MIRROR TO HOSPITAL PHARMACY Fifty years of advancement
ar Layar
Fifty years of advancement in American hospital pharmacy Douglas J. Scheckelhoff Am J Health-Syst Pharm. 2014; 71:1947-57
T
he Mirror to Hospital Pharmacy not only served an important role in assessing the state of pharmacy practice in hospitals 50 years ago but more importantly offered recommendations that contained great vision and direction for practice.1 The Mirror served as a final report of the Audit of Pharmaceutical Services in Hospitals and was the forerunner to the many national surveys regularly conducted by ASHP over the past 50 years.2-25 The importance of the Mirror’s recommendations and the profound impact they had on driving how pharmacy is practiced in hospitals cannot be overstated. Drivers of change There have been many drivers of change in the evolution of pharmacy practice in hospitals. Professional leadership, often demonstrated through organizations such as ASHP, has been essential to seeing the advances made over the past 50 years. This leadership has been expressed through progressive education and information sharing, such as at the ASHP Midyear Clinical Meeting and, in the Society’s early days, at ASHP
Institutes offered around the country. Specialty conferences, such as the ASHP National Pharmacy Preceptor Conference and the ASHP Conference for Leaders, also have served as a mechanism to share a vision for pharmacy and learn about advances in practice. Professional policy positions, including practice standards such as statements, guidelines, and technical assistance bulletins, have also been important in voicing goals for practice and setting a high bar. Publishing a consistently high-quality journal, the American Journal of Hospital Pharmacy that was later renamed the American Journal of Health-System Pharmacy, has also served an important role in providing a forum where scholarly work can be presented, editorials can express a point of view, and advances can be shared. Changes in pharmacy education, especially the shift to an entry-level doctor of pharmacy degree, have also made a profound impact on how pharmacists practice and what they are prepared and trained to do. The expansion of postgraduate residency training has also played a significant role in both training individuals to
Douglas J. Scheckelhoff, M.S., FASHP, is Vice President, Office of Practice Advancement, American Society of Health-System Pharmacists, Bethesda, MD ([email protected]). The significant contributions of Craig A. Pedersen and Philip J. Schneider in conducting the ASHP national survey of pharmacy practice in hospital settings, the source of much of the data contained herein, are acknowledged.
better care for patients and elevating the level of practice at the sites where they train. And without a doubt, major advances in therapeutics and the complexity of drugs and biologicals have also created a need for the advanced level of care provided by pharmacists. The profession has been served by a number of visionary initiatives aimed at directing practice and further defining professional goals. Landmark initiatives such as the ASHP Hilton Head Conference in 1985, the Pharmacy in the 21st Century conference in 1989, the Implementing Pharmaceutical Care conference in 1993, the ASHP 2015 Health-System Initiative launched in 2003, and the ASHP Pharmacy Practice Model Initiative, initiated in 2010, have each sought to bring professional consensus around goals for practice, the future roles of pharmacists, and the training needed to achieve those goals.26-31 Other forces, such as conditions of participation established for facilities authorized to treat Medicare patients and accreditation standards from the Joint Commission, have also influenced how many patient care ser-
Presented at the ASHP Midyear Clinical Meeting, Orlando, FL, December 10, 2013. The author has declared no potential conflicts of interest. Copyright © 2014, American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/14/1102-1947. DOI 10.2146/ajhp140239
Am J Health-Syst Pharm—Vol 71 Nov 15, 2014
1947
The Mirror reported full-time and part-time pharmacists and nonpharmacists as individuals (total head count). These figures have been converted to full-time equivalents (FTEs). The ASHP national survey counts full-time and part-time pharmacists and nonpharmacists as FTEs. Estimate based on 2013 ASHP national survey responses. c
b
1,739 98c 4,000 3,652 698 99c 4,048 3,350 1,041 100 9,473 9,785 622 100 11,072 10,387 358 100 10,418 8,914 535 100 25,214 20,657 4,893 99c 64,225 56,746 19 115 567 693 435 740 2,517 136 356 1,058 943 650 1,370 4,513 3.5 17.8 72.2 96.3 99.5 100 35
Am J Health-Syst Pharm—Vol 71 Nov 15, 2014
a
No. Beds
2,409 1,296 973 461 229 227 5,645
Total No. Nonpharmacistsa Total No. Pharmacistsa % Hospitals With ≥1 Full-time Pharmacist Total No. Hospitals by Bed Size
19571
Hospital Pharmacy Staffing in 1957 Versus 2013
Table 1. 1948
vices are offered, including pharmacy services.
ar Layar
Fifty years of advancement in American hospital pharmacy Douglas J. Scheckelhoff Am J Health-Syst Pharm. 2014; 71:1947-57
T
he Mirror to Hospital Pharmacy not only served an important role in assessing the state of pharmacy practice in hospitals 50 years ago but more importantly offered recommendations that contained great vision and direction for practice.1 The Mirror served as a final report of the Audit of Pharmaceutical Services in Hospitals and was the forerunner to the many national surveys regularly conducted by ASHP over the past 50 years.2-25 The importance of the Mirror’s recommendations and the profound impact they had on driving how pharmacy is practiced in hospitals cannot be overstated. Drivers of change There have been many drivers of change in the evolution of pharmacy practice in hospitals. Professional leadership, often demonstrated through organizations such as ASHP, has been essential to seeing the advances made over the past 50 years. This leadership has been expressed through progressive education and information sharing, such as at the ASHP Midyear Clinical Meeting and, in the Society’s early days, at ASHP
Institutes offered around the country. Specialty conferences, such as the ASHP National Pharmacy Preceptor Conference and the ASHP Conference for Leaders, also have served as a mechanism to share a vision for pharmacy and learn about advances in practice. Professional policy positions, including practice standards such as statements, guidelines, and technical assistance bulletins, have also been important in voicing goals for practice and setting a high bar. Publishing a consistently high-quality journal, the American Journal of Hospital Pharmacy that was later renamed the American Journal of Health-System Pharmacy, has also served an important role in providing a forum where scholarly work can be presented, editorials can express a point of view, and advances can be shared. Changes in pharmacy education, especially the shift to an entry-level doctor of pharmacy degree, have also made a profound impact on how pharmacists practice and what they are prepared and trained to do. The expansion of postgraduate residency training has also played a significant role in both training individuals to
Douglas J. Scheckelhoff, M.S., FASHP, is Vice President, Office of Practice Advancement, American Society of Health-System Pharmacists, Bethesda, MD ([email protected]). The significant contributions of Craig A. Pedersen and Philip J. Schneider in conducting the ASHP national survey of pharmacy practice in hospital settings, the source of much of the data contained herein, are acknowledged.
better care for patients and elevating the level of practice at the sites where they train. And without a doubt, major advances in therapeutics and the complexity of drugs and biologicals have also created a need for the advanced level of care provided by pharmacists. The profession has been served by a number of visionary initiatives aimed at directing practice and further defining professional goals. Landmark initiatives such as the ASHP Hilton Head Conference in 1985, the Pharmacy in the 21st Century conference in 1989, the Implementing Pharmaceutical Care conference in 1993, the ASHP 2015 Health-System Initiative launched in 2003, and the ASHP Pharmacy Practice Model Initiative, initiated in 2010, have each sought to bring professional consensus around goals for practice, the future roles of pharmacists, and the training needed to achieve those goals.26-31 Other forces, such as conditions of participation established for facilities authorized to treat Medicare patients and accreditation standards from the Joint Commission, have also influenced how many patient care ser-
Presented at the ASHP Midyear Clinical Meeting, Orlando, FL, December 10, 2013. The author has declared no potential conflicts of interest. Copyright © 2014, American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/14/1102-1947. DOI 10.2146/ajhp140239
Am J Health-Syst Pharm—Vol 71 Nov 15, 2014
1947
The Mirror reported full-time and part-time pharmacists and nonpharmacists as individuals (total head count). These figures have been converted to full-time equivalents (FTEs). The ASHP national survey counts full-time and part-time pharmacists and nonpharmacists as FTEs. Estimate based on 2013 ASHP national survey responses. c
b
1,739 98c 4,000 3,652 698 99c 4,048 3,350 1,041 100 9,473 9,785 622 100 11,072 10,387 358 100 10,418 8,914 535 100 25,214 20,657 4,893 99c 64,225 56,746 19 115 567 693 435 740 2,517 136 356 1,058 943 650 1,370 4,513 3.5 17.8 72.2 96.3 99.5 100 35
Am J Health-Syst Pharm—Vol 71 Nov 15, 2014
a
No. Beds
2,409 1,296 973 461 229 227 5,645
Total No. Nonpharmacistsa Total No. Pharmacistsa % Hospitals With ≥1 Full-time Pharmacist Total No. Hospitals by Bed Size
19571
Hospital Pharmacy Staffing in 1957 Versus 2013
Table 1. 1948
vices are offered, including pharmacy services.
