Thesis (MSc ( Med In Pharmacy)) -- University of Limpopo (Medunsa / Summary Summary Summary The words “researcher” and “pharmacist” are used interchangeably. In the last two decades, the role of the pharmacist has been expanding beyond product orientated functions, such as procurement, stock control and dispensing, towards patient centered functions, in which the pharmacist assumes responsibility for treatment outcomes as part of the health care team. This research aimed to assess the need for the provision of pharmaceutical care from the pharmacist to the surgical wards of Steve Biko Academic Hospital. The objectives of the study were to determine the role of the pharmacist in the general surgical wards, to assist in the design of an antimicrobial ward protocol for the surgical wards, to record and assess antimicrobial patterns in the surgical wards, to describe and categorize the interventions performed by a pharmacist during the provision of pharmaceutical care, to identify factors which limited the provision of pharmaceutical care and provide recommendations for future undertakings, to calculate the cost implications of pharmaceutical care interventions made, to assess the time spent on interventions performed by a pharmacist during the provision of pharmaceutical care and to determine if the medical staff members in the surgical unit feel there is a need for the pharmacist providing pharmaceutical services to the wards. The study was conducted in the surgical wards of Steve Biko Academic Hospital. The study design was a cross-sectional operational study in which 62 patients were recruited over the eight week period. A pilot study was conducted to validate the data collection instruments. The data was analyzed with the assistance of a statistician using various statistical methods for the different variables in the study. ix Of the 62 study patients, 33 were female and 29 were male. The female-to-male ratio of the study patients was thus 1:0.88. The average age of the patient population, was 52.5 ± 17.2 years, with a range of 15 to 88 years. The mean duration of stay for the study patients was 8.9 days, with a range 1 to 111 days. A total of 120 diagnoses were made for the 62 study patients. Conditions diagnosed most frequently included conditions affecting the gastro-intestinal tract (38 patients), conditions affecting the cardiovascular system (28 patients), conditions affecting the endocrine system (14 patients) and infections (12 patients). The five medicines used most frequently in terms of numbers of patients and duration of therapy were paracetamol (53 patients, 277 patient-days), morphine/papaverine/codeine (41 patients, 155 patient-days), enoxaparin sodium (24 patients, 113 patient-days), co-amoxiclav (21 patients, 101 patient-days) and metoclopramide (22 patients, 90 patient-days). A total 188 interventions were made and documented during the study period and 153 (81.4%) interventions were accepted. The number of interventions suggested ranged from 0 to 10, with an average of three interventions per patient and a median of one intervention per patient. The most frequent interventions were made due to system error or non-compliance (29.3% of all interventions), on patient or nursing staffs’ knowledge of the medication (18.6%), untreated medical conditions (11.2%), therapeutic duplications (9.0%) and on prescribed doses and dosing frequency (5.9%). The total time spent providing pharmaceutical care services within the surgical wards over the study period was 32 days (227.9 hours) with an average time of 7.1 hours per day. Of the total time in the ward, 48% was spent on providing pharmaceutical care to the patients, 26% to record and access the total antibiotic usage in the ward, 9% on administration and 6% on meetings. Other functions comprising of 3% and less of the time was information to patients, x communication with doctors, educational sessions with nursing staff, communication with the pharmacy and stock control procedures. Questionnaires were completed by the doctors and nursing staff before and after the study period to determine if they felt there was a need for a pharmacist in the surgical ward. The doctors felt that there was a need for a pharmacist in the ward in terms of providing information and assisting in the rational use of medication. All of the nursing staff felt that there was a need for a pharmacist to visit the surgical ward and specifically to assist with the legal aspects of the prescriptions and with the education of the nursing staff. The pharmacist played an important role in the design of an antimicrobial ward protocol and in order to do so the pharmacist recorded and assessed the antimicrobial prescribing patterns of the surgical wards. In conclusion, the pharmacist present in the ward functioned as a gateway between the nursing staff and the doctors. The interventions that require the most attention was made due to system error and non-compliance. Important interventions were made on the patients’ and nursing staffs’ knowledge of the prescribed medication. The pharmacist played an important role in the education of nursing staff to discuss relevant topics and problems often encountered. Educational sessions with the patients involved giving them advice on home medication and the medication prescribed to them to take home. The amount of patients seen per week increased with time and the average time spent per patient consultation decreased with time. This is a clear indication that the researcher gained confidence and became more familiar with the pharmaceutical care process as the time passed. From the questionnaires completed by the doctors and nursing staff it was clear that they felt that there was a need for a pharmacist in the ward in terms of xi providing information, assisting in the rational use of medication, to assist with the legal aspects of the prescriptions and with the education of the nursing staff.

Zugl.: Diss. jur. Fak. Univ. Bern, 1952.

Submitted by Biblioteca da Faculdade de Farmácia (bff@ndc.uff.br) on 2017-03-22T17:40:52Z No. of bitstreams: 1 Santos, Ana Izabel Bezerra [Dissertação, 2014].pdf: 14837704 bytes, checksum: 251d1b7592c1fd8d834033af111ff9b3 (MD5) / Made available in DSpace on 2017-03-22T17:40:52Z (GMT). No. of bitstreams: 1 Santos, Ana Izabel Bezerra [Dissertação, 2014].pdf: 14837704 bytes, checksum: 251d1b7592c1fd8d834033af111ff9b3 (MD5) / O Instituto para Práticas Seguras no Uso de Medicamentos (ISMP) define uma lista de Medicamentos Potencialmente Perigosos (MPP) a ser utilizada pelos hospitais para fundamentar a elaboração de listas próprias das instituições hospitalares. Dificuldades podem ser encontradas pelas instituições ao incluir medicamentos na sua lista, devido ao grande número de MPP na lista do ISMP e a tendência de número de itens limitado pelos procedimentos de segurança adicionais que em geral acompanham a entrada desse tipo de medicamentos na lista. Esse trabalho objetiva desenvolver de uma ferramenta que avalie critérios relacionados aos riscos na utilização de medicamentos no âmbito hospitalar, promovendo uma escolha mais segura dos medicamentos a fazer parte da lista de MPP da instituição. Para isso, uma revisão de literatura foi realizada e foram incluídos questionamentos referentes aos riscos intrínsecos ao medicamento e riscos extrínsecos referentes ao processo de utilização hospitalar. Por se tratar de área multidisciplinar, a ferramenta foi validada através do método de consenso de especialistas, que além de determinar a inclusão e exclusão de itens, também determinou os valores atribuídos às respostas dos questionamentos. Após a validação, a ferramenta mostrou ser de fácil utilização, apresentando após sua utilização uma classificação de risco dos medicamentos da instituição, que possibilitará estabelecer prioridades de inclusão na lista de MPP, sendo os de maior risco os primeiros a serem incluídos. A utilização da ferramenta pode auxiliar a inclusão de medicamentos na lista de MPP da instituição de maneira mais criteriosa, contribuindo para o aumento da segurança dos pacientes / The Institute for Safe Practices in the Use of Medicines (ISMP) defines a list of High-Alert Medication (HAM) to be used by hospitals to support the development of their own lists. Difficulties may be encountered by institutions to include medications in their own list, due to the large number of HAM in ISMP’s list and the trend of the number of items limited by the additional security procedures that usually accompany the entry of such drugs on the institutional list. This work aims to develop a tool to assess risks related to the use of medicines in hospitals, promoting a safer choice of drugs to be part of the HAM institutional list. For this, a literature review was conducted and questions related to intrinsic and extrinsic drug risks related to the use of hospital process risks were included. As it is a multidisciplinary area, the tool has been validated by the method of expert consensus, which in addition to determine the inclusion and exclusion items, also determined the values assigned to answers the questions. After validation, the tool proved to be easy to use, with its use after a risk rating of the institution of the drugs, which allow to set priorities for listing of HAM, the highest risk being the first to be included. The use of the tool can aid the inclusion of medicines on the list of HAM to implementing more rigorous way, contributing to increased patient safety

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

L’iatrogénie médicamenteuse à l’hôpital est un problème majeur de santé publique dont les causes sont multiples. La diffusion de recommandations de bonnes pratiques de prescription pourrait permettre de diminuer ce phénomène. L’objectif de cette thèse est de modéliser un vecteur possible des bonnes pratiques de prescription, celui des interventions pharmaceutiques. Ce travail se décline en trois séquences : 1.contexte et justification, 2.développement d’un outil de documentation et d’analyse des interventions pharmaceutiques, 3.évaluation d’un modèle de diffusion des recommandations associant l’intervention d’un pharmacien clinicien intégré dans l’unité de soins à un rappel informatique de l'intervention au moment de la prescription. L’ensemble de ces données assoit la pertinence d’une diffusion des interventions pharmaceutiques basée sur les outils technologiques et les activités de pharmacie clinique. / Medication errors in hospitals have become a major public health problem with multiple causes. The diffusion of prescription guidelines could reduce this phenomenon. The objective of this thesis is to modelize a potential vector of prescription guidelines: the pharmacists’ interventions. This work is declined in three sequences: 1.context and justification, 2.development of a tool for the documentation and the analyse of pharmacists’ interventions, 3.assessment of a model of prescription guidelines diffusion combining intervention of a clinical pharmacist integrated into clinical ward with a computerized reminder of the intervention. Our data supports the relevance of pharmacists’ interventions diffusion based on technological tools and clinical pharmacy activities.

Šis tyrimas biomedicinos mokslui pateikia naujų duomenų apie galimybes ir pasiruošimą teikti vieną iš sveikatos priežiūros sistemos paslaugų – farmacinę paslaugą. Darbo tikslas – atskleisti farmacinės paslaugos sampratą ir prielaidas sociumo kaitos kontekste ir, remiantis farmacijos specialistų požiūriu bei pacientų lūkesčiais, pateikti rekomendacijas farmacinei paslaugai tobulinti. Darbe tiriama farmacinės paslaugos prielaidos ir samprata, remiantis Lietuvos farmacinę veiklą reglamentuojančiais norminiais aktais. Teoriniu atžvilgiu tyrime atskleistas farmacinės paslaugos daugiamatiškumas, principai ir funkcijos praplečia požiūrį į farmacijos specialistą, kuris, teikdamas farmacinę paslaugą, atlieka plačias socialines, taip pat ir sveikatos priežiūros specialisto funkcijas. Išanalizavus problemas, su kuriomis susiduria farmacijos specialistai, teikdami farmacinę paslaugą, ir įvertinus veiksnių, mažinančių galimybes suteikti pilnavertę paslaugą, įtaką, pateikiamos rekomendacijos, kurių įgyvendinimas padėtų tobulinti farmacijos specialistų veiklą. Pacientų lūkesčių ir farmacijos specialistų nuomonės analizė sudaro sąlygas įvertinti priežastis ir numatyti modelius, kaip užtikrinti tinkamą tarpusavio bendradarbiavimą, lemiantį gerą farmacinės paslaugos kokybę. / The sociologic data from the study showed the possibility and readiness to introduce the pharmacy service as a part of the health care services. The aim of this research was to develop the concept of, and preconditions for, the pharmacy service in the context of the social changes, and to offer recommendations for the improvement of the service, according to the attitudes of pharmaceutical specialists and expectations of patients. Preconditions for, and the concept of, the pharmacy service are analyzed in the context of the modern pharmacy regulations of the Republic of Lithuania, which has not yet been done in other research works. The theoretical analysis discloses the multidimensionality, the fundamentals and functions of the pharmacy service and creates a comprehensive view of the pharmaceutical specialist who performs multiple social and health care functions while providing the pharmacy service. Based on the analysis of problems occurring in the pharmacist’s work as well as on the evaluation of factors influencing the provision of a high-quality pharmacy service, recommendations are given in this work, which may improve the quality of pharmacists’ activities. Research findings may help to adjust the pharmaceutical specialists’ education programmes, develop a strategy for avoidance of internal and external barriers in the pharmacy sector, improve the pharmacy service and make it more accessible to the public.

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

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

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