Pharmacy Staff Members Research Articles

Justification of a Pharmacy Intravenous Admixture Service in an Australian Hospital

The time and cost of i.v. admixture preparation by hospital pharmacy staff members in an established admixture unit was compared with that by nurses working on wards. The preparation time of antimicrobial admixtures was determined by using a stopwatch. The total cost of preparing an admixture by pharmacy and nursing staff was calculated by combining the respective labor costs (preparation time x average salary rates weighted for overtime) with the cost of disposable items. The mean +/- S.D. time for admixture preparation in the pharmacy was 3.38 +/- 0.38 minutes, whereas preparation by nurses required 14.37 +/- 1.55 minutes. The mean +/- S.D. total cost (in Australian dollars) of admixture preparation was $1.42 +/- 0.34 per dose, and $4.59 +/- 0.46 per dose, respectively. Centralization of admixture preparation would reduce the time required by 18.32 hours for every 100 admixtures prepared, equivalent to an annual cost avoidance of $112,420 for every 100 admixtures prepared each day. Centralizing the preparation of i.v. admixtures in a hospital pharmacy resulted in significant time savings and cost avoidance.

Drug information course for pharmacy staff development

An interactive course in drug information skills developed for pharmacists at a not-for-profit, tertiary-care hospital is described. Faculty members from the area school of pharmacy developed, taught, and evaluated the program. Before the course was developed, pharmacy staff members were asked to rate their drug information skills; the pharmacists' responses indicated their belief that they were not proficient enough in the skills needed in daily practice. The course content and format were refined after 11 pharmacists completed a pilot program. A handbook was developed that contained objectives, session outlines, and literature for each of the six topics chosen for the course. Although the handbook was the primary teaching aid, wall charts and computer demonstrations were also used. Sessions were structured for the needs of adult students by using a small-group discussion format that emphasized the practical relevance of the information and encouraged participants to share personal experiences. Each session was offered on two separate days to facilitate attendance. Those who completed the course received credit for 12 contact hours of continuing education. Of 16 pharmacists enrolled in the course, 11 completed it. An interactive course in drug information skills, developed to meet the needs of hospital pharmacists, was well accepted because it incorporated personal experiences, small-group activities, and flexible scheduling.

Use of Cytogenetic Methods to Determine Mutagenic Changes in the Blood of Pharmacy Personnel and Nurses Who Handle Cytotoxic Agents

Lymphocytes of subjects from throughout the United Kingdom were studied over a two-year period beginning in January 1985 to determine the level of chromosomal damage produced by environmental exposure to cytotoxic agents. A small pilot study was conducted to determine the expected background level of chromosomal aberrations. Four groups of subjects were then recruited: pharmacy personnel who reconstituted the drugs under recommended conditions, nurses who did not reconstitute the drugs but worked on units where patients received cytotoxic chemotherapy, unexposed office workers from the same geographic location as the pharmacy personnel and nurses (negative control), and patients receiving cytotoxic drugs (positive control). Subjects completed questionnaires about smoking, viral illnesses, radiation exposure, and medication use in the past 12 months; pharmacy personnel were asked the numbers of times (1) they had handled specific drugs and (2) spills had occurred with these drugs. Lymphocytes from subjects were incubated for 48 hours, and first-division metaphases were examined for chromosome and chromatid aberrations; damage was measured as the number of aberrations per 100 cells. For a blood sample to be included in the analysis, at least 100 metaphase divisions had to be examined. Data were analyzed for 50 pharmacy staff members, 11 nurses, 12 controls, and 6 patients. Metaphase divisions in cells of the pharmacy personnel and nurses indicated no significant difference in chromosomal damage compared with the unexposed office workers. When the pharmacy, nurse, and control groups were pooled into a nonpatient group and compared with the patient group, significantly greater damage was observed in the patient group.(ABSTRACT TRUNCATED AT 250 WORDS)

Implementation of product-line management in a hospital pharmacy department

The development and implementation of product-line management (PLM) in a pharmacy department is reviewed. The PLM system of hospital organization shifts the emphasis from function to product. The pharmacy department at a 737-bed nonprofit hospital adopted PLM in an effort to reach more directly the physician and patient markets, enhance the image of pharmacy, and help meet requirements of the Joint Commission on Accreditation of Healthcare Organizations. The department surveyed physicians and administrators to identify their product and service needs and surveyed pharmacy staff members to identify the perceived benefits and risks of a PLM system. A strategic-planning session was held to decide how best to match the pharmacy department's product lines with market needs. The team leaders were renamed clinical supervisors and were no longer responsible for defined physical areas but rather for clinical matters relating to patients in the product line assigned. Pharmacy's chosen product lines were oncology services, neuropsychiatry, maternal and child care, cardiovascular, operating room-anesthesia-pain clinic, and general medical. The transition is being accomplished one product line at a time; interested team leaders transfer into clinical supervisor positions by achieving clinical expertise within the relevant product lines. Despite some initial confusion, PLM contributed to job satisfaction and morale and allowed the pharmacy department to provide increased clinical consultation and intervention services. PLM enhanced the clinical pharmacy program and focused clinical services on the physician and ultimately the patient.

Management consultant review of three departments of pharmacy to identify cost-reduction opportunities

A review by a management consulting firm to identify cost-reduction opportunities at three hospital pharmacy departments is described. A multihospital corporation hired a management consulting firm to review the operating procedures of several departments, including pharmacy, and recommend measures for reducing costs. A team approach was adopted to enable the pharmacy department managers and the consultants to freely contribute their expertise; input was also solicited from staff members. A review of each pharmacy department's operating costs showed that drugs and i.v. supplies consumed 60-67% of the expenses, and salaries and wages 27-36%. Estimates of the full-time equivalents allocated to inpatient, clinical, support, and ambulatory and outside contract service activities were compared. The relative costs of personnel allocated to all inpatient drug distribution activities were also compared. Cost-reduction recommendations were divided into short- and long-term measures. Short-term measures involved decreasing drug expenditures, decreasing the number of personnel, and limiting decentralized services in one of the departments; savings of $500,000 were projected. Long-term recommendations involved increasing the use of technology, expanding the use of technicians, and consolidating the management staffs among the hospitals. Management consultants, in cooperation with pharmacy department managers and staff members, can identify cost-reduction opportunities without compromising patient care.

Managing part-time pharmacy staff members

Managing part-time pharmacy staff members

Strategic planning for clinical services: Panel discussion

A panel of hospital pharmacy managers representing three institutions discussed issues related to planning for patient-oriented pharmacy services. The panelists discussed organizational benefits of strategic planning, ways to gain momentum for change among pharmacy staff members and from others within the institution, the need for setting realistic goals, and problems in differentiating roles for pharmacy staff. They also discussed the funding of strategic-planning programs. The panelists advocated an integrated approach to providing drug distribution and clinical services. Management must provide whatever support is necessary for integrating patient-oriented services into the daily activities of all pharmacists. That support may be in the form of additional personnel, better use of supportive personnel, staff development programs, or automation. Pharmacists, too, must recognize their combined responsibilities for drug distribution and clinical services. Only by having all pharmacists clinically trained can a department provide clinical services when needed. The experiences of these panelists may be useful to other institutions planning patient-oriented pharmacy services.

Strategic planning for clinical services: The University of Texas M.D. Anderson Hospital and Tumor Institute

A formal, hospitalwide strategic-planning process provides structure for the pharmacy's plans for implementing clinical services. The state-supported clinical cancer and research center began a formal strategic-planning process in 1981. The institution's planning report, prepared every two years and covering three two-year periods, drives the institution's budget through the state's biennial budget process. The report focuses on each department's responsibilities, areas of service, and relationship to the mission of the institution. Through the long-range planning process, upper-level administrators learned that pharmacy was eager not only to provide high-volume drug distribution services but also to assume direct patient-care and research responsibilities. This prompted an organizational change for pharmacy from a hospital department to a clinical division. The division of pharmacy now consists of three professional departments (patient care, pharmacy research, and pharmacy academic programs) and an administrative support service area. Services offered by each of the three departments are discussed, along with specific initiatives planned for the years 1987-1993. Within the next few years, all managers will come from the ranks of clinical practitioners; nonpharmacists will oversee financial and human resource functions. The division encourages existing pharmacy staff members to enhance their clinical skills through staff development programs. Strategic planning serves the dual purposes of structuring plans for implementing clinical pharmacy services and communicating pharmacy's goals within the institution.

Solving problems through staff participation in focus groups

Use of a survey and employee focus groups to solve problems in a hospital pharmacy department is described. All pharmacy staff members were asked to identify perceived problems; 33% completed the written questionnaire. Managers clarified the survey comments and ranked problems for priority, using nominal group technique. Focus groups were formed to address appropriate problems; for each focus group supervisors selected two pharmacists and two technicians who volunteered or were nominated by peers. A pharmacy resident was the facilitator for each group. Meeting weekly for one hour, each group defined problems, set priorities, gathered ideas, analyzed possible solutions, and proposed a solution to the pharmacy supervisors. One group proposed guidelines for staff scheduling and seven-days-on, seven-days-off rotations for night pharmacists; the other proposed a structure for technician training in the department and a required orientation and training schedule for all employees. This process required more staff time than unilateral management decisions would have, but the solutions were acceptable to all levels of staff members. The focus group process was effective in identifying and solving problems at this hospital. Routine resurveys will be conducted and new focus groups will be formed to address problems that would benefit from analysis and consensus by employees.

Implementing a mainframe packaged pharmacy computer system in a 190-bed hospital

The implementation of a pharmacy computer system in a 190-bed institution is described. A computer system was instituted in the pharmacy department as part of a hospitalwide conversion to an online information system. Planning for implementation began nine months before the actual live date (date of full computerization). Problems in the existing distribution and record-keeping systems that might be eliminated by computerization were identified, and changes in the layout of the pharmacy and department procedures were initiated to prepare for computerization. The events leading to computerization are presented in chronological order, and the advantages and shortcomings of the system are discussed. Because of careful planning, the cooperation of all pharmacy staff members, and frequent assistance from the computer vender, the nine-month conversion to a computerized system proceeded smoothly.

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.

Reduction in work hours during a period of reduced patient census

Implementation of and experience with a temporary reduction in hours worked at a large teaching hospital in California are described. During a period of reduced patient census, the hospital administration ordered a 20% reduction in the number of hours worked by employees in all departments for three months. Employees were required to take one extra day off per week as paid vacation or holiday time or as leave without pay. During this period, pharmacy staff members averaged seven extra days off. Pharmacy personnel were unable to complete some routine responsibilities, and their involvement in interdisciplinary patient rounds and inservice education decreased. The temporary cutback in work hours allowed the work force to be preserved. Departmental managers should keep staff members informed about potential changes in staffing patterns that may be required for cost containment.

Recognizing, reversing, and preventing hospital pharmacist burnout

The stress-related syndrome of "burnout" is reviewed, especially as it relates to work in hospital pharmacy. Included are suggestions for preventing and reversing burnout among hospital pharmacists. Burnout comprises a distinct series of symptoms that involve a regressive spiral in personal energy, vitality, and interest; it may be described as a disease in personal relationships. The five stages of burnout are: (1) physiological, (2) social, (3) intellectual, (4) psycho-emotional, and (5) spiritual. Regeneration from burnout can be pursued more systematically by striving for balance among these five aspects of life. Certain characteristics of hospital pharmacists increase their susceptibility toward burnout. Preventing imbalance/providing balance in one's life is a basic personal responsibility; no one can do it for another person. However, attentive management can provide conditions that help pharmacy staff members prevent burnout. Preventing burnout requires learning from past burnout-prone behavior and making the necessary changes in life style.