Hospital pharmacists' role in patient care continues to grow

Hospital pharmacists are more involved in medication therapy decisions than ever before, according to an annual survey of hospital pharmacy directors. These and other results of the American Society of Health-System Pharmacists [ASHP] National Survey of Pharmacy Practice in Hospital Settings: Prescribing and Transcribing 2010 were published in the American Journal of Health-System Pharmacy.

Conducted by internet and e-mail, the ASHP survey queried a stratified random sample of pharmacy directors at 1,968 general and children’s medical-surgical hospitals.

Findings demonstrated that the role of pharmacists in patient care continues to grow, according to Douglas J. Scheckelhoff, a study author and ASHP vice president.

“Throughout the survey, there is significant evidence that pharmacists’ unique expertise is sought after and valued by other healthcare providers,” said Scheckelhoff. “This includes the increase in hospitals providing 24-hour review of medication orders by pharmacists and the growing ways that pharmacists provide leadership in the medication-use system.”

Among the key findings:

• Sixty percent of pharmacy directors view P&T committees as highly effective at “increasing safety,” scoring their effectiveness even higher than such committees’ role in decreasing cost, improving outcomes, or promoting evidence-based use of medicines.
• The rate at which prescribers accept pharmacists’ recommendations has risen dramatically over the last decade, most significantly in the areas of antibiotic use (55.5% in 2001; 94% in 2010), pain management (65% in 2001; 98.9% in 2010), dosage adjustment (72.7% in 2001; 99.3% in 2010), and anticoagulation therapy (73.2% in 2001; 98% in 2010).
• Pharmacists are providing prescribing advice through consultations at a great majority of hospitals, especially in the areas of dosage adjustment (88.1% in 2001; 98.1% in 2010), drug information (91.9% in 2001; 98.1% in 2010), pharmacokinetics (76.9% in 2001; 90.6% in 2010), antibiotics (78.8% in 2001; 83.8% in 2010), and anticoagulation (33.8% in 2001; 64.8% in 2010). Pharmacy directors find that intervention by pharmacists is the most effective strategy for improving the appropriateness of drug use (69.4%), rating it significantly more effective than the formulary (52%), P&T policy (52.4%), and clinical guidelines (58.2%).
• Pharmacists are routinely engaged in a variety of high-risk therapies, managing both dosing and monitoring, including with warfarin (37.1%), low-molecular-weight heparin (35.7%), and heparin (32.3%).
• The percent of hospitals without a system to provide 24-hour review of prescriptions by pharmacists, either on-site or remotely, has significantly decreased over the past 10 years (59.6% in 2001; 43.4% in 2010).
• Pharmacists lead antimicrobial stewardship programs in nearly half (48.5%) of all hospitals, with the highest percentage in hospitals with 400 to 599 beds (73.3%) and hospitals with more than 600 beds (77.3%).