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


CONCLUSIONS
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.
Craig A. Pedersen, B.S.Pharm., Ph.D., FAPhA, is Pharmacy Manager, Confluence Health-Central Washington Hospital, Wenatchee, WA. Philip J. Schneider, M.S., FASHP, FFIP, FASPEN, is Professor and Associate Dean, College of Pharmacy, Phoenix Biomedical Campus, University of Arizona, Phoenix. Douglas J. Scheckelhoff, M.S., FASHP, is Vice President, Office of Practice Advancement, American Society of Health-System Pharmacists, Bethesda, MD. pedersen.craig@gmail.com.
Craig A
CA
Pedersen
Craig A. Pedersen, B.S.Pharm., Ph.D., FAPhA, is Pharmacy Manager, Confluence Health-Central Washington Hospital, Wenatchee, WA. Philip J. Schneider, M.S., FASHP, FFIP, FASPEN, is Professor and Associate Dean, College of Pharmacy, Phoenix Biomedical Campus, University of Arizona, Phoenix. Douglas J. Scheckelhoff, M.S., FASHP, is Vice President, Office of Practice Advancement, American Society of Health-System Pharmacists, Bethesda, MD.
Philip J
PJ
Schneider
Craig A. Pedersen, B.S.Pharm., Ph.D., FAPhA, is Pharmacy Manager, Confluence Health-Central Washington Hospital, Wenatchee, WA. Philip J. Schneider, M.S., FASHP, FFIP, FASPEN, is Professor and Associate Dean, College of Pharmacy, Phoenix Biomedical Campus, University of Arizona, Phoenix. Douglas J. Scheckelhoff, M.S., FASHP, is Vice President, Office of Practice Advancement, American Society of Health-System Pharmacists, Bethesda, MD.
Douglas J
DJ
Scheckelhoff
D002626:Chemistry, Pharmaceutical; D011307:Drug Prescriptions; D057286:Electronic Health Records; D005820:Genetic Testing; D006801:Humans; D050316:Medical Order Entry Systems; D054539:Medication Therapy Management; D010595:Pharmacists; D010607:Pharmacy Service, Hospital; D024382:Professional Role; D012017:Referral and Consultation