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ASHP national survey of pharmacy practice in hospital settings: Dispensing and administration—2017
Abstract
Purpose:
The results of the 2017 ASHP national survey of pharmacy practice in hospital settings are described.
Methods:
Pharmacy directors at 4,828 general and children's medical- surgical hospitals in the United States were surveyed using a mixed-mode method of contact by mail and e-mail. Survey completion was online, using Qualtrics (Qualtrics, Provo, UT). IMS Health supplied data on hospital characteristics; the survey sample was drawn from the IMS hospital database (IMS Health, Yardley, PA).
Results:
The response rate was 14.4%. Drug distribution systems have evolved from centralized unit dose programs to decentralized programs based on the use of automated dispensing cabinets (ADCs). These systems have been made safer by the use of lidded pockets, by the use of machine-readable coding during ADC stocking, and by linking access to medications to results of pharmacist order review. Health-system pharmacists continue to improve quality practices for compounding sterile preparations, including the use of safeguards in handling hazardous drugs. While some hospitals are prepared for more stringent standards, including United States Pharmacopeia chapter 800 requirements, much still needs to be done to meet these standards. Pharmacists are taking an active role in improving the responsible use of medications through antimicrobial stewardship and controlled-substance diversion prevention programs. The quality of the pharmacy workforce continues to be improved through the increased credentialing of both pharmacists and pharmacy technicians.
Conclusion:
Health-system pharmacists continue to have a positive impact on improving healthcare through programs that improve efficiency, safety, and clinical outcomes of medication use in health systems.
... Data from the 2017 ASHP survey provide a snapshot of the progress made toward USP <800> implementation by US hospitals in the summer of 2017. 13 Almost 700 of 4828 hospital pharmacy directors responded to the survey, including 450 hospitals that prepare chemotherapy. Overall, results of the survey showed that larger hospitals and those that compound chemotherapy are more likely to have facilities and policies in place for HD handling. ...
... Overall, results of the survey showed that larger hospitals and those that compound chemotherapy are more likely to have facilities and policies in place for HD handling. 13 Focusing on hospitals that prepare chemotherapy, almost 30% had conducted an institution-wide gap analysis to assess USP <800> compliance; 50% had done a pharmacy-focused analysis; and the remaining 20% had not conducted a formal analysis. Engineering controls include a negative-pressure compounding room (74%), externally vented class II BSC (66%), separate HD storage (64%), secondary engineering control environment (57%), and externally vented compounding aseptic containment isolator (31%). ...
... The remainder were mostly compliant with no major facility upgrades planned (38%), of limited compliance with major facility upgrades planned (52%), or had not conducted a compliance assessment (<3%). 13 This survey shows the progress hospital pharmacies have made in USP <800> compliance; however, the progress and perspective of the oncology community is missing. ...
Pharmacy Times Continuing Education™ (PTCE), a leader in continuing education for retail, health system, managed care and specialty pharmacists, announced The Council for Medication Safety: Mitigating Contamination and Improving the Safe Handling of Hazardous Drugs on Wednesday, Nov. 7, at the 36th Annual Chemotherapy Foundation Symposium Innovative Cancer Therapy for Tomorrow® meeting. The steering committee was charged with reviewing and discussing methods and strategies to improve the handling of hazardous drugs and will be publishing a special print and digital continuing education (CE) article that was distributed in February 2019.
... To evaluate dispensing and administration practice in GCC countries, we prepared a modified survey questionnaire from the original ASHP survey questions in consultation with ASHP survey members (Pedersen et al., 2015, Schneider et al., 2018. Prior to finalization and distribution, we validated the questionnaire using the following approaches: (1) A research team in our group reviewed the questionnaire and provided feedback. ...
... The survey was conducted using the online survey platform ''Google Forms," which was considered user-friendly and easily accessible with different web browsers (Rayhan et al., 2013) and was comparable to those of the ASHP survey method (Pedersen et al., 2015, Schneider et al., 2018, Pedersen et al., 2021. The hospitals were classified based on bed capacity (number of beds), location, type, ownership, and accreditation. ...
... Outsourcing medication preparation can provide substantial economic and patient care benefits for hospitals with limited pharmacy staff and compounding facilities. Our survey result showed that 28.1 % of hospitals partially or completely outsourced some medication preparation activities, which is lower than the finding of the ASHP study, where 79.6 % of hospitals outsource some drug preparation activities (Schneider et al., 2018). ...
Purpose:
To outline dispensing and administration practices in hospital pharmacy across the Gulf Cooperation Councils (GCC) countries' hospitals. Paucity of data in appraising hospital pharmacy practice in GCC regions motivated us to conduct this study.
Methods:
A modified survey questionnaire was prepared from the American Society of Health-System Pharmacist (ASHP) survey questions. Three major domains of questions for general characteristics of the medication use process for dispensing and administration were identified. These were, (1) medication distribution system, and medication distribution technology, (2) technology used to compound sterile preparations, compounding I.V. medication and method of compounding nutrition support preparations, (3) medication administration practices, medication orders, medication administration records (MARs), and technician activities. A list of hospitals was obtained from the Ministry of Health of the targeted GCC countries. A secure invitation link containing a survey questionnaire was sent to the participants directly.
Results:
Sixty-four hospitals responded to this survey. The overall response rate was 52%. Most surveyed hospitals have centralized inpatient medications distribution system (75.0%). About 37.5% of hospitals used automated dispensing cabinets (ADCs) in their patient care areas. Compounding sterile preparations in the pharmacy, barcode verification technology, workflow management technology, and robotic technology were used by 17.2%, 15.6%, and 4.7% of hospitals, respectively. In using safety technology for medication administration, almost all hospitals have partially or completely implemented an electronic health record (EHR). About 40.6% of hospitals used electronic medication administration records (e-MARs), 20.3% used bar-code-assisted medication administration (BCMA), and 35.9% used smart infusion pumps.
Conclusion:
The results of this survey revealed an opportunity to improve the medication use management process on dispensing and administration practices in hospitals in GCC countries.
... Several studies have undertaken surveys to assess current hospital pharmacy practices in their country or region to understand the pharmacy practice culture across different health care systems (Doloresco and Vermeulen, 2009;Alsultan et al., 2012a;Alsultan et al., 2012b;Alsultan et al., 2013;Pedersen et al., 2017;Schneider et al., 2018;Lemay et al., 2019;Pedersen et al., 2019;Altyar et al., 2020;Pedersen et al., 2020). These surveys assessed practices at different times and guided strategic initiatives. ...
... The survey was conducted using the online survey platform ''Google Forms," which was considered user-friendly and easily accessible with the different web browsers (Rayhan et al., 2013) and was comparable to those of the ASHP survey method (Pedersen et al., 2017;Schneider et al., 2018;Pedersen et al., 2019Pedersen et al., , 2020. The hospitals were classified based on bed capacity (number of beds), location, type, ownership and accreditation. ...
... Additionally, only 44% of hospitals compare the effectiveness of products, when taking formulary decisions for drug inclusion. This may be explained by the fact that 50% of the hospitals have open formulary system and is significantly lower than US hospitals which reported more than 70% of using such strategies according to the findings from ASHP surveys in 2016 and 2019 respectively, (Schneider et al., 2018;Pedersen et al., 2019). According to the present survey, clinical effectiveness, stringent pharmacoeconomic assessment, and evidence-based clinical practice guidelines were the key parameters accounted for in formulary decisions for the GCC region. ...
Purpose
To outline hospital pharmacy practices across the Gulf Cooperation Councils (GCC) countries’ hospitals.
Methods
A modified survey questionnaire was prepared from the original 2019 American Society of Health-System Pharmacist (ASHP) survey questions. Survey details were discussed with some pharmacy directors for clarity and relevance. A list of hospitals were obtained from the Ministry of Health of each of the targeted GCC countries. A secure invitation link containing a survey questionnaire was sent to the participants directly.
Results
Sixty four hospitals responded to this survey. The overall response rate was 52%. About 47% of the surveyed hospitals considered their drug formularies as closed, and strict. Additionally, only 44% of hospitals compare the effectiveness of products, when taking formulary decisions for drug inclusion. Forty-four percent of hospitals have computerized prescriber order entry (CPOE / EHR) system functionality for formulary system management. At about 39.1% hospitals, pharmacists have the responsibility for managing medication therapies, majority were engaged in providing anticoagulation therapies. About 61% of hospital pharmacies in GCC countries receive medication orders electronically, through CPOE/EHR. Majority (66%) of the hospitals in GCC countries have an active Antimicrobial Stewardship Program (ASP) while only 40% of pharmacists have a key role in providing clinical support. About 57.8% of hospital pharmacy directors reported that pharmacists do not provide ambulatory care clinical pharmacy services in their hospitals.
Conclusion
In GCC countries’ hospitals, there are major areas for improvement to patient care of which pharmacists are uniquely qualified as the medication experts to have the most meaningful outcomes in all of the domains of safe medication use, medication therapy management, antimicrobial stewardship program and participation in outpatient clinics.
... The percentage of hospitals not reviewing orders after hours has declined annually since 2005, when we first surveyed order review, from 59.6% of US hospitals. 3,[5][6][7][8][9][10][12][13][14][15] A c c e p t e d M a n u s c r i p t Inpatient medication distribution technology. In 2020, 4.1% of general and children's medical/surgical hospitals used a robotic distribution system that automates the dispensing of unit dose inpatient medications in a centralized distribution system (Table 3). ...
... The use of lidded pockets has increased over the last decade, from 51.5% of hospitals in 2008 12 to 61.9% in 2011, 9 65.7% in 2014, 6 and 70.1% in 2017. 3 Machine-readable coding in pharmacy. Robots, carousels, and, sometimes, manual unit dose pick stations use machine-readable coding to verify removal and replenishment of medications. ...
... The use of machine-readable coding in pharmacy departments has steadily increased over the past 12 survey years A c c e p t e d M a n u s c r i p t (frequencies of use were 5.7% in 2002, 18 11.5% in 2005, 15 24.0% in 2008, 12 33.9% in 2011, 9 44.8% in 2014, 6 and 74.7% in 2017. 3 This practice differs by hospital size, with larger facilities using scanning during dispensing more than smaller facilities. Furthermore, 81.4% of hospitals scan medication barcodes during restocking of ADCs; this differs by hospital size, with 100% of the largest hospitals (600 or more staffed beds) scanning barcodes while restocking ADCs, as compared with 90.2% of hospitals with 400 to 599 beds, 87.8% with 300 to 399 beds, 93.5% with 200 to 299 beds, 80.0% with 100 to 199 beds, 84.8% with 50 to 99 beds, and 72.2% with fewer than 50 beds. ...
Purpose
Results of the 2020 ASHP national survey of pharmacy practice in hospital settings are presented.
Methods
Pharmacy directors at 1,437 general and children’s medical/surgical hospitals in the United States were surveyed using a mixed-mode method of contact by email and mail. Survey completion was online. IQVIA supplied data on hospital characteristics; the survey sample was drawn from the IQVIA hospital database.
Results
The response rate was 18.7%. Almost all hospitals (92.5%) have a method for pharmacists to review medication orders on demand. Most hospitals (74.5%) use automated dispensing cabinets (ADCs) as their primary method for drug distribution. A third of hospitals use barcodes to verify doses during dispensing in the pharmacy and to verify ingredients when intravenous medications are compounded. More than 80% scan barcodes when restocking ADCs. Sterile workflow management technology is used in 21.3% of hospitals. Almost three-quarters of hospitals outsource some sterile preparations. Pharmacists can independently prescribe in 21.1% of hospitals. Pharmacist practice in ambulatory clinics in 46.2% of health systems and provide telepharmacy services in 28.4% of health systems.
Conclusion
Pharmacists continue their responsibility in their traditional role in preparation and dispensing of medications. They have successfully employed technology to improve safety and efficiency in performance of these duties and have employed emerging technologies to improve the safety, timeliness, and efficiency of the administration of drugs to patients. As pharmacists continue to expand their role to all aspects of medication use, new opportunities highlighted in ASHP’s Practice Advancement Initiative 2030 have been identified.
... In the US, small-to medium-size hospitals tend to use commercial MCBs much more than larger institutions, mainly as 2CBs that include glucose/dextrose and amino acids (generally, lipids are given separately or added to the 2CB), with overall MCB use increasing yearover-year. 24 It is important to consider which patients would benefit most from compounded PN, and who are the best candidates for MCBs, perhaps through the use of standard algorithms. 25 Furthermore, it would be beneficial if manufacturers introduced a wider variety of MCBs as 3CBs to the US market, including different types of lipids and macronutrient compositions. ...
... Thus, in Europe, where the nutritional needs of the majority of adult patients are covered by MCBs/3CBs, this has further facilitated the use of PN in centers with only a few PN prescriptions per day, 28 a trend that is also increasingly being noticed in the US. 2,24 During the summit, the PN use process and efforts to overcome current challenges were discussed, as mentioned previously, with regard to hospitals covering 39 US states and ranging in size from 38 to 748 licensed beds, mostly in acute care. Measures taken to improve the safety and quality of PN were in line with expert recommendations 2,5,9 and included PN process standardization, implementation of electronic order sets and systems, fostering interdisciplinary communication, vigilant surveillance for complications, and staff education. ...
Purpose
The International Safety and Quality of Parenteral Nutrition (PN) Summit consisted of presentations, discussions, and formulation of consensus statements. The purpose here is to briefly summarize the summit and to present the consensus statements.
Summary
There was a high degree of consensus, with all statements approved by all authors/summit experts. These consensus statements should be regarded not as formal guidelines but rather as best-practice guidance intended to complement national and international nutrition society evidence-based guidelines and position statements. This article also summarizes key discussion topics from the summit, encompassing up-to-date knowledge and practical guidance concerning PN safety and quality in various countries and clinical settings, focusing on adult patients. Clear geographical differences exist between practices in Europe and the United States, and different approaches to improve the safety, quality, and cost-effectiveness of PN vary, particularly with regard to the delivery systems used. Discussion between experts allowed for an exchange of practical experience in optimizing PN use processes, opportunities for standardization, use of electronic systems, potential improvements in PN formulations, better management during PN component shortages, and practical guidance to address patients’ needs, particularly during long-term/home PN.
Conclusion
The consensus statements are the collective opinion of the panel members and form best-practice guidance. The authors intend that this guidance may help to improve the safety and quality of PN in a variety of settings by bridging the gap between published guideline recommendations and common practical issues.
... 25 Whether one system is preferred over the other varies geographically (see statement 4 in the summary article). 9 Whereas the use of MCBs in the US (typically 2CBs with ILE given separately) is often seen in smaller centers with lower PN volumes, 26 Overall, MCBs were more frequently used when the local pharmacy was the HPN provider, while compounded admixtures were more frequently used when the HPN provider was a home care company. Moreover, customized admixtures tailored to patients' needs were mainly used in cases of benign chronic intestinal failure, while MCBs were used mainly in cases of malignant chronic intestinal failure. ...
... It is worth noting in this context that a survey of hospital pharmacy practices in the US found that the percentage of hospitals using 2CBs as the predominant form of PN preparations increased from 36% (in 2011) to 45% (in 2017), and that this increase was driven mainly by smaller institutions (<200 beds). 26 Daily use of iles. ILEs are an integral part of PN, serving as an energydense source of calories, reducing the glucose/dextrose load and providing essential fatty acids (EFAs). ...
Purpose
Parenteral nutrition (PN) is an established therapy when oral/enteral feeding is not sufficient or is contraindicated, but nevertheless PN remains a complex, high-alert medication that is susceptible to errors that may affect patient safety. Over time, considerable progress has been made to make PN practices safer. The purpose of this article is to address ongoing challenges to improve the PN use process from prescription to administration and monitoring, and to outline practical aspects fostering the safety, quality, and cost-effectiveness of PN, as discussed at the International Safety and Quality of PN Summit.
Summary
Opportunities to improve the PN use process in clinical practice include the promotion of inter-disciplinary communication, vigilant surveillance for complications, staff education to increase competency, and more consistent use of advanced technologies that allow automated safety checks throughout the PN process. Topics covered include considerations on PN formulations, including the value of intravenous lipid emulsions (ILEs), trends in compounding PN, the current and future role of market-authorized multi-chamber PN bags containing all 3 macronutrients (amino acids, glucose/dextrose, and ILE) in the United States and in Europe, and strategies to cope with the increasing global problem of PN product shortages.
Conclusion
This review outlines potential strategies to use in clinical practice to overcome ongoing challenges throughout the PN use process, and ultimately promote PN patient safety.
... Nine unique medication access services were included in the questionnaire based on a literature review of health-system based medication access programs, and common issues facing patients related to medication access. [5][6][7][12][13][14][15][16][17][18][19][20][21][22][23][24][25] The nine services selected for the study are identified and described in Table 1. Questionnaire recipients were asked if their hospital had at least one dedicated FTE that provided each of the medication access services listed in Table 1. ...
... While the response rate of 23.6% is higher than that of previous studies targeted to a similar population , there are limitations to this study. [23][24][25] Greater participation from hospitals located in the Midwest region, government-owned hospitals, and those with 340B status contributed to response bias. Since the institution that conducted this study is located in the Midwest, it is possible that name recognition led to a higher response rate in the Midwest. ...
Background
For patients that face barriers to filling their prescriptions, the availability of medication access services at their site of care can mean the difference between receiving prescribed drug therapy, and undue interruptions in care. Hospitals often provide medication access services that are not reimbursed by payers; however, they can be challenging to sustain. The 340B Drug Pricing Program allows covered entities to generate savings through discounted pricing for certain outpatient medications, which can then be used to provide more comprehensive services, including medication access services.
Objective
To characterize medication access services provided at hospitals that participate in the 340B Drug Pricing Program compared to hospitals that do not participate in the 340B Program.
Methods
Primary questionnaire response data was collected from a national sample of Directors of Pharmacy at non-federal acute care hospitals from March 2019 to May 2019. American Hospital Association Data Viewer was used to collect demographic information on 1,531 hospitals. Hospitals were excluded if they had 199 beds or fewer, did not have a unique Medicare provider ID, were federally owned, were located outside the continental U.S., or were non-acute care hospitals that served niche patient populations. This study utilized a proportional stratified sampling strategy to administer an electronic questionnaire to 340B and non-340B hospitals to assess the number and type of medication access service offerings. A final randomized sample of 500 hospitals were administered the questionnaire, and data was collected through recorded responses in Qualtrics software.
Results
340B hospitals provided a significantly higher average number of medication access services compared to non-340B hospitals (6.20 vs. 3.91, p=0.0001), adjusted for differences in hospital size and ownership type. For all nine medication access services that were assessed, a higher percentage of 340B hospitals reported providing the service compared to non-340B hospitals. This difference was statistically significant for six out of nine programs assessed.
Conclusions
340B hospitals provided more medication access services, on average, than comparably sized non-340B hospitals, suggesting that hospitals that participate in the 340B Drug Pricing Program may be better positioned to create and administer programs that support medication access services.
... Thus, a survey of hospital pharmacy practices in the US found that the percentage of hospitals using 2CBs as the predominant form of PN preparations increased from 36% of hospitals in 2011 to 44.8% in 2017, an increase driven mainly by smaller institutions (<200 beds). 11 For these and numerous other institutions, particularly outside the US, MCBs offer opportunities for the standardization of the PN process and addressing some safety concerns. It is important to note that no PN preparation method relieves prescribers from carefully assessing each patient's nutritional needs, including the requirements for electrolytes or micronutrients, and pharmacists' responsibility to provide customized PN where this is needed. ...
Purpose
This article is based on presentations and discussions held at the International Safety and Quality of Parenteral Nutrition (PN) Summit concerning the acute care setting. Some European practices presented in this article do not conform with USP general chapter <797> requirements. Nevertheless, the purpose is to cover the challenges experienced in delivering high-quality PN within hospitals in the United States and Europe, in order to share best practices and experiences more widely.
Summary
Core issues regarding the PN process within an acute care setting are largely the same everywhere: There are ongoing pressures for greater efficiency, optimization, and also concurrent commitments to make PN safer for patients. Within Europe, in recent years, the use of market-authorized multi-chamber bags (MCBs) has increased greatly, mainly for safety, cost-effectiveness, and efficiency purposes. However, in the US, hospitals with low PN volumes may face particular challenges, as automated compounding equipment is often unaffordable in this setting and the variety of available MCBs is limited. This can result in the need to operate several PN systems in parallel, adding to the complexity of the PN use process. Ongoing PN quality and safety initiatives from US institutions with various PN volumes are presented. In the future, the availability of a greater selection of MCBs in the US may increase, leading to a reduction in dependence on compounded PN, as has been seen in many European countries.
Conclusion
The examples presented may encourage improvements in the safety and quality of PN within the acute care setting worldwide.
... Additionally, specific risks and disadvantages have been associated with using automated dispensing technologies. As per the literature, implementing automated technologies can introduce new organisational and technical risks due to alterations in the dispensing process and the organisation of hospital tasks [45,46] proposes that changes in the work routine following the introduction of automated dispensing technologies can be managed by organising regular meetings with professionals involved in the dispensing process. This would foster knowledge sharing, heighten awareness of automated solutions, and facilitate revising human resource plans in the early stages of implementation. ...
... 5 Many healthcare systems in the United States have implemented technologies required for interoperability, such as computerized prescriber order entry, barcode-assisted medication administration, and electronic health records (EHRs), yet most hospitals have not integrated these systems with IV smart pumps to achieve bidirectional interoperability. [6][7][8][9][10] Broad implementation of bidirectional IV smart pump interoperability could improve patient safety, clinical outcomes, and work efficiency. 3,7,[11][12][13][14] Bidirectional interoperability Bidirectional IV smart pump interoperability involves 2-way, real-time, continuous communication between a smart pump and the EHR that enables both auto-programming and autodocumentation. ...
Purpose
Smart pump bidirectional interoperability offers automated infusion programming and documentation that can improve patient safety and workflow efficiency. This technology has been poorly implemented across US hospitals, and there is little guidance on the tracking or monitoring of interoperability systems. The purpose of this report is to describe the successful implementation of intravenous (IV) smart pump interoperability in a large health system.
Summary
Bidirectional IV smart pump interoperability and compliance monitoring were implemented across a large Midwestern health system using ICU Medical’s Plum 360 and LifeCare PCA devices and Smith Medical’s MedFusion 4000 Syringe Pump devices. The hospital system’s experience in implementing and monitoring IV smart pump compliance using automated reports and a dedicated medication safety integration nurse is described. Compliance trends suggest that the implementation of IV smart pump interoperability has achieved a reduction in programming outside of the dose error reduction system, manual overrides, and IV medication administration error rates.
Conclusion
The monitoring of smart pump compliance has had demonstrated benefits in investigating usability concerns, recognizing system errors, and identifying increased needs for nurse training. This program can serve as an example for other healthcare systems adopting IV smart pump interoperability.
... [5,7] Pharmaceutical care services expanded nationally and internationally. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] The pharmacy strategic plan was established several years back and eventually updated and evaluated thoroughly. [23,35] Various pharmacy programs were founded, for instance, drug information services, total parenteral nutrition, medication safety, intravenous medicine preparation, and administration. ...
... También del SDA por su estructura física de armario con cajoneras, permitió tener una organización y manejo fácil en el cuarto de medicamentos de la UCI, el uso de las alertas tecnológicas reconocidas como mensajes cortos preestablecidos llevan a que cada usuario constate el medicamento o DM la presentación el equipo y cantidad, asociado al uso del 100 % de los controles de las dispensaciones antes del retiro de cada medicamento por parte de las auxiliares y enfermeras. Se encontró que este chequeo valida el planteamiento que "las estrategias para prevenir y disminuir los errores de medicación deben basarse en intervenciones sobre los sistemas, más que sobre las personas, y las nuevas tecnologías como herramientas que potencialmente mejoran el uso de los medicamentos" [9]. ...
Objetivo:
Determinar el impacto de la dispensación automatizada en la seguridad del paciente en una unidad de cuidado crítico y medir el tiempo de dispensación para conocer los efectos en la atención del paciente y los trabajadores de la salud.
Metodología:
Estudio retrospectivo observacional. La técnica fue documentar la dispensación tomando las bases de datos en el sistema tradicional y automatizado procesados en Microsoft Excel y medición del tiempo.
Resultados:
Con el sistema automatizado el uso de controles para el acceso en la dispensación de los medicamentos e insumos fue del 100 %. Y, el porcentaje de casos de problemas con el uso de medicamentos en el sistema tradicional fue de 0,38 y en el automatizado descendió a 0,007.
Discusión:
Pasar de manual a automatizado en la dispensación representa reducción del tiempo de un día a 22 segundos, el uso del 100 % de las alertas tecnológicas y la eficiencia en los procesos de dispensación reflejado por el 15,2 % de transacciones en el cargue de los dispositivos médicos y medicamentos.
Conclusiones:
La dispensación automatizada impacta en el paciente acortando el tiempo para que el medicamento sea administrado oportunamente, en los trabajadores este tiempo es una ventaja para invertir en los cuidados, el equipo de sistema automatizado adiciona controles que ayudan al doble chequeo en el alistamiento y cargue y la reducción de eventos adversos. Y, en la organización disminuye los eventos relacionados con roturas de envases, daño de empaques por la menor manipulación y disposición de medicamentos en gabinetes cerrados.
... Credentials in healthcare can be used to improve performance [7], skills, and behavior in-between caregivers [8]. With credentials, caregivers can improve efficiency, safety, and the expected effect of a therapy [9]. With excellent standardization, unexpected events can be prevented [10], such as: prescription error [11] miscommunications [12]. ...
Health service credentials are important because they can improve the quality and profitability of health care facilities. Performance improvement through structured credentialing needs to be carried out continuously to support the quality of health care facilities, both in terms of skills, knowledge, and behavior in the work environment. Evidence-based implementation of credentials to support the quality of health services needs to be reviewed further because science and technology are increasingly developing. A series of selection went through 1705 publications and 639 publications meet the desired criteria in Scopus Database (Publications from 2011-2021 using keywords: ‘credentialing’ AND ‘quality’, and within medicine-related field of study). The data then being analyzed using VOSViewer to form whole 4 clusters. The majority of studies was held in America. Most citated publications are about standardization of medical processes. Throughout cluster themes assessed, the main topic of the publications was described as such: Standardization actions, and credentialing team programs. Future reviews with similar approach are needed to further expand new ideas to improve healthcare service quality.
... MARCH 2020 M ANY PHARMACIES HAVE implemented or considered implementing cleanroom automation or compounding systems. 1 Intravenous (IV) admixture automation is one of the newest areas of technology that has been applied to pharmacy workflow. ...
Many pharmacies have implemented or considered implementing cleanroom automation or compounding systems. Intravenous (IV) admixture automation is one of the newest areas of technology applied to pharmacy workflow. Manufacturers tout systems for reducing errors in reaching patients. Clinical literature supports that cleanroom technology can aid in patient safety.
... A 2017 survey conducted by the American Society of Health-System Pharmacists (ASHP) found 43% of all hospital pharmacy departments were staffed by a CSP around the clock, with the prevalence increasing to 56.7 to 100% in hospitals with > 100 beds. 9 As a result, CSPs may be a useful resource to assist with the management of patients with sepsis in hospitals without an ED pharmacist. ...
Background:
Sepsis is a medical emergency in which timely, appropriate antibiotic therapy improves patient outcomes. While the addition of emergency department (ED) pharmacists has been found to optimize timely antimicrobial therapy in patients with sepsis, the role of clinical staff pharmacists (CSPs) in the sepsis response has not been studied.
Methods:
We implemented a process of incorporating CSPs in sepsis antimicrobial management in the ED. To evaluate the accuracy of antimicrobial selection by CSPs with a sepsis antibiotic algorithm and vancomycin dosing nomogram, a retrospective cohort study was conducted on patients with sepsis presenting to the ED from December 3, 2018 through March 31, 2020.
Results:
Of the 157 sepsis alerts included in this study, CSPs correctly used the antibiotic selection algorithm in 154 (98%) instances and the vancomycin dosing nomogram in 147 (94%) instances.
Conclusions:
A process incorporating CSPs into the ED sepsis response resulted in high rates of accuracy for antibiotic selection and vancomycin dosing.
... A survey study conducted between 2015 and 2017 in the United States to evaluate practices in hospital pharmacies showed a low response rate (x= 22.3%). [34][35][36] Another study conducted in 2018 with 35 countries in Europe, evaluated the implementation of European declarations for hospital pharmacy, with an approximately 14% response rate. 37 The great adherence of the institutions participating in the current research may be justified by the fact that the studied hospitals develop studies frequently, as well as the ease of the data collection method and all hospitals were already being asked to pass the medicinal gases management to pharmacists. ...
Objective: To characterize compliance with good practices in medical gas management in federal teaching hospitals in Brazil. Methods: A cross-sectional survey-type study, designed to perform a situational diagnosis of the pharmacy services in 40 federal teaching hospitals in Brazil linked to the Brazilian Hospital Services Company, with respect to compliance with good practices in gas management, through the application of the ABPGasMed 1.0 instrument. This instrument consists of 54 compliance standards divided into two sections (structure and process). The characterization of research participants and hospitals, and the classification of hospitals in terms of performance categories were expressed as absolute and relative values. Chi-square tests of independence were performed to investigate the association between the hospital’s performance category and the hospital’s geographic region and size. Results: In total, 87.5% of the invited hospitals participated in the study, and only 27.59% of the hospitals had a pharmacist responsible for medicinal gases. Pharmacovigilance was performed by pharmacists in 20.59% of the hospitals. Analyzing the hospitals by region of the country and size, statistically significant associations were found between the general classification of hospitals and the geographic region (x2(8)=18.936, p= 0.015), as well as the classification of the hospital and structure and size (x2(9)= 20.373, p= 0.016). Analyses of the adjusted standardized residues returned an association between the southeastern region and the satisfactory performance category when analyzing the entire instrument, and between the excellent performance category in the structure section and size of a small hospital. Conclusion: In most of the hospitals studied, management of medicinal gases did not show the desired performance, which indicates the need to comply with current healthcare legislations and improve the provided services. It is believed that compliance rates may evolve training of healthcare team members, with an emphasis on the pharmacist.
... This reflects a major gap in pharmacy practice, with an indirect cost on consumers of pharmaceutical services and products. The use of automated/point-of-care dispensing technologies has prevented this gap in United States 16,17 and Europe 18,19 but was among the least performed activity by our study participants. The absence or infrequent use of automated technologies in our study was expected as a result of minimal or nonexistent automated medicine dispensing technologies in the country. ...
Background
Identifying involvement of pharmacy technicians (PTs) in non-clinical and clinical duties will provide insight for improved pharmaceutical services.
Objectives
This study assessed involvement of PTs in non-clinical tasks, patient-centered services, and more specialized patient care services, and the difference in practice between hospital and community PTs.
Methods
A cross-sectional survey was conducted using a 5-point Likert scale, and analysis of data was performed using SPSS version 21.0. Descriptive statistics was done and p≤0.05 was considered significant. The study was conducted in community and hospital pharmacies in Ogun State, Nigeria, among 100 pharmacy technicians. Outcome measures were involvement of PTs in clinical roles and other pharmaceutical care practices.
Results
A total of 73(73.0%) participated in the study, 45(61.6%) and 28(38.4%) practiced in hospital and community pharmacies respectively. From the 11 listed non-clinical activities, only stocking of medications 61(83.6%) and processing patient/client’s charges 48(65.8%) were often/very often performed. Over half of participants often performed each of all 7 listed patient-centered activities, particularly empathy/confidentiality 62(84.9%), providing information and referrals to patients/clients 56(76.7%) and identifying patients/clients for counselling 51(69.9%) respectively. No significant difference was observed between the practice areas (P>0.05). Only 2 of the 11 listed specialized clinical activities were performed by over half of respondents; screening prescriptions for completeness and authenticity 43(58.9%) and alerting the pharmacist of drug therapy problems 46(63.0%). Differences in practice of specialized tasks was significant for consultations (P=0.002) and resolution of clinical conflict (P=0.040), between the practice areas.
Conclusion
Study participants were less frequently involved in non-clinical activities, but often involved in clinical activities. They also participated in specialized clinical tasks at lesser frequencies. Differences were observed between the practice areas in performance of non-clinical and specialized activities. Strategies to fill-in the observed gaps should be explored, for improved practice.
... 2022;79:306-313 A n automated dispensing cabinet (ADC) is a computerized drug dispensing system utilized by many health systems to ease medication distribution within patient care areas while also controlling and tracking inventory. 1 While ADC medications are generally accessible pursuant to an order, one key ADC function is the ability to dispense inventoried medications "on Quality improvement and reconciliation process for automated dispensing cabinet medication overrides override. " 2 ADC medication overrides, or medication dispenses permitted without pharmacist review, undermine traditional safeguards, enable access to secured medications, and promote unsafe workflows through error-prone interactions and technology workarounds. ...
Disclaimer
In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
Purpose
To describe a pharmacist-led reconciliation process for automated dispensing cabinet (ADC) medication override setting maintenance at an academic medical center.
Summary
ADC override management requires alignment of people, processes, and technology. This evaluation describes system-wide improvements to enhance institutional medication override policy compliance by establishing a formalized evaluation and defined roles to streamline ADC dispense setting management. A pharmacist-led quality improvement initiative revised the institutional medication override list to improve medication dispensing practices across an academic medical center campus with a pediatric hospital and 2 adult hospitals. This initiative included removal of patient care unit designations from the medication override list, revision of institutional override policy, creation of an online submission form, and selection of ADC override metrics for surveillance. A conceptual framework guided decisions for unique dosage forms and interdisciplinary engagement. Employing this framework revised workflows for stakeholders in the medication-use process through clinical pharmacist evaluation, existing shared governance structure communication, and pharmacy automation support.
The revised policy increased the number of medications available for override from 80 to 106 (33% increase) and unique dosage forms from 166 to 191 (15% increase). The total number of medication dispense settings was reduced from 5,600 to 541 (90% decrease). The proportion of override dispenses compliant with policy increased from 59% to 98% (P < 0.001). Median monthly ADC overrides remained unchanged following policy revision (P = 0.995). ADC override rate reduction was observed across the institution, with the rate decreasing from 1.4% to 1.2% (P < 0.001). Similar ADC override rate reductions were observed for adult, pediatric, and emergency department ADCs.
Conclusion
This initiative highlights pharmacists’ role in leading institutional policy changes that influence the medication-use process through ADC dispensing practices. A pharmacist-led reconciliation process that removed practice area designations from our medication override policy streamlined ADC setting maintenance, increased the compliance rate of ADC override transactions, and provided a formalized process for future evaluation of medication overrides.
... 39 40 In line with our study, they acknowledge clinical pharmacists' educational capabilities, and their role in reviewing and managing the safe medication therapy process. 15 However, prior studies also indicate that emergency medicine clinical pharmacists, 41 are typically not dedicated full-time to the ED. 42 This issue is likely to be related to clinical pharmacy shortage and inadequate financial resources. ...
Objectives
Edication management is a process in which medications are selected, procured, delivered, prescribed, reviewed, administered and monitored to assure high-quality patient care and safety. This paper explores clinicians’ attitudes towards medication management which is both open to influence and strongly linked to successful changes in mediation behaviour. We aimed to investigate effects of engaging in participatory action research to improve emergency medicine clinicians’ attitudes to safety in medication management.
Setting
Emergency department of one university affiliated hospital.
Participants
A total of 85 clinicians including nurses and physicians partook as participants. Eight managers and clinicians participated as representatives.
Design
Data are drawn from two-cycle participatory action research. Initially, a situation analysis on the current medication management and clinician views regarding medication management was conducted using three focus groups. Evaluation and reflection data were obtained through qualitative interviews. All qualitative data were analysed using content analysis.
Results
Clinicians initially expressed negative attitudes towards existing and new plans for medication management, in that they were critical of current medication-related policy and procedures, as well as wary of the potential relevance and utility of potential changes to medication management. Through the action research, improvement actions were implemented including interprofessional courses, pharmacist-led interventions and the development of new guidelines regarding medication management. Participants and their representatives were engaged in all participatory action research stages with different levels of involvement. Extracted results from evaluation and reflection stages revealed that by engaging in the action research and practice new interventions, clinicians’ attitude towards medication management was improved.
Conclusions
The results support the impact of participatory action research on enhancing clinicians’ positive attitudes through their involvement in planning and implementing safety enhancing aspects of medication management.
... 61,110 Although health care tasks may differ from tasks performed in other industries, and thus, the automation approaches from other industries may not be directly applicable; there are lessons learned regarding how to approach automation that may be important to consider in the application of automation approaches in health care. Although health care has made use of automation, it is generally employed in administrative and operational processes such as billing, 98 compound preparation, 45,111 or delivery of medications, meals, or linens 112 with the purpose of reducing "no-show" rates for scheduled appointments, increasing patient throughput, and reducing the burden of operational workflows. There are examples of automation of clinical care tasks such as screening processes, 113 transmitting results and other communications, 114 and application of clinical guidelines 115,116 that use health IT. ...
Background Workflow automation, which involves identifying sequences of tasks that can be streamlined by using technology and modern computing, offers opportunities to address the United States health care system's challenges with quality, safety, and efficiency. Other industries have successfully implemented workflow automation to address these concerns, and lessons learned from those experiences may inform its application in health care.
Objective Our aim was to identify and synthesize (1) current approaches in workflow automation across industries, (2) opportunities for applying workflow automation in health care, and (3) considerations for designing and implementing workflow automation that may be relevant to health care.
Methods We conducted a targeted review of peer-reviewed and gray literature on automation approaches. We identified relevant databases and terms to conduct the searches across sources and reviewed abstracts to identify 123 relevant articles across 11 disciplines.
Results Workflow automation is used across industries such as finance, manufacturing, and travel to increase efficiency, productivity, and quality. We found automation ranged from low to full automation, and this variation was associated with task and technology characteristics. The level of automation is linked to how well a task is defined, whether a task is repetitive, the degree of human intervention and decision-making required, and the sophistication of available technology. We found that identifying automation goals and assessing whether those goals were reached was critical, and ongoing monitoring and improvement would help to ensure successful automation.
Conclusion Use of workflow automation in other industries can inform automating health care workflows by considering the critical role of people, process, and technology in design, testing, implementation, use, and ongoing monitoring of automated workflows. Insights gained from other industries will inform an interdisciplinary effort by the Office of the National Coordinator for Health Information Technology to outline priorities for advancing health care workflow automation.
... The ASHP survey is open to all hospitals, including those with fewer than 50 acute care beds. [5][6][7] The Canadian Institute for Health Information reported that Canada had 591 hospitals (acute to long-term care) in 2017/18. 8 However, up to 62% of Canadian institutions, including small hospitals (fewer than 50 acute care beds) are not represented in the Hospital Pharmacy in Canada Report. ...
Background:
The Canadian Society of Hospital Pharmacists' Hospital Pharmacy in Canada Report presents data from pharmacy departments that service hospitals with at least 50 acute care beds. This report provides valuable data on pharmacy distribution, clinical, and management services in relation to hospital size, type, and geographic region. Pharmacy and hospital leadership use these extensive data in identifying baseline, benchmarking current, and planning enhanced pharmacy services. However, for most of Canada's small hospitals, such data remain unknown, and leadership remains uninformed.
Objective:
To gather and analyze data about current pharmacy distribution, clinical, and management services in hospitals with fewer than 50 acute care beds receiving third-party remote pharmacy (telepharmacy) services.
Methods:
In April 2019, pharmacy administrators of hospitals in Ontario, Quebec, and Saskatchewan that had fewer than 50 acute care beds and were using third-party telepharmacy services were invited to complete a comprehensive survey addressing concepts similar to those in the Hospital Pharmacy in Canada Survey. The following data on clinical pharmacy practice were collected: models of care, assignments to patient care programs, pharmacists' activities, performance indicators, and professional evaluation. The description of pharmacy distribution services comprised type of system, technology, location, hours of operation, method of medication order entry and verification, and medication administration records. Details on facilities' parenteral admixture infrastructure, policy for and provision of sterile compounding, and pharmacy department human resources, including composition and staffing ratios, were also collected.
Results:
Of the 27 hospitals in Ontario, Quebec, and Saskatchewan that were invited to participate, 24 (89%) completed the survey. The median facility size was 19 acute care beds.
Conclusions:
Previously unavailable in Canada, these quantitative data from small hospitals supported by telepharmacy services provide facts about pharmacy distribution, clinical, and management services to inform hospital and pharmacy leaders. Creation of a survey unique to small hospitals, whether or not they use telepharmacy services, could provide a valuable resource to assist in the benchmarking, planning, and enhancement of pharmacy services in remote and rural communities.
... The survey was conducted using methods similar to those used in past ASHP surveys. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Questionnaire development. The 2020 questionnaire was developed using procedures suggested by Dillman. ...
Purpose
Results of the 2020 ASHP national survey of pharmacy practice in hospital settings pertaining to pharmacy operational changes implemented in response to the coronavirus disease 2019 (COVID-19) pandemic are presented.
Methods
Pharmacy directors at 1,437 general and children’s medical/surgical hospitals in the United States were surveyed using a mixed-mode method of contact by email and mail. Survey completion was online.
Results
The response rate was 18.7%. Seventy-three percent of hospitals implemented changes to hospital units, including 46% that increased intensive care unit bed capacity; 94% made changes to pharmacy supply chain acquisition, changes to products, and/or increased inventory. Staffing changes were implemented by 69% of hospitals, with the most common being staffing reductions (55%) and salary reductions (16%). Medication-use changes were implemented by 86% of hospitals, with treatment guidelines for COVID-19 treatment (79%) and opening compassionate use or investigational drug studies (55%) being the most common. Changes in sterile compounding processes were implemented by 84% of hospitals. Personal protective equipment (PPE) shortages led to 71% of hospitals modifying PPE use standards in sterile compounding. Eighty-seven percent of hospitals changed operational activities, such as changing medication return practices (56%), medication reconciliation processes (46%), intravenous medication recycling (38%), and discharge counseling (37%). Hospitals experienced shortages of many medications, including albuterol inhalers (60%), sedatives and anesthetic agents (58%), neuromuscular blockers (43%), corticosteroids (34%), cardiovascular agents (24%), investigational agents (24%), and dialysis solutions (6%).
Conclusion
The pharmacy profession responded to myriad threats to operations and patient care during the COVID-19 pandemic in 2020.
... Unlike other studies conducted, interventions on medication simplification by changing direct services delivered by healthcare professionals [25][26][27][28], we believe that the significance of our study was in its approach to provide a system change. As Schneider et al. described, over 95% of health institutions in the United States use the CPOE system [29]; therefore, our study demonstrating our collaborative approach toward changing the HIS can be instrumental in enhancing this system's feasibility, serve as a potentially adaptable method to enhance the CPOE system in other healthcare settings, and prove to be a methodological tool for real-world-based intervention studies. ...
The multiplicity of dosing frequencies that are attached to medication orders poses a challenge to patients regarding adhering to their medication regimens and healthcare professionals in maximizing the efficiencies of health care service delivery. A multidisciplinary team project was performed to simplify medication regimens to improve the computerized physician order entry (CPOE) system to reduce the dosing frequencies for patients who were discharged from the hospital. A 36-month pre-test–post-test study was performed, including 12-month pre-intervention, 12-month intervention, and 12-month post-intervention periods. Two-pronged strategies, including regimen standardization and prioritization, were devised to evaluate the dosing frequencies and prescribing efficiency. The results showed that the standardized menu reduced the dosing frequencies from 4.3 ± 2.2 per day in the pre-intervention period to 3.5 ± 1.8 per day in the post-intervention period (p < 0.001). In addition, the proportion of patients taking medications five or more times per day decreased from 40.8% to 20.7% (p < 0.001). After prioritizing the CPOE dosing regimen, the number of pull-down options that were available reflected an improvement in the prescribing efficiency. Our findings indicate that concerted efforts in improving even a simple change on the CPOE screen via standardization and prioritization simplified the dosing frequencies for patients and improved the physicians’ prescribing process.
... Due to the lack of standardization in on-hand inventory between hospital pharmacies, there are few protocols for medications regarding storage and dispensing. 2 Medications can be dispensed via automated dispensing cabinets, pharmacy technician deliveries, cart fill, pneumatic tube system, or individually handed to a specific practitioner. At the study institution, if a nurse did not have a specific medication, a request for the missing medication could be placed through the electronic medical record (EMR) via an old process. ...
Missing medications can negatively contribute to the financial and operational workflows of pharmacy departments and add medication safety challenges. The missing medication request (MMR) system at the study institution converted to entirely electronic in June 2018 from a hybrid electronic system. This study evaluated 4-week periods pre- and post-conversion. The objective of this study was to evaluate the impact of conversion to an electronic MMR system on the quantity of requests received at an academic medical center. The average daily number of MMR’s decreased from the pre-conversion group to the post-conversion group (1.77 (±0.16) vs 1.48 (±0.17), p < 0.001). During post-conversion, the median triage time was 8 min [3 min–19 min], pharmacists triaged 62.4% of requests, and 29.6% of requests were declined. Conversion to an electronic MMR system represents one solution to decreasing missing medications. Future studies are needed to evaluate the financial, operational, and medication safety impact of conversion.
Background: The ever-increasing complexity and demand for antineoplastic therapy necessitates innovative solutions to improve the accuracy and safety of drug preparation. Objective: To evaluate the utilization of an advanced robotic chemotherapy drug compounding system (APOTECAchemo) at a Community Cancer Center (CCC), examining accuracy, efficiency, and staff perceptions. Methods: This single-center, retrospective study evaluated the preparation of 7 intravenous (IV) antineoplastics at a CCC over a 1-year period. We compared manual methods with the APOTECAchemo system. The primary measure of accuracy was the absolute drug error percentage, with a comparison of pass and fail rates. Secondary endpoints included the overall use of APOTECAchemo for all IV antineoplastic preparations and average preparation times. An end-user satisfaction survey gathered feedback from pharmacists and pharmacy technicians. Results: A total of 8210 doses were prepared at the CCC, with 52.1% compounded by APOTECAchemo and 47.9% manually. Of these, the CCC prepared 5526 doses of the 7 routinely compounded antineoplastics. APOTECAchemo prepared 3851 (69.7%) doses, while manual compounding accounted for 1675 (30.3%) doses. The average absolute drug error was 1.44% (95% CI, 1.35-1.53) with robot compounding versus 1.17% (95% CI, 1.03-1.32) with manual ( P < 0.001). The overall failure rate was 0.72%. There were 25 failed doses (0.45%), with 8 (0.2%) failures attributed to APOTECAchemo and 17 (1%) to manual compounding ( P < 0.001). The average dose preparation time was longer with APOTECAchemo compared with manual methods. The end-user satisfaction survey indicated a positive reception toward APOTECAchemo. Conclusions: Our study demonstrates the successful implementation, extensive utilization, and high accuracy of both APOTECAchemo and manual compounding methods in the preparation of routinely administered antineoplastics at a CCC.
Purpose
Results of the 2023 ASHP National Survey of Pharmacy Practice in Hospital Settings are presented.
Methods
Pharmacy directors at 1,497 general and children’s medical-surgical hospitals in the United States were surveyed using a mixed-mode method of contact by email and mail. Survey completion was online using Qualtrics. IQVIA supplied data on hospital characteristics; the survey sample was drawn from IQVIA’s hospital database.
Results
The response rate was 21.6%. Inpatient pharmacists independently prescribe medications in 26.7% of hospitals. Advanced analytics are used in 5.7% of hospitals. Basic analytics are used in 87.3% of hospitals. Pharmacists work in ambulatory or primary care clinics in 54.2% of hospitals operating outpatient clinics. Most hospitals (86.1%) use automated dispensing cabinets as the primary method of maintenance dose distribution. Machine-readable coding is used in 73.6% of hospitals to verify doses during dispensing in the pharmacy. Autoverification functionality in the electronic health record system is used in 73.4% of hospitals. Most hospitals report some integration of pharmacy services to optimize patient care transitions (60.0%), while 24.9% report no integration. Traditional technician activities still predominate, but more advanced roles are emerging. Technologies to assist sterile product preparation are used in 62.8% of hospitals.
Conclusion
Drug distribution continues to trend toward decentralized models with medications available closer to patients. Technologies are enabling this transition to occur without a significant negative impact on patient safety. The pharmacy workforce is stable, and more advanced responsibilities are being assigned to pharmacy technicians, enabling pharmacists to increase their clinical role.
To improve efficiency, quality and safety of medication administration systems, hospitals have been implementing automated dispensing cabinets (ADCs) in healthcare units. The purpose of this study was to evaluate nursing staff’s level of satisfaction with ADCs by analyzing several aspects and differences in perceptions between groups of users. It being a fact that nurses are the end users of the ADC system, their perceptions and opinions are crucial to the success of this technological implementation. A cross-sectional survey was conducted in units with ADCs from a Spanish hospital (n = 97, 32.12%. response rate). Data were analyzed using comparisons between groups and principal component analysis (PCA). The results show that, in general terms, nursing staff have a high degree of satisfaction with ADCs, with order and organization being the most valued aspect. The type of clinical unit and personnel seniority explain some of the differences in valuation. PCA revealed the existence of two general dimensions of nurse satisfaction: efficiency and safety. From this study, conclusions can be drawn to help hospital managers achieve success in implementing ADCs in their centers.
Purpose
Our study aims to provide an overview of medication therapy monitoring practices carried out by pharmacists in hospitals across the Gulf Cooperation Council (GCC) countries.
Methods
This is a cross-sectional questionnaire-based study of hospitals located in the GCC. Questions were adopted from the American Society of Health-System Pharmacists (ASHP) national survey. Frequency analyses were used to examine the number and percentages of specific responses to the survey questions.
Results
A total of 64 hospitals participated in this survey, reflecting an overall response rate of 52.0%. Almost half of participating hospitals (48.4%) were from Saudi Arabia. Among the 64 participating hospitals, 54.7% monitored their patients daily, 40.6% assigned pharmacists to patient care units for at least eight hours per day, and 42.2% held pharmacists accountable for medication-related outcomes. Moreover, the criteria used to identify patients requiring monitoring, 35.9% relied on the list of high-risk medications, 26.5% relied on specific medical services, 21.9% relied on directions from the hospital committee, and 17.2% relied on lab abnormalities. The most frequently utilized method for monitoring adverse drug events (ADEs) was through notifications from nurses or physicians, observed in 60.9% of participating hospitals.
Conclusion
The survey emphasizes the need for hospitals in the GCC to promote increased pharmacist accountability for medication-related outcomes, explore technological solutions to enhance monitoring efficiency and extend the presence of pharmacists in patient care units beyond the current level.
Standard concentration infusions and ‘smart-pumps’ are recognised as best practice in the paediatric setting. Implementation rates in European hospitals remain low. Children’s Health Ireland (CHI) developed a paediatric ‘smart-pump’ drug library using standardised concentrations. At time of development, other Irish hospitals continued to use traditional pumps and weight-based paediatric infusions.
To expand best paediatric infusion practices by nationalising use of the CHI drug library.
Tertiary paediatric, maternity and general acute hospitals, and associated transport services in Ireland.
The CHI drug library was first developed for paediatric intensive care and then adapted over a 10-year period for use in emergency departments, general paediatric wards, neonatal units, adult intensive care and transport services. The original library (42 drug lines, 1 ‘care-unit’) was substantially expanded (223 drug lines, 6 ‘care-units’). A neonatal sub-library was created.
Executive support, dedicated resources and governance structures were secured. Implementation and training packages were developed. Implementation has occurred across CHI, in paediatric and neonatal transport services, 58% (n = 11) of neonatal units, and 23% (n = 6) of paediatric sites.
A before and after study demonstrated significant reductions in infusion prescribing errors (29.0% versus 8.4%, p < 0.001). Direct observation of infusions (n = 1023) found high compliance rates (98.9%) and low programming errors (1.6%). 100% of nurses (n = 132) surveyed 9 months after general ward implementation considered the drug library had enhanced patient safety.
Strategic planning and collaboration can standardise infusion practices. The CHI drug library has been approved as a National Standard of Care, with implementation continuing.
Objectives
Medication management is a core process in hospital administration. The safety, timeliness and efficiency of medication distribution may be improved by automating logistical and administrative aspects of the process. Forming an accurate high-level picture of current practices may help decision-makers to better advance the state of automation. This study aims to identify which systems for automating the medication process are currently in use in Swiss hospitals, and to what extent each system is used.
Methods
A 27-question survey was developed and distributed to Swiss Association of Public Health Administration and Hospital Pharmacists (GSASA) members. The survey focused on enterprise resource planning (ERP) systems, automation of in-hospital distribution and dispensing of pharmaceutical goods, bedside scanning, and the management of drug master data.
Results
The response rate was 98% (58/59 hospital pharmacies). All institutions had an ERP system in use, most frequently SAP (n=23, 39%). Electronic invoices from suppliers were fully processed by 37% and partially processed by 17% of respondents. Twenty-five percent of respondents reported performing bedside scanning for the purpose of medication administration. Automated medication distribution systems were available in 20 hospitals (34%), of which 13 were central robots and seven were decentralised systems.
Conclusion
A considerable gap remains to achieve closed loop processes between multiple systems. The present results provide an inventory of existing systems and current trends for use by decision-makers in hospitals and hospital pharmacies.
Purpose
Results of the 2022 ASHP National Survey of Pharmacy Practice in Hospital Settings are presented.
Methods
Pharmacy directors at 1,498 general and children’s medical/surgical hospitals in the United States were surveyed using a mixed-mode method of contact by email and mail. Survey completion was online. IQVIA supplied data on hospital characteristics; the survey sample was drawn from IQVIA’s hospital database.
Results
The response rate was 23.7%. Inpatient pharmacists independently prescribe in 27.1% of hospitals. Advanced analytics are used in 8.7% of hospitals. Pharmacists work in ambulatory or primary care clinics in 51.6% of hospitals operating outpatient clinics. Some level of pharmacy service integration is reported in 53.6% of hospitals. More advanced pharmacy technician roles are emerging. For health systems offering hospital at home services, 65.9% of pharmacy departments are involved. Shortages of pharmacists and technicians were reported but are more acute for pharmacy technicians. Aspects of burnout are being measured in 34.0% of hospitals, and 83.7% are attempting to prevent and mitigate burnout. The average number of full-time equivalents per 100 occupied beds is 16.9 for pharmacists and 16.1 for pharmacy technicians.
Conclusion
Health-system pharmacies are experiencing workforce shortages; however, these shortages have had limited impact on budgeted positions. Workforce challenges are influencing the work of pharmacists and pharmacy technicians. Adoption of practice advancement initiatives has continued the positive trend from past years despite workforce issues.
Objective
The healthcare workers and the workers in the manufacturing industry of chemotherapy drugs are exposed to the “hazardous” effects of these drugs during production, transportation, distribution, administration, and disposal. In order to be protected from these harmful effects, personal protective equipment and medical devices providing safe applications are used. The aim of the present article is to review of medical devices used for safe chemotherapy applications in line with the information obtained from the literature.
Data sources
The international and national reliable sources, were used in the literature review for data analysis by using the keywords including chemotherapy, chemotherapy drugs, antineoplastic drugs, cytotoxic drugs, hazardous drugs, exposure to chemotherapy drugs, side effects of chemotherapy drugs, closed-system drug transfer devices, healthcare staff, needle-free devices, needle-free connectors, surface contamination, and phthalates.
Data summary
In order to minimize cytotoxic drug exposure, international standards were developed in the mid-1980s stating that all cytotoxic drugs should be prepared preferably in a ventilated biological safety cabinet, nurses dealing with the use of these drugs should use appropriate personal protective equipment, and in case of cytotoxic drug spillage, predefined cleaning and decontamination protocols should be followed. Although the risk of acute and long-term toxic effects in healthcare workers has decreased in recent years with these applications in the preparation and administration of cancer drugs, measurable contamination occurs in the workplace. A large number of medical devices have been developed for minimizing this type of contamination with chemotherapy drugs. In this article, these medical devices have been reviewed in detail under subtitles of closed system transfer devices, needle-free devices, and valve technology.
Conclusions
Until the results of the evaluations to be made in new studies prove the opposite, the use of these devices with additional protection measures taken, especially during the application of dangerous drugs, is of great importance in terms of patient and employee safety.
Drug underdosing and overdosing are potential causes of medication errors and adverse drug events when inadequate consideration is given to factors such as height, weight, and body composition when designing dosing regimens. A landmark study by Leape et al¹ was one of the first to document the frequent occurrence of drug dosing errors as a common but usually preventable form of medication error. The reasons for dosing errors are multifactorial, including inexperience, inattention, and fatigue.² One study highlighted the lack of computational training as a requirement for entry into medical school and evaluated drug calculation errors via a calculations test given to anesthesiology residents and attending faculty at 7 academic institutions.³ The study found a median of 2 errors for every 15 questions in both groups, although residents had twice as many hundredfold errors as faculty. Computerized prescriber order entry (CPOE) and clinical decision support systems (CDSSs) are examples of technologies with the potential to reduce prescribing errors, including those related to dosing, but errors still occur for a variety of reasons, including disjointed CPOE displays, order formatting, and inconsistencies within prescriptions.⁴⁻⁶ Another ongoing source of potential prescribing error relates to the number and choice of descriptors for weight (eg, total body weight, ideal body weight [IBW], amd adjusted body weight) and size (eg, height, body mass index [BMI], and body surface area [BSA]) available for drug dosing,⁷ particularly with respect to weight-based dosing regimens. The purpose of this commentary is to discuss potential prescribing errors involving the use of weight and size descriptors such as choice of weight for weight-based dosing regimens and provide suggestions to decrease the likelihood of error occurrence.
Purpose
To determine the impact of a business intelligence dashboard tool to optimize automated dispensing cabinets (ADCs).
Methods
A pre-post implementation design was used to evaluate key performance indicators (KPI) before and after the implementation of a dashboard tool to optimize ADCs. Eleven ADCs were optimized in 2 phases according to dashboard recommendations: (1) removal of unused medications over 90 days, (2) adjusting periodic automatic replenishment (PAR) levels, and (3) addition of commonly dispensed medications. The KPI measures that were assessed included inventory cost, no. of stocked medications, stockout percentage, vend to refill ratio, and missing dose messages from nursing. An interrupted-time-series regression was used to quantify the impact of ADCs on the means of measured KPIs.
Results
Differences in mean distribution of all KPIs, except missing dose, between the pre- and post-ADC periods during the Phase 1 period were statistically significant: inventory cost (54.2 vs 56), stockout percentage (1.55 vs 1.12), vend to refill ratio (6.83 vs 6.14), and missing dose messages (221 vs 229). Only the mean ADC utilization (57.3 vs 64) and missing dose (228 vs 179) were statistically different between the pre- and post-ADC periods in Phase 2. The interrupted-time-series analysis showed that Phase 1 optimization significantly reduced the cost of inventory (β = −$1.238.00, P < .01), no. Stocked medications (β = −8.2, P < .01), percent stockout (β = −.49%, P < .01), vend-to-refill ratio (β = −1.29%, P<.01) and ADC utilization (β = −.2, P < .01).
Conclusion
Automated dispensing cabinets optimization, through the use of a dashboard tool, had a positive impact on almost all measured KPIs.
Purpose
Results of the 2021 ASHP National Survey of Pharmacy Practice in Hospital Settings are presented.
Methods
Pharmacy directors at 1,498 general and children’s medical/surgical hospitals in the United States were surveyed using a mixed-mode method of contact by email and mail. Survey completion was online. IQVIA supplied data on hospital characteristics; the survey sample was drawn from IQVIA’s hospital database.
Results
The response rate was 21.9%. Pharmacists are routinely assigned to a majority of patients at least 8 hours per day, 5 days per week in 70.4% of hospitals. This is an increase from 60.8% in 2018 and has steadily increased over the past decade. Pharmacists independently prescribe medications pursuant to a diagnosis in 30.9% of hospitals, an increase from 21.1% in 2020. Pharmacists have prescribing authority in 67% of health-system ambulatory clinics and can recommend or schedule pharmacogenomics testing for drug and dosage selection in 11.4% of hospitals, an increase from 5.4% in 2019. Pharmacists are using electronic methods in 82.5% of hospitals to collect information for monitoring medication therapy. Shortages of entry-level pharmacy technicians are acute, with 73.4% of survey respondents reporting a shortage. Technician shortages have affected pharmacy operations and have prompted new recruitment and retention strategies.
Conclusion
Despite workforce challenges, clinical pharmacy services continue to expand to cover increasing numbers of patients with medication management services in both the inpatient and outpatient settings. The use of data analytics and pharmacy technicians has contributed to this evolution. Addressing the workforce challenges will be critical to sustain this progress.
Objective:
To describe the provision of pharmaceutical services within Ministry of Health hospitals in Mexico and identify the main factors that affect their implementation.
Methods:
Between November 2018 and April 2019, we conducted telephone interviews with the heads of pharmacy departments of 413 state and federal Ministry of Health hospitals in Mexico. Responses were analyzed with descriptive and inferential statistics to determine the main factors influencing the implementation of pharmaceutical services within these public hospitals.
Key findings:
Of the 413 hospitals, a total of 96 hospitals in 27 states reported the provision of at least one pharmaceutical service. The most frequently reported services were: patient education on the correct use of medications (23%), provision of information to other health professionals on the rational use of medications (21%), and participation in the hospital´s pharmacovigilance system (19%). The main factors associated with the implementation of HPS were the number of pharmacists (46%, n = 215, p=0.001) and the pharmaceutical- or health sciences-oriented education of the head of the pharmacy department of the hospital (46%, n = 215, P = 0.001).
Conclusions:
Hiring more pharmacists and ensuring the appropriate professional education of the head of the pharmacy department are key factors to expanding the implementation of pharmaceutical services in Mexico's public hospitals.
Purpose
In this paper, we describe CommonSpirit Health’s telepharmacy service, which serves 64 hospitals in 10 states. Hospitals range in size from critical access to quaternary care centers.
Summary
Telepharmacy services in acute care may be divided into 2 primary styles: hospitals requiring after-hours support utilizing telepharmacists to bridge shifts otherwise uncovered by pharmacists and hospitals with round-the-clock onsite pharmacy services utilizing telepharmacists to enhance efficiency in processing medication orders. When providing after-hours service, telepharmacists review all medication orders. The primary goal is to provide pharmacist care at all hours. In hospitals with round-the-clock onsite pharmacy services, telepharmacists focus on efficiency of medication order review. Median turnaround times in these hospitals decreased 50% to 70% after implementing a telepharmacy service. Barriers to implementation include managing different electronic health records, variability in hospital practices, and communicating with onsite clinicians. Regular interaction with onsite leaders is a key component in overcoming these barriers. This enables the telepharmacy team to respond to hospital-specific changes and maintain competence. The service adjusts to provide additional support based on the needs of the sites. Most telepharmacists work from home. While this can present challenges, we consider it an advantage in recruitment and retention.
Conclusion
CommonSpirit Health utilizes its telepharmacy service for hospitals large and small to enhance efficiency in processing medication orders and to provide round-the-clock pharmacist care.
The medication-use process (MUP) is the essential and foundational system that provides the framework for safe medication use within the healthcare environment, ensuring medications are utilized and patients are followed in the most appropriate manner across all settings.¹ As stewards for appropriate medication use within healthcare organizations, health-system pharmacists have a leadership role in optimizing the MUP to increase the efficiency and safety of patient care.¹
The US Pharmacopeia describes 8 major steps of the MUP: procurement, prescribing, transcribing, order entry, preparation, dispensing, administration, and monitoring.¹ The MUP is represented in Figure 1. The authors have used the working terms of prescribing/transcribing, dispensing, administration, and monitoring for the 4 steps of the MUP because the broad use of computerized prescriber order entry (CPOE) has limited transcribing.² The American Society of Health-System Pharmacists (ASHP) has been an advocate for the importance of the role of the pharmacist in the MUP through advocacy, policy statements, and publications.
Address correspondence to Bruce Hawkins (standards@ashp.org).
Automated dispensing cabinet (ADC) technology is used to improve patient care, enhance the efficiency and accuracy of medication dispensing in the medication-use system, support medication storage and security, and provide evaluation of ADC-user interactions. ADC use has become widespread in healthcare institutions, with 93% of hospitals using ADCs in their medication-use systems,¹ and 70.2% using ADCs as a primary method of maintenance dose distribution.²
Implementation steps and objectives to support an ADC system include the following:
These guidelines address components of ADC technology implementation and important detailed steps to meet and maintain basic ADC requirements.
Background
Appropriate, accurate, and timely distribution of medications to patients is a well-established responsibility of pharmacists. Use of ADCs has become the standard of care for the medication-use process in healthcare systems.² ASHP supports use of ADCs, because they are essential to provide quality patient care, secure storage of medications, and ensure viability of the medication-use process in healthcare organizations.
Aim
This work aimed to evaluate the impact of automated dispensing cabinets on the dispensing error rate, the number of interruptions, and pillbox preparation times.
Methods
A prospective observational study was conducted across 16 wards in two departments (internal medicine and surgery) of a large teaching hospital. The study compared eight wards using automated dispensing cabinets (ADCs) and eight using a traditional ward stock (TWS) method. A disguised observation technique was used to compare occurrences of dispensing errors and interruptions and pillbox preparation times. The proportion of errors was calculated by dividing the number of doses with one or more errors by the total number of opportunities for error. Wards participating in the ‘More time for patients’ project—a Lean Management approach—were compared with those not participating. The potential severity of intercepted errors was assessed.
Results
Our observations recorded 2924 opportunities for error in the preparation of 570 pillboxes by 132 nurses. We measured a significantly lower overall error rate (1.0% vs 5.0%, p=0.0001), significantly fewer interruptions per hour (3.2 vs 5.7, p=0.008), and a significantly faster mean preparation time per drug (32 s vs 40 s, p=0.0017) among ADC wards than among TWS wards, respectively. We observed a significantly lower overall error rate (1.4% vs 4.4%, p=0.0268) and a non-significantly lower number of interruptions per hour (3.8 vs 5.1, p=0.0802) among wards participating in the ‘More time for patients’ project.
Conclusions
A high dispensing-error rate was observed among wards using TWS methods. Wards using ADCs connected to computerised physician order entry and installed in a dedicated room had fewer dispensing errors and interruptions and their nurses prepared pillboxes faster. Wards participating in a Lean Management project had lower error rates than wards not using this approach.
Disclaimer
In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
Purpose
Integrating smart pumps with an electronic health record (EHR) reduces medication errors by automating pump programming and EHR documentation. This study describes the patient safety and financial impact of pump-EHR interoperability at a community hospital.
Methods
A 316-bed community hospital in Sugar Land, TX, went live with pump-EHR interoperability in October 2019. Data were collected from April 1, 2019, to June 30, 2019 (before implementation) and from April 1, 2020, to June 30, 2020 (after implementation). Rates of drug library compliance, alert firing, alert override, override within 2 seconds, high-risk alert override, and alert resulting in pump reprogramming were measured. Financial impact was measured by Current Procedural Terminology code capture per kept appointment in the infusion center.
Results
Drug library compliance increased from 73.8% to 82.9% with pump-EHR interoperability (P < 0.001). Infusions generating alerts among all infusions programmed with the drug library decreased from 3.5% to 2.6% (P < 0.001), overridden alerts increased from 64.8% to 68.9% (P < 0.001), alerts overridden within 2 seconds decreased from 17.3% to 13.8% (P < 0.001), and reprogrammed alerts decreased from 20.7% to 18.3% (P = 0.002).
Conclusion
Pump-EHR interoperability leads to safer administration of intravenous medications based on improved drug library compliance and more accurate smart pump programming.
Background:
The implementation of pharmaceutical services in hospitals contributes to the appropriate use of medicines and patient safety. However, the relationship of implementation with the legal framework and organizational practice has not been studied in depth. The objective of this research is to determine the role of these two factors (the legal framework and organizational practice) in the implementation of pharmaceutical services in public hospitals of the Ministry of Health of Mexico.
Methods:
Semi-structured interviews were conducted with four groups of actors involved. The analysis focused on the legal framework, defined as the rules, laws and regulations, and on organizational practice, defined as the implementation of the legal framework by related individuals, that is, how they put it into practice.
Results:
The main problems identified were the lack of alignment between the rules and the incentives for compliance. Decision-makers identified the lack of managerial capacity in hospitals as the main implementation barrier, while hospital pharmacists pointed to poor regulation and the lack of clarity of the legal framework as the problems to consider.
Conclusions:
Although the legal framework related to hospital pharmaceutical services in Mexico is inadequate, organizational factors (such as adequate skills of professional pharmacists and the support of the hospital director) have facilitated gradual implementation. To improve implementation, priority should be given to evaluation and modification of the current legislation along with the development of an official minimum standard for activities and services in hospital pharmacies.
Purpose
To describe the implementation of an IV room technology-assisted workflow (TAWF) system integrated within a health system’s electronic medical record (EMR) and compare the TAWF system’s impact in improving workflow at multiple ambulatory infusion pharmacies.
Summary
IV room TAWFs help to standardize intravenous admixture operations while incorporating patient safety measures such as ingredient barcode scanning and image capture. The 4 oncology infusion center pharmacies of a large health system implemented a TAWF system integrated within the health system’s EMR software, transitioning to the new TAWF system from an external TAWF system operating outside of the EMR. Considerable planning was required to determine the hardware and workflow processes needed for the new integrated TAWF system to function within pharmacy IV rooms. Several operational challenges were encountered during the initial implementation phase of the project. Frequent occurrence of system malfunctions during the product imaging step was the largest problem, which was overcome by special hardware and a software upgrade. The project also involved an evaluation of the integrated TAWF system after implementation to ensure the pharmacies maintained operational efficiency and patient safety. The evaluation showed that after an initial transition period, the new technology was able to maintain IV admixture efficiency and safety.
Conclusion
This project and subsequent evaluation showed the operational feasibility, efficiency, and safety of a TAWF integrated within the health system’s EMR software.
Purpose
Results of the 2019 ASHP national survey of pharmacy practice in hospital settings are presented.
Methods
Pharmacy directors at 4,863 general and children’s medical/surgical hospitals in the United States were surveyed using a mixed-mode method of contact by email and mail. Survey completion was online, using an online survey application. IQVIA supplied data on hospital characteristics; the survey sample was drawn from the IMS Health hospital database.
Results
The response rate was 10.8%. Pharmacists are increasingly managing medication use in the areas of vancomycin therapy, antibiotic selection and dosing, and anticoagulation. Electronic health record (EHR) decision support is guiding prescribing, and nearly 50% of hospitals are customizing drug warnings. Adoption of compounding technology continues, with 43.6% of hospitals using technology in their sterile compounding processes. Nearly half of hospitals have active opioid stewardship programs, and pharmacists are leading these efforts. Specialty pharmacy operations are growing in health systems. Human resource commitments to support new services are increasing; however, vacancy rates for technicians are challenging. Staff credentialing continues to expand for pharmacist and technicians.
Conclusion
Pharmacists continue to assume greater responsibility for writing medication orders, dosing, ordering laboratory tests, and monitoring outcomes. Health-system pharmacists are taking a leading role in addressing the opioid crisis, advancing safety in compounded sterile preparations through adoption of intravenous workflow technologies, and optimizing EHR applications to leverage clinical decision support tools to improve the safe prescribing and use of medications.
Purpose. The results of the 2014 ASHP national survey of pharmacy practice in hospital settings that pertain to dispensing and administration are described. Methods. A stratified random sample of pharmacy directors at 1435 general and children's medical surgical hospitals in the United States were surveyed by mail. Results. In this national probability sample survey, the response rate was 29.7%. Ninety-seven percent of hospitals used automated dispensing cabinets in their medication distribution systems, 65.7% of which used individually secured lidded pockets as the predominant configuration. Overall, 44.8% of hospitals used some form of machine-readable coding to verify doses before dispensing in the pharmacy. Overall, 65% of hospital pharmacy departments reported having a cleanroom compliant with United States Pharmacopeia chapter 797. 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, in 81.2% of hospitals. Adoption rates of electronic health information have rapidly increased, with the widespread use of electronic health records, computer prescriber order entry, barcodes, and smart pumps. Overall, 31.4% of hospitals had pharmacists practicing in ambulatory or primary care clinics. Transitions-of-care services offered by the pharmacy department have generally increased since 2012. Discharge prescription services increased from 11.8% of hospitals in 2012 to 21.5% in 2014. Approximately 15% of hospitals outsourced pharmacy management operations to a contract pharmacy services provider, an increase from 8% in 2011. Conclusion. Health-system pharmacists continue to have a positive impact on improving healthcare through programs that improve the efficiency, safety, and clinical outcomes of medication use in health systems.
Results of the 2005 ASHP national survey of pharmacy practice in hospital settings that pertain to dispensing and administration are presented.
A stratified random sample of pharmacy directors at 1173 general and children's medical-surgical hospitals in the United States was surveyed by mail.
The response rate was 43.5%. Most hospitals had a centralized drug distribution system; however, there is evidence of growth in decentralized models compared with data from 2002. Automated dispensing cabinets were used by 72% of hospitals and robots by 15%. The percentage of doses dispensed in unit dose form increased, as did the use of two-pharmacist checks for high-risk drugs and high-risk patient groups. However, the percentage of medication preparation and dispensing quality-improvement programs declined over the past six years. Medication administration records (MARs) have become increasingly computerized over the past six years. Consequently, the use of handwritten MARs has declined substantially. Technology implemented at the administration step of the medication-use process is continuing to grow. Bar-code technology was implemented by 9.4% of hospitals, and 32.2% of hospitals had smart infusion pumps. Pharmacy hours of operation were stable, with 30% of hospitals providing around-the-clock services. About 12% of hospitals are using off-site medication order review and entry after hours. Pharmacy staffing has steadily increased over the past three years; however, hospital pharmacies reported a 5.6% vacancy rate.
Safe systems continue to be in place in most hospitals, but the adoption of new technology is changing the philosophy of medication distribution. Pharmacists are continuing to improve medication use at the dispensing and administration steps of the medication-use process.
Results of the 2006 ASHP national survey of pharmacy practice in hospital settings that pertain to monitoring and patient education are presented.
A stratified random sample of pharmacy directors at 1178 general and children's medical-surgical hospitals in the United States were surveyed by mail. SMG Marketing Group, Inc., supplied data on hospital characteristics; the survey sample was drawn from SMG's hospital database.
The response rate was 39.0%. Virtually all hospitals (93.4%) had pharmacists regularly monitoring medication therapy in some capacity. Patient monitoring has improved since 2003; fewer respondents reported monitoring less than 25% of patients in the hospital. More than two thirds of hospitals had a process for routine monitoring of patient profiles by pharmacists, and 87.3% of hospitals provided pharmacists with computer access to laboratory data to facilitate this function. Nearly 60% of hospitals allowed the transfer of electronic information between inpatient and outpatient settings. Over 87% of hospitals routinely monitored serum medication levels or a surrogate marker. In these hospitals, pharmacists ordered serum medication levels (69.1%), adjusted dosages (73.2%), and were notified when a level was outside the therapeutic range (47.3%). The number of adverse drug events (ADEs) reported by hospitals internally and externally decreased from the numbers reported in 2003 (213 and 31 versus 271 and 45, respectively). Medication counseling by pharmacists continued to be infrequent, with only 7.6% of hospitals reporting that 26% or more of inpatients received medication counseling. Documentation of patient education decreased from 58.0% in 2003 to 51.7%. Medication reconciliation programs were implemented in 71.7% of hospitals. The vacancy rate for budgeted pharmacist positions increased from 4.3% in 2003 to 4.6%.
Pharmacists have made significant strides to increase the number of patients whose drug therapy is monitored. Electronic access to laboratory data by pharmacists greatly increased, as did the availability of information transferred between the inpatient and outpatient settings. Therapeutic drug monitoring by pharmacists increased, as did pharmacists' ability to order serum medication levels and adjust dosages. More pharmacists were notified when medication levels fell outside the therapeutic range. Internal and external reporting of ADEs has decreased. Documentation of patient education declined. A significant percentage of hospitals developed and implemented medication reconciliation programs. The number of pharmacists per 100 occupied beds has increased, and the number of pharmacist vacancies remained stable.
Purpose. Results of the 2004 ASHP national survey of pharmacy practice in hospital settings that pertain to prescribing and transcribing are presented.
Methods. A stratified random sample of pharmacy directors at 1183 general and children’s medical–surgical hospitals in the United States was surveyed by mail. SMG Marketing Group, Inc., supplied data on hospital characteristics; the survey sample was drawn from SMG’s hospital database.
Results. The response rate was 41.7%. Compared with the results of the 2001 survey, the number of times pharmacy and therapeutics committees met increased, suggesting an increase in efforts to monitor and manage medication use in hospitals. There was an increase in the use of quality-of-life information to make formulary decisions, indicating a shift away from cost-based formularies. There was a decrease in the rates of formulary compliance, but an increase in the use of evidence-based clinical practice guidelines, suggesting the emergence of more comprehensive approaches to improving prescribing. The use of medication-use evaluations increased in smaller hospitals, suggesting greater use of best practices is occurring in these institutions. The use of drug information services continues to decline, as the use of more efficient and easily accessible online sources of drug information increases. Reading back oral orders to improve accuracy dramatically increased since 2001. The adoption of computerized prescriber-order-entry systems continues to be slow, with fewer than 5% of hospitals reporting their use.
Conclusion. The 2004 ASHP survey results indicate that pharmacists are continuing to improve medication use at the prescribing and transcribing steps of the medication-use system.
Purpose:
The results of the 2016 ASHP national survey of pharmacy practice in hospital settings are presented.
Methods:
A stratified random sample of pharmacy directors at 1,315 general and children's medical-surgical hospitals in the United States were surveyed using a mixed-mode method offering a choice of completing a paper survey or an online survey. IMS Health supplied data on hospital characteristics; the survey sample was drawn from IMS's hospital database.
Results:
The survey response rate was 29.8%. Drug policy development by pharmacy and therapeutics committees continues to be an important strategy for improving prescribing. Strict formulary systems are maintained in 63.0% of hospitals, and 89.7% of hospitals use clinical practice guidelines that include medications. Pharmacists have the authority to order laboratory tests in 89.9% of hospitals and order medications in 86.8% of hospitals. Therapeutic interchange policies are used in 89.2% of hospitals. Electronic health records (EHRs) have been implemented partially or completely in most hospitals (99.1%). Computerized prescriber-order-entry systems with clinical decision support are used in 95.6% of hospitals, and 92.6% of hospitals have barcode-assisted medication administration systems. Transitions-of-care programs are increasing in number, with 34.6% of hospitals now offering discharge prescription services. Pharmacists practice in 39.5% of hospital ambulatory or primary care clinics. The most common service offered by pharmacists to outpatients is anticoagulation management (26.0%). When pharmacists practice in ambulatory care clinics, 64.5% have prescribing authority through collaborative practice agreements.
Conclusion:
Pharmacists continue to expand their role in improving the prescribing of medications in both hospital and outpatient settings. The adoption of EHRs and medication-use technologies has contributed to this growth.
Purpose:
The results of the 2015 ASHP national survey of pharmacy practice in hospital settings are presented.
Methods:
A stratified random sample of pharmacy directors at 1432 U.S. general and children's medical-surgical hospitals were surveyed using a mixed-mode method. IMS Health supplied data on hospital characteristics; the survey sample was drawn from IMS's hospital database.
Results:
The survey response rate was 22.7%. Since the 2000 survey, the proportion of hospitals reporting that pharmacists monitor at least 75% of patients has increased from 20.3% to 57.8%. The use of therapeutic drug monitoring has increased from 63.0% to 70.6% since the 2012 survey. The percentage of hospitals reporting that pharmacists have primary responsibility for discharge counseling has increased from 1.2% to 7.3% since the 2012 survey, with 33.8% of hospitals reporting pharmacist counseling of at-risk patients. Virtually all hospitals (97.5%) have partially or completely implemented electronic health records; most have computerized prescriber-order-entry (84.1%) and barcode-assisted medication administration (93.7%) systems. At an increasing percentage of hospitals (86.2% in the 2015 survey), medication orders are reviewed by a pharmacist before a dose is made available and administered to a patient.
Conclusion:
The role of pharmacists in measuring, monitoring, and managing medication use in health systems continues to be significant, important, and growing. The evolution of electronic health information and technologies that make this information more readily available to patients is transforming healthcare in a positive way and enabling pharmacists to more efficiently contribute to improving medication use.
PURPOSE: Results of the 2003 ASHP national survey of pharmacy practice in hospital settings that pertain to monitoring and patient education are presented. METHODS: A stratified random sample of pharmacy directors at 1173 general and children's medical-surgical hospitals in the United States was surveyed by mail. SMG Marketing Group, Inc., supplied data on hospital characteristics; the survey sample was drawn from SMG's hospital database.
RESULTS: The response rate was 47.1%. Virtually all hospitals (95.3%) had pharmacists regularly monitoring medication therapy in some capacity. Patient monitoring has improved since 2000; fewer respondents reported monitoring less than 25% of patients in the hospital, and most hospitals reported an increase in the amount of time pharmacists devoted to monitoring activities. Pharmacists were provided computer access to laboratory information in 78% of hospitals to facilitate this function. Detection and reporting of adverse drug events (ADEs) have substantially increased since 1999, with an increase of 42% in events reported internally. Strategies to improve ADE reporting were in place in 84% of hospitals, indicating that pharmacists are adopting the widely recommended philosophy of learning from errors. Errors were less widely reported externally, limiting the value of aggregated data for improving the medication-use process. Most hospitals (85.5%) had an interprofessional infrastructure in place to discuss and learn from voluntary reports of ADEs. Medication counseling continued to be relatively infrequent, with nearly three fourths of hospitals reporting fewer than 26% of inpatients received medication education. Pharmacist staffing in hospitals has risen significantly, from an average of 8.6 full-time equivalents (FTEs) in 2002 to 9.4 FTEs per hospital. Vacancy rates for pharmacists decreased from 7.3% in 2002 to 43%. It is now estimated that there are 1846 vacancies in hospital pharmacies.
CONCLUSION: Notable improvements in hospital pharmacy practice have been made. The percentage of patients whose medication therapy is monitored by pharmacists has increased, and most hospitals reported that the amount of time pharmacists spent monitoring patients' medication therapy had increased. Internal and external reporting of ADEs has increased, and pharmacist vacancies have decreased from 2002. Staffing has also improved, suggesting an abatement of the critical shortage of pharmacists in the hospital setting.
Results of the 1998 ASHP national survey of pharmacy practice in acute care settings that pertain to prescribing and transcribing practices are presented. Pharmacy directors at 1058 general and children's medical-surgical hospitals in the United States were surveyed by mail. Data on hospital characteristics were supplied by SMG Marketing Group, Inc.; the survey sample was drawn from SMG's hospital database. The response rate was 51.8%. Respondents reported that at least 90% of hospital and health-system pharmacy and therapeutics (P&T) committees are responsible for formulary development and management, drug policy development, medication-use evaluation, adverse-drug-reaction reporting, and medication error monitoring. More than 90%, of the facilities use pharmacoeconomic, clinical and therapeutic, and cost information in formulary development; 83% have a medication-use-evaluation program designed to improve prescribing; more than 95% have P&T committees, infection control committees, and quality control committees; and more than 80% provide pharmacist consultations on drug information, dosage adjustments for patients with renal impairment, antimicrobials, and pharmacokinetics. A majority of respondents reported that accurate transcription of medication orders is ensured by use of standardized physician order forms, clarification of illegible orders, reconciliation of medication administration records (MARs) and pharmacy profiles at least daily, and use of computer-generated MARs. The 1998 ASHP survey results suggest that pharmacists in acute care settings have positioned themselves well to improve the prescribing and transcription components of the medication-use process.
Results of the 2011 ASHP national survey of pharmacy practice in hospital settings that pertain to dispensing and administration are presented.
A stratified random sample of pharmacy directors at 1401 general and children's medical-surgical hospitals in the United States were surveyed by mail.
In this national probability sample survey, the response rate was 40.1%. Decentralization of the medication-use system continues, with 40% of hospitals using a decentralized system and 58% of hospitals planning to use a decentralized model in the future. Automated dispensing cabinets were used by 89% of hospitals, robots were used by 11%, carousels were used in 18%, and machine-readable coding was used in 34% of hospitals to verify doses before dispensing. Overall, 65% of hospitals had a United States Pharmacopeia chapter 797 compliant cleanroom for compounding sterile preparations. Medication administration records (MARs) have become increasingly computerized, with 67% of hospitals using electronic MARs. Bar-code-assisted medication administration was used in 50% of hospitals, and 68% of hospitals had smart infusion pumps. Health information is becoming more electronic, with 67% of hospitals having partially or completely implemented an electronic health record and 34% of hospitals having computerized prescriber order entry. The use of these technologies has substantially increased over the past year. The average number of full-time equivalent staff per 100 occupied beds averaged 17.5 for pharmacists and 15.0 for technicians. Directors of pharmacy reported declining vacancy rates for pharmacists.
Pharmacists continue to improve medication use at the dispensing and administration steps of the medication-use system. The adoption of new technology is changing the philosophy of medication distribution, and health information is rapidly becoming electronic.
Results of the 2010 ASHP national survey of pharmacy practice in hospital settings are described.
A stratified random sample of pharmacy directors at 1968 general and children's medical-surgical hospitals in the United States was surveyed by Internet and mail. SDI Health LLC supplied data on hospital characteristics; the survey sample was drawn from the SDI Health hospital database.
In this national probability sample survey, the response rate was 28.8%. Patient-specific pharmacist activities are increasing, as shown by the substantial use of pharmacist empowered therapeutic interchange programs, extensive prevalence of pharmacist review of medication orders before doses are available for administration to patients, and the widespread use of pharmacist consultations by prescribers, with almost complete acceptance of pharmacist recommendations. Pharmacists are also leading antibiotic stewardship programs, managing anticoagulation medication therapy, addressing pharmaceutical waste management, and standardizing i.v. infusion concentrations. Electronic health information is rapidly being adopted, with the use of electronic medical records and computerized prescriber-order-entry to improve prescribing and use of medications. Metrics are commonly used to track and monitor trends in operational, clinical, and safety performance in hospital pharmacy departments. Pharmacist and pharmacy technician staffing has increased significantly, while vacancy rates have declined.
Pharmacists contribute to improving prescribing and transcribing. Patient safety is now a priority for medication management.
Purpose
Results of the 2009 ASHP national survey of pharmacy practice in hospital settings that pertain to monitoring and patient education are presented.
Methods
A stratified random sample of pharmacy directors at 1364 general and children’s medical–surgical hospitals in the United States were surveyed by mail. SDI Health supplied data on hospital characteristics; the survey sample was drawn from SDI’s hospital database.
Results
The response rate was 40.5%. Virtually all hospitals (97.3%) had pharmacists regularly monitor medication therapy in some capacity; nearly half monitored 75% or more of their patients. Over 92% had pharmacists routinely monitor serum medication concentrations or their surrogate markers, and most hospitals allowed pharmacists to order initial serum concentrations (80.1%) and adjust dosages (79.2%). Interdisciplinary committees reviewed adverse drug events in 89.3% of hospitals. Prospective analysis was conducted by 66.2% of hospitals, and retrospective analysis was performed by 73.6%. An assessment of safety culture had been conducted by 62.8% of hospitals. Most hospitals assigned oversight for patient medication education to nursing (89.0%), but many hospitals (68.9%) reported that pharmacists provided medication education to 1–25% of patients. Computerized prescriber-order-entry systems with clinical decision support were in place in 15.4%, bar-code-assisted medication administration systems were used by 27.9%, smart infusion pumps were used in 56.2%, and complete electronic medical record systems were in place in 8.8% of hospitals. The majority of hospitals (64.7%) used an integrated pharmacy practice model using clinical generalists.
Conclusion
Pharmacists were significantly involved in monitoring medication therapy. Pharmacists were less involved in medication education activities. Technologies to improve the use of medications were used in an increasing percentage of hospitals. Hospital pharmacy practice was increasingly integrated, with pharmacists having both distribution and clinical roles.
Results of the 2008 ASHP national survey of pharmacy practice in hospital settings that pertain to dispensing and administration are presented.
A stratified random sample of pharmacy directors at 1310 general and children's medical-surgical hospitals in the United States were surveyed by mail.
The response rate was 40.2%. Most hospitals had a centralized medication distribution system; however, there is evidence of growth in decentralized models compared with data from 2005. Automated dispensing cabinets were used by 83% of hospitals and robots by 10%. The percentage of doses dispensed in unit dose form increased, as did the use of two-pharmacist checks for high-risk drugs and high-risk patient groups. Medication administration records (MARs) have become increasingly computerized over the past nine years, and the use of handwritten MARs has declined substantially. Technology implemented at the drug administration step of the medication-use process is continuing to increase. Bar-code technology was implemented in 25% of hospitals, and 59% of hospitals had smart infusion pumps. Only 6.8% of hospitals had a pharmacist practicing in the emergency department (ED). Pharmacists prospectively reviewed only a small percentage of ED medication orders before the first dose was administered, and only 40.7% of hospitals retrospectively reviewed ED medication orders for prescribing errors. Pharmacy hours of operation have been increasing, with 36.2% of hospitals providing around-the-clock services. Off-site medication order review was used in 20.7% of hospitals. Directors of pharmacy reported a vacancy rate of 5.9% for pharmacists and 4.7% for technicians and a turnover rate of 8.6% for pharmacists and 13.8% for technicians.
Safe systems continue to be in place in most hospitals, but the adoption of new technology is rapidly changing the philosophy of medication distribution. Pharmacists are continuing to improve medication use at the dispensing and administration steps of the medication-use process.
Results of the 2001 ASHP national survey of pharmacy practice in hospital settings that pertain to prescribing and transcribing are presented.
A stratified random sample of pharmacy directors at 1091 general and children's medical-surgical hospitals in the United States was surveyed by mail. SMG Marketing Group, Inc., supplied data on hospital characteristics; the survey sample was drawn from SMG's hospital database.
The response rate was 49.0%. During 2001, nearly all hospitals are estimated to have pharmacy and therapeutics (P&T) committees that meet an average of seven times per year. It is estimated that more than 90% of P&T committees are responsible for formulary development and management, drug policy development, adverse-drug-reaction review, and medication-use evaluation. More than 90% of hospitals use clinical and therapeutic, cost, and pharmacoeconomic information in the formulary management process, while nearly two thirds consider quality-of-life issues. Nearly 70% use clinical practice guidelines in the formulary management process, and 78% have a medication-use evaluation program designed to improve prescribing. Pharmacists in more than 75% of hospitals provide consultations on drug information, dosage adjustments for patients with renal impairment, antimicrobials, and pharmacokinetics. Further, a majority of hospitals ensure accurate transcription of medication orders by clarifying illegible orders before transcription or entry into medication administration records (MARs), using standardized prescriber order forms, requiring prescribers to countersign all oral orders, and reconciling MARs and pharmacy patient profiles at least daily. In 2001, large hospitals are most likely to use prescriber order-entry systems to improve patient safety and are least likely to require the reentry of medication orders into the pharmacy computer system.
The 2001 ASHP survey results suggest that pharmacists in hospital settings have positioned themselves well to improve the prescribing and transcribing components of the medication-use process.
Results of the 2002 ASHP national survey of pharmacy practice in hospital settings that pertain to dispensing and administration are presented.
A stratified random sample of pharmacy directors at 1101 general and children's medical-surgical hospitals in the United States were surveyed by mail. SMG Marketing Group, Inc., supplied data on hospital characteristics; the survey sample was drawn from SMG's hospital database.
The response rate was 46.7%. During 2002, both inpatient and outpatient hours of service increased compared with 2001. Paradoxically, there was an 8.5% decrease in pharmacy staffing and a 7% vacancy rate, suggesting that pharmacists are busier. Most hospitals (80%) had a centralized inpatient dispensing system, but 44% were planning to become more decentralized. Automated dispensing cabinets were used by 58% of hospitals with decentralized drug distribution systems. Most hospitals (81.4%) dispensed more than three quarters of oral doses as unit doses and 63.3% of injectable doses to non-critical care patients, increases from 1999. A large percentage of hospitals (89%) repackaged both oral and injectable medications. More hospitals were repackaging medications than three years ago, primarily because of lack of commercial availability. Approximately 20% of pharmacies either partially or completely outsourced drug preparation activities. Nurses administered medications in virtually all hospitals (99.7%). Despite widespread recommendations to use bar-code technology to check and document doses administered, only 1.5% of hospitals used this technology, an increase from 1.1% in 1999. Nearly two thirds of hospitals used computer-generated medication administration records.
While pharmaceutical services are expanding, workforce issues continue to challenge pharmacists trying to maintain and enhance safe medication systems. Safe systems continue to be in place in most hospitals, but the adoption of new technology to improve safety is slow.
Results of the 2004 ASHP national survey of pharmacy practice in hospital settings that pertain to prescribing and transcribing are presented.
A stratified random sample of pharmacy directors at 1183 general and children's medical-surgical hospitals in the United States was surveyed by mail. SMG Marketing Group, Inc., supplied data on hospital characteristics; the survey sample was drawn from SMG's hospital database.
The response rate was 41.7%. Compared with the results of the 2001 survey, the number of times pharmacy and therapeutics committees met increased, suggesting an increase in efforts to monitor and manage medication use in hospitals. There was an increase in the use of quality-of-life information to make formulary decisions, indicating a shift away from cost-based formularies. There was a decrease in the rates of formulary compliance, but an increase in the use of evidence-based clinical practice guidelines, suggesting the emergence of more comprehensive approaches to improving prescribing. The use of medication-use evaluations increased in smaller hospitals, suggesting greater use of best practices is occurring in these institutions. The use of drug information services continues to decline, as the use of more efficient and easily accessible online sources of drug information increases. Reading back oral orders to improve accuracy dramatically increased since 2001. The adoption of computerized prescriber-order-entry systems continues to be slow, with fewer than 5% of hospitals reporting their use.
The 2004 ASHP survey results indicate that pharmacists are continuing to improve medication use at the prescribing and transcribing steps of the medication-use system.
Results of the 2007 ASHP national survey of pharmacy practice in hospital settings that pertain to prescribing and transcribing are presented.
A stratified random sample of pharmacy directors at 1264 general and children's medical-surgical hospitals in the United States were surveyed by mail. SMG Marketing Group, Inc., supplied data on hospital characteristics; the survey sample was drawn from SMG's hospital database.
The response rate was 42.0%. The use of nearly all formulary management techniques has declined since 2001 in favor of the use of clinical practice guidelines to promote rational drug therapy. Retrospective methods to improve prescribing are being replaced by concurrent methods including the provision of drug information to prescribers by pharmacists, consultations with prescribers, and the continued gradual adoption of computerized prescriber-order-entry systems with decision support. The trends toward more electronic communication and ease of reference availability and away from resource-intensive methods continue to grow. Accreditation standards prompted the implementation of safe medication practices as shown by the rapid increase in medication reconciliation and the reading back of oral orders to improve prescribing and transcribing.
The 2007 ASHP survey results indicate that pharmacists are responding to changes in the health care system to find appropriate ways to improve medication use at the prescribing and transcribing steps of the medication-use system.
Results of the 2003 ASHP national survey of pharmacy practice in hospital settings that pertain to monitoring and patient education are presented.
A stratified random sample of pharmacy directors at 1173 general and children's medical-surgical hospitals in the United States was surveyed by mail. SMG Marketing Group, Inc., supplied data on hospital characteristics; the survey sample was drawn from SMG's hospital database.
The response rate was 47.1%. Virtually all hospitals (95.3%) had pharmacists regularly monitoring medication therapy in some capacity. Patient monitoring has improved since 2000; fewer respondents reported monitoring less than 25% of patients in the hospital, and most hospitals reported an increase in the amount of time pharmacists devoted to monitoring activities. Pharmacists were provided computer access to laboratory information in 78% of hospitals to facilitate this function. Detection and reporting of adverse drug events (ADEs) have substantially increased since 1999, with an increase of 42% in events reported internally. Strategies to improve ADE reporting were in place in 84% of hospitals, indicating that pharmacists are adopting the widely recommended philosophy of learning from errors. Errors were less widely reported externally, limiting the value of aggregated data for improving the medication-use process. Most hospitals (85.5%) had an interprofessional infrastructure in place to discuss and learn from voluntary reports of ADEs. Medication counseling continued to be relatively infrequent, with nearly three fourths of hospitals reporting fewer than 26% of inpatients received medication education. Pharmacist staffing in hospitals has risen significantly, from an average of 8.6 full-time equivalents (FTEs) in 2002 to 9.4 FTEs per hospital. Vacancy rates for pharmacists decreased from 7.3% in 2002 to 43%. It is now estimated that there are 1846 vacancies in hospital pharmacies.
Notable improvements in hospital pharmacy practice have been made. The percentage of patients whose medication therapy is monitored by pharmacists has increased, and most hospitals reported that the amount of time pharmacists spent monitoring patients' medication therapy had increased. Internal and external reporting of ADEs has increased, and pharmacist vacancies have decreased from 2002. Staffing has also improved, suggesting an abatement of the critical shortage of pharmacists in the hospital setting.
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education-2015. Am J Health-Syst
Pharm. 2016; 73:1307-30.