by Zara Qadir – Five years of evolution in Hospital Pharmacy. The 40th EAHP meeting provided an opportunity for Tajda Miharija-Gala and Juraj Sykora, Directors of Professional Development, to preview the findings of the fourth pan-European EAHP survey of hospital pharmacy practice.The results of the survey are due to be published later in 2012 but the preliminary findings can be found on the EAHP website (www.eahp.eu).
“The survey is a valuable source of information about the status quo of hospital pharmacy in Europe. The data from the survey highlights priorities for actions to achieve the state of the art as postulated in the Basel statements of FIP,” commented Ms. Miharija-Gala, who is a Hospital Pharmacist at the Quality Department at the University Medical Centre in Ljubljana, Slovenia.
The results from the fourth pan-European survey1 on hospital pharmacy practice were based on 1,238 (26.1%) answers from all European pharmacies (n=4,747). However, there were some limitations due to insufficient data. The methodology included a survey comprised of 87 questions with the aim of providing up-to-date comparative national information on a wide range of areas including staffing ratios, staff qualification levels, etc.
During the EAHP presentation, the survey data was analysed across a number of different parameters (country, size and type of hospital) and comparisons were made with previous surveys and also the recently presented, American Society of Hospital Pharmacists (ASHP) survey2.
One of the key findings highlighted by the survey results was that across European hospital pharmacy there exists a shortage in staffing. The average number of pharmacists and pharmacy technicians in a hospital pharmacy in Europe remains low compared to North America and has not grown significantly since 1995 (one pharmacist and one pharmacy technician per 100 beds). In the United States, the ratio of full-time pharmacists to 100 beds was 15 times higher than in Europe, and for pharmacy technicians was 19 times more. In Europe, pharmacists (27%) and qualified technicians (32%) cover 60% of the total staff.
“Only a few countries did not experience shortages of pharmacists and technicians. The number of pharmacists per 100 beds varied from 0.33 in Germany to 3.47 in the UK,” reported Juraj Sykora, an Oncology pharmacist at the National Cancer Institute in Bratislava, Slovakia, who presented a snapshot of the findings under the different categories.
Some of the results are listed below:
Procurement and distribution
- EAHP survey revealed that 45% of European pharmacists are purchasing resources in groups
- Industry-Western Europe (46%) and wholesalers-Eastern Europe (51%) are the most important suppliers
- 55.8% of the pharmacists are also responsible for medical devices
- Only 39% of the European hospitals have 24-hours on call service
- Formularies have an average of 1,006 products with a broad range from 246 to 1982, which has increased by 43.7% since 2000
- 94.2% of the pharmacies distribute by manual picking and the total of automation is still only 10.1%
- Not more than 26% of hospitals provide patients with medicines at discharge from hospital
- In only 14% of hospitals in Europe do pharmacists spend at least 50% of their time on the ward
- Only 23% of pharmacies offer clinical services at the ward and only 7% do it on a regular basis
- Clinical services for outpatients are common practice (66%)
- The major field of consultations are antibiotics, cytotoxic induced nausea and nutrition
- Drug information by pharmacists is implemented in only 29% of the hospitals and has remained constant since 2000
- Only 24% of the pharmacies document at least 80% of their interventions
Production and Quality assurance
- Both batch and individual production of sterile and non-sterile medications decreased significantly since 2000
- On average 58.5% of pharmacies follow GMP guidelines with a broad range between countries from 0 to 100%. Even in the biggest hospitals (with more than 2000 beds) the pharmacies fail to achieve the GMP requirements.
- There is a need for more resources in the field of quality assurance, especially in the eastern part of Europe
- 46.6% of the pharmacies are certified by external bodies
- Almost 50% of HP have some kind of certification, ISO9001 is held by almost 30% but the percentage holding environmental ISO 14001 is still very low, at 2.4%
- Patient safety is the focus of hospital pharmacies and 80% have implemented activities in safe medication practice
- There is a broad range between countries from 0 to 100% with some need for improvement especially in the eastern part of Europe.
- There is a lack of documentation with only 16% of interventions registered in medical records.
- 76% of pharmacies have at least one education activity in safe medication.
Education and research
- Hospital pharmacists are highly involved (68%) in teaching programmes for health professionals including physicians, pharmacists and nurses
- 61% of hospital pharmacists are involved in clinical research.
“The EAHP survey revealed a gap in services,” commented Juraj Sykora, who offered some concluding remarks after presenting the data: “All modern practices in hospital pharmacy are present in European hospital pharmacists but there is a large variety of health systems in Europe. There are some similarities but also many differences in practice in hospital pharmacists between European countries. There are some similarities but also still many differences in practice in hospital pharmacists between Western and Eastern Europe.” Many Western countries (e.g. Denmark, Spain) were very advanced in a number of areas whereas many of the newer European member states lack accreditation status and had poorer services.
Ms. Miharija-Gala also outlined some of the challenges faced by European hospital pharmacists. “In order to further develop and improve will require reprioritisation of our practice with the same or fewer staff: distribution services, production and quality assurance, clinical pharmacy services, patient safety and research”.
A lengthy and lively discussion followed the Seminar, which delved deeper into addressing the gap in service provision across Europe, and seminar attendees also suggested EAHP carried out a follow-up study examining the link between outcomes and staffing.
1. EAHP Five Year Survey (Source: http://www.eahp.eu/EAHP-survey/2010-Survey-preliminary-reports)
2. ASHP National Survey 2011 presented at Midyear Clinical Meeting, Dec. 2011: Authors: C.A.Pedersen, P.J.Schneider, D.J.Scheckelhoff (http://www.softconference.com/ashp/sessionDetail.asp?SID=253897)