17 Jul Pharmacists Increasingly Managing Medication Therapy
MedicalResearch.com Interview with:
Craig A. Pedersen, RPh, PhD, FAPhA
Manager, Sterile Compounding and Investigational Drug Service,
Pharmacy Clinical Professor
University of Washington
MedicalResearch.com: What is the background for this study?
Response: The ASHP national survey of pharmacy practice in hospitals originated with the Mirror to Hospital pharmacy, the first comprehensive, national audit of pharmaceutical services in hospitals, published in 1964. Since that time, ASHP has conducted national surveys to document practices and technologies for managing the improving the medication-use system and the role that pharmacist play in that effort. Beginning in 1998, the national survey became an annual project by ASHP. This survey provides important information to pharmacists, managers, and external stakeholders to document the current state of pharmacy practice.
MedicalResearch.com: What are the main findings?
Response: Pharmacists are increasingly managing medication therapy, including selecting appropriate drug therapies, monitoring patients and assessing outcomes, and educating and patients and other providers. Pharmacists have previously demonstrated leadership in antimicrobial stewardship programs designed to address the growing epidemic of resistant infections. This survey shows that pharmacists are also being looked to as leaders in addressing the opioid crisis by implementing similar stewardship programs designed to ensure the appropriate use of opioids and prevent and detect opioid diversion. Finally, this survey shows that pharmacists are continuing to improve sterile compounding operations in hospitals by implementing bar code double checks and other systems beyond the pharmacist check of the end product.
MedicalResearch.com: What should readers take away from your report?
Response: Pharmacists are monitoring a greater proportion of all hospitalized patients, in large part due to increased use of efficiencies of computerized data mining tools in the electronic health record and/or clinical surveillance software that helps screen patients for additional pharmacist follow-up, and increasing assignment to specific medical services in the hospital. In addition, pharmacists are using an increasingly diverse set of criteria to select patient for daily medication therapy monitoring and targeting prescribing interventions based on a formalized list of medications, focusing on selected disease states or on selected units in the hospital. Increasing emphasis by pharmacists are patients prescribed medications on shortage, as well as high-cost medications.
The increasing sophistication of electronic health record systems, availability of lab values, increased pharmacist involvement in drug therapy management and therapeutic drug monitoring, as well as patient counseling activities of pharmacists in hospitals, has led to increasing pharmacist involvement in identifying adverse drug events.
Pharmacists have a long standing focus on continuously improving sterile compounding operations in hospitals. Many hospitals are using bar code scanning to verify ingredients during the sterile compounding preparation steps, which provides an extra verification step to ensure quality, beyond the double check provided by the pharmacist. Hospitals are either adopting i.v. workflow management software to help with bar code scanning, and some electronic health records offer this feature within their system. Furthermore, some hospitals are implementing video of compounding operations, and/or pictures to document the compounding process as an extra measure of safety.
Because sterile compounding processes can be complex, or needed volumes exceed capacity of hospital pharmacy operations, over three-fourths of hospitals outsource some compounded sterile preparations for use in their facility. Hospital pharmacy departments are using many strategies to evaluate external compounded sterile preparation providers, including a review of licensure, establishing contracts, reviewing quality assurance documentation, reviewing FDA issued deficiencies in quality oversight and potential non-compliance with good manufacturing practices at the compounder, state board inspections, visiting sites to observe and validate quality oversight, and using the ASHP Foundation Outsourcing Sterile Products Preparation Vendor Assessment Tool.
With an increasing focus in medicine and society on decreasing the use of addictive opioid medications, and appropriate opioid use when needed, pharmacists are stepping to the forefront in hospitals to address this critical need. Over 40% of hospitals have active opioid stewardship programs. And in nearly 55% of those hospitals, pharmacists are in a leadership and accountability role for that program. Common strategies used by pharmacists include guidelines and prescriber education, use of the state prescription drug monitoring systems to guide prescribing, emphasizing non-pharmacologic and non-opioid pain management methods, and having robust opioid diversion detection programs. Many hospitals are limiting quantities of home discharge opioid prescriptions, benchmarking prescribers prescribing patterns, prescribing opioid reversal agents, limiting maximum doses for opioids, and offering opioid take-back receptacles to get unneeded opioids out of home medication cabinets.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: This survey is designed to be a 30,000 foot look at the processes pharmacists are using to improve medication use. Future research needs to document how these systems improve patient outcomes at the local level.
MedicalResearch.com: Is there anything else you would like to add?
Response: The trended results show how pharmacists have incrementally improved medication use over the last 20+ years in hospitals. Hospital pharmacist directors have continuously used study results to identify opportunities to advance practice. Pharmacists are responding to public health issues related to medication use.
The authors have no conflicts.
Craig A. Pedersen, Philip J. Schneider, Michael C. Ganio, Douglas J. Scheckelhoff, ASHP national survey of pharmacy practice in hospital settings: Monitoring and patient education—2018, American Journal of Health-System Pharmacy, Volume 76, Issue 14, 15 July 2019, Pages 1038–1058, https://academic.oup.com/ajhp/article/76/14/1038/5526850
Philip J. Schneider, Craig A. Pedersen, Douglas J. Scheckelhoff, ASHP national survey of pharmacy practice in hospital settings: Dispensing and administration—2017, American Journal of Health-System Pharmacy, Volume 75, Issue 16, 15 August 2018, Pages 1203–1226, https://doi.org/10.2146/ajhp180151
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