birth wei~ht inf Ants: the absorption of rA lr.ium 1uul fa t . l'edi(cid:173)
`ot1ic1. 1\176; 57:16- 25.
`9 Rowe JC, Wood DH, Rowe OW cl al. Nutrilional hypopho,.
`phatemic rickets inn premature inronl fed brcaSL-milk. N Engl
`J Med. 1979; 300:293-6,
`10. K11lkorni PH, Hall RT, Rhodes PG ct ttl. .Rickets in very low
`birt.h weight infant~ . J Pediatr. 1960; 96:249-52.
`I I Oily GM, Chanr.e GW, Radde IC el el. GrowLh and rnin~Jal
`metobohem in very low birth weight infanh. II. Effects of cal(cid:173)
`cium supplementation on growth and divalent catinns. l'edialr
`Rei. 1975; 9:568-75.
`
`12. ){niehL P,J, Ruchnnan S, Clatwo1lh) W Jr. Colclum nncl phoo
`phste requirement.. of prcterin infanl6 who requi r~ p rolonged
`hyperalimcnlation. JAMA 1980; 243:1244-6.
`l:J. Schuetz Dli, l<ing JC. Compatibility nnd sta bility of electro·
`lytes, vitamins, and antibiotics in combination with 8% nmino
`acid solution. Am J Ho•p Pho rm. 1978; 36:33-44.
`14. Weast It, ed. llandhouk of chemistry and physics. Cle,·elunrl:
`CRC Pre§~; t976:B-100.
`to. Henry HS, Jurgen" RW Jr., St ur~eon R el al Compatibility of
`Clllciurn chloridt and calcium gluconate wiLh sodium phosphate
`in a mixed 1'1'N solu!-ion. Am,/ Hn~p /'harm. 1980; 37:673- 4.
`
`Review Article
`
`""' J tlu._p t'barm. ltl2; :.W-'3 10
`
`Review of computer applications in institutional pharmacy-197 5-
`1981
`
`Ken W. Burleson
`
`A literature review of <"OJnpuler applicnlions i11 in:,tilulional pliRrmacy, coveri ~ paJ»tH& puh
`liahcd from 197& to 1981, is presented.
`Articles nre ca tc~oriied a• comµuter concept.., Hpµl ications to ndininistrntivo functionb, con(cid:173)
`Ltollcd substanc<'5, drop, cliqtribution ~yot~ m • (mrluning on-l inr •nrl off-line services, intrnve·
`nous admixlurc •ervices, and nmbulattiry •ervices), drug information, clinical services (inrlud(cid:173)
`in~ drug-use review, dru~ int.cractions end thernpeutic incompatibility surveillance, and p har·
`macokinetics), and pharmacy-related epplicotions developed by nnnpharmacists.
`Before 1910, computer applications In lnstltutlonol pharmacy reported In the literature were
`largely single-use applications. After 1976, many report..~ describod Lhe int egration of individu(cid:173)
`al applications into sophi•t.ic8led •Yolemi. that •upported ma ny function•. '!'here ill •till H 11-1
`for good cost justificnt!on stud ies of compulcri2alion in phormacy.
`
`Index lerms: Administrnt.ion; Automat ion, dota processing, computers; Controlled sub·
`sllnre•; Omg distribution systems; Drug infom111tio11; OruR i11leructio11s: l11compA t.i hilili ~-';
`Pharmacy, instit utionol
`
`In the past 20 ycurs electronic cl11t.i 1m icessing (EDP) in
`huspiu1l phnrmncy hm; grown rrom upplit~ution~ that im(cid:173)
`provrd uccounling procedures lo sophiRl.icate1I multifunc(cid:173)
`tional, int~grated syslem.c; for instit.ulimrnl dn1g nmtrnl and
`clinical pharmacy support. Early innovators were hospital
`pharmacists who applied computers to accounting nnd
`billing functions. Howrver, as pharmacists hecame aw11re
`of the benefits of automat ion ond os !.hey gained ci.pertisi:
`in the fie ld, applications of EDP become varied. lnnovotive
`a1>proachcs to pharmacy practice h11ve been ins tituted thet.,
`
`Ken W. DurleJion ls J)irl'Clor. Phnrm~cy Strvku, Cot1wba C-Ount.Y Me.morial
`Hoopi11!, Hickory, NC: 20601.
`'l'hc P.$~L-.aenu of the librnrmns of the- Aioo Health E<.lueatkm Center
`(AHFC), Cawwbo Counw Memorial J luspitttl, in performin~ the litef'Slu r ~
`.cercl>ts; Rihcl Hill fo1 >tcreturiol help: and Mor. try Ad•m•. M.S.N. lor
`crilica1 review it. •cknowledt;ed
`
`Co1Jyrigh1 f; 1982, American Soc1~ty1i 11m11itnl Pl1nnr111ci' '"· Inc. All ri,hW
`n. ~cn.'t'CI.
`
`without uutomution, would be loo time-con sumini:, loo
`coslly, or loo difficult t-0 implement. A11tom11tetl drug coutrol
`system s, medication delivery S}'1!lems, and support of clinicul
`services are exam pit:> of thesu Hpplicetions. lnwresl in au(cid:173)
`tomation for pharmacy practice hos stimulated vendor~ of
`commercial systems to drvclop hardware and softwnrc
`packagt:8 rle~igncd for 1>hormacy.
`The ex1>nnded use of electronic dulo processing in phar(cid:173)
`m acy practice has been d11c lo hoth the development of more
`sophisticat.ed hardware and softwaro during t he pest 20 y~ars
`end the experiences of individual prnctilioncrs in applying
`EDP t o various sogments of prMtice. The literut uro has
`contributed s ubstontiolly to the increasod awareness of the
`individuul pharmacist of the benefits of automation. Jn 1975,
`!(night a nd Conrad ' published nn extensive review of
`pharmacy 11pplications of electronic dote processing made
`l o that lime. This article reviews those applications m11dc
`from 1975 to the present
`
`0002-9?89/8210101-005~$04 . 60
`
`Vol 39 Jan 1982 American Journ•I of tiospllat PMrmaci• 53
`
`CFAD VI 1016-0001
`
`

`
`Computer Concepts
`Oata processing concepts and technology arc a reas in
`which few phnrmacisL~ have had formal training. They
`should l>ec<1me familiar with fundamentals of systems
`analysis, design, and computer technology prior lo involve(cid:173)
`ment with npplic:1Won development. A number of a rticlus
`hove described the basic conceptg of datn processing for the
`phurmncist.
`Nolson2 prc~onted nn introduction to computer hardwnre
`that could be used in a pharmacy system. He described tho
`vurious hardwnre component~. including the central p ro
`<:csfiing unit (CPU), input devices, and dntn storage devices.
`/\dvnnla~es and disadvantages of different componrnti. were
`prcKentcd. Downtime, system security, and vendor ftysterns
`cvnluntions were discussed. He also presented 11 dictionary
`of <:(lmputcr terminology. Meh!!•outlincd the minimum re·
`quirrments for a pharmacy data pra<:essing system. He
`compmed ;idvnntages of centralized versus decentralized
`systems, and cxruninc."<l lhe methods of dole entry and types
`of drug coding for developing 11 data base. I le also empha·
`~iicd the need for order verification to prevent e11ots
`Computer h:mlwarr configurntions runge from the Jorge
`m11infr11mc rompnter Lo the minicomputer lo t hP most r~nt
`d .. volupm~nt in the field, the microprocessor. Given the
`premise that the pharrnaci~t has a choice in the selection of
`hardware, an understa nding of the advantage~ anu disad (cid:173)
`vantages of each can be essential to the development of o
`successful application. Knowles• explained t he differences
`between mainframe sy~tems and minicompuler~. Lauer ct
`al.~ cxplnincd the apparent- and subtle differences between
`a mainframe computer shared with other users (shared
`system) and a stnnd-alone dedicated minicomputer aystem
`for pharmacy, particularly in regard t6 ambulatory phor
`macy practrcc. Advantngcs and disndvantogcs of each ron(cid:173)
`figuroWon were presented. Data storage wBS found to be the
`most serious d rawback to u stand -alone system, a disad (cid:173)
`vanwge that could be minimized with a properly de~ig ned
`system . The authors concluded that in most situations for
`ph~rm acy prnctice, either conrigurntion could provide ad·
`equate support.
`AnoUicr configurntion is a phannucy application devcl·
`011ed as 11 t>Hrt of o iota I hospital information system (HIS).
`Ball ct ul.G examined the pnst, present. nnd future develop·
`ment..• in hospital clnta proce-«.•ing ~yslem.~. frum tilnnd-ulone
`phurmncy sybt~ms to IHrge hospital infor mutiou systemH.
`The authorN prctlii:tcrl t hal in the immediate futurn, many
`phy5kians woultl have terminals in their offices interfaced
`wi th hospital informutio n systems. Mecklenburg7 described
`the expanding applications of hOfipital information systems,
`includin11 pharmacy and other clinical applicationR.
`An im1>0rtont concept for the p harmacist to understand
`before developing an npplicatiun is the methods used to
`justify the need for and cost of a computerized system. Al(cid:173)
`though many articles h:ive hcen wnlten describing the vnried
`applications of comput.urizatio11, few o.-Licles have de:;cribed
`controlled documented studies to justify the cost and eval
`unle tho elfccl~ of o computeri1.cd system '!'he fact thut
`evoluat ion of systems nncl inlensi\"c cost bcncfil studies have
`
`54 AnlCfk:on Journol of Hospital Phormaoy Vol 39 Jen 1982
`
`not llecn nccomplished may he a major reAson why t hcte hos
`not hcen n greater acceptirnce of pharmacy systems by hos(cid:173)
`pital administrators or pharmAcists. In 19'/5, Gouveia& re(cid:173)
`viewed the few studies to elate that had allempLed to analyse
`the effecU. of computerization on hospital coslil, medication
`errors, and patient care. He found that the few studies
`published actually raised more questionh than they an(cid:173)
`swered. He emphasized the need for research to establish
`udequatc cost-benefit ratios lo justify computcrizntion to
`hospital administrators, patients, and third 1>arty payers.
`Since thul time, other studies hove hecn published de(cid:173)
`scribing tho steps involved with nnulyzing and justifying the
`need for ond ~t of comput.erization. ~'reihrun9 anelyzed a
`traditional ph11rmncy system in a 360-bed hospitnl. H e
`identified procedures needing improvements and examined
`alternate manual and automated appro.;ches for change;
`areas in which automation would offer potential savings;
`developed a ntting scale for vendors; and described steps
`involved in successful operation• analysis in a pharmacy.
`I<ay eL al.10 described the method used to Hnalyse a hospital
`phormacy's need for automation u11d identify the vurintt•
`arens where automation would he1wfit hoth pharmncy nncl
`Lhe hospital. '!'he impact of t.hP proposed system upon other
`nrens of thP hospital were also listed . Costjustification for
`a dedicated mini-computer was devclo1ied. The authors were
`successful in just.ifying automation of the phnrrnacy de(cid:173)
`partment, ba~cd upon a potential cost savings and nn im(cid:173)
`proved' medication delivery system.
`Neal 11 developed an in-depth 008t proposal to justify to
`hospital administration tho compulcrizotion of o hospital
`pharmacy. He Identified seven areas of tangible cost snvings
`(reduction in coRts;, elimination of ealories paid, increased
`revenues) and two arcaR of intangible savings (reduced
`overhead, labor reallocnWon) He was able to project tangible
`dollar sovings to eoch of these areas. He fou nd that 11uto(cid:173)
`molion of the department would resul~ in a substantial cost
`Mvings. He olso described the various steps in developing
`end presenting thr analysis lo hospital administration.
`Grny11 evnlualL'<l the cost of computerization of an i.v. ad(cid:173)
`mixture service in a hospital pharmacy. Staffing analysis and
`life cycle cosL projection were determined. Workloads and
`staffing patterns both with and without the comtmler wt<rl'
`Clllculated. The basis of the study wus lo determine the
`amount of money thaL could be invested inn r.omputtr sys(cid:173)
`tem a• justified by b1affing reductions ond other snvings. '!'he
`1111lhor's corn:lu~io11 wm; that Um computer was cost effective
`anii, thl'rcforc, shuuld be pun·hased.
`Lauer13 gave an overview of the need for automation in
`pharmacy practice and the benefit..~ to he reolized from
`computerization. Three areas of savings as a result of auto(cid:173)
`mation-
`time, space, and personnel costs- justified the cost
`of computerization.
`Two authorR have described the met.hods of dealing with
`vendorR of computer syRtems. Olsen et al. M described the
`method used to select an upgraded computer system thnt
`would tiUpport an automated clinical depnrtmcnl in the
`hosp ital Although the article dealt specifically with an au(cid:173)
`tomated laboratory sysiem, the nuthcin; prcsontcd o general
`
`CFAD VI 1016-0002
`
`

`
`discussion o r vendor~, vendor selccl ion, S>'Stems rcquil'tl·
`menb, lerminal requircmenls, and hardware and soflwarc
`lhnt could ho used by lh( phannacisl in selecting a pharmacy
`system. CuLely1r. prcsent.ed an ei.tonsive list of 1iucstions a
`phnrmaci~L should ask a hardware or soflwere vundor of a
`comme1cinl system when considering the p111·chase of such
`o system.
`Before IJcginning d evelopment or ony a ut.omnlcd nppli
`cations, the phorrnaeisl mnsl develop a duta liase, or drug
`file, list.ing oil the drugs lo be round in the pharmacy, nlong
`with 11ny information pertinent lo Lhe del!Criplion of each
`drug. The method in which o dnlll hasc is developed can
`mean the rlifference between a nexihle system with the
`ability fo1 eKpandcd npplicalions a nd a rigid, single appli(cid:173)
`cation system. Hanson et nl. 16 have described the develop·
`1111•11 t or 11 111usler ti rui; filp lhnl was developed by examiuinl(
`:m existing compulerize1I 1lrug duh1 Cile Lo determine which
`existing fielcl•rnr information shoulcl hr 1·P.t11ine1i for thf' nrw
`dalll base. The new dau base WM dcvclopecl to support in(cid:173)
`creasini:ly sophisticated pharmacy applications. Twenty(cid:173)
`sel'cn dnto fields for the masl1<r drug file were identiried.
`l'rogrums were written to permit entry und maintenance of
`the I 1le by using 111111<:hed cards input to :m ofni.11c compul.er.
`The nulhors envisiorwd using online entry or dntu through
`a c:t thodc ray tube (CRT) in the Cutul'C. Pro~ram6 were
`written thut permiLtod m11cl11n~ vcrifi~at.ion or data ac·
`cord mg lo predefined ~pccrlications. Any error• t..letcctcd
`were rejected for correction. Tl11& editing feature resulted
`in" high dc~ rec of ncc11r11cy of the ~lorcd do LO. Strand cLol.17
`dcvelot:>ed 11 master drug file after w11111arin!( commcrcinlly
`arnilable data bases which they found to be d eficient.
`Twenty-seven different dal<l ficld6 wcrn identified ond in(cid:173)
`formation for each lhug tnlered lo a coding form which was
`used for data entry. gntry was nnlinc via a cathode rny t ube.
`The dole hose wos u~~I to su11po1·t certain administrative
`and drug clistrihut.ion programs fur hoth inpalient and
`ouqmticnt services. The author>< alMo rxami11Ptl tlw 1·0ML of
`tJw dl'vr.lcrpment of t he file. They found lllRt morn thnn !lOO
`hours were im•olved with the devclop1111:nt, at n tolnl salary
`cost of $8451. This calcula ted tu $7.4:i per line item in the
`dnta ba~c. Although thi~ rost wo~ twicl" that of n rommer(cid:173)
`ciolly available dnta base, the a u thoni thought that t hu ad(cid:173)
`ditionnl data fields lhaL were avoilnhlc lo lhem justified the
`cost.
`The American 8ociety of Hospilol Pha1macists p rovides
`a computcr-gencrolcd, mndiine readable dole hnse cnllcd
`Drug P roducts lnformntion }c'ile (IJPIJ•')• for use hy phar(cid:173)
`muci~L• in computeri?.ecl syslcms. ~'rnnkenfcld lti examined
`U1e problems n~ociot.cd with lho Nationul Drug Code (NOC)
`sy~tcm as n pharmacy data hose aud the polenliul for in
`terfacing it to DPrF'. I le explained the adv11nlnges of rross(cid:173)
`refercncinK the informal ion in the two riles.
`
`Administrative Applications
`
`B1:1·ttust> of Ll1t> romp11tw '• inlwrt>nl nlrility to quickly
`1<1hulot.t> nurneri<·nl 1lnlll, 11ntl to i;t1u t', rol.rievc, nnd compile
`slntistien) infnnnnlinn, t't!rl!l in uuminislrati\'C runclion~ ore
`
`lclenlly suilc>d to uulomulion. Am(111g the"'"' fu11ctio na or(!
`p111ic11t hillini:; nncl ncc."Ounling, drui: use re\icw, and imcn
`tory rnnlrol. A number of 111ticl~ liovo dcbcribed upplica
`I ions or RDP in tht'W lll'CllS.
`Silve1mon19 described tho ndminislrnt ive functions tlint
`could IJc nutomnlcd usin,:: a dedicated minicomputer.
`Amoni: these upplicat.ion~ were personnel mono~cmcnl,
`pet icnt billing end accounting, and inventory control.
`Wue~l and SchnengoldW described an automated ac·
`counting system shnred by two hospital phnr1nacies, using
`11 lime-shared computer system. Oat.a were entered from
`dispensing l't.'Cmds showing all transactions for each phar(cid:173)
`macy. The sy•tem l(cncraletl n m onthly report or ex1JC11seb
`for chargeable patient drUI{$ and nonchargeable fioOI Klock.
`Drui; use statistics from this report wert> used for pnrcho,•i11g
`UllU inventory cunt roJ. 'l'hc sy>HPm also printed II formulary
`for euch ho~pit,11.
`In a hC18pital without dAtH proc·e,~ing capability, Rlliott21
`eonll'ectecl 10 use the comp ute1 services of a local drug
`wholesaler t u d evclo() an inventory and purchasing system.
`T he wholesaler's progta ms for inventory control were
`rnod ified to ndnpt lo the special needs of the hospital. All
`drui: issues lo stock from mvcntmy were muuually recorded
`on an inventory master lii;l by o clerk and tl1i.~ wa.~ sent. to the
`wholesaler for keypunching into lhe R)'fltcm. A weekly
`computer -i;c•nurnled report sum mnrized the use of each item,
`ond lhis list served Mu slock slnlus report v11d µurclrnsc lisL
`Each item lhut hou 1eac:hed o prcdet.ermined order point w11s
`llit11Kcd. Items supplied by the wholesaler were autom11lically
`shipped and entered into Lhc computeri:r.('cl inventory. Or(cid:173)
`ders lo d irect \'t:ndors were completed by the pharmncist,
`workin;:: from the report. 'l'he system also generated a hos·
`pil 111 fonnulury h_v use of therapeutic cat.ei::ory coding. Buth
`an alphnhet.icnl list.ing and 11 lisl ing by ther11peuticcatcgories
`were ovailolilc.
`Pickup ct 111.22 ul ili1.t•d tlrt! Massachus1•lls General H o~­
`pit 111 Utility Multi-Progrnmming Syi;tem (MUMPS) todc(cid:173)
`velo11 pro1mims tn control ward stock levl!ls 11nd con t ributf>
`to worldri;1n 1111alysis in a quality control s•:ction of n hospit.al
`pharmacy. The system was programmed to determine each
`hos1>ital ward 's minimum stock levels, ha.<:e<l u1>on hii,torical
`drmand and the ahility or tho pharmacy to r<:Spond to the
`needs ol the l'Orious wards. Jlosults showed that the system
`could reduc~ tho inventory of drugs on the nursing units,
`thereby i;ffccting a cost sm•inHs, wilhnul any deterioration
`of service or inconvenience to the nursing u111ts. T he system
`nlso handled doto concernini; row m11tcriols in the quality
`cuntrul ~eel.ion. l l wos determined that 11 time savings could
`he realized by automating some of the reports in this area.
`Automated patient hilling has been a feature of ho.~1>ilal
`computer i;ystems for many yc11rs. This i~ one of the earlier
`applic.utions lo wh ich P.DP wns app lied in pharmacy. Trn(cid:173)
`deau2!l mocliried an t::xisling time-shared payroll and ac·
`l'Ounling ~ystc:n lo provide drug use review and patient d1 ug
`hilling. Tht: timcS1wed from these nppli1·ntio11s was used lo
`pf>rmil the phnnnnry to cu11111l~ll' A hospillll-widP t r11d it ional
`unit <loHI' syst em. Thi' author clid not,use Uw computer cli (cid:173)
`rer1ly lo ~11P1H11 l I he unit dose system. Priest2~ used com-
`
`vol 39
`
`,Jan 1982 American Journal DI Hospll•I Prwf1lilcy SS
`
`CFAD VI 1016-0003
`
`

`
`Comr"'er •ppUce1lon1
`
`puler- printecl gurnmNI la heh, lo he Rltuch~d LO inlnwenou'l
`lluids nnd other pha1m11t·y patie11l r lmrge ilems lhal were
`kept a 8 floor stock on tht> nursing units T heEe gummed
`s licke rs functioned as n charge vouchrr HS well as o stock
`replenishment mechanism 1'hc author concluded that the
`sy~tem aided i11 the capture of more ch arges, wh ile simu l(cid:173)
`t.ancously saving personnel time.
`Fish25 deocribecl a computeri:ied patient billing system
`lhnt was hosed on a combination of 11 percentage markup of
`drug cos ls pluR o dose fee. Seven different dose fees (fuctors)
`were used, depending upon the type.of drug produc t ad(cid:173)
`rninisLered lo the patient; e.g., ort1I unil dose, injectable unit
`dose, and i.v. addith•e!I- Manual poti~nt. profiles were used
`for 11 unit dose medica tion system, and cumulative chn rgc.'l
`!or each pa tient were ma intained on these profileb. Al the
`time of patient discharge, the profile for the patient w11s
`inactivnled a nd llll drug charges were added. A pharmacy
`technician also entered l he patient number, computer drug
`code. and do~e factor fo1· all drugs. '!'he profile was then sent
`to the pharmacy pridnA area, where the chnrgeh were entered
`into die rompuler viu ,i c11lhodP ray tuhc. A final patient hill
`w11s produr.etl as R rP.~ult of clntn tmlly. 'l'he system offered
`advantages of an accurate, ile111ir.t'rl sllllemr.nt; ch111-g~~ were
`equitable, hased upon the type of drug ndmini~tere1l; Rnrl
`the system p roduced useful stalistical reports. 'l'he lime
`required to enter charges manually int.n t he system was a
`drawback, and the author proposed 11n automated unit dose
`system that would eliminate much of the manual daLa
`on t ry.
`G urtcl e t al.2ll projected drug use review statistic~ for a
`phnrmacy and therapeutics conuniLtee to ure in determining
`the benefit of adding a n11w drug Lo the fomn:lary of on am(cid:173)
`hulatory patient core clinic. A computer supported ambu (cid:173)
`lutory pharmncy system WttS used to dct.ermine if u new drug,
`ticryn11fen, a diuretic with uricosuric properties, would
`hcnefil patients in the clinic. The computcrii.cd patient.
`profile was used lo determine lhe number of patients lnkini:
`o diuretic who were also Laking a uricosuric agent, to deter(cid:173)
`mine how many pa tients cou ld benefit. from !he new drug
`which offered both therapeutic act.ions. Computer analysis
`revealed that only 8% of the patie nts on 11 diuretic were s i(cid:173)
`mul!.llneously receiving u uricosuric ugent. In view of the cost.
`of the new drui: and the limited application, as ~huwn by
`mmpult:r nnalysis, thP. pharmacy and lhernpeut.ic~ com(cid:173)
`rnilti.e chose to adtl the drug only on a restriclt>..d formulary
`status. T he drug was eventually prescribed for four 1.ldt.ic11U<.
`Lat.er, the drug was recalled from Ow m arket. because of its
`adverse reactions. 1'he computer was used t o search t he
`patient profiles for those patients receiving the d rug a t the
`time of recall, so that t heir physicians could contact them
`and make appropriate changes in thera1>Y· Thi. authors
`concluded lhat the use of the computeri:ied patient. infor(cid:173)
`mation system e nabled the p harmacy and therapeutics
`committee to prevent t he potential axpo~ ure of more thnn
`160 putients to the od\'erse effects or tho drng.
`Nol oil udministrntivc a pplications or datn processing
`must be developed on a computer. Word processing equip(cid:173)
`ment is similor t oo computer, with the exception that word
`
`58 American Jol!fnol ot 11~spltel Pharmacy Vol 30 Jon 1982
`
`prucPssing equipment ord in:i1 ily ha> no h11ilt·lll logir. Th"
`system is used for storage of small amounts ol dnla and re(cid:173)
`LriPval and printing of Uiis information on a repetitive hasis.
`Letcher2'I compured rhref! different comnrnrcinl lmmcls of
`word proces'ling equipment l<l vorious apphCJ1tion~ in hos(cid:173)
`pital pharmacy. The application~ stud ied were label pro(cid:173)
`duct ion; storage of personnel informa tion ; scheduling of
`repetitive l esks; and composition of narrative information,
`such as drug bulletins and procedure manuals. 1 ' he evalua(cid:173)
`tion included keyboard design, disk storage capabilities,
`software, print format., and security of data. One of the three
`systems wos clearly superior l o the other two becausP of its
`flexibility of 11pplications. 'l'he author summari7.ed the re(cid:173)
`sults of t he evoluut ions of each machine.
`
`Controlled Substances Appllcallons
`
`Cont1olled substa nces arc defined as those drugs which
`ha"e the potPntial and liability fm abuse; i.e., narcotics and
`barbiturate>. Federal 1md ~ tnte L:iws require that pracli(cid:173)
`t ioners who di,pense the,e medications maintain records of
`dispol>ition for all drugs u11dcr lh1s rcgul11t.ion. Because of Lhe
`large 11u111hcr of drngN in !his c-nwgory, proper rncorrlkecping
`has bP.tm t ime-cnnsum mg for hoth l he pharmacist a n1l
`nursing personnel. Aulomolion of this segment of practice
`can reduce time involvement for both the pharmacist and
`nur..e, while maint.aining accurate cont rol and occountAbility
`records as required by law.
`Petolett.i~; used an off-line ~ystem in un outpatient clinic
`Lo monitor for potential abuse of controlled drugs hy JlB·
`Lien ts. D1gpensing dala wcr<: entered on a source document
`for each prescription dispensed. These d11ta we1e key(cid:173)
`punched weekly, ond re1iorts were gencrol.cd thnt notir1ed
`U1e phnnnncist of those pnticmls receiving excessive supplies
`of controlled drugs.
`McDanicl211 m odified an cxis tini: potientaccounting sys(cid:173)
`tem lo develop on automated recordkeepin,: system. All
`controlled drugs were assigned specific service codes within
`a designat ed group of service numbe rs. A separate file was
`set up in the com put.er for this group designation. As charges
`were posted to the patient's account, records of cont rolled
`drugs dispen•ed were created. Daily and cumulative monthly
`l'tJpurL• wen: print.ed , which showed distribution uf con(cid:173)
`trolled drugs Naz7.aro30 developed 11 prngrnm on an off-line
`compule r w provide >i('<;uratt- records for controllLd ~u b­
`sla.nces account.ability, while n.Jucini: m11nuul Lrnnscriptions
`involved with recortl maint e1111nce. The ~ystem was used for
`hoth inpatient w11rd stock And outpatient pre~criptinns in
`a m ilitary hospital. All prescription trans actions were re(cid:173)
`corded manually on punched card~. a nd included patient
`num ber or hobpital ward code, phys ician's identification
`code, drug code, and quimlity of drug dis pensed. All d ata
`were later keypunched oml entered into the computer.
`Various records were genera ted hy the system, including
`perpelunl records of ench drug by pa tient or ward, monthly
`inventory of all cunt.rolled sub~t~nces, and wnrd m onitorini:
`lists of excess stock of controlled subsLances. 1'he svstcm
`could ulso search for pre~criptions by pa tient or prcs~riber.
`
`CFAD VI 1016-0004
`
`

`
`Shnvcr et a1.:11 described11 system for un inpoticnt and out·
`pat ienl milit111·y hospil 11l phorm11ry which used limited
`compulc1· hardware. The syslem was run on 11 remote
`mttinf1nmc computer throui:h n te leph one hookup. A phar(cid:173)
`macist or technician entero:cl e ll trausncLions daily via 11
`cathode ray tube. After dat.11 entry was complete, all trans(cid:173)
`actions were verilit:d before the update 11rogram was run, to
`1.nsure accuracy of information. The system generated a
`numhor of report..~. including tra11sn1.-tions by drug and cur·
`rent inv1mtnry hAIAnCP.~. IL also 1wrn1il INI p11l itmL cl rug usP.
`screening and physiciHn prescribing Ncreening to monitor
`for potentinl d rug nhuse. 'l'he system wAs c11pnble of lying
`in Lerminals at other military hospilals.
`J"inally. Oickin~on~2 re1iorted how the Drug Enforcement
`Agency used computero to map entire states t o show drug
`distribution, tn pinpoint areas of potentiAI drug nhuse. Data
`a re obtained from two sources-the Automat ed Rerx>rling
`a nd Consolidated Order System (ARCOS), which showi;
`drug distribution from manufocturets and whnlesnlers t.o
`pharmacies; and the Drug Abuse W11rni11g Network
`(DAWN), which lrnck~ drugs lrom selected hospital emer(cid:173)
`gency room,;, A II dnln were entered into th~ compuler and
`anuly1.ed The rcbultnnL output w11~ disl.ributed to ))~A field
`offices ond other local 11nd state law enforcement officials
`for follow-up.
`
`Drug Distribution System Applicatlons
`
`' l'raditional 11um\1nl drug distribulion systems nre time
`consumini::, involvti much clerira I work for hcoth plumnucisl
`and 11urse, 111111 t+md to he error-pront'. Autonrnt iun of lhti
`mt!cli1·atinn rycle cnn provide substantial benefits to the
`phar1naci:,l, uur!\t, and fJlllitn\. by 1~Jucing Lht muuunl or
`cleriCAI work invoh'ell with maintnining o medication syst.cm,
`reducing errors, improving administrative control, !ind
`freeing the pharmocist for more clinical involvement.. Much
`work has been done in uulomnting variouR ~egments of the
`medication cycle. Mnny pharmacists have oulomoted one
`or more procedures involved in medication delive1y. How(cid:173)
`ever, prior to 197&, only :1 few systems hnd integrnted lhc
`various components of the cycle into o completely auLomated
`medicntion delivery system. Since thnt time, Bcvcrnl nrlicles
`hove described the d evelopment and npplicotion of t ot al
`S)'6tems for automated mcdicntion delivery. This increased
`development has been due, in part, t.o the reduced cost. of
`hardware necessary to support an automated medication
`delivery system und to the ent.ry of vendors thnt provide
`hardware nnd software packages. Yet, the use of EDP in t he
`medication cycle is not extensively employrd by hospitals.
`Stolar,3S in~ 1978 notional survey of hospital pharmacies,
`found thal uf the 738 reporting ho~pituls, only 13% of I.he
`large hospillll8 u11d 5% of the smull lmspilals u~c<l computer
`systems in the drui: dispensing proces~.
`The imporloncc ofF.OP in hospital drug delivery syslet:is
`um! the role of the pharmnrisl in implr nwnting iL<111sr l111s
`been recognized by the America n Society of Hos )lit.al
`Pharmacists (ASHP). The ASHP Statcmenl on Hospilnl
`Drug Control SystcmsM sta t es, "The pharmacist s hould
`utilize EDP Lo decrease the m ony lraditional pnper-handling
`
`Cornpultt •PpllCMlons
`
`chorea Ao th.ti h1~ clinicr.I role 111uy b~ ert'ccl ivcly Pxpu11d1•cl
`und hib t11lenl.111ttilized properly." Thi~ l}Os ilion st.<1lcmcnt
`ulMo outlined Lhe many applir11tionR of RDP lo )lhnrmacy
`practice nnd Lh~ role of the pharmncisl in systems develop(cid:173)
`ment.
`Off-line Medication Sybtcms. Pt im to 1975, tmrny
`automated medication dist rihutiou bY~lcnL~ \\Cr!! deVt:lupe1l
`utilizing off.li ne systems, 11rnnlly hy rnoclil:vin~ 1u1 Hxisting
`hatch process accounting ~yslem lo provi1le ph11rn111cy ap (cid:173)
`plicatio11s. l111P('Hnl.yt!1irs, mnrP nnd morP pharmarisL~ havt>
`had access to on-line computer syst1<ms, and only a few au(cid:173)
`thors huve drscrihcd thr development of systems using
`off-Jin~ 1·.,mpmer hardware.
`S" ift~& dN:crihed o semi-automntcd nppronch l.o n unil
`dose system, in which punched carcls were used lo p10\•1dt!
`informal.inn for medication cart filling. &!ch d t ug order was
`transferred in writing hy n pharmacy lt!cl111ician to a
`1>1mched CMcl, called the masler do~e cnrd. After verification
`of the lrnnHcript i(l)t hy a phrmnaciBt , l he dotn were koy
`punched onto cnrds. The cards fur ench putient's medic1t
`lions were then pl11cod in l he )Jroper meclicotion cart. drawer.
`T hese cards were color-coded by drug lypc nnd a lphabelical
`name• to simplify cart fill ing 'l'he technrci11n~ Ii lied a 24-houi
`supply of medico lion from the informa tion on the cards. The
`doily churi:e data were lhtn entered m11nually on each card
`fur the 11mounl or drug dispe nsed. After Lhc pharmacist
`cherkcd the medications in the t·nrt, u•in~ the maste r dost'
`card~. the cards were senl lot he d~t~ l'rore~sing center for
`daily charging. Tho: cards were then returned to phonnac>
`for subsequent use in the medication system. The system ww;
`cumbersome, since the cards wert' ofu.11 111ispl11c-Pd and tinily
`1nai nl enn nt.~ of I hr f'JHlirn t record$ involved a sul>slttnlial
`11111ount of µuper handling. The corcls Wl'm nol used to~rn ­
`PrnLi; H pntient profile; therefore, monitoring uf patient
`medir11tion records was noL 1>0~sihle.
`Gilbert el nl :w; described a batch mode o rder entry pro(cid:173)
`<'cdurc on 1111 nff. Jine computci . The phnrm11c1st reduced 1111
`drug orders l o numeric codeo on punched cords. Once euch
`eight houl's, the coded order8 wel'e batch keypunched. Tlw
`computer print.cd n dmg <ii8tribution lol( for unit dose can
`filling , a cumulative patient. profilP, Rnd n doily m edication
`chart.int: document for nursmg. Aulomutcd patient chnrging
`and census wntrol were fealurcs of the system . The author
`over<·ome lhc lopsc between profile printings by sending
`doses of medications for n~w ordetll lo t'Ove1 the interim until
`l he next c11rt e>rh1rnge.
`On-line Medication Systems. On-lino systems allow the
`op1m1tor t.o interurl directly with the com1mler, allowing
`immediale access lo data stored, thus overcoming the lime
`lapse in information processing which occurs with off-line
`sy~tcms. Thus, on-line system:. lend lheur~clves to more
`nexible proi:rnmming. For thih reason, on-line medication
`sy;tems hove usually involved more sophi~LiCllted applica(cid:173)
`tion~. A numLer of such syst.Pm~ lrnv1· l>een surces-;fully
`imphm1enlutl, holh ns c!edirated phHl'mary module~ and as
`Kuh~ysluns of lari;tit ho~pi tal information !.ystems.
`A series of urliclc~ h ru; described thu medicntion distri(cid:173)
`bution system at The Johns Hopkins Ho~pital. Two genel'-
`
`VGI 39 Jon 1982 Amorlcon Journal of Hospilal Pha11mcy 67
`
`CFAD VI 1016-0005
`
`

`
`Compult r llppllcf'11ont.
`
`a lions uf Lhe &) >tem, ihc fi