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Survey says: Pharmacists contribute to med safety
Troubling results: Adverse drug event reports fall
Pharmacists in hospitals and health systems continue to make significant contributions to the overall safety and effectiveness of medication therapy, according to results of the 2006 ASHP National Survey of Pharmacy Practice in Hospital Settings. The survey results, which were reported in the March 1, 2007, issue of the American Journal of Health-System Pharmacy, focus on the role pharmacists play in managing and improving the medication use process.
The survey found that pharmacists regularly monitor medication therapy for patients in nearly all hospitals in the US (93.4%). Both the percentage of pharmacists' time spent monitoring medications and the percentage of patients monitored continue to increase, researchers said.
More hospitals are providing a technology infrastructure to augment medication therapy monitoring by pharmacists. Some 87% of hospitals provide computer access to laboratory data compared with 78% in 2003 and 74% in 2002. Nearly 60% of hospitals allow for transfer of electronic information between inpatient and outpatient settings compared with 45% in 2003.
"The survey results highlight encouraging trends that can greatly improve care in hospitals," said ASHP president Cynthia Brennan, Pharm.D. "Utilizing pharmacists in a patient care role capitalizes on their unique expertise and provides tremendous benefits to the safety, effectiveness and value of medication therapy.
Other survey highlights include:
Expanding Access to Patient Care: Increased use of technicians and automation are strategies many institutions are using to facilitate pharmacists' involvement in patient care. Some 46% of hospitals have expanded the responsibilities of pharmacy technicians to free up pharmacists' time, and 45% of hospitals have increased pharmacists' access to patient-specific data, while nearly 40% have implemented automated dispensing systems.
Patient Education & Counseling: Some 73% of hospitals provide medication education for up to one-quarter of their patients. However, only a small percentage of hospitals (7.3) provide patient medication education to 26% or more of their patients. Most hospitals select specific patients for medication counseling; only 4.5% of hospitals have pharmacists counsel all patients. Patients were most often selected for counseling because of physician orders (82.9%) or patient request (64.5%). Patients were also tapped for counseling if they were discharged on complex or high-risk medications (34.2%) or had a specific disease state (25.8%).
Identifying Patients for Monitoring: More than 60% of hospitals have a list of specific medications that require daily monitoring. Patients were less likely than in 2003 (38% in 2006 vs. 48% in 2003) to be identified for monitoring based on their treatment in a specific medical or surgical service. Other methods for identifying patients include abnormal laboratory test values requiring dosage adjustments (72.5%), high-cost medications, (34.1%), and disease state (32.2%).
Medication Reconciliation: Some 72% of hospitals report having met the Joint Commission's National Patient Safety Goal on medication reconciliation— a significant increase compared to 2005 (44.8%).
Therapeutic Drug Monitoring: Therapeutic drug monitoring has increased since 2003. More than 87% of hospitals have pharmacists regularly monitor serum medication levels, also an increase since 2003.
Pharmacy Operations: The physical location of pharmacy departments often aids pharmacists' medication monitoring efforts. The survey found that 46.8% of pharmacy departments are located on a patient care floor of a hospital, which makes pharmacists readily available for consultations with physicians and nurses. However, nearly 43% of respondents noted that their current space allocations were inadequate for the level and types of services the department offered.
ASHP officials said a sobering finding from the survey shows a decrease in both internal and external reporting of adverse drug events (ADEs). Reporting of ADEs saw a substantial increase in 2003, most likely attributed to the influence of the Institute of Medicine's 1999 report, "To Err is Human: Building a Safer Health System." The decrease suggests that impact of the report is diminishing in hospitals and health systems, officials said.
"This is a troubling finding in an otherwise positive report," said Brennan. "Reporting of adverse drug events is a critical piece in the development of a fail-safe medication-use system. These reports help us gain a better understanding of why errors happen and allow practitioners to learn from the mistakes of others."
Survey respondents reported several methods to improve internal ADE reporting, including working to drive fear out of the workplace (76.9%); providing in-service education to promote voluntary reporting (64%); and sharing improvements resulting from events reported (60.1%).
ASHP said that monitoring and patient education are often shared responsibilities among the different healthcare disciplines. "The fact that pharmacists are not always involved in monitoring drug therapy or educating patients about medications does not mean that these activities are not being conducted in U.S. hospitals.
Nevertheless, if pharmacists were to assume a leadership role in improving the use of medications, it is important that they become involved." The survey was intended to determine the extent to which pharmacists are involved in monitoring and patient education activities and the percentage of patients who benefit from these services.
Data from the 2002 and 2003 surveys suggest that pharmacists continue to be very involved in monitoring and patient education activities. Interestingly, ASHP said, the percentage of patients being monitored increase, despite the fact that the time spent by pharmacists on monitoring activities did not increase. One explanation for this advanced by the paper is the increased use of technology, particularly electronic patient information, which improves monitoring efficiency. Another explanation is the increased transfer of patient information between inpatient and outpatient settings. An additional interesting finding was the increased autonomy granted to pharmacists to initiate orders for lab tests and make changes in drug therapy based on the results of these tests.
The role of pharmacists in patient education and counseling programs continues to be limited, ASHP said. Few hospitals reported having pharmacists provide medication education to patients during hospitalization and at discharge. "An unacceptably high percentage of hospitals had neither of these programs, the report said. "It is also discouraging to find that the percentage of hospitals that document patient education activities had declined."
Work force issues continued to be a source of concern among all healthcare disciplines, including pharmacy, in 2008. The rapid proliferation of chain drugstores with extended hours of service has exacerbated the shortage of pharmacists in many areas of the U.S. Therefore, it was surprising to find that the number of vacant pharmacy positions was as low as it was. The estimated number of vacancies was actually slightly lower than that reported in 2003. Therefore, ASHP says, this is even more surprising given the finding that the number of pharmacist positions per 100 beds continues to increase, perhaps because pharmacists find practicing in hospitals and health systems more professionally satisfying.