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PRACTICE REPORTS  Dispensing and administration

PRACTICE REPORTS

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ASHP national survey of pharmacy practice in hospital settings: Dispensing and administration—2014 Craig A. Pedersen, Philip J. Schneider, and Douglas J. Scheckelhoff Supplemental graphs describing trends in safety-related technology use by hospital size over the past six years and an audio interview are available with the full text of this article at www.ajhp.org. Readers can also access this supplementary content through AJHP’s augmented reality (AR) feature by launching the Layar app and scanning this page with their mobile devices.

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he ASHP national survey of pharmacy practice in hospital settings focuses on practices and technologies for managing and improving the medication-use system and the role that pharmacists play in this effort. The national surveys are organized according to six components of the medication-use system: prescribing, transcribing, dispensing, administration, monitoring, and patient education. The survey focuses on two components in the medication-use system each year. The 2014 survey evaluated practices and technologies related to dispensing and administration. When combined, the most recent three surveys represent a composite

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

picture of the ways hospitals and health systems are managing and improving the entire medication-

Craig A. Pedersen, B.S.Pharm., Ph.D., FAPhA, is Pharmacy Manager, Confluence Health, Wenatchee, WA. Philip J. Schneider, M.S., FASHP, FFIP, FASPEN, is Professor and Associate Dean, College of Pharmacy at the Phoenix Biomedical Campus, University of Arizona, Phoenix. Douglas J. Scheckelhoff, M.S., FASHP, is Vice President, Office of Practice Advancement, American Society of Health-System Pharmacists, Bethesda, MD. Address correspondence to Dr. Pedersen (pedersen.craig@gmail. com).

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. Am J Health-Syst Pharm. 2015; 72:111937

use system and the current role that pharmacists play in medication-use system management.

The assistance of Moyo Myers, M.S.; Renee Barnes; the staff of ASHP; and the pharmacy directors who participated in the survey is acknowledged. Partially supported by a grant from Merck & Co., Inc., and the ASHP Research and Education Foundation. The authors have declared no potential conflicts of interest. Copyright © 2015, American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/15/0701-1119. DOI 10.2146/ajhp150032

Am J Health-Syst Pharm—Vol 72 Jul 1, 2015

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PRACTICE REPORTS  Dispensing and administration

In assessing dispensing and administration practices, the present study was intended to describe and evaluate trends in the inpatient medication distribution system, the methods for medication preparation and dispensing, the use of technology in medication distribution, the preparation of compounded sterile preparations, hazardous drug handling, the process of medication administration, the use of smart infusion pumps, the use of barcode technology, the use of medication administration records (MARs), the outsourcing of preparation activities, and the process of medication order review. This report also describes human resource commitments and turnover, estimates national vacancy rates for hospital pharmacist and pharmacy technician positions, and profiles the acquisition cost of pharmaceuticals. Methods The extent of pharmacists’ involvement in the dispensing and administration aspects of the medication-use system in U.S. hospitals and health systems was evaluated using methods similar to past ASHP surveys.1-13 Questionnaire development. The 2014 questionnaire was developed using procedures suggested by Dillman.14 Questions from previous surveys that pertained to topics of interest in this survey were evaluated for clarity and response. Data about hospital characteristics (i.e., number of beds, ownership, and U.S. Census Bureau metropolitan statistical area [MSA] status)15 were obtained from the IMS Health hospital database.16 Survey sample. From the IMS Health database of 7053 hospitals, a sampling frame of 4893 general and children’s medical–surgical hospitals in the United States was constructed. Specialty, federal, and Veterans Affairs hospitals were excluded from this sampling frame. Hospitals were stratified by size before sampling, and random samples of hospitals 1120

within these strata were taken to select the sample of 1439 hospitals. We sampled 300 hospitals that had fewer than 50 beds to account for historically lower response rates in hospitals of this size. We sampled all hospitals with 600 or more staffed beds (n = 139) to collect data from enough very large hospitals to provide reliable estimates. Two-hundred hospitals were sampled in each of the other hospital size categories. In May 2014, each of the 1439 hospitals was called to verify the name of the pharmacy director. After eliminating closed hospitals, hospitals that no longer had pharmacies, hospitals without a permanent director of pharmacy, and pharmacies unwilling to provide the name of the director of pharmacy, the adjusted sample included 1435 hospitals. Data collection. Pharmacy directors in the sample were contacted up to six times during the survey period. An announcement letter was sent in May 2014, followed two weeks later by the first survey mailing in June 2014. To maximize the response rate, respondents were offered a free e-book from ASHP as an incentive to respond to the questionnaire. One week after the initial survey mailing, reminder postcards were mailed. The surveys were mailed a second time to nonrespondents in July 2014. Three weeks later, the survey was sent a third time by United Parcel Service to the remaining nonrespondents. A final telephone contact was made with nonrespondents in August 2014. Data analysis. Each hospital in the sample was assigned a unique identification number. This number allowed the survey response to be matched with the hospital characteristics in the IMS Health database. As with past surveys, data are presented by categories of staffed beds to more closely align with data from the American Hospital Association.17 Because of the stratified randomsampling procedure, it was necessary to employ a design-based analysis.18

Am J Health-Syst Pharm—Vol 72 Jul 1, 2015

This technique results in population estimates that are more accurate than unweighted results. Data were entered using SPSS, version 21 (IBM Corporation, Armonk, NY). Data were converted to an Intercooled Stata, version 8, readable format (StataCorp, College Station, TX). All non-design-based analyses were conducted using SPSS, version 21. All design-based analyses were conducted using Stata, version 8, with the set of survey commands. To account for the sampling method, weights were assigned to respondents to adjust their contribution to the population estimate. The weights were 20.46 for hospitals with fewer than 50 staffed beds, 12.93 for hospitals with 50–99 beds, 21.69 for hospitals with 100–199 beds, 8.89 for hospitals with 200– 299 beds, 6.17 for hospitals with 300–399 beds, 4.55 for hospitals with 400–599 beds, and 3.02 for hospitals with 600 or more staffed beds. The strata were the categories for the number of staffed beds, and the finite population correction was the total number of hospitals in the population (n = 4893). Descriptive statistics were used extensively. Chi-square analysis and analysis of variance or regression were used to examine how responses differed as a function of hospital characteristics. The a priori level of significance was 0.05. Results A total of 426 hospitals submitted usable data for analysis, yielding an overall response rate of 29.7%. Hospital characteristics. Table 1 shows the size, location, MSA status, and ownership of the respondents’ hospitals, the nonrespondents’ hospitals, the surveyed hospitals, and the 4893 general and children’s medical– surgical hospitals. The characteristics of the surveyed hospitals are presented to highlight the complex sampling design employed in this survey. Respondents and nonrespondents

PRACTICE REPORTS  Dispensing and administration

Table 1.

Size, Location, and Ownership of Respondents’ Hospitalsa Characteristic

Respondents n %

Nonrespondents n %

Surveyed n

%

Population n %

All hospitals 426 29.7 1009 70.3 1435 29.3 4893 100 No. staffed beds