[THE SHERLOCK SYSTEM - CLINICAL AND LOGISTIC PHARMACEUTICAL SERVICES].

BACKGROUND: The drug inventory in the hospital consumes a large part of the hospital's budget. Classic drug management is based on weekly visits of the pharmacist in the departments, writing an order and dispensing it. This method is wasteful in terms of sending a bulk of drugs that will not necessarily be utilized, and it is also inefficient in terms of human resources. The unit-dose method, which is more advanced, is based on filling out individual prescriptions for each of the inpatients in the department. This minimizes the potential of making an error on administration of the drug to the patient, while reducing the shelf-inventory in the department. A new method has been initiated at Barzilai Medical Center, starting January 2013, based on the implantation of the NAMER computerized clinical record system. This method, called SHERLOCK, which transforms the physician orders into logistic information for the pharmacist, holds all the unit-dose method advantages without the heavy costs. The system is an innovative development of the pharmacy staff in cooperation with the computer department. OBJECTIVES: To design a computerized system to make drug inventory management more efficient. Methods: We started using the SHERLOCK system in the two computerized internal departments. RESULTS: The data for 9 months was collected during January- September 2013 and was compared to data for the same period in 2012. This showed a significant reduction in the cost of drug distribution (p<0.05). This reduction projects an almost 20% decrease in the yearly budget at the research department. In the control departments, no significant reduction has been demonstrated. CONCLUSIONS: In light of these results, it is visible that the SHERLOCK system is an efficient tool to improve drug inventory management and medication safety.

[To reduce drug expenditure in the operating room (OR)--a paradigm].

BACKGROUND: The main advantages of pharmacy controlled IV preparations (CIVAS) are reduced expenditures, contaminations, and human errors. Today, IV preparations by physicians in the operating room (OR) are based on axioms such as: purchased drugs have standard dosages, IV are prepared immediately before operation, quantity of drug used is unpredictable due to patient's body weight and type of operation and opened injections can't be used for different patients and operations. Due to those limitations, the quantities of drugs used are significantly lower than supplied and wastage cost is high. AIM: To optimize CIVAS and reduce drug expenditure, using techniques from management and engineering sciences. METHOD: A model of optimization, based on credibility and prediction tests was used to analyze CIVAS. The model uses parameters such as number and type of operations, drugs and quantities/operation. It identifies wastage for each drug used (quantities and cost) and predicts optimal doses and quantities to be prepared. RESULTS: Although wastage (quantities) ranged from 30-70%, wastage cost was attributed mainly to two drugs: rocuronium (72%) and propofol (13 %). The model predicts that preparation of three standard doses of rocuronium will allow a 52.7% cost saving from the OR's IV drug budget. CONCLUSION: This optimization model can be applied in wards where wastage cost of IV drugs is high. It will indicate which standard doses of which drug should be prepared, that will enable lowest wastage with minimal addition of manpower.

Nurses' evaluation of pharmacists' services--a hospital survey.

BACKGROUND: One of the tools to evaluate quality of service is to measure satisfaction from services provided. This survey evaluates the quality of pharmacy services based on the satisfaction of nurses who require pharmacy services on the wards. When a nurse evaluates pharmacist services, an appropriate concept of their evaluation should be selected. Three different types of evaluation have been identified that could be applied to these services: performance evaluation (how convenient, reliable, and accessible is a service), disconfirmation of expectations (service experience that involves comparison between the service experience and expectation), and self- efficacy evaluation (extent to which a pharmacist service leads to nurse self-efficacy). OBJECTIVE: To measure nurses' evaluations of pharmacists' services in a general hospital in Israel, using those three types of evaluations. METHOD: Nurses were asked to evaluate, by a questionnaire the service in terms of performance, disconfirmation of expectations by rating statements for each subject on a 5-point scale, where 5 was the highest rating. Self-efficacy was evaluated by one choice positive or negative answer. RESULTS: A total of 252 (95.1) questionnaires were filled out and returned for evaluation. Nurses rated pharmacists' performance as 4.2 (+/-0.5) (P=0.01). Disconfirmation of expectations was rated as 3.6 (+/-0.8) and self-evaluation as 3.7 (+/-0.2). Linear regression models were estimated for general satisfaction of pharmacists' services and performance was significant when correlated with the period of nurses' professional service. CONCLUSIONS: Analysis of the three tools of evaluation for pharmacy services by nurses showed that the performance evaluation was most favored, followed by disconfirmation of expectations and self-efficacy evaluation. Conceptualization of satisfaction, with tools as performance evaluation and disconfirmation of expectations is useful for those services that nurses have experience with and can relate to. For services with ambiguous or unfamiliar nature (e.g., professional self-evaluation due to pharmacist services), most nurses do not have the expertise to assess pharmacist performance. This survey provides for a better conceptual understanding of how nurses evaluate pharmacist services and how these evaluations should be measured.

[Simple method to detect factors influencing drug expenditures].

BACKGROUND: Analysis of drug expenditures as part of an assessment of various forms of management interventions is rarely reported. Several strategies have been used to decrease injudicious drug use: restricted availability of specific drugs under formulary instructions, educational programs for prescribing practices and streamlining to discontinue or limit therapy. Each intervention has limited effectiveness. OBJECTIVE: To detect factors influencing drug expenditures by a simple and accessible method. METHOD: Data analysis on drug utilization and expenditures was performed according to the "Pareto" technique and changes were calculated. Changes in expenditure due to inflation were also calculated; the cost value of each drug in 2000 was multiplied by its quantity used in years 2000 and 2001. Comparison of expenditures using this method of calculation enabled us to find the inflation rate of the drugs used in the hospital. RESULTS: Five important factors were found to have an impact on the pharmacy budget and calculations: drug inflation rate (-1%), new drugs introduced through the Pharmaceuticals & Therapeutic Committee (1.9%), extended usage of drugs due to new approved clinical indications (0.7%), opening of new services or widening of special old services (3.4%) and usage of commonly high volume prescribed drugs in various wards of the hospital (-8.9%). Quantities and costs for the 80 most expensive pharmaceuticals showed factors responsible for the drug expenditure when compared with the leading drug classes, as well as with leading drugs. Antimicrobials (27.5%), high volume IV infusions (11.0%), small volume infusions (8.5%), and anticoagulants (6.7%) were the most prominent drug classes that contributed to the high cost of the drug budget. Small volume infusions of Sodium Chloride 0.9% (7.8%), Piperacillin and tazobactam injections (5.6%). Ofloxacin & Ciprofloxacin drugs (4.7%), and Enoxaparin injections (4.6%) were the highest costing drugs. CONCLUSION: This simple method based on comparison of costs, utilization and judicious drug use, can provide accurate information that can be useful in planning and implementing a reasonable drug budget.