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C A Bond - One of the best experts on this subject based on the ideXlab platform.
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2006 national Clinical Pharmacy services survey Clinical Pharmacy services collaborative drug management medication errors and Pharmacy technology
Pharmacotherapy, 2008Co-Authors: C A Bond, Cynthia L RaehlAbstract:Study Objective. To determine the extent of 15 hospital-based Clinical Pharmacy services, 51 different drugs managed under protocol by pharmacists, medication errors, and Pharmacy technology in United States hospitals. Design. A survey was mailed, as well as sent electronically, to pharmacists in 2893 hospitals. Results. A total of 1125 surveys were returned (38.9% response rate). The 1125 hospitals had 14,315,506 patients admitted, which represented 45.7% of the 31,324,496 admissions to all U.S. hospitals in 2006. The proportion of Clinical Pharmacy services provided by Veterans Affairs (VA) hospitals was higher compared with non-VA hospitals. In all hospitals, the Clinical Pharmacy services with the greatest growth from 1989–2006 were pharmacist-provided admission drug histories (300% increase), pharmacist participation on medical rounds (292.3% increase), drug protocol management (208% increase), pharmacist-conducted Clinical research (166.7% increase), pharmacist-provided drug information (150% increase), and pharmacist-provided pharmacokinetic consultation (117.5% increase). A total of 864 hospitals (76.8%) had pharmacists providing drug protocol management (collaborative drug management). Pharmacists managed a mean ± SD of 9.18 ± 10.23 different drugs/hospital (7932 protocols). Drugs commonly managed included aminoglycosides (64.4% of hospitals), vancomycin (63.8%), warfarin (37.8%), low-molecular-weight heparins (32.7%), unfractionated heparin (30.0%), fluoroquinolones (30.0%), antiparkinsonian drugs (22.8%), proton pump inhibitors (22.7%), human immunodeficiency virus drugs (21.9%), and cephalosporins (19.7%). The mean number of medication errors reported/hospital increased by 151.4% between 1995 and 2006. The percentage of patients who experienced a medication error increased from 4.7% to 6.5% between 1995 and 2006 (a 38.3% increase). A total of 220 hospitals (19.6%) had computerized prescriber order entry systems, 263 (23.4%) had bar coding for drug administration, and 439 (39.0%) used robotics for dispensing. Conclusion. This study provides continuing evidence of the growth and value of Clinical Pharmacy services and Clinical pharmacists in our nation's hospitals. These data will guide hospital Pharmacy directors and Clinical coordinators in allocating resources to optimally meet their patients' needs.
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Clinical Pharmacy services Pharmacy staffing and hospital mortality rates
Pharmacotherapy, 2007Co-Authors: C A Bond, Cynthia L RaehlAbstract:Objective: To determine if hospital-based Clinical Pharmacy services and Pharmacy staffing continue to be associated with mortality rates. Methods: A database was constructed from 1998 MedPAR, American Hospital Association's Annual Survey of Hospitals, and National Clinical Pharmacy Services databases, consisting of data from 2,836,991 patients in 885 hospitals. Data from hospitals that had 14 Clinical Pharmacy services were compared with data from hospitals that did not have these services; levels of hospital pharmacist staffing were also compared. A multiple regression analysis, controlling for severity of illness, was used. Results: Seven Clinical Pharmacy services were associated with reduced mortality rates: pharmacist-provided drug use evaluation (4491 reduced deaths, p=0.016), pharmacist-provided in-service education (10,660 reduced deaths, p=0.037), pharmacist-provided adverse drug reaction management (14,518 reduced deaths, p=0.012), pharmacist-provided drug protocol management (18,401 reduced deaths, p=0.017), pharmacist participation on the cardiopulmonary resuscitation team (12,880 reduced deaths, p=0.009), pharmacist participation on medical rounds (11,093 reduced deaths, p=0.021), and pharmacist-provided admission drug histories (3988 reduced deaths, p=0.001). Two staffing variables, number of Pharmacy administrators/100 occupied beds (p=0.037) and number of Clinical pharmacists/100 occupied beds (p=0.023), were also associated with reduced mortality rates. Conclusion: The number of Clinical Pharmacy services and staffing variables associated with reduced mortality rates increased from two in 1989 to nine in 1998. The impact of Clinical Pharmacy on mortality rates mandates consideration of a core set of Clinical Pharmacy services to be offered in United States hospitals. These results have important implications for health care in general, as well as for our profession and discipline.
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Clinical Pharmacy services Pharmacy staffing and adverse drug reactions in united states hospitals
Pharmacotherapy, 2006Co-Authors: C A Bond, Cynthia L RaehlAbstract:Adverse drug reactions (ADRs) were examined in 1,960,059 hospitalized Medicare patients in 584 United States hospitals in 1998. A database was constructed from the MedPAR database and the National Clinical Pharmacy Services survey. The 584 hospitals were selected because they provided specific information on 14 Clinical Pharmacy services and on Pharmacy staffing; they also had functional ADR reporting systems. The study population consisted of 35,193 Medicare patients who experienced an ADR (rate of 1.8%). Of the 14 Clinical Pharmacy services, 12 were associated with reduced ADR rates. The most significant reductions occurred in hospitals offering pharmacist-provided admission drug histories (odds ratio [OR] 1.864, 95% confidence interval [CI] 1.765-1.968), drug protocol management (OR 1.365, 95% CI 1.335-1.395), and ADR management (OR 1.360, 95% CI 1.328-1.392). Multivariate analysis, performed to further evaluate these findings, showed that nine variables were associated with ADR rate: pharmacist-provided in-service education (slope -0.469, p=0.018), drug information (slope -0.488, p=0.005), ADR management (slope -0.424, p=0.021), drug protocol management (slope -0.732, p=0.002), participation on the total parenteral nutrition team (slope 0.384, p=0.04), participation on the cardiopulmonary resuscitation team (slope -0.506, p=0.008), medical round participation (slope -0.422, p=0.037), admission drug histories (slope -0.712, p=0.008), and increased Clinical pharmacist staffing (slope -4.345, p=0.009). As Clinical pharmacist staffing increased from the 20th to the 100th percentile (from 0.93 ± 0.77/100 to 5.16 ± 4.11/100 occupied beds), ADRs decreased by 47.88%. In hospitals without pharmacist-provided ADR management, the following increases were noted: mean number of ADRs/100 admissions by 34.90% (OR 1.360, 95% CI 1.328-1.392), length of stay 13.64% (Mann-Whitney U test [U]=11047367, p=0.017), death rate 53.64% (OR 1.574, 95% CI 1.423-1.731), total Medicare charges 6.88% (U=111298871, p=0.018), and drug charges 8.16% (U=108979074, p<0.001). Patients in hospitals without pharmacist-provided ADR management had an excess of 4266 ADRs, 443 deaths, 85,554 patient-days, $11,745,342 in total Medicare charges, and $1,857,744 in drug charges. The implications of these findings are significant for our health care system, especially considering that the study population represented 15.55% of 12,261,737 Medicare patients and 5.71% of the 34,345,436 patients admitted to all U.S. hospitals.
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evidence based core Clinical Pharmacy services in united states hospitals in 2020 services and staffing
Pharmacotherapy, 2004Co-Authors: C A Bond, Cynthia L Raehl, Roland A PatryAbstract:Abstract We developed a model for the provision of Clinical Pharmacy services in United States hospitals in 2020. Data were obtained from four National Clinical Pharmacy Services database surveys (1989, 1992, 1995, and 1998) and from the American Health-System Association's 2000 Abridged Guide to the Health Care Field. Staffing data from 1998 indicated that 45,734 pharmacist and 43,836 Pharmacy technician full-time equivalent (FTE) staff were employed in U.S. hospitals; 17,325 pharmacist FTEs (38%) were devoted to providing Clinical Pharmacy services. To provide 14 specific Clinical Pharmacy services for 100% of U.S. inpatients in 2020, 37,814 new FTEs would be needed. For a more realistic manpower projection, using an evidence-based approach, a set of five core Clinical Pharmacy services were selected based on favorable associations with major health care outcomes (mortality rate, drug costs, total cost of care, length of hospital stay, and medication errors). The core set of services were drug information, adverse drug reaction management, drug protocol management, medical rounds, and admission drug histories. Implementing these core Clinical Pharmacy services for 100% of inpatients in 2020 would require 14,508 additional pharmacist FTEs. Based on the current deployment of Clinical pharmacists and the services they perform in U.S. hospitals, change is needed to improve health care outcomes and reduce costs. The average U.S. hospital (based on an average daily census of 108.97 +/- 169.45 patients) would need to add a maximum of 3.32 pharmacist FTEs to provide these core Clinical services (if they were not provided already by the hospital). Using this evidence-based approach, the five selected core Clinical Pharmacy services could be provided with only modest increases in Clinical pharmacist staffing.
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the feasibility of implementing an evidence based core set of Clinical Pharmacy services in 2020 manpower marketplace factors and Pharmacy leadership
Pharmacotherapy, 2004Co-Authors: C A Bond, Cynthia L Raehl, Roland A PatryAbstract:Development of a national plan to implement a core set of Clinical Pharmacy services in United States hospitals by 2020 requires assertive leadership from Pharmacy organizations and state boards of Pharmacy, and a commitment from the profession. Factors that may affect the development are grouped into three areas: manpower, marketplace variables, and Pharmacy leadership. Although the number of Pharmacy school graduates (7000) was about the same in 1990 and 2000, a greater number of Pharmacy schools and high student enrollment, coupled with the Accreditation Council for Pharmacy Education's acceptance of foreign-trained pharmacists, suggest that the number of pharmacists will increase substantially in the near future. We estimate that the net increase in pharmacists (new Pharmacy graduates less pharmacists who retire or die) in the United States will be 139,929 from 2000-2020, for a total of 335,040 pharmacists (71% increase). The number of Pharmacy technicians increased substantially (66%), from 150,000 in 1996 to 250,000 in 2002. The number of residents in programs accredited by the American Society of Health-System Pharmacists increased 148%, from 435 in 1990 to 1080 in 2002. We conservatively project an increase of 33,000 pharmacists who complete residencies from 2000-2020. The Pharmacy marketplace has changed dramatically over the last 12 years, with 10,754 independent community pharmacies closing (2.46 pharmacies/day) and 8459 chain outlets opening (1.93 chains/day). In recent years, mail-order pharmacies have expanded faster than other retail outlets and now process over 18% of U.S. prescriptions. Increased use of robotic systems (some can process 5000 prescriptions/hr) and technicians will diminish the demand for dispensing pharmacists. In addition, up to 10% of U.S. retail prescriptions may be filled outside the country's borders. These data indicate that there will be a sufficient supply of pharmacists and technicians in the future. Thus, it is feasible, based on manpower, marketplace factors, and Pharmacy leadership, to implement a core set of Clinical Pharmacy services for patients in U.S. hospitals by 2020.
Cynthia L Raehl - One of the best experts on this subject based on the ideXlab platform.
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2006 national Clinical Pharmacy services survey Clinical Pharmacy services collaborative drug management medication errors and Pharmacy technology
Pharmacotherapy, 2008Co-Authors: C A Bond, Cynthia L RaehlAbstract:Study Objective. To determine the extent of 15 hospital-based Clinical Pharmacy services, 51 different drugs managed under protocol by pharmacists, medication errors, and Pharmacy technology in United States hospitals. Design. A survey was mailed, as well as sent electronically, to pharmacists in 2893 hospitals. Results. A total of 1125 surveys were returned (38.9% response rate). The 1125 hospitals had 14,315,506 patients admitted, which represented 45.7% of the 31,324,496 admissions to all U.S. hospitals in 2006. The proportion of Clinical Pharmacy services provided by Veterans Affairs (VA) hospitals was higher compared with non-VA hospitals. In all hospitals, the Clinical Pharmacy services with the greatest growth from 1989–2006 were pharmacist-provided admission drug histories (300% increase), pharmacist participation on medical rounds (292.3% increase), drug protocol management (208% increase), pharmacist-conducted Clinical research (166.7% increase), pharmacist-provided drug information (150% increase), and pharmacist-provided pharmacokinetic consultation (117.5% increase). A total of 864 hospitals (76.8%) had pharmacists providing drug protocol management (collaborative drug management). Pharmacists managed a mean ± SD of 9.18 ± 10.23 different drugs/hospital (7932 protocols). Drugs commonly managed included aminoglycosides (64.4% of hospitals), vancomycin (63.8%), warfarin (37.8%), low-molecular-weight heparins (32.7%), unfractionated heparin (30.0%), fluoroquinolones (30.0%), antiparkinsonian drugs (22.8%), proton pump inhibitors (22.7%), human immunodeficiency virus drugs (21.9%), and cephalosporins (19.7%). The mean number of medication errors reported/hospital increased by 151.4% between 1995 and 2006. The percentage of patients who experienced a medication error increased from 4.7% to 6.5% between 1995 and 2006 (a 38.3% increase). A total of 220 hospitals (19.6%) had computerized prescriber order entry systems, 263 (23.4%) had bar coding for drug administration, and 439 (39.0%) used robotics for dispensing. Conclusion. This study provides continuing evidence of the growth and value of Clinical Pharmacy services and Clinical pharmacists in our nation's hospitals. These data will guide hospital Pharmacy directors and Clinical coordinators in allocating resources to optimally meet their patients' needs.
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Clinical Pharmacy services Pharmacy staffing and hospital mortality rates
Pharmacotherapy, 2007Co-Authors: C A Bond, Cynthia L RaehlAbstract:Objective: To determine if hospital-based Clinical Pharmacy services and Pharmacy staffing continue to be associated with mortality rates. Methods: A database was constructed from 1998 MedPAR, American Hospital Association's Annual Survey of Hospitals, and National Clinical Pharmacy Services databases, consisting of data from 2,836,991 patients in 885 hospitals. Data from hospitals that had 14 Clinical Pharmacy services were compared with data from hospitals that did not have these services; levels of hospital pharmacist staffing were also compared. A multiple regression analysis, controlling for severity of illness, was used. Results: Seven Clinical Pharmacy services were associated with reduced mortality rates: pharmacist-provided drug use evaluation (4491 reduced deaths, p=0.016), pharmacist-provided in-service education (10,660 reduced deaths, p=0.037), pharmacist-provided adverse drug reaction management (14,518 reduced deaths, p=0.012), pharmacist-provided drug protocol management (18,401 reduced deaths, p=0.017), pharmacist participation on the cardiopulmonary resuscitation team (12,880 reduced deaths, p=0.009), pharmacist participation on medical rounds (11,093 reduced deaths, p=0.021), and pharmacist-provided admission drug histories (3988 reduced deaths, p=0.001). Two staffing variables, number of Pharmacy administrators/100 occupied beds (p=0.037) and number of Clinical pharmacists/100 occupied beds (p=0.023), were also associated with reduced mortality rates. Conclusion: The number of Clinical Pharmacy services and staffing variables associated with reduced mortality rates increased from two in 1989 to nine in 1998. The impact of Clinical Pharmacy on mortality rates mandates consideration of a core set of Clinical Pharmacy services to be offered in United States hospitals. These results have important implications for health care in general, as well as for our profession and discipline.
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Clinical Pharmacy services Pharmacy staffing and adverse drug reactions in united states hospitals
Pharmacotherapy, 2006Co-Authors: C A Bond, Cynthia L RaehlAbstract:Adverse drug reactions (ADRs) were examined in 1,960,059 hospitalized Medicare patients in 584 United States hospitals in 1998. A database was constructed from the MedPAR database and the National Clinical Pharmacy Services survey. The 584 hospitals were selected because they provided specific information on 14 Clinical Pharmacy services and on Pharmacy staffing; they also had functional ADR reporting systems. The study population consisted of 35,193 Medicare patients who experienced an ADR (rate of 1.8%). Of the 14 Clinical Pharmacy services, 12 were associated with reduced ADR rates. The most significant reductions occurred in hospitals offering pharmacist-provided admission drug histories (odds ratio [OR] 1.864, 95% confidence interval [CI] 1.765-1.968), drug protocol management (OR 1.365, 95% CI 1.335-1.395), and ADR management (OR 1.360, 95% CI 1.328-1.392). Multivariate analysis, performed to further evaluate these findings, showed that nine variables were associated with ADR rate: pharmacist-provided in-service education (slope -0.469, p=0.018), drug information (slope -0.488, p=0.005), ADR management (slope -0.424, p=0.021), drug protocol management (slope -0.732, p=0.002), participation on the total parenteral nutrition team (slope 0.384, p=0.04), participation on the cardiopulmonary resuscitation team (slope -0.506, p=0.008), medical round participation (slope -0.422, p=0.037), admission drug histories (slope -0.712, p=0.008), and increased Clinical pharmacist staffing (slope -4.345, p=0.009). As Clinical pharmacist staffing increased from the 20th to the 100th percentile (from 0.93 ± 0.77/100 to 5.16 ± 4.11/100 occupied beds), ADRs decreased by 47.88%. In hospitals without pharmacist-provided ADR management, the following increases were noted: mean number of ADRs/100 admissions by 34.90% (OR 1.360, 95% CI 1.328-1.392), length of stay 13.64% (Mann-Whitney U test [U]=11047367, p=0.017), death rate 53.64% (OR 1.574, 95% CI 1.423-1.731), total Medicare charges 6.88% (U=111298871, p=0.018), and drug charges 8.16% (U=108979074, p<0.001). Patients in hospitals without pharmacist-provided ADR management had an excess of 4266 ADRs, 443 deaths, 85,554 patient-days, $11,745,342 in total Medicare charges, and $1,857,744 in drug charges. The implications of these findings are significant for our health care system, especially considering that the study population represented 15.55% of 12,261,737 Medicare patients and 5.71% of the 34,345,436 patients admitted to all U.S. hospitals.
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evidence based core Clinical Pharmacy services in united states hospitals in 2020 services and staffing
Pharmacotherapy, 2004Co-Authors: C A Bond, Cynthia L Raehl, Roland A PatryAbstract:Abstract We developed a model for the provision of Clinical Pharmacy services in United States hospitals in 2020. Data were obtained from four National Clinical Pharmacy Services database surveys (1989, 1992, 1995, and 1998) and from the American Health-System Association's 2000 Abridged Guide to the Health Care Field. Staffing data from 1998 indicated that 45,734 pharmacist and 43,836 Pharmacy technician full-time equivalent (FTE) staff were employed in U.S. hospitals; 17,325 pharmacist FTEs (38%) were devoted to providing Clinical Pharmacy services. To provide 14 specific Clinical Pharmacy services for 100% of U.S. inpatients in 2020, 37,814 new FTEs would be needed. For a more realistic manpower projection, using an evidence-based approach, a set of five core Clinical Pharmacy services were selected based on favorable associations with major health care outcomes (mortality rate, drug costs, total cost of care, length of hospital stay, and medication errors). The core set of services were drug information, adverse drug reaction management, drug protocol management, medical rounds, and admission drug histories. Implementing these core Clinical Pharmacy services for 100% of inpatients in 2020 would require 14,508 additional pharmacist FTEs. Based on the current deployment of Clinical pharmacists and the services they perform in U.S. hospitals, change is needed to improve health care outcomes and reduce costs. The average U.S. hospital (based on an average daily census of 108.97 +/- 169.45 patients) would need to add a maximum of 3.32 pharmacist FTEs to provide these core Clinical services (if they were not provided already by the hospital). Using this evidence-based approach, the five selected core Clinical Pharmacy services could be provided with only modest increases in Clinical pharmacist staffing.
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the feasibility of implementing an evidence based core set of Clinical Pharmacy services in 2020 manpower marketplace factors and Pharmacy leadership
Pharmacotherapy, 2004Co-Authors: C A Bond, Cynthia L Raehl, Roland A PatryAbstract:Development of a national plan to implement a core set of Clinical Pharmacy services in United States hospitals by 2020 requires assertive leadership from Pharmacy organizations and state boards of Pharmacy, and a commitment from the profession. Factors that may affect the development are grouped into three areas: manpower, marketplace variables, and Pharmacy leadership. Although the number of Pharmacy school graduates (7000) was about the same in 1990 and 2000, a greater number of Pharmacy schools and high student enrollment, coupled with the Accreditation Council for Pharmacy Education's acceptance of foreign-trained pharmacists, suggest that the number of pharmacists will increase substantially in the near future. We estimate that the net increase in pharmacists (new Pharmacy graduates less pharmacists who retire or die) in the United States will be 139,929 from 2000-2020, for a total of 335,040 pharmacists (71% increase). The number of Pharmacy technicians increased substantially (66%), from 150,000 in 1996 to 250,000 in 2002. The number of residents in programs accredited by the American Society of Health-System Pharmacists increased 148%, from 435 in 1990 to 1080 in 2002. We conservatively project an increase of 33,000 pharmacists who complete residencies from 2000-2020. The Pharmacy marketplace has changed dramatically over the last 12 years, with 10,754 independent community pharmacies closing (2.46 pharmacies/day) and 8459 chain outlets opening (1.93 chains/day). In recent years, mail-order pharmacies have expanded faster than other retail outlets and now process over 18% of U.S. prescriptions. Increased use of robotic systems (some can process 5000 prescriptions/hr) and technicians will diminish the demand for dispensing pharmacists. In addition, up to 10% of U.S. retail prescriptions may be filled outside the country's borders. These data indicate that there will be a sufficient supply of pharmacists and technicians in the future. Thus, it is feasible, based on manpower, marketplace factors, and Pharmacy leadership, to implement a core set of Clinical Pharmacy services for patients in U.S. hospitals by 2020.
Todd Franke - One of the best experts on this subject based on the ideXlab platform.
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Clinical Pharmacy services hospital Pharmacy staffing and medication errors in united states hospitals
Pharmacotherapy, 2002Co-Authors: C A Bond, Cynthia L Raehl, Todd FrankeAbstract:The direct relationships and associations among Clinical Pharmacy services, pharmacist staffing, and medication errors in United States hospitals were evaluated. A database was constructed from the 1992 National Clinical Pharmacy Services database. Both simple and multiple regression analyses were employed to determine relationships and associations. A total of 429,827 medication errors were evaluated from 1081 hospitals (study population). Medication errors occurred in 5.22% of patients admitted to these hospitals each year. Hospitals experienced a medication error every 22.04 hours (every 19.13 admissions). These findings suggest that at minimum, 90,895 patients annually were harmed by medication errors in our nation's general medical-surgical hospitals. Factors associated with increased medication errors/occupied bed/year were drug-use evaluation (slope = 0.0023476, p=0.006), increased staffing of hospital Pharmacy administrators/occupied bed (slope = 29.1972932, p<0.001), and increased staffing of dispensing pharmacists/occupied bed (slope = 19.3784148, p<0.001). Factors associated with decreased medication errors/occupied bed/year were presence of a drug information service (slope = −0.1279301, p<0.001), pharmacist-provided adverse drug reaction management (slope = −0.3409332, p<0.001), pharmacist-provided drug protocol management (slope = −0.3981472, p=0.013), pharmacist participation on medical rounds (slope = −0.6974303, p<0.001), pharmacist-provided admission histories (slope = −1.6021493, p<0.001), and increased staffing of Clinical pharmacists/occupied bed (slope = −9.5483813, p<0.001). As staffing increased for Clinical pharmacists/occupied bed from the 10th percentile to the 90th percentile, medication errors decreased from 700.98 ± 601.42 to 245.09 ± 197.38/hospital/year, a decrease of 286%. Specific increases or decreases in yearly medication errors associated with these Clinical Pharmacy services in the 1081 study hospitals were drug-use evaluation (21,372 more medication errors), drug information services (26,738 fewer medication errors), adverse drug reaction management (44,803 fewer medication errors), drug protocol management (90,019 fewer medication errors), medical round participation (42,859 fewer medication errors), and medication admission histories (17,638 fewer medication errors). Overall, Clinical Pharmacy services and hospital Pharmacy staffing variables were associated with medication error rates. The results of this study should help hospitals reduce the number of medication errors that occur each year.
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Clinical Pharmacy services Pharmacy staffing and the total cost of care in united states hospitals
Pharmacotherapy, 2000Co-Authors: C A Bond, Cynthia L Raehl, Todd FrankeAbstract:This study evaluated direct relationships and associations among Clinical Pharmacy services, pharmacist staffing, and total cost of care in United States hospitals. A database was constructed from the 1992 American Hospital Association's Abridged Guide to the Health Care Field and the 1992 National Clinical Pharmacy Services Database. A multiple regression analysis, controlling for severity of illness, was employed to determine the relationships and associations. The study population consisted of 1016 hospitals. Six Clinical Pharmacy services were associated with lower total cost of care: drug use evaluation (p=0.001), drug information (p=0.003), adverse drug reaction monitoring (p=0.008), drug protocol management (p=0.001), medical rounds participation (p=0.0001), and admission drug histories (p=0.017). Two services were associated with higher total cost of care: total parenteral nutrition (TPN) team participation (p=0.001) and Clinical research (p=0.0001). Total costs of care/hospital/year were lower when any of six Clinical Pharmacy services were present: drug use evaluation $1,119,810.18 (total $1,005,589,541.64 for the 898 hospitals offering the service), drug information $5,226,128.22 (total $1,212,461,747.04 for the 232 hospitals offering the service), adverse drug reporting monitoring $1,610,841.02 (total $1,101,815, 257.68 for the 684 hospitals offering the service), drug protocol management $1,729,608.41 (total $614,010,985.55 for the 355 hospitals offering the service), medical rounds participation $7,979,720.45 (total $1,212,917,508.41 for the 152 hospitals offering the service), and admission drug histories $6,964,145.17 (total $208,924,355.10 for the 30 hospitals offering the service). Clinical research $9,558,788.01 (total $1,013,231,529.06 for the 106 hospitals offering the service) and TPN team participation $3,211,355.12 (total $1,027,633,638.43 for the 320 hospitals offering the service) were associated with higher total costs of care. As staffing increased for hospital Pharmacy administrators (p=0.0001) and Clinical pharmacists (p=0.007), total cost of care decreased. As staffing increased for dispensing pharmacists, total cost of care increased (p=0.006). Based on this total cost of care model, optimal hospital Pharmacy administrator staffing was 2.01/100 occupied beds. Staffing for dispensing pharmacists should be as low as possible, and definitely fewer than 5.11/100 occupied beds. Staffing for Clinical pharmacists should be as high as possible, but definitely more than 1.11/100 occupied beds. The results of this study suggest that increased staffing levels of Clinical pharmacists and Pharmacy administrators, as well as some Clinical Pharmacy services, were associated with reduced total cost of care in United States hospitals.
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Clinical Pharmacy services pharmacist staffing and drug costs in united states hospitals
Pharmacotherapy, 1999Co-Authors: C A Bond, Cynthia L Raehl, Todd FrankeAbstract:We evaluated direct relationships and associations among Clinical Pharmacy services, pharmacist staffing, and drug costs in United States hospitals. A database was constructed from the 1992 American Hospital Association's Abridged Guide to the Health Care Field and the 1992 National Clinical Pharmacy Services database. Multiple regression analysis, controlling for severity of illness, was employed to determine the associations. The study population consisted of 934 hospitals. Four Clinical Pharmacy services were associated with lower drug costs: in-service education, $77,879.19 ± $56,203.42 (a total of $48,518,735.37 for the 623 hospitals offering this service, p=0.016); drug information, $430,579.84 ± $299,232.76 ($90,852,346.24 for the 211 hospitals offering this service, p=0.015); drug protocol management, $137,333.67 ± $98,617.83 ($45,045,443.76 for the 328 hospitals offering this service, p=0.049); and admission drug histories, $213,388.21 ± $201,537.85 ($5,548,093.46 for the 26 hospitals offering this service, p=0.011). As staffing increased for hospital Pharmacy administrators (p<0.0001), dispensing pharmacists (p<0.0001), and Pharmacy technicians (p<0.0001), drug costs increased. As staffing increased for Clinical pharmacists, drug costs decreased (p=0.018). The results of this study show that increased staff levels of Clinical pharmacists and some Clinical Pharmacy services are associated with reduced hospital drug costs.
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Clinical Pharmacy services and hospital mortality rates
Pharmacotherapy, 1999Co-Authors: C A Bond, Cynthia L Raehl, Todd FrankeAbstract:We evaluated the associations between Clinical Pharmacy services and mortality rates in 1029 United States hospitals. A data base was constructed from Medicare mortality rates from the Health Care Financing Administration and the National Clinical Pharmacy Services data base. A multivariate regression analysis, controlling for severity of illness, was employed to determine the associations. Four Clinical Pharmacy services were associated with lower mortality rates: Clinical research (p<0.0001), drug information (p=0.043), drug admission histories (p=0.005), and participation on a cardiopulmonary resuscitation (CPR) team (p=0.039). The actual number of deaths (lower) associated with the presence of these four services were Clinical research 21,125 deaths in 108 hospitals, drug information 10,463 deaths in 237 hospitals, drug admission histories 3843 deaths in 30 hospitals, and CPR team participation 5047 deaths in 282 hospitals. This is the first study to indicate that both centrally based and patient-specific Clinical Pharmacy services are associated with reduced hospital mortality rates. This suggests that these services save a significant number of lives in our nation's hospitals.
Herbert J Patterson - One of the best experts on this subject based on the ideXlab platform.
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Clinical Pharmacy services in heart failure an opinion paper from the heart failure society of america and american college of Clinical Pharmacy cardiology practice and research network
Pharmacotherapy, 2013Co-Authors: Sherry K Milfredlaforest, Robert L Page, Christopher R Ensor, Sheryl L Chow, Robert J Didomenico, Kathleen Dracup, Wendy Gattisstough, Thomas J Heywood, Joann Lindenfeld, Herbert J PattersonAbstract:Heart failure (HF) care takes place in multiple settings, with a variety of providers, and generally involves patients who have multiple comorbidities. This situation is a "perfect storm" of factors that predispose patients to medication errors. The goals of this paper are to outline potential roles for Clinical pharmacists in a multidisciplinary HF team, to document outcomes associated with interventions by Clinical pharmacists, to recommend minimum training for Clinical pharmacists engaged in HF care, and to suggest financial strategies to support Clinical Pharmacy services within a multidisciplinary team. As patients transition from inpatient to outpatient settings and between multiple caregivers, pharmacists can positively affect medication reconciliation and education, assure consistency in management that results in improvements in patient satisfaction and medication adherence, and reduce medication errors. For mechanical circulatory support and heart transplant teams, the Centers for Medicare and Medicaid Services considers the participation of a transplant pharmacology expert (e.g., Clinical pharmacist) to be a requirement for accreditation, given the highly specialized and complex drug regimens used. Although reports of outcomes from pharmacist interventions have been mixed owing to differences in study design, benefits such as increased use of evidence-based therapies, decreases in HF hospitalizations and emergency department visits, and decreases in all-cause readmissions have been demonstrated. Clinical pharmacists participating in HF or heart transplant teams should have completed specialized postdoctoral training in the form of residencies and/or fellowships in cardiovascular and/or transplant pharmacotherapy, and board certification is recommended. Financial mechanisms to support pharmacist participation in the HF teams are variable. Positive outcomes associated with Clinical pharmacist activities support the value of making this resource available to HF teams.
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Clinical Pharmacy services in heart failure an opinion paper from the heart failure society of america and american college of Clinical Pharmacy cardiology practice and research network
Journal of Cardiac Failure, 2013Co-Authors: Sherry K Milfredlaforest, Robert L Page, Christopher R Ensor, Sheryl L Chow, Robert J Didomenico, Kathleen Dracup, Wendy Gattisstough, Thomas J Heywood, Joann Lindenfeld, Herbert J PattersonAbstract:Abstract Background Heart failure (HF) care takes place in multiple settings, with a variety of providers, and generally involves patients who have multiple comorbidities. This situation is a “perfect storm” of factors that predispose patients to medication errors. Methods and Results The goals of this paper are to outline potential roles for Clinical pharmacists in a multidisciplinary HF team, to document outcomes associated with interventions by Clinical pharmacists, to recommend minimum training for Clinical pharmacists engaged in HF care, and to suggest financial strategies to support Clinical Pharmacy services within a multidisciplinary team. As patients transition from inpatient to outpatient settings and between multiple caregivers, pharmacists can positively affect medication reconciliation and education, assure consistency in management that results in improvements in patient satisfaction and medication adherence, and reduce medication errors. For mechanical circulatory support and heart transplant teams, the Centers for Medicare and Medicaid Services considers the participation of a transplant pharmacology expert (e.g., Clinical pharmacist) to be a requirement for accreditation, given the highly specialized and complex drug regimens used. Although reports of outcomes from pharmacist interventions have been mixed owing to differences in study design, benefits such as increased use of evidence-based therapies, decreases in HF hospitalizations and emergency department visits, and decreases in all-cause readmissions have been demonstrated. Clinical pharmacists participating in HF or heart transplant teams should have completed specialized postdoctoral training in the form of residencies and/or fellowships in cardiovascular and/or transplant pharmacotherapy, and board certification is recommended. Financial mechanisms to support pharmacist participation in the HF teams are variable. Conclusions Positive outcomes associated with Clinical pharmacist activities support the value of making this resource available to HF teams.
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Clinical Pharmacy services in heart failure an opinion paper from the heart failure society of america and american college of Clinical Pharmacy cardiology practice and research network
Pharmacotherapy, 2013Co-Authors: Sherry K Milfredlaforest, Robert L Page, Christopher R Ensor, Sheryl L Chow, Robert J Didomenico, Kathleen Dracup, Wendy Gattisstough, Thomas J Heywood, Joann Lindenfeld, Herbert J PattersonAbstract:Heart failure (HF) care takes place in multiple settings, with a variety of providers, and generally involves patients who have multiple comorbidities. This situation is a "perfect storm" of factors that predispose patients to medication errors. The goals of this paper are to outline potential roles for Clinical pharmacists in a multidisciplinary HF team, to document outcomes associated with interventions by Clinical pharmacists, to recommend minimum training for Clinical pharmacists engaged in HF care, and to suggest financial strategies to support Clinical Pharmacy services within a multidisciplinary team. As patients transition from inpatient to outpatient settings and between multiple caregivers, pharmacists can positively affect medication reconciliation and education, assure consistency in management that results in improvements in patient satisfaction and medication adherence, and reduce medication errors. For mechanical circulatory support and heart transplant teams, the Centers for Medicare and Medicaid Services considers the participation of a transplant pharmacology expert (e.g., Clinical pharmacist) to be a requirement for accreditation, given the highly specialized and complex drug regimens used. Although reports of outcomes from pharmacist interventions have been mixed owing to differences in study design, benefits such as increased use of evidence-based therapies, decreases in HF hospitalizations and emergency department visits, and decreases in all-cause readmissions have been demonstrated. Clinical pharmacists participating in HF or heart transplant teams should have completed specialized postdoctoral training in the form of residencies and/or fellowships in cardiovascular and/or transplant pharmacotherapy, and board certification is recommended. Financial mechanisms to support pharmacist participation in the HF teams are variable. Positive outcomes associated with Clinical pharmacist activities support the value of making this resource available to HF teams.
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Clinical Pharmacy services in heart failure an opinion paper from the heart failure society of america and american college of Clinical Pharmacy cardiology practice and research network
Journal of Cardiac Failure, 2013Co-Authors: Sherry K Milfredlaforest, Robert L Page, Christopher R Ensor, Sheryl L Chow, Robert J Didomenico, Kathleen Dracup, Wendy Gattisstough, Thomas J Heywood, Joann Lindenfeld, Herbert J PattersonAbstract:Abstract Background Heart failure (HF) care takes place in multiple settings, with a variety of providers, and generally involves patients who have multiple comorbidities. This situation is a “perfect storm” of factors that predispose patients to medication errors. Methods and Results The goals of this paper are to outline potential roles for Clinical pharmacists in a multidisciplinary HF team, to document outcomes associated with interventions by Clinical pharmacists, to recommend minimum training for Clinical pharmacists engaged in HF care, and to suggest financial strategies to support Clinical Pharmacy services within a multidisciplinary team. As patients transition from inpatient to outpatient settings and between multiple caregivers, pharmacists can positively affect medication reconciliation and education, assure consistency in management that results in improvements in patient satisfaction and medication adherence, and reduce medication errors. For mechanical circulatory support and heart transplant teams, the Centers for Medicare and Medicaid Services considers the participation of a transplant pharmacology expert (e.g., Clinical pharmacist) to be a requirement for accreditation, given the highly specialized and complex drug regimens used. Although reports of outcomes from pharmacist interventions have been mixed owing to differences in study design, benefits such as increased use of evidence-based therapies, decreases in HF hospitalizations and emergency department visits, and decreases in all-cause readmissions have been demonstrated. Clinical pharmacists participating in HF or heart transplant teams should have completed specialized postdoctoral training in the form of residencies and/or fellowships in cardiovascular and/or transplant pharmacotherapy, and board certification is recommended. Financial mechanisms to support pharmacist participation in the HF teams are variable. Conclusions Positive outcomes associated with Clinical pharmacist activities support the value of making this resource available to HF teams.
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interprofessional education principles and application a framework for Clinical Pharmacy
Pharmacotherapy, 2009Co-Authors: Robert L Page, Anne L Hume, Jennifer M Trujillo, Greg W Leader, Orly Vardeny, Melinda M Neuhauser, Devra K Dang, Suzanne Nesbit, Lawrence J CohenAbstract:With the increasing prevalence of chronic diseases, advancements in health care technology, and growing complexity of health care delivery, the need for coordination and integration of Clinical care through a multidisciplinary approach has become essential. To address this issue, the Institute of Medicine has called for a redesign of the health professional education process to provide health care professionals, both in the academic setting and in practice, the knowledge, skills, and attitudes to work effectively in a multidisciplinary environment. Such programmatic redesign warrants the implementation of interprofessional education (IPE) across health care disciplines. Pharmacists play a critical role not only in the provision of patient care on multidisciplinary teams but also in the delivery of IPE. National Pharmacy organizations have endorsed IPE, and several have articulated specific policies and/or initiatives supporting IPE. However, IPE has not yet been implemented effectively or consistently; moreover, the inability to effectively deliver IPE in the classroom and clinic has been correlated with a decrease in the quality of patient care provided. In addition, the incorporation of interprofessional patient care into daily practice has been compromised by workforce shortages within respective health care fields. This White Paper from the American College of Clinical Pharmacy (ACCP) addresses terminology, levels of evidence, environment-specific models, assessment methods, funding sources, and other important implications and barriers as they apply to IPE and Clinical Pharmacy. Current instruments that have been tested and validated in the assessment of IPE are reviewed, including the Readiness for Interprofessional Learning Scale, the Interdisciplinary Education Perception Scale, and the Attitudes Toward Health Care Teams Scale. Finally, strategies are suggested that ACCP might pursue to assist in the promotion and implementation of IPE both within and outside the Pharmacy profession.
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future Clinical Pharmacy practitioners should be board certified specialists
Pharmacotherapy, 2006Co-Authors: Joseph J Saseen, Sarah E Grady, Laura B Hansen, Brian M Hodges, Steven J Kovacs, Larry D Martinez, John E Murphy, Robert L Page, Marc G Reichert, Kathleen A StringerAbstract:The vision of the American College of Clinical Pharmacy (ACCP) is that, in 20–30 years, most Clinical Pharmacy practitioners will be boardcertified specialists. 2 This White Paper develops a rationale for this position, describes specialty board certification in Pharmacy, and articulates recommendations for attaining the vision. The justification of the need for board certification as a part of future quality assurance and professional privileging processes, the rationale for the argument that most future Clinical faculty and residency preceptors should be board certified, and the identification of obstacles that hinder achieving this vision are also discussed.