Hospital pharmacists increasingly involved in direct patient care


Health-System Edition

Pharmacy continues to respond to the needs of patients and the health-care system. That’s a key theme in results of the 2014 American Society of Health-System Pharmacists (ASHP) national survey of pharmacy practice in hospital settings that pertain to dispensing and administration, according to a recent practice report in the American Journal of Health-System Pharmacy.


Positive impact


Some examples of these responses include shifts to direct patient care to improve outcomes and reduce errors; pharmacy’s drive toward more use of automation and technology to improve safety and efficiency, rather than resisting it or seeing it as a threat; and many strategies and new services addressing the need to improve transitions of care, according to an e-mail interview with the article’s lead author, Craig A. Pedersen, BSPharm, PhD, FAPhA, pharmacy manager at Confluence Health in Wenatchee, WA.


“Health-system pharmacists continue to have a positive impact on improving health care through programs that improve the efficiency, safety, and clinical outcomes of medication use in health systems,” the article concluded.


The ASHP national survey of pharmacy practice in hospital settings focuses on practices and technologies for managing and improving the medication-use system and the role that pharmacists play in this effort. The 2014 survey evaluated practices and technologies related to dispensing and administration, according to the article. A stratified random sample of pharmacy directors at 1,435 general and children’s medical–surgical hospitals in the United States were surveyed by mail; 426 hospitals submitted usable data for analysis.


Direct patient care increasing


According to the interview with Pedersen, the most important results from the survey included the following:


  • Adoption of medication-related automation and technology continues to grow at a rapid pace. The availability of technology, compounded by the push for improved safety and meaningful use, have pushed adoption of these systems in hospitals of all sizes.

  • The goal of reducing readmissions and unnecessary care has increased pharmacy’s involvement in ensuring better transitions of care, especially from the hospital back into the home or other settings.

  • Drug distribution is now automated in 75% of U.S. hospitals. This is up from only 30% being automated just 12 years ago.

  • Pharmacy technicians continue to play a big role in the preparation and distribution of medications but are also taking on more and more nontraditional roles and activities.


These results show that as hospital pharmacy practice evolves over time, “pharmacists are increasingly involved in direct patient care in both acute and ambulatory care settings,” said Pedersen. “Less and less time is spent on preparation and distribution of medications, with automation and pharmacy technicians taking over more of these functions.”


A notable finding was the need to improve systems to be in alignment with the proposed USP <800>. (For more information, see Pharmacy Today’s previous coverage, including page 9 of the August 2015 issue.)


By the numbers


A total of 97% of hospitals used automated dispensing cabinets in their medication distribution systems, and 44.8% used some form of machine-readable coding to verify doses before dispensing. Overall, 65% of hospital pharmacy departments reported having a cleanroom compliant with USP <797>. 


In 81.2% of hospitals, pharmacists reviewed and approved all medication orders before the first dose was administered, either onsite or by remote order view, except in procedure areas and emergency situations. Adoption rates of electronic health information have rapidly increased, with widespread use of electronic health records, bar codes, and smart pumps. 


Overall, 31.4% of hospitals had pharmacists practicing in ambulatory care or primary care clinics. Transitions-of-care services offered by the pharmacy department have generally increased since 2012. Discharge prescription services increased by 11.8% of hospitals in 2012 to 21.5% in 2014.


After-hours pharmacy access


One big change for pharmacies not open 24/7 is the availability of after-hours pharmacy access through remote order review and other mechanisms, according to Pedersen. 


“For many years, when the pharmacy closed, access to medications and pharmacist order review was very limited. Now only about 20% of hospitals have no form of pharmacist review after hours, significantly lower than the 60% that did not have after-hours access as recently as 2005.”