Planning an Integrated and Fulfilled Life

Most pharmacy leaders are motivated by altruistic personal and professional goals. Pharmacy leaders want to develop departments that are patient-centered and optimize financial performance, quality, and safety in the medication use process. In addition, many pharmacy leaders want to give back to their communities; this may be in the form of volunteerism, service on leadership boards, or through philanthropy. Because of these many, often competing, personal and professional priorities, life can become chaotic. By taking the time and effort to think about their priorities and to create a comprehensive life plan, pharmacy leaders can integrate all aspects of their lives and achieve their aspirations. An integrated life plan will help the pharmacy leaders to conduct their personal and professional lives with purpose.

Strategic approach for improving the medication-use process in health systems: The high-performance pharmacy practice framework

PURPOSE

A strategic approach to improving the medication-use process in health systems by using a framework for setting priorities on the basis of feasibility, the potential for financial return, and the effect on quality and safety is described.

SUMMARY

A panel consisting of leaders in health-system pharmacy identified seven dimensions of high-performance pharmacy (HPP) framework: medication preparation and delivery, patient care services, medication safety, medication-use policy, financial performance, human resources, and education. Performance elements, which are specific policies, procedures, activities, and practices that indicate high performance and result in a financial or clinical return on investment of resources, within each dimension were identified. References, practice standards, and policies related to each performance element were also identified. By consensus, the panel assigned qualitative metric scores for each of the 69 performance elements that represent the panel's assessment of the resources necessary to achieve full implementation of the element and the potential financial and quality and safety returns if the element has not yet been implemented. It is noted that a pharmacy department's actual outlay of resources and expected financial return will differ depending on the size of the health system, the size of pharmacy staff, and the extent of previous implementation efforts. The framework can also be used to rejustify existing services and programs and identify opportunities for improvement.

CONCLUSION

The HPP framework characterizes pharmacy performance elements on the basis of feasibility, financial return, and effect on quality and safety. The framework provides pharmacists with a means to establish priorities in improving the medication-use system.

Harvey A. K. Whitney lecture. Interdependence in pharmacy: risks, rewards, and responsibilities

The importance of interdependence in the future of the pharmacy profession is discussed. In politics, economics, business, and health care, the pursuit of individual independence is giving way to the realization that interdependence is necessary for future success. Communication technology and the accelerated growth of new knowledge foster interdependence. When one sector of society creates large and interdependent structures, other sectors with which it interacts must do likewise to retain a balance of power or influence. Interdependence--sharing ideas and information--has helped institutional pharmacists to gain influence in health care; with this influence have come responsibilities and risks. Pharmacists' contribution to clinical research is increasingly respected and needed by the pharmaceutical industry. However, compromised ethical standards are at risk when drug companies reward pharmacists for research or presentations involving their products or for influencing prescribing of these products. Industry is also dependent on pharmacists making purchasing decisions. Biotechnology products in particular set the stage for potential conflict of interest. Pharmacy should formulate guidelines defining standards of conduct; ASHP is encouraged to establish a commission on ethics. Guidelines might require (1) that pharmacy and therapeutics committee members fully disclose any relationship with manufacturers of drugs considered for the formulary and (2) that pharmacists' publications in industry-sponsored literature and presentations at industry-supported educational programs be objective and scientifically sound. Successful organizational leadership will require the ability to identify opportunities for interdependence.

Effects of bar coding on a pharmacy stock replenishment system

A bar-code stock ordering system installed in the ambulatory-care pharmacy and sterile products area of a hospital pharmacy was compared with a manual paper system to quantify overall time demands and determine the error rate associated with each system. The bar-code system was implemented in the ambulatory-care pharmacy in November 1987 and in the sterile products area in January 1988. It consists of a Trakker 9440 transaction manager with a digital scanner; labels are printed with a dot matrix printer. Electronic scanning of bar-code labels and entry of the amount required using the key-pad on the transaction manager replaced use of a preprinted form for ordering items. With the bar-code system, ordering information is transferred electronically via cable to the pharmacy inventory computer; with the manual system, this information was input by a stockroom technician. To compare the systems, the work of technicians in the ambulatory-care pharmacy and sterile products area was evaluated before and after implementation of the bar-code system. The time requirements for information gathering and data transfer were recorded by direct observation; the prevalence of errors under each system was determined by comparing unprocessed ordering information with the corresponding computer-generated "pick lists" (itemized lists including the amount of each product ordered). Time consumed in extra trips to the stockroom to replace out-of-stock items was self-reported. Significantly less time was required to order stock and transfer data to the pharmacy inventory computer with the bar-code system than with the manual system.(ABSTRACT TRUNCATED AT 250 WORDS)

Qualifications for future hospital pharmacy directors as perceived by pharmacy directors and hospital administrators in Wisconsin

Hospital pharmacy directors and administrators in Wisconsin were surveyed to determine their perceptions of the responsibilities, skills, postgraduate education, training, and experience necessary for hospital pharmacy directors during the next 10 years. Packages containing two identical questionnaires were mailed in April 1985 to the pharmacy directors at all 159 hospitals in Wisconsin. The pharmacy director and his or her immediate supervisor were asked to use a 5-point Likert-type scale to rate the importance of various responsibilities and skills and also to rank the most important responsibilities, skills, and issues. In addition, respondents answered forced-choice questions about postgraduate education and training and an open-ended question about academic coursework. All responses were compared by respondent characteristics and hospital size. There was a response rate of 48.1% to the questionnaire, representing 60.7% of the pharmacy directors (n = 96) and 34.6% of the administrators (n = 55). Both groups agreed on which responsibilities and issues will be very important (mean importance rating of greater than 4) for future pharmacy directors. However, administrators rated clinical and technical skills as significantly more important than did pharmacy directors. Only 48% of pharmacy directors believed that a residency is essential and preferred either a general or administrative residency coupled with an advanced degree, whereas more than 50% of the responding administrators favored residencies not affiliated with a degree program. The majority of pharmacy directors and administrators believed that both general staff and administrative experience is necessary for future pharmacy directors.(ABSTRACT TRUNCATED AT 250 WORDS)

Current trends in home health care

The historical development and future of home health-care (HHC) services are reviewed from the perspectives of hospitals and hospital pharmacists. Hospitals have had three choices available to them for offering HHC services: refer patients to outside vendor, establish joint ventures, or establish independent programs. The market strategies of HHC vendors are reviewed, and the factors that portend continued rapid growth for HHC are discussed. An active role by hospital pharmacy directors in planning hospital HHC services is advocated. HHC offers an opportunity for hospital pharmacists to contribute to the financial well-being of the institution and to better patient care.

Health-care trends influencing the financial management of hospital pharmacies

Current trends affecting health care and the response of the health-care industry to these trends are described, and recommended actions for hospital pharmacy departments are presented. The effects of societal changes, technological advances, information collection and exchange, excess physician population, cost constraints, and competition are examined. Appropriate responses include programs to lower costs, improved financial-monitoring systems, creative methods for attracting patients and donations, specialization of care, corporate formation and restructuring, emphasis on ambulatory and preventive programs, partnership with medical staff, deregulation initiatives, and standardization of hospital statistics. More aggressive management, financial expertise, and greater accountability will be expected of hospital pharmacy managers.

Medication data sheets--an aid to patient education

The effect on patient knowledge of self-administration of medications was evaluated for verbal instruction versus verbal instruction reinforced with written Medication Data Sheets.

Significant improvement in self-administration was noted with the use of written reinforcement of the pharmacist's verbal explanations concerning the proper way to correct for a missed dose of the medication (p<0.0005), foods or drinks to avoid while taking the prescribed medication (p<0.05), understanding of the purpose for taking the medication (p<0.005), and whether or not the prescribed medication was refillable (p<0.0005).

In addition it was shown that informing patients in writing of the potential side effects of the medication did not increase the incidence of their occurrence (p = N.S.).