the largest numbers of patients in need of vaccination, as did age over 64 years. Patients with more than one risk factor for infection were significantly more likely to accept vaccination than patients with only one risk factor. Pharmacoepidemiologic programs can help pharmacists to fulfill their role as advocates of immunization.

Long-term Care Facilities: Distribution and Reimbursement Systems

There are several types of drug distribution systems available for use in long-term care facilities. They include floor stock, traditional, unit-dose, and modified unit-dose systems. There are advantages and disadvantages to each system, all of which can have an impact on pharmacy, nursing, and long-term care facility residents. Other services that can be provided by pharmacies include emergency services and drug supplies; controlled drug handling, accounting and disposition procedures; automatic stop order policies; and computer and formulary services. In order to continue providing services to a long-term care facility, a pharmacy must be adequately reimbursed. The most important part of a reimbursement system is developing a pricing method. The amount that a pharmacy is reimbursed should include the drug acquisition cost, cost of dispensing, and a net profit. Drug acquisition cost can include average wholesale price, actual acquisition cost, or a hybrid of these amounts, an estimated acquisition cost. The total costs involved in operating the prescription department should be computed in order to arrive at a cost of dispensing. Net profit should be an equitable amount that will allow the pharmacy to remain financially solvent. Types of reimbursement systems include private payment, where the individual resident reimburses the pharmacy, and third party payment, where agencies such as Medicaid, private insurance companies, and, in the near future, Medicare, reimburse the pharmacy. A major component of nursing home pharmacy services is the drug distribution system. There are various types of distribution systems, which differ in many ways. A key factor in the provision of pharmacy services to nursing homes is reimbursement. This article will discuss the different types of drug distribution systems available, as well as the various methods of reimbursement for pharmaceutical products and services.

National survey of hospital pharmacy facilities: Planning and design experience

Recent major renovation or construction programs of hospital pharmacy facilities and pharmacists' involvement in the planning process for those new facilities are described. A 12-page questionnaire was sent in July 1982 to the chief pharmacists in a random sample of 1846 hospitals in the United States stratified by 10 hospital types. The percentage of hospitals of each type involved in an ongoing or recent (within the preceding 10 years) major renovation or construction project of all or part of the pharmacy was determined. Of those respondents having an ongoing or recent major project, the extent and timing of pharmacists' involvement in the planning process were determined for hospitals of each type. The response rate was 45.6%, and the respondents were representative of the population. Thirty percent of all hospitals had not altered their pharmacy facilities within the preceding 10 years. Nonprofit general medical-surgical hospitals and federal hospitals had the highest percentages of recent projects (78% and 79%, respectively); projects were more likely to involve a new pharmacy facility than remodeling. In 1982, 27% of all respondents had a major pharmacy facilities project under way. Of respondents with an ongoing or recent project, 38% were asked to propose needs for new pharmacy facilities, 45% served on the planning team, and 20% anticipated the need for new facilities; space and location were predetermined without pharmacist involvement in 25% of all cases. Two percent of the respondents had no notice of the deadline for finalizing plans for the new facilities; 22% had one to six months' notice, and 48% had over a year.(ABSTRACT TRUNCATED AT 250 WORDS)

National survey of hospital pharmacy facilities: Adequacy of facilities and changes planned

The adequacy of existing space allocations for hospital pharmacy facilities and planned changes are described. A 12-page questionnaire was sent in July 1982 to the chief pharmacists in a random sample of 1846 hospitals in the United States stratified by 10 hospital types. The respondents in each hospital type and size were categorized by their perceived adequacy of existing space for pharmacy facilities and their plans for adding pharmacy functions and staff. Changes in pharmacy facilities that would improve pharmaceutical services were identified, as were planned changes in facilities. The amount of proposed space approved and not approved for pharmacies in hospitals of each type were determined. The response rate was 45.6%, and the respondents were representative of the population. Forty-nine percent of the respondents reported having adequate space. Only 35% of the respondents indicated that no changes could be made in facilities to improve pharmaceutical services. Forty-one percent of respondents planned one or more changes of some kind in pharmacy facilities; this ranged from 14% for long-term, nonprofit hospitals to 50% for long-term, for-profit hospitals. Sixty-six (8%) of the 843 hospitals had additional floor space approved and funded for the pharmacy; 71% had proposed space that was not approved. Sixty-three percent of all respondents planned new pharmaceutical functions; 56% and 42% planned an increase and no change, respectively, in the number of pharmacy staff members. Adding more space may be one way to improve hospital pharmacy facilities, but more attention also should be directed toward better use of existing space, equipment, and fixtures.

National survey of hospital pharmacy facilities: Space allocations and functions

Space allocations for hospital pharmacies and the demand on these facilities in terms of the external environment and functions performed are described. A 12-page questionnaire was sent in July 1982 to the chief pharmacists in a random sample of 1846 hospitals in the United States stratified by 10 hospital types. The respondents in each hospital type were categorized by variables characterizing the external environment. The mean total amount of existing pharmacy space was computed for hospitals categorized by type and number of beds, and the mean space per bed in nonprofit, for-profit, and government (federal and nonfederal) hospitals was compared. The mean space for specific pharmacy functions was determined. The response rate was 45.6%, and the respondents were representative of the population. The majority of all hospitals served only one building (67%) and had no teaching affiliation agreement (63%). Forty-eight percent of the hospitals administered medications using medication nurses; another 48% used primary or team nursing. There was little relationship between the number of beds and total space allocated for pharmacy facilities. Pharmacies had a mean of 6.9, 5.0, 7.0, and 10.6 gross square feet per bed, respectively, in nonprofit, for-profit, nonfederal government, and federal government hospitals. Space for selected pharmacy functions in the three types of general medical-surgical short-term hospitals are described. Further studies examining the relationships between space and other variables described in this article are needed to explain apparent differences in the amount of space allocated to the pharmacy department among hospital types.

National survey of hospital pharmacy facilities: Introduction

This paper introduces three articles that report results of a national survey of hospital pharmacy facilities conducted in July 1982. A historical perspective of pharmacists' involvement in facilities planning and examples of internal and external factors influencing the optimal design of hospital pharmacies are presented. The survey aimed to identify and describe existing hospital pharmacy facilities, the adequacy of existing facilities, the anticipated need for facilities, and the processes used for planning facilities. These baseline data can be used in the future as a starting point for developing updated model plans for hospital pharmacies and recommending improvements in the planning process.

Medication maintenance of mentally ill patients by a pharmacist in a community setting

The use of a community pharmacy as a facility for medication maintenance services usually provided by a mental health center was evaluated. The project pharmacist was affiliated with the community mental health center, the community pharmacy facility was borrowed for purposes of this study. Records and prepackaged medication were transported by the pharmacy-clinic. Medication histories were taken and maintained by the pharmacist. Problems such as medication noncompliance, drug side effects, drug interactions and minor alterations in the patients mental status were handled by the pharmacist. Telephone consultations with a psychiatrist were also available. Twenty-two patients were involved in the study over an eight-month period. The evaluation consisted of a patient acceptance questionnaire and a retrospective chart review analyzing the clinical response of patients. Data suggest that selected stabilized psychiatric patients can be safely maintained in the community pharmacy. A carefully structured program and a pharmacist with special competencies are felt to be prerequisites for this type of service.

Assistance in Planning Hospital Pharmacy Facilities

Journal Article Assistance in Planning Hospital Pharmacy Facilities Get access William A. Zellmer William A. Zellmer Search for other works by this author on: Oxford Academic Google Scholar American Journal of Hospital Pharmacy, Volume 30, Issue 11, 1 November 1973, Page 1009, https://doi.org/10.1093/ajhp/30.11.1009 Published: 01 November 1973

Planning a hospital pharmacy facility

Planning a hospital pharmacy facility