Transcript Hospital Pharmacy in Canada Summary Report 2003-04

Hospital Pharmacy in Canada Report
2005/06 Report Summary
Nancy Roberts, BSc.(Pharm) FCSHP
VP Planning and Professionals Services
South-East Regional Health Authority
Moncton, NB
April 25th, 2008
Hospital Pharmacy in Canada Report
Sections
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Demographics
Clinical Pharmacy
Services
Drug Information and
Drug Use Evaluation
Drug Distribution
Drug Purchasing and
Inventory Control
Human Resources
Medication Safety
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Technology
Education and
Research
Ethics
Benchmarking, staffing
and drug costs
- Acute Care
- Pediatric
Mental Health
2005/06 HPCR Report Focus
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Medication safety, incident reporting,
disclosure and medication reconciliation
Clinical practice, priority and reality
Distribution delivery systems, enhanced
role of technicians
Escalating drug costs
Human resources – impacts of shortages,
student training
Technology uptake
Ethics – special interest section
Demographics
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Demographics very similar to the 2003/04 survey
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142 hospitals responded Nationally
– Inclusion criteria – 100 beds, 50 acute
– Represents 60,000 beds (115,120 beds in
Canada)
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74% response rate overall, 90% for teaching
hospitals
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66% of respondents were multi-site facilities, 59%
last survey, (only 39% in Ontario, 60% Quebec,
other over 90%)
Demographics continued
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92% of hospitals reported a pharmacist as leader of
the department/service - CSHP recommendation
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Facilities with program management (43%):
- 82% reported pharmacist salaries paid by
pharmacy
- 79% indicated the pharmacists report to pharmacy
- 20% reported shared responsibility
- 13% shared the salary cost
New for 2006
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Teaching hospital designation changed:
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Uses Association of Canadian Academic
Healthcare Organizations (ACAHO) definition
Note some data may not be comparable to
previous surveys
Mental Health recognized as distinct group
– Specific report
Service volume comparisons
2005-06 versus 2003-04
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Acute care admissions: 5.3%
increase
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Acute care patient days: 3.4%
increase
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Emergency dept visits: 11% higher
Proportion of Time Spent by
Pharmacists in Each Category of
Service
Drug Distribution
48%
Drug Distribution
43%
Research
1%
Teaching
5%
Research
2%
Teaching
6%
Other Non-patient Care
8%
Clinical
38%
2003-04 Base: All respondents (144)
Clinical
41%
2005-06 Base: All respondents (142
Other Non-patient Care
8%
Clinical Data Captured by the Report
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Clinical pharmacy practice models – prevalence
Specific clinical activity priority ranking and actual
service level
Specific programs - % hospitals with assigned
clinical pharmacists by clinical program
Seamless care activities, % hospitals providing
specific activities
Methods and types of practice evaluation
Prescribing privileges by profession
Pharmacist prescribing authority by activity
ASHP/CSHP 2015 goals and baseline from current
survey
–
How well do our priorities line up with evidence for
outcomes
Outpatient Clinical Pharmacy
services provided by more than 50%
of respondents
Outpatient Program
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Hematology-oncology
80%
Renal dialysis, 63%
Emergency 54%
Hematologyanticoagulation 52%
Regional Prevalence
- Ontario, Quebec
- Ontario, Prairies
- Ontario, BC, Quebec
- All regions similar except Atl
40%
Different Provinces –
Different Priorities - Clinical Pharmacy
Outpatient Pharmacy Clinical Service NOT
Provided or significant variation from provincial
pattern
 Transplant – Quebec, (0/17)
 Mental Health – Atlantic, (0/11)
 Emergency –Atlantic only 8%, (1/13)
 Geriatrics – British Columbia only 8 %, (1/13)
 Palliative Care – Ontario only 12%, (3/26)
 Rehabilitation – none - BC, Quebec, Atlantic
 Diabetes – BC only 13%, (2/16)
Inpatient Clinical Pharmacy
Services Provided by More than
50% of respondents
Inpatient Program
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Geriatric/LTC
Adult critical care
Hem-oncology
Medicine
Pain/Palliative
Cardio/lipid
Mental Health
Surgery
Peds/neonates
Renal/dialysis
Rehab
83%
79%
78%
78%
70%
68%
63%
63%
56%
51%
50%
Regional Prevalence
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Similar across Provinces
BC, Prairies, Ontario
Ontario, Quebec
Prairies 100%
All similar, Quebec bit lower
Prairies, Ontario
Prairies, Ontario, Atlantic
BC, Prairies, Ontario
Prairies, Ontario
Ontario
Ontario
Clinical Pharmacy ServicesPriority versus Level of Service
Seamless Care – Medication
Reconciliation on Discharge
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Increase in number of respondents with seamless care
policy – now 37%, (from 28%), in all Provinces except BC
(20%)
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An average of 24% of patients receive seamless care
Seamless care information provided:
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Medications at discharge, 96%
Medications during stay, 72%
Drug monitoring parameters, lab values, 60%
Care plan, 55%
Diagnosis, 34%, (down from 46% in 2003/04)
Prescribing Rights for Pharmacists
Notable increase in types of prescribing rights for
Pharmacists:
2005/06 2003/04
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Independent Lab tests
Dependent, dosage
adjustment
Dependent, new therapy
Independent dosage
adjustment
41%
79%
32%
70%
42%
30%
19%
35%
Independent dosage adjustment by pharmacists much
more prevalent in Quebec, 57% versus 13-33% for
other Provinces.
Current status compared to ASHP 2015
Drug Evaluation and Drug Information
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DUE – increased pharmacist and support
resources reported in 2005/06 survey.
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1.1 FTE pharmacist, up from 0.8 FTE 2004
0.7 FTE support staff, up from 0.5 FTE 2004
Drug Information – no change in
pharmacist resources, increase in support:
- 1.4 FTE pharmacists, similar to 2004
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0.7 FTE support staff, up fro 0.4FTE in 2004
Beds Serviced by Distribution
Systems
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2004
Unit Dose
51%
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Total Wardstock
3%
Carded Dose
6%
Traditional
32%
Unit Based Automated
8%
Base: All respondents (144)
2006
Automated Dispensing Systems
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Centralized automated dispensing, 66% of
unit dose respondents
– 83% canister type
– 17% robotic
Unit based automation
32%
– Emergency dept
80%
– Critical Care
54%
– Operating rooms
43%
– Inpatient
39%
– Recovery room
35%
Certification Required for Technician
Function
Blue 2005/06, Green 2003/04
Activities
IV Admixture Preparation
(Patient Specific)
86%
IV Admixture Preparation
(Batching)
Chemotherapy
Preparation
83%
82%
Traditional Prescriptions
(New Orders)
81%
TPN Preparation
Interim Dose
Filling
Traditional Prescriptions
(Refills)
Unit Dose
Tray Filling
Medication
Order Entry
Unit Dose
Packaging
Extemporaneous
Compounding
Cardiac Arrest
Tray Filling
Replenishing
Automated Cabinets
77%
76%
75%
72%
67%
54%
41%
39%
31%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
% of Respondents
Base: Respondents using technician check technician
Chemotherapy Preparation
Systems 2005-06
Drug Purchasing and Inventory
Control
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Spending on drugs in Canada increased by 11%
in 2005, (CIHI annual drug expenditures report)
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Equals 17.5% total healthcare spending 2005
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Drug expenditure growth increasing – 10.9% in
2004, 9.1% in 2003
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New drug therapies, consumer marketing, changes in
practice, demographics
Future impacts include pandemics, biotechnology,
pharmacogenomics
Ave inventory turnover is 10.9%
How will the Report Help me to
Evaluate my Drug Management?
By hospital type and size
 Total drug cost by care area
 Drug cost per patient day
 Drug costs by admission
 Outpatient drug costs per visit
 % drug costs by care area
 % changes in costs by care area – 2005/06
compared with 2004/05
Percentage of Drug Expenses by
Patient Care Area
Inpatient Acute Care
55%
Ambulatory
(Retail Pharmacy)
3%
Ambulatory
(Take Home)
3%
Emergency
Room
8%
Inpatient Long-Term Care
6%
Clinic / Medical Day Unit
25%
Base: Respondents who provided relevant drug cost information (82)
Drug Expenditure changes
2005/06 versus 2003/04
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Average annual drug costs were up by $1.27 million,
15.9% increase over a 2 year period
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Acute care inpatient drug costs per patient day increased
17.3% and the cost per acute care admission increased 16.2%
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Average drug cost per non-acute admission increased 20.6%
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likely due to length of stay as drug cost per patient day was
similar
100-200 bed hospitals cost per admission increased 98%
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Average Clinic drug costs per visit decreased 46%, $30.89
compared with $53.83 in 2003/04 ( Note: visits up 23%)
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Average emergency visit drug costs continues to increase, up
$8.33 from $8.01 in 2003/04
Human Resources
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Survey questions changed since previous survey:
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Budget hours /patient days captured instead of
paid hours/patient day
Allows comparison of organizational
commitment to resources and is unaffected by
staff shortages, absences
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Staff shortages continue
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Number of eligible retirees is similar to number of
current vacancies
Staffing Composition of Ave Hospital
Pharmacy Department 2005-06
Human Resources
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Average budgeted hours per acute patient day was
reported at 0.81 in 2005/06 compared to 0.74 in 2003/04
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Ontario highest at 0.96, British Columbia lowest at 0.65
Increases of 14% were reported for Ontario and Quebec
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Staffing Ratios, unchanged from previous survey
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Salaries
– Average increase 2.1% annual, compared with 5.6%
annual reported in 2003/04 survey
– Staff pharmacist top level increase average 2.8%
annual, downward trend from the 6.7% annual in
2003/04
– Technician top level increase 3.8% annual compared
with 2.6% in 2003/04
Human Resource Shortages
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73% of respondents reported vacancies compared
with 63% in 2003/04 although total pharmacist
vacancies were reduced, (270 vs 331 in 2003/04)
Position
– Pharmacist vacancies
– Management
– Technicians
– Residency vacancies
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2005/06
13.3%
7%
2%
6.2%
2003/04
12.9%
7%
0.9%
13.8%
Staggering 11.8% of pharmacists, 16.2% of
management and 8.4% of technicians expected to
retire in next 5 years
Medication Incident Reporting and
Reduction - How have we changed in 2
years?
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Not all respondents using a med incident
reporting tool (95% versus 100% 2003/04)
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A higher percentage have implemented
strategies to increase reporting (77% vs 67%)
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Significant increase in:
– presence of disclosure policy, (80% vs 63% in
2003/04; highest in the Prairies at 95%)
– Completion of self assessment tool, (71% vs
51% in 2003/04. Highest in the Prairies at
100%)
Canadian Council on Health
Services Accreditation (CCHSE) Required Operational Practices
(ROPs)
Focused on improving safety of patient care,
medication related ROPs for:
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Removal of concentrated electrolytes
Standardization
Order entry, verification
Medication reconciliation
Informing and educating patients/family
Compliance to Medication
Related ROPs
2005/06 2003/04
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Verbal and telephone orders limited
Med orders conditional until
pharmacist review
List of non-acceptable abbreviations
High alert med list identified
2 patient identifiers for high risk drugs
Allergy status prior to dispensing
42%
38%
44%
58%
61%
40%
68%
52%
40%
38%
31%
72%
Management of Concentrated High
Risk Drugs on Patient Care Units
2005/06
2003/04
Removal of High conc.
 Narcotics
 KCl
65%
85%
47%
72%
Standardize/limit conc.
 Heparin
 Insulin
 Morphine
 Hydromorphone
75%
48%
57%
53%
81%
47%
47%
41%
Medication History and Reconciliation
Emergency dept. med history
 Admission med history
 Transfer med reconciliation
 Counseling pamphlet provided
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45%
42%
35%
65 %
Technology – Clinical Decision
Function Availability and Use
Strong uptake of function
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Low uptake of function
Allergy alerts
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Drug interaction alerts
Input patient specific variables
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to assess drug therapy
Slow but visible growth
 Wireless networks
 Bar coding
 Approved plan for CPOE
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Computer generated max dose
alerts, especially non-teaching
hospitals
Dose modification alert for
renal dysfunction
Dose modification alert for
hepatic dysfunction
Evidence based guidelines
(low availability and uptake)
Uses of Bar Coding
Education and Research
Education
 Student training remained a high priority, especially for
Masters and Pharm D levels where the largest increase in
training days was observed
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Significant proportion of hospitals receiving stipends for
undergraduate pharmacist and Pharm D training
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Increase in university funded positions for student training,
(11 versus 6 in 2003/04)
Research
 Similar response to 2003/04
 Original research – reduction in average number of
published papers ( 4.5 compared to 7.1 in 2003/04)
Ethics – Special Interest Section
Addresses organizational policies and ethical
decision making processes.
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Most hospitals have access to on, or off site,
research ethics board, of which most have
pharmacist members
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Most have a bioethics/ethics advisory group or
access to one, only 32% have pharmacist
members
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Addresses patient care, education, research and
business ethics
Conflict of Interest
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68% of hospitals have a conflict of interest policy
45% report P& T conflict of interest policy
51% have a requirement for declaration of vendor
involvement
–
Report lists comprehensive list of issues e.g. gifts,
honoraria, outside employment, data selling
Risk Areas
 Educational sponsorship
 Formulary decisions
 Research
 Clinical decision-making
Additional benchmarking tables :
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Ave drug costs per day by clinical program
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Ave paid hours per admixture – CIVA, Oncology, TPN, per
investigational drug study
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Ave paid hours for inventory/procurement and for DUE per
$1m drug purchases
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Ave paid hours per patient day for high acuity programs e.g
bone marrow transplant, neonatal or pediatric ICU
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Changes in drug expense by patient care area
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Total drug costs by patient care area/visit
Questions
www.lillyhospitalsurvey.ca
Contact Information
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Nancy Roberts – [email protected]
THANK-YOU - MERCI