Millcroft Hospital Pharmacy Leadership Conference - June 1 - 3, 2007

Theme: Hospital Pharmacy Practice Today - Just How Good are We?

Group Reports:
Preparing For Our Future

In their final set of small group discussions, participants zeroed in on a definition of the services that hospital pharmacy should provide, identified barriers and implementation strategies to enhancing or introducing these services, and suggested some ways in which the Hospital Pharmacy in Canada Report could measure progress. Participants expressed agreement on the importance of assessing the current environment, defining clear directions for change or improvement, and providing strong leadership in those directions. They recommended an abundance of concrete actions that could advance hospital pharmacy practice from the systems/vision level right down to daily practice in their organizations.

Most recommended starting by comprehensively comparing current and proposed practice against the evidence. Specific research goals were to: assess the current state of pharmacy practice, conduct a gap analysis, produce an environmental scan of standards used by compatible stakeholders, and provide an honest assessment of the competencies that currently exist.

A consistent message concerned the need to base decisions about how to lead evolving pharmacy practice on strong, clear evidence. Organizational and leadership priorities must be system-wide and must bridge the disconnection between common practice and what the evidence supports. Evidence-based practice must be more than a philosophical commitment, participants said. Evidence-based practice must be embedded in CSHP’s Vision 2015, CPhA’s Blueprint for Pharmacy, CCHSA and Canadian Hospital Pharmacy Residency Board (CHPRB) standards, and CSHP standards and guidelines. The Hospital Pharmacy in Canada Report should be used to map actual practices against standards and to evaluate standards and ROPs against what the evidence supports.

Participants spoke of the importance of identifying priorities by service or specialty and of defining both discipline-exclusive and shared scope of practice for interdisciplinary teams. Roles in the team must be clearly defined and must be based on grassroots realities and needs, rather than from a top-down directive. Successful collaboration will be the key to advancing practice. Opportunities must be seized to communicate across disciplines, geographic boundaries, administrative structures, professional bodies, and with patients and the public. One group identified the Hospital Pharmacy in Canada Report as a practical mechanism to provide explicit examples of linkages between standards and outcomes.

Group members recommended ongoing evaluation to ensure efforts to expand scope of practice and stay on course. Concrete measures are needed to determine the extent of clinical pharmacist involvement, such as comparing the number of rounds regularly attended by pharmacists against the total number of rounds or the percentage of high-risk, high-alert medications for which specific protocols exist. Internal leaders were advised to ask themselves the following questions:

•	Do you have a strategic plan for advance practice?
•	Is it evidence-based?
•	Is it being followed?

Several participants questioned whether evidence really exists to show that pharmacy directors have an impact on care. Citing the current Hospital Pharmacy in Canada Report results, they noted that change was limited, except where it was mandated by regulation or legislation. They challenged pharmacy leaders to adopt a coordinated approach, choose some concrete actions, implement them, and then assess the results. They recommended prioritizing opportunities that add the most value and that are within pharmacy’s sphere of influence. Pharmacy leaders can be held accountable for the actions they can control. Basing activities on the Chartered Quality Institute will ensure continuous improvement.

The groups identified several specific actions that could be taken immediately:

•	Standardize and limit the number of drug concentrations available.
•	Segregate/ differentiate various heparin products.
•	Implement a formally approved list of unacceptable dangerous abbreviations and audit the number of times dangerous abbreviations are used.
•	Clearly define medication reconciliation within particular institutions.
•	Create opportunities for staff to share evidence/experience about role development.
•	Integrate the correction of safety gaps into clinical practice and service planning.
•	Ensure that every patient has a medication history that features a face-to-face meeting with a pharmacist.

To move practice forward, pharmacy leaders need to invest in and drive practice-based research and research collaboration, participants said. Pharmacy leaders need to work within their agencies and together to market pharmacy services through consistent messages about the roles of individual pharmacists and professional bodies. Mechanisms must be identified to help pharmacy leaders engage with educators, as individuals and as a group, to influence curriculum and training approaches. Equally important is to build consensus about core pharmacy services across a continuum of care.

One group reminded participants of the many individuals at the conference who are already doing a very good job in advancing practice. They recommended identifying these “stars” and inviting them to serve as facilitators at a meeting using a “Hilton Head” consensus approach. Based on the ICU collaborative model, the meeting would identify high-priority services, develop a plan for implementation, and create external validation processes. Consensus for next steps would be reached because everyone would be addressing the same priorities. The results could be taken to CCHSA, ISMP, and other bodies, to be used as part of the validation process.

Several participants expressed enthusiasm for maintaining momentum and holding another meeting designed to distil the directions, actions, and ideas that had been explored at this conference. A group member suggested holding such a meeting in conjunction with the CSHP Annual General Meeting. The group mandated several key players to explore how best to organize a follow-up meeting. Echoing the need for momentum, one participant observed: “We achieve sustainability, and keep our vision forever green, as we continue to discover new best practices and work together to form a tsunami of effort that is tightly directed.”