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North Bethesda, MD, United States

Pedersen C.A.,Monroe Hospital | Schneider P.J.,University of Arizona | Scheckelhoff D.J.,Professional Development
American Journal of Health-System Pharmacy | Year: 2012

Purpose. Results of the 2011 ASHP national survey of pharmacy practice in hospital settings that pertain to dispensing and administration are presented. Methods. A stratified random sample of pharmacy directors at 1401 general and children's medical-surgical hospitals in the United States were surveyed by mail. Results. In this national probability sample survey, the response rate was 40.1%. Decentralization of the medication-use system continues, with 40% of hospitals using a decentralized system and 58% of hospitals planning to use a decentralized model in the future. Automated dispensing cabinets were used by 89% of hospitals, robots were used by 11%, carousels were used in 18%, and machine-readable coding was used in 34% of hospitals to verify doses before dispensing. Overall, 65% of hospitals had a United States Pharmacopeia chapter 797 compliant cleanroom for compounding sterile preparations. Medication administration records (MARs) have become increasingly computerized, with 67% of hospitals using electronic MARs. Bar-code-assisted medication administration was used in 50% of hospitals, and 68% of hospitals had smart infusion pumps. Health information is becoming more electronic, with 67% of hospitals having partially or completely implemented an electronic health record and 34% of hospitals having computerized prescriber order entry. The use of these technologies has substantially increased over the past year. The average number of full-time equivalent staff per 100 occupied beds averaged 17.5 for pharmacists and 15.0 for technicians. Directors of pharmacy reported declining vacancy rates for pharmacists. Conclusion. Pharmacists continue to improve medication use at the dispensing and administration steps of the medication-use system. The adoption of new technology is changing the philosophy of medication distribution, and health information is rapidly becoming electronic. Copyright © 2012, American Society of Health-System Pharmacists, Inc. All rights reserved. Source


Pedersen C.A.,3758 78th Avenue | Schneider P.J.,University of Arizona | Scheckelhoff D.J.,Professional Development
American Journal of Health-System Pharmacy | Year: 2011

Purpose: Results of the 2010 ASHP national survey of pharmacy practice in hospital settings are described. Methods: A stratified random sample of pharmacy directors at 1968 general and children's medical-surgical hospitals in the United States was surveyed by Internet and mail. SDI Health LLC supplied data on hospital characteristics; the survey sample was drawn from the SDI Health hospital database. Results: In this national probability sample survey, the response rate was 28.8%. Patient-specific pharmacist activities are increasing, as shown by the substantial use of pharmacist empowered therapeutic interchange programs, extensive prevalence of pharmacist review of medication orders before doses are available for administration to patients, and the widespread use of pharmacist consultations by prescribers, with almost complete acceptance of pharmacist recommendations. Pharmacists are also leading antibiotic stewardship programs, managing anticoagulation medication therapy, addressing pharmaceutical waste management, and standardizing i.v. infusion concentrations. Electronic health information is rapidly being adopted, with the use of electronic medical records and computerized prescriber-order-entry to improve prescribing and use of medications. Metrics are commonly used to track and monitor trends in operational, clinical, and safety performance in hospital pharmacy departments. Pharmacist and pharmacy technician staffing has increased significantly, while vacancy rates have declined. Conclusion: Pharmacists contribute to improving prescribing and transcribing. Patient safety is now a priority for medication management. Copyright © 2011, American Society of Health-System Pharmacists, Inc. All rights reserved. Source


Gresham R.M.,Professional Development
Tribology and Lubrication Technology | Year: 2013

The article discusses how to control lubrication contamination in an industrial plant machinery. One needs to establish an acceptable level of contamination via the ISO code for each machine and perform oil sampling and analysis to determine the level of contamination. Then one should select filters and filter placement to remove contaminants, whether generated in the machine or from the outside. The ISO 4406 Solid Contamination Code is the most widely used method for characterizing particle counts in oils. The current standard is still the 1999 version that employs a two-number system, although the new standard will use a three-number system. Often a particle distribution more or less follows a bell curve skewed one way or another. The R is a so-called range number representing the range of the number of particles corresponding to a certain size. With three range numbers, one gets a snapshot of the distribution curve in three places. Source


Gresham R.M.,Professional Development
Tribology and Lubrication Technology | Year: 2015

A manure spreader manages a significant hygienic issue in an ecologically sound manner by recycling nutrients to the soil and increasing the amount of topsoil so more nutrients can be grown to feed livestock. The newer manure spreaders have better corrosion protection, lube-for-life bearings and a more robust chain design. The older design had the manually greased, difficult-to-reach, open-rear spreader bearing mounted on sheet metal that was in area severely contaminated by manure itself. The newer design has lube-for-life bearings sealed from contaminatination and mounted on an eighth inch backing plate that easily could be replaced were it to corrode badly. The new design has a better housing to protect from rain and corrosive elements and with lube-for-life bearings, so only minor periodic maintenance is needed to oil the chain and inspect for rachet wear and loose bolts. Source


Pedersen C.A.,3758 78th Avenue SE | Schneider P.J.,University of Arizona | Scheckelhoff D.J.,Professional Development
American Journal of Health-System Pharmacy | Year: 2010

Purpose. Results of the 2009 ASHP national survey of pharmacy practice in hospital settings that pertain to monitoring and patient education are presented. Methods. A stratified random sample of pharmacy directors at 1364 general and children's medical-surgical hospitals in the United States were surveyed by mail. SDI Health supplied data on hospital characteristics; the survey sample was drawn from SDI's hospital database. Results. The response rate was 40.5%. Virtually all hospitals (97.3%) had pharmacists regularly monitor medication therapy in some capacity; nearly half monitored 75% or more of their patients. Over 92% had pharmacists routinely monitor serum medication concentrations or their surrogate markers, and most hospitals allowed pharmacists to order initial serum concentrations (80.1%) and adjust dosages (79.2%). interdisciplinary committees reviewed adverse drug events in 89.3% of hospitals. Prospective analysis was conducted by 66.2% of hospitals, and retrospective analysis was performed by 73.6%. An assessment of safety culture had been conducted by 62.8% of hospitals. Most hospitals assigned oversight for patient medication education to nursing (89.0%), but many hospitals (68.9%) reported that pharmacists provided medication education to 1-25% of patients. Computerized prescriber-order-entry systems with clinical decision support were in place in 15.4%, bar-code-assisted medication administration systems were used by 27.9%, smart infusion pumps were used in 56.2%, and complete electronic medical record systems were in place in 8.8% of hospitals. The majority of hospitals (64.7%) used an integrated pharmacy practice model using clinical generalists. Conclusion. Pharmacists were significantly involved in monitoring medication therapy. Pharmacists were less involved in medication education activities. Technologies to improve the use of medications were used in an increasing percentage of hospitals. Hospital pharmacy practice was increasingly integrated, with pharmacists having both distribution and clinical roles. Copyright © 2010, American Society of Health-System Pharmacists, Inc. All rights reserved. Source

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