Staffing, Workload, and Productivity Benchmark Statistics in Psychiatric Hospital Pharmacies

Purpose: To establish benchmarks for assessing workload, staffing, and productivity in state psychiatric hospital pharmacy departments, and to compare productivity by bed size. Methods: An electronic survey of state psychiatric hospitals was conducted. Hospitals were categorized based on number of occupied beds. Descriptive statistics using Student’s t-tests, Pearson Chi-Square, and Pearson Correlations were used to characterize the data and compare productivity by bed size. Results: Responses were received from 41 hospitals (35.7%) and benchmarks were established. Respondent hospitals did not differ from non-respondents based on demographic data from the American Hospital Association (AHA) DataViewer. There was a positive correlation between daily census, patient days, expenditures, paid hours and productive hours per week, workload metrics, total pharmacy staff, and occupied bed size (r=0.381-0.991, p\u3c0.05). Over 30% of hospitals reported using no indicators to monitor pharmacy productivity. Productivity ratios differed between Very Small/Small and Medium/Large hospital groups: mean pharmaceutical expenditures per 100 occupied beds and per 1000 patient days (p=0.017 and 0.05 respectively), mean FTEs per 1000 doses dispensed/administered per month and per 100 occupied beds (p=0.042 and 0.026), and mean pharmacist and technician FTEs per 100 occupied beds (p=0.012 and 0.019 respectively). Conclusion: Results of the survey suggest staffing, workload, and productivity metrics to be dependent on bed size, with larger hospitals operating more efficiently than hospitals of lower bed size. Over 30% of hospitals reported using no indicators to monitor pharmacy productivity

The Impact of Computerized Provider Order Entry (CPOE) on Medication Order Processing and Workflow Efficiency by Pharmacists: A Time and Motion Study

Introduction: Recently, there has been a tremendous increase in the preparation on the part of US hospitals to implement CPOE. Employer groups, the federal government, and others have been advocating its implementation since the early 2000s, yet the number of hospitals which have met meaningful use criteria for CPOE is still less than 15%. This number is projected to increase exponentially in a very short time, spurred by incentives from the Centers for Medicare and Medicaid (CMS). With such a large amount of hospitals preparing for CPOE implementation, there is still much to learn about the impact of these systems. The objective of this study is to quantify the change in pharmacist workflow after CPOE is implemented. Methods: An experimental, enhanced pretest-posttest, prospective, time and motion study was conducted in four inpatient pharmacies within the same hospital system. Order entry pharmacists were observed for two separate time periods. The intervention pharmacy was observed first as a non-CPOE pharmacy and then later, after CPOE had been implemented. There was a control pharmacy which was non-CPOE for both time periods. There were two treatment control pharmacies, both of which had CPOE for both time periods. A database instrument recorded 37 different pharmacist tasks, which were grouped into four activities: clinical, distributive, administrative, and miscellaneous. Comparisons of the amount of time spent by the order entry pharmacist in each of the four different activities were conducted. SAS® version 9.3 was used to analyze the data, with statistical significance set at 0.05. Results: A total of 114 hours at the non-CPOE site and 197 hours at the CPOE site met the inclusion criteria. Non-parametric linear regressions were modeled and the predicted values were analyzed. The predicted mean number of minutes for each recorded hour were, by activity (predicted mean ± SD for non-CPOE versus CPOE, p-value): clinical (5.10 ± 2.24 versus 3.83 ± 1.34, p<0.05); distributive (44.55 ± 1.07 versus 47.61 ± 1.43, p<0.05); administrative (7.25 ± 2.34 versus 6.67 ± 1.28, p<0.05); and miscellaneous (3.11 ± 0.77 versus 1.89 ± 0.68, p<0.05). Conclusions: Less time was spent in the clinical, administrative, and miscellaneous activities, while more time was spent in the distributive activity after CPOE implementation. These findings were statistically significant.Pharmacological and Pharmaceutical Sciences, Department o

Recreating the wheel: redeploying pharmacy services to improve efficiency and patient safety

The Institute of Medicine’s (IOM) publication To Err is Human identified medical and medication errors as a significant threat to public welfare and public health. In response to the publication the Institute for Healthcare Improvement (IHI) has created the “5,000,000 lives” campaign to reduce adverse outcomes due to error. Simultaneously, the IHI has promoted it’s Triple Aim Campaign which compels health care organizations to increase the health of populations while also minimizing patient costs and enhancing the patient experience. The UPMC Presbyterian Pharmacy department is redeploying its pharmacy resources in an attempt to better contribute to the principles of the Triple Aim Campaign and improve patient safety by enhancing its technical efficiency, improving operational services, and optimizing its automation to improve medication safety. The pharmacy department created service line groups that treat specific patient populations such as cardiology and neurology. These groups consist of a central pharmacist, unit-based pharmacist, and service line technician. This intervention was created to address the problem of medication delays and the lack of standardization and accountability for the provision of operational and clinical pharmacy services. Objective measures of performance include reported medication delays, missing medications, number of discharge prescriptions, and percent of total medications discharges from the automated dispensing cabinets and from the RobotRx machine. Comparison of pre-model to post-model pharmacy services showed that medication delays and missing medications decreased by 49% and 85%, respectively. The pharmacy department service line model has taken measures to improve patient health by minimizing medication delays and missing medications within UPMC Presbyterian hospital. This was accomplished by stream-lining services and improving the department’s technical efficiency and patient safety surrogates measures

Perception and satisfaction of stakeholders regarding the patient care area pharmacist initiative in a military hospital in Saudi Arabia

Purpose: To explore the perceptions and satisfaction of stakeholders (physicians, nurses, and pharmacists) regarding services provided by the patient care area pharmacist (PCAP) initiative. Methods: This was a cross-sectional study conducted at Prince Sultan Military Medical City (PSMMC). The questionnaire was hand-delivered to a random sample of stakeholder groups (including physicians, nurses, and pharmacists) in three different areas of the hospital: the neonatal intensive care unit (NICU), high dependency unit (HDU), and pediatric nephrology. The questionnaire consisted of three sections. The first section collected demographic information of the participants, and the other sections collected anonymous opinions regarding services provided by the PCAP. Results: Ninety-nine participants, comprising physicians (n = 27; 27.27 %), nurses (n = 55; 55.55%), inpatient pharmacists (n = 13; 13.13%), and PCAPs (n = 4; 4.04%), participated in the survey. A majority of the respondents (92.3 %) were satisfied with the PCAP services, and all respondents recommended expansion of the PCAP service to cover all wards. Conclusion: The findings show that all participants have a positive perception of the PCAP service; PCAPs were seen by the participants as drug experts, and their recommendations were perceived as clinically relevant. All stakeholders sought to continue working with the PCAP. Keywords: Patient care, PCAP, Attitude, Satisfaction, Pharmac

Meaning of Justice for Mississippians with Regard to Health Care Pricing

Throughout most of human history, justice has been perceived as an extremely important virtue. The primary objective of this study is to investigate the meaning of justice with a focus on a particular subject—pricing, specifically as it pertains to healthcare. In addition to the primary goal, there are also some secondary objectives: uncovering the procedure of healthcare pricing, revealing the role of government in achieving justice of healthcare pricing, and identifying the influential factors that affect the formation of people’s understanding of justice regarding healthcare pricing. The findings indicate that the equity perspective and the perspective of the need principle have substantial influence on the formation of people’s understanding of justice with regard to healthcare pricing. From the equity perspective, people believe that a just healthcare pricing should be reasonably based on cost. From the need principle perspective, people believe that just healthcare pricing should guarantee the affordability of healthcare, especially basic care. In regard to the role of government, a majority of participants believe that the government-market mixed mechanism is the most just pricing mechanism and government should play the role of a regulator. Government interventions should strive toward assisting the spontaneous forces of the market competition. Finally, findings in this study state that the participants’ general belief of distributive justice exerts a significant effect upon their understanding of justice regarding healthcare pricing. However, there is no one-to-one correspondence between these two. These findings prove that people have the tendency to treat healthcare as a special good and view justice of healthcare pricing as a particular subject to which the general belief of distributive justice may not be applicable. By focusing on justice of healthcare pricing, this study bridges the research gap and contributes to the literature on ethical study of pricing. The identifications of the popularly shared understanding of justice regarding healthcare pricing and the proper role of government provide important reference information to governments and policy makers, enlightening people with new solutions to some pressing healthcare issues

Solving Problems of Interruptions and Multitasking in the Pharmacy of a Large Hospital Centre

This paper presents an approach to solving problems of interruptions and multitasking in inpatient pharmacy processes of a large hospital centre, which is based on statistical modelling and simulations. The approach is applied to the process of receiving deliveries (from suppliers) to determine the feasibility of improvements in the organization of work. In the initial phase of research, data on the deliveries from suppliers were collected during the time study and a typical daily load on the pharmacy staff and infrastructure in the current state was simulated. Subsequently, a new organizational model, which included two defined blocks of time for delivery, was suggested and three simulation scenarios were created to examine the effects of new organization of work on daily activities. Finally, a comparison of system constraints and results obtained by the simulation models confirmed the feasibility of the proposed improvements. By implementing the new organization of work, it will be possible to avoid overlapping in pharmacy processes, which will reduce interruptions to work and the need for multitasking and will finally result in fewer errors in work

Hospital Pharmacy Management: Australian and Indonesian Perspectives

The role of pharmacists in the healthcare sector is vital. In Indonesia, medicines accounted for 12 – 38% of hospitals’ expenses, and hospital pharmacy is the main department in the hospital charged with the responsibility to manage the safe, appropriate and judicious use of medicines. Many studies have investigated clinical and financial benefits of pharmacists and pharmaceutical services in hospitals. To assist authorised bodies in each country to establish relevant document and regulations, World Health Organization (WHO) and International Pharmaceutical Federation (FIP) have stipulated Good Pharmacy Practice (GPP) guidelines. Hospital pharmacy practice standards have also been ratified in many countries, and a global consensus was developed and called “The Basel Statements on the future of hospital pharmacists”. It reflects the importance of service provision by hospital pharmacy. However, much variation of hospital type, ownership (private or public), and stage of regional development is common in Indonesia. With constant changes in healthcare industry, such as change of health systems, patients’ demography, or advancement of medical technology and science, many hospital pharmacies face challenges to meet the practice standards. For example, with the implementation of National Health Insurance scheme in Indonesia in early 2014, the medicines funding scheme was changed. Healthcare funding which was previously dominated by private health funds has been reformed into public funding using case mix. In the old scheme, medicines costs were paid out-of-pocket by patients, or fully reimbursed by private or public health insurance bodies. In the new scheme, medication costs are paid as a package with other health costs. Hence, hospital pharmacy plays a vital role in managing medicines to improve efficiency and service quality as well as managing financial sustainability. Management is an essential factor to ‘scale up’ service delivery to strengthening health systems and improving population health in low-middle income countries. Managers in the hospital sector are key health service managers especially in low income countries. Although the importance of management in hospital pharmacy is clear, it is common for many hospital pharmacists to overlook rather than value management practice. While there has been some research reported from developed countries, there is relatively little current research from developing countries. Research exploring hospital pharmacists’ experiences in hospital pharmacy management is critical to gain more understanding about current issues, and potential future application of management in hospital pharmacy. Therefore, the aims of the research described in this thesis were to explore Australian and Indonesian hospital pharmacists’ perceptions of their roles in hospital pharmacy management, challenges and enablers in managing hospital pharmacy, and vision for the future. This research has adopted a qualitative approach using semi-structured interviews in two stages. Stage 1 explores the Australian hospital pharmacists’ and Stage 2 investigates Indonesian hospital pharmacists’ perceptions and experiences in hospital pharmacy management. The main focus of this research is on Stage 2, thus the results are presented in three chapters. However, Stage 1 provides an international perspective and commentary for the findings in Stage 2. In Chapter 1, an overview of the literature regarding hospital pharmacy management, details of the Australia’s and Indonesia health systems, and hospital pharmacy activities in each country are summarised and discussed. It also includes a structured literature review to explore international perspectives on management aspects in hospital pharmacy. The results are presented and discussed in this chapter. In Chapter 2, the Stage 1 of this research is presented comprising a qualitative study exploring the perceived roles, challenges, opportunities, and key factors in managing and optimising resources in Australian hospital pharmacy. The main themes identified from semi-structured interviews are summarised and discussed in this chapter. In Chapter 3, the first part of Stage 2 of this research is documented. A qualitative study was conducted to explore perceived roles, challenges, opportunities, and key factors in managing and optimising resources in Indonesian hospital pharmacy. This chapter focuses on Indonesian hospital pharmacists’ perceptions of roles, barriers and facilitators of roles, and attitudes toward current roles. The main themes identified from semi-structured interviews are summarised and discussed in this chapter. In Chapter 4, the second part of Stage 2 is documented. This chapter focuses on Indonesian hospital pharmacists’ experiences and concerns in the management of hospital pharmacy. The main themes identified from semi-structured interviews are summarised and discussed in this chapter. In Chapter 5, the last part of Stage 2 is documented. This chapter focuses on the views and perceptions of Indonesian hospital pharmacists related to the professions’ future direction and vision for hospital pharmacy practice. The main themes identified from semi- structured interviews are summarised and discussed in this chapter. In Chapter 6, main findings of each project stage from each stage are compared and summarised. Future directions in this area are discussed in this chapter

Progress Notes

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Is interoperability a hindrance to the nationwide health information exchange (NHIE)?

Introduction: HIE is the exchange of clinical data as well as healthcare data among the providers, healthcare institutions, and data repositories. Nationwide Health Information Network (NHIN), was adopted in the year 2004, under the Office of the National Coordinator for Health Information Technology (ONCHIT) with an objective to share the files electronically securely and in a safe manner. Methodology: The literature review included 40 references in which information relevant to the purpose of this study was scrutinized; these references met the inclusion criterion. The methodology for this study was an extensive and thorough literature review. The sources utilized in this study encompassed primary and secondary data. Results: HIE has significantly increased by 41% from 2008 to 2012. Also, the exchange of health information by type of clinical data has risen from 39% to 55% during the same period. NHIN has been widely recognized in the U.S, but the storage of patient data and the data architectures have remained uncertain among two models the patient-centric or centralized model, in which the patient data for a given patient is stored at one central location. Discussion: To evaluate the effectiveness of the NHIN the hospital exchange activity, costs of implementation and the quality of care were analyzed. From the literature review, there has been a significant increase in the costs spending associated with the NHIN implementation. Conclusion: The literature has suggested that NHIN could achieve cost savings, increase quality of care and communication between physician and the patient