Pharmacy Care Under Pressure: Pairing Standard Practice With Always-On Surveillance for Safer, More Efficient Care

Across the country, pharmacy is in a state of transformation. Community pharmacies often serve as patients’ front door to care, but their closures have led to gaps in access. As of 2025, an average of 1 in 7 Americans live in pharmacy deserts, limiting access to essential medication expertise in both rural and urban communities.¹ Hospitals likewise confront a widening gap between rising patient acuity, the growing complexity of emerging drug therapies, and the availability of pharmacists who can help advise on their care.

Amid these growing pressures, health systems are being pushed to fundamentally rethink how to support medication safety, regulatory compliance, and patient care with fewer resources. Pairing standardized clinical practices with always-on technology that supports pharmacy teams behind the scenes best positions hospitals to deliver safer, more reliable care even amid industry flux.

Persistent Resource Constraints Are Reshaping Pharmacy Operations

Hospital pharmacies are navigating a period of sustained workforce pressure, while their clinical responsibilities are expanding. Staffing shortages are forcing pharmacy leaders to rethink how teams prioritize their time and where pharmacists can have the greatest clinical impact.

Recent findings from the American Society of Health-System Pharmacists (ASHP) illustrate the scale of the challenge. The 2025 ASHP Pharmacy Forecast warned of an insufficient quantity of trained pharmacists, including technicians, while also projecting a decline in pharmacy school graduates and the potential for unfilled residency positions if the profession does not evolve.² The latest ASHP National Survey of Pharmacy Practice in Hospital Settings reinforces this pressure: More than 80% of pharmacy directors report shortages of experienced pharmacy technicians, and roughly 60% cite shortages of clinical specialists and coordinators.³ For many health systems, these gaps translate directly into an operational strain, with fewer staff expected to manage increasingly complex medication regimens across the continuum of care.

At the same time, the role of the hospital pharmacist has expanded far beyond traditional dispensing and medication verification. Clinical pharmacy services now routinely reach the majority of hospitalized patients. According to the ASHP National Survey, more than 75% of hospitals assign pharmacists directly to inpatient units, embedding them within interdisciplinary care teams to support medication management, antimicrobial stewardship, and therapy optimization. In a growing number of organizations, pharmacists are also practicing with greater clinical autonomy, with 18.5% of hospitals now granting pharmacists independent prescribing authority, reflecting broader recognition of pharmacists as direct care providers within multidisciplinary care teams.³

Compounding these workforce and scope-of-practice shifts is the increasing complexity of the patient needs that hospital pharmacy teams serve. An analysis from the American Hospital Association found that the average patient acuity level in US hospitals increased by roughly 3% between 2019 and 2023, meaning clinicians are treating sicker and more medically complex patients.⁴ This trend is expected to continue over the coming decade as the population ages and the prevalence of chronic diseases rises. Next-generation therapeutics such as cellular and gene therapies, tissue-engineered products, and targeted drug delivery will require pharmacists’ expertise and clinical leadership to ensure their safe and cost-effective use in patients.

Together, these forces are redefining the operational reality of hospital pharmacy. Pharmacists are increasingly expected to function as embedded clinical partners while still maintaining oversight of medication safety across the organization, often with fewer team members available to manage the growing workload. In this environment, technologies and workflows can help extend pharmacists’ visibility, surface clinically meaningful insights, and enable targeted intervention. These are becoming critical abilities to ensure patients receive the right therapy at the right time, even amid persistent workforce and resource constraints.

Standardization Supports Increased Efficiency, While Surveillance Makes It Sustainable

Standardized pharmacy practices can help improve efficiency and support consistent patient outcomes. Everything from medication reconciliation workflows to formulary management and documentation standards ensures consistency, which allows pharmacy teams to operate more predictably. However, when pharmacists are asked to oversee increased volumes of work with expanding regulatory requirements all on a smaller team, standardization alone is not enough.

Intelligent, always-on surveillance across clinical and operational areas helps arm pharmacists with the data they need to make patient-related decisions and keep a watchful eye over pharmacy operations. Continuous monitoring of medication data increases visibility over manual checks and augments workflows with real-time insight into potential risks. Where technology and teams work together, we can build greater resiliency for care models. This technology can help alleviate overloaded staff amid operational stress on technicians and surface clinically relevant insights for pharmacists with an expanded role in the patient’s care team. This partnership between people and technology becomes a model for increased efficiency and safety.

Real-World Impact: How Clinical Surveillance Supports Thin Pharmacy Teams

Rather than adding additional manual tasks, modern surveillance systems work proactively in the background, analyzing large volumes of data to prioritize the issues that require immediate intervention. This model allows smaller teams to maintain high levels of safety oversight while focusing their limited time on the most clinically meaningful actions.

One of the clearest examples of this impact is drug diversion prevention. Detecting diversion traditionally requires pharmacy teams to manually review and reconcile hundreds of medication transactions, automated dispensing cabinet logs, electronic health record data, and documentation across multiple systems. For understaffed teams, conducting these reviews can be difficult and time-consuming, leaving gaps in oversight. Artificial intelligence–supported surveillance technology addresses this challenge by automatically analyzing these data sources and identifying patterns that may signal potential diversion, enabling earlier intervention and reducing the burden of manual investigation.

At St Jude Children's Research Hospital in Memphis, for example, this approach has produced measurable results. By implementing automated surveillance tools to support its diversion monitoring program, the organization increased its review capabilities from 15% to 100% of drug transaction records.⁵ The expanded visibility allowed pharmacy leaders to detect anomalies earlier and strengthen compliance efforts without requiring additional staff resources. Beyond improving oversight, organizations that adopt automated diversion monitoring often report reduced medication waste, lower investigation costs, and fewer disruptions associated with staff replacement or extended inquiries. Most importantly, earlier detection helps protect patients from compromised medications or impaired care while safeguarding staff well-being.

Technology can also drive measurable impact in highly specialized medication workflows, where precision and standardization are critical but staffing levels remain tight. One example is sterile compounding and intravenous (IV) medication preparation, an area where errors can have significant patient safety implications and where pharmacists and technicians must adhere to detailed protocols.

Technology designed to guide IV compounding workflow helps ensure these complex processes are performed accurately and consistently. Solutions integrate barcode verification, digital documentation, and step-by-step preparation guidance into the compounding process. These tools provide real-time checks to confirm the correct ingredients, dilutions, and preparation steps while creating a verifiable record of each compounded dose. By automating verification and documentation tasks that were previously manual, the technology helps pharmacy teams reduce the risk of compounding errors while maintaining compliance with sterile preparation standards, providing more oversight without additional team members.

For organizations managing high volumes of compounded medications, this type of guided workflow functions as a specialized form of quality management, continuously monitoring preparation steps and alerting staff when deviations occur. The result is a safer, more standardized process that reduces rework, minimizes medication waste, and enables pharmacists to oversee more complex operations without being interrupted to manually verify every preparation in the clean room.

Together, these examples highlight how surveillance technologies deliver measurable outcomes across different pharmacy challenges. Whether identifying safety risks such as drug diversion or guiding highly specialized compounding workflows, these systems extend the reach of pharmacy teams, allowing them to maintain strong safety and compliance practices despite workforce constraints. In an environment where pharmacists are expected to manage expanding clinical responsibilities with limited staff, this type of technology-enabled support is becoming essential to sustaining safe and reliable care.

Moving Forward With Smarter Support Models

Pharmacy workforce shortages are unlikely to resolve quickly, but the impact can be mitigated through smarter, technology-enabled workforce models. Standardized surveillance creates the structure for safe and efficient practice, providing the visibility and intelligence needed to sustain that structure under pressure. These tools enable pharmacy teams to deliver safer, more reliable care in an increasingly complex health care environment.

REFERENCES

1. Marsh T. 48.4 million Americans lack adequate access to a pharmacy. GoodRx. Updated March 20, 2025. Accessed May 11, 2026. https://www.goodrx.com/healthcare-access/research/many-americans-lack-convenient-access-to-pharmacies

2. DiPiro JT, Hoffman JM, Tichy E, et al. ASHP and ASHP Foundation pharmacy forecast 2025: strategic planning guidance for pharmacy departments in hospitals and health systems. Am J Health-Syst Pharm. 2025;82(2):17-47. doi:10.1093/ajhp/zxae280

3. Pederson CA, Naseman RW, Schneider PJ, Ganio MC, Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital settings: clinical services and workforce - 2024. Am J Health-Syst Pharm. 2025;82(18):979-1005. doi:10.1093/ajhp/zxaf150

4. New analysis shows hospitals improving performance on key patient safety measures surpassing pre-pandemic levels. American Hospital Association. September 2024. Accessed May 11, 2026. https://www.aha.org/system/files/media/file/2024/09/New-Analysis-Shows-Hospitals-Performance-on-Key-Patient-Safety-Measures-Surpassing-Pre-pandemic-Levels.pdf

5. Bresnick J. AI is making drug diversion easier to detect and address. Digital Health Insights. August 13, 2024. Accessed May 11, 2026. https://www.dhinsights.org/news/ai-is-making-drug-diversion-easier-to-detect-and-address