Hospital Pharmacy Directors Research Articles

Achieving a Computer System's Benefits

Computer systems with expanded features and functions and mechanical dispensing devices are making medication systems safer and more efficient and increasing the productivity of pharmacy operations. Hospital pharmacy managers have many questions about computer systems and automation devices. This bimonthly column will alternate between an up-to-date comparison of computer systems and articles about automated dispensing systems. We invite system users, hospital information officers, and vendors to comment on systems from their unique viewpoints. Please e-mail your comments to hospharm@uic.edu .

When should pharmacists visit their wards? An application of simulation to planning hospital pharmacy services.

This paper reports a pilot study of the use of simulation in planning hospital pharmacy services. The objectives were to create a simulation model of the hospital drug distribution system, to use the model to investigate a simple problem and to assess the potential for simulation to aid decision making in hospital pharmacy management. The problem chosen for investigation focused on the UK ward pharmacy system, where a pharmacist visits each ward daily to initiate the supply of newly prescribed non-stock medication. A simulation model was used to investigate how changing the time of the ward pharmacist's visit could affect the mean time delay between the prescription of a non-stock drug and the arrival of that drug on the ward. The simulation results suggest that the time of day at which pharmacists visit their wards can have a major impact on delay times, and that the relative benefit of different visit times is likely to vary between wards. Simulation was found to be a useful approach to investigating different service alternatives without the expense and disruption of assessing each in practice.

Attitudes of Ohio hospital pharmacy directors toward national voluntary pharmacy technician certification.

Ohio pharmacy directors' attitudes about national voluntary pharmacy technician certification were surveyed. In May 1996 a questionnaire was mailed to all 224 hospitals in Ohio. The questionnaire contained 29 attitudinal statements constructed as forecasts of the effects of certification; pharmacy directors were asked to rate their level of agreement or disagreement with each statement using a 7-point Likert scale. The response rate was 61.4% (137 questionnaires returned). Respondents indicated modest agreement with 21 of 27 attitudinal statements and therefore had a generally positive view of certification. For example, they agreed that certification will improve technicians' knowledge, image, confidence, skills, and job satisfaction. They disagreed that certification will allow technicians to function independently, result in the replacement of pharmacist positions with technicians, or eliminate the need for on-the-job training of technicians. There were significant differences in scores between directors working at hospitals employing certified technicians and directors working at hospitals not employing certified technicians for only three statements. Overall, Ohio hospital pharmacy directors had positive attitudes about pharmacy technician certification.

Multisystem Director: A Product of Managed Care in Today'S Health System

The reform of the health care system in this country has led to a restructuring of hospitals into large networks. Hospital administrators in new affiliates face the problem of coordinating services while reducing costs. One solution is the unification of congruent departments in nearby affiliates into multisystem departments under the lead of one director. This paper summarizes the experiences of a newly-appointed multisystem hospital pharmacy director, emphasizing his approaches to leadership, employee motivation, organization, and time management.

The effects of acquisition cost and budget-based compensation on the attitudes of pharmacy directors toward the adoption of a cost-effective new drug.

To test the effect of differences in acquisition cost and budget-based monetary compensation systems on the intent to support the adoption of a cost-effective new drug, over 350 hospital pharmacy directors were asked to indicate their intentions as to the adoption of a cost-effective new thrombolytic agent, presented at 3 different prices. Although the economic savings for the hypothetical product were constant across all price points tested, respondents exposed to the highest price were more likely to resist the adoption of the new agent than those exposed to lower prices (p < 0.001). Respondents whose compensation was contingent on their control of the drug budget indicated a higher likelihood to resist the adoption of the new agent than did those whose salary was not so determined. These findings indicate that significant hurdles, psychological and organisational, still exist for the acceptance and use of pharmacoeconomic information in the hospital setting.

Use of pharmaceutical manufacturers' value-added services to build customer loyalty

Maximum difference conjoint analysis is used to determine which value-added services offered by pharmaceutical manufacturers are liked the best (worst) as perceived by hospital pharmacy directors. When pharmacy directors are presented with opportunities to switch biotechnological products, it is possible to assess the relative value of value-added services in maintaining customer loyalty. A manufacturer's resources, such as educational programs, product services, and other specialized skills, are valued by hospital pharmacy directors as revealed by their reluctance to switch to a competitor's product. Differential effects of hospital size and managerial implications are also discussed.

On-site availability of selected antidotes: Results of a survey of Massachusetts hospitals

Hospital pharmacies in Massachusetts were surveyed to determine their patterns of stocking antidotes. Mailed questionnaires were completed by hospital pharmacy directors at 82 of 93 acute care institutions (87% response rate). Results confirmed great variability in on-site accessibility of antidotes. Only 8 of the 82 hospitals (9.8%) stocked all of 14 common antidotes inventoried by the survey. Even fewer hospital pharmacies stocked specific antidotes (eg, Crotalid anti-venin, digoxin-specific Fab antibodies, pyridoxine) in an adequate quantity to treat one poisoned adult. Larger hospitals and those with a 24-hour pharmacy were more likely to have certain antidotes than smaller institutions. We conclude that Massachusetts hospitals do not carry complete inventories of 14 common antidotes. It is important that poisoned patients be referred to medical centers with adequate toxicological care. Improved guidelines for the accessibility of antidotes need to be developed and made available to hospital pharmacies and emergency departments.

Insufficient Stocking of Poisoning Antidotes in Hospital Pharmacies

To determine whether antidotes for poisoning and overdose are available in hospitals that provide emergency department care. Written survey of hospital pharmacy directors, each of whom reported the amount currently in stock of 8 different antidotes: antivenin (Crotalidae) polyvalent, cyanide kit, deferoxamine mesylate, digoxin immune Fab, ethanol, naloxone hydrochloride, pralidoxime chloride, and pyridoxine hydrochloride. Pharmacy directors of all hospitals with emergency departments in Colorado, Montana, and Nevada. Proportions of hospitals with insufficient stocking of each antidote, defined as complete lack of the antidote or an amount inadequate to initiate treatment of 1 seriously poisoned 70-kg patient. Questionnaires were mailed to 137 hospital pharmacy directors and 108 (79%) responded. Only 1 (0.9%) of the 108 hospitals stocked all 8 antidotes in adequate amounts. The rate of insufficient stocking for individual antidotes ranged from 2% (for naloxone) to 98% (for digoxin immune Fab). In a multiple regression analysis, smaller hospital size and lack of a formal review of antidote stocking were independent predictors of the number of antidotes stocked insufficiently. Insufficient stocking of antidotes is a widespread problem in Colorado, Montana, and Nevada. Although these states are served by a certified regional poison center, potentially lifesaving antidotes are frequently not available when and where they might be needed to treat a single poisoned patient.

National survey of quality assurance activities for pharmacy-prepared sterile products in hospitals and home infusion facilities--1995.

The results of a survey of hospital pharmacy and home infusion facility activities for quality assurance in the preparation of sterile drug products are reported, and the hospital results are compared with those of a 1991 ASHP survey. A questionnaire was mailed in May and June 1995 to 778 hospital pharmacy directors and 203 home infusion pharmacy directors. Usable questionnaires were returned by 547 hospitals and 111 home infusion facilities, for an overall response rate of 67%. The percentages of hospitals with pharmacists involved in extemporaneous (70%) and batch (28%) preparation of sterile drug products have decreased since 1991, while the percentage with technicians who are not limited as to the types of sterile products they may prepare has increased. Some 16% of all sterile products compounded in hospitals were prepared by nonpharmacy personnel. Few respondents contracted with outside sources for compounding of sterile products. A need for educational programs on aseptic technique was identified by 83% of hospitals, and 84% of home infusion facilities indicated a need for education on environmental monitoring. Three fourths of respondents used the ASHP Technical Assistance Bulletin on Quality Assurance for Pharmacy-Prepared Sterile Products in developing their policies and procedures. Significant improvements in orientation and training techniques have occurred since 1991. Use of a laminar-airflow hood in a limited-access room has increased. The aspects of sterile product compounding most often modified since 1991 were, for hospitals, personnel training and evaluation (74%), facilities and equipment (48%), and garb policies (36%); for home infusion facilities, personnel training and evaluation (76%), facilities and equipment and garb policies (both 69%), and end-product testing and evaluation (66%). There have been advances in quality assurance procedures related to pharmacy-prepared sterile products, but opportunities for improvement remain.

The relationship of service user closeness and belief in departmental values with perceived marketing effectiveness of hospital pharmacy directors.

This study examines the relationships between department values, service user closeness and marketing effectiveness as perceived by hospital pharmacy directors. Data from 171 hospital pharmacy directors, representing a cross-section of hospitals, revealed that departments of pharmacy characterized as having superior perceived marketing effectiveness also have shared department value profiles. However, no significant relationship was found between perceived level of marketing effectiveness and perceived service user closeness. More years of experience as a director and the larger the size of pharmacist staff each positively influence the director's perception of marketing effectiveness. The results of the study indicate that hospital pharmacy directors generally perceive the services offered by their respective departments are marketed effectively.

Relationship between hospital pharmacists’ job satisfaction and involvement in clinical activities

Job satisfaction among hospital pharmacists employed by a national hospital pharmacy management company was measured by using a mail questionnaire. A previously validated survey that measured pharmacists' job satisfaction was adapted for use in this study. Additional questions determined the pharmacist's clinical pharmacy training and participation in clinical pharmacy services. Questionnaires were mailed to all full-time hospital pharmacists employed by the pharmacy management company. Of the 606 mailed, deliverable questionnaires, 354 usable responses were returned, for a response rate of 58.4%. The respondent hospital pharmacists' level of job satisfaction showed a positive association with clinical pharmacy involvement. Of the nine items in the questionnaire that measured the pharmacists' involvement in clinical pharmacy services, seven items showed a positive relationship between involvement in that clinical activity and job satisfaction. Mean job satisfaction increased as the percentage of time spent performing clinical pharmacy activities increased. Job satisfaction decreased as time spent performing distributive functions increased. The percentage of time hospital pharmacists were engaged in clinical activities was significantly associated with job satisfaction.

Econotherapeutics

A program that represents the efforts of a hospital pharmacy management company to control drug costs is described. The program, Econotherapeutics, was developed in response to a changed health care reimbursement system that focused on the costs of products rather than the revenue generated by these products. For antimicrobial agents, a hospital-specific antibiogram is used to encourage cost-effective prescribing. A pharmacist intervention program, medical staff presentations, drug usage evaluation, management systems, and educational programs for pharmacists are all essential parts of the program. Centralized data gathering has allowed cost comparison of specific antimicrobial agents so that differences between variable cost estimates and costs based on actual use cam be evaluated. Actual dose and dosage interval were used to calculate average cost per treatment day in a 121-hospital sample. Our cost data support the choice of cefotaxime over ceftriaxone.

Hospital pharmacy directors receive SmithKline Beecham–Leonard Davis Institute fellowships

Hospital pharmacy directors receive SmithKline Beecham–Leonard Davis Institute fellowships

Benefits and work-schedule options in hospital pharmacy practice

Hospital pharmacy directors were surveyed to determine whether their departments offered specific family-related benefits and work-schedule options and how their attitudes about these options compared with those of female hospital pharmacists. Questionnaires were mailed to 300 randomly selected hospital pharmacy directors to collect the following information: vacancy rates and male:female ratios in hospital pharmacy positions, which of 13 selected benefits and work-schedule options were offered, barriers that prevented the other options from being offered, and attitudes about the listed options. The options included in the survey were selected because they represent ways of balancing home and work (e.g., maternity leave, job sharing, day care). The pharmacy directors' responses were compared with those from a similar survey of female hospital pharmacists. The usable response rate was 50.3%. Position vacancy rates ranged from 5.5% for directors to 35.8% for clinical supervisors. All full-time positions had an even distribution of men and women except for director and assistant or associate director positions. Of 13 options, only maternity leave, part-time schedules, and flexible schedules were offered by more than half of the hospitals. These three were also the only listed options that the respondents considered important in recruiting and retaining pharmacists. Barriers to offering other options included the perception that current benefits and work-schedule options were adequate, lack of staff coverage, lack of funds, and the perception that some positions are not compatible with alternative schedules. Respondents' ratings of the importance of the listed benefits and work-schedule options were significantly lower than ratings given by female hospital pharmacists in a separate survey.(ABSTRACT TRUNCATED AT 250 WORDS)

Trends in Educational Qualifications Specified in Advertisements for Hospital Pharmacy Managers

Educational and experiential qualifications required for hospital pharmacv management positions were determined through content analysis of advtisements for these positions. Principal results include the fact that requirements for the studied management positions have remained remarkably constant over the year. Because many advertisements specify or Pharm.D., degree, or do not specify a degree requirement at all, either an M.S. or a Pharm.D. will quallfy the candidate for most positions. Where no degree is specifled, a B.S. will qualify for application. The exception is for clinical management positions, where the Pharm.D. is a distinct advantage. Possession of experience appears more important than possession of an advanced degree. While many advertisements did not specify educational qualifications, almost all mentioned specific experirntial requirements. A principal conclusion is that educational qualifications required of hospital pharmacy management applicants do not reflect the con...

Trends in Educational Qualifications Specified in Advertisements for Hospital Pharmacy Managers

Educational and experiential qualifications required for hospital pharmacv management positions were determined through content analysis of advtisements for these positions. Principal results include the fact that requirements for the studied management positions have remained remarkably constant over the year. Because many advertisements specify "M.S. or Pharm.D.," "advanced degree," or do not specify a degree requirement at all, either an M.S. or a Pharm.D. will quallfy the candidate for most positions. Where no degree is specifled, a B.S. will qualify for application. The exception is for clinical management positions, where the Pharm.D. is a distinct advantage. Possession of experience appears more important than possession of an advanced degree. While many advertisements did not specify educational qualifications, almost all mentioned specific experirntial requirements. A principal conclusion is that educational qualifications required of hospital pharmacy management applicants do not reflect the contemporary demand for management experience.

Hospital pharmacy directors' perceptions of job stress in staff pharmacists

Hospital pharmacy directors' perceptions of job stress in staff pharmacists

Matrix management in hospital pharmacy departments

The results of a nationwide survey to determine the managerial structures of selected hospital departments are reported. A questionnaire was mailed in August 1990 to a random sample of 1792 hospital pharmacy directors. The survey included questions on hospital bed capacity and ownership and on the managerial structures used for several departments and services, including pharmacy, satellite pharmacy, home health care, and hospice care. Recipients were asked to indicate a centralized management structure if decisions were made by a single individual; decentralized if the responsibility was distributed down the hierarchy; functional if departments were grouped according to specialties, skills, and knowledge; and matrix if the vertical hierarchy was overlaid by lateral mechanisms of authority. A total of 567 usable responses were received, for a response rate of 31.6%. Across departments, the most frequently reported type of management was centralized. Functional systems and systems that included a combination of features were cited least often. Of the pharmacy departments, 24.5% had decentralized management. Matrix management was used for 11.8%, 9.7%, 7.0%, and 4.7% of the pharmacy, home health-care, hospice-care, and satellite pharmacy departments, respectively, and was used more often in large hospitals than small hospitals. Pharmacy departments in nonprofit hospitals tended to use decentralized management more often than those in for-profit institutions. Centralized management was used most frequently by pharmacy departments, followed by decentralized and matrix management structures. Few pharmacy directors reported plans to implement matrix management.

Perceptions and use of performance measures by hospital pharmacy directors

The extent to which hospital pharmacy directors use and value specific pharmacy department performance measures was studied. Questionnaires were mailed to pharmacy directors at 834 randomly selected hospitals. The questionnaires contained a list of seven data collection methods and 32 financial, 25 productivity, and 9 quality assurance measures obtained from a review of the literature. Respondents were asked to indicate familiarity, perception of usefulness, and current use of each method or measure. Perception of usefulness was measured on a five-point scale (1 = not useful, 5 = very useful). Respondents were also asked if the measures were requested by hospital administration or an external consultant. The overall response rate was 24.1%. Less than 30% of the respondents indicated that they used any of the data collection methods; however, the mean value for perceived usefulness was higher than 3 for almost all of the methods. Only five of the financial measures, two of the productivity measures, and two of the quality assurance measures were being used by more than 50% of the respondents. The value for mean perceived usefulness was higher than 3 for all but two of the measures. Most of the measures showed significantly higher frequency of use when they were requested by hospital administrators than when they were not. Requests by external consultants showed less effect on the use of the measures. The use of performance measures was low, but hospital pharmacy directors were familiar with many of these measures and perceived them to be useful.

Community Versus Hospital Pharmacy Management: The Principles Are the Same, But the Incentives for Success Are Different

Community Versus Hospital Pharmacy Management: The Principles Are the Same, But the Incentives for Success Are Different