ASHP Survey Sheds Light on Hospital Pharmacists' Role in Patient Wellness Activities
While many hospitals have increased the amount of time that pharmacists spend on monitoring patients' drug therapy, nearly half (43 percent) report that less than 25 percent of all patients receive these services, according to results of the 2000 ASHP National Survey of Pharmacy Practice in Acute Care. The survey also found that over three-fourths of hospital pharmacists spend less than 30 percent of their time monitoring medication therapy.
The survey found that in the last three years most hospitals have increased the amount of time pharmacists devote to monitoring patients' medication therapy. Pharmacy directors said they use a broad range activities to promote pharmacists' involvement in medication therapy monitoring, including:
- Expanding the responsibilities of pharmacy technicians (53 percent),
- Demonstrating the benefits of clinical pharmacy services to administrators (45 percent), and
- Increasing access to patient-specific data (38 percent).
Implementing automated dispensing systems (30 percent), re-deploying pharmacists to patient care units (26 percent), and utilizing electronic prescriber order entry (5 percent) were techniques were employed less frequently.
High-risk patients are most often the beneficiaries of pharmacists' medication monitoring services. Patients in the intensive care unit were most likely to be monitored (80 percent), followed by patients being treated in the medical-surgical service (64 percent), nutrition service (55 percent) and pediatric service (39 percent). More than half of the survey respondents (54 percent) maintain a list of medications that require daily monitoring and nearly half (48 percent) reported that the pharmacists in their hospitals are required to routinely monitor patients on specific medical or surgical services. These results indicated that opportunities still exist for pharmacists to increase monitoring efforts for those patients in greatest need.
Other survey highlights include:
- Adverse Drug Event Monitoring: Notification from nurses was the method used most frequently (96 percent) to monitor patients for adverse drug events (ADEs). Hospitals also employed alerting orders or trigger medications (81 percent), therapeutic drug monitoring (81 percent) and routine review of lab values (66 percent) to monitor for ADEs. Pharmacist's rounds, medical record E-code assessment and patient counseling are less frequently used methods.
- Internal ADE Reporting: Most respondents (87 percent) said that their hospitals report ADEs to their P&T committees. Nearly two-thirds report ADEs to a quality assurance or quality improvement committee, and less than 25 percent report adverse events to the nursing department or the pharmacy and nursing committee. Approximately 81 percent of respondents have implemented strategies to improve internal reporting, including holding in-service education sessions, creating a supportive environment, and making ADE reports non-discoverable.
- External ADE Reporting: More than 40 percent of pharmacy directors indicated that they do not report ADEs to outside sources. Of those who do report, the majority report to the FDA Medwatch program (92 percent). More than a quarter (27 percent) report errors to the manufacturer of the drug in question and fewer still report to programs run by the United States Pharmacopoeia or the Institute for Safe Medication Practices.
- Patient Counseling: Nearly half of all hospitals surveyed (48 percent) utilize some method to select patients for counseling. Physician orders or patient requests are used most frequently (68 percent and 57 percent, respectively), while identifying patients discharged on a specific list of targeted drugs, patients with a history of non-compliance, and focusing on specific diseases are used less frequently.
- Wellness Programs: Slightly more than 50 percent of survey respondents reported that their hospitals and health systems have wellness programs in place. Pharmacists are most likely to participate in disease-based wellness programs, such as those for patients with diabetes, asthma, hyperlipidemia, and hypertension.
"Ensuring that pharmacists are available to supervise drug therapy is probably the most important quality assurance enhancement an institution can make related to medication use," said Mick L. Hunt, M.S., FASHP. "Encouraging pharmacists to focus on the patient care activities described in this survey will help to improve the effectiveness, safety, and value of pharmacotherapy."
ASHP has conducted national surveys of pharmacy practice since 1975. This survey, which is supported by Eli Lilly and Company, is the third in a series of three studies that focuses on the role pharmacists play in managing and improving the medication-use process. The three-part series examines a variety of pharmacists' activities, including medication prescribing, dispensing, administration, and education. The entire 2000 survey is featured in the December 1, 2000, issue of the American Journal of Health-System Pharmacy. A summary report containing graphs and charts of the survey data may be obtained from Eli Lilly by calling 1-800-874-2778.
ASHP is the 30,000-member national professional association that represents pharmacists who practice in hospitals, health maintenance organizations, long-term care facilities, home care, and other components of health care systems. ASHP, which has a long history of medication-error prevention efforts, believes that the mission of pharmacists is to help people make the best use of medicines. Assisting pharmacists in fulfilling this mission is ASHP's primary objective. The Society has extensive publishing and educational programs designed to help members improve their delivery of pharmaceutical care, and it is the national accrediting organization for pharmacy residency and pharmacy technician training programs.