ASHP national survey of pharmacy practice in hospital settings: Dispensing and administration-2008

Purpose. Results of the 2008 ASHP national survey of pharmacy practice in hospital settings that pertain to dispensing and administration are presented. Methods. A stratified random sample of pharmacy directors at 1310 general and children's medical-surgical hospitals in the United States were surveyed by mail. Results. The response rate was 40.2%. Most hospitals had a centralized medication distribution system; however, there is evidence of growth in decentralized models compared with data from 2005. Automated dispensing cabinets were used by 83% of hospitals and robots by 10%. The percentage of doses dispensed in unit dose form increased, as did the use of two-pharmacist checks for high-risk drugs and high-risk patient groups. Medication administration records (MARs) have become increasingly computerized over the past nine years, and the use of handwritten MARs has declined substantially. Technology implemented at the drug administration step of the medication-use process is continuing to increase. Bar-code technology was implemented in 25% of hospitals, and 59% of hospitals had smart infusion pumps. Only 6.8% of hospitals had a pharmacist practicing in the emergency department (ED). Pharmacists prospectively reviewed only a small percentage of ED medication orders before the first dose was administered, and only 40.7% of hospitals retrospectively reviewed ED medication orders for prescribing errors. Pharmacy hours of operation have been increasing, with 36.2% of hospitals providing around-the-clock services. Off-site medication order review was used in 20.7% of hospitals. Directors of pharmacy reported a vacancy rate of 5.9% for pharmacists and 4.7% for technicians and a turnover rate of 8.6% for pharmacists and 13,8% for technicians. Conclusion. Safe systems continue to be in place in most hospitals, but the adoption of new technology is rapidly changing the philosophy of medication distribution. Pharmacists are continuing to improve medication use at the dispensing and administration steps of the medication-use process.