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Purpose: The results of a survey evaluating pharmacy staffing and vacancies in small and rural hospitals in Illinois are reported., Methods: Questionnaires were mailed in November 2011 to pharmacy directors at 86 small and rural hospitals in Illinois. The survey included several items regarding human resources and staffing, and it used work-force items and methods similar to surveys conducted in 1991 and 2001. Descriptive analyses were used to assess differences in staffing and vacancies across different hospital sizes (number of staffed beds), and inferential statistics were used to compare selected hospital characteristics., Results: A total of 40 responses were received, yielding a response rate of 46.5%. Most rural hospitals reported having no vacancies in their pharmacy work force (62.5%, n = 25). Vacancy rates in 2011 were very low for pharmacists (1.8%), pharmacy technicians (2.5%), and pharmacy staff overall (2.1%). For several specific occupational titles, vacancy rates were zero. Nonetheless, adverse consequences (sites could report more than one effect) of vacancies included longer hours worked by part-time staff (27.5%, n = 11), reduced time to provide clinical pharmacy services (20.0%, n = 8), job dissatisfaction of remaining staff (17.9%, n = 7), and reduced time to provide drug distribution services (10.0%, n = 4)., Conclusion: The shortage of pharmacists in small and rural hospitals in Illinois largely subsided from 2001 to 2011, with many hospitals reporting no vacancies at all. The total number of actual full-time equivalent pharmacy staff has sizably increased since 2001.

Purpose: The results of a survey evaluating pharmacy services and technology use at critical access hospitals (CAHs) and other small and rural hospitals in Illinois are reported., Methods: A mail survey was sent to pharmacy directors at 86 CAHs and other rural and small hospitals in Illinois not designated as CAHs. Independent sample t tests and chi-square statistics were used to compare CAHs and non-CAHs in areas such as pharmacy services, staffing, use of technology, and sterile compounding practices., Results: The survey response rate was 46.5%, with usable data received from 40 hospitals. Analysis of the survey data indicated that hospitals designated as CAHs were significantly less likely than non-CAHs to have automatic therapeutic interchange policies (p = 0.012) and more likely to conduct pharmacist-provided educational programs on medication costs for physicians and other health care personnel (p = 0.037). Relative to non-CAHs, CAHs were significantly less likely to have automated dispensing cabinets (p = 0.016) and to out-source the preparation of sterile products to offsite vendors (p = 0.012); pharmacy directors at CAHs were less likely to report the use of technology for remote medication order entry or review (p = 0.038). At both types of facilities, pharmacists typically have both distributive and clinical responsibilities, and patient-specific clinical pharmacy services (e.g., patient education or counseling, other drug therapy monitoring, medication reconciliation, pharmacokinetic consultations) are offered at similar frequencies., Conclusion: A survey of pharmacy departments at small and rural hospitals in Illinois determined that there were more similarities than differences between CAHs and non-CAHs. The survey indicated significant differences in dispensing processes, the use of technology and drug policy tools, and outsourcing of sterile product preparation.

Purpose: The results of a 2011 survey evaluating pharmacy services at small and rural Illinois hospitals are presented and compared with data from similar surveys in 2001 and 1991., Methods: A questionnaire modeled on the previous survey instruments but updated to reflect contemporary pharmacy practice was mailed to pharmacy directors at 86 small hospitals (i.e., <150 staffed beds) and rural hospitals (i.e., located outside metropolitan areas)., Results: The response rate was 46.5%. The survey data indicated that 57.5% of hospitals represented in the 2011 survey had a centralized drug distribution system, 35.0% had a hybrid system, and 7.5% had a decentralized system. The most commonly reported form of technology was automated dispensing cabinets, which were in use at 75.0% of hospitals in 2011, compared with 34.8% of hospitals represented in the 2001 survey. Barcode verification of medication doses before dispensing and at the time of administration was performed at 50% and 70% of hospitals, respectively. While the provision of clinical pharmacy services has risen sharply since 1991, substantial changes were not observed between 2001 and 2011 except in the provision of compliance and drug histories (67.6% of hospitals in 2011 versus 46.8% in 2001) and pharmacist participation in medical emergency responses (54.0% versus 34.0%)., Conclusion: A 2011 survey of pharmacy departments in small and rural Illinois hospitals provided information on the use of automation and health information technologies and showed changes in the provision of many clinical pharmacy services since 1991.

Three problems impede the assessment of hospital pharmacy efficiency. First, although multiple efficiency indicators are utilized to measure a large variety of activities, it has not been possible to validly measure overall efficiency. Second, there have been no widely-used clinical activity indicators, so key outputs often have not been accounted for. Third, there has been no effective methodology for identifying when declines in efficiency are normal random variations and when they represent true decreases in performance. This paper presents a procedure that simultaneously addresses these three problems. It analyzes data from a group of U.S. hospital pharmacies that collect an inclusive set of clinical and distributional indicators. It employs Data Envelopment Analysis to develop comprehensive efficiency measures from the numerous outputs and inputs. It applies statistical Panel Data Analysis to estimate confidence intervals within which each pharmacy's true efficiency resides, and to develop control charts for signaling when a pharmacy's efficiency has declined by more than can be attributed to random variation. This integrated efficiency evaluation system is transferable to other hospital pharmacy systems, thereby offering decision makers a better way of measuring, controlling and improving hospital pharmacy efficiency.

Purpose: The purposes of this study were to characterize and quantify workload and productivity in hospitals according to their size, to establish comparative statistics useful for pharmacy administrators as a means to contrast their efficiency to that of other hospitals of similar sizes, and to provide data to enable policymakers to better assess staffing and resource needs., Methods: A 50-item Web-based survey designed to illicit information about pharmacy department staffing, workload, and productivity was sent electronically to 242 members of Consorta, Inc., a group-purchasing organization. Responses were received from 110 organizations, a response rate of 45.5%. The responses were categorized into three groups according to the number of staffed beds and were profiled and compared using descriptive and inferential statistics., Results: Pharmacy department workload and expenditures were primarily a function of hospital size: Hospital volume statistics, pharmacy expenditures, hours of operation, pharmacy full-time equivalents (FTEs), and dispensing workload all are highly dependent on the size of the facility. The range of clinical services provided by small, medium, and large hospitals did not differ with the exception of a few services provided more often in larger hospitals. Overall productivity ratios demonstrated greater efficiency among larger hospitals. In terms of costs, pharmacy and hospital expenditures per occupied bed and per admission generally decreased as hospital size increased., Conclusion: Results of a survey suggested consistency in clinical services provided by hospitals of varying size and increased productivity with increasing hospital size. Respondents employed fewer FTEs than those in other national surveys.

The results of a survey characterizing pharmaceutical services in rural hospitals in Illinois are reported and compared with results of a similar survey conducted in 1991. A questionnaire was developed and mailed to pharmacy directors at rural hospitals in Illinois to obtain information about product-related services, the use of technology, clinical pharmacy services, and human resources data (including vacancies) for 2001. Of the 71 surveys that were mailed, 47 pharmacy directors (66%) responded. Respondent hospitals were smaller compared with those responding in 1991 (mean average daily census, 41.0 versus 51.2, respectively). As in 1991, nearly all respondents reported the provision of unit dose services and complete and comprehensive i.v. admixture programs (100% and 83%, respectively, for 2001). Three respondents (6%) reported having a cleanroom facility. The most commonly used technology reported was nursing-unit-based automated drug dispensing cabinets (35%). Nearly all hospitals reported providing drug therapy monitoring, patient education and counseling, pharmacokinetic consultations, and nutritional support. Consistent with national reports, staffing levels and vacancies increased between 1991 and 2001. In 2001, the mean number of full-time equivalents was 7.1, with a pharmacist to technician ratio of 1.0:1.08 and a ratio of pharmacists to occupied beds of 1.0:22.6. The overall vacancy rate was 8%, with a vacancy rate of 14% and 5% for pharmacists and pharmacy technicians, respectively. A 2001 survey of pharmacy departments in rural hospitals in Illinois showed progression in the provision of distributive and clinical pharmacy services since 1991. Employee vacancy rates in pharmacy departments were high in 2001, especially among pharmacist positions, but were lower than those reported for the general population of hospitals.

Hospital policies regarding the use of low-molecular-weight heparins (LMWHs) were studied. A questionnaire addressing the formulary status of LMWH products, the use of prescribing guidelines, programs for therapeutic interchange, and policies to promote alternatives to LMWHs when appropriate was prepared. The questionnaire was mailed in January 2001 to pharmacy directors at 70 hospitals located in 19 states. All the hospitals were members of a national group purchasing organization. Forty-nine usable responses were received, for a response rate of 70%. Enoxaparin and dalteparin were the LMWH products most likely to be on the respondents' formularies (98% and 29% of hospitals, respectively). About 29% of the hospitals reported having guidelines on the use of LMWHs. Among hospitals that did not, most indicated that they were considering or would like to implement such guidelines. The most commonly cited barrier to the development and implementation of guidelines was lack of pharmacy personnel. Ten percent of the respondents reported having therapeutic-interchange programs for LMWHs. Cited barriers to therapeutic interchange programs included lack of therapeutic equivalence among products and lack of comparable labeled indications. Policies to promote alternatives to LMWHs were reported by 18% of the respondents. A multihospital survey showed that many hospitals wanted but relatively few had prescribing guidelines for LMWHs.