Hospital pharmacists: Pioneers in clinical pharmacy

March 19, 2007

Today's hospital pharmacists have evolved to such a point that many pioneering pharmacists like Charles Rice and Harvey A. K. Whitney might not recognize their own profession.

Hospital pharmacists are no longer relegated to the basement with their mortar and pestle. They are now integrated onto patient floors, collaborating with physicians and nurses to deliver pharmaceutical care. Hospital pharmacists nowadays have prescribing privileges within Veterans Affairs medical centers, administer vaccines in more than 40 states across the country, and are generally viewed as medication counselors.

"Our profession has made tremendous progress," commented Kurt Kleinmann, R.Ph., M.S., former pharmacy director at Montefiore Medical Center in New York. When he started his pharmacy career at Johns Hopkins in the 1950s, the pharmacy department was located in the basement and was responsible for making all the intravenous solutions as well as the blue and red ink for the entire hospital. "Compounding was a major part of our job, but many pharmacists find it hard to believe we also used to make ink."

Early beginnings

When the first edition of Drug Topics, then called AmericanDruggists Circular and Chemical Gazette, was published in 1857, there were fewer than 170 hospitals across the country, and drug therapy comprised mainly cathartics, emetics, and diaphoretics. It wasn't until the early 20th century that hospital pharmacy transformed into a formal profession. Efforts to organize a professional association started in the 1920s with the support of the American Pharmaceutical Association. By 1942, the American Society of Hospital Pharmacists was established with 154 members and a volunteer staff.

The society helped to advance the profession and make it better recognized by the medical community, said William Zellmer, R.Ph., M.P.H., deputy executive VP with ASHP. "The association helped nurture the ideals and aspirations of the profession," said Zellmer, a 36-year veteran with ASHP.

Despite a newly formed association, hospital R.Ph.s' role in drug therapy was not fully acknowledged. According to a national survey conducted in 1946, about 10% of hospitals gave control of medications to the chief medical resident or nurse superintendent rather than a pharmacist. In some hospitals, R.Ph.s were burdened with extra responsibilities, including taking electrocardiograms, fitting patients with eyeglasses, and assisting with autopsies.

Collaborators in care

Pharmacy schools responded with expanded curriculums. Visionary pharmacy leader Whitney started the first internship program at University Hospital in Ann Arbor, Mich.