Pharmacists Providing More Care in Health Systems

There is a continued increase in pharmacists routinely providing care to patients by selecting appropriate drug therapies, monitoring patients, and assessing outcomes, and educating patients and other providers, according to a new study.

The National Survey of Pharmacy Practice in Hospital Settings - 2018 analyzes pharmacy’s role in drug therapy monitoring and patient education. In addition to opioid stewardship, the survey covers several pharmacy practice issues, including management of medication therapy activities, pharmacogenetics, and pharmacist participation in outpatient clinics.

“The purpose of the study was to characterize hospital pharmacy practice related to drug therapy management and patient education. The survey also examined current hot topics in healthcare and pharmacy practice,” says study author Michael Ganio, PharmD, director of pharmacy practice and quality at the American Society of Health-System Pharmacists.

“Hospital and health-system pharmacists play a major role as part of the interprofessional team in helping to solve issues like the opioid crisis and drug shortages,” Ganio says. “Most large health systems have developed active stewardship programs to prevent the misuse of opioids, and pharmacists are playing a key role in detecting drug diversion and identifying strategies to encourage appropriate opioid prescribing.”

In response to the opioid crisis, the appropriate prescribing of opioids has been a major focus in recent years. Pharmacists are uniquely positioned to ensure opioid use in hospitals is optimal, safe, and effective, according to the study.

“Additionally, pharmacists are safeguarding opioid procurement, storage, use, and waste through diversion prevention and detection programs,” Ganio says. 

Opioid stewardship

The findings on opioid stewardship programs is consistent with antimicrobial stewardship programs where results of a 2017 survey also show pharmacists have a leadership role in addressing the growing threat of resistant infections, according to Ganio.

“Healthcare executives should be relying on their medication experts to help address these public health crises,” he says.

The survey results also allow healthcare executives at hospitals and health systems to see how pharmacists are leading innovative efforts to improve medication safety and patient outcomes. “Healthcare executives can compare their institutions to peer hospitals of similar size across the country to determine if they are fully utilizing pharmacists’ leadership potential,” Ganio says.

Address the crisis

The most common strategies that health systems employ for preventing opioid misuse include providing clinician education and guidelines (71.4%), followed by using prescription drug monitoring database searches to track prescribing practices and patient behaviors that can lead to abuse (65.3%), and opioid diversion detection programs (55.6%).

Related: Hospital Pharmacist Role Expands In Patient Care

In opioid stewardship, pharmacists most commonly play a role in diversion detection (70.8%). Pharmacists are also likely to be involved in:

• clinical utilization review (57.2%)

• leadership and accountability (54.8%)

• prescribing support (34.5%).

“Pharmacists are also demonstrating their ability to meet the needs of patients while the nation faces a shortage of primary care providers,” Ganio says. “Pharmacists are working in ambulatory or primary care clinics in almost one-third of hospitals, an increase from just 17% of hospitals 10 years ago.”

The number of pharmacists dedicated to providing pharmacy services to inpatient clinical specialties is also increasing, according to the report. The most common clinical specialties with dedicated pharmacy services for at least eight hours a day include critical care (57.2%), general medical/surgical patients (53.6%), and oncology patients (45.4%).

Pharmacists are also involved with patient transitions of care to help reduce readmissions and prevent medication-related problems when patients change care settings. Forty-seven present of hospitals report pharmacist participation in discharge planning, and 44.1% report that pharmacists conduct medication counseling at discharge.