Philip J Schneider
Clinical Professor and Director
Latiolais Leadership Program
College of Pharmacy
Ohio State University
Workforce in the US healthcare market is a critical issue. The American Hospital Association (AHA) recently published a report entitled In our hands – how hospitals can build a thriving workforce.(1) Long-term shortages of qualified workers, including pharmacists, are forecast for several reasons: an ageing US workforce; fewer workers coming behind the ageing “baby boomers”; and dissatisfaction with hospital work. A five-point strategy is recommended in the report:
- Fostering meaningful work.
- Improving workplace partnerships.
- Broadening the base of healthcare workers from diverse groups.
- Collaboration with others.
- Building public support for the resources needed to hire and retain qualified workers.
In a recent survey,(2) hospital pharmacy directors in the US reported an average pharmacist vacancy rate of 7.3%. We estimate that there are currently 3,000 vacant hospital pharmacist positions in the US. Given the fact that there are approximately 8,000 graduates from US Colleges of Pharmacy, 75% of whom enter community practice, there is clearly a workforce issue for hospital pharmacy in our country.(3) Because this shortage is not likely to be solved quickly, two strategies are being employed: use of pharmacy technicians in place of pharmacists for nonjudgmental, technical tasks; and the use of technology that can replace human resources.
Many traditional activities that have been performed by pharmacists can be performed under the supervision of a pharmacy technician. The average hospital employs 10.4 pharmacists per 100 occupied beds and 10.0 pharmacy technicians per 100 occupied beds.(2) The ratio of pharmacists to technicians has decreased compared with data obtained in a similar 1999 survey,(4) indicating that the use of pharmacy technicians is increasing. Activities that are increasingly performed by properly supervised technicians include: entering orders into the computer; preparing medications, including IV admixtures; dispensing and delivering medications; and gathering patient data for the pharmacist. There are more than 100,000 certified pharmacy technicians (CPhTs) in the US.(5)
Technology can also improve pharmacy job satisfaction and reduce the number of pharmacists needed to staff the pharmacy department. Technologies that can improve accuracy and efficiency include:
- Computer prescriber order entry systems: decision support systems provide information directly to prescribers, so pharmacists do not need to call prescribers so often to correct prescribing errors or clarify the prescription. Only 4.3% of US hospitals have such a system in place,(2) but this number is likely to rise.
- Automated dispensing technologies: including robotic cart filling devices, which are used by 8% of hospitals,(2) and dispensing cabinets located in patient care areas, now used in 58% of US hospitals.(2) Some 72.4% of hospitals using point-of-care dispensing cabinets link them to the pharmacy system, so that nurses cannot obtain a dose until the pharmacist has reviewed the prescription.(2)
- IV admixture technology: robotic mixing devices have become more common for the preparation of complex IV solutions. They are used in 32.1% of hospitals to save time and improve accuracy.(2) Systems that enable the nurse to attach a medication vial directly to an IV bag, mix it and administer the dose are increasing in popularity.(2) This decreases waiting time and pharmacist workload, but may result in fewer orders being reviewed by a pharmacist before the dose is administered.
While some pharmacists lament the transition of traditional activities to technicians and technology, it is essential that this transfer take place if hospital pharmacy departments are to ensure effective, safe and cost-effective medication treatment in hospitals with the currently available workforce.
- American Hospital Association. In our hands – how hospital leaders can build a thriving workforce. Chicago: AHA; 2002.
- Pedersen CA, PJ Schneider, DJ Scheckelhoff. Am J Health-Syst Pharm. In press 2003.
- Available from URL: http://www. aacp.org/, accessed 16 October 2002.
- Ringold DJ, Santell JP, Schneider PJ, Kelly EJ. Am J Health-Syst Pharm. 2000;57:1759-75.
- Available from URL: http://www. ptcb.org/frame.primary.asp, accessed 16 October 2002.