Improving a pharmaceutical purchasing and inventory control system

A method by which a pharmacy department improved its purchasing and inventory control system is described. System changes to the computerized inventory control system included implementation of a formulary, affiliation with a group purchasing association, and transfer of specified purchasing and inventory control functions to the technical staff of the purchasing department. Pharmacy maintained the decision-making authority over all vendors and dosage forms of drug products. Optimal results were achieved when the purchasing department's pharmacy buyer position was staffed with an employee who had previous experience as a clerical worker in the pharmacy. The authors state that this system has proved to be an effective, cost efficient method of purchasing and inventory control of pharmaceuticals in their hospital.

Clinical pharmacy services in a pediatric ambulatory care clinic

The implementation of pharmacy services in an ambulatory pediatric clinic has met with initial success in acceptance by the medical and nursing staffs, the administrator, and the patient population. Errors in medication dispensing and prescription labeling have decreased, and patient understanding of prescribed therapy has improved. The number of ER visits by clinic patients has been reduced since the implementation of our service. The importance of patients' understanding directions for use and of dispensing medications in childproof containers for the pediatric population cannot be overstressed. A future goal of our service is to expand the pharmacist's clinical role to allow further participation in pharmacokinetics, specialty clinics, teaching, and patient education. Further documentation of the value of such services is essential to the expansion of the pharmacist's role in patient care.

Influencing drug use through prescribing restrictions

The effect of several drug restriction policies on benzodiazepine and cephalosporin use was evaluated in a large federal hospital. Computerized drug-use data were examined for the 10-year period from 1972 through 1981. The five major types of drug restrictions implemented were the: (1) requirement that all diazepam prescriptions be countersigned by the chief of staff, (2) deletion of cephalothin sodium from the formulary, (3) required countersignature by a physician from the infectious disease service for all cefazolin sodium prescriptions, (4) requirement that justification accompany all cefazolin sodium prescriptions after the countersignature requirement was lifted, and (5) amendment of the countersignature requirement for diazepam with a series of designated exceptions. All of the restrictions resulted in a decrease in the number of dosage units dispensed; however, the required countersignature by the chief of staff and deletion from the formulary were the most effective in restricting drug use. The effect of the restriction policies appears to be related to the influence or power of the restriction enforcer and the perceived importance of the restriction, as well as the relative difficulty of drug acquisition by the prescriber. Formulary deletion, countersignature requirements, or restricted use to a service or physician are action plans that may alter the use rates of drugs.

Developing a formulary for enteral nutrition products

A formulary for enteral nutrition products was developed at a university hospital. Advice was solicited from clinical dietetics and the medical staff. Reported important product variables were osmolality, caloric density, protein content and source, fat content and source, freedom from lactose, and, for oral supplements, available flavors. Data were also obtained from manufacturers regarding the composition of their products. Products were categorized as follows: liquid supplemental feedings, high calorie supplemental feedings, isotonic tube feedings, high caloric/high nitrogen tube feedings, high nitrogen tube feedings, and blenderized tube feedings. Bids were solicited in April 1981 (and annually thereafter) from manufacturers of the classified enteral nutrition products, and a contract was signed with the manufacturer in each category submitting the lowest bid. In contrast with previous experience, there was no loss from outdated products during the first year of the formulary. Categorizing enteral nutrition products into therapeutic categories appears to be a workable method to limit the number of products used in a hospital, thereby potentially decreasing inventory, waste, and hospital costs. The descriptive category titles also may encourage rational use of these products without promoting allegiance to a particular company or product.

Preparing to implement

The steps involved in preparing to implement a pharmacy computer system are described. Although the order in which the various steps have to be completed varies according to the hospital specifics, important elements of the preparation process include preparation of the site, organization of personnel, development of policies and procedures, developing and ordering forms, preparation of the implementation schedule, file development, and preparation of other departments. A well-designed plan and a realistic time schedule for the preparation process facilitates the actual implementation of a pharmacy computer system.

Evaluation of a limited drug formulary in an adult internal medicine clinic

The utility of a 30-drug, limited formulary in an adult internal medicine, ambulatory-care clinic was investigated. The formulary was developed using a mail survey of a random sample of members of the ASHP Ambulatory Care Pharmacy Practice Special Interest Group. The consensus formulary comprised the 30 most frequently recommended drugs; the utility of the formulary was then tested by chart review in a primary-care internal medicine clinic. Over a two-month period, the charts of alternating patients were reviewed daily; patient data collected included demographic information and prescribed drug therapy. A panel of two physicians and one pharmacist reviewed each patient's data and determined the appropriateness of drug treatment. If an agent was prescribed that was not on the consensus formulary, the panel determined whether an appropriate formulary agent could have been prescribed. Of the prescribed drug orders, 57.8% were for agents in the consensus formulary; by including patients who could have received formulary drugs appropriately, 73.7% of all prescription orders were or could have been for formulary drugs. Age, race, and sex of patients had no significant effect on utility of formulary agents. Had the 30 drugs most commonly prescribed in this clinic been in the formulary, 82.6% of all prescription orders would have been covered. This approach to establishing a new formulary and selecting drugs for inclusion is potentially useful.

Fatal falciparum malaria and the availability of parenteral antimalarial drugs in hospitals

Images

Strategies for deleting popular drugs from a hospital formulary

The approach used by a hospital pharmacy in planning, implementing, and evaluating a major formulary revision and the strategies used in deleting popular analgesics from the formulary are described. All phenacetin-containing products were deleted from the formulary of The Ohio State University Hospitals. The following steps of the process are described; identification of the problem, literature evaluation, soliciting medical staff support, presentation to the pharmacy and therapeutics committee, designing an implementation timetable, education, monitoring analgesic use, coordination of departmental activities, implementation and follow-up. The strategy used in this case resulted in the policy being implemented successfully.