The stability of solutions of the antitumour antimetabolites, vinca alkaloids, podophyllotoxins, interferons, steroids and platinum drugs as well as maytansine, asparaginase, amsacrine, flavone-8-acetic acid, mitoguazone, and N-phosphonoacetyl-L-aspartate (PALA) is reviewed. Much of the published work has been done with biological, not stability-indicating, assays; thus, the relevant results should be used with caution. With this proviso, almost all of these drugs can be stored in solution for several days at room temperature or 4°C. Most reports also suggest that the drugs that have been tested are stable when frozen in solution. For a number of the drugs, particular precautions are required; for instance, amsacrine should not be mixed with chloride-containing solutions, whereas cisplatin is most stable in solutions containing >0.1 M chloride.

Stability of solutions of antineoplastic agents during preparation and storage for in vitro assays. II. Assay methods, adriamycin and the other antitumour antibiotics.

Purpose The current status of external and internal workload and productivity measurement systems and strategies to improve their use to maximize overall pharmacy department operational performance and staffing effectiveness are described.

Summary The use of operational benchmarking is increasing within health systems as a tool for continuously measuring and improving departmental performance and evaluating departmental success. Unfortunately, software used for benchmarking purposes is available through a limited number of commercial vendors and consultants, and these systems are unable to effectively measure department operations and overall performance. The theoretical value of benchmarking and productivity measurement systems, including a description of the various definitions, tools, and data sources for comparing pharmacy productivity data, is summarized. The limitations of commercially available vendor productivity monitoring systems and desired strategies for improving their use are also reviewed. Preferred productivity and cost metrics for measuring pharmacy department effectiveness are suggested, and strategies for obtaining value from external and internal productivity monitoring systems are explored.

Conclusion Challenges with external operational benchmarking and internal productivity monitoring systems are numerous. These systems rarely measure the quality of pharmacy services provided and their effect on patient care outcomes and the total cost of care. Benchmarking vendors must modernize their software and develop internal checks to confirm data integrity in order to make their products more useful and reliable. In addition, data supporting the patient care role of the pharmacist should be integrated into all productivity monitoring systems and be used to demonstrate the positive impact of pharmacy services on the total cost and quality of patient care.

Effective use of workload and productivity monitoring tools in health-system pharmacy, part 1

JANUARY/FEBRUARY 2003 ■ VOLUME 19 ■ J PHARM TECHNOL 23 The counting and pouring now often alleged to be the pharmacist’s chief occupation will in time be done by technicians and eventually by automation. The pharmacist of tomorrow will function by reason of what he knows, increasing the efficiency and safety of drug therapy and working as a specialist in his own right. It is in this direction that pharmaceutical education must evolve without delay. —Linwood F Tice DSc Dean, Philadelphia College of Pharmacy and Science (1966)1

White Paper on Pharmacy Technicians 2002: Needed Changes Can No Longer Wait:

Achieving effective new models for pharmacy services in hospitals and health systems will depend on full utilization of pharmacists’ professional knowledge and contact with patients. The need is urgent to redeploy health-system pharmacists’ time to clinical activities, but this will be possible

Opportunities and challenges related to pharmacy technicians in supporting optimal pharmacy practice models in health systems.

Dispensary workload is widely perceived by pharmacists as limiting the time available for customer contact. This study compared pharmacist work patterns at two neighbouring independent pharmacies, one without (A) and one with (B) a trained dispensing technician, using fixed interval activity sampling. Pharmacists were observed at work over two weeks; six half-day observation sessions (A = 1,181 observations; B=1,348) could be matched for incoming dispensing workload. Data on 505 prescription issues and 74 over-the-counter events (advice requests, advised sales, and health information) were collected. Pharmacy B dispensed a greater proportion of antibiotics (19 per cent v 11 per cent, P<0.02) but there were no other significant differences. Pharmacists at site B spent 20 per cent less of their time on dispensary activities, 14 per cent more of their time on the counter and had 6 per cent more time to rest and read, but they did not spend significantly longer talking to customers about medicines and health. Skilled dispensing help released over an hour of pharmacist time per day, but these savings were linked to prescription workload, which is unpredictable. The pharmacists could not plan to give this extra time to their customers because they did not know when it would be available, or when it would be needed.

Time for customer contact in pharmacies with and without a dispensing technician

Efforts to meet growing clinical and distributive demands without increasing pharmacy staff are described. Real and expected increases in demands for services led pharmacists at a cancer center to seek ways of accommodating those demands within budgetary limits. Growth in the distributive workload was interfering with clinical consultation work. Research studies by the medical staff were resulting in complex dosage calculations and time-consuming compounding. Increasing requests for clinical services had to be met without compromising distributive services and teaching responsibilities and without raising costs. A plan of action was approved that included the use of a written test and a training manual to allow the hiring and retaining of skilled pharmacy technicians qualified to assume greater responsibilities. Technicians were assigned to enter drug orders into the computer, check other technicians, and dispense certain drugs. Greater use was made of commercially prepared i.v. solutions, and the floor stock was expanded. A comprehensive quality control program was concurrently put in place. The larger role for technicians not only enabled the pharmacy department to increase its distributive workload dramatically but reduced pharmacy medication errors and provided more time for clinical pharmacy practice. The number of pharmacist and technician full-time equivalents increased by only 1.5 in each category between 1985 and 1990. By making more use of pharmacy technicians, a pharmacy department was able to meet escalating demands for services with only a minor increase in personnel.

Gary S. Ogawa

Papers

Increasing pharmacy productivity by expanding the role of pharmacy technicians.

Dispensing-pin problems.