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Practice Report |
CRAIG A. PEDERSEN, PH.D., is Associate Professor and Director of Graduate Studies in the Division of Pharmacy Practice and Administration; and PHILIP J. SCHNEIDER, M.S., FASHP, is Clinical Professor and Director, Latiolais Leadership Program, College of Pharmacy, The Ohio State University, Columbus. DOUGLAS J. SCHECKELHOFF, M.S., FASHP, is Director, Pharmacy Practice Sections, American Society of Health-System Pharmacists (ASHP), Bethesda, MD.
Address correspondence to Dr. Pedersen at the College of Pharmacy, The Ohio State University, 500 West 12th Avenue, Columbus, OH 43210-1291 (pedersen.18{at}osu.edu).
Methods. A stratified random sample of pharmacy directors at 1178 general and children’s medical–surgical hospitals in the United States were surveyed by mail. SMG Marketing Group, Inc., supplied data on hospital characteristics; the survey sample was drawn from SMG’s hospital database.
Results. The response rate was 39.0%. Virtually all hospitals (93.4%) had pharmacists regularly monitoring medication therapy in some capacity. Patient monitoring has improved since 2003; fewer respondents reported monitoring less than 25% of patients in the hospital. More than two thirds of hospitals had a process for routine monitoring of patient profiles by pharmacists, and 87.3% of hospitals provided pharmacists with computer access to laboratory data to facilitate this function. Nearly 60% of hospitals allowed the transfer of electronic information between inpatient and outpatient settings. Over 87% of hospitals routinely monitored serum medication levels or a surrogate marker. In these hospitals, pharmacists ordered serum medication levels (69.1%), adjusted dosages (73.2%), and were notified when a level was outside the therapeutic range (47.3%). The number of adverse drug events (ADEs) reported by hospitals internally and externally decreased from the numbers reported in 2003 (213 and 31 versus 271 and 45, respectively). Medication counseling by pharmacists continued to be infrequent, with only 7.6% of hospitals reporting that 26% or more of inpatients received medication counseling. Documentation of patient education decreased from 58.0% in 2003 to 51.7%. Medication reconciliation programs were implemented in 71.7% of hospitals. The vacancy rate for budgeted pharmacist positions increased from 4.3% in 2003 to 4.6%.
Conclusion. Pharmacists have made significant strides to increase the number of patients whose drug therapy is monitored. Electronic access to laboratory data by pharmacists greatly increased, as did the availability of information transferred between the inpatient and outpatient settings. Therapeutic drug monitoring by pharmacists increased, as did pharmacists’ ability to order serum medication levels and adjust dosages. More pharmacists were notified when medication levels fell outside the therapeutic range. Internal and external reporting of ADEs has decreased. Documentation of patient education declined. A significant percentage of hospitals developed and implemented medication reconciliation programs. The number of pharmacists per 100 occupied beds has increased, and the number of pharmacist vacancies remained stable.
Index terms: American Society of Health-System Pharmacists; Data collection; Documentation; Drugs, adverse reactions; Errors, medication; Interventions; Manpower; Patient information; Pharmaceutical services; Pharmacists, hospital; Pharmacy, institutional, hospital
Purpose. Results of the 2006 ASHP national survey of pharmacy practice in hospital settings that pertain to monitoring and patient education are presented.
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