ASHP national survey of hospital pharmaceutical services--1987.

The results of a fall 1987 national mail survey of pharmaceutical services in short-term hospitals are reported and compared with similar surveys conducted in 1975, 1978, 1982, and 1985. A sample of 875 hospitals was selected randomly from among the estimated 5600 U.S. short-term hospitals that employ a pharmacist on at least a part-time basis. The survey had a 71.1% response rate (617 usable replies). Nearly three-fourths of the respondents had complete unit dose drug distribution services (UDD), 68% reported complete i.v. admixture services (IVA), and 57% reported both complete UDD and complete IVA. Nearly 5% of respondents offered five specified clinical services (up from 1.8% in 1985); 24% reported having no clinical services (versus 38% in 1985). Nineteen percent said their departments had one or more clinical specialists. Overall, about one-third of pharmacy technicians had completed formal training. The number of respondents with programs to contain drug costs increased about 10% since 1985. Weekly hours of pharmacy operation averaged 102; 36.7% of respondents had pharmacy service around the clock. The percentage of hospitals with computerized drug distribution systems increased from 32% in 1985 to 52% in 1987. Prime vendors were used by 94.6% of respondents, and only 2% reported that they did not use a purchasing group. National expenditures for drugs and fluids for community hospitals were projected at $4.7 billion, personnel costs at $1.8 billion, and other pharmacy expenditures at $0.4 billion. The projected numbers of open positions nationally for pharmacists in community hospitals was 1950. The survey also collected data on the use of personal computers, inventory turnover, quality assurance, continuing-education philosophy, revenue-generating programs, and outpatient services. Drug control in community hospitals is improving, and clinical services are more widespread. Twenty percent of respondents had comprehensive pharmaceutical services, defined as complete UDD and complete IVA plus three or more clinical services.

Use of spreadsheet software for short-range forecasting of pharmacy management data.

The use of a personal-computer spreadsheet program (Lotus 1-2-3) for forecasting pharmacy management data is described. Exponential smoothing is used in the forecasting model; historical data are used to predict subsequent values. Future performance is assumed to be more closely related to recent performance than to older performance data, so the model gives greater weight to more recent data. The smoothing weight controls the magnitude of error correction; a mean squared error table in the spreadsheet is used to determine the weighting. Two versions of the forecasting model are described. Version A, for a service or product for which data are expected to remain fairly stable, is used to predict values for the next time period. Version B, for data in which a substantial upward or downward trend exists, can be used to predict values for several time periods in the future. Version B differs from version A in that the forecast in version B is an estimate of the overall average of the data (weighted toward the most recent data) plus the estimated change per time period (weighted toward the most recent changes). Data from a university hospital for 1986-87 are used to illustrate the spreadsheet's tabular and graphic output; version A is used to predict the number of outpatient prescriptions for the next month, and data for the hospital's semiannual expenditures on i.v. solutions and sets are used to illustrate version B's forecast. Pharmacy managers can use these spreadsheet forecasts to quantify drug-use and personnel information for presentation to hospital administration.

Developing drug-use indicators with a computerized drug database and a personal computer software package.

The use of a multihospital drug- and patient-database system, a personal computer (PC), and a standard PC software package to monitor drug-use indicators is described, and a five-step method for analyzing a set of data is presented. An integrated spread-sheet, database, and graphics program (Lotus 1-2-3), which is compatible with an IBM PC, can manipulate data obtained from a multihospital database system. To demonstrate the utility of this system, a previously published procedure for analyzing drug-use indicators (e.g., length of stay, drug cost per patient, number of drugs received) for patients in two diagnosis-related groups was repeated using the database and PC software. The records of patients in each DRG were randomly selected from the database. The following steps were applied to the data: (1) data (as a whole) were characterized statistically, (2) data were examined to identify subgroups of interest, (3) groups of data were characterized statistically and compared with each other, (4) the effect of changing the characteristics of one or more subgroups was predicted, and (5) the results of the data manipulations were presented in tables and graphs. A multihospital database can serve as a source for obtaining large quantities of hospital-specific data. These data can be manipulated and presented in tabular or graphic form on a personal computer and used by hospitals to monitor various drug-use indicators.

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.

Description of an experimental hospital pharmacy management information system.

The objectives, characteristics, and uses of hospital pharmacy work-measurement systems are discussed, and the development and operation of an experimental hospital pharmacy management information system (HPMIS) is described. Hospital pharmacy work-measurement systems are designed to measure and evaluate the productivity of a hospital pharmacy or group of pharmacies. Previous work-measurement systems used by hospital pharmacies have been too time consuming or imprecise for widespread use. A national hospital pharmacy work-measurement system known as HPMIS was developed to provide comprehensive and widely applicable information on pharmacy expenses, personnel use, and productivity. HPMIS converts data from participating hospitals into 17 indicators that enhance the comparability of the information between the hospitals. The 17 indicators relate to pharmacy production, clinical services, and administrative functions; also included are several gross department indicators that combine elements of all three areas. After analysis and categorization of the data according to characteristics such as bed size, geographical location, and type of drug-distribution system, results are reported to individual hospitals. A national work-measurement system such as HPMIS should enable hospitals to evaluate their pharmacy operations in relation to those of other hospitals and to track their department's relative management performance over time.

National test of an experimental hospital pharmacy management information system.

An experimental hospital pharmacy management information system (HPMIS) was evaluated in a national pilot test. Approximately 250 information and materials packets were distributed to hospitals that had inquired about the project. Monthly data on pharmacy expenses, personnel use, and productivity were collected for a six-month period by participating hospitals. This information was processed quarterly and converted into the HPMIS indicators; results were categorized according to hospital characteristics and locations. A questionnaire soliciting opinions about the system was sent to participants at the end of the data-collection period. One hundred six hospitals agreed to participate; 84 hospitals submitted data for at least one quarterly period. The range of values for most indicators varied 100-fold; this was attributed to misinterpretation of data item definitions. Based on indicator values, drug and personnel expenses and supportive-personnel use were greater in unit dose hospitals than in hospitals without total unit dose drug distribution systems. Both drug and fluid costs and the extent of supportive-personnel use increased with increasing hospital size. Data-collection time was less in hospitals with computerized pharmacy operations. Responses to the questionnaire indicated that the clinical services indicators were favored the least; however, only a few changes in the data-collection format of the system were suggested. HPMIS appears to be a useful work-measurement tool but needs to be simplified if it to serve as the standard for these systems.

Recommendations for handling cytotoxic drugs in hospitals.

Recommended procedures for handling cytotoxic drugs in hospitals are presented. The recommended procedures are designed to reduce the number of opportunities for unnecessary contact with cytotoxic agents (CYTAs) by hospital personnel and to prevent contamination of the hospital environment and staff with cytotoxic agents. The recommendations incorporate elements of previously published and unpublished guidelines; they admittedly are based on informed judgment as well. Three sets of recommended procedures are presented, each offering a varying degree of protection. The number of cytotoxic drug doses prepared and administered is suggested as the determinant of which level of protection is followed. The cytotoxic workload index, defined as the number of CYTAs prepared or administered (or both) divided by the number of available staff hours, is proposed as a quantitative method of deciding which level of protection is required for a particular work station or work shift. The recommended procedures cover the following seven topic areas: general guidelines; apparel, equipment, and facilities; drug preparation; drug administration; housekeeping, waste disposal, and management of spills and contamination; medical surveillance of staff; and legal and personnel considerations. The recommended procedures and associated equipment are considered to be practical and to adequately protect hospital personnel from risks associated with handling cytotoxic agents.

Pharmacy-coordinated investigational drug services.

The concept of a pharmacy-coordinated investigational drug service (IDS) is proposed as an approach to better control of investigational drugs. The IDS should be considered as set of service functions aimed to ensure that investigational drug studies in the hospital are executed in a safe, effective, and efficient manner. These functions are the distribution and control of study drugs, clinical services, research activities, and management of clinical studies. The IDS will vary from hospital to hospital, and should reflect the extent to which the institution is involved with research, available resources, and the needs of the hospital. Successful development and operation of an IDS depend on proper planning and continued effective management. The IDS will require resources of personnel, money, and facilities, space, and equipment. The primary expense of the IDS (probably about 80%) will be personnel. Job descriptions for each staff position should be prepared, and a complete set of standard operating policies and procedures is required. Periodic reports summarizing the activities of the IDS and an ongoing quality assurance program are needed. To create an IDS, the pharmacy must acquire the necessary approvals, authority, and resources. The IDS will benefit patients, nursing staff, clinical investigators, hospital risk management, and sponsors of clinical research. These benefits can be used to gain support for the IDS concept. Once the IDS is established, the best promotion will be a successful track of accomplishing the IDS objectives.

National survey of hospital pharmacy technician use.

Results of a national survey of nonfederal hospitals on the use of pharmacy technicians are presented. A random sample of nonfederal hospitals in the U.S. that employ a pharmacist (either full- or part-time) was selected; the sample size was 808. Survey questionnaires were mailed to directors of pharmacy at those hospitals. The response rate was 83.4%. Survey results are reported as percent of total respondents +/- three sampling errors. Overall, 75.4 +/- 5.8% of hospitals use pharmacy technicians; more larger hospitals use technicians than do smaller ones. The most common reason for not using pharmacy technicians was insufficient workload. For all hospitals, 43.8 +/- 7.2% do not have enough technicians, usually because of insufficient funds. Pharmacy directors preferred that technicians be trained in formal program (51.7 +/- 5.4%), and most preferred training (either formal or on-the-job) be conducted in-house (60.2 +/- 4.5%). Respondents were overall slightly favorable toward both accreditation of technician-training programs and certification of individual technicians, but only a small group had no opinion--large groups of respondents had either positive or negative feelings on the issues. Data collected on approximately 2600 technicians at the respondents' hospitals showed that most technicians were high school graduates who have been working as a technician about two years and were trained informally on-the-job.