Decentralization of pharmaceutical services without satellite pharmacies.

The decentralization of pharmaceutical services without the addition of pharmacy satellites is described. Mobile, master medication carts are used by pharmacy personnel in the patient-care areas to fill the unit dose carts used by nurses. A combination medication administration record and patient profile eliminates duplication of effort by pharmacy and nursing. Responsibilities of pharmacists and technicians, the process of hospital-wide implementation of the system, current levels of service, and a clerkship designed to improve staff pharmacists' clinical abilities are described. The ratio of the number of drug doses administered to the number of drug doses handled per patient-day increased after the implementation of the new system. This indicated that individual doses were handled fewer times by pharmacy personnel. This method of decentralization permitted integration of distributive and clinical pharmaceutical services with a minimal personnel cost increase, no additional space requirements nor expenditures for renovation, and only a small cost for master medication carts. Because the pharmacists work in the patient-care areas, they are in more frequent contact with nurses, physicians and patients.