Adjustments of distributive and clinical pharmacy services to financial constraints.

The effects of hospital budget constraints on a pharmacy department's ability to provide distributive and clinical services are described, and the development and use of workload-monitoring systems to match resources with demand is discussed. In 1980, the pharmacy department at Grace Hospital, a 402-bed community hospital in Detroit, Michigan, began quantifying workload by using five drug distribution indicators. After the pharmacy began providing clinical services in 1981, workload elements were measured in a pilot program for ASHP's Hospital Pharmacy Management Information System. Hospitalwide staff reductions occurred in 1985, eliminating most clinical pharmacy services. From 1985 to 1986, drug costs increased more than expected; also, turnaround time for medication orders increased. In 1986, 1.4 full-time-equivalent positions were added, and the pharmacy instituted use of decentralized carts and a pharmacist on the patient-care units to provide first doses. The hospital's management engineering department had selected patient days as the single indicator for pharmacy workload, but pharmacy used the ASHP Pharma Trend monitoring system to present data that convinced management engineering that patient days was an inadequate indicator of pharmacy workload. Also, drug costs decreased after the drug distribution changes and the reinstitution of patient drug therapy monitoring. Pharmacy managers need workload monitoring systems that are responsive to changes and include departmental expense information; these systems should be able to interrelate to hospital cost-accounting systems.