Survey of Pharmacy Services and Drug Usage in Victorian Public Hospital HITH Programs

Abstract

Objective: To determine the extent of pharmacy serv ices and drug usage for Hospital-in-the-Home (HITH) programs in Victoria. M ethod: In 1997, 42 Victorian hospital pharmacies with H IT H services were surveyed by a questionnaire on services and drug usage over the previous six months. R esults: O f the 29 hospital pharm acies which re sponded, 5 were not providing services, 16 provided 6-m onth drug usage data and 15 provided drug ex penditure data. Pharmacy staffing varied from a dedi cated H IT H pharm acist actively involved in patient management to no pharmacy involvement beyond drug dispensing. The range of pharmacy services provided included: preparation of intravenous additives; devel opm ent of drug and adm inistration protocols; care plans (including allergy and anaphylaxis procedures); supply of information regarding drug stability, storage and appliances, and consumer medicine information; patient counselling; therapeutic drug monitoring; and dosing advice.T he data on drug usage and pharmaceutical ex penditure was compromised by the inability of some pharmacies to identify H IT H patients and inconsistent inclusion of non-drug items. The range of drugs dis pensed to H IT H patients was broad, reflecting con current medical conditions and individual hospital prac tices. The most commonly dispensed parenteral drugs were ceftriaxone, cephazolin, dalteparin, flucloxacillin and vancomycin -reflecting the most common indica tions for H ITH . Conclusion: H IT H is an emerging alternative to in hospital patient management resulting in more patients being managed in the community. This creates an op portunity for hospital-based health professional serv ices to go beyond the hospital boundaries. Unlike the US, pharmacy services in H IT H in Victoria are still evolving. A ust J H osp Pharm 1999; 29: 16-19.

Clinic- and Hospital-Based Home Care, Outpatient Parenteral Antimicrobial Therapy (OPAT) and the Evolving Clinical Responsibilities of the Pharmacist

“…The type and extent of pharmacist involvement in clinic- and home-based hospital care described in the literature varies considerably. An Australian review of pharmacy services provided to HITH ranged from a dedicated HITH pharmacist to no pharmacist involvement, other than the dispensing and supply of medications [ 52 ]. For the HITH services that have a dedicated pharmacist, service provision includes aseptic manufacture; provision of drug stability, storage and intravenous pump information; therapeutic drug monitoring and dosing advice; patient counselling and administrative services, such as policy and procedure development.…”

“…Without definitive stability data for all intravenous antibiotics used in continuous infusions, it is expected that treatments may vary between clinic- and home-based hospital models of care depending on local policy and decision-making. These factors are described in an early Australian study describing the activities of HITH pharmacists in Victoria, where a range of practices were observed relating to drug selection and dosing regimens for HITH patients [ 52 ]. Due to the rapidly evolving nature of HITH and OPAT, it is important for pharmacists to be conscious of emerging research, particularly in the field of antibiotic stability, to support evidence-based practice.…”

Brave New World or Future Shock?

“…Patients receiving active treatment for acute conditions are increasingly being treated in the home as the so-called 'hospital-in-the-home' concept is further developed and embraced. 5 Given then that there will be significant changes in the healthcare environment perhaps the question that we should be asking ourselves is, will we see the demise of the hospital-based pharmacy service in all but major referral hospitals? Are hospital pharma cists, like frogs in a pot of gradually heating water, unaware of the impact of the changes in our sur roundings and the effect of those changes on our future?…”