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Use of Technology Growing, Pharmacists’ Roles Changing

ASHP National Survey Tracks Pharmacy Trends Over Time

Mar 28, 2011

OVER THE YEARS, ASHP’s National Survey of Health-System Pharmacy Practice has evolved into a powerful tool to track pharmacy developments. The results of the survey, which monitors both micro- and macrotrends, help highlight changes that can feel almost glacial in pace but that are critical to the profession’s future.

“Although we publish the overarching results of the survey in the American Journal of Health- System Pharmacy (AJHP) each year, the article alone doesn’t capture the trends over longer periods of time,” said Douglas Scheckelhoff, M.S., FASHP, ASHP’s vice president of professional development. “When you stand back and look at the larger picture, you see some startling and exciting changes in the profession.”

The survey, which has its roots in the Mirror to Hospital Pharmacy (published in 1964), was first fielded by ASHP in 1975. What initially began as an occasional survey, occurring once every few years, has become an annual effort at data collection. The new survey will appear in the April 15 issue of AJHP.

Since 1990, the survey has documented three important trends in health-system pharmacy: the influence of The Joint Commission (TJC’s) on national safety standards, the growth of technology in pharmacy practice, and the evolution of roles for pharmacists and pharmacy technicians.

Guiding Pharmacists, Policymakers, Stakeholders

Each year, approximately half of the survey focuses on two of six aspects of the medication-use system: prescribing, transcribing, dispensing, administration, monitoring, and patient education. The other half comprises of standard questions about staffing or current hot topics and evolving issues, such as informatics or the environmental impact of drug disposal.

The consistency of the survey’s questions gives it clout, according to Craig A. Pedersen, Ph.D., Pharm.D., FAPhA, a health care consultant in Mercer Island, Wash., and lead author of the forthcoming practice report in AJHP’s April issue.

“Our methods have been maintained over time, including the weighting and phrasing of the questions, and we’ve had a consistent team of investigators, so the trends are very likely real,” Pedersen said. “This survey is a trusted source of information not only to our profession, but to policymakers and other stakeholders.”

Pharmacists Respond to TJC

In recent years, survey responses have reflected the impact of TJC’s medication safety guidance. For example, after TJC announced national patient safety goals, the number of hospitals in which pharmacists read back verbal orders in detail, including spelling the drug’s name, increased from 30 percent of respondents to more than 83 percent of respondents within five years.

In 2006, 59 percent of hospital pharmacies did not offer after-hours review of orders. Now only 43 percent of hospital pharmacies do not perform after-hours review. There also has been a growth in the number of facilities that have affiliation agreements with other hospitals for order review and remote pharmacy services.

Hospital and health-system pharmacy has changed markedly in the years since ASHP first started surveying pharmacists about their practices. Photos courtesy of ASHP Archives.

“When The Joint Commission gets involved, hospitals step up to the plate with new processes,” said Pedersen. He noted the impact of TJC guidelines on medication reconciliation. “The Commission said we need to perform medication reconciliation, and now everyone is doing that,” he said. “The survey has enabled us to document our progress.”

Expanding Reach of Technology

ASHP’s national survey has captured a second pronounced trend: the growth of technology. In 2010, 34.5 percent of hospitals had adopted bar code medication administration, compared with just 1.5 percent in 2002. In 2010, 18.9 percent of hospitals had adopted computerized prescriber order entry with clinical decision support, compared with 2.7 percent in 2003.

Although seven- and eight-year trends demonstrate growth, longer trends illustrate just how far the use of technology in pharmacy has come, Scheckelhoff said.

“Think about computerization of the hospital pharmacy. In 1982, only 17.6 percent of hospital pharmacies were computerized. Now, virtually all are,” he said. Scheckelhoff noted that the near universal use of automated dispensing cabinets reflects the shift toward unit-dose drug distribution.

“All of these technologies improve efficiency and safety, and we’re able to take the information the survey provides about their use in forming practice models, to make sure these technologies are used to maximum effect,” Scheckelhoff added.

Changing Roles

The growth of technology has positively affected how pharmacists and pharmacy technicians go about their work, according to the survey.

“One could imagine technology replacing people, but we’ve seen the opposite,” said Scheckelhoff. “Technicians are doing more for prepping and distribution of medications, while pharmacists are moving into advanced roles with more direct patient care, such as working in the ER and going on patient care rounds.”

In 1982, pharmacists went on rounds in 13 percent of hospitals. Now, pharmacists go on rounds at 43 percent of hospitals overall and in nearly all hospitals that have 300 beds or more.

Philip J. Schneider, M.S., FASHP, clinical professor and associate dean at the University of Arizona College of Pharmacy in Phoenix, notes the increase in pharmacists’ responsibilities.

“Pharmacists are being delegated responsibility for prescribing or making changes in drug therapy without necessarily having to get physician approval, and we think that’s important,” Schneider said.

“The survey has shown us that there is a shift away from labor-intensive activities and toward pharmacist empowerment in terms of drug therapy management,” he said. “It’s clear that this is a vision for a lot of pharmacists, and it shows how hospitals are increasingly making better use of their pharmacists’ time to achieve that vision.”

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