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South Africa has a high prevalence of infectious diseases; the major ones being the Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome epidemic, and tuberculosis. South Africa’s burden of resistant bacteria is also increasing. Antibiotic resistance in hospitalised patients leads to an increase in morbidity and mortality, resulting in longer hospital stays, and an increase in hospital costs. In order to counteract the problem of antibiotic resistance in hospitals and other healthcare facilities and preserve the efficacy of currently available antibiotics, there is a need for serious antibiotic management. Antibiotic stewardship initiatives have thus been put in place to guide healthcare professionals on the correct use of antibiotics. Clinical pharmacists can intervene and contribute to antibiotic stewardship owing to comprehensive knowledge of antibiotics, including the properties, uses, safety and efficacy of individual agents. There is a paucity of research to support the role of the clinical pharmacist in antibiotic stewardship in public sector hospitals. The current pharmacist staffing system within public sector hospitals does not adequately support pharmacists, in particular clinical pharmacists, to participate actively in antibiotic stewardship. The primary aim of the study was to evaluate the role of the clinical pharmacist in antibiotic stewardship in a public hospital setting. A secondary aim was to contribute towards more rational inpatient use of antibiotics in the general medical ward. The hypothesis for the study was that clinical pharmacists can make a positive contribution to the correct use of antibiotics in a public hospital setting. The study showed that the introduction of a pharmacist-driven antibiotic stewardship in the ward, using a prospective audit and feedback strategy, had a positive effect on overall appropriateness of antibiotic prescribing (Chi2=7.89; df=3; p=0.04815, Cramer’s V=0.13). However, this finding did not show any reduction in the volume of antibiotic use. Positive patient outcomes were achieved and shown through a reduction in the length of hospital stay (p=0.00487; one-way ANOVA). Although patients were not followed up on discharge to assess re-admission rates, the results are relevant in order to inform the hospital staff about the implementation of antibiotic stewardship at the public hospital setting with the aims of reducing inappropriate antibiotic prescribing and improving patient outcomes. From the results of the study, it can be concluded that the hypothesis was achieved and that the clinical pharmacist did play an integral role in antibiotic prescribing at the public hospital setting. Thus, it can be concluded that the study, though limited in its scope, achieved its aims and objectives, and showed that the clinical pharmacist does play an integral role in the rational use of antibiotics in a public hospital setting.

There are many examples in the literature of conventional or traditional drug distribution systems in hospitals which possess many shortcomings with reference to medication errors, the amount of time spent by nursing personnel in medication-related duties, inventory losses, the preparation of intravenous admixtures, and the lack of adequate drug usage records. These deficiencies primarily are due to the pharmacist's minimal influence over the control of the traditional drug distribution systems. An analysis and evaluation of the present pharmacy services at St. Paul's Hospital, Vancouver, B.C., similarly identified a traditional distribution system subject to many of the aforementioned potential problems. Using information based on existing unit dose systems as reviewed in the literature and data collected from a general questionnaire, new pharmacy services based on unit dose drug distribution are projected for St. Paul's Hospital. The required facilities and personnel for a progressive unit dose drug distribution system, an intravenous (I.V.) admixture preparation service and a drug surveillance program are projected accordingly. It would appear that a "centralized" approach to implementing unit dose distribution is most appropriate for St. Paul's Hospital's present requirements. This would involve the preparation and distribution of all drugs to nursing units in single dose packages from a central pharmacy area. A similarly centralized intravenous admixture service and a decentralized drug surveillance program also are described. These services commonly feature a greater responsibility being placed with the pharmacy department for preventing therapy problems such as admixture incompatibilities, drug interactions, adverse drug reactions and inappropriate drug selection. The effect of the above services on the responsibilities and number of pharmacy and nursing personnel is estimated based on results in similar programs. These changes also reflect extended hours of coverage in each area. Finally, a potential phasing plan and time schedule for the implementation of the proposed unit dose drug distribution system, I.V. admixture preparation service and drug surveillance program at St. Paul's Hospital is suggested. / Pharmaceutical Sciences, Faculty of / Graduate

The objective of this research is to develop a simulation model as an aid in planning hospital operations. The hospital pharmacy is selected as an appropriate area for study. An extensive systems analysis of pharmacy functions is undertaken. A simulation model of the inpatient dispensary operations is developed using the IBM General Purpose Simulation System. This model allows experimentation with dispensary work-load, operations, and manpower schedule. Statistics are provided on service to the patient, work-load distribution, and manpower utilization. Variation in pharmacist availability and type of prescription entering the dispensary allows optimization of operations. Several experiments are conducted to illustrate the model concept and experiment possibilities. It is concluded that the model is a valuable planning tool for the hospital pharmacy administrator and can be extended to simulate operations in other areas of the pharmacy. / Business, Sauder School of / Graduate

As part of the health services, pharmaceutical services consist in the supply of drugs, maintenance, quality control, safety, therapeutic efficacy, as well as monitoring and evaluation of its use by subsidizing the guarantee rational use. However, since 1992, Brazilian authorities point to the need for tools that allow evaluating pharmacy services in hospitals inserted, making it necessary to perform diagnostic pharmaceutical services at all levels of health care. Given the above this thesis was aimed to develop and validate the content of an instrument for evaluation of pharmaceutical care in hospitals of Sergipe. Therefore a study of type Evaluative Research in Health Initially, we conducted a survey on the theoretical evaluation of the quality of health services, with emphasis on pharmaceutical care services, and the conceptual aspects involved in the validation of a measuring instrument. The practical section was developed with a systematic review of the pharmaceutical services that utilized the psychometric characteristics of reliability and validity and content validation procedure for an instrument using the Delphi technique. In validation strategy content, which was found after analysis and opinion of the evaluators (judges) of the 60 indicators proposed assessment, four experienced changes between standard and compliance elements of measurement. After the modifications, the instrument was administered, applicability of the results showed that 94% of hospital pharmacists understand the questions posed in the instrument, however 33.3% of pharmacists chose not to answer the item related to service pharmacotechnics hospital for not being inserted or structured in some of the hospitals assessed. In parameter suggestion only 11.1% suggested change in the structure of the instrument, the doubts about the instrument in general, 100% of pharmacists said they have no doubts about the proposed questions. This study contributed to improving the quality of hospital pharmacy through content validation process, underscores the importance of further studies to determine the reliability of this instrument, which is to determine the degree of consistency with which the instrument measures the attribute under study. / Como parte integrante dos serviços de saúde, os serviços farmacêuticos, consistem no fornecimento de medicamentos, manutenção, controle de qualidade, segurança, eficácia terapêutica, bem como o acompanhamento e avaliação do seu uso subsidiando a garantia do uso racional. No entanto desde 1992, entidades brasileiras apontam a necessidade de instrumentos que possibilitem avaliar os serviços de farmácia inseridos em hospitais, tornando-se necessário realizar diagnósticos dos serviços farmacêuticos em todos os níveis de atenção à saúde. Diante do exposto a presente dissertação teve como meta o desenvolvimento e validação de conteúdo de um instrumento para avaliação da assistência farmacêutica em hospitais de Sergipe. Para tanto foi realizado um estudo do tipo Pesquisa Avaliativa em Saúde. Inicialmente, foi realizado uma fundamentação teórica sobre à avaliação da qualidade de serviços de saúde, com ênfase nos serviços da Assistência Farmacêutica, e os aspectos conceituais envolvidos na validação de um instrumento de medida. O capítulo prático foi desenvolvido com uma revisão sistemática sobre os serviços farmacêuticos que utilizaram as características psicométricas de validação e confiabilidade e o procedimento de validação de conteúdo de um instrumento utilizando a técnica Delphi. As análises das variáveis dos estudos obtidos com a revisão sistemática evidenciaram que o campo dos serviços farmacêuticos ainda precisa ser explorado, com pesquisas que elaborem e validem instrumentos direcionados aos serviços farmacêuticos, sobretudo no âmbito hospitalar. O painel de avaliadores utilizado para validação do conteúdo do instrumento apresentou-se como um painel misto com um alto grau de qualificação. À estratégia de validação de conteúdo, foi verificada que após análise e parecer dos avaliadores (juízes) dos sessenta indicadores de avaliação propostos, quatro sofreram modificações entre padrão de conformidade e elementos de mensuração, após o resultado das modificações o instrumento foi aplicado com seus resultados aplicabilidade do instrumento sobre o nível de compreensão dos farmacêuticos hospitalares quanto às diretrizes foi de 94%, 100%para não apresentação de dúvidas e 12% para sugestão de mudança na estrutura do instrumento. Este estudo contribuiu para a melhoria da qualidade dos serviços de Farmácia Hospitalar, através processo de validação de conteúdo, ressalta-se a importância de estudos posteriores para determinação da confiabilidade deste instrumento, que vem determinar o grau de coerência com que o instrumento mede o atributo em estudo.

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Thesis (MPH.) -- University of Limpopo, 2015 / Background Drugs expiration in public hospital pharmacies is a concern to health professionals as the Department of Health spends a lot of money to buy drugs. The number of drugs which expire in public hospital pharmacies can give an indication of how the drugs are used, and consequently reflect on the disease prevalence for which the drugs are indicated for. Drugs cannot be used beyond expiry date. The purpose of this study was to determine the cause or causes, extent and costs of expired drugs in public hospital pharmacies of Sekhukhune District in Limpopo Province of South Africa. Methods Sekhukhune District has seven public hospital pharmacies. Data collection involved interviews conducted by the researcher from thirty-five participants with each hospital having five participants. All interviews were recorded by the use of a laptop voice recorder. Participants in each hospital involved a pharmacy manager, an additional pharmacist who had twelve months or more working experience within the facility under study, a clinical manager, a nurse who attends the hospital Drug and Therapeutics Committee and a medical practitioner who had twelve or more working experience within the facility under study. Results and conclusion In this study it was identified that, overstocking; prescribing tendencies by medical practitioners; delivery of short-dated drugs from the supplier; poor stock rotation and unreliably minimum and maximum order levels were cited as some of the reasons for stock expiration. The study found drugs expiration value to be above the set limit of 0.05% of the expenditure in a financial year. An expired stock value of R86 815 was found based on the data collected for 2010/2011 financial year.

Thesis (M.H.A.)--University of Michigan, 1976.

Thesis (M.H.A.)--University of Michigan, 1974.

Thesis (M.H.A.)--University of Michigan, 1975.