Better Use of Technology Needed to Improve Safety in Hospitals
Patient safety in hospitals could be greatly improved through the optimal use of technologies such as computer-prescriber-order entry systems, and bar code scanning at patients besides, according to the results of the latest installment of the ASHP National Survey of Pharmacy Practice in Hospital Settings. The survey suggests that broader use of technology into the medication-use process could free pharmacists to provide clinical services that improve patient care and medication safety.
Adoption of technology into the medication-use system hospitals and health systems has been slow. Only a small number of survey respondents reported having proven safeguards available in their facilities including, computerized prescriber order entry systems (7 percent) and bar code technology at the patients beside (1.5 percent). Bar codes are used to a greater extent (10 percent) to verify doses before dispensing. Robotic distribution systems are used in only eight percent of hospitals.
A majority of institutions do report using point-of-use dispensing devices (58 percent) in decentralized distribution systems. More than 70 percent of those devices are linked to the pharmacy computer system, ensuring that nurses can only access the medication orders appropriate for a specified patient.
Patient safety demands that hospitals and health systems take steps now to integrate available technology into their medication-use systems, said ASHP President Debra S. Devereaux, M.B.A., FASHP. Appropriate use of this technology is also an important step to ensure that pharmacists are used where they are needed mostat the patients bedside.
Respondents also reported that pharmacist and pharmacy technician staffing levels were almost nine percent lower than last year. The vacancy rate for pharmacists remains near 7 percent, which translates into approximately 3,000 vacant positions in U.S. hospitals and health systems.
Other survey highlights include:
- Unit Dose Availability. A majority of hospitals (89 percent) repackage oral medications into unit dose form. Seventy percent report a higher volume of repackaging from three years ago, and 90 percent report that this is partially due to the availability of fewer unit dose products from manufacturers. This figure is significant as a majority of hospitals (81 percent) dispense more than three-fourths of oral medications to non-critical patients in unit-dose form.
- Quality Improvement Programs. Most pharmacy directors reported having quality improvement (QI) programs in place to monitor drug preparation and dispensing operations. The most common program is the monitoring of dispensing errors. Accuracy of the patients medication record, the accuracy of medication carts filled by technicians, and IV admixture preparation are also commonly monitored. Monitored less frequently are accounting for missing doses, dispensing turnaround time, and sterility of IV admixtures.
- Pharmacist Approval of Medication Orders. Pharmacists are required to review and approve all medication orders prior to administration in 79 percent of hospitals. One fourth of hospitals require pharmacist review and approval of orders written for medical procedures in areas such as labor and delivery, surgery, and radiology.
ASHP has conducted national surveys of pharmacy practice since 1975. This survey, which is supported by Eli Lilly and Company, is the second in a series of three studies that focuses on the role pharmacists play in managing and improving the medication-use process. The study examines a variety of pharmacists activities, including prescribing, dispensing, and patient monitoring. The entire survey will be published in the January 1, 2003, 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 professional practice, and it is the national accrediting organization for pharmacy residency and pharmacy technician training programs. For more information, visit www.ashp.org or www.safemedication.com.