Hospital Pharmaceutical Services Research Articles

Analysis of the Relationship between Tangible and Reliability with Patient Satisfaction in Level III Hospital Pharmacy Installations in Southeast Sulawesi

Backgrounds: Hospital Pharmaceutical Services are an inseparable part of the Hospital health service system which is oriented towards patient service, providing quality and affordable Pharmaceutical Preparations, Medical Devices and Consumable Medical Materials for all levels of society, including clinical pharmacy services. The results of the survey conducted in June 2021, the average tangible value was (6.70%), while the reliability value was (46.83%). The aim of this research is to analyze the relationship between Tangible and Reliability and Patient Satisfaction in Level III Hospital Pharmacy Installations in Southeast Sulawesi.
 Methods: This research is a quantitative study with a cross sectional study design. The population in this study was 314 people. The sample size was 206 people. Data was processed using the SPSS program.
 Results: Test results using the chi-square test show significance figures for five variables. Tangible variables show a value of pvalue = 0.634 > α value = 0.05 indicating there is no relationship between the service quality variable (tangible) and patient satisfaction in hospital pharmacy installations, the Reliability variable shows a significance value of Asym.sig pearson chi-square 0.004 < α value = 0.05 indicates there is a relationship between the service quality variable (Reliability) and patient satisfaction in the hospital pharmacy installation.
 Conclusion: It is necessary to improve the quality of service in order to maintain a satisfactory level of service, where the Hospital should continue to maintain conditions such as Tangible and Reliability dimensions.

Analysis of Management Elements in Antibiotic Inventory Control with EOQ and MMSL Methods at Aisyiyah Bojonegoro Hospital

Inventory control is important in managerial activities because it involves investment and is hospitals' most significant expenditure component. The Aisyiyah Bojonegoro Hospital requires a logistics management system that can maintain the safety and effectiveness of the use of drugs for the smooth running of hospital pharmaceutical services in the long term. This analytical observational study analyzes management elements in controlling antibiotic inventory by simulating the Economic Order Quantity (EOQ) and Minimum-Maximum Stock Level (MMSL) methods. Determination of the sample purposively, i.e., 17 types of antibiotic drugs category A from the results of the ABC analysis, with the inclusion criteria being high cost, high volume, clinically important drugs for antibiotic drugs that are included in the 2020 Hospital Formulary and the exclusion criteria are drugs with inadequate supply. The analysis technique used the Mann-Whitney test and the Kruskal-Wallis test. Based on the results of the study, it was concluded that. Applying the EOQ and MMSL methods has been proven to increase the efficiency and effectiveness of the supply of category A antibiotics at Aisyiyah Bojonegoro Hospital.

Assessment of patient satisfaction with pharmaceutical services in two tertiary health facilities in Rivers State, Nigeria

Patient satisfaction measurements are necessary to evaluate the quality of care given to patients within a healthcare facility. Healthcare facilities in Africa are faced with numerous challenges such as lack of human and financial resources which can lead to inadequate provision of healthcare to patients. This study aims to assess the level of patient satisfaction with hospital pharmaceutical services in the two tertiary health facilities in Rivers State. A descriptive cross-sectional study was conducted at the various pharmacy units at the health facilities between September and December 2020. Qualitative data was collected using structured self-administered questionnaires. A total of 200 patients from each of the two tertiary health facilities participated in the study. The study showed that majority of the participants( 34 and 64%) at the Rivers State University Teaching Hospital (RSUTH) were either very satisfied or satisfied with pharmaceutical services while 36.5 and 43.5% showed varied level of satisfaction with care by pharmacists. At the University of Port Harcourt Teaching Hospital (UPTH), those that reported satisfaction were 37 and 57.5% for the very satisfied and satisfied respectively for pharmaceutical services while it was 38 and 36% respectively for the very satisfied and satisfied with pharmaceutical care rendered by the pharmacists at the facility. However, there was no statistically significant difference in the satisfaction profile at the two facilities (p<0.05). This study concludes that majority of patients assessing the two tertiary health facilities were either very satisfied or satisfied with the pharmaceutical services and care rendered by Pharmacists. The study recommends that similar studies be conducted to assess patient satisfaction at secondary and primary health care facilities.

Facilitating Patient-Centric Thinking in Hospital Facility Management: A Case of Pharmaceutical Inventory

Conventional hospital facility management (FM) focuses on reasonably allocating various resources to support core healthcare services from the perspectives of the FM department and hospital. However, since patients are the main service targets of hospitals, the patients’ demographic and hospitalization information can be integrated to support the patient-centric facility management, aiming at a higher level of patient satisfaction with respect to the hospital environment and services. Taking the pharmaceutical services in hospital inpatient departments as the case, forecasting the pharmaceutical demands based on the admitted patients’ information contributes to not only better logistics management and cost containment, but also to securing the medical requirements of individual patients. In patient-centric facility management, the pharmacy inventory is regarded as the combination of medical resources that are reserved and allocated to each admitted patient. Two forecasting models are trained to predict the inpatients’ total medical requirement at the beginning of the hospitalization and rectify the patients’ length of stay after early treatment. Specifically, once a patient is admitted to the hospital, certain amounts of medical resources are reserved, according to the inpatient’s gender, age, diagnosis, and their preliminary expected days in the hospital. The allocated inventory is updated after the early treatment by rectifying the inpatient’s estimated length of stay. The proposed procedure is validated using medical data from eighteen hospitals in a Chinese city. This study facilitates the integration of patient-related information with the conventional FM processes and demonstrates the potential improvement in patients’ satisfaction with better hospital logistics and pharmaceutical services.

Views of Pharmacists and Government Representatives Toward the Pilot Chief Pharmacist System in Chinese Hospitals: A Multicenter Exploratory Qualitative Study

BackgroundIn China, the pharmacy departments of most hospitals have changed their main focus from drug procurement and distribution to providing pharmaceutical care services. Various regions of China have successively implemented the pilot Chief Pharmacist System (CPS) to help improve pharmaceutical care services and rational drug use in hospitals. This study was designed to explore the perspectives of pharmacists and government officials on CPS, including the advantages and barriers to the successful implementation of CPS.MethodsA qualitative study, based on semi-structured interviews, was conducted from October 1, 2018 to March 1, 2019. The interview data were gathered from 18 pharmacy staff and government representatives working in five distinct regions of China using purposive sampling. A thematic analysis approach and NVivo version 12 Plus was utilized to code and analysis of all interviews.ResultsFive broad themes were identified: the role of the chief pharmacist; their attitudes toward the CPS; the advantages and results of the CPS; the barriers toward CPS; and their suggestions toward CPS. Most of the participants believed that the chief pharmacist played a vital role in a hospital. Under CPS, the hospital pharmacy department pays more attention to prescription review, medication monitoring, and pharmaceutical consultation. However, an insufficient number of pharmacy personnel, unclear authority, and inadequate salaries were the main barriers to the implementation of the CPS.ConclusionThe attitudes of most of the participants were found to be positive toward CPS in China. The CPS can enhance the prestige of the hospital pharmacy department, improve the quality of hospital pharmaceutical care services, and promote rational drug use. Nevertheless, certain barriers highlighted in this study should be addressed promptly.

A pilot study to assess the need for new hospital pharmaceutical services in Algerian patients and physicians’ perspective

Abstract Objectives The objective of this study was to assess the needs for pharmaceutical services from the perspectives of physicians and patients in the hospital setting and to contribute to the implementation of new hospital pharmacy activities. Methods A cross-sectional descriptive study was carried out among the doctors and patients encountered in hospital departments in Sidi Bel Abbès (Algeria); each service was evaluated using a Likert scale. Associated characteristics with an important need were evaluated by univariate analysis and binary logistic regression. Key findings All pharmaceutical services were important to the patients, particularly providing treatment advice and therapeutic education. Women presented an important need for insurance of the availability of pharmaceutical products (P = 0.02) and lifestyle and dietetic information (P = 0.05). High frequency of taking medication was associated with an important need for information about drug interactions (P = 0.005). Patient-oriented pharmaceutical services were not important to the physicians who considered drug information and therapeutic education to be the most important need. Conclusions To implement patient-centred services, it is important to improve the contact between pharmacists and physicians and to provide information about pharmaceutical services that can benefit patients. Implementation of new practices in university hospital is more feasible than in public health facilities.

The implementation of pharmaceutical services in public hospitals in Mexico: an analysis of the legal framework and organizational practice

BackgroundThe implementation of pharmaceutical services in hospitals contributes to the appropriate use of medicines and patient safety. However, the relationship of implementation with the legal framework and organizational practice has not been studied in depth. The objective of this research is to determine the role of these two factors (the legal framework and organizational practice) in the implementation of pharmaceutical services in public hospitals of the Ministry of Health of Mexico.MethodsSemi-structured interviews were conducted with four groups of actors involved. The analysis focused on the legal framework, defined as the rules, laws and regulations, and on organizational practice, defined as the implementation of the legal framework by related individuals, that is, how they put it into practice.ResultsThe main problems identified were the lack of alignment between the rules and the incentives for compliance. Decision-makers identified the lack of managerial capacity in hospitals as the main implementation barrier, while hospital pharmacists pointed to poor regulation and the lack of clarity of the legal framework as the problems to consider.ConclusionsAlthough the legal framework related to hospital pharmaceutical services in Mexico is inadequate, organizational factors (such as adequate skills of professional pharmacists and the support of the hospital director) have facilitated gradual implementation. To improve implementation, priority should be given to evaluation and modification of the current legislation along with the development of an official minimum standard for activities and services in hospital pharmacies.

Splitting Teams at a Hospital Pharmaceutical Care Services during COVID-19 Pandemic: A Tertiary Hospital Experience in Saudi Arabia.

Background:The cautionary procedures of COVID-19 indicate the importance and urgency of preventing “community transmission” in the overall pandemic control. Pharmacy professionals are considered essential partners in response to the ongoing COVID-19 pandemic. Hospital pharmacies are expanding services and providing essential services, putting pharmacists and their co-workers at the frontlines for patient care and safety to improve the public health.Objective:The objective was to provide a guidance on minimizing pharmacy staff at risk of COVID-19 exposure and serve as emergency preparedness in case of mass staff infected with COVID-19 pandemic within the department.Setting:This study was conducted at Pharmaceutical Services Administration at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.Methods:An instructional intervention using an electronic survey and summarization of the experience during the COVID 19 outbreak in a hospital pharmacy setting. We analyzed and discussed the methods and strategies that pharmacy settings and pharmacists should use to provide pharmaceutical care during the pandemic crisis.Main Outcome Measure:The outcome measures include staff perception and acceptance for splitting teams at pharmaceutical care services during the COVID-19 pandemic.Results:A total of 119 electronic surveys were distributed to the pharmacy staff and responded by 102 pharmacists and pharmacy technicians. All the study participants agreed on two group system which includes working-week-week-off. However, only three participants chose a full-team monthly roster. All participants agreed to be ready for work in their week-off as on demand. Furthermore, they all agreed to strictly follow the preventive measures of wearing masks and physical distancing. Furthermore, they gave permission to the administration to review the working schedule every 2 weeks to either continue the same way or to back to the full-team scheduled monthly roster.Conclusion:During the COVID-19 outbreak, the pharmaceutical services provided valuable pharmacy functions and care considering that we work into two teams and, yet, we are united in one mission and objective. Through these services, pharmacists have presented their professional competence, dedication, and responsibility to patients, other health-care providers, and society.

Study of the state of readiness of pharmaceutical institutions of Ukraine for implementation of integrated quality systems

One of the most promising ways to increase the efficiency of pharmaceutical enterprises in the field of quality assurance of medicines is the introduction of integrated quality systems (IQS).
 The aim of the work is to study of the state of readiness of pharmaceutical institutions (pharmaceutical warehouses, pharmacies) and hospital pharmaceutical services of Ukraine for the implementation of integrated quality systems.
 The materials of the research are: scientific publications; regulatory legal acts of the Ministry of Health of Ukraine; public reporting information of the State Service of Ukraine on Medicines and Drug Control; information posted on professional specialized websites and official websites of pharmaceutical enterprises, hospitals, health departments of local government; information obtained in the process of direct observation and questionnaire survey. Research methods are: systematic review, generalization, observation, questionnaire survey, mathematical-statistical, graphical modeling.
 The paper analyzes the availability of certificates of conformity to the requirements of good distribution practice (GDP) in wholesale pharmaceutical enterprises of Ukraine. The geography of the location of certified pharmaceutical warehouses in different regions of Ukraine is considered. In the context of the prospect of formation of IQS, the experience of a wholesale pharmaceutical company with respect to environmental, hygiene and safety and social responsibility is demonstrated. Based on the study of public information, the state of implementation of certified quality management systems (QMS) based on the standard ISO 9001 in pharmacies and hospitals of Ukraine is considered. The expediency of the development of the pharmaceutical IQS as an integral part of the overall QMS of the hospital is shown. Through the questionnaire survey of pharmacists, the state of readiness of Ukrainian pharmacies for the implementation of IQS based on the requirements of good practices and international standards in the field of quality, ecology, health and safety and social responsibility was explored. The state of implementation of good pharmaceutical practice (GPP), the requirements of the ISO 9001 standard, the risk management process for medicines quality, corrective and preventive actions has been studied in pharmacies. Positive tendencies and problems in the context of the readiness of pharmacies of Ukraine for the implementation of IQS have been established. Priority steps for improving the state of readiness of Ukrainian pharmacies for the implementation of IQS are identified.
 The research results confirm that over the last years the pharmaceutical sector of Ukraine has made significant progress towards increasing the readiness of pharmaceutical institutions for the implementation of integrated quality systems.

Relationship between use of general practice and healthcare costs at the end of life: a data linkage study in New South Wales, Australia

ObjectiveThis analysis investigated the relationships between healthcare expenditures in the last 6 months of life and use of general practitioner (GP) services in the preceding 12-month period among older residents...

Understanding Where We've Been to Inspire Where We're Going.

While waiting for our first leadership elective class to begin this semester, one of the students made a comment about how pharmacy practice used to be not that long ago. The third-year students read Sara White’s Whitney lecture, “Leadership: Successful Alchemy,”1 to frame a conversation on leadership and identifying themselves as “little L” leaders. The student was intrigued to realize that pharmacists had not always been integrated into multidisciplinary teams and that unit dose and intravenous admixture services were great advances in their time. During the first class, we identified that none of the students had been in a hospital setting without an electronic health record. Lost are the understanding of transcription errors and the appreciation of a Bates stamper to assist with typing prescription labels and creating medication profiles. Each of our leadership elective classes begins with a student pair presenting a Whitney award recipient and a brief overview of their award lecture as it relates to the topic of the week. We create a personal philosophy and a leadership development plan, explore personalities and networking, and discuss communication, mentor relationships, and organizational and personal change throughout the 10-week course. Whitney recipients Jim McAllister, Charles Hepler, Paul Abramowitz, Jannet Carmichael, Tom Thielke, Henri Manasse, and Dan Ashby help set the stage each week, and each leader reflects on their experiences as they present their vision for the future of pharmacy. The students continue to marvel in how the practice of pharmacy has changed, and I believe this understanding helps them appreciate the responsibility of their generation in continuing the advancement our profession. The American Society of Health-System Pharmacists (ASHP) Foundation created the harveywhitney.org Web site as a repository for Whitney award information and access to the lecture series. Hospital Pharmacy recently published a 2-part Director’s Forum series, “Measuring Change in Health-System Pharmacy Over 50 Years: ‘Reflecting’ on the Mirror.”2,3 A comprehensive survey of hospital pharmaceutical services conducted in 1963 provided a baseline for establishing goals for the profession in 6 paradigms known as the Mirror to Hospital Pharmacy published in 1964.4 Examining the progress made on the 6 paradigms provides a historical viewpoint and presents a starting place to develop strategies to continue the advancement of pharmacy services. Sara White has invested countless hours interviewing great pharmacy leaders to share their personal stories and provide inspiration for continuing to challenge our practice model.5 Harold Godwin shares ideas on pharmacy innovation and justification of comprehensive pharmacy services. Paul Pierpaoli discusses academic health-system practice, mentoring, and residency training. Mary Jo Reilly reflects on change management and professional organization involvement. Others offer insight to the profession by sharing stories, including Bruce Scott, Dave Zilz, Billy Woodward, Pam Ploetz, John Gans, and Sharon Enright. One of the most powerful stories you can tell is your own. Make the time to share with your students and residents how the practice of pharmacy has evolved during your career and where you see the profession going. Challenge the new practitioner to maintain their involvement in the profession and encourage seasoned practitioners to continue or renew their engagement with our practice. We know times change, and we must choose to be an active participant in that change while celebrating our previous successes.

DI-035 Hospital pharmaceutical services for people who travel abroad

BackgroundConsultation about travel abroad addresses preventive attitudes before, during and after the trip, which may include immunisations, the prescription of prophylactic medicines and advice on food safety. Advice to travellers...

DGI-039 Guide to the Preparation and Administration of Injectable Cytotoxic Drugs

BackgroundThe preparation of injectable cytotoxics is a key activity of many hospital pharmaceutical services. Due to the increasing availability of cytotoxic medicines, either branded or generic, the time spent by...

Patients' experience of hospital pharmaceutical services

This study aimed to investigate inpatients' and outpatients' need for information about medication, to what extent those needs were addressed and patient attitudes regarding pharmaceutical services. Self-administered questionnaires were distributed to a sample of outpatients and inpatients in a UK district general hospital. Themes included satisfaction with information given about medication, potential confusion over medication prescribed by the general practitioner and by the hospital, access to a member of the pharmacy team and preferences on how information on medication should be given. Ninety-one outpatient and 126 inpatient questionnaires were available for analysis. All outpatients who responded acknowledged that they were told how long they might need to wait for their medicines to be dispensed, although approximately one-fifth felt they had to wait a long time. Nearly three-quarters of outpatients felt there was an opportunity to ask medication-related questions of the pharmacy team. Nearly three-quarters of inpatients reported they were encouraged to bring into any hospital any medication they were taking at home. Twenty-eight per cent of 95 inpatients reported that some of their existing medication was stopped while in hospital. For the inpatients who received information about new medication, this was explained to the patient verbally (76%) and both verbally and in writing (22%). Forty-two per cent of inpatients (and 36% of outpatients) expressed a preference to receive information about medication both verbally and in writing. Thirty-five (32%) of 110 inpatients were not aware that a pharmacy team had a presence on the ward. Overall the majority of both in- and outpatients appeared to be receiving appropriate pharmaceutical services. There is a need to raise the profile of the pharmacy team in regards to provision of medication advice for inpatients. Consideration needs to be given to better provision of written information about medication for patients.

Cost analysis for reimbursement-rate setting of hospital pharmaceutical services in Thailand

OBJECTIVES This study aimed to develop a hospital pharmaceutical service model, together with a costing template for unit cost analysis and to analyse unit costs of hospital pharmaceutical services. METHODS The study was designed on the basis of activity-based costing. A model of the services was set up by consensus of the working group. Pharmaceutical services among the study hospitals were standardised. A Microsoft Excel-based costing template was developed. Finally, the costing template was used for the unit cost analysis. Sensitivity analysis and descriptive statistics were used for further analysis. KEY FINDINGS Four general and seven regional hospitals participated in the study. Hospital pharmaceutical services were divided into nine supporting activities and nine patient-service activities. Unit costs of drug dispensing per prescription by regional hospitals were approximately double that of general hospitals. In contrast, the cost of aseptic dispensing per item in regional hospitals was lower than those in general hospitals. In comparing the unit costs from standard labour costs with those from actual labour costs, both increases and decreases were found. CONCLUSIONS Costing and the use of Microsoft Excel can be applied to the development of a costing template for unit cost analysis of hospital pharmaceutical services. This programme can provide accurate unit costs for services. The results can be used when considering pharmacy service reimbursement, efficiency and service development.

Pengembangan Indikator Efisiensi Pengelolaan Obat Di Farmasi Rumah Sakit

Hospital Pharmacy is an integral part of hospital that provides hospital pharmaceutical services. The budget which is used to operate it, is very high such as in the Developing Countries for instance approximately 40% from the total budget. The implementation of an adequate management consequently must be carried out. Hospital management mentioned above consists of planning, procurement, storage and distribution. The parameter or the indicator can be used to know the efficiency level of each step in the hospital pharmacy management should be valid, and or specific, and or sensitive. In addition to the indicators available in the hospital pharmacy, other indicators should be improved in order to make it more perfect. The objective of the current study is to develop the efficiency indicators of the hospital pharmacy management that consists of planning, procurement, storage, and distribution. The method starts with literary study work-shop, maturation of the instrument with Delphi Method and then testing the indicators in six hospitals. The results are three efficiency indicators in planning stage, three efficiency indicators in procurement stage, four efficiency indicators in storage stage, and six efficiency indicators in distribution. The conclusion of the study is that all of the indicators are valid, and or sensitive, and or specific. keyword : Hospital Pharmacy

The effectiveness of hospital pharmacy in the UK: methodology for finding the evidence.

To describe the methodology used to identify United Kingdom (UK) hospital pharmacy practice research work from the last two decades. A comprehensive search for citations that appeared to contribute to the overall evidence or in some way measure, demonstrate or evaluate the effectiveness of UK hospital pharmacy practice. This involved a search of thirteen electronic databases covering a wide variety of UK, European and international publications, hand searching of selected UK journals and conference proceedings, a written request for details sent to all UK Chief Pharmacists and Directors of Pharmacy and a bibliography search of each reference identified. All appropriate references were then added to a single computer database. Number of references identified by each strand of the search strategy. The search initially highlighted a total of 10,099 articles from the thirteen reference databases, but only 281 were considered suitable for inclusion in the final review. Hand searching of the selected journals and conference proceedings yielded another 173 references and the written requests to hospital chief pharmacists resulted in another 128 references being identified. Finally, bibliography searches of the articles identified by the above three methods resulted in another 242 references, bringing the total number of references to 824. This paper describes a strategy to identify a comprehensive collection of citations supporting the evidence for the effectiveness of hospital pharmaceutical services in the UK. The large number of references identified demonstrate that hospital pharmacists in the UK make significant contributions to both the research literature and to patient care. However, database searches alone highlighted just 34% of the total references finally included in this study, demonstrating that pharmacy practice research work may be difficult to access by conducting database searches alone. The results from this project provide a resource for the profession and can be utilised as a foundation for future developments in both the delivery and research of hospital pharmacy practice.

Comparison of direct hospital costs and length of stay for radical nephrectomy versus nephron-sparing surgery in the management of localized renal cell carcinoma

Objectives. Recent work has demonstrated comparable surgical results and 5-year cancer-specific survival rates between radical nephrectomy and nephron-sparing surgery (NSS) in the treatment of patients with small (4 cm or smaller) solitary renal cell carcinomas (RCCs). However, differences exist in the intraoperative management and postoperative care of patients undergoing NSS versus radical nephrectomy, and we sought to compare direct hospital costs and length of stay (LOS) between these two groups to determine whether either treatment imparts a specific cost advantage. Methods. Data were retrieved from medical records and administrative data sets containing billing encounters for all costs incurred during hospitalization at the Cleveland Clinic Foundation. Individual costs were grouped together using nine cost center categories encompassing every aspect of direct hospital care, including anesthesiology, laboratory, radiology, nursing, pharmaceutical, and emergency services, and medical care, surgical care, and miscellaneous costs. Each cost center was further subdivided, and a total of 52 cost subcategories were assessed. The total direct costs of hospitalization were compared using a multivariate regression model in which patient demographics and tumor characteristics, type and year of surgery, LOS, and cost center categories were assessed as single and interactive factors. Postoperative complication and cancer-specific survival rates were also compared to identify any potential therapeutic differences between the two groups. Results. Between 1991 and 1995, 80 patients underwent surgery at the Cleveland Clinic Foundation for solitary RCCs 4 cm or smaller, including 52 partial and 28 radical nephrectomies. We found no difference in the postoperative complication rate or cancer-specific survival rate between the two surgical groups. Total direct hospital costs and LOS were not statistically different between the NSS and radical nephrectomy groups ( P >0.05). This was further supported by our multivariate model, which accounted for 61% of the observed variance in the total costs (F = 12.11, P = 0.0001). The type of surgery was not associated with total cost when controlling for all other factors, including age, sex, year of surgery, tumor size, grade, and stage, and postoperative complications ( P = 0.7). There was no significant interaction between the type of surgery and the LOS ( P = 0.5). Conclusions. This study demonstrated that elective NSS can be performed with equivalent direct hospital costs and LOS when compared with patients undergoing radical nephrectomy for small solitary RCCs. These data have significant economic implications for the comparison of competing surgical treatment strategies for localized RCC.

Mirror to ASHP: 1942–1992

Highlights from the history of ASHP are presented on the occasion of the Society's 50th anniversary. Efforts to organize a formal group representing hospital pharmacists, begun in the 1920s, resulted in the formation of a subsection on hospital pharmacy of the American Pharmaceutical Association in 1936. In 1942, ASHP became a distinct organization affiliated with APhA. The body's goals were to establish minimum standards for pharmaceutical services, ensure a supply of well-qualified hospital pharmacists by providing hospital internships, facilitate information exchange, and foster cost-effective use of medicines. The development of practice standards and periodic surveys of hospital pharmaceutical services, educational efforts and accreditation programs, publications, and ASHP's role in the development of principles for hospital formulary systems are described. ASHP's endorsement of unit dose drug distribution and systems for preparation of intravenous admixtures is discussed. The evolution of pharmacists' clinical roles, their increased involvement in drug therapy decisions and the provision of drug information to patients, and the expanded responsibility implicit in the pharmaceutical care concept are traced. Today's ASHP members can build on the work of yesterday's members to provide better pharmaceutical care.

National Survey of Pharmaceutical Services in Psychiatric Hospitals

The results of a summer 1989 nationwide mail survey of psychiatric hospital pharmaceutical services are reported and discussed. A simple random sample of 200 hospitals was selected from 600 psychiatric hospitals registered by the American Hospital Association. Questionnaires were mailed to the director of pharmacy at each institution. Usable responses were received from 114 hospitals, for a net response rate of 57%. Responses were categorized by hospital size, ownership status, geographic region, and average length of stay. Substantial differences were noted between government and nongovernment hospitals in the number and types of pharmaceutical services provided, as well as in the manner in which services are provided. Non-government hospitals generally appeared to offer more progressive pharmaceutical services. Psychiatric hospitals in western states appeared to offer more advanced clinical pharmacy services than institutions in other geographic areas. The survey established baseline data on the nature and extent of both clinical and distributive services in psychiatric hospital pharmacy departments.