The dilemma of establishing effective pharmacy staffing levels

Abstract

As new and enhanced pharmacy practice models are implemented to meet the complex needs of patients in health systems, it is imperative to establish the staffing and the skill levels of pharmacy generalists and specialists within our organizations. Specialty care such as that provided by pediatric, oncology, transplantation, and critical care pharmacy specialists must be considered when developing staffing algorithms to make the best use of the skills and competencies of specialty pharmacy practitioners. Medical and surgical patients also require pharmacists to evaluate their medication regimens to ensure optimal and safe medication management. How do we ensure that pharmacists are deployed at the proper ratios to both reduce adverse drug events and improve the effectiveness of the medications administered to all patients? Should we develop minimum staffing ratios for those units with a high concentration of critically ill patients, particularly those with conditions requiring intensive drug therapy? Should hospitals perform a risk assessment based on the populations it serves to determine how pharmacy staffing should be allocated? Until now, management consultants have, under the pressures of cost containment or staffing reduction, focused on the “efficiency” of pharmacy operations rather than the “effectiveness” of pharmacy staffing. Typically, these consultants have treated all inpatients as requiring the same level and type of pharmacist intervention. The increasing acuity of hospitalized patients receiving complex medication regimens, the national focus on medication safety, the increasing number of drug safety warnings issued by the Food and Drug Administration, and the number of national quality measures that include medications strongly support the need to examine pharmacist staffing levels. Of note, the National Quality Forum recently endorsed 18 measures related to medication safety and quality.1 In addition, the Society of Critical Care Medicine has recognized the pharmacist as a key member of the intensive care unit team,2 and the American Academy of Pediatrics policy statement on prevention of medication errors in inpatients specifies the need for adequate pharmacy staffing.3 The Joint Commission has stated that “data continue to point to effective staffing as a critical component in the provision of safe, high quality care.” As a result, the Joint Commission is currently revising its staffing effectiveness standard, which includes using indicators to determine staffing adequacy in the evaluation of events related to safety or quality. Numerous publications, many not specifically related to pharmacy, attest to the need for a pharmacist presence on the patient care team.