Hospital Pharmacy Leadership Conference - June 1 - 3, 2007
Hospital Pharmacy Practice Today - Just How Good are We?
Editorial Advisory Board
Hospital Pharmacy in Canada Report
Jean-François Bussières presented an overview of
the data from the latest Hospital Pharmacy in Canada Report. He
contextualized his remarks in terms of “what we know, what
we ignore, and what we should do.”
The survey’s overall response rate was 74%, he said. With
26% from teaching institutions, the survey is now capturing more
high tertiary institutions. He reviewed some of the basic findings:
average number of beds per respondent was 320.
average length of hospital stay was seven days.
The average annual admission rate was 14,740.
Bussières cautioned that these figures do not reflect the
large variations across the country, but are useful for country-to-country
The survey indicated that the two different models of care are both
largely implemented, with traditional clinical services at 89% and
pharmaceutical care at 82%. However, 80% of institutions continue
to have some beds without pharmacy coverage. There were increases
to both the number of beds covered by pharmaceutical care and those
not covered; however, as a proportion, the number of uncovered beds
has decreased. Numbers for traditional clinical services, on the
other hand, have remained static.
The survey avoided value judgements about whether one model is superior
to the other and does not examine criteria used to determine which
model should be implemented in any given circumstance, Bussières
said. Each pharmacy department, therefore, should have a reproducible
framework for clinical services. He also recommended better alignment
between academia, hospital, and community practice, and called for
the identification and publication of successful practices.
Survey findings revealed that the number of Full Time Equivalencies
(FTEs) per 100 occupied beds is increasing but that staffing proportions
are remaining roughly the same. Therefore, nothing is really changing,
Bussières explained. There are many questions the survey
did not consider, such as optimal FTE staffing levels and the impact
of non-pharmacists serving as department heads, and pharmacy technicians
providing non-dispensing activities. Bussières recommended
tracking indicators to help determine optimal staff ratios and key
ratios for benchmarking, at least regionally. Indicators need to
be developed for ambulatory/outpatient care activities.
The average proportion of a pharmacist’s time devoted to clinical
care remained unchanged, at 41%. Bussières called for the
development of a target for proportion of time devoted to clinical
care, even if the target had to be “intelligently guessed”
in the absence of empirical evidence. He suggested a target of between
70–80%. A simple system to document and evaluate the optimal
mix of pharmacist activities would enhance the productivity, retention,
and impact of pharmacists.
Survey results showed differences in the relative importance of
pharmacy and the use of pharmacy for in-patient versus outpatient
services. There remains a lack of good evidence to support positive
impacts of pharmacy in particular areas such as ICU or critical
care. Published evidence tends to be single-site focused with small
sample sizes. Furthermore, evidence is often collected by the practitioner
providing the services, which may call into question the objectivity
of the research. Good clinical practice research is needed to demonstrate
the benefits of pharmacy in particular sectors, to help prioritize
practice areas, and to build the business case for expanding the
scope of hospital pharmacy practice, Bussières said.
The survey identified that admission and discharge interviews continued
to increase, but did not assess the quality of those interviews
or the definitions used for what constituted an interview. Rounds
and consultations with nurses increased, as did pharmacokinetic
dosage information. The survey also ranked and compared service
levels and relative priorities. However, the need to prioritize
clinical services, share tasks and collaborate with other professionals,
and evaluate practice is evident, Bussières said.
For the future, it will be important to continue to assemble, understand,
and use strong evidence to advance practice, he concluded. As benchmarks
are developed for specialties that help create a hierarchy of activities,
models must be updated and evaluated. Work must continue toward
building consensus around the role of the pharmacist, founded on
an evidence-based practice model. Better mechanisms for knowledge
transfer inside and outside the profession must be developed.