Early Hospital Development and Current Trends

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  1. 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
  2. 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
  3. 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
  4. 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
  5. floor stock
    items kept in pt care areas
  6. central pharmacy location
    one site to serve the entire hospital
  7. 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
  8. 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
  9. ways to categorize hospitals today
    • bed number: licensed beds
    • level of service: primary, tertiary
    • financial organization
    • governance
    • teaching vs non-teaching and community
  10. hospital administration today
    • upper administration: President/ CEO business- educated or MD/ other health practice degree
    • 1 or more VP
    • clerical
  11. ancillary and support department administration of hospitals today
    • director/ manager
    • associate or assistant director
    • secondary managers
  12. 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)
  13. Pharmacy and Therapeutics Committee in Hospitals today
    • purpose
    • membership
    • activities
    • the pharmacy presentation
  14. the formulary in Hospitals today
    • "formulary system" vs the "formulary"
    • the formulary purpose
    • drug addition 
    • drug removal
    • non-formulary usuage
  15. 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
  16. 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
  17. 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
  18. 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
  19. 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"
  20. pharmacist involvement in hospitals today
    • traditional: drug dispensing, integrity, security, info
    • advanced: dosing, interchange
    • other: safety committee (HAZMAT), EOC rounds, administration
  21. 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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Early Hospital Development and Current Trends
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