Study objective: To determine the extent of 15 hospital-based clinical pharmacy services, 51 different drugs managed under protocol by pharmacists, medication errors, and pharmacy technology in United States hospitals.
Design: A survey was mailed, as well as sent electronically, to pharmacists in 2893 hospitals.
Results: A total of 1125 surveys were returned (38.9% response rate). The 1125 hospitals had 14,315,506 patients admitted, which represented 45.7% of the 31,324,496 admissions to all U.S. hospitals in 2006. The proportion of clinical pharmacy services provided by Veterans Affairs (VA) hospitals was higher compared with non-VA hospitals. In all hospitals, the clinical pharmacy services with the greatest growth from 1989-2006 were pharmacist-provided admission drug histories (300% increase), pharmacist participation on medical rounds (292.3% increase), drug protocol management (208% increase), pharmacist-conducted clinical research (166.7% increase), pharmacist-provided drug information (150% increase), and pharmacist-provided pharmacokinetic consultation (117.5% increase). A total of 864 hospitals (76.8%) had pharmacists providing drug protocol management (collaborative drug management). Pharmacists managed a mean +/- SD of 9.18 +/- 10.23 different drugs/hospital (7932 protocols). Drugs commonly managed included aminoglycosides (64.4% of hospitals), vancomycin (63.8%), warfarin (37.8%), low-molecular-weight heparins (32.7%), unfractionated heparin (30.0%), fluoroquinolones (30.0%), antiparkinsonian drugs (22.8%), proton pump inhibitors (22.7%), human immunodeficiency virus drugs (21.9%), and cephalosporins (19.7%). The mean number of medication errors reported/hospital increased by 151.4% between 1995 and 2006. The percentage of patients who experienced a medication error increased from 4.7% to 6.5% between 1995 and 2006 (a 38.3% increase). A total of 220 hospitals (19.6%) had computerized prescriber order entry systems, 263 (23.4%) had bar coding for drug administration, and 439 (39.0%) used robotics for dispensing.
Conclusion: This study provides continuing evidence of the growth and value of clinical pharmacy services and clinical pharmacists in our nation's hospitals. These data will guide hospital pharmacy directors and clinical coordinators in allocating resources to optimally meet their patients' needs.