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ASHP's annual survey shows increases in pharmacy medication monitoring
Hospital pharmacies are at a tipping point
The 2009 American Society of Health-System Pharmacists (ASHP) National Survey highlights the escalating trend of hospital pharmacists becoming more involved in clinical care.
The future of pharmacy likely will see the continuation of a trend of health systems moving away from the centralized dispensing pharmacy and the continued integration of new technology that makes this process easier to accomplish, according to experts and the survey's results.
"We're in a good place, but we have a long way to go," says Lynnae M. Mahaney, MBA, RPh, FASHP, president of ASHP and chief of pharmacy at William S. Middleton Memorial Veterans Hospital in Madison, WI.
"Some hospital practices are much further ahead of the curve than others," Mahaney adds.
"But the idea is that we're at a turning point, or maybe even a tipping point, in hospital pharmacy practice," Mahaney says. "The pharmacy roles have changed a great deal, and they'll continue to change and evolve into direct patient care roles."
The 2009 survey found that the proportion of patients monitored by a pharmacist has increased dramatically, says Douglas Scheckelhoff, MS, FASHP, vice president of professional development for ASHP in Bethesda, MD.
In this survey, the percentage of hospitals who said more than 75% of patients are monitored by pharmacists was 43%, up from 24% in 2006, he says.
The number of hospitals that reported having at least half of their patients monitored by pharmacists increased from 43% in 2006 to 62% in 2009, he adds.
"We're really excited about this trend because historically the profession of pharmacy has been charged with dispensing medicines," says Philip Schneider, MS, FASHP, an associate dean for academic and professional affairs in the College of Pharmacy at Phoenix Biomedical Campus in Phoenix, AZ.
"We think everyone needs to be involved in monitoring patients' response to therapy," Schneider adds. "We need to make sure everyone is benefiting from therapy; we need to detect adverse events, and the outcomes noted from the monitoring process are an important determinant of quality."
So why has medication therapy monitoring increased so significantly?
"This is due to a combination of things," Scheckelhoff says. "Partly, it's a recognition that drug therapies continue to be more complex, and hospitals recognize that pharmacists are able to improve the safety of medication use."
The 2009 survey found many improvements, but one area seemed to lag behind, and that involved having pharmacy play a role in discharge planning.
"There are certain areas where we have a long way to go, like the whole discharge counseling area, and that's because the attention is being paid on the front-end," Mahaney says.
ASHP has pushed for this trend of having pharmacists more involved in direct patient care for a number of years, Scheckelhoff notes.
"One of the things that has helped improve drug therapy monitoring is improved access to clinical laboratory data," Scheckelhoff says. "In the year 2000, about 73% of pharmacists had access to lab data; in 2009, that was up to 93%."
Electronic medical systems are better interfaced now than they had been, he adds.
The improvement in access to electronic medical data has made it possible for pharmacists to look at clinical information and monitor medication therapy no matter where they are located, Schneider explains.
Also, the education and training of pharmacists have advanced over the past decade to accommodate this expanded role, he adds.
The Accreditation Counsel for Pharmaceutical Education (ACPE) in 2000 changed their standards to accredit only colleges that offer a doctorate of pharmacy degree as an entry-level degree, Schneider says.
"The aim was to prepare pharmacists for the future," he says. "So students are graduating with more qualifications and confidence and interest in being involved in medication use than they were before."
This led to a trend of increased numbers of internships and residencies, which gave hospitals the opportunity to involve pharmacy students in drug therapy monitoring, he adds.
"We think this is one of the reasons why more patients can be monitored through pharmacy services," Schneider says.
The 2009 ASHP survey found the percentage of hospitals that have students involved in monitoring medication therapy has increased from 25% to 38% between 2000 and 2009.1
Since 2000, there has been significant growth in new graduates who pursue residency training, Scheckelhoff says.
"So the typical new pharmacist hired within a hospital setting has far advanced clinical training compared with 10-15 years ago," he says.
ASHP has surveyed hospital pharmacy directors for nearly 50 years, Scheckelhoff says.
"For the last 10 years we've looked at the medication use process, dividing it into three components and surveying each of these every three years," he explains. "This year we focused on patient monitoring and education."
The survey also looked at medication reconciliation programs, finding a variety of barriers to their implementation, including a lack of staff resources, which was cited by 37.4% of hospitals; staff resistance, listed by 11.8% of hospitals; and lack of commitment by institutional leadership, cited by 9.3% of hospitals.1
Also, the survey's results seem to confirm anecdotal evidence that the current economic crisis has had an impact on inpatient pharmacy staff turnover rates.
"We always ask about staffing levels for pharmacists and technicians, and we do continue to see an increase in staffing for pharmacists and technicians," Scheckelhoff says. "It continues to grow year after year."
The total pharmacy full-time equivalent positions (FTEs) per 100 occupied beds has continued to rise, the survey found. There are 18.4 FTEs per 100 occupied beds among total pharmacist positions in 2009, vs 13.1 FTEs in 2005. Total technician FTEs per 100 occupied beds also has increased from 12.3 in 2005 to 16.9 in 2009.
"One element that was a little different this year was we saw the vacancy rate drop," Scheckelhoff says. "We anticipated this with the economy being what it is, and we've heard that a lot of people delayed their retirement or went from part-time to full time."
The 2009 ASHP survey found that the pharmacist staff turnover rate for all hospitals was 6.6% in 2009, compared with 8.6% in 2008 and 7.7% in 2007. The rate for vacant pharmacist FTEs went from 6.4% in 2007 to 3.7% in 2009.1
"Of that 3.7%, about one-fourth of those positions in the survey, which took place in July, 2009, had been frozen," Scheckelhoff notes. "They were not allowed to hire because of the current economic situation and the financial situation within their hospital."
The 2009 survey's take-home message is that hospital pharmacies are evolving at a fairly brisk pace, and this will continue as they increasingly adopt new technology and embrace a more integrated pharmacy practice model.
"We definitely continue to see significant expansion in the pharmacist's role and advancement in what pharmacists are doing in terms of their involvement in impacting patient care," Scheckelhoff says. "We also see continual adoption of technology that will support the pharmacist's role," he adds.