Hospital Pharmacy
Aiya Almogaber, PharmD
The American Society of Health-System Pharmacists (ASHP) recently released the 2023 National Survey of Pharmacy Practice in Hospital Settings, revealing significant advancements in hospital pharmacy operations.
The survey, published on May 23, 2024, in the American Journal of Health-System Pharmacy, highlights an increase in the adoption of automation and informatics technologies, such as automated dispensing cabinets and enhanced electronic health record (EHR) systems, which can improve medication safety and operational efficiency.
Additionally, the growing use of telepharmacy services in hospitals and the expanding role of pharmacists in clinical decision support highlight the advancing hospital pharmacy landscape.
“One of the strengths of the ASHP survey is that it evaluates practice at an individual hospital level—each hospital that is part of the survey sample receives one survey to complete,” said Michael Ganio, PharmD, senior director of pharmacy practice and quality at ASHP.
The 2023 survey evaluated the progress of the ASHP Practice Advancement Initiative (PAI) 2030 goals, highlighting trends such as the significant presence of pharmacists in ambulatory clinics (54.2%), the extensive use of automated dispensing cabinets (86.1%), and the integration of pharmacy services to optimize patient care transitions (60%).
The survey also revealed that advanced analytics are used in 5.7% of hospitals, and basic analytics in 87.3%, reflecting a data-driven approach to enhancing medication safety and operational efficiency.
“I expect continued adoption of technology to improve the medication use process,” said Ganio. “We also expect to see more use of analytics and artificial intelligence to support the practice of pharmacy in the future.”
Best practices
The survey aimed to comprehensively evaluate the use and integration of automated dispensing cabinets in hospital settings, focusing on various configurations, technologies, and best practices used to optimize medication distribution and safety.
With only 2.2% of hospitals lacking automated dispensing cabinets, a significant decrease from 5.9% in 2020, the survey underscores the widespread adoption of this technology, especially in hospitals with more than 50 staffed beds. Mostly, hospitals use individually secured lidded pockets (78.7%), a trend that has steadily increased over the years, ensuring controlled access to medications while reducing the risk of diversion and errors.
“Many of the questions about operations and technology were repeated from previous surveys, which allowed us to trend data going back several years,” said Ganio.
A key aspect of the survey was the investigation into the use of machine-readable coding and barcode scanning technologies. Researchers found that 73.6% of hospitals use some form of machine-readable coding for verifying medication doses during pharmacy dispensing, with larger facilities showing higher adoption rates. They also found that 92.6% of hospitals use barcode scanning during automated dispensing cabinet restocking, a practice more prevalent in larger hospitals.
Hospitals have also adopted various strategies to prevent diversion and ensure the proper handling of controlled substances.
Survey results found that 91.7% of hospitals use lock-lidded pockets for medications prone to diversion, 89.6% review controlled substance discrepancies within 24 hours, and 85.4% have policies limiting overrides to emergent situations. These practices, among others, reflect a growing emphasis on stringent control measures and the implementation of robust policies to mitigate risks associated with controlled substances, demonstrating a commitment to maintaining high standards of medication security and patient safety.
Expanding on the results
By automating routine tasks and improving accuracy in medication dispensing, technology can allow pharmacists the ability to focus more on clinical roles and direct patient care.
“The survey’s findings on the use of barcode scanning and machine-readable coding highlight a critical shift towards greater accuracy and efficiency in medication handling,” said Ganio. “This not only reduces the risk of medication errors, but also ensures that patients receive their medications promptly and safely.”
The survey also shed light on the increasing role of pharmacists in clinical settings. With 54.2% of hospitals employing pharmacists in ambulatory or primary care clinics, there is a clear trend toward integrating pharmacy services into broader health care teams. ■