ASHP national survey of pharmacy practice in hospital settings: Prescribing and transcribing - 2013

Purpose. The results of the 2013 ASHP national survey of pharmacy practice in U.S. hospital settings are presented. Methods. A stratified random sample of pharmacy directors at 1433 general and children's medical-surgical hospitals was surveyed by mail. IMS Health supplied data on hospital characteristics; the survey sample was drawn from IMS's hospital database. Results. In this national probability sample survey, the response rate was 28.9%. Drug policies developed by pharmacy and therapeutics committees continue to be an important strategy for improving prescribing. Strict formulary systems were maintained in 60.4% of hospitals, and 77% used clinical practice guidelines that included medications. Direct clinical services by pharmacists are becoming a more important way to identify and resolve medication-related problems with prescribing. Therapeutic interchange policies were used in 87.2% of hospitals, and pharmacist consultation to improve prescribing was common. Pharmacists most commonly provided consultations to prescribers for dosage adjustment (98.3%), drug information (93.2%), recommendations for antibiotic therapy (91.7%), and pharmacokinetics (91.5%). Electronic health records (EHRs) have been implemented partially or completely in most hospitals (92.6%). Computer prescriber-order-entry systems with clinical decision support were used in 65.2% of hospitals, 80% had barcode-assisted medication administration systems, 80.8% had smart infusion pumps, and 93.9% had electronic medication administration records. EHRs were used in 60.7% of outpatient clinics, with electronic prescribing to outpatient pharmacies used in 59.6% of hospitals. Pharmacists practiced in 27.1% of hospital ambulatory or primary care clinics, which is an increase from 18.1% compared with 2010. The most common service offered by pharmacists to outpatients was anticoagulation management (63.5%). The percentage of hospitals using performance metrics increased from 58.7% in 2010 to 68.7%. Conclusion. Pharmacists continue to expand their role in improving the prescribing of medications in both the hospital and outpatient settings. The adoption of EHRs and medication-use technologies has contributed to this growth.