Hospital Pharmacy Directors Research Articles

The benefits (or detriments) of adapting to demand disruptions in a hospital pharmacy with supply chain disruptions.

Supply chain disruptions and demand disruptions make it challenging for hospital pharmacy managers to determine how much inventory to have on-hand. Having insufficient inventory leads to drug shortages, while having excess inventory leads to drug waste. To mitigate drug shortages and waste, hospital pharmacy managers can implement inventory policies that account for supply chain disruptions and adapt these inventory policies over time to respond to demand disruptions. Demand disruptions were prevalent during the Covid-19 pandemic. However, it remains unclear how a drug's shortage-waste weighting (i.e., concern for shortages versus concern for waste) as well as the duration of and time between supply chain disruptions influence the benefits (or detriments) of adapting to demand disruptions. We develop an adaptive inventory system (i.e., inventory policies change over time) and conduct an extensive numerical analysis using real-world demand data from the University of Michigan's Central Pharmacy to address this research question. For a fixed mean duration of and mean time between supply chain disruptions, we find a drug's shortage-waste weighting dictates the magnitude of the benefits (or detriments) of adaptive inventory policies. We create a ranking procedure that provides a way of discerning which drugs are of most concern and illustrates which policies to update given that a limited number of inventory policies can be updated. When applying our framework to over 300 drugs, we find a decision-maker needs to update a very small proportion of drugs (e.g., ) at any point in time to get the greatest benefits of adaptive inventory policies.

Cross-sectional description of hospital pharmacy services in Puerto Rico in 2022 using the Practice Advancement Initiative 2030 Self-Assessment Tool.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. The American Society of Health-System Pharmacists (ASHP) developed the Practice Advancement Initiative 2030 (PAI 2030) to support the continuous improvement of hospital pharmacy services in the United States. Puerto Rico (PR) hospitals' level of compliance with PAI 2030 recommendations is not currently known. The primary objective of this study was to describe the hospital pharmacy scenario in PR in the 5 areas addressed in PAI 2030 recommendations. Through a collaboration between the state affiliate, a school of pharmacy, and ASHP, completion of the PAI 2030 Self-Assessment Tool was promoted among hospital pharmacy directors between August 2022 and March 2023. A total of 18 out of 66 hospitals completed the survey. The results were compared with national data provided by ASHP from 163 US hospitals. Areas where PR hospitals rated high were in PAI 2030 domain A (Pharmacy Technician Role, Education, and Training) and domain E (Pharmacist Leadership in Medication Use and Safety). PR hospitals rate their performance lower in domain A (Patient-Centered Care) and domain B (Pharmacist Role, Education, and Training). Specific focus areas for improvement by PR hospitals include pharmacist participation in medication reconciliation, 24/7 access to advanced clinical pharmacy services, expansion of the pharmacist's scope of practice, and training through the Board of Pharmacy Specialties and residency programs. This study illustrates how the PAI 2030 Self-Assessment Tool can be used to benchmark pharmacy services at the state level. We suggest that changes are needed to close the gap between hospital pharmacies working towards optimizing the role of pharmacists in healthcare systems and those still struggling with dedicating staff to well-recognized pharmacist roles and responsibilities.

Closed-form (R,S) inventory policies for perishable inventory systems with supply chain disruptions

Hospital pharmacy managers make inventory decisions for thousands of different perishable drugs. Commonly, these managers do not have the resources to implement advanced mathematical models. Closed-form solutions are attractive because they provide the inventory policy quickly and are easy to implement. However, when deriving these solutions, one must consider that pharmaceutical supply chains experience disruptions. We first derive closed-form solutions for a non-perishable lost-sales (R,S) periodic review inventory system with supply chain disruptions. We then extend the solutions to incorporate perishability and apply the solutions to a hospital pharmacy inventory system. We find that (i) it is important to account for perishability and supply chain disruptions simultaneously as only accounting for supply chain disruptions increases both drug shortages [possible 65% increase] and waste [possible waste equivalent to 50% of the daily demand], (ii) it is critical to consider the duration of and time between supply chain disruptions, (iii) the expected number of shortages is insensitive to changes in the standard deviation when demand is normally distributed, but for short expiration lifetimes, the expected number wasted increases linearly as the standard deviation of demand increases, and (iv) not accurately depicting the supply chain disruption process can triple the number of shortages.

Investigating antibiotic use in Gaza Strip hospitals: A retrospective cross-sectional analysis.

Rates of antimicrobial resistance in the Gaza Strip are rising while regulations on antibiotics use are weakly implemented. This study aimed to investigate antibiotic use in hospitals utilizing World Health Organization (WHO) hospital, prescribing, and patient care indicators. A retrospective study was conducted at Al Shifa medical complex (SMC), Nasser Medical Complex (NMC), and European Gaza Hospital (EGH). Data for hospital indicators were collected from drug inventory records and by interviewing hospital pharmacy managers, while data for prescribing and patient care indicators were collected from medical records from all departments. WHO standard data collection forms and formulas to calculate quantitative indicators were used. Standard treatment guidelines for infectious diseases were unavailable. The availability of key antibiotics on the day of the investigation was 58.62%, 90.9%, and 44.82%, and antibiotics were out of stock for 120.5, 63.3, and 119.8 days/year in SMC, NMC, and EGH, respectively. A total of 1400 patients' records were screened; 68.2% of patients were prescribed antibiotics with an average duration of 3 days. The number of antibiotics prescribed was 1.26/hospitalization, 55% were prescribed by generic name, 98% were consistent with the essential medicine list, and 94.7% were given parenterally. Ceftriaxone was the most commonly used antibiotic (47.5%). Adherence rates to STGs for Caesarean section antibiotic prophylaxis and for pneumonia were 43% and 6.3%, respectively. About 97% of doses of prescribed antibiotics were administered and patients on antibiotics stayed in the hospital for 4.1 days. Antibiotic utilization patterns are less than optimal. Strategies to improve antibiotic use in the investigated hospitals are needed.

Pharmacy Champion Award.

New Hampshire House of Representatives member Gary Merchant, MBA, RPh, and the Colorado Pharmacists Society are the 2022 recipients of the ASHP Board of Directors Pharmacy Champion Award. The award recognizes leadership in advocacy and public policy that helps to improve patient care, drug safety, and medication-use outcomes and advances the vital roles pharmacists play as patient care providers. Merchant is a subject-matter expert on the 340B Drug Pricing Program and the orphan drug exclusion, the pharmacy supply chain, and hospital pharmacy management. He is an avid champion for advancing pharmacists’ scope of practice, expanding reimbursement for services provided by a pharmacist, and fostering medication safety and positive health outcomes. He played a major role in facilitating legislation that recognizes pharmacists as healthcare providers under Medicaid and expands pharmacists’ authority to prescribe medications for tobacco cessation. Merchant also championed legislation creating a new license category for advanced pharmacy technicians authorizing them to perform most technical dispensing functions without the review or approval of a licensed pharmacist.

Application Protocol of Standardized Neonatal Parenteral Nutrition Formulations

With the improvements in medical technology, more premature infants and infants with congenital intestinal malformations or other conditions who need parenteral nutrition (PN) support can survive. PN technology has become an important therapeutic strategy in neonatal intensive care units. Due to differences in the qualifications of medical staffs, hospital pharmacy management, hospital level, etc, the composition and preparation methods of PN prescription vary greatly in different regions and hospitals in China. In addition, delays in the starting time of PN, unreasonable formula of nutrition components, poor prescription review, large workload involved in the preparation of PN for nurses, and waste of drugs are prone to happen. In view of these issues, our hospital independently developed standardized formulas of neonatal PN solution, which has been approved in Australia as a patented invention. Herein, we reported the composition and application protocol of this standardized PN solution for newborns.

Hospital pharmacy management in a tertiary care charitable hospital: Compliance study with quality standards

ObjectiveTo perform a qualitative and quantitative comparison of the practice and infrastructure with applicable legislations governing hospital pharmacy while the secondary objective was to calculate the average dispensing time of a prescription in the hospital pharmacy. Materials and methodsA prospective observational study was carried out in the hospital pharmacy for one year. A blend of quality control parameters was drafted after referring various guidelines put forward by the statutory bodies. Qualitative data was collected by continuous observation, physical inspection and after a thorough interview of hospital pharmacists. The collected data was summarized and compared with the standards. Quantitative data on the minimum requirement of hospital pharmacy infrastructure and dispensing time was collected by using the designed data collection form and analysis was performed using SPSS (version 20.0). ResultsThe hospital pharmacy met all the criteria that are necessary to satisfy legal requirements, availability of medicine, medicine and general safety and most of the quality parameters. However, few deviations were observed in the management of the drug store. The shortage in the floor space and waiting area was identified. The average dispensing time without waiting was 113.93 ± 28.92 s and the time spent collectively for dispensing and waiting was measured to be 533.13 ± 128.51 Sec. The average waiting time in the hospital pharmacy was approximately around 419 Sec. ConclusionMajority of the quality parameters were noted to be compliant with the standards. Few deviations were identified and measures to improve them were suggested.

Discovering hidden patterns among medicines prescribed to patients using Association Rule Mining Technique

ABSTRACT Hospital pharmacies are experiencing significant rise in demand for medicines for treatment and care of patients admitted to hospitals. Nevertheless, inefficient processes continue to be a problem in hospital pharmacy management, resulting in mismatch between demand and supply, time-consuming manual tasks, out-of-stock situations, medicine expiration, and excessive operating costs. Prior research has addressed various aspects of hospital pharmacy management, but limited studies have focused on discovering hidden patterns and knowledge from large volume of data stored in hospital information systems, which can help improve pharmacy operations. Primary goal of this research is to extract meaningful knowledge from hospital databases to improve pharmacy operations. Hospital pharmacy database from multispecialty hospital in India is used to examine associations among medicines prescribed to hospitalized patients using Apriori approach, which is one of the algorithms of Association Rule Mining. Data comprising 745,176 pharmaceutical item order records were gathered, processed and analyzed. Around sixty-three association rules were discovered. Different measures like support, confidence, and lift are used to evaluate the rules. Rule comprising medicines Atracurium, Febuxostat, and Multivitamins achieved the highest confidence of 87.35%. Discovered rules can help pharmacists to anticipate demand, develop better inventory system, improve operational efficiency and lead to effective healthcare system.

Automation of a tertiary hospital pharmacy drug dispensing system in a lower-middle-income country: A case study and preliminary results

BackgroundAn increase in the use of automated systems has optimised the drug dispensing process in hospitals. MethodsThis case study describes the implementation of automated drug dispensing system and presents the preliminary results of automated pharmaceutical dispensing with robots (PillPick® and BoxPicker®, ©Swisslog Healthcare) at Hospital Sírio-Libanês, a private tertiary hospital in Brazil. ResultsDuring the study period, between 2013 (pre-automation) and 2017 (post-automation) the number total of medication errors has not changed post-automation, but there was significant reduction in error in the dispensing phase with a relative risk of 0.84 (95% confidence interval: 0.70–0.99) withal a reduction in the numbers of returned items, breakages, and loss of medications, although that delivery times have increased.. ConclusionThe study results suggest that the use of robotic systems in the central pharmacy may improve hospital pharmacy management and generate only a few errors in dispensing pharmaceuticals.

Current Situation and Development of Hospital Pharmacy Management and Pharmacy Service

Current Situation and Development of Hospital Pharmacy Management and Pharmacy Service

Reasons for Low Regulatory Body Discipline Rates for Canadian Hospital Pharmacists.

Past research on disciplinary action by pharmacist regulatory bodies has shown that most cases concern community pharmacists, with few occurring in a hospital setting. To investigate how discipline-related issues involving pharmacists are dealt with by hospital pharmacy departments in Canada. Hospital pharmacy directors and managers from small, medium, and large hospitals across Canada were invited to participate in semi-structured telephone interviews. The interview questions focused on the discipline process in participants' organizations, the situations when reporting to the regulatory body is deemed to be warranted, possible penalties, and recommendations for improving the regulatory body or organizational discipline process. Ten participants, from British Columbia, Saskatchewan, Ontario, New Brunswick, Prince Edward Island, and Newfoundland and Labrador, agreed to be interviewed. Five key themes emerged as contributing to lower rates of hospital pharmacist discipline cases being escalated to the regulatory college level: robust organizational discipline processes independent from the regulatory college, a practice environment promoting competence, union representation, preference for a remedial approach to discipline, and lack of clarity about when to report to the regulatory authority. This study identified a number of reasons why discipline of hospital pharmacists by a regulatory body may be less prevalent than discipline relating to community pharmacists. The main reasons may be lack of clarity about when to report a case to the regulator and a lack of transparency, given that many cases are handled internally within hospitals. Environmental supports for competence and employee protections (e.g., through a union) may also reduce discipline cases.

Prevalence of and incentives for board certification among hospital pharmacy departments in California.

Board of Pharmacy Specialties (BPS) certification is endorsed to distinguish pharmacists for advanced practice areas, yet perceived value to stakeholders remains poorly described. This study characterized how board certification is integrated in hospital pharmacy departments across California. A prospective, cross-sectional study was conducted in which a survey was administered to all hospital pharmacy directors in California between November 2019 and March 2020. Licensed institutions and corresponding pharmacy directors were identified from the California State Board of Pharmacy. The survey queried for institution and pharmacy director characteristics and if/how board certification was integrated. Multivariable logistic models identified predictors of institutions with at least 25% full-time board certified pharmacists and those that reward board certification. Surveys were completed by 29% of institutions. Most of these institutions were urban (81%) and nonteaching (57%), with fewer than 325 hospital beds (71%), and with fewer than 50 full-time pharmacist positions (86%). The majority reported that less than 25% of their pharmacists were board certified. Currently, 47% consider board certification during hiring and 38% reward board certified employees. Predictors of institutions with 25% or more board certified pharmacists included being a teaching institution (odds ratio [OR], 2.96; 95% confidence interval [CI], 1.24-7.06), having 325 or more beds (OR, 7.17; 95% CI, 2.86-17.97), and having a pharmacy director who was previously or currently board certified (OR, 3.69; 95% CI, 1.46-9.35). Hospitals with 100 or more pharmacist positions predicted institutions that reward board certification (OR, 16.69; 95% CI, 1.78-156.86). Board certification was an employment preference for almost half of the hospital survey respondents in California. Institutions more likely to reward board certified pharmacists are larger, urban, and teaching hospitals and have pharmacy directors who have been board certified.

Impact on decision making framework for medicine purchasing in Chinese public hospital decision-making: determining the value of five dipeptidyl peptidase 4 (DPP-4) inhibitors

BackgroundMedicine purchasing in Chinese public hospitals is decided by the hospital Pharmacy Management Committee (PMC), that is complex, subjective and requires efficient approaches to ensure transparency and consistency for the factors being considered. This study aimed to use the Evidence and Value: Impact on Decision Making (EVIDEM) framework to assess medicine in these hospitals. In this study anti-diabetic drugs DPP-4 inhibitors, which work by inhibiting the activation of the Dipeptidyl Peptidase 4 (DPP-4) inhibitors, were appraised.MethodsFollowing EVIDEM methodology (EVIDEM-10th), we convened an appraisal group and asked each individual to express their perspectives by assigning weights to each criterion. A systematic literature search for information of each criterion of five DPP-4 inhibitors was completed. Then the appraisal group scored for each criterion of the five DPP-4 inhibitors. The estimated value of the five DPP-4 inhibitors was obtained by Multi-Criteria Decision Analysis (MCDA) which combined individual weighting of each criterion with individual scoring for each intervention in each criterion.ResultsBy assigning weights, the most important criterion was the quality of evidence (4.01±0.52), and that the comparative cost consequences-non-medical cost was the least important criterion (2.87±1.03). Criteria included disease severity, size of the affected population, comparative effectiveness, type of therapeutic/preventive benefit and cost of intervention, all of which were assigned the same weight of 3.58. After MCDA, the overall value orders for each DPP-4 inhibitor included Sitagliptin (0.45), Linagliptin (0.44), Vildagliptin (0.43), Alogliptin (0.42) and Saxagliptin (0.40).ConclusionsBased on EVIDEM framework and MCDA, we found that overall value of five DPP-4 inhibitors was similar. It is feasible to use the EVIDEM framework and MCDA in purchasing medicine for Chinese public hospitals.

Pharmacy practice in hospital settings in GCC countries: Prescribing and transcribing

PurposeTo outline hospital pharmacy practices across the Gulf Cooperation Councils (GCC) countries’ hospitals. MethodsA modified survey questionnaire was prepared from the original 2019 American Society of Health-System Pharmacist (ASHP) survey questions. Survey details were discussed with some pharmacy directors for clarity and relevance. A list of hospitals were obtained from the Ministry of Health of each of the targeted GCC countries. A secure invitation link containing a survey questionnaire was sent to the participants directly. ResultsSixty four hospitals responded to this survey. The overall response rate was 52%. About 47% of the surveyed hospitals considered their drug formularies as closed, and strict. Additionally, only 44% of hospitals compare the effectiveness of products, when taking formulary decisions for drug inclusion. Forty-four percent of hospitals have computerized prescriber order entry (CPOE / EHR) system functionality for formulary system management. At about 39.1% hospitals, pharmacists have the responsibility for managing medication therapies, majority were engaged in providing anticoagulation therapies. About 61% of hospital pharmacies in GCC countries receive medication orders electronically, through CPOE/EHR. Majority (66%) of the hospitals in GCC countries have an active Antimicrobial Stewardship Program (ASP) while only 40% of pharmacists have a key role in providing clinical support. About 57.8% of hospital pharmacy directors reported that pharmacists do not provide ambulatory care clinical pharmacy servicesin their hospitals. ConclusionIn GCC countries’ hospitals, there are major areas for improvement to patient care of which pharmacists are uniquely qualified as the medication experts to have the most meaningful outcomes in all of the domains of safe medication use, medication therapy management, antimicrobial stewardship program and participation in outpatient clinics.

Competency framework for hospital pharmacy residency: a scoping review

The training and roles of pharmacists around the world are undergoing drastic changes. In the hospital environment, pharmaceutical care services must incorporate hospital pharmacy management necessities, which must consider the constant technological and process innovations. However, there is a scarcity of studies exploring how pharmacy residency programs real experiences in hospitals can improve these essential competencies. This scoping review allowed an overview of the pharmacy residency programs' competency framework's scientific production in the world. These documents review about training programs in the world showed that U.S. programs have teaching processes that evaluate resident's development to certify the program structure to qualify them. Australian and Canadian studies demonstrated advances in the search for pharmacy residents' qualifications with competency-based curricula. It highlighted that a structured and evidence-based approach to these programs' curricula is required and still has ample space in several countries to improve hospital pharmacists' training through residency programs. The most appropriate is that the programs are evaluated in terms of educational results by measuring residents' involvement by considering the course, tutors, and other program components.

Hospital pharmacy management: Logistics focus on the supply chain

The hospital is a critical unit in the management process in general. This criticality becomes more pronounced when it comes to supply logistics. In the hospital unit, it is important to highlight the hospital pharmacy as an indispensable nucleus for effective and safe treatment of the patient. Objective: to identify and report the main difficulties and inefficiencies in the process of supply management in hospital pharmacies. Methodology: Literary review of articles indexed in lilacs, SPELL, Scielo, Medline and CAPES Journal Portal databases, from 2005 to 2019, on supply management in hospital pharmacies. Results: 25 articles were selected, which addressed the theme, which were critically studied, aiming to understand the supply chain process in hospital pharmacies. Conclusion: the main difficulty encountered was the effective control of inventories. As a result, at any given time, the lack of some materials and medications, thus bringing harm or damage to patients.

Practice of prescription review mode based on data mining in hospital.

Our study aims to solve the problems caused by the large numbers of prescriptions and insufficient pharmacists in the hospital by using a prescription review model based on data mining. A hospital pharmacy management analysis and decision system was established based on the data of the hospital information system, requirement of pharmacy management and data mining technology. Based on application of this information system, a four-step data mining prescription review model was created and put into practice, which included presentation of model for prescription evaluation, instance problem model, full-scale extraction of problem prescriptions tracking correction and dynamic monitoring of changes in drug dosage distribution for proposing new problem model. Through the application of this model, the problems caused by overdosage, over-treatment, the combined use of drugs with the same curative effect, and non-indication use of antibacterial drugs in our hospital's prescription reviews were almost solved. The unreasonable rate of prescriptions has remained below 0.05% since 2015, and the unreasonable rate of doctor's orders has been controlled below 0.24%. The proportion of medicines dropped from 45.4% to 28.2%. The proportion of adjuvant drugs used decreased from 21% to 1.6%. This data mining prescription evaluation model is an efficient prescription quality management tool suitable for implementation in the digital, big data era.

Collaborative Governance Framework in Health Care: A Qualitative Exploration of Hospital Pharmacy Management Reform at Hospital Setting in Indonesia

Since January 2014, the Indonesian government has implemented national health insurance (NHI) policy which aims to achieve universal health coverage by 2019. Through the new insurance scheme, hospitals are obliged to reform its pharmacy management practices by following national formulary and implementing e-catalogue. However, researches on pharmacy management under the NHI suggests that hospitals as the forefront of health services have limited resources to manage competing interests that hamper the reform. In this paper we examine local hospitals’ governing strategies and adaptations to implement the reform. Through extensive in-depth interviews with hospital managers, doctors and staffs at the hospitals pharmacy units in government hospitals in Central Java, we demonstrate the importance of collaborative governance in health care reform including pharmacy management. From the cases, we argue that the national’s policy reform is only effective when hospitals’ leaderships are able to create collaboration among stakeholders. Trust to leadership plays a crucial role in establishing organizational change including mitigating negative responses from actors that losing financial benefits due to the reform.

The Clinical Pharmacist-Led Consultation for Infectious Diseases in Guizhou Province, China: A Survey Among Hospital Pharmacies.

BackgroundAs antimicrobial resistance became an increasing threat to global public health, Clinical Pharmacist-led Consultation (CPC) for Infectious Diseases (ID) was developed in China. We conducted a survey among hospital pharmacies to investigate the present situation and potential determinants of CPC for ID in China's Guizhou Province.MethodsThe study was conducted by sending the questionnaire to the directors of hospital pharmacy who were members of Guizhou Province Pharmaceutical Administration Collaboration Network (GPPACN) from April to May 2019. We implemented the Firth's logistic regression model to analyze the factors that influence the implementation of CPC. The acceptance rate of consultation suggestions (ARCS) and effective response rate after acceptance of pharmacists' suggestions (ERRAPS) were pooled by meta-analysis using a random effect model, respectively. A pairwise meta-analysis was performed to compare the effective response rate between patients whose treatment followed the pharmacists' suggestions and those whose treatment did not.ResultsA total of 83 hospitals covering 9 regions in Guizhou Province were included in this survey. The results showed that 50 hospitals (60.24%) developed the CPC for ID. Staffing ID, respiratory, or general clinical pharmacist had a significantly positive effect on the implementation of CPC [adjusted odds ratios = 7.298, 95% CI (confidence interval): 2.232 to 23.858]. The pooled ARCS and ERRAPS for secondary hospitals were 97.59% (95% CI: 94.27 to 100.00%) and 88.36% (95% CI: 84.71 to 92.17%), respectively. Importantly, CPC improved the prognosis of ID patients [risk ratio (RR) = 6.49, 95% CI: 2.84 to 14.82] in these hospitals.ConclusionCPC adoption is gradually increasing among hospitals and will be a promising intervention for ID treatment at grassroots medical institutions in Guizhou Province. Training more clinical pharmacists to specialize in ID, respiratory, or general diseases might be the most practical measure to promote the development of CPC for ID.

6S管理在住院药房管理中的应用及对工作效率的影响

6S管理在住院药房管理中的应用及对工作效率的影响