Pharmacists' Influence Growing in Hospitals

Pharmacists are more integrated and influential in medication therapy decisions in hospitals than ever before, according to the results of an annual survey conducted by the American Society of Health System Pharmacists (ASHP).

The findings demonstrate that the pharmacist’s role in patient care continues to grow, according to ASHP Vice President Douglas J. Scheckelhoff, one of the study’s authors. “Throughout the survey, there is significant evidence that pharmacists’ unique expertise is sought after and valued by other health care providers,” he said in a statement. “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.”

The results of the ASHP National Survey of Pharmacy Practice in Hospital Settings: Prescribing and Transcribing 2010 are published in the April 15 issue of the American Journal of Health-System Pharmacy.

According to the report, the rate at which prescribers accept pharmacists’ recommendation has increased dramatically over the last decade, most significantly in the areas of antibiotic use (94% in 2010 compared to 55.5% in 2001), pain management (98.9% in 2010 compared to 65.9% in 2001), dosage adjustment (99.3% in 2010 compared to 72.7% in 2001), and anticoagulation therapy (98% in 2010 compared to 73.2% in 2001).

More key findings from the survey are as follows:

• 60% of pharmacy directors view prescribing and transcribing committees as being highly effective at “increasing safety,” scoring it even higher than the committee’s role in decreasing cost, improving outcomes, or promoting evidence-based use of medicines.
• Pharmacists are providing prescribing advice through consultations at a vast majority of hospitals, particularly in the areas of dosage adjustment (98.1%), drug information (98.1%), pharmacokinetics (90.6%), antibiotics (83.8%), and anticoagulation (64.8%).
• Pharmacy directors find that pharmacists’ intervention is the most effective strategy to improve 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 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 5 years (43.4% in 2010 compared to 59.6% in 2001).
• Pharmacists lead antimicrobial stewardship programs in nearly half (48.5%) of all hospitals, with the highest percentage in hospitals with 400-599 beds (73.3%) and greater than 600 beds (77.3%).

For the survey, ASHP surveyed a stratified random sample of pharmacy directors at 1968 general and children’s medical-surgical hospitals in the United States, via Internet and mail. ASHP conducts the survey annually to examine trends in pharmacy practice over time, focusing on one of three themes on a rotating basis. This year, the survey focused on prescribing and transcription issues. Other years have focused on dispensing and administration and medication monitoring and patient education.

To view the full study, click here.