FIP Congress 2005
|
Human resources in hospital pharmacy was the subject
of a Hospital Pharmacy Group session on 7 September. Roger
Tredree reports
|
 The World
Congress of Pharmacy and Pharmaceutical Sciences was
organised by the International
Pharmaceutical Federation in association with the Syndicate
of Pharmacists of the Arab Republic of Egypt.
It took place in
Cairo from September 2 to 8, 2005 |
How service provision in hospitals is affected by the pharmacy workforce
The provision of appropriate human resources is a key determinant of
the quality of any service, not least that provided in a hospital pharmacy.
Ensuring that medicines are properly obtained and supplied relies upon
the pharmacy workforce and speakers from Europe, Japan, Africa and the
US explained how human resources in
these areas of the world impact on service
provision.
Europe
Jacqueline Surugue, president of the European Association of Hospital
Pharmacists, presented the results of a comprehensive overview of
European demographics from three surveys, including the most recent 2005
data.
Information from 26 countries was presented. There are about 21,000
hospital pharmacists in the EU with an average of 43 pharmacists
per million patients.
However, clinical practice is different across Europe and the workforce
is unevenly distributed, so although the average number of pharmacists
per hospital is 2.5, in the UK it is 9.5. The UK is the top country
for clinical activity in the EU and hospital wards have far more
patients
on acute care. In addition, the UK and France provide more outpatient
services than other countries.
There are other marked differences in the ways in which services are
provided between countries. For example, France has many small hospitals
with a few
pharmacists in each whereas, in the UK, many pharmacists are concentrated
in fewer hospitals that are much bigger than their French counterparts.
Information was also presented on the physician and nurse workforce across
EU countries, and compared with pharmacist numbers, but there is no correlation
or trend. The conclusion was that it is not possible to study hospital pharmacy
in isolation, but the whole workforce needs to be taken into
consideration. Japan
Hitoshi Sasaki, from Nagasaki University Hospital, explained the changes
to the training of pharmacists in Japan. These changes have their
origin in the need for a greater in-depth clinical education which hitherto
had been inadequate.
In Japan, as in many other countries, the age distribution of the
population is now dominated by older people. This costs the health
service more.
There are also many inefficiencies in the Japanese system because there
are too many beds and the average length of the hospital stay is much
longer than in other developed countries. There was a great need for
standardisation which would control the use of medicines and number
of days patients spent in hospital. It is essential that the appropriate
care is given in the appropriate institution.
At present patients may attend any institution regardless of urgency
or illness. Guidelines and critical pathways should be determined using
evidence-based medicine.
On average 1,427 patients per day attend outpatient clinics at NUH.
There are also many medicines on each prescription and several may
be dispensed
as powders to give an accurate dose per body weight. In order to cope
with the large number of prescriptions, outpatient prescriptions are
sent to community pharmacists by the hospital pharmacy for dispensing.
Numbers of hospital pharmacists are increasing slowly. At NUH there
are 869 beds and these are serviced by 37 pharmacists, three clerks
and 10
students. The role of the technician has not been developed in Japan. Africa
Andy Gray from University of KwaZulu-Natal, South Africa, reported
that African countries face particular problems with inadequate staffing.
Hospital pharmacies in Africa are, with the exception of some in
middle
income countries, mostly located in the public sector. Government
health services are under extreme pressure from an ever-increasing burden
of disease and a chronic lack of resources.
As staff salaries account for the single largest component of recurrent
costs in such health systems, this places real pressure on staffing
levels. A number of African
countries have no pharmacy schools and rely upon training institutions
in neighbouring countries.
Suitably trained technicians may also not be available in all settings.
Problems may occur even in countries that do have access to suitable
training institutions and an appropriate mix of professionals and technicians.
Of particular concern is the recruitment of African professionals by
developed country health care systems, both government and private.
Such migration can have dire consequences for a country with already
stretched
human resources.
The countries of southern Africa provide representative examples of
these problems. Potential solutions include the use of community service
commitments,
locally relevant training and the effective use of mid-level workers. United States
Phil Schneider, from Ohio State University, described the results of
work carried out in the US. Some 26.4 per cent of pharmacists in the
US work in hospital. There is currently a 6.3 per cent vacancy rate and
filling some posts can be difficult.
In the US only 31 per cent of hospital pharmacies have 24-hour, seven-days-a-week
operation. Nearly half of hospital pharmacies provide services less than
16 hours per day. There are currently over 50,000 pharmacy technicians
in hospitals in the US and this presents an opportunity for greater use
of technicians who are good at routine tasks.
Currently the ratio of technicians to pharmacists is lower than 1:1.
Technician certification has been shown to improve competency and the
American Society of Health-System Pharmacists, as part of its 2015 objective,
is aiming for 85 per cent of pharmacy technicians in health systems to
be certified by the pharmacy technicians certification board. It is hoped
that these
initiatives will improve recruitment and
retention.
New developments in the US include the development of a chief pharmacy
officer position. This is an executive level position within the hospital
health system which is regularly involved in strategic decisions of the
organisation. It is equivalent to the highest level nurse executive with
regard to reporting relationships and therefore is part of the chief
officer group within the organisation. Medication safety officer appointments
are also being made. This is defined as “an individual whose job
it is to ensure that the medication use system is designed to prevent
accidental harm to patients”. The individual seeks to implement
best practice relating to measuring, monitoring and continually improving
performance of the medicines use system.
Apparently, 13 per cent of hospitals have an individual designated as
a medication safety officer. As in many countries, there
is a developing leadership crisis within
the US. Only 44 per cent of pharmacy
directors in the US could readily identify a
successor.
Technology is being harnessed to solve some of the potential problems
of workforce shortfall. In particular computer-prescribed order entry
is seen as a major step forward but still only 4.2 per cent of hospitals
in the US have adopted this. Similarly robotics and dispensing devices
have only been partially taken up. |
The
Pharmaceutical Journal