hospital pharmacy in europe 2010 survey... · dr. roberto frontini, president eahp...

Dr. Roberto Frontini, President EAHP [email protected]

Hospital Pharmacy in Europe

The EAHP survey 2010

© EAHP Dr. Roberto Frontini ASHP Midyear New Orleans 05/12/2011

EAHP

Methodology of the survey

Results

General frame, staffing

Procurement

Production & Quality assurance

Clinical services

Patient safety

Education & Research

Outline

2

European Association of Hospital Pharmacists

(EAHP)

Created in 1972 in The Hague (NL)

Federation of National Associations of

Pharmacists

Members of the Council of Europe

31 countries: 24 EU + 7 outside EU

More than 21,000 Hospital Pharmacists

working in hospitals and other healthcare

facilities in Europe

3 © EAHP Dr. Roberto Frontini ASHP Midyear New Orleans 05/12/2011

EAHP Members

Austria Belgium

Bosnia Herzegovina Bulgaria

Croatia Czech Republic

Denmark Estonia

Finland France

Germany Greece

Hungary Ireland

Italy Latvia

Lithuania Luxembourg

FYROM Netherlands

Norway Poland

Portugal Serbia

Slovakia Slovenia

Spain Sweden

Switzerland Turkey

United Kingdom

31 members



4th pan-European survey (1995/2000/2005/2010)

87 questions on hospital pharmacy

practice

Direct approach through national

coordinators of every Head of Pharmacy

of the member states (4,747 in total)

Data collection Oct.2010 -Jan. 2011

Total number of answers 1,238 = 26.1%

Methodology

5

Methodology: Response rate

green = > 20 (30)%

yellow = 10-20%

orange = < 10%

red = no answer

grey = no member


Max % = 100% (Fyrom)

Max # = 130 (Germany)


By insufficient response rate (<25%) check

by national coordinators

Decision on inclusion in national reports

based on the national distribution of hospital

types and the distribution of answering

hospitals

Rates (%) always in relation to the total

number of answers to the question

Response rate for each question ranges

between 5.0% and 91.0%

Methodology

7


The response rate varies substantially from country

to country and does not reflect the weight of the

population of that country in Europe

Language barriers might have created a bias of

answering pharmacists

Some of the questions might have been

misunderstood by non native English speakers

Enlargement of EU to eastern countries might have

created a bias in relation to past survey

Limitations by bias

8

General frame

Staffing


0

500

1000

1500

2000

2500

3000

3500

Au

str

ia

Be

lgiu

m

BiH

Bu

lga

ria

Cro

ati

a

Czec

h R

ep

ub

lic

De

nm

ark

Esto

nia

Fin

lan

d

Fra

nce

FY

RO

M

Germ

an

y

Gre

at

Bri

tain

Gre

ece

Hu

ng

ary

Irela

nd

Italy

Latv

ia

Lit

hu

an

ia

Lu

xe

mb

urg

Ne

the

rlan

ds

No

rwa

y

Po

lan

d

Po

rtu

gal

Serb

ia

Slo

vak

ia

Slo

ven

ia

Sp

ain

Sw

ed

en

Sw

itzerl

an

d

2010 2005 2000


General Frame: Number of beds served

10

0

100

200

300

400

500

600

700

800

2000 2005 2010

Sum Complete Partial

General Frame: Number of beds served


Sum 2010 2005 2000

Average 708 703 648

Median 427

Hospitalisation


General Frame: Ownership

12

Public hospital (i.e. owned by the

government) 81%

Church affiliated hospital

4%

Private hospital 10%

Other 5%

Hospital ownership in 2010 (n= 1102)

Question to audience


The biggest group of staff in European Hospital

Pharmacies is

Green = Bachelor of Pharmacy

Blue = Qualified Technician

Yellow = Unqualified Technician

Red = Pharmacist


Staffing: Qualification of Staff in Pharmacies (FTE)

14

Qualified pharmacy

assistants / technicians

32%

Pharmacists 27%

Non qualified pharmacy assistants

14%

Administrative Staff 8%

Others 5%

Trainee pharmacists (interns)

4%

Nurses 3%

Cleaning personnel

3%

Pharmacy students 3%

Prescriptionists (Bachelor of Pharmacy)

1%

0.33

3.47

0,00 0,50 1,00 1,50 2,00 2,50 3,00 3,50 4,00

GermanyCroatia

HungaryLithuania

AustriaSlovakia

PolandFYROMSerbiaFranceGreece

NetherlandsLatvia

BulgariaSlovenia

Czech RepublicFinland

DenmarkBelgiumEstonia

ItalySweden

LuxemburgSpain

BiHNorwayIreland

PortugalSwitzerland

Great Britain


Staffing: Pharmacists/100 beds (complete + partial hospitalisation)

15

2010 2005 2000

Average 1.0 0.9 0.7

Median 0.7

1.4

10.6

0 2 4 6 8 10 12

CroatiaGermanyLithuania

AustriaHungary

LatviaEstonia

BulgariaFYROM

SlovakiaSerbia

GreeceBiH

SwedenSlovenia

PolandCzech Republic

FinlandIreland

LuxemburgItaly

BelgiumNorway

DenmarkFrance

NetherlandsPortugal

SpainSwitzerland

Great Britain


Pharmacy staff / 100 beds (complete + partial hospitalisation)

16

2010 2005 2000

Average 3.1 3.6 2.9

Median 2.6

Staffing: Shortages

17

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%G

reece

Serb

ia

BiH

Hu

ng

ary

Gre

at

Bri

tain

Italy

Slo

ven

ia

FY

RO

M

Slo

vak

ia

Irela

nd

Po

rtu

gal

Czec

h R

ep

ub

lic

Po

lan

d

Sw

itzerl

an

d

Bu

lga

ria

Be

lgiu

m

Cro

ati

a

Ne

the

rlan

ds

Sp

ain

Lu

xe

mb

urg

Fin

lan

d

Au

str

ia

De

nm

ark

Latv

ia

Fra

nce

No

rwa

y

Germ

an

y

Sw

ed

en

Esto

nia

Lit

hu

an

ia

Have you experienced any shortages of pharmacists (n=939) or Technicians (n=936) in your hospital pharmacy in the past 2 years?

Pharmacist Technicians


Staffing: Specialisation in Hospital Pharmacy

18

0 10 20 30 40 50 60 70 80 90 100

EstoniaFYROM

LithuaniaSlovakiaDenmarkSweden

LatviaCroatiaFinlandNorwayPoland

Czech RepublicGreat Britain

SloveniaBulgaria

GreeceAustria

SwitzerlandBiH

LuxemburgSerbia

PortugalHungary

GermanyNetherlands

SpainItaly

FranceBelgium

Ireland

% 2010

Average 49.5

Median 33.3


Staffing: % of pharmacies with internal CPD

19

* Total >100% as partially more than 1 target group


0,0

10,0

20,0

30,0

40,0

50,0

60,0 50.1

40.2

20.8

Pharmacists

Technicians

Others

Target Group

*

Staffing: Financial support of CPD

20

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0

75.6

16.4

38.7 Time off

Full reimbursement

Partial reimbursement

*

* Total >100% as partially more than 1 system


General frame / Staffing

21

The average number of bed served by one pharmacy did not change since 2005 but there is a decrease of complete and an increase of partial hospitalisation

Pharmacists (27%) and qualified technicians (32%) cover 60% of the total staff

The number of pharmacists/100 beds varies from 0.33 (Germany) to 3.47 (UK)

Only few countries did not experience shortages for pharmacists and technicians

49% of the pharmacists are specialised in Hospital Pharmacy


Procurement


Purchasing groups

23

No group purchasing

55%

Local group 6%

Regional group 17%

National multi hospital alliance

15%

Multiple answers

7%




The major source of procurement in European

hospital pharmacies is

Green = Industry

Blue = Wholesalers

Yellow = Own production

Red = Other pharmacies

Procurement’s source

25

Wholesaler 51%

Industry 46%

Other hospital

1%

Own production

2%


Purchasing: Responsibility for medical devices

26

0

10

20

30

40

50

60

70

80

90

100

55.8

47.2

56.2

48.7

Selection

Evaluation

Purchasing

Vigilance

Selection 2010 2005 2000

% 55.8 77.8 84.6


Formularies

27

246

1,982

0 500 1000 1500 2000 2500

BiHEstoniaNorway

DenmarkHungary

ItalyLatvia

LithuaniaBulgariaSlovakia

PolandFinlandSerbia

Czech RepublicLuxemburg

SpainBelgiumPortugal

CroatiaGermany

FranceSwitzerland

GreeceSweden

NetherlandsIreland

SloveniaAustria

Great Britain

Number of Products in formulary

2010 2005 2000

Average 1,006 1,031 700

Median 960

2010 2005 2000

% Hospitals with 77.1 82.4 85.3


Formularies: Information content

28

0

10

20

30

40

50

60

70

80

90

100

43.6

52.1

56.8

14.4

28.9 29.9

Price

Dosage

Hospital drug policy

Local antibiotics sensitivity

Antibiotics surgical prophylaxis

Antibiotics guideline

*

* Total >100% as partially more than 1 information


Distribution

29

0

10

20

30

40

50

60

70

80

90

10094.2

6.3

7.3 2.4

10.9

Manual picking

Stock robotic

Unit picking automat

Unit dose (patient supply)

Automated cabinets

2010 2005

Total robotic % 10.1 3.3 *

* Total >100% as partially more than 1 system


Procurement

30

45% of pharmacies are purchasing in groups

Industry (46%) and wholesalers (51%) are the most important suppliers

55.8% of the pharmacies are responsible also for medical devices

Formularies have an average of 1,006 products with a broad range from 246 to 1982 and an increase since 2000 by 43.7%

94.2% of the pharmacies distribute by manual picking and the total of automation is still only 10.1%


Batch production

32

0

10

20

30

40

50

60

70

80

90

100

29.9

48.4

16.3

Sterile pharmaceuticals

Non sterile pharmaceuticals

Laboratory reagents

% 2010 2005 2000

Sterile 29.9 54.9 66.8

Non sterile 48.4 92.3 92.1

Reagents 16.3 30.1 33.6




Sterile production of individual preparations is

performed by

Green = 10% of Pharmacies

Blue = 80% of Pharmacies

Yellow = 30% of Pharmacies

Red = 50% of Pharmacies

Individual prescriptions

34

0

10

20

30

40

50

60

70

80

90

100

48.5

64.9 Sterileprescriptions

Non sterileprescriptions

% 2010 2005 2000

Sterile 48.5 66.2 71.0

Non sterile 64.9 91.6 92.5


GMP

35

0 10 20 30 40 50 60 70 80 90 100

SlovakiaLithuania

EstoniaLatvia

BulgariaGreeceAustriaSerbia

FYROMBelgium

GermanySlovenia

LuxemburgPoland

BiHItaly

HungaryPortugal

CroatiaIreland

SpainCzech Republic

FranceSwitzerland

NorwayNetherlands

DenmarkFinland

Great BritainSweden

% 2010

Average 58.5


External quality certification

36

0

10

20

30

40

50

60

70

80

90

100

27.7

2.4

16.6

ISO 9001

ISO 14001

Others

% 2010

External certification 46.8



37

The batch as well as the individual production of sterile and non sterile medicines decreased significantly since 2000

In average 58.5% of pharmacies follow GMP guidelines with a broad range between countries from 0% to 100%

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


Clinical services




Pharmacists are working at the ward in

Green = 10% of Hospitals

Blue = 80% of Hospitals

Yellow = 25% of Hospitals

Red = 95% of Hospitals

Presence of pharmacists at ward

40

77%

16%

4%

3%

23%

* pharmacists at least 50% of time at ward

no yes occasionally yes daily yes decentralised*


Clinical services by technicians

41

25% 75%

yes no

0

10

20

30

40

50

60

70

80

90

100

84.32

41.2

20.2 22.6 25.1 25.1

ward stock

drug information

patient counselling

member ofcommittees

member of audit

other

*

* Total >100% as partially more than 1 activity

% of yes


Outpatients services

42

Yes, through the hospital in

inpatient pharmacy

department

49%

Yes, through a separately licensed

outpatient pharmacy

8%

Both

9%

No

34%


Clinical consultations

43

0

10

20

30

40

50

60

70

80

90

100

14.9

6.0

41.3

21.1

11.7 15.4

Anticoagulants

Lipids drugs

Antibiotic therapy

Cytotoxic inducednausea

Immunosuppresivetherapy

Others


Clinical services nutrition

44

10%

32%

No

58% Yes

42%

Participation in TPN team only

Participation in TPN/Enteral nutrition team

Not involved in decisions about nutrition prescription


Clinical services pharmacokinetic

45

No 81.1%

inpatients

0.2%

outpatients

13.5%

Both 5.3%

Yes 18.9%


Drug information by pharmacist

46

29% 71%

yes no

Yes 2010 2005 2000

% 29.0 29.5 29.2


Documentation of services

47

No

76%

inpatients

14%

outpatients

2% Both

8%

Yes*

24%

* At least 80% of interventions


Clinical services

48

Only 23% of pharmacies offer clinical services at the ward and only 7% do it on regular base

Clinical services for outpatients are common (67%)

The major field of consultations are antibiotics, cytotoxic induced nausea and nutrition.

Drug information by pharmacists is implemented only in 29% of the hospitals and constant since 2000

Only 24% of the pharmacies document at least 80% of their interventions


Patient safety


Policy of hospital in safe medication

50

74%

26%

At least 1 None

0

10

20

30

40

50

60

70

80

90

100

51.1

38.1 35.2

55.1

policy on safemedication practice

committee for safemedication practice

dedicated teamdoctor/pharmacist/nurse

clinical incidentreporting system (CIRS)

% of ‘at least 1’

*

** Total >100% as partially more than 1 activity


Patient safety system implemented in hospital

51

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Greece

Lithuania

FYROM

BiH

Estonia

Croatia

Latvia

Slovakia

Austria

Bulgaria

Slovenia

Germany

Italy

Hungary

Poland

Serbia

France

Portugal

Czech Republic

Ireland

Finland

Spain

Switzerland

Netherlands

Norway

Belgium

Great Britain

Sweden

Denmark

Luxemburg

% 2010

Average 55.0




The most common activity for save medication in

European hospitals is

Green = Therapeutic drug monitoring

Blue = Drug information

Yellow = Unite dose dispensing

Red = Centralized cytotoxics reconstitution

Implemented activities in safe medication practice*

53

* At least 50% of activities on regular base ** Total >100% as partially more than 1 activity


**

80%

20%

At least 1 None

0

10

20

30

40

50

60

70

80

90

100

22.1

44.1

9.2

25.5

54.6

17.6

22.7

3.8

unit dose dispensing

centralized cytotoxicreconstitution

centralized intravenousadministration service

therapeutic drugmonitoring

drug information

patient visits atadmission

patient counselling atdischarge

other


Patient care of adverse reactions

54

No 46%

Inpatients

31%

Outpatients

4% Both 19%

Yes

54%


Activities to avoid medication errors

55

No 47%

Inpatients

31%

Outpatients

3% Both 19%

Yes

53%


Documentation of interventions in medical record

56

* At least 80% of the interventions

No 84%

Inpatients

11%

Outpatients

1% Both 4%

Yes

16%


Education activities in safe medication

57


76%

24%

At least 1 None

0

10

20

30

40

50

60

70

80

90

100

46.6 49.0

53.3

24.2

4.4

national congress

CPD programmes

incidentalseminars

education includedin facultyprogramme

other

*

** Total >100% as partially

more than 1 activity


SOP for withdrawing own products

58

64%

36%

yes no

Yes 2010 2005 2000

% 64.1 55.5 61.0


Patient safety

59

Patient safety is in focus of hospital pharmacies and 80% of them 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 1 education activity in safe medication

64% of pharmacies with production have a SOP for withdrawing own products


Affiliation with teaching programmes

61

68%

32%

At least 1 None

0

10

20

30

40

50

60

70

80

90

100

58.1

73.7

60.4

43.9

University PharmacySchool

Nursing school

University MedicalSchool

College offeringpharmacytechnician training


*




Training of students

62

0

10

20

30

40

50

60

70

80

90

10081.5

48.2

55.5

Pharmacystudents

post graduatepharmacy trainingprogramme

Technicianstrainingprogramme

68%

32%

At least 1 None% of ‘at least 1’

*






How many hospital pharmacies are involved in

research

Green = 10% of Pharmacies

Blue = 90% of Pharmacies

Yellow = 30% of Pharmacies

Red = 60% of Pharmacies

Participation in research

64

39%

61%

None At least 1 field

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0

90,0

100,0

A B C

41.2

18.2 15.4

17.5

28.5

18.5

2.4

0.7

1.4

Outpatients

Inpatients

Both

∑ 47.3%

∑ 35.3%


*



A) Research (including

clinical drug trials)

B) Drug use evaluation

programmes

C) Pharmaco-

epidemiological

studies

∑ 61.1%



65

Hospital pharmacies are highly involved (68%) in teaching programmes for health professionals including physicians, pharmacists, technicians and nurses

61% of hospital pharmacies are involved in clinical research


Take home messages

66

The 4th pan-European survey on Hospital Pharmacy is based on 1,238 (26.1%) answers out of all European pharmacies (# = 4,747)

Despite some unavoidable bias, the survey is a valuable source of information about the status quo of hospital pharmacy in Europe

The data from the survey highlight priorities for actions to achieve the state of the art as postulated in the Basel statements of FIP


Thanks for great input and

dedication!

67

Tajda Miharija Gala University Medical Centre Ljubljana

Prof. Juraj Sykora Pharmacy Department SZU

National Cancer Institute Bratislava

EAHP board members responsible for the survey


Thanks to all national

coordinators!

68

AUSTRIA Silvia HETZ

BELGIUM Raphaël COLLARD

Sofie VERBEKE

BOLGARIA Nina PURVANOVA

Ilko GETOV

BIH Enisa SALIHEFENDIĆ

Tijana MARINKOVIĆ

CROATIA Marijeta DUKARIĆ KURTIĆ

Ana CRNKOVIĆ

CZECH REP. Helena ROTTEROVA

Petr Horak

DENMARK Helle McNULTY

Gitte NIELSEN

ESTONIA Tiia VALS

FINLAND Hanna TOLONEN

FYROM Maja KOVAČEVA

FRANCE André RIEUTORD

GERMANY Steffen AMANN

GREECE Despina MAKRIDAKI

HUNGARY Gyöngyver SOOS

IRELAND Joan PEPPARD

ITALY Ilaria UOMO

LATVIA Valdis PIRSKO

LITHUANIA Birute VARANAVICIENE

LUXEMBOURG Patrick ENGELHARDT

NETHERLANDS Rob MOSS

Hans OVERDIEK

NORWAY Frank JORGENSEN

PORTUGAL Aida BATISTA

POLAND Dariusz SMOLINSKI

SERBIA Dragana RAJINAC

SLOVAKIA Juraj SYKORA

SLOVENIA Tajda MIHARIJA GALA

SPAIN María José TAMES

Eduardo ECHARRI

SWITZERLAND Susanna KUSSMANN

SWEDEN Per Nydert

UK Richard CATELL


hospital pharmacy in europe 2010 survey... · dr. roberto frontini, president eahp...

Documents