Hospital Pharmacy Directors Research Articles

Validating a Hospital Medicines Formulary Survey in the Western Pacific Region—A global hospital pharmacy initiative based on the Basel Statements

BackgroundIn 2008, the Basel Statements were developed to reflect the future of hospital pharmacy worldwide. Included were a key set of statements regarding the expanding role of hospital pharmacists' influence on prescribing from the management of medicines formularies to being an active member of the therapeutic decision-making process. ObjectivesThis study aimed to validate a survey to measure Basel Statement 26 regarding the role of medicines formularies and the factors that affect its use in the Western Pacific Region (WPR). MethodsThe survey was developed in consultation with a WPR advisory group and current literature. The survey was translated using the forward-backward method into Chinese (simplified) and Vietnamese. The instrument was pilot tested in a stratified random sample of 260 hospital pharmacy directors in the WPR. Principal components analysis (PCA) was applied to the data to assess construct validity of the Medicines Formulary Scale that assessed responders’ perceptions of their formulary and impact on utilization. ResultsThe Medicines Formulary Survey was completed by 107 hospital pharmacy directors or equivalent. The survey contained the Medicines Formulary Scale in addition to questions regarding the content and review process of the hospital’s formulary as well as demographic questions. Application of the PCA procedures resulted in a parsimonious 2-factor solution in which 33.8% of the variance was explained. The Cronbach alpha for the 17-item scale was found to be 0.70. The Cronbach alpha values for the first and second factor/subscales were 0.76 and 0.68, respectively. ConclusionThe Medicines Formulary Survey appears reliable and valid for assessing hospital pharmacy directors’ perceptions of hospital medicine formularies in the WPR. Further development of validated instruments to assess other areas of hospital pharmacy practice will help track the progression of hospital pharmacy and aid in globalization of the profession.

A changing professional profile: ethnicity and gender issues in pharmacy employment in the United Kingdom

AbstractObjectiveThis research was conducted to determine whether there were significant differences between the career profiles and ambitions of United Kingdom pharmacists from different ethnic and gender sub-populations. The results were subsequently analysed to determine whether any differences found between sub-populations had varied over time.MethodThe research methodology employed a postal survey and interviews, to measure parameters relating to pharmacists' current careers, career histories and career ambitions. Questionnaires were distributed to 500 ethnic minority pharmacists and 500 non-ethnic minority pharmacists; there were 1,867 valid returns. Twenty-seven ethnic minority community pharmacists working in one inner city area were interviewed.SettingThe sample for the postal survey was identified from a surname analysis of the Register of Pharmaceutical Chemists.Key findingsEthnic minority (mainly Asian) pharmacists accounted for 15 per cent of UK pharmacists. Of pharmacists aged under 30 years, 72 per cent of white pharmacists and 50 per cent of ethnic minority pharmacists were female. Both male and female community pharmacists from ethnic minorities favoured ownership roles relative to white pharmacists in all measured age groups. Management roles were favoured by both white male and female pharmacists, while locum roles were more frequently undertaken by white female pharmacists. Family ties were found to have a relatively strong influence on the careers of ethnic minority pharmacists.ConclusionWe speculate that family involvement may have enhanced the availability of both human and financial capital for business start-up, but find indications that this influence may not persist over time. In hospital pharmacy, there were indications of underachievement and career anxiety among pharmacists from ethnic minorities, the proportion of hospital pharmacy managers from ethnic minorities being disproportionately low. Attention is drawn to some policy implications, notably for training, flexible working patterns and the need for demographic scenario planning in the profession.

Functions performed by paid pharmacy interns in hospitals in New York

The types of clinical and nonclinical activities performed by paid pharmacy interns in the hospitals in New York state were studied. In November 2008, a list of hospitals in New York was obtained from the website of the New York State Department of Health. A survey was sent to each hospital's pharmacy director requesting information on hospital characteristics and whether the pharmacy department employed nongraduate pharmacy interns. For those hospitals that employed pharmacy interns, questions were asked about the number of nongraduate pharmacy interns employed, the shifts worked by interns, whether there was a minimum work-hour requirement for interns, the functions routinely performed by interns, and the percentage of interns who remained employed at the hospital upon licensure. Of the 184 surveys distributed, 96 responses (52.2%) were received. The majority of hospitals had 400 beds or fewer and were teaching institutions, and 45 employed pharmacy interns. The five functions reported most frequently were answering telephone calls (91%), preparing and distributing medications (82%), compounding nonparenteral medications (69%), compounding parenteral medications (62%), and responding to drug information queries (51%). The mean ± S.D. number of clinical activities performed by interns was 2.1 ± 2.1. The most frequently reported clinical activities were responding to drug information queries (51.1%), performing clinical interventions (33.3%), and completing adverse-drug-reaction reports (31.1%). Hospital pharmacy departments in New York utilized paid pharmacy interns to perform a variety of functions, including clinical activities. While there appears to be recognition that interns can perform clinical activities, the mean number of such activities was relatively low.

The Voice of Canada’s Front-line Pharmacists: CSHP Survey of Non-management Pharmacists

For any profession, competent, committed leadership represents the difference between progress and extinction. Hospital pharmacy is no different. An editorial and a CSHP position statement on nonpharmacists in pharmacy leadership positions focused attention on a professional background in pharmacy as a prerequisite for senior managers in hospital pharmacy. However, being a pharmacist is far from the only necessary qualification. With an analysis based on the supplemental standard and learning objectives for residency training in pharmacy practice management of the American Society of Health-System Pharmacists, a pair of related articles considered the relative importance and self-evaluated skill level of current pharmacy managers. In addition, a survey of hospital pharmacy managers in Canada evaluated the contribution of various training programs in preparing hospital pharmacy managers for this role and provided demographic insight into the nature of hospital pharmacy management positions and their incumbents in Canada. Together, these studies created a useful framework for the identification and preparation of excellent hospital pharmacy managers, but there appears to be a shortage of one key ingredient: a pool of hospital pharmacist candidates interested in pursuing these management positions. The survey of Canadian hospital pharmacy managers identified the positive aspects of their role, in the hopes that this knowledge would help in promoting these positions. This information has been used extensively in the subsequent preparation of action plans, education sessions, and promotional material. However, the survey analysis was barely complete when an intrinsic bias in the survey itself was identified: only pharmacists in management positions had been included. Another limitation of the survey was the potential difference in the values held by those in management positions and the pharmacists most likely to replace them. A crude analysis comparing the demographic characteristics of hospital phar macy managers and staff pharmacists confirmed differences in the age and gender mix of these groups, but more specific information about the pharmacists who will be managers in the future is essential to developing an effective plan. The CSHP Hospital Pharmacy Management Task Force recognized this gap in understanding and recommended another survey, focusing on non-managers, to determine their demographic characteristics, interests, perceptions, and concerns about taking on formal management positions. This article describes the survey that we undertook in response to the task force recommendation and the interpretation of its results. The ultimate goal is to ensure that effective hospital pharmacy management continues into the future.

Availability and use of essential medicines in China: manufacturing, supply, and prescribing in Shandong and Gansu provinces

BackgroundThe current health care reform in China launched in 2009 tackles the problem of access to appropriate medicines for its 1.3 billion people by focusing on providing essential medicines to all. To provide evidence for the reform process, we investigated the manufacturing, purchasing, and prescribing of essential medicines in two provinces.MethodsWe conducted surveys in 2007 of all manufacturers (n = 253) and of 59 purposively selected retail and 63 hospital pharmacies in Shandong and Gansu provinces to assess production and supply of products on the 2004 National Essential Medicines List (NEML), as well as factors underlying decision making about production and supply. We also reviewed prescriptions (n = 5456) in health facilities to calculate standard indicators of appropriate medicines use.ResultsOverall, manufacturers in Shandong and Gansu produced only 62% and 50%, respectively, of the essential medicines they were licensed to produce. Of a randomly selected 10% of NEML products, retail pharmacies stocked up to 60% of Western products. Median availability in hospital pharmacies ranged from 19% to 69%. Manufacturer and retail pharmacy managers based decisions on medicines production and stocking on economic considerations, while hospital pharmacy managers cited clinical need. Between 64% and 86% of prescriptions contained an essential medicine. However, overprescribing of antibiotics (34%-77% of prescriptions) and injectables (22%-61%) for adult non-infectious outpatient consultations was common.ConclusionsWe found that manufacturers, retail pharmacies, and hospital pharmacies paid limited attention to China's 2004 NEML in their decisions to manufacture, purchase, and stock essential medicines. We also found that prescribing of essential medicines was frequently inappropriate. These results should inform strategies to improve affordable access to essential medicines under the current health care reform.

Variable Infusion Rates Associated with TKO/KVO Abbreviations: A Survey of Illinois Hospital Pharmacists

Purpose To identify variability of infusion rates associated with TKO (to keep open) and KVO (keep vein open) orders in Illinois hospitals. Method An Internet survey of Illinois hospital pharmacists was conducted. Existence and identification of standardized rates for TKO/KVO were obtained. Chi-square analysis (significance P = 0.05) of frequency of responses to responders and rates was used. Results Sixty-nine (30%) of 230 hospital pharmacy directors responded. The majority of responders (78%) indicated that their institutions defined a standard rate. Rate ranges of 0 to 10, 20 to 29, 30 to 39, and 40 to 50 mL/h were identified as specified TKO infusion rates. A statistically significant difference between frequency of range rates was found ( P = 0.05). Six of “no” responders indicated TKO/KVO was an approved abbreviation and required a rate be given for each order. Total responses indicate 87% (60/69) have a standard rate or require a rate be specified. Conclusion The majority (87%) of responders indicate a standardized rate for TKO/KVO or require that a rate be indicated for each order. Variability in meaning exists for TKO/KVO infusion rates as fluid requirements differ with clinical status and age. Clarification of flow rates provides consistent interpretation. Each institution should have an approved rate for TKO. A policy requiring a rate for each order should be investigated.

Survey of Hospital Pharmacy Directors: Assessment of the Current State of Unit-Dose Acquisition

Background: Many hospitals are in the planning stage of barcode point-of-care (BPOC) implementation. One of the challenges that hospital pharmacies face in BPOC implementation is unit-dose acquisition. Objective: This article presents the results of a survey of hospital pharmacy directors to assess the current state of unit-dose acquisition to support bedside barcode-enabled dispensing practices. Methods: An online survey was administered over 2 months and was available from September to November 2008. The University of Arkansas Institutional Review Board approved the survey before it was disseminated. The survey was developed in collaboration with 2 hospital pharmacy directors. Ninety-one valid survey responses were representative in terms of the distribution of hospital size compared with previous surveys of the American Society of Health-System Pharmacists. Though there were 91 total respondents, not all provided responses to all of the survey questions. Thus, some of the figures, tables, and text refer to fewer than 91 respondents. Results: The results of interest to pharmacy technicians indicated that most hospitals today are able to purchase at least 40% of their medications in unit-dose packaging directly from the manufacturer. For medications that cannot be acquired in unit-dose packaging, 85% of the hospitals surveyed perform repackaging operations in-house. However, 87% of the hospitals that use a high-speed oral solid repackager only use this equipment, at most, 4 hours per day. Our survey results showed that only 8% of the hospitals surveyed used a third-party repackager to acquire unit-dose medications, compared with 85% of hospitals that are either currently using or in the planning phase of using BPOC. Conclusions: The survey found that most hospital pharmacy directors choose to repackage medications in-house, despite the high cost of repackaging equipment and a relatively low utilization of that equipment. Hospitals indicated that cost and turnaround time were the 2 issues of greatest concern when considering outsourcing unit-dose medication repackaging to a third-party repackager.

Does the Standardization Process Matter? A Study of Cost Effectiveness in Hospital Drug Formularies

While research on the cost effectiveness of standardization to date has focused on the impact of different degrees of standardization, it has paid insufficient attention to the process an organization uses to formulate and implement standardized procedures. Drawing on the organizational decision-making literature and procedural fairness literature, this study identifies a number of key process features in standardization and argues that variations in these process features across organizations help account for the varying success of standardization in achieving cost effectiveness. Using hospital drug standardization for coronary artery and pneumonia cases to ground much of the argument, I analyzed inpatient discharge data from Florida, Illinois, New York, and Texas, combined with an original survey of 243 hospital pharmacy directors. The results indicated that an increasing degree of standardization was associated with cost effectiveness when the level of formal objectivity in creating the standardized procedure was high and when there was due process in resolving disputes about the standardized procedure. This finding broadly supports the argument that the cost effectiveness of standardization depends not just on the degree of standardization but also on the process by which the standardized procedures are created and implemented.

A Focus on Leadership: CSHP’s 2007 National Leadership Survey

Today’s hospital pharmacists face a choice among numerous career paths, of which pharmacy management is only one. Effective leadership of an institution’s pharmacy department has been identified as crucial to staff development and the maintenance of high patient-care standards.1 However, there are many barriers to attracting interested and qualified candidates to this realm of management. As with many professional curricula, undergraduate pharmacy programs focus on the development of clinical competency, with only minimal exposure to management-specific tasks. Although hospital pharmacy residency programs include an administration rotation, these tend to be shorter than the clinical rotations, which further downplays management as a potential career option. Once clinicians enter the field of hospital pharmacy, they are faced with a health care environment that has undergone a flattening of organizational structure and elimination of many entry-level management positions. Consequently, it is challenging for front-line clinicians to obtain meaningful exposure to leadership tasks that allow for development of the necessary skills, networking base, and confidence to pursue a management career path. The results of these barriers to the preparation and support of individuals interested in pursuing hospital pharmacy management are becoming obvious. Organizations are having great difficulty in attracting and retaining pharmacists in practice management and leadership roles. In some cases, this has led to the appointment of nonpharmacists to these leadership positions. As well, surveys of hospital pharmacy managers in both the United States2 and Canada3 have shown gaps in self-perceived competency in managerial skills. The environment within hospital pharmacy reflects the bigger picture within health care, where there are similar concerns. A study of management competencies conducted in collaboration with the Canadian College of Health Service Executives revealed a self-identified skill deficit among Canadian health care managers.4 Finally, both hospital pharmacy departments and departments outside pharmacy are identifying concerns about the number of current leaders nearing retirement age and the limited number successors in sight. A first step to correcting the current deficit in candidates interested in pursuing a career in hospital pharmacy management is to identify positive factors that would support such an interest. We developed a survey to solicit the insights and perspectives of current hospital pharmacy leaders in the hope of gaining an understanding of the career paths, education and training, external influences, and motivating factors that led these leaders to accept their current management positions.

Creating a joint full-time pharmacist position between a community pharmacy and a family health team

Project Objective:To use a coordinated hiring process for a joint pharmacist position affiliated with a hospital-owned community pharmacy and a new Ontario Family Health Team (FHT).Target Groups:Hospital, community pharmacy, and FHT managers could use this approach to recruit and hire pharmacists who prefer full-time employment versus part-time positions.Activities:A hospital-owned community pharmacy and an FHT each had part-time pharmacist positions available. Both organizations felt that filling the positions would be difficult, based on previous recruitment attempts. The hospital pharmacy director approached the FHT manager to advertise the positions separately, with potential for a full-time position for a suitable candidate. No pharmacists applied for the part-time positions, but 3 applied for the joint position and a pharmacist with experience in community and hospital pharmacy practice was hired. A contract was signed by all 3 parties describing the working conditions. The hospital contracts out 50...

2006 National Clinical Pharmacy Services Survey: Clinical Pharmacy Services, Collaborative Drug Management, Medication Errors, and Pharmacy Technology

To determine the extent of 15 hospital-based clinical pharmacy services, 51 different drugs managed under protocol by pharmacists, medication errors, and pharmacy technology in United States hospitals. A survey was mailed, as well as sent electronically, to pharmacists in 2893 hospitals. A total of 1125 surveys were returned (38.9% response rate). The 1125 hospitals had 14,315,506 patients admitted, which represented 45.7% of the 31,324,496 admissions to all U.S. hospitals in 2006. The proportion of clinical pharmacy services provided by Veterans Affairs (VA) hospitals was higher compared with non-VA hospitals. In all hospitals, the clinical pharmacy services with the greatest growth from 1989-2006 were pharmacist-provided admission drug histories (300% increase), pharmacist participation on medical rounds (292.3% increase), drug protocol management (208% increase), pharmacist-conducted clinical research (166.7% increase), pharmacist-provided drug information (150% increase), and pharmacist-provided pharmacokinetic consultation (117.5% increase). A total of 864 hospitals (76.8%) had pharmacists providing drug protocol management (collaborative drug management). Pharmacists managed a mean +/- SD of 9.18 +/- 10.23 different drugs/hospital (7932 protocols). Drugs commonly managed included aminoglycosides (64.4% of hospitals), vancomycin (63.8%), warfarin (37.8%), low-molecular-weight heparins (32.7%), unfractionated heparin (30.0%), fluoroquinolones (30.0%), antiparkinsonian drugs (22.8%), proton pump inhibitors (22.7%), human immunodeficiency virus drugs (21.9%), and cephalosporins (19.7%). The mean number of medication errors reported/hospital increased by 151.4% between 1995 and 2006. The percentage of patients who experienced a medication error increased from 4.7% to 6.5% between 1995 and 2006 (a 38.3% increase). A total of 220 hospitals (19.6%) had computerized prescriber order entry systems, 263 (23.4%) had bar coding for drug administration, and 439 (39.0%) used robotics for dispensing. This study provides continuing evidence of the growth and value of clinical pharmacy services and clinical pharmacists in our nation's hospitals. These data will guide hospital pharmacy directors and clinical coordinators in allocating resources to optimally meet their patients' needs.

Director's Forum - Developing Patient-Centered Pharmacy Services through Residency Training

Hospital pharmacy directors are faced with the challenge of implementing patient-centered services, which often requirers changing the pharmacists' role in patient care. An approach to develop pharmacists focused on patient care is to support post-graduate training programs that provide the pharmacists with specific patient-care skills. This month's Director's Forum presents a brief overview of pharmacy residency training as well as practical tips for directors interested in developing a residency program.

The contemplative manager

The John W. Webb Lecture Award presentations, published first in 1986 in AJHP , have filled an important void in our literature. With the theme of “Achieving Excellence in Pharmacy Management,” the Webb lectures are a set of personal reflections written by leading hospital pharmacy managers.

Critical Assessment of Statewide Hospital Pharmaceutical Surge Capabilities for Chemical, Biological, Radiological, Nuclear, and Explosive Incidents

In recent years, government and hospital disaster planners have recognized the increasing importance of pharmaceutical preparedness for chemical, biological, radiological, nuclear, and explosive (CBRNE) events, as well as other public health emergencies. The development of pharmaceutical surge capacity for immediate use before support from the (US) Strategic National Stockpile (SNS) becomes available is integral to strengthening the preparedness of local healthcare networks. The Pharmaceutical Response Project served as an independent, multidisciplinary collaboration to assess statewide hospital pharmaceutical response capabilities. Surveys of hospital pharmacy directors were conducted to determine pharmaceutical response preparedness to CBRNE threats. All 45 acute care hospitals in Maryland were surveyed, and responses were collected from 80% (36/45). Ninety-two percent (33/36) of hospitals had assessed pharmaceutical inventory with respect to biological agents, 92% (33/36) for chemical agents, and 67% (24/36) for radiological agents. However, only 64% (23/36) of hospitals reported an additional dedicated reserve supply for biological events, 67% (24/36) for chemical events, and 50% (18/36) for radiological events. More than 60% of the hospitals expected to receive assistance from the SNS within < or = 48 hours. From a pharmaceutical perspective, hospitals generally remain under-prepared for CBRNE threats and many expect SNS support before it realistically would be available. Collectively, limited antibiotics and other supplies are available to offer prophylaxis or treatment, suggesting that hospitals may have insufficient pharmaceutical surge supplies for a large-scale event. Although most state hospitals are improving pharmaceutical surge capabilities, further efforts are needed.

Reporting the Real Value of a Hospital Pharmacy Service

ABSTRACTBackgroundHospital pharmacy managers have to account for the expenditure of millions of dollars of public funds for drugs provided in healthcare delivery. There appeared to be variation in the method of reporting drug expenditure data in Australian hospitals.AimTo investigate the reporting practices used by hospital pharmacy departments to account for their drug expenditure.MethodPharmacy managers of Australia's major metropolitan and rural hospitals were surveyed for their financial reporting practices. These baseline data were then compared to the financial reporting methods used by UK hospital pharmacy managers (a comparable public health provider). Hospital administrators were also interviewed to determine their ideal drug expenditure report.ResultsThe baseline survey consisted of 93 responses and demonstrated that varying types of financial reporting are used with a primary focus on gross expenditure and high‐cost drug use with variable definition. Few drug expenditure reports considered cost per patient treated. Other pharmacy services delivered adjacent to this expenditure were separately reported.ConclusionSignificant variation was identified in reporting hospital drug expenditure data. The disparate models of financial reporting in Australia are in contrast with the unified UK model. A reporting template is proposed that will provide a means of identifying key variation in expenditure alongside service delivery.

Hospital Pharmacy Management— What a Career!

Hospital Pharmacy Management— What a Career!

Survey of pharmacist collaborative drug therapy management in hospitals

The extent and scope of collaborative drug therapy management (CDTM) in U.S. hospitals and pharmacy directors' perceptions regarding CDTM were studied. A survey was developed after reviewing the literature on CDTM. The sample for the study was obtained from the 2001 American Hospital Association Guide. The mail survey was pretested in January 2002 with 30 hospital pharmacy directors in Illinois, Indiana, and Michigan. A national random sample of 1000 hospital pharmacy directors stratified by state were mailed surveys in March 2003. Two follow-up surveys were mailed at approximately four-week intervals. Responses were received from 327 hospitals, a 32.7% response rate. A total of 158 respondents (49.7%) indicated that some pharmacists in their hospital were engaged in CDTM. Most hospitals with CDTM authorized pharmacists to adjust a drug's strength (86.7%), order laboratory or related tests (84.2%), and change a drug's frequency of administration (81.6%). The CDTM-related activities pharmacists performed varied with disease and treatment area. Payment or reimbursement for some CDTM was received by 12.7% of hospitals with CDTM. Respondents from hospitals with CDTM perceived significantly greater support for CDTM and greater strategic impact of CDTM than those from hospitals without CDTM. Respondents perceived positive support for CDTM but believed that CDTM had little or no financial impact on pharmacy departments. Approximately 50% of respondent hospitals had some pharmacists engaged in CDTM. Although CDTM was perceived as not having a positive financial impact on pharmacy departments, it was perceived as having a positive strategic impact by improving the views of upper administration regarding the value of pharmacists and facilitating implementation of other pharmacy services.

Madison hospitals say no to food, gifts, trinkets

As the gift-giving season approaches, drug company representatives will not be bringing anything to hospitals and clinics in Madison, Wisconsin. No food, no gifts, no trinkets—just as it has been day in and day out since about 2001. That is when the pharmacy directors in this college town adopted a citywide policy to tame the behavior of drug company representatives. Also, thanks to that strict policy, drug samples and surprise visits from drug company representatives are a thing of the past—for the most part. The push to have all the health care organizations in Madison agree on a single policy started when pharmacy leaders at managed care organizations joined the every-other-month meeting of the hospital pharmacy directors, said Russell J. Jensen, pharmacy director at Saint Mary’s Hospital Medical Center and the Dean Clinic. As a group, the directors saw the opportunity to deal consistently with company representatives who visited Madison facilities.

Human Resources Management for the Pharmacy Director

This article of the Director's Forum provides hospital pharmacy directors with an introduction to the essential human resources skills of behavioral interviewing and performance management. While patients are a pharmacy department's most valued asset, the staff that care for those patients are critical to a patient-centered pharmacy service. Hospital pharmacy directors must practice effective human resource management to effectively recruit and retain a highly qualified and professionally satisfied staff.

Adoption of Technology to Improve Medication Safety

Objective: To explore perspectives about issues surrounding organizational decisions to adopt and implement medication safety technologies. Methods: Three focus groups and 5 telephone interviews with US hospital pharmacy directors were conducted, representing 25 hospitals. A written survey provided supplemental information about adoption of the technologies. We used one component of Rogers’ diffusion of innovation model to guide our study. Results: Pharmacy directors reported different adoption rates for medication safety technologies, with 100% adoption of automated dispensing systems, 36% of electronic medication administration records, 27% of bar code medication administration technology, and 18% of computerized prescriber order entry systems. We explored 6 major themes within our study, with 4 themes suggested by Rogers’ model: (1) agenda-setting, (2) matching, (3) redefining, and (4) clarifying. These themes were characterized from discussions on issues such as the importance of patient safety as a motivator for technology adoption; prioritizing implementation of medication safety technologies; choosing a vendor for safety innovations; the need for technology customization; and the need to clarify an innovation’s role in addressing patient safety at an institution. Two emergent themes included (5) participants’ roles in the innovation process and (6) perspectives about future adoption of medication safety technologies. Conclusion: Understanding the applicability of Rogers’ innovation process model can help institutions interested in promoting the adoption of medication safety technologies. Recognizing the variability of different stakeholders’ perspectives and appreciating the insight of pharmacy directors may be important for organizations hoping to expand the use of information technology to improve patient safety.