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Millcroft Hospital Pharmacy Leadership Conference - June 1 - 3, 2007

Theme: Hospital Pharmacy Practice Today - Just How Good are We?

Jean-François Bussières
Editorial Advisory Board
Hospital Pharmacy in Canada Report
Montréal, QC

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:

The average number of beds per respondent was 320.
The 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 comparison.

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.

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