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The ASHP national survey of pharmacy practice in hospital settings focuses on the role pharmacists play in managing and improving the medication-use process. The national surveys are organized according to six steps in the medication-use process: prescribing, transcribing, dispensing, administration, monitoring, and patient education. Each year, the survey focuses on two steps of the medication-use process.
The 2005 survey represents the second part in the cycle and is concerned with dispensing and administration. When combined, the 2004-06 surveys will represent a composite picture of the current role of pharmacists in managing and improving the medication-use process.
In assessing the role of pharmacists in dispensing and administration, the present study sought to describe the inpatient drug distribution system, the use of technology in drug distribution, drug preparation and dispensing, drug administration, the use of smart infusion pumps, the use of bar-code technology, the use of medication administration records (MARs), repackaging operations, outsourcing of preparation activities, quality-improvement activities, and the progress made on two key national patient safety goals established by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
In addition, this study describes the hours of operation, off-site order review, outsourcing of pharmacy operations, human resource commitments, national vacancy rates for hospital pharmacist positions, and acquisition cost of pharmaceuticals.
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Summary of Findings
The purpose of these surveys is to determine the extent to which safe medication practices are in place in hospitals and how pharmacists are contributing to medication-use safety. When possible, this is assessed by asking respondents if they follow evidence-based best practices or published professional standards of practice. It is important to audit these practices periodically because of changes in health care, including increases in workload and acuity of care, pressure to reduce health care costs, work-force shortages in nursing and pharmacy, and rising pressure to improve quality and safety in health care.
This year's survey results, especially when compared with previous survey data, showed some encouraging trends related to the safety of medication use in U.S. hospitals. First, medication dispensing and preparation systems are becoming safer. Pharmacies are dispensing more doses in a ready-to-administer unit dose form for both oral and injectable medications. The number of injectable products that must be prepared at the bedside by nurses is decreasing, and the use of double-check systems for high-risk drugs and patient groups is increasing. These trends all suggest a commitment of resources and resolve to expand the use of proven systems for reducing errors.
The medication distribution system, while still predominately a centralized system, has moved toward more decentralization over the past three years. The adoption of automated dispensing cabinets has facilitated this transition to a more decentralized medication distribution system. In addition to the increased adoption of automated dispensing cabinets is the associated increase in the delivery of first and maintenance doses using a decentralized automated system, and the decline in use of traditional centralized manual unit dose as the primary method to provide first and maintenance doses. A total of 72% of hospitals have adopted automated dispensing cabinets, with nearly 90% of hospitals having the automated dispensing cabinet linked to patients' medication profile. Furthermore, the percentage of doses accessed from the automated dispensing cabinets as overrides has declined from 22% in 2002 to 13% in 2005. These findings suggest a safer use of automation in providing medications for patient use.
Medication administration processes and systems are also becoming safer. BCMA is increasing, with 9.4% of hospitals reporting its implementation in 2005, compared with just 1.5% in 2002. The use of handwritten MARs is decreasing, with a shift toward computer-generated paper MARs and e-MARs, both of which reduce the risk of errors related to handwriting, omission, and transcription.
Smart infusion pumps have diffused rapidly as a way to make drug infusion safer, with 32% of hospitals using smart infusion pumps in 2005. However, 23% of hospitals have yet to build extensive drug libraries for use with their smart infusion pumps, therefore limiting a key safety feature of this technology.
Small hospitals continue to have challenges in implementing best practices when compared with larger institutions. Automated dispensing methods are more difficult to implement in smaller hospitals. BCMA is also less frequently utilized in small hospitals, but the difference between small and large hospitals was less dramatic than in 2002, suggesting that small hospitals are finding ways to implement this method of improving the safety of medication administration. Small hospitals are striving to meet minimum standards for prospective medication order review by turning to larger hospitals and outside companies that use technology that provides pharmacists at remote sites with access to patients' medication, laboratory, and medical profiles. Services utilizing such technology can allow even the smallest hospitals to have 24-hour access to pharmacist-provided patient care services. |
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