Survey Of Pharmaceutical Services Research Articles

Survey of pharmaceutical services in pediatric resuscitation.

Survey of pharmaceutical services in pediatric resuscitation.

Hospital pharmacy service provision in Australia—1998

The results of a 1998 national survey of pharmaceutical services in hospitals throughout Australia are reported. A self-administered questionnaire was sent to all directors of hospital pharmacy services and senior hospital pharmacy managers to determine the extent of clinical and nonclinical pharmacy services provided by hospitals in Australia. Respondents chose the services their departments provide from a list of 26 commonly provided services. The response rate was 58.5%. Respondents were fairly evenly divided between teaching and nonteaching hospitals, but most of the respondents were from public (versus nongovernment) hospitals. The five most commonly provided services were imprest (a wordstock of frequently used medications that are regularly restocked by the pharmacy department), informal drug education for hospital staff, review of medication charts, control of drug purchasing, and inpatient dispensing. Review of medication charts and provision of drug education for the hospital staff were the most widely provided clinical pharmacy services. The most common services available from hospital pharmacies throughout Australia were imprest, informal drug education for hospital staff, review of medication charts, control of drug purchasing for the hospital, and inpatient dispensing.

ASHP national survey of pharmacy practice in acute care settings--1996.

The results of the 1996 ASHP national survey of pharmaceutical services in nonfederal community hospitals are presented and compared with the findings of the 1994 ASHP survey. A questionnaire was mailed to pharmacy directors at hospitals randomly sampled from those registered by the American Hospital Association. A total of 713 usable surveys were returned, for a net response rate of 37.1%. Inpatient pharmaceutical services were provided an average of 17.4 hours per weekday and ambulatory care pharmaceutical services 13.3 hours per weekday. Pharmacy directors were more likely to have duties beyond the department than in 1994 (24% versus 12%). The percentage reporting a patient-focused-care model increased from 18% in 1994 to 33% in 1996. The percentage reporting some automation of drug distribution increased from 55% in 1994 to 65% in 1996. Provision of ambulatory care pharmaceutical services was indicated by 63% of respondents, and 35% indicated providing home infusion services. Compared with 1994, pharmacy departments provided more clinical services to inpatients. The most commonly offered clinical pharmacy services for inpatients were drug-food interaction screening, drug-use evaluations, adverse-drug-reaction programs, and medication error management programs. The percentage providing pharmaceutical care to some extent increased from 44% to 60%. The percentage reporting that pharmacists had the authority to initiate or modify medication orders increased from 35% to 56%. A well-controlled formulary system was in place at 60% of hospitals, while 39% reported restrictions on prescribing. Nearly three fourths of respondents reported a therapeutic interchange policy. Mean inventory cost per patient day was $4.67, a decrease from $5.62 in 1994. About 68% of inpatient pharmacy expenditures went for drugs and fluids, 27% for staff, and 5% for other noncapital expenditures. The 1996 ASHP survey revealed continued growth in various activities related to patient care, such as implementation of patient-focused care, enhanced clinical services, and therapy management programs. Although the provision of pharmaceutical care increased, ample room for growth remains.

ASHP national survey of hospital-based pharmaceutical services—1994

The results of a national survey of pharmaceutical services in federal and nonfederal community hospitals conducted by ASHP during summer 1994 are reported and compared with the findings of earlier ASHP surveys. A simple random sample of community hospitals (federal and nonfederal) was selected from hospitals registered by the American Hospital Association. A questionnaire was mailed to each director of pharmacy. The adjusted gross sample size was 896. The net response rate was 44% (393 usable replies). The mean number of hours that respondents' pharmacies were open per week for inpatient services was 107.5. An increasing number of pharmacy directors were managing other departments within the institution. Of respondents, 18% indicated that a patient-focused-care model was in place. Complete unit dose drug distribution was offered by 92% of respondents, and 67% provided complete, comprehensive i.v. admixture services. A total of 29% provided decentralized inpatient pharmaceutical services. Automation of some type to support drug distribution was used by 55%. Provision of ambulatory care pharmaceutical services was indicated by 82% of nonfederal hospitals and by 98% of federal hospitals. Home infusion therapy services were offered by 27% of respondents. Some 89% had a computerized pharmacy system. The most commonly offered clinical pharmacy services for inpatients were drug-use evaluations and programs to monitor drug therapy, adverse drug reactions, and drug-food interactions. About half of respondents indicated that they did not provide pharmaceutical care. One third indicated that pharmacists had the authority to write drug orders or prescriptions. Pharmacokinetic consultations were provided by 65% and nutritional-support consultations by 35%. Of nonfederal respondents, 86% participated in quality assurance for inpatient dispensing and 28% did so for ambulatory care dispensing. A well-controlled formulary system was in place at 60% of the hospitals. About 74% of inpatient pharmacy expenditures went for drugs and fluids, 20% for staff activities, and 6% for other noncapital expenditures. Almost half of respondents indicated that staff reductions had occurred. About 9% of nonfederal hospitals had an ASHP-accredited residency program. The 1994 ASHP survey revealed a continuation of growth in some areas of hospital pharmacy (clinical services, computerization, formulary management techniques, and residency programs) and identified static areas (ambulatory care services, scope of drug distribution services, and quality assurance programs) that should be addressed by pharmacy leaders.

Survey of clinical pharmacy services in United Kingdom National Health Service hospitals

The extent to which clinical pharmacy services are provided in National Health Service (NHS) hospitals in the United Kingdom was studied by means of a questionnaire. Questionnaires inquiring whether and to what extent certain clinical pharmacy services were provided were mailed to all NHS hospital pharmacies in 1992. The questionnaires also requested information about the hospital and the number and qualifications of pharmacists employed. The results were compared with those of a survey of pharmaceutical services in the United States. Of 508 questionnaires mailed, 416 usable responses were returned. Services commonly provided were inpatient drug therapy monitoring (96%), clinical trials support (92%), formulary management (89%), participation in drug and therapeutic committees (97%), and an on-site drug information center (60%). Services infrequently provided were therapeutic drug monitoring (21%), medication history-taking (16%), and a 24-hour on-site pharmacist (10%). Several services were associated with pharmacies that employed many pharmacists, pharmacists with advanced education, or specialist clinical pharmacists and pharmacies located in medical school teaching hospitals. U.K. hospital pharmacies provided fewer patient-oriented services and more drug information, therapy monitoring, and pharmacist education services than U.S. hospital pharmacies. Provision of clinical pharmacy services in the United Kingdom was associated with employment of many pharmacists, pharmacy clinical specialists, and pharmacists with advanced education.

ASHP national survey of pharmaceutical services in federal hospitals—1993

The results of a national mail survey of pharmaceutical services in federal hospitals conducted by ASHP from May to July 1993 are reported. Mailing lists were compiled of all Air Force, Army, Navy, Public Health Service, and Department of Veterans Affairs (VA) hospitals, as well as some federal prison hospitals. Questionnaires were mailed to each chief of pharmacy. The adjusted gross population size was 326. The net response rate was 76%. Complete unit dose drug distribution was offered by 85% of respondents, and 83% offered complete, comprehensive i.v. admixture programs. About half of the pharmacies provided decentralized services. Over 99% provided services to ambulatory care patients. A computerized pharmacy system was present in 99% of the departments. More than 95% of hospitals participated in adverse drug reaction, medication error management, and drug-use-evaluation programs. A total of 93% provided drug therapy monitoring, and 89% provided patient education. About 70% provided written documentation of pharmacist interventions in the medical records, and 57% participated in drug research. A total of 42% provided pharmacist-managed drug clinics, 41% participated in drug management of medical emergencies, 30% provided written medication histories, and 30% provided drug therapy management planning. Pharmacokinetic consultations were provided by 64% of departments. About 90% had a well-controlled formulary system and prescribing restrictions. Therapeutic interchange was practiced by 64%. Diversified pharmaceutical services included telephone or mail-in refill services (80%), mail-out pharmaceutical services (58%), and services to long-term-care facilities (49%). A total of 70% of the hospitals were affiliated with a pharmacy school. The first ASHP national survey of pharmaceutical services in federal hospitals showed that comprehensive distributive and clinical services were offered by most of the facilities.

ASHP National Survey of Hospital-based Pharmaceutical Services-1992

The results of a national mail survey of pharmaceutical services in community hospitals conducted by ASHP during summer 1992 are reported and compared with the results of earlier ASHP surveys. A simple random sample of community hospitals (short-term, nonfederal) was selected from community hospitals registered by the American Hospital Association. Questionnaires were mailed to each director of pharmacy. The adjusted gross sample size was 889. The net response rate was 58% (518 usable replies). The average number of hours of pharmacy operation per week was 105. Complete unit dose drug distribution was offered by 90% of the respondents, and 67% offered complete, comprehensive i.v. admixture programs. A total of 73% of the hospitals had centralized pharmaceutical services. Some 83% provided services to ambulatory-care patients, including clinic patients, emergency room patients, patients being discharged, employees, home care patients, and the general public. A computerized pharmacy system was present in 75% of the departments, and 86% had at least one microcomputer. More than 90% participated in adverse drug reaction, drug-use evaluation, drug therapy monitoring, and medication error management programs. Two thirds of the respondents regularly provided written documentation of pharmacist interventions in patients' medical records, and the same proportion provided patient education or counseling. One third provided drug management of medical emergencies. One fifth provided drug therapy management planning, and 17% provided written histories. Pharmacokinetic consultations were provided by 57% and nutritional support consultations by 37%; three fourths of pharmacist recommendations were adopted by prescribers. A well-controlled formulary system was in place in 51% of the hospitals; therapeutic interchange was practiced by 69%. A total of 99% participated in group purchasing, and 95% used a prime vendor. The 1992 ASHP survey revealed a continuation of the changes in many hospital-based pharmaceutical services documented in earlier surveys (e.g., growth in clinical services, ambulatory-care services, computerization) and identified static areas that merit the attention of pharmacy leaders (e.g., provision of complete, comprehensive i.v. services).

Pharmaceutical services in rural hospitals in Illinois—1991

The results of a 1991 survey of pharmaceutical services in rural hospitals in Illinois are reported and compared with the results of previously published national and regional surveys. A questionnaire was developed and mailed to the director of pharmacy at each hospital in the study population (n = 95 rural hospitals in Illinois) to obtain information about inpatient drug distribution services, ambulatory-care services, clinical services, and human resources. The response rate was 81% (77 usable responses). Respondents reported a mean hospital size of 115.5 licensed beds. The mean average daily census was 51.2. Drug distribution systems appear similar to those reported in the 1990 ASHP survey, with complete unit dose drug distribution systems existing in 90.1% of respondent rural Illinois hospitals and complete and comprehensive i.v. admixture services in 71.2%. The percentage of pharmacy departments that are decentralized is lower among rural Illinois hospitals than among previous survey populations. Respondents indicated that they provided the following clinical pharmacy services: drug therapy monitoring (73%), patient rounds (12.2%), nutritional support (37.8%), pharmacokinetic consultations (32.4%), and patient education and counseling (24.3%). These results are comparable to those reported in previous surveys. Respondents reported an average of 5.9 full-time equivalents per hospital pharmacy department. The pharmacist vacancy rate and the total vacancy rate per department were reported as 10% and 5.3%, respectively, with vacant positions taking an average of 15 months to fill. The pharmacist vacancy rate is markedly higher than that reported in the 1990 ASHP survey. Rural Illinois hospitals are comparable to other U.S. hospitals in the provision of most pharmaceutical services.(ABSTRACT TRUNCATED AT 250 WORDS)

Association between formulary strategies and hospital drug expenditures

National survey data were analyzed to determine whether an association existed between formulary strategies and hospital drug expenditures. Data on community hospitals were obtained from (1) ASHP's 1987 national survey of pharmaceutical services, (2) the American Hospital Association, and (3) the Health Care Financing Administration. Along with size, case mix, and salary information, data were collected on whether the hospitals used a well-controlled formulary, whether they used therapeutic interchange, and how much money they spent on drugs. A logarithmic cost-function model was used to obtain a straight-line equation that expressed the relationships between drug cost per patient day and the other variables assessed. Summary statistics were calculated with data from 514 hospitals. The adjusted coefficient of multiple determination indicated that the model was able to explain 24.6% of the observed variation in drug cost per patient day. A significant association was found between decreased costs and a well-controlled formulary, therapeutic interchange, or both. Hospitals that used either strategy spent 10.7% less for drugs than those that used neither. Hospitals that used both strategies spent 13.4% less than those that used neither. Analysis of national survey data suggests that use of a well-controlled formulary, therapeutic interchange, or both are associated with lower pharmacy drug expenditures.

National survey of quality assurance activities for pharmacy-prepared sterile products in hospitals

The results of a survey of pharmacy department activities for quality assurance in the preparation of sterile drug products in short-term, nonfederal hospitals are reported. A questionnaire was mailed in March and April 1991 to pharmacy directors at hospitals that had indicated in ASHP's 1990 national survey of pharmaceutical services that they had formal quality assurance processes for intravenous admixture preparation. The adjusted gross sample size was 465. The net response rate was 71% (330 usable replies). Nearly all respondents indicated that sterile drug products were prepared extemporaneously in their departments; 61% reported batch preparation of such products. Both pharmacists and pharmacy technicians prepared sterile products. Respondents identified which guidelines were used in developing departmental policies and procedures for sterile product preparation. Specific areas were identified in which educational programs for pharmacists are needed; the most frequently indicated area (85%) was principles of aseptic technique. A majority of respondents used the following means for the orientation and training of personnel who prepare sterile products: aseptic technique lectures or videotapes, on-the-job training, written policies and procedures, and direct observation of technique. Almost all of the respondents (99%) had laminar-airflow hoods in their departments. Three fourths of those respondents indicated that laminar-airflow hoods were located in a limited-access room. Half of the respondents reported that laminar-airflow hoods were located certified every six months and that prefilters were changed monthly. Less than one third sampled environmental areas for microbial contamination. Less than one third of the surveyed hospitals routinely sampled sterile products for microbial contamination or pyrogens. Almost half indicated the absence of policies and procedures for testing chemical purity, drug concentration, sterility, pyrogenicity, or the environment for sterile preparations. Few respondents indicated the use of sterilization techniques other than microbial filtration, which was used by 32% of pharmacies involved in extemporaneous preparation and 16% of those involved in batch preparation. About 90% of the respondents used published references and manufacturers' recommendations to determine expiration dating. This survey revealed that certain quality assurance procedures related to pharmacy-prepared sterile products need major improvement.

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.

National survey of state psychiatric hospital pharmacies

The results of a winter 1990 nationwide mail survey of pharmaceutical services provided in state psychiatric hospitals are reported and discussed. The survey universe consisted of all 207 state psychiatric hospitals registered by the American Hospital Association. Private and federal and other government-operated psychiatric hospitals were not included. Questionnaires were mailed to the director of pharmacy at each institution. Two questionnaires were not deliverable. There were 117 usable replies, for a net response rate of 57.1%. Compared with community hospitals, state psychiatric hospitals had pharmacy departments that were open fewer hours per week, occupied more floor space, were less likely to have a complete unit dose distribution system and i.v. admixture program, had lower inventory turnover rates, and had fewer full-time positions. About 28% of the respondents employed pharmacists who spent at least two thirds of their time providing clinical services. Differences in the provision of pharmaceutical services between state psychiatric hospitals and community hospitals may be due in part to the fact that most of the former are long-term-care institutions rendering a specific class of therapies.

ASHP national survey of hospital-based pharmaceutical services—1990

The results of a national mail survey of pharmaceutical services in community hospitals conducted by ASHP during May through July 1990 are reported and compared with the results of earlier ASHP surveys. A sample of community hospitals (short-term, nonfederal) was selected randomly from the population of community hospitals registered by the American Hospital Association. Questionnaires were mailed to each director of pharmacy. The adjusted gross sample size was 881. The net response rate was 66% (582 usable replies). The average number of hours of pharmacy operation per week reported by the respondents was 96. Complete unit dose drug distribution was offered by 89% of the respondents (up from 74% in 1987). About 70% offered complete, comprehensive i.v. admixture programs (essentially unchanged from 1987). Most of the hospitals (70%) had centralized pharmaceutical services. A computerized pharmacy system was present in 64% of the departments, and 75% had at least one microcomputer. More than 90% reported participation in adverse drug reaction and drug-use evaluation programs. Some 80% participated in drug therapy monitoring. Almost half of the respondents regularly provided written documentation of pharmacist interventions in patients' medical records. Approximately one third provided patient education or counseling, and one third provided drug management of medical emergencies. A well-controlled formulary system was in place in 58% of the hospitals; therapeutic interchange was practiced by 49%. A total of 98% of the respondents participated in group purchasing, and 96% used a prime vendor. Half of the departments served as training sites for pharmacy students. Less than half had a staff development program, but about two thirds supported continuing-education activities for pharmacists. The 1990 survey revealed a continuation of the changes in many hospital-based pharmaceutical services documented in earlier surveys and identified static areas that merit the attention of pharmacy leaders.

National survey of hospital pharmaceutical services—1985

The results of a 1985 national mail survey of pharmaceutical services in short-term hospitals are reported and compared with similar surveys conducted in 1975, 1978, and 1982. A sample of 809 hospitals was selected randomly from among the estimated 5480 U.S. short-term hospitals that employ a pharmacist on at least a part-time basis. The survey had an 84.6% response. Fewer than 10% of respondents did not have and were not planning for unit dose systems. The percentage of hospitals with complete or partial pharmacy-based i.v. admixture services increased since 1982 from 67.4% to 80.6%. More than half the respondents said floor-stock i.v. solutions were distributed by a department other than pharmacy. Only about half the respondents had both unit dose drug distribution and i.v. admixture services. Prime vendors were used by 87% of small hospitals, 75% of medium hospitals, and 51% of large hospitals. The percentage of pharmacies involved in patient monitoring increased from 27% in 1982 to 44% in 1985. The survey also collected data on other clinical services, computerization, inventory turnover, use of prime vendors, and selection of therapeutic alternates. Drug distribution services are improving, but the distribution of injectable drugs often is not under pharmacy control. Only 10% of respondents had comprehensive pharmaceutical services, defined as complete unit dose drug distribution and i.v. admixture services plus three or more clinical services.

Hospital pharmacy purchases and inventories

The results of the hospital pharmacy purchases and inventories portion of a 1978 national mail survey of pharmaceutical services in short-term hospitals are reported. A sample of 815 hospitals was selected randomly from among 5,200 U.S. short-term hospitals that employ a pharmacist on at least a part-time basis. The inventory question had a response rate of 67.7%, the purchasing question, 62.2%; inventory turnover was calculated based on a response rate of 60.5% to both questions. Inventories were inordinately large in small hospitals. Inventory turnover rates, which increased with hospital size, were somewhat less than optimal in small and medium hospitals. The Pacific region's inventory/bed and purchases/bed values were substantially greater than those of any other region. Large hospitals had a 20% higher annual purchases/bed figure than the smaller hospitals, perhaps because of their relatively greater volume of outpatient services. Based on their respective demand (as measured by adjusted inpatient days), the drug purchases of the New England and Mid-Atlantic regions were less than expected, while the Mountain and Pacific regions' drug purchases were much greater than expected. Total 1979 purchases of pharmaceuticals and related supplies by pharmacies in all short-term hospitals are estimated to reach $2,215 to $2,772 million.