ASHP Survey Finds That Prescribers Are Seeking Input Of Pharmacists

Main Category: Pharmacy / Pharmacist
Article Date: 22 May 2008 - 5:00 PDT

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Pharmacists in hospitals and health systems continue to exert a considerable amount of influence on the prescribing activities of their institutions, according to the findings of the 2007 ASHP National Survey of Pharmacy Practice in Hospital Settings. The survey, conducted by the American Society of Health-System Pharmacists (ASHP), focuses on the role pharmacists play in managing and improving the medication-use process.

Pharmacists continue to be consulted by physicians at a significant level and adoption of pharmacist recommendations continues to rise. Pharmacists at more than 75 percent of hospitals provided consultations on dosage adjustments, drug information, pharmacokinetics, and antibiotics. Consultations on nutrition support were provided in nearly 50 percent of hospitals, while patient education and consultations on anticoagulation therapy were provided in nearly 40 percent. Ninety-eight percent of hospitals report an 80 percent or greater acceptance rate for pharmacist recommendations. In 2001, only 73 percent of hospitals reported this level of acceptance.

Round-the-clock access to pharmacists is becoming more widespread, with fewer hospitals having periods of the day without any pharmacist access. The percentage of hospitals with 24-hour pharmacy services has remained steady at 28 to 30 percent for many years, but this year 34 percent reported providing such a service. Off-site medication order review occurs at 22 percent of the nation's hospitals, up from 12.2 percent in 2003. Many still use an affiliated hospital (45 percent) for off-site medication order review, but the use of a national or regional company providing this service is growing, now at 34 percent.

"These findings suggest that more and more patients are benefitting from the expertise of pharmacists," said ASHP president Janet A. Silvester, M.B.A., FASHP. "Pharmacists' active involvement in the prescribing phase of the medication-use process can significantly improve the safety, effectiveness and value of medication therapy."

Accreditation standards, such as The Joint Commission's patient safety goals for medication reconciliation and anticoagulation therapy, have a major influence on pharmacy departments. A majority of hospitals (78 percent) report pharmacy involvement in the development and implementation of the medication reconciliation process as required by the Commission and 68 percent report performing an annual assessment of processes for compounding sterile medications, up from 36 percent in 2004. Compounding processes and facilities are surveyed under infection control standards.

Most hospitals (76 percent) report that at least 95 percent or more of medication orders are reviewed by a pharmacist before the first dose is administered, up from 46 percent in 2004. This has been a focus area by The Joint Commission as a means of improving medication safety.

The percentage of hospital pharmacist positions vacant nationally was 6.4 percent, and the turnover rate of pharmacy staff was 7.7 percent, the survey found. Those rates were higher at small hospitals, which often face challenges in recruiting and retaining pharmacy staff. For example, hospitals with between 50 and 100 beds had 9.7 percent of pharmacist positions vacant, and turnover was 9.1 percent.

The survey was authored by Craig A. Pedersen, Ph.D., Philip J. Schneider, M.S., FASHP and Douglas J. Scheckelhoff, M.S., FASHP. The full survey appears in the May 1 edition of the American Journal of Health-System Pharmacy (Am J Health-Syst Pharm 2008 65: 827-84) and is available online. Enter "ashppr" when prompted for a username and password.

ASHP has conducted national surveys of pharmacy practice since 1975. This survey, which is supported by Merck & Co., Inc., is part of a series of studies that examine a variety of pharmacists' activities, including medication prescribing, dispensing, administration, and education.

About ASHP

For more than 60 years, ASHP has helped pharmacists who practice in hospitals and health systems improve medication use and enhance patient safety. The Society's 30,000 members include pharmacists and pharmacy technicians who practice in inpatient, outpatient, home-care, and long-term-care settings, as well as pharmacy students. For more information about the wide array of ASHP activities and the many ways in which pharmacists help people make the best use of medicines, visit ASHP's Web site, http://www.ashp.org, or its consumer Web site, http://www.SafeMedication.com.

American Society of Health-System Pharmacists