An adequate supply of qualified nurses and pharmacists in hospitals is critical to safe and effective medication use. Current work-force shortages, combined with an increasing demand for the knowledge and skills that these professionals possess, have immediate and long-term implications on over-all patient safety and quality of health care.
Hospitals have serious shortages of qualified nurses and pharmacists. A survey of hospitals conducted in 2001 by the American Hospital Association found a vacancy rate of 13% for both professions. Other studies have reported similar findings, including two conducted by the federal government.[2,3]
With these work-force shortages in mind, consider a few of the major problems in hospitals reported by the Institute of Medicine: unsafe and overly complex medication-use systems, lack of teamwork and communication among health care providers, poorly aligned incentives for reimbursement, inadequate application of science and technology, the need to better match patient care services with practitioner skills, and major deficiencies in professional education. These problems, coupled with work-force shortages, hinder the goal of fail-safe medication use in hospitals. Furthermore, if hospitals continue to use ineffective and antiquated approaches to the deployment of nurses and pharmacists, these problems are likely to get worse.
Nurses and pharmacists have knowledge and skills that are specific to their profession yet complementary when applied to patient care. There is little disagreement about this. But, are these professional attributes consistently applied to optimize medication use? To what extent are work-force shortages exacerbated by having nurses and pharmacists perform tasks that could be assigned to qualified and adequately credentialed technical personnel? How can hospitals best empower nurses and pharmacists with technology to improve patient safety? What are the major cultural issues in the two professions that demand careful examination and reevaluation as we strive to achieve fundamental changes in medication-use safety?
These issues, and others, were the focus of a recent, unprecedented, executive session at ASHP headquarters among five nursing and pharmacy organizations with a strong desire to develop a shared vision for safe medication use in hospitals. This was the beginning of an ongoing national dialogue about a revolutionary change to realign nursing and pharmacy to ensure safe medication use in hospitals. A summary of the discussion appears in this issue of AJHP. Readers should consider using it as a catalyst for discussion between pharmacy and nursing about making improvements in medicationuse safety in their own hospitals.
Nurses and pharmacists, the first and third largest groups of health professionals, respectively, are morally and professionally obligated to provide leadership toward the development of fail-safe medication-use systems in hospitals. To achieve fundamental changes in the delivery of health care, we must challenge the status quo, avoid protectionist behaviors, and talk openly and honestly about how we can change the system to best benefit patients. We simply can not be afraid to discuss and experiment with different approaches that might improve patient safety. Some ideas for consideration might include
Allowing technicians to administer medications,
Assigning responsibility for medication supply and distribution to expert supply-chain managers and logisticians, and
Making medication prescribing a function of an interdisciplinary team instead of an individual prescriber.
Nurses and pharmacists do not need to wait for the emergence of a grand, new, nationally standardized model for safe medication use. It might be some time before such a model materializes. Experiment with new models and approaches in your own hospital, and share those experiences widely. Our patients are counting on us to design a safer, more effective medication-use system. Together, nurses and pharmacists can lead this charge.
Am J Health Syst Pharm. 2003;60(10) © 2003 American Society of Health-System Pharmacists
Cite this: Nursing and Pharmacy Agree: It is Time For Change - Medscape - May 01, 2003.