ASHP National Survey of Pharmacy Practice in Hospital Settings: Dispensing and Administration - 2002

Craig A. Pedersen, Philip J. Schneider, Douglas J. Scheckelhoff


Am J Health Syst Pharm. 2003;60(1) 

In This Article

Abstract and Introduction

Results of the 2002 ASHP national survey of pharmacy practice in hospital settings that pertain to dispensing and administration are presented.

A stratified random sample of pharmacy directors at 1101 general and children's medical-surgical hospitals in the United States were surveyed by mail. SMG Marketing Group, Inc., supplied data on hospital characteristics; the survey sample was drawn from SMG's hospital database.

The response rate was 46.7%. During 2002, both inpatient and outpatient hours of service increased compared with 2001. Paradoxically, there was an 8.5% decrease in pharmacy staffing and a 7% vacancy rate, suggesting that pharmacists are busier. Most hospitals (80%) had a centralized inpatient dispensing system, but 44% were planning to become more decentralized. Automated dispensing cabinets were used by 58% of hospitals with decentralized drug distribution systems. Most hospitals (81.4%) dispensed more than three quarters of oral doses as unit doses and 63.3% of injectable doses to non-critical care patients, increases from 1999. A large percentage of hospitals (89%) repackaged both oral and injectable medications. More hospitals were repackaging medications than three years ago, primarily because of lack of commercial availability. Approximately 20% of pharmacies either partially or completely outsourced drug preparation activities. Nurses administered medications in virtually all hospitals (99.7%). Despite widespread recommendations to use bar-code technology to check and document doses administered, only 1.5% of hospitals used this technology, an increase from 1.1% in 1999. Nearly two thirds of hospitals used computer-generated medication administration records.

While pharmaceutical services are expanding, workforce issues continue to challenge pharmacists trying to maintain and enhance safe medication systems. Safe systems continue to be in place in most hospitals, but the adoption of new technology to improve safety is slow.

The ASHP national survey of pharmacy practice in hospital settings focuses on the role pharmacists play in managing and improving the medication-use process. The national surveys are organized according to six steps in the medicationuse process: prescribing, transcribing, dispensing, administration, monitoring, and patient education and wellness. ASHP's hospital survey was redesigned on the basis of this construct into a three-part series beginning in 1998 and concluding in 2000. Therefore, the cycle repeats every three years. The 2002 survey represents the second part in this cycle and is concerned with dispensing and administration. When combined, the 2001-2003 surveys will represent a composite picture of the current role of pharmacists in managing and improving the process of medication use.

In assessing the role of pharmacists in dispensing and administration, the present study sought to describe the inpatient drug distribution system, the use of technology in drug distribution, medication preparation and dispensing, drug administration, the use of bar-code technology, the use of medication administration records, repackaging operations, outsourcing of pharmacy operations and preparation activities, and quality improvement activities.