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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5497_Библиотеки_им_академика_М_И_Перельмана.pdf
Pharmacy Practice148
pharmacists can provide pharmaceutical care. In addition, the
pharmacists must make reasonable effort to collect, record, and
maintain the following information about patients receiving
medical aid benefits like patient’s name, address, telephone
number, date of birth (or age), and gender. Communication is
the sharing of information, ideas, thoughts, and feelings. It
involves not just spoken word, but also what is conveyed
through inflection, vocal quality, facial expression, body
posture, and other behavioral responses. As a first step toward
communicating more effectively, pharmacists must understand
the communication process.
The goal of all communication is understanding, for one
person to understand a message composed by another, the
receiver must do more than recognize the words used in the
message by the sender. Effective communication occurs only
by participants. Communication usually takes place through
multiple non-verbal channels as well. For example, as the words
of a message are transmitted, facial expressions, gestures, vocal
quality, and other non-verbal cues are also sent.
INFORMAINFORMA
INFORMAINFORMA
INFORMA
TION GATION GA
TION GATION GA
TION GA
THERERS AND GIVERSTHERERS AND GIVERS
THERERS AND GIVERSTHERERS AND GIVERS
THERERS AND GIVERS
The interactions of a pharmacist and a patient usually can be
categorized as either an information gathering or information-
giving session. Information gathering usually is done during a
multifaceted purpose. Pharmacists initiate the interaction to
investigate and acquire data about a patient’s medication taking
experiences, assess a patient’s understanding of past and
current medication taking experiences, assess a patient’s
motivation for complying with the medication regimen, and
possibly suggest to the prescriber a change in regimen if the
information gathered warrants such an action.
In the community setting, pharmacists should be flexible
enough to give or gather information in a variety of situations,
interview or a medication-history time constraints, a lack of
privacy, and noise. Pharmacists can overcome these constraints
by providing shorter and more frequent patient interactions,
making follow-up telephone calls, establishing a private
consultation area, and making appointments with specific
Prescribed Medication Order and Communication Skills 149
patients, if necessary. Information gleaned from medication-
history, interview and counseling sessions should be
documented on the patient profile so that all pharmacists
working in that setting can use the information when making
follow-up consultations and referrals.
Pharmacists can do a great deal to decrease the uncertainties
of illness and drug therapy by responding to patient questions,
clarifying misconceptions, and preparing patients for probable
feelings or events. A patient's past illness experience or
reactions to the present illness contain stressors that may
interfere with the communication process. For instance, patients
may be facing separation from family, loss of important social
roles, permanent bodily changes, feelings of helplessness, and
an uncertain future. A skilful pharmacist, aware of both the
dynamics of communication and the stressors imposed on
patients by an illness, can help patients recognize and cope
with these reactions. For example, a patient’s anxiety may be
so great before a surgical or diagnostic procedure that effective
communication virtually is impossible. Practitioners can help
relieve the anxiety by offering reassurance and a simple
explanation of the procedure.
Disability is another fear that patients may face. For instance,
patient in serious accidents may have to cope with permanent
impairment, and those with heart disease may have to deal
with changes in lifestyle. Nurses, physical therapists, and other
healthcare professionals play a vital role in restoring the
confidence of patients and helping them adjust to such
disabilities.
ISOLISOL
ISOLISOL
ISOL
AA
AA
A
TED KEY POINTSTED KEY POINTS
TED KEY POINTSTED KEY POINTS
TED KEY POINTS
• A medication order is written directions provided by a
prescribing practitioner for a specific medication to be
administered to an individual.
• The different types of medication orders are:
i. Written order on a consultation form, signed by the
practitioner
ii. Written list of medication orders, signed by the
practitioner
Pharmacy Practice150
iii. A verbal order given to a licensed person
iv. Electronic prescriptions signed electronically via a
secured system.
• Medication orders are given on an “as needed” basis for
specific signs and symptoms like:
i. Tiredness
ii. Increased anxiety or agitation
iii. Headache
iv. Coughing, sneezing, fever and itching.
• Medication orders (prescriptions) contain following
elements:
i. Patient name
ii. Date
iii. Name of medication
iv. Strength of medication
v. Dose and dosage form
vi. Frequency of administration
vii. Route of administration
viii. Duration of therapy
ix. Prescriber name and signature
x. Refill authorization
• Communication is the sharing of information, ideas,
thoughts, and feelings. It involves not just spoken word, but
also what is conveyed through inflection, vocal quality,
facial expression, body posture, and other behavioral
responses.
PRAPRA
PRAPRA
PRA
CTICE QUESTIONSCTICE QUESTIONS
CTICE QUESTIONSCTICE QUESTIONS
CTICE QUESTIONS
VV
VV
V
erer
erer
er
y Shory Shor
y Shory Shor
y Shor
t Answer Tt Answer T
t Answer Tt Answer T
t Answer T
ype Questionsype Questions
ype Questionsype Questions
ype Questions
1. Define medication order.
2. What are verbal and nonverbal communication?
3. What is medication error?
4. Write the parts of a prescription.
ShorShor
ShorShor
Shor
t Answer Tt Answer T
t Answer Tt Answer T
t Answer T
ype Questionsype Questions
ype Questionsype Questions
ype Questions
1. Give in detail the interpretation of prescribed medication
order.
Prescribed Medication Order and Communication Skills 151
2. Write a note on importance of communication skills.
3. Mention all the elements of a prescription order.
4. Enlist various types of medication orders.
LL
LL
L
ong Answer Tong Answer T
ong Answer Tong Answer T
ong Answer T
ype Questionsype Questions
ype Questionsype Questions
ype Questions
1. Give detailed information about medication orders. What
are the advantages of medication orders?
2. Define communication skills. What is the importance of
communication skills?
3. Explain the guidelines for the exchange of info between
pharmacist and nurses.
Objective TObjective T
Objective TObjective T
Objective T
ype Questionsype Questions
ype Questionsype Questions
ype Questions
1. Verbal prescription orders are received only by:
A. Ward boys B. Nurses
C. Licensed pharmacist D. Other working staff
2. The term prescribing practitioner can include:
A. Physicians B. Dentists
C. Nurse practitioners D. All of the above
3. To promote rational drug therapy, pharmacist must have
good:
A. Leadership quality B. Communication skills
C. Training D. None of these
4. ________ is a sharing of information, ideas, thoughts and
feelings.
AnswersAnswers
AnswersAnswers
Answers
1. C 2. D 3. B 4. Communication
BUDGET PREPBUDGET PREP
BUDGET PREPBUDGET PREP
BUDGET PREP
ARAARA
ARAARA
ARA
TIONTION
TIONTION
TION
Budgeting is an essential and crucial function for hospital
management due to the continuous changes in the
reimbursement system, increasing costs, and the increased
competition among hospitals. Budgeting is an ongoing process.
The budget is a financial road map for the hospital to use every
year. A budget is a plan in rupees or an estimate of and control
over future operations in the hospital. Budget preparation is a
vital task of pharmacy department of any hospital and requires
all factors into consideration while formulating the budget.
Preparation of a budget is planning which should take into
consideration all relevant facts and figures which are going to
influence the preparation of budget of a hospital. It happens
sometimes that the pharmacist as well as the administrator
takes the problem of developing a sound budget lightly with
the result that they prepare a document which does not serve
its actual purpose leading to lack of flow of money at the end
of the financial year.
The budget has two functions. First, it estimates, as
realistically as possible, the cost of completing the objectives
identified in the proposal. The administrator will use the budget
details to determine whether the proposal is economically
feasible and realistic. Secondly, the budget provides a means
to monitor the project’s financial activities over the life of the
project. In this way, it is possible to determine how closely the
Budget Preparation and
Implementation
16
Budget Preparation and Implementation 153
actual progress toward achieving the project objectives is being
made relative to the proposed budget.
According to the Institute of Cost and Works Accountants,
London, budget is a financial interpretation prior to a defined
period of time, of a policy to be pursued for that period to
attain given objectives.” Halma described “Budget as an
instrument through which hospital administration, manage-
ment at the departmental levels and the governing board can
review the hospital’s services in relationship to a prepared plan
in a comprehensive and integrated form expressed in financial
terms.” Best practices in setting and managing healthcare
organization budgets include:
a. Using comparative benchmarks
b. Setting accurate, high performance department budgets
c. Establishing a culture of accountability
d. Managing expenses
e. Monitoring variances and requiring corrective action plans
f. Employing a balanced scorecard.
The budget is a strategic plan. The strategic plan should be
integrated into a financial plan that calculates cash, debt, capital,
and profitability requirements to fund routine and five-year
strategic plans and maintain financial integrity. The first year
of the finance plan is the current year’s budget. Academic
hospital budgets should be set to obtain at least a 3–5%
operating margin target. Since the budget is a short range plan
for future plans of operations. The meaning and appropriate
use of budget must be clearly understood by those in
managerial positions. The participation of pharmacist is
required in its preparations and their cooperation is essential
if it is to serve the function of a control device over operations.
Before the management undertakes to execute a plan it must
define the purpose of the unit, establish policies for its
operations and prospect of the hospital’s growth. The plan
should be reasonable and thorough with sincere and
conscientious efforts of the personnel attainable. It should not
forecast results, which are not possible under the prevailing
and the future conditions.
Pharmacy Practice154
PREPPREP
PREPPREP
PREP
ARAARA
ARAARA
ARA
TION OF BUDGETTION OF BUDGET
TION OF BUDGETTION OF BUDGET
TION OF BUDGET
Each budget is classified into the following three divisions:
1. Income accounts
2. Expenditure accounts
3. Equipment and construction budget
1. Income (or revenue) accounts: A commonly used method
for determining the income may be the maintenance of
daily, weekly, monthly or annual accounts to get the total
cost of the pharmaceuticals issued to various patient service
as well as to special services departments. Thus, the average
total sum up represents income of the department from
various sources. Generally, the income in the hospital
pharmacy is limited to the sale of drugs to inpatients as well
as outpatients. It further depends upon the type of patients,
i.e. category of patients:
1. Those who will give full payment
2. Those who give partial payment
3. Those who cannot pay at all
4. Employees of the hospital
To provide detailed statistical data, following steps are to
be considered:
1. Number of prescriptions received according to the
categories mentioned above.
2. Total number of prescriptions dispensed by each
pharmacist.
3. Number of working hours.
4. Medication cost per prescription.
5. Medication cost per patient/day.
6. Medication cost per clinic visit.
7. Average drug cost per prescription.
8. Average salary cost per prescription.
9. Average supply cost per prescription.
10. Prescription volume per hour of service.
11. Hours of work put in.
Although ‘income’ is considered as a single figure by the
beginner, it is important to understand the derivation of the
figure. Generally, income in the hospital pharmacy is limited
Budget Preparation and Implementation 155
to the sale of drugs to inpatients, ambulatory patients and the
departments of the hospital.
2. The expense accounts: Fixed expenses generally remain
fixed or same at all levels. Expenditure accounts are further
subcategorized into the following expenses:
1. Administration and general expenses
2. Expenses for professional care of patients
3. Expenses for outpatient
4. Emergency expenses
5. Miscellaneous expenses
The department of pharmacy is normally listed under the
category of professional care of the patients. For accounts
purpose a suitable code number mat be given to these
categories.
Pharmacy department prepares expenditure accounts using
following expenses:
1. Salaries and wages
2. Supplies and materials
3. Drugs and pharmaceuticals
4. Purchase expenses
5. Miscellaneous expenses
1. Salaries and wages: This includes salaries and wages of
(i) pharmacists (ii) assistants (iii) clerks, and (iv) others.
Salaries and wages include complete break-up of all
salaries and wages paid to permanent and temporary staff
(full time and part time).
Fig. 16.1: Component of a budget
Pharmacy Practice156
The chief pharmacist should subdivide the above
mentioned posts into further three categories, viz. adminis-
trative, professional and non-professional staff. It would
prove useful if a chart is prepared of these posts, etc. In a
tabular form so that an overall view can be presented
at a glance. The chart should separate the full time and
part time staff in administrative, professional and non-
professional categories. The total of these expenses
constitutes the anticipated salaries and wages, expenditure
for next year.
2. Supplies and expenses: It is important for the head of a
department to have a readily available the rupee amount
budgeted for each expense code for the financial year. The
head of department should prepare a financial statement
showing amount in rupees budgeted for each item pre-
senting actual cost of materials and supplies. This helps in
preparation of estimate for the next financial year. If the
budgeted figures and estimated figures match each other,
that means the previous budget was well prepared. On the
other hand, if the figures are different, it needs re-evaluation
of the previous budget as well as estimated budget. If the
pharmacy department is required to participate in the
expansion schedule of the service, e.g. dispensing to new
clinics or manufacturing a new product, etc. Then the chief
pharmacist should ascertain the costs of materials and
supplies to be used in the new work scheduled to be
undertaken and provide them in the new budget.
3. Drugs and pharmaceuticals: Preparations are categorized
as those dispensed by hospital pharmacy or those in OPD
emergency and other department charges for the latter are
submitted to the respective department. It may be classified
into:
a. Those dispensed by prescriptions or otherwise from the
hospital pharmacy department.
b. Those used in the outpatients and emergency and other
departments.
The latter should be charged to its respective department
and not in this category of drugs and pharmaceuticals.
Budget Preparation and Implementation 157
4. Purchase expenses: This account should include the cost of
prescriptions (excluding those intended for outpatient)
purchased from an outside pharmacy in case the hospital
does not have its own pharmacy.
5. Miscellaneous expenses: Miscellaneous expenses include
glasswares, labels, stationary, uniform, repair and mainte-
nance, etc. In practice, there should be a close liaison
between the chief pharmacist and accounts department for
maintenance of statistical data.
IMPLEMENTIMPLEMENT
IMPLEMENTIMPLEMENT
IMPLEMENT
AA
AA
A
TION OF BUDGETTION OF BUDGET
TION OF BUDGETTION OF BUDGET
TION OF BUDGET
1. As budgeting is an essential tool in the process of planning
and control and is an instrument of forecast to achieve
objectives. It is not only the responsibility of the budget
division but should be the joint effort of a committee
consisting of the heads of all the functional departments.
2. Needs for the implementation could be clearly illustrated by
comprising two captains sailing down a wide and shallow
Fig. 16.2: Information flow among components of budget