2004 ASHP Leadership Conference on Pharmacy Practice Management Executive Summary: improving patient care and medication safety

Using personal strengths with intention in pharmacy: implications for pharmacists, managers, and leaders

BACKGROUND

The importance of allowing individuals to use their strengths in a work environment has been articulated through research focused on general audiences as well as by thought leaders within pharmacy. In particular, the work of Gallup has described how organizations that foster an environment in which employees frequently use their strengths achieve increased productivity, customer and employee satisfaction, and improved success at meeting goals. Despite acknowledging the importance of such an environment, little has been articulated in the pharmacy literature regarding how pharmacists can identify and apply their unique strengths within their profession.

OBJECTIVE

To provide an overview of the concept of individual strengths, the value of utilizing strengths in the profession, and the authors' experiences facilitating an awareness of this concept with student pharmacists, pharmacy residents, and pharmacists.

METHODS

Discovery and application of strengths has become a foundational theme in leadership development activities at the University of Minnesota College of Pharmacy. The learning process begins with building awareness and identifying individual talents using the Clifton StrengthsFinder Profile and reflecting on previous use of these talents. Throughout the activities, participants are encouraged to examine how professional experiences that correlate with their talents intersect and affect their knowledge and skills. Finally, participants are encouraged to utilize and maximize their talents in a team environment.

RESULTS

Experience has been gained delivering this educational process to 225 student pharmacists, 39 ambulatory care residents, and 22 practicing pharmacists. Participants have viewed this program favorably and articulated that utilization and growth of strengths is valuable to their career.

CONCLUSIONS

In order to achieve our potential as a profession, it is critical to identify and apply the strengths that individual pharmacists bring to their practice settings. The identification, understanding, and application of strengths have the potential to increase professional satisfaction, enhance leadership, and empower change that will evolve patient-centered care.

The informatics opportunities at the intersection of patient safety and clinical informatics

Health care providers have a basic responsibility to protect patients from accidental harm. At the institutional level, creating safe health care organizations necessitates a systematic approach. Effective use of informatics to enhance safety requires the establishment and use of standards for concept definitions and for data exchange, development of acceptable models for knowledge representation, incentives for adoption of electronic health records, support for adverse event detection and reporting, and greater investment in research at the intersection of informatics and patient safety. Leading organizations have demonstrated that health care informatics approaches can improve safety. Nevertheless, significant obstacles today limit optimal application of health informatics to safety within most provider environments. The authors offer a series of recommendations for addressing these challenges.

New agents for managing hyponatremia in hospitalized patients

PURPOSE

An overview of hyponatremia is provided, including its pathophysiology, clinical manifestations, signs and symptoms, and treatment, particularly with arginine vasopressin (AVP)-receptor antagonists.

SUMMARY

Hyponatremia (generally defined as a serum sodium concentration of <135 meq/L) is one of the most common electrolyte disorders in hospitalized and clinic patients. It may be caused by a number of conditions, including infections, heart disease, surgery, malignancy, and medication use. Clinical signs and symptoms such as hallucinations, lethargy, weakness, bradycardia, respiratory depression, seizures, coma, and death have been reported. Conventional treatment consists of fluid restriction and administration of hypertonic saline and pharmacologic agents, such as demeclocycline, lithium carbonate, and urea. These treatment options are often of limited effectiveness or difficult for patients to tolerate. AVP promotes the reabsorption of water in the renal collecting ducts by activation of V(2) receptors, resulting in water retention and dilution of serum solutes. The AVP-receptor antagonists, conivaptan, lixivaptan, and tolvaptan, are being studied for the treatment of hyponatremia. Conivaptan has been shown in clinical trials to increase free-water excretion and safely normalize serum sodium concentrations in patients with hyponatremia and is well tolerated. Also in clinical trials, lixivaptan and tolvaptan have safely improved serum sodium concentrations in patients with hyponatremia.

CONCLUSION

Hyponatremia is a serious health condition for which treatment should be carefully performed. As new agents for treating hyponatremia, AVP-receptor antagonists have demonstrated efficacy and safety in clinical trials and may serve as significant improvements in the current treatment options for managing this disorder.

Monitoring of pharmacy staffing, workload, and productivity in community hospitals

PURPOSE

The purpose of this survey was to identify and characterize pharmacy productivity monitoring systems used in community hospitals that were part of a national group purchasing organization (GPO).

METHODS

A 50-item questionnaire was developed, pretested, and sent electronically to the directors of pharmacy at 242 member hospitals of Consorta, Inc., a national GPO. The questionnaire was designed to elicit information on (1) hospital pharmacy demographics, (2) systems used to measure hospital pharmacy productivity, and (3) staffing levels and workload. Hospital demographic data were also obtained for respondent and nonrespondent hospitals from the American Hospital Association's AHA Guide. Descriptive statistics, Student's t tests, and chi-square tests were used to characterize the data and compare respondents with nonrespondents.

RESULTS

Responses were received from 110 hospitals (45.5%). No clinically significant differences were found when respondent and nonrespondent hospitals were compared based on AHA Guide data. The productivity workload ratios monitored most often by respondent hospitals were full-time equivalents (FTEs) per adjusted patient day, FTEs per dose dispensed, and FTEs per dose billed. Respondents reported a mean +/- S.D. of 21.90 +/- 18.83 actual FTEs and total doses dispensed, billed, or administered per year of 111,391.4 +/- 111,538.0. A major limitation of the productivity systems used in the hospitals was the inability of the systems to account for clinical services performed by the pharmacy staff.

CONCLUSION

A survey of community hospitals indicated that although most engaged in productivity monitoring, systems for such measurement often failed to capture all relevant clinical workload data.