IMPLEMENTING COMPREHENSIVE PHARMACEUTICAL SERVICES AT AN ACADEMIC TERTIARY CARE HOSPITAL

The implementation and impact of comprehensive pharmaceutical services at a hospital are described. Before 1992, pharmaceutical services at Detroit Receiving Hospital and University Health Center were comparabl e to those of many departments serving similar academic tertiary care institutions. A major conflict with the principles of pharmaceutical c are existed in that specific tasks were assigned to pharmacists, so th at up to four pharmacists may have been involved in one patients drug therapy while other patients were ignored. Several steps were taken to solve this problem, The department's mission and vision statements we re modified to embrace pharmaceutical care. The support of administrat ion and department leaders was secured, pharmacist evaluations were ad justed to make pharmaceutical care skills baseline competencies, and s taffing was reconfigured. A voluntary pharmaceutical care committee wa s formed to transform pharmaceutical services at the hospital. It was decided that all staff pharmacists would provide clinical and distribu tive services on a rotating basis. The drug distribution system was al tered to free more pharmacist time for patient care, and two technicia n positions were added. The clinical program was made more patient foc used. The program was implemented in a stepwise manner beginning in Se ptember 1992. Computerized systems for tracking workload and documenti ng clinical interventions and drug cost savings were established, Late r changes included making pharmacists responsible for all patients on a medical service rather than for specific problems in a particular lo cation and changing scheduling to enhance the continuity of care. The number of clinical interventions by pharmacists increased from 3,563 i n 1993 to 15,476 (projected) in 1995, and drug cost savings and avoida nce increased from $239,248 in 1992 to $562,402 (projected) in 1995. M ajor change was necessary to implement comprehensive pharmaceutical se rvices at an academic tertiary care hospital.