Janning S W, Stevenson J G, Smolarek R T
Department of Pharmacy, Duke University Medical Center, Durham, NC 27710, USA.
Am J Health Syst Pharm. 1996 Mar 1;53(5):542-7. doi: 10.1093/ajhp/53.5.542.
The implementation and impact of comprehensive pharmaceutical services at a hospital are described. Before 1992, pharmaceutical services at Detroit Receiving Hospital and University Health Center were comparable to those of many departments serving similar academic tertiary care institutions. A major conflict with the principles of pharmaceutical care existed in that specific tasks were assigned to pharmacists, so that up to four pharmacists may have been involved in one patient's drug therapy while other patients were ignored. Several steps were taken to solve this problem. The department's mission and vision statements were modified to embrace pharmaceutical care. The support of administration and department leaders was secured, pharmacist evaluations were adjusted to make pharmaceutical care skills baseline competencies, and staffing was reconfigured. A voluntary pharmaceutical care committee was formed to transform pharmaceutical services at the hospital. It was decided that all staff pharmacists would provide clinical and distributive services on a rotating basis. The drug distribution system was altered to free more pharmacist time for patient care, and two technician positions were added. The clinical program was made more patient focused. The program was implemented in a stepwise manner beginning in September 1992. Computerized systems for tracking workload and documenting clinical interventions and drug cost savings were established. Later changes included making pharmacists responsible for all patients on a medical service rather than for specific problems in a particular location and changing scheduling to enhance the continuity of care. The number of clinical interventions by pharmacists increased from 3,563 in 1993 to 15,476 (projected) in 1995, and drug cost savings and avoidance increased from $239,248 in 1992 to $562,402 (projected) in 1995. Major change was necessary to implement comprehensive pharmaceutical services at an academic tertiary care hospital.
本文描述了一家医院综合药学服务的实施情况及其影响。1992年之前，底特律接收医院和大学健康中心的药学服务与许多为类似学术型三级医疗机构服务的科室相当。当时存在一个与药学服务原则的重大冲突，即特定任务被分配给药师，以至于在同一患者的药物治疗中可能有多达四名药师参与，而其他患者却被忽视。为解决这个问题采取了几个步骤。该部门的使命和愿景声明被修改以纳入药学服务。获得了行政部门和科室领导的支持，调整了药师评估，使药学服务技能成为基本能力要求，并重新配置了人员编制。成立了一个自愿性质的药学服务委员会来转变医院的药学服务。决定所有药剂师将轮流提供临床和配药服务。改变了药品分发系统，以使更多药师有时间进行患者护理，并增设了两个技术员岗位。临床项目更加以患者为中心。该项目于1992年9月开始逐步实施。建立了用于跟踪工作量、记录临床干预措施和节省药物成本的计算机系统。后来的变化包括让药师负责医疗服务中的所有患者，而不是特定地点的特定问题，并改变排班以增强护理的连续性。药师的临床干预次数从1993年的3563次增加到1995年预计的15476次，药物成本节省和避免金额从1992年的239248美元增加到1995年预计的562402美元。在学术型三级医疗机构实施综合药学服务需要进行重大变革。
