Hospital Pharmacy Leadership Conference - June 1 - 3, 2007
Hospital Pharmacy Practice Today - Just How Good are We?
Preparing For Our Future
In their final set of small group discussions, participants zeroed
in on a definition of the services that hospital pharmacy should
provide, identified barriers and implementation strategies to
enhancing or introducing these services, and suggested some ways
in which the Hospital Pharmacy in Canada Report could measure
progress. Participants expressed agreement on the importance of
assessing the current environment, defining clear directions for
change or improvement, and providing strong leadership in those
directions. They recommended an abundance of concrete actions
that could advance hospital pharmacy practice from the systems/vision
level right down to daily practice in their organizations.
Most recommended starting by comprehensively comparing current
and proposed practice against the evidence. Specific research
goals were to: assess the current state of pharmacy practice,
conduct a gap analysis, produce an environmental scan of standards
used by compatible stakeholders, and provide an honest assessment
of the competencies that currently exist.
A consistent message concerned the need to base decisions about
how to lead evolving pharmacy practice on strong, clear evidence.
Organizational and leadership priorities must be system-wide and
must bridge the disconnection between common practice and what
the evidence supports. Evidence-based practice must be more than
a philosophical commitment, participants said. Evidence-based
practice must be embedded in CSHP’s Vision 2015,
CPhA’s Blueprint for Pharmacy, CCHSA and Canadian
Hospital Pharmacy Residency Board (CHPRB) standards, and CSHP
standards and guidelines. The Hospital Pharmacy in Canada Report
should be used to map actual practices against standards and to
evaluate standards and ROPs against what the evidence supports.
Participants spoke of the importance of identifying priorities
by service or specialty and of defining both discipline-exclusive
and shared scope of practice for interdisciplinary teams. Roles
in the team must be clearly defined and must be based on grassroots
realities and needs, rather than from a top-down directive. Successful
collaboration will be the key to advancing practice. Opportunities
must be seized to communicate across disciplines, geographic boundaries,
administrative structures, professional bodies, and with patients
and the public. One group identified the Hospital Pharmacy in
Canada Report as a practical mechanism to provide explicit examples
of linkages between standards and outcomes.
Group members recommended ongoing evaluation to ensure efforts
to expand scope of practice and stay on course. Concrete measures
are needed to determine the extent of clinical pharmacist involvement,
such as comparing the number of rounds regularly attended by pharmacists
against the total number of rounds or the percentage of high-risk,
high-alert medications for which specific protocols exist. Internal
leaders were advised to ask themselves the following questions:
questioned whether evidence really exists to show that pharmacy
directors have an impact on care. Citing the current Hospital Pharmacy
in Canada Report results, they noted that change was limited, except
where it was mandated by regulation or legislation. They challenged
pharmacy leaders to adopt a coordinated approach, choose some concrete
actions, implement them, and then assess the results. They recommended
prioritizing opportunities that add the most value and that are
within pharmacy’s sphere of influence. Pharmacy leaders can
be held accountable for the actions they can control. Basing activities
on the Chartered Quality Institute will ensure continuous improvement.
you have a strategic plan for advance practice?
it being followed?
The groups identified several specific actions that could be taken
To move practice
forward, pharmacy leaders need to invest in and drive practice-based
research and research collaboration, participants said. Pharmacy
leaders need to work within their agencies and together to market
pharmacy services through consistent messages about the roles of
individual pharmacists and professional bodies. Mechanisms must
be identified to help pharmacy leaders engage with educators, as
individuals and as a group, to influence curriculum and training
approaches. Equally important is to build consensus about core pharmacy
services across a continuum of care.
and limit the number of drug concentrations available.
differentiate various heparin products.
a formally approved list of unacceptable dangerous abbreviations
and audit the number of times dangerous abbreviations are
define medication reconciliation within particular institutions.
opportunities for staff to share evidence/experience about
the correction of safety gaps into clinical practice and service
that every patient has a medication history that features
a face-to-face meeting with a pharmacist.
One group reminded participants of the many individuals at the conference
who are already doing a very good job in advancing practice. They
recommended identifying these “stars” and inviting them
to serve as facilitators at a meeting using a “Hilton Head”
consensus approach. Based on the ICU collaborative model, the meeting
would identify high-priority services, develop a plan for implementation,
and create external validation processes. Consensus for next steps
would be reached because everyone would be addressing the same priorities.
The results could be taken to CCHSA, ISMP, and other bodies, to
be used as part of the validation process.
Several participants expressed enthusiasm for maintaining momentum
and holding another meeting designed to distil the directions, actions,
and ideas that had been explored at this conference. A group member
suggested holding such a meeting in conjunction with the CSHP Annual
General Meeting. The group mandated several key players to explore
how best to organize a follow-up meeting. Echoing the need for momentum,
one participant observed: “We achieve sustainability, and
keep our vision forever green, as we continue to discover new best
practices and work together to form a tsunami of effort that is