Microcost analysis of the prescription dispensing process in an outpatient hospital pharmacy.

The costs involved in dispensing a prescription in an outpatient pharmacy at a 450-bed teaching hospital were studied. Work sampling was used to determine pharmacist and technician time involved in dispensing a prescription, and other direct and indirect costs involved in dispensing a prescription were isolated. The cost per prescription was calculated as the total of personnel costs for dispensing plus other costs, excluding the cost of the drug. Average of 2.68 and 3.37 minutes of pharmacist and technician time, respectively, were directly involved in dispensing each prescription. The standard auxiliary times per prescription were calculated to be 1.17 minutes and 4.66 minutes for the two groups, respectively. Total pharmacy personnel time consumed in dispensing a prescription was 13.33 minutes. Total calculated personnel cost included in dispensing a prescription was +3.14. Adding to this figure other direct and indirect costs resulted in a total cost of +5.42 for dispensing a prescription. Although the time and cost figures identified are unique to this outpatient pharmacy, other institutions can use these microcosting techniques to provide data that can be useful in the negotiation of contracts for the provision of pharmaceutical services to ambulatory patients.

Interdisciplinary committee on infusion-control devices: containing related-product costs.

A program for decreasing expenditures for i.v. sets and related items at a 530-bed university teaching hospital is described. A multidisciplinary committee originally formed to evaluate infusion-control devices (ICDs) developed a cost-containment strategy for reducing the number of accessories and amount of equipment used in i.v. therapy and for reducing inappropriate use of these items. Major problems identified in an audit were excessive use of secondary sets; inappropriate use of add-on flow-control devices, extension sets, and metered-chamber sets; and use of the wrong type of i.v. set with ICDs. New procedural guidelines, inservice-education programs, evaluation of new and different i.v. products, and increased enforcement of policies and procedures by the pharmacy department were implemented to address these problems. For fiscal year 1986, the bid process for i.v. equipment was divided into 10 sections so that manufacturers who may not have been able to bid on every item could bid only on individual sections if they desired. A follow-up audit six months after implementation of the strategy showed increased compliance with guidelines for use of i.v. sets and devices. Compared with the previous year, data for fiscal year 1986 showed total savings of $142,223 attributable to decreased use of i.v. equipment. The competitive-bid process saved $54,942; the total amount saved was $197,165. The trend of appropriate use as a result of adherence to the guidelines continued through fiscal year 1987. This multidisciplinary cost-containment approach was effective in reducing expenditures for i.v. sets and equipment.

Interdisciplinary committee on infusion-control devices: evaluating new products.

Evaluation and selection of volumetric infusion-control devices (ICDs) by an interdisciplinary committee in a university teaching hospital is described. The committee, which was originally formed to evaluate problems with the existing system of ICD management, determined that the ICDs in use at the hospital were outdated. After gathering information on the types of ICDs available and identifying options for replacing the existing equipment, the committee decided to replace some of the devices with new volumetric ICDs. A six-page evaluation form was mailed to ICD manufacturers, and representatives from 16 manufacturers were invited to demonstrate their devices to the committee members. Five manufacturers were then invited to participate in a two-week, inhouse comparative trial, during which the devices were objectively evaluated by nurses, the bioinstrumentation department, and the ICD committee. The results of that evaluation were used to construct bid specifications. The decision of which ICDs to purchase was based on cost factors and the degree to which the devices met the specifications. The use of a multidisciplinary committee to evaluate and select new ICDs was an effective strategy. The devices that were purchased represented improvements in patient safety and cost-effectiveness.

Decision analysis applied to the purchase of frozen premixed intravenous admixtures.

A structured decision-analysis model was used to evaluate frozen premixed cefazolin admixtures. Decision analysis is a process of stating the desired outcome, establishing and weighting evaluation criteria, identifying options for reaching the outcome, evaluating and numerically ranking each option for each criterion, multiplying the ranking by the weight for each criterion, and calculating total points for each option. It was used to compare objectively frozen premixed cefazolin admixtures with batch reconstitution from vials and reconstitution of lyophilized, ready-to-mix containers. In this institution the model numerically demonstrated a distinct preference for the premixed frozen admixture over these other alternatives. A comparison of these results with the total cost impact of each option resulted in a decision to purchase the frozen premixed solution. The advantages of the frozen premixed solution that contributed most to this decision were decreased waste and personnel time. The latter was especially important since it allowed for the reallocation of personnel resources to other potentially cost-reducing clinical functions. Decision analysis proved to be an effective tool for formalizing the process of selecting among various alternatives to reach a desired outcome in this hospital pharmacy.

Pharmacy unit devises quality assurance plan.

As the basis for a total quality assurance program, a hospital's pharmacy department developed minimum standards of practice and a compliance audit procedure.