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Reasons behind hospital evolution
- Flexner Report
- Health insurance provided financial stability
- Demand for health care increased
- Hill-Burton Act
- Changes in prevalent epidemiology. Disease changes from acute to chronic
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Hill-Burton Act
- 1946
- Hospital Survey and Construction Act
- Created federal funding for hospital development and construction
- increased overall system bed capacity
- provided for hospital construction in less populated areas (rural and small towns)
- ensure the growth of modern hospitals as indispensable element Health Care
- led to an abundance of hospital beds and favored middle income communities
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DRG influence
- forced hospitals to selectively admit and discharge pt quicker
- shift to higher inpt acuity (seriousness or serverity of illness
- unbundling of DRG items allowed under Part B (as outpt services)
- decrease in payments recieved decreased the buffer again loss from indigents
- creating a need for efficieny, utilization review, evalution of Diagnostic procedures for appropriateness
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Early Hospital Pharmacy
- meds in bulk
- IVs in glass
- small floor space
- floor stock
- manipulations on floors by non-pharmacy personnel
- lack of security
- relaxed in the pharmacy
- '' central" pharmacy location
- differences in pharmacy inventory; variety, lack of control, unusual items
- -staffing: less professionals, more assistants
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floor stock
items kept in pt care areas
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central pharmacy location
one site to serve the entire hospital
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Hospitals 50 years ago
- greater number of beds
- longer LOS
- greater staffing
- more space for pts, less for offices and labs
- less security
- less detail orientation
- more independents (governance)
- visiting hours
- dive doctor- rxs and orders
- accountability for "written policies"
- focus on inpt care
- health care team
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Hospital Characteristics Today
- efficient of space (space is at a premium)
- high tech: diagnostics, lab RAD, PT, HIS, delivery
- downsize inpt beds
- bedsize range: 30 to hundreds
- enhanced awareness of customer needs
- lengthened visitation hours
- ownership changes
- increased budget
- heightened awareness of good practices
- changes in budgetary status of Pharmacy, RAD, materials, caused a change in philosophy of operation
- heightened awareness of keeping costs down
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ways to categorize hospitals today
- bed number: licensed beds
- level of service: primary, tertiary
- financial organization
- governance
- teaching vs non-teaching and community
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hospital administration today
- upper administration: President/ CEO business- educated or MD/ other health practice degree
- 1 or more VP
- clerical
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ancillary and support department administration of hospitals today
- director/ manager
- associate or assistant director
- secondary managers
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Modern Hospital Pharmacy
- unit dose system of drug distribution
- formulary: closed vs open
- use of automation: compounders, robotics, dispensing cabinets
- Rx I/S vs old hard-copy profiles
- changes in charge processing
- centralized vs decentralized
- IV admixtures
- speciality items (wound treatment)
- drug info
- dosing services
- clinical programs (IV to PO, therapeutic interchange, cost savings)
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Pharmacy and Therapeutics Committee in Hospitals today
- purpose
- membership
- activities
- the pharmacy presentation
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the formulary in Hospitals today
- "formulary system" vs the "formulary"
- the formulary purpose
- drug addition
- drug removal
- non-formulary usuage
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Hospital Accreditation today
- JCAHO: Joint Commission on Accreditation of Healthcare Organizations
- independent corporation: not government
- unannounced surveys ( vs traditional 3 year cycle)
- accreditation services vs. educational services
- inspection vs survey
- medium-sized metro hospital 3 surveyors on site for 3-4 days
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JCAHO Standards today
- described minimal good practices
- standards book in large; covers all phases of hospital practice, function, and operation
- emphasis on observation, whats done in practice (vs what is written in policy)
- pt tracer methodology
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JCAHO and Pharmacy today
- standards cover ALL phases of medication use
- documentation is key: if its not documented you didnt do it
- essential, basic areas: medication integrity, identification, and security
- clinical and cognitive functions are assessed
- pharmacy director, or designee, is involved throughout the survey duration
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Problem Areas in Hospitals todays
- infection control: nosocomial infections; hand washing
- staffing: too few staff
- security: of meds, supplies, the institution
- care transitions: times of increased oversight
- coordination of care: fasting tests
- errors: wrong site
- finances: disproportionate share
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Issues in Hospital Pharmacy today
- expired meds
- medication security
- after-hours services
- prescriber legibility
- unacceptable abbreviations
- medication storage
- medication reconciliation
- control of new drug items: radiocontrast media, respiratory meds
- control over med inventory in "remotes sites"
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pharmacist involvement in hospitals today
- traditional: drug dispensing, integrity, security, info
- advanced: dosing, interchange
- other: safety committee (HAZMAT), EOC rounds, administration
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Pharmacist Participation today
- safety committee
- infection control committee
- director of MM, RAD, PT, educational services, LAB
- design of new facilities: pharmacies, storage areas
- discharge planning
- critical care committee
- liaison to other customer groups
- attend medical department meetings: IM, OB-GYN,surgery
- attend MEC by invitation
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