PRACTICE REPORTS Prescribing and transcribing
PRACTICE REPORTS
ASHP national survey of pharmacy practice in hospital settings: Prescribing and transcribing—2013
T
Craig A. Pedersen, Philip J. Schneider, and Douglas J. Scheckelhoff
he ASHP national survey of pharmacy practice in hospital settings focuses on practices and technologies for managing and improving the medication-use system and the role that pharmacists play in this effort. The national surveys are organized according to six components of the medication-use process: prescribing, transcribing, dispensing, administration, monitoring, and patient education. The survey focuses on two components in the medication-use process each year. The 2013 survey evaluated practices and technologies related to prescribing and transcribing. The most recent three surveys therefore represent a composite picture of the ways hospitals and health systems are managing and improving the entire medicationuse system and the current role that pharmacists play in medication-use system management. In assessing prescribing and transcribing practices, the present study was intended to describe and trend the process of formulary system management; the use of drug policy tools by the pharmacy and therapeutics (P&T) committee to improve
Purpose. The results of the 2013 ASHP national survey of pharmacy practice in U.S. hospital settings are presented. Methods. A stratified random sample of pharmacy directors at 1433 general and children’s medical–surgical hospitals was surveyed by mail. IMS Health supplied data on hospital characteristics; the survey sample was drawn from IMS’s hospital database. Results. In this national probability sample survey, the response rate was 28.9%. Drug policies developed by pharmacy and therapeutics committees continue to be an important strategy for improving prescribing. Strict formulary systems were maintained in 60.4% of hospitals, and 77% used clinical practice guidelines that included medications. Direct clinical services by pharmacists are becoming a more important way to identify and resolve medication-related problems with prescribing. Therapeutic interchange policies were used in 87.2% of hospitals, and pharmacist consultation to improve prescribing was common. Pharmacists most commonly provided consultations to prescribers for dosage adjustment (98.3%), drug information (93.2%), recom-
medication use; the extent of pharmacist consultations and prescrib-
Craig A. Pedersen, B.S.Pharm., Ph.D., FAPhA, is Pharmacy Manager, Confluence Health—Central Washington Hospital, Wenatchee, WA. Philip J. Schneider, M.S., FASHP, FFIP, FASPEN, is Professor and Associate Dean, College of Pharmacy, Phoenix Biomedical Campus, University of Arizona, Phoenix. Douglas J. Scheckelhoff, M.S., FASHP, is Vice President, Office of Practice Advancement, American Society of Health-System Pharmacists, Bethesda, MD. Address correspondence to Dr. Pedersen ([email protected]).
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Am J Health-Syst Pharm—Vol 71 Jun 1, 2014
mendations for antibiotic therapy (91.7%), and pharmacokinetics (91.5%). Electronic health records (EHRs) have been implemented partially or completely in most hospitals (92.6%). Computer prescriberorder-entry systems with clinical decision support were used in 65.2% of hospitals, 80% had barcode-assisted medication administration systems, 80.8% had smart infusion pumps, and 93.9% had electronic medication administration records. EHRs were used in 60.7% of outpatient clinics, with electronic prescribing to outpatient pharmacies used in 59.6% of hospitals. Pharmacists practiced in 27.1% of hospital ambulatory or primary care clinics, which is an increase from 18.1% compared with 2010. The most common service offered by pharmacists to outpatients was anticoagulation management (63.5%). The percentage of hospitals using performance metrics increased from 58.7% in 2010 to 68.7% . Conclusion. Pharmacists continue to expand their role in improving the prescribing of medications in both the hospital and outpatient settings. The adoption of EHRs and medication-use technologies has contributed to this growth. Am J Health-Syst Pharm. 2014; 71:924-42
ing authority; the provision of drug information to prescribers; the proc-
The assistance of Moyo Myers, Renee Barnes, the staff of ASHP, and the pharmacy directors who participated in the survey is acknowledged. Partially supported by a grant from Merck & Co. and the ASHP Research and Education Foundation. The authors have declared no potential conflicts of interest. Copyright © 2014, American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/14/0601-0924$06.00. DOI 10.2146/ajhp140032
PRACTICE REPORTS Prescribing and transcribing
ess of medication order receiving, evaluation, and transcription activities; and the use of computerized prescriber-order-entry (CPOE) systems, electronic medical records, and other medication safety technologies. This study also evaluated medication safety and quality-improvement activities, antibiotic stewardship programs, the use of key metrics to measure pharmacy department performance, anticoagulation management by pharmacists, pharmacist participation in outpatient clinics, pharmaceutical acquisition costs, the number of doses billed, human resource commitments and turnover, and estimates of national vacancy rates for hospital pharmacist and pharmacy technician positions. Methods Prescribing and transcribing practices in U.S. hospitals and health systems were evaluated using meth-
ods similar to those of past ASHP surveys.1-12 Questionnaire development. The 2013 questionnaire was developed using procedures suggested by Dillman.13 Questions from previous surveys that pertained to topics of interest in this survey were evaluated for clarity and response. As with past surveys, data about hospital characteristics (i.e., number of beds, U.S. Census Bureau region and metropolitan statistical area,14 and ownership) were obtained from the IMS Health hospital database.15 Survey sample. From the IMS database of 7053 hospitals, a sampling frame of 4893 general and children’s medical–surgical hospitals in the United States was constructed. Specialty, federal, and Veterans Affairs hospitals were excluded from this sampling frame. Hospitals were stratified by size before sampling, and random samples of hospitals within
these strata were taken to select the sample of 1439 hospitals. We sampled 300 hospitals with fewer than 50 beds to compensate for historically lower response rates in hospitals of that size. We sampled all hospitals with 600 or more staffed beds (n = 139) to collect data from enough very large hospitals to provide reliable estimates. Two hundred hospitals were sampled in each of the other hospital size categories (Table 1). In May 2013, each of the 1439 hospitals was called by telephone (Reliance Solutions, Arnold MD) to verify the name of the pharmacy director. After eliminating closed hospitals, hospitals that no longer had pharmacies, hospitals without a permanent director of pharmacy, and pharmacies unwilling to provide the name of the director of pharmacy, the adjusted sample was 1433 hospitals. Data collection. Pharmacy directors in the sample were contacted
Table 1.
Size, Location, and Ownership of Respondents’ Hospitalsa No. (%) Characteristic
Respondents
Nonrespondents
Surveyed
Population
All hospitals No. staffed beds
PRACTICE REPORTS
ASHP national survey of pharmacy practice in hospital settings: Prescribing and transcribing—2013
T
Craig A. Pedersen, Philip J. Schneider, and Douglas J. Scheckelhoff
he ASHP national survey of pharmacy practice in hospital settings focuses on practices and technologies for managing and improving the medication-use system and the role that pharmacists play in this effort. The national surveys are organized according to six components of the medication-use process: prescribing, transcribing, dispensing, administration, monitoring, and patient education. The survey focuses on two components in the medication-use process each year. The 2013 survey evaluated practices and technologies related to prescribing and transcribing. The most recent three surveys therefore represent a composite picture of the ways hospitals and health systems are managing and improving the entire medicationuse system and the current role that pharmacists play in medication-use system management. In assessing prescribing and transcribing practices, the present study was intended to describe and trend the process of formulary system management; the use of drug policy tools by the pharmacy and therapeutics (P&T) committee to improve
Purpose. The results of the 2013 ASHP national survey of pharmacy practice in U.S. hospital settings are presented. Methods. A stratified random sample of pharmacy directors at 1433 general and children’s medical–surgical hospitals was surveyed by mail. IMS Health supplied data on hospital characteristics; the survey sample was drawn from IMS’s hospital database. Results. In this national probability sample survey, the response rate was 28.9%. Drug policies developed by pharmacy and therapeutics committees continue to be an important strategy for improving prescribing. Strict formulary systems were maintained in 60.4% of hospitals, and 77% used clinical practice guidelines that included medications. Direct clinical services by pharmacists are becoming a more important way to identify and resolve medication-related problems with prescribing. Therapeutic interchange policies were used in 87.2% of hospitals, and pharmacist consultation to improve prescribing was common. Pharmacists most commonly provided consultations to prescribers for dosage adjustment (98.3%), drug information (93.2%), recom-
medication use; the extent of pharmacist consultations and prescrib-
Craig A. Pedersen, B.S.Pharm., Ph.D., FAPhA, is Pharmacy Manager, Confluence Health—Central Washington Hospital, Wenatchee, WA. Philip J. Schneider, M.S., FASHP, FFIP, FASPEN, is Professor and Associate Dean, College of Pharmacy, Phoenix Biomedical Campus, University of Arizona, Phoenix. Douglas J. Scheckelhoff, M.S., FASHP, is Vice President, Office of Practice Advancement, American Society of Health-System Pharmacists, Bethesda, MD. Address correspondence to Dr. Pedersen ([email protected]).
924
Am J Health-Syst Pharm—Vol 71 Jun 1, 2014
mendations for antibiotic therapy (91.7%), and pharmacokinetics (91.5%). Electronic health records (EHRs) have been implemented partially or completely in most hospitals (92.6%). Computer prescriberorder-entry systems with clinical decision support were used in 65.2% of hospitals, 80% had barcode-assisted medication administration systems, 80.8% had smart infusion pumps, and 93.9% had electronic medication administration records. EHRs were used in 60.7% of outpatient clinics, with electronic prescribing to outpatient pharmacies used in 59.6% of hospitals. Pharmacists practiced in 27.1% of hospital ambulatory or primary care clinics, which is an increase from 18.1% compared with 2010. The most common service offered by pharmacists to outpatients was anticoagulation management (63.5%). The percentage of hospitals using performance metrics increased from 58.7% in 2010 to 68.7% . Conclusion. Pharmacists continue to expand their role in improving the prescribing of medications in both the hospital and outpatient settings. The adoption of EHRs and medication-use technologies has contributed to this growth. Am J Health-Syst Pharm. 2014; 71:924-42
ing authority; the provision of drug information to prescribers; the proc-
The assistance of Moyo Myers, Renee Barnes, the staff of ASHP, and the pharmacy directors who participated in the survey is acknowledged. Partially supported by a grant from Merck & Co. and the ASHP Research and Education Foundation. The authors have declared no potential conflicts of interest. Copyright © 2014, American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/14/0601-0924$06.00. DOI 10.2146/ajhp140032
PRACTICE REPORTS Prescribing and transcribing
ess of medication order receiving, evaluation, and transcription activities; and the use of computerized prescriber-order-entry (CPOE) systems, electronic medical records, and other medication safety technologies. This study also evaluated medication safety and quality-improvement activities, antibiotic stewardship programs, the use of key metrics to measure pharmacy department performance, anticoagulation management by pharmacists, pharmacist participation in outpatient clinics, pharmaceutical acquisition costs, the number of doses billed, human resource commitments and turnover, and estimates of national vacancy rates for hospital pharmacist and pharmacy technician positions. Methods Prescribing and transcribing practices in U.S. hospitals and health systems were evaluated using meth-
ods similar to those of past ASHP surveys.1-12 Questionnaire development. The 2013 questionnaire was developed using procedures suggested by Dillman.13 Questions from previous surveys that pertained to topics of interest in this survey were evaluated for clarity and response. As with past surveys, data about hospital characteristics (i.e., number of beds, U.S. Census Bureau region and metropolitan statistical area,14 and ownership) were obtained from the IMS Health hospital database.15 Survey sample. From the IMS database of 7053 hospitals, a sampling frame of 4893 general and children’s medical–surgical hospitals in the United States was constructed. Specialty, federal, and Veterans Affairs hospitals were excluded from this sampling frame. Hospitals were stratified by size before sampling, and random samples of hospitals within
these strata were taken to select the sample of 1439 hospitals. We sampled 300 hospitals with fewer than 50 beds to compensate for historically lower response rates in hospitals of that size. We sampled all hospitals with 600 or more staffed beds (n = 139) to collect data from enough very large hospitals to provide reliable estimates. Two hundred hospitals were sampled in each of the other hospital size categories (Table 1). In May 2013, each of the 1439 hospitals was called by telephone (Reliance Solutions, Arnold MD) to verify the name of the pharmacy director. After eliminating closed hospitals, hospitals that no longer had pharmacies, hospitals without a permanent director of pharmacy, and pharmacies unwilling to provide the name of the director of pharmacy, the adjusted sample was 1433 hospitals. Data collection. Pharmacy directors in the sample were contacted
Table 1.
Size, Location, and Ownership of Respondents’ Hospitalsa No. (%) Characteristic
Respondents
Nonrespondents
Surveyed
Population
All hospitals No. staffed beds
