Medication safety in the hospital setting - role and tools for the Swiss hospital pharmacist

The role of Swiss hospital pharmacists has changed substantially over the last decade. In the past, the
pharmacist’s responsibility centered upon the timely dispensing and delivery of medication. However, at
the present time, the hospital pharmacist is involved as a critical partner in the entire medication use
process, focusing on the safe and effective use of drugs.
The aims of this work are to 1) Describe Swiss hospital pharmacists’ perceptions of their current and
future role in medication safety and 2) Identify efficient tools to allow hospital pharmacists to proactively
address medication safety.
1) Survey of medication safety activities in Swiss hospitals: The role of the hospital pharmacist
A structured online survey was sent to all 41 Swiss hospital pharmacy directors to assess current
medication safety activities.
The 26 respondents (response rate 62%) employed an average of 0.76 pharmacist full-time employees
per 100 beds (European average: 1 full-time employee per 100 beds). Swiss hospital pharmacists are
participating in pharmacy & therapeutics committee meetings (23/26 hospitals, 88%) and providing
pharmacovigilance (12/26, 46%). Clinical pharmacy services are offered in 25/26 institutions (96%)
Other activities identified among 22 participants included the implementation of eHealth tools (11/22
hospitals, 50%) and the increase of clinical pharmacy services (4/22, 18%).
Tools most likely used in medication safety activities among 24 respondants were direct observation
(23/24, 96%), critical incident reporting system (20/24, 83%), and chart review (16/23, 67%). Surveys
(7/24, 29%) and analysis of MedWatch data (8/26, 33%) were less often utilized. Of the respondents,
38% (9/24) were not familiar with the trigger tool technology.
2) Medication safety assessment methods: How can institutions efficiently address drug-related
problems?
Organizations, including the Institute for Safe Medication Practice, recommend different methods for the
assessment of medication safety, including incident reporting (IR), direct observation (OB), chart review
(CH) and trigger tool analysis (TR). However, the optimal method for identifying drug-related problems
(DRPs) is unknown.
Pubmed, Embase and Scopus databases were systematically searched for any comparative study in
which IR, OB, CH and TR were compared to one another. Twenty-eight studies were included in this
review.
All four assessment techniques have different strengths and weaknesses. Overlap between different
methods in identifying DRPs is minimal. While TR appears to be the most effective and labor-efficient
method, IR best identifies high severity DRPs. Considering the lack of overlap and the ability of each
method to identify different medication errors, the use of a combination of methodologies is strongly
recommended.
Different examples applying methods recommended for medication safety assessment are provided.
Although staff resources are limited, our survey showed that Swiss hospital pharmacists are proactively
participating in medication safety activities.
Several available methods like trigger tool and incident reporting allow for an effective, labor-efficient
approach to medication safety assessment. With Swiss physicians increasingly dispensing drugs and the
discipline of pharmacology also in the hands of physicians, comprehensive medication safety
assessment potentially creates important professional opportunities for hospital pharmacists in
Switzerland.