ASHP Annual Survey Reveals Key Trends in Health-System Pharmacy

The annual survey hit on key health-system pharmacy insights related to formulary management, pharmacogenomics, and opioid stewardship, among others.

The American Society of Health-System Pharmacists (ASHP) announced the results of its annual survey of pharmacy directors from almost 5000 hospitals across the country, which delivered valuable insights on hospital and health system pharmacy practice.

The 2019 ASHP National Survey, published in the American Journal of Health-System Pharmacy (AJHP), gauged prescribing and transcribing strategies used by hospital pharmacy and therapeutics (P&T) committees, with the most common tools including therapeutic interchange, evidence-based clinical practice guidelines, opioid stewardship, and comparing the efficacy of products when making formulary decisions. The survey also pointed to additional trends in areas of staffing and the use of mobile technology.

Formulary Management

Lead author Craig A. Pederson of Virginia Mason Medical Center noted that the findings are not surprising, as these strategies have been proven to be effective. Of note, the results determined an increase in the use of therapeutic interchange since 2016.

Other noteworthy trends on the basis of formulary management from the survey:

  • Thirty-one percent of hospitals reported rationing medications due to expected patient outcomes and cost of therapy, up from 25% in 2016.
  • Seventy-three percent of hospitals has be limited strict formulary and tight restrictions on non-formulary medication use, up from 63% in 2016.
  • Eighty-nine percent of hospitals provide their pharmacists the authority to write medication orders; among these locations, 94% of pharmacists are able to modify or initiate therapy by policy or protocol, whereas 6% are authorized to prescribe medications.

“Seventy-two percent of hospitals use protocols that transfer authority for product selection and dosing from prescribers to pharmacy as a strategy by P&T, suggesting that pharmacists are increasingly recognized as effective stewards of the formulary system, and at implementing formulary standards,” Pedersen said. “This is significantly less than 77% of hospitals in 2016.”

Pharmacogenomics Management

Related to pharmacogenomics, a mere 5.4% of hospitals who participated in the survey reported their recommendations for or scheduling of pharmacogenomics testing for determining drug and dosage; 90% indicated that their pharmacists experience limitations in dispensing products for pharmacogenomics drugs therapy management.


But although the survey showed limited pharmacy involvement in this area of drug management, Pederson remains hopeful that the prevalence of pharmacogenomics will only improve from here.

“There are a lot of drug products with pharmacogenomic markers,” Pederson said. “So where are pharmacists in pharmacogenomics? At this point, pharmacists play a very limited role. Some might be very disappointed in that — I think there are a lot of people that are highly invested in this. But my point is that pharmacogenomics has not yet become the pharmacokinetic monitoring of pharmacy. That’s not to say that I don’t think it will.”

Opioid Stewardship

On the other hand, more positive trends from ASHP’s survey were found in opioid stewardship, as 47% of hospitals had active opioid stewardship programs, compared with 41% in 2018, and 65% indicated that their pharmacists function as leaders for accountability concerning the hospital’s opioid stewardship programs.

Philip J. Schneider, co-author and professor in the College of Pharmacy at The Ohio State University, lauded these trends showing increased pharmacist participation. “The good news is that if a hospital has an opioid stewardship program, which nearly half do, pharmacists are almost always involved,” he said.

Other areas of growth in this sector included the following:

  • Eighty-five percent of hospitals reported educations programs or guidelines, compared to 71.4% in 2018.
  • Eighty-five percent have been using a prescription drug monitoring database, compared to 63.5% in 2018.
  • Sixty-one percent limit home discharge prescription supplies of opioid medications, compared to 46.3% in 2018.


Results from the survey also included data on hospital staffing of pharmacists, as the number of full-time pharmacist positions have grown since 2016, with a mean of 19.2 positions for each 100 occupied beds. Pharmacists also showed a vacancy rate of less than 3%; pharmacy technicians had a vacancy rate of 6.5%. Despite challenges in vacancy rates for technicians, human resource commitments to support new services are increasing, and staff credentialing continues to expand for pharmacists and technicians, the authors wrote.

Mobile technology

Encouraging results also took form in the survey’s data concerning mobile technology. The majority of pharmacists are now using smartphones, tablets, or laptops to supplement and facilitate patient care services following the nearly universal adoption of the universal electronic health records.

“Pharmacists continue to assume greater responsibility for writing medication orders, dosing, ordering laboratory tests, and monitoring outcomes,” the authors of the survey reported. “Health-system pharmacist are taking a leading role in addressing the opioid crisis, advancing safety in compounded sterile preparations through adoption of intravenous workflow technologies, and optimizing EHR applications to leverage clinical decision support tools to improve the safe prescribing and use of medications.”

The survey was conducted prior to the COVID-19 pandemic.


  1. ASHP National Survey Reveals Trends in Pharmacy Practice. News Release. ASHP; June 26, 2020. Accessed July 7, 2020.