ASHP national survey of pharmacy practice in hospital settings ...

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PRACTICE RESEARCH REPORT

DISPENSING AND ADMINISTRATION

ASHP national survey of pharmacy practice in hospital settings: Dispensing and administration—2017 Philip J. Schneider, M.S., FASHP, FFIP, FASPEN, MediHealthInsight, Scottsdale, AZ. Craig A. Pedersen, B.S.Pharm., Ph.D., FAPhA, Virginia Mason Medical Center, Seattle, WA. Douglas J. Scheckelhoff, M.S., FASHP, Office of Practice Advancement, American Society of Health-System Pharmacists, Bethesda, MD.

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. Keywords: antimicrobial stewardship, controlled-substance diversion prevention, dispensing, drug administration, hazardous substance compounding, pharmacy workforce Am J Health-Syst Pharm. 2018; 75:e447-70

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Address correspondence to Mr. Schneider ([email protected]). This article will appear in a future issue of AJHP. Copyright © 2018, American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/18/0000-e447. DOI 10.2146/ajhp180151

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 6 components of the medication-use system: prescribing, transcribing, dispensing, administration, monitoring, and patient education. The survey focuses on 2

components in the medication-use system each year. The 2017 survey evaluated practices and technologies related to dispensing and administration. The most recent 3 surveys therefore represent a composite picture of the ways hospitals and health systems are managing and improving the entire medication-use system and the current roles that pharmacists play in medication-use system management.

AM J HEALTH-SYST PHARM | VOLUME 75 | 2018  e447

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PRACTICE RESEARCH REPORT In assessing dispensing and administration practices, the 2017 survey 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, including the use of bar-coding technology in the preparation of compounded sterile preparations; and hazardous drug handling. It also addressed the process of medication administration, including the use of smart infusion pumps, the use of medication administration records, the outsourcing of preparation activities, the process of medication order review, pharmacists’ roles in antimicrobial stewardship programs, and controlled-substance diversion prevention programs. The survey results also characterize human resource commitments and turnover, pharmacist and phar-

DISPENSING AND ADMINISTRATION

Methods

KEY POINTS • Technology has facilitated the decentralization of drug supply and dispensing in U.S. hospitals. • Antimicrobial stewardship programs are common, and pharmacists usually play a leadership role in those programs. • Pharmacies are actively using strategies to detect and prevent controlled-substance diversion, although best practices are not universally used.

macy technician credentials, and estimated national vacancy rates for hospital pharmacist and pharmacy technician positions.

Table 1. Size, Location, and Ownership of 2017 Survey Respondents’ and Nonrespondents’ Hospitalsa No. (%) Characteristic

Respondents

Nonrespondents

Population

693 (14.4)

4,135 (85.6)

4,828 (100)