Hospital Pharmacy Practice Research Articles

Déterminants de l’évolution de la pharmacie hospitalière en France et au Québec : perception de pharmaciens hospitaliers

Hospital pharmacy practice has evolved differently between France and Quebec. While this development is part of broader systems, French and Quebec hospitals have undergone significant changes over the years to cope with challenges, among others, the economic and demographic realities. The main objective is to evaluate and compare the perception of French and Quebec hospital pharmacists about the factors that have contributed to the evolution of pharmacy practice in their respective context. This is a descriptive cross-sectional study. The study focuses on a sample of experienced hospital pharmacists in France and Quebec. We targeted a convenience sample of 50 respondents per country. An online questionnaire with 15 pharmaceutical activities to which are connected nine factors that may have influenced the implementation of each of these activities in each country was used. The mean score was calculated for each of the nine factors for each activity. The perception of French and Quebec hospital pharmacists was then compared. A P value less than 0.05 was considered statistically significant. Two hundred and sixty hospital pharmacists were directly contacted in France and 79 in Quebec. Seventy-eight French pharmacists and 77 Quebec pharmacists responded to the survey, that is a respective response rate of 30% and 97%, respectively. The hierarchy of factors that contributed to the evolution of pharmacy practice was similar between the two countries, legislative and regulatory factors as well as the concern for risk management and quality dominate; scientific human, economic factors and training have a relatively similar position. For cons, the news factor (6th in France against the 10th position in Quebec) and the academic factor (10th position in France against the 6th position in Quebec) obtained inverse scores between France and Quebec. There are few data on the determinants of the evolution of hospital pharmacy in France and Quebec. The hierarchy of factors that contributed to the evolution of pharmacy practice is similar between the two countries, although differences of rank were found for the news and academic factors. Further studies are needed to better understand the factors that influence the evolution of pharmacy practice in health care institutions.

A Summit to set out the future of hospital pharmacy in Europe

Dr Roberto Frontini, President of the European Association of Hospital Pharmacists, explains the concepts behind the European Summit on Hospital Pharmacy, and why its outcomes should positively impact practice in...

OHP-038 The midline results of the hospital pharmacy survey in Moscow (Russia)

BackgroundOver the past 20 years in Russia functions of hospital pharmacies (HP) have significantly narrowed to only supplying drugs because of compounding departments closing and the lack of clinical training...

An innovative approach to enhancing continuing education activities for practising pharmacists using clicker technology.

The objective of this study was to evaluate the use of an audience response system (i.e. clickers) as an engaging tool for learning and examine its potential for enhancing continuing education (CE) activities. Attendees at a symposium were invited to utilise and evaluate the use of clickers. Electronic data relating to participant demographics and feedback were collected using clickers during the symposium. The 60 attendees who used the clickers were mostly pharmacists (76%) who worked in hospital pharmacy practice (86%). Attendees strongly agreed or agreed that clickers were easy to use (94%), enhanced interaction (98%), allowed comparison of knowledge with that of their peers (78%), brought to attention their knowledge deficits (64%) and should be used again (94%). The innovative use of clickers at the symposium was very well received by all attendees and offered a number of benefits, including the ability to provide a more engaging and interactive CE activity.

Fifty Years of Advancement in American Hospital Pharmacy

The 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][1] The Mirror served as a final report of the Audit of

Improving pharmacy practice through public health programs: experience from Global HIV/AIDS initiative Nigeria project

BackgroundThe use of medicines is an essential component of many public health programs (PHPs). Medicines are important not only for their capacity to treat and prevent diseases. The public confidence in healthcare system is inevitably linked to their confidence in the availability of safe and effective medicines and the measures for ensuring their rational use. However, pharmacy services component receives little or no attention in most public health programs in developing countries. This article describes the strategies, lessons learnt, and some accomplishments of Howard University Pharmacists and Continuing Education (HU-PACE) Centre towards improving hospital pharmacy practice through PHP in Nigeria.MethodIn a cross-sectional survey, 60 hospital pharmacies were randomly selected from 184 GHAIN-supported health facilities. The assessment was conducted at baseline and repeated after at least 12 months post-intervention using a study-specific instrument. Interventions included engagement of stakeholders; provision of standards for infrastructural upgrade; development of curricula and modules for training of pharmacy personnel; provision of job aids and tools amongst others. A follow-up hands-on skill enhancement based on identified gaps was conducted. Chi-square was used for inferential statistics. All reported p-values were 2-tailed at 95% confidence interval.ResultsThe mean duration of service provision at post-intervention assessment was 24.39 (95% CI, 21.70–27.08) months. About 16.7% of pharmacies reported been trained in HIV care at pre-intervention compared to 83.3% at post-intervention. The proportion of pharmacies with audio-visual privacy for patient counseling increased significantly from 30.9% at pre-intervention to 81.4% at post-intervention. Filled prescriptions were cross-checked by pharmacist (61.9%) and pharmacy technician (23.8%) before dispensing at pre-intervention compared to pharmacist (93.1%) and pharmacy technician (6.9%) at post intervention. 40.0% of pharmacies reported tracking consumption of drugs at pre-intervention compared to 98.3% at post-intervention; while 81.7% of pharmacies reported performing periodic stock reconciliation at pre-intervention compared to 100.0% at post-intervention. 36.5% of pharmacies were observed providing individual counseling on medication use to patients at pre-intervention compared to 73.2% at post-intervention; and 11.7% of pharmacies had evidence of monitoring and reporting of suspected adverse drug reaction at pre-intervention compared to 73.3% at post-intervention. The institution of access to patients’ clinical information by pharmacists in all pharmacies at post-intervention was a paradigm shift.ConclusionThrough public health program, HU-PACE created an enabling environment and improved capacity of pharmacy personnel for quality HIV/AIDS and TB services. This has contributed in diverse ways to better monitoring of patients on pharmacotherapy by pharmacists through access of pharmacists to patients’ clinical information.

World’s pharmacists gather in Dublin

This year’s World Congress of Pharmacy and Pharmaceutical Sciences, organized by the International Pharmaceutical Federation (FIP), attracted more than 3000 participants from 107 countries. The congress featured business meetings, educational programs, poster sessions, and other activities from August 31 through September 5 in the heart of Ireland’s largest city, Dublin. FIP’s Hospital Pharmacy Section has added a research component to ongoing work with the Basel Statements, the 75 consensus statements on the future of hospital pharmacy practice, said Marianne F. Ivey, the section’s vice president representing the Americas. Ivey, a professor of pharmacy practice at the University of Cincinnati, said initial research has focused on drug formularies in hospitals. Research activities are being driven by Rebekah Moles, the section’s assistant secretary, Ivey said. Moles established the World Hospital Pharmacy Research Consortium at the University of Sydney in Australia, where she is a senior lecturer.

Conflict management styles in academic and hospital pharmacy practice areas in affiliated tertiary institutions in Lagos, Nigeria

Background/Objective: Types of conflicts in pharmacy organizations were discussed and conflict management styles by pharmacists in academia and hospital pharmacists in two affiliate tertiary institutions in Lagos, Nigeria were assessed. Methods: An adapted questionnaire of 20-item inventory for conflict management scale (CMS) for pharmacy was used to obtain responses from hospital pharmacists and pharmacists in academia in the practice areas. The multistage inventory item comprising questions that used four graded scales and appropriate alphabets A to D against each column was used in line with the described explanatory model. Scales of A, B, C, and D represent: imposing, settling, avoiding and thwarting respectively. Some items were rephrased and content-validated for clarity to respondents, while the last item (number 20) was introduced to reflect a pertinent issue in conflict management. The instrument was administered in voluntary situation over a period of two weeks; the results were collated and analyzed. Results: Thirty-one full-time pharmacist lecturers (14 males, 17 females) and 29 registered hospital pharmacists (6 males, 23 females) in the respective institutions completed the questionnaires. The summed scores of dominant and secondary conflict management styles for the two respective groups show that pharmacists in the two practice areas have different approaches to conflict management in workplace. A substantial number of respondents in both settings are either dominantly settling or avoiding in their style. Conclusion: Training in conflict management and reflective practice is highly recommended for pharmacists, to attain the skills that enhance their interpersonal environment, aimed at making pharmacy practice a very fulfilling and rewarding profession.

Conflict management styles in academic and hospital pharmacy practice areas in affiliated tertiary institutions in Lagos, Nigeria

Background/Objective: Types of conflicts in pharmacy organizations were discussed and conflict management styles by pharmacists in academia and hospital pharmacists in two affiliate tertiary institutions in Lagos, Nigeria were assessed. Methods: An adapted questionnaire of 20-item inventory for conflict management scale (CMS) for pharmacy was used to obtain responses from hospital pharmacists and pharmacists in academia in the practice areas. The multistage inventory item comprising questions that used four graded scales and appropriate alphabets A to D against each column was used in line with the described explanatory model. Scales of A, B, C, and D represent: imposing, settling, avoiding and thwarting respectively. Some items were rephrased and content-validated for clarity to respondents, while the last item (number 20) was introduced to reflect a pertinent issue in conflict management. The instrument was administered in voluntary situation over a period of two weeks; the results were collated and analyzed. Results: Thirty-one full-time pharmacist lecturers (14 males, 17 females) and 29 registered hospital pharmacists (6 males, 23 females) in the respective institutions completed the questionnaires. The summed scores of dominant and secondary conflict management styles for the two respective groups show that pharmacists in the two practice areas have different approaches to conflict management in workplace. A substantial number of respondents in both settings are either dominantly settling or avoiding in their style. Conclusion: Training in conflict management and reflective practice is highly recommended for pharmacists, to attain the skills that enhance their interpersonal environment, aimed at making pharmacy practice a very fulfilling and rewarding profession.

Pharmacy practice in small and rural hospitals in Illinois—2011

The results of a 2011 survey evaluating pharmacy services at small and rural Illinois hospitals are presented and compared with data from similar surveys in 2001 and 1991. A questionnaire modeled on the previous survey instruments but updated to reflect contemporary pharmacy practice was mailed to pharmacy directors at 86 small hospitals (i.e., <150 staffed beds) and rural hospitals (i.e., located outside metropolitan areas). The response rate was 46.5%. The survey data indicated that 57.5% of hospitals represented in the 2011 survey had a centralized drug distribution system, 35.0% had a hybrid system, and 7.5% had a decentralized system. The most commonly reported form of technology was automated dispensing cabinets, which were in use at 75.0% of hospitals in 2011, compared with 34.8% of hospitals represented in the 2001 survey. Barcode verification of medication doses before dispensing and at the time of administration was performed at 50% and 70% of hospitals, respectively. While the provision of clinical pharmacy services has risen sharply since 1991, substantial changes were not observed between 2001 and 2011 except in the provision of compliance and drug histories (67.6% of hospitals in 2011 versus 46.8% in 2001) and pharmacist participation in medical emergency responses (54.0% versus 34.0%). A 2011 survey of pharmacy departments in small and rural Illinois hospitals provided information on the use of automation and health information technologies and showed changes in the provision of many clinical pharmacy services since 1991.

Evaluation of rule effectiveness and positive predictive value of clinical rules in a Dutch clinical decision support system in daily hospital pharmacy practice

Our advanced clinical decision support (CDS) system, entitled 'adverse drug event alerting system' (ADEAS), is in daily use in our hospital pharmacy. It is used by hospital pharmacists to select patients at risk of possible adverse drug events (ADEs). The system retrieves data from several information systems, and uses clinical rules to select the patients at risk of ADEs. The clinical rules are all medication related and are formulated using seven risk categories. This studies objectives are to 1) evaluate the use of the CDS system ADEAS in daily hospital pharmacy practice, and 2) assess the rule effectiveness and positive predictive value (PPV) of the clinical rules incorporated in the system. Leiden University Medical Center, The Netherlands. All patients admitted on six different internal medicine and cardiology wards were included. Outcome measures were total number of alerts, number of patients with alerts and the outcome of these alerts: whether the hospital pharmacist gave advice to prevent a possible ADE or not. Both overall rule effectiveness and PPV and rule effectiveness and PPV per clinical rule risk category were scored. During a 5 month study period safety alerts were generated daily by means of ADEAS. All alerts were evaluated by a hospital pharmacist and if necessary, healthcare professionals were subsequently contacted and advice was given in order to prevent possible ADEs. During the study period ADEAS generated 2650 safety alerts in 931 patients. In 270 alerts (10%) the hospital pharmacist contacted the physician or nurse and in 204 (76%) cases this led to an advice to prevent a possible ADE. The remaining 2380 alerts (90%) were scored as non-relevant. Most alerts were generated with clinical rules linking pharmacy and laboratory data (1685 alerts). The overall rule effectiveness was 0.10 and the overall PPV was 0.08. Combination of rule effectiveness and PPV was highest for clinical rules based upon the risk category "basic computerized physician order entry (CPOE) medication safety alerts fine-tuned to high risk patients" (rule efficiency=0.17; PPV=0.14). ADEAS can effectively be used in daily hospital pharmacy practice to select patients at risk of potential ADEs, but to increase the benefits for routine patient care and to increase efficiency, both rule effectiveness and PPV for the clinical rules should be improved. Furthermore, clinical rules would have to be refined and restricted to those categories that are potentially most promising for clinical relevance, i.e. "clinical rules with a combination of pharmacy and laboratory data" and "clinical rules based upon the basic CPOE medication safety alerts fine-tuned to high risk patients".

Implementing hospital pharmacy practice changes

Accountability, bedside discharge counseling, and the Pharmacy Practice Model Initiative (PPMI) were just a few topics spotlighted at the 2012 American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting & Exposition.

Hospital pharmacy practice in Saudi Arabia: Drug monitoring and patient education in the Riyadh region

BackgroundThe purpose of this national survey is to evaluate hospital pharmacy practice in the Riyadh region of Saudi Arabia. The results of the survey pertaining to the monitoring and patient education of the medication use process were presented. MethodsWe have invited pharmacy directors from all 48 hospitals in the Riyadh region to participate in a modified-American Society of Health-System Pharmacists (ASHP) survey questionnaire. The survey was conducted using similar methods to those of the ASHP surveys. ResultsThe response rate was 60.4% (29/48). Most hospitals (23, 79%) had pharmacists regularly monitor medication therapy for patients. Of these hospitals, 61% had pharmacists monitoring medication therapy daily for less than 26% of patients, 17% monitored 26–50% of patients and 22% monitored more than half of patients daily. In 41% of hospitals, pharmacists routinely monitored serum medication concentrations or their surrogate markers; 27% gave pharmacists the authority to order initial serum medication concentrations, and 40% allowed pharmacists to adjust dosages. Pharmacists routinely documented their medication therapy monitoring activities in 52% of hospitals. Overall, 74% of hospitals had an adverse drug event (ADE) reporting system, 59% had a multidisciplinary committee responsible for reviewing ADEs, and 63% had a medication safety committee. Complete electronic medical record (EMR) systems were available in 15% of hospitals and 81% had a partial EMR system. The primary responsibility for performing patient medication education lays with nursing (37%), pharmacy (37%), or was a shared responsibility (26%). In 44% of hospitals, pharmacists provided medication education to half or more inpatients and in a third of hospitals, pharmacists gave medication education to 26% or more of patients at discharge. ConclusionHospital pharmacists in the Riyadh region are actively engaged in monitoring medication therapy and providing patient medication education, although there is considerable opportunity for further involvement.

Enhancing Pharmacy Practice Models through Pharmacists’ Privileging

Director's Forum is designed to guide pharmacy leaders in establishing patient-centered services in hospitals and health systems. This article focuses on the concept of granting clinical privileges to pharmacists (acute and ambulatory care) to improve the efficiency and effectiveness of medication use. As the practice models change in hospital pharmacy practice to require the pharmacist to enter into pharmacy board-approved consult agreements, institutional privileging of pharmacists will be necessary. The pharmacy director must understand the steps of the credentialing and privileging process and should apply the process where appropriate in the department. Through hospital medical staff actively supporting pharmacists’ privileging, the national Pharmacy Practice Model Initiative (PPMI) can meet its goals of integrating pharmacists as effective members of the patient care team with tangible accountability for achieving optimal drug therapy outcomes.

Centres of Excellence Course in Pharmacogenetics, 25–28 June 2012

Pharmacogenetics, promising the end of ‘one size fits all’ drugs and of trial and error in pharmacotherapy, is often predicted to be one of the first clinical applications in the...

International hospital pharmacy section’s work on Basel statements continues

With the global consensus statements on the future of hospital pharmacy practice reaching their four-year anniversary, the hospital pharmacy section of the International Pharmaceutical Federation (FIP) is considering some adjustments. Marianne F. Ivey, section vice president representing the Americas, said the officers have talked about splitting the consensus statements into two groups: necessary and optional. Ivey said such a bifurcation could result, for example, in the statements about formulary issues being put into the necessary category and the statement about collaborative prescribing—a “sophisticated” practice—into the optional category. Lee C. Vermeulen, recently elected to a four-year term as section secretary after serving two terms as assistant secretary, said the group may simplify some of the statements. The 75 statements, known as the Basel statements, resulted from the 2008 Global Conference on the Future of Hospital Pharmacy, held in Basel, Switzerland. This conference was conducted by the section. There are 16 overarching statements on essential concepts and 59 statements on the topics of procurement, influences on prescribing, preparation and delivery, administration, monitoring of medication practice, and human resources and training.

Preceptors’ Self-Assessment of Their Ability to Perform the Learning Objectives of an Experiential Program

To evaluate preceptors' perception of their ability to perform the Structured Practical Experiences in Pharmacy (SPEP) learning objectives through a self-assessment activity. A self-assessment instrument consisting of 28 learning objectives associated with clinic, community, and hospital pharmacy practice experiences were developed. Preceptors rated their performance ability for each of the learning objectives using a 3-point Likert scale. Of the 116 preceptors, 89 (77%) completed the self-assessment survey instrument. The overall preceptor responses to the items on performance of the 28 SPEP learning objectives ranged from good to excellent. Years of experience, practice experience setting, and involvement as a SPEP or SPEP and PharmD preceptor had no influence on their self-reported capabilities. Most preceptors rated their ability to perform the learning objectives for the structured practical experiences in pharmacy as high. Competency areas requiring further preceptor development were identified.

Perceptions of safety culture in hospital pharmacy: how safe do we think we are?

ObjectivesDespite growing recognition of the importance of staff perceptions of safety culture to the quality of care provided to patients, there is limited published work describing the safety culture within...

EAHP Survey 2010 on hospital pharmacy in Europe: Part 1. General frame and staffing

In 2010, the European Association of Hospital Pharmacists (EAHP) conducted its fourth survey on hospital pharmacy practice in Europe. 4748 heads of pharmacy were contacted in all member states through...

Largest pharmacy conference in history to help pharmacists improve global health: Preview 2012 FIP centennial congress

Pharmacists worldwide have one shared goal: to better the health of those around them through the unique skills and knowledge that make them the medicines experts within healthcare circles. Dedicated...