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H ospitals and health systems are required to measure and track performance due to government, private, and consumer pressures to ensure quality health care services. Hospital valuebased purchasing (HVBP) programs, meaningful use incentives, and the Patient Protection and Affordable Care Act (ACA) are examples of programs that force accountability and quality of care while reducing overall health care expenditure.1 Pharmacy directors face signifi cant challenges with rising drug costs and limited pharmacy staff while being expected to provide the highest quality pharmacy services. To meet these expectations, the pharmacy director must balance resources and performance. They must show how they have achieved that balance. Essential department data can be effectively used to help measure the success of the department in meeting their strategic goals, which are ideally aligned with the organization's priorities. 2Balanced scorecards (BSCs) are used in health care to list the results of the delivery of health care services as a continuous quality improvement approach.3 The BSC was fi rst introduced in 1992 byKaplan and Norton as a way to view performance broadly rather than a narrow focus on fi nancial measures. 4,5 The BSC contains 4 perspectives: customer, internal process, innovation and learning, and fi nancial. The BSC was fi rst discussed as a tool to be used in health-system pharmacy as a way to demonstrate pharmacy's value in meeting its key performance metrics. 6 In addition, BSCs were introduced in 1999 to improve medication use and to manage resources devoted to drug therapy. 7 The BSC is often divided into sections that refl ect the key operations of a pharmacy department, including medication safety, operations, quality, fi nance, education, and research.The terms BSCs and dashboards are often used interchangeably, but these tools are distinctly different. BSCs trend performance metrics over longer time intervals of weeks, months, and quarters; dashboards, track performance over shorter intervals in minutes, hours, and days. Dashboards typically serve as tactical indicators on the state of a process and focus on action limits involving trend lines instead of progress toward prespecifi ed goals. A BSC is often structured to measure organizational performance Having accurate data is essential for the pharmacy director to manage the department and develop patient-centered pharmacy services. A balanced scorecard (BSC) of essential department data, which is a broad view of a department's function beyond its fi nancial performance, is an important part of any department's strategic plan. This column describes how the pharmacy director builds and promotes a department's BSC. Specifi cally, this article reviews how the BSC supports the department's mission and vision, describes the metrics of the BSC and how they are collected, and recommends how the pharmacy director can effectively use the scorecard results in promoting the pharmacy. If designed properly and updated consistently, a BSC can present a broad view...

An automatic substitution of ipratropium-albuterol nebulization solution for MDIs resulted in a three-month savings of $99,359 in drug cost and an extrapolated full-year savings of $397,436. When additional costs associated with the substitution were taken into account, there was an overall savings of $146,806 during the implementation year and a projected savings of $257,936 for each following year.

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Background and Objective: Urea is an alternative for treatment of hyponatremia however, its use has not been widely studied. The purpose of this study was to evaluate the safety and efficacy of urea for the treatment of hyponatremia. Methods: A retrospective cohort of patients with hyponatremia (serum sodium <135 mEq/L) of any cause who received at least 1 dose of urea during hospitalization and no prior use of urea. Serum sodium levels were collected at baseline and for 4 days or until urea was discontinued, whichever occurred first. The primary outcome was the serum sodium change between baseline and discharge or urea discontinuation. Results: Median serum sodium increased 2 [IQR, 0-4] mEq/L per day after urea administration at a median dose of 30 g/day. A significant difference in serum sodium was observed between baseline and discharge or discontinuation (124.2 ± 4 vs 130.1 ± 5.1; P < .001) and serum blood urea nitrogen (BUN) levels (18.4 ± 13.1 vs 41.1 ± 26.6; P ≤ .001). Serum sodium overcorrection (increase >8 mEq/L in 24 hours) occurred in 6 patients (8%). Urea was discontinued in 39 patients (53%); 20 discontinuations were due to patient intolerance. Conclusion: Urea appears to be an effective treatment for hyponatremia; however, patient tolerance, the rate of serum sodium overcorrection, and outpatient affordability may limit its use.