Hospital pharmacists are experts in medicines who work as part of multidisciplinary healthcare teams to manage the use of medicines in hospitals. Clinical hospital pharmacists are embedded into medical wards and units and provide clinical pharmacy services to patients at the bedside, with each clinical pharmacist (or a team of) being responsible for patient care in a particular medical unit or ward.
According to the most recent data released by the Pharmaceutical Board of Australia, there were 31,785 registered pharmacists as of May 2019. Hospital pharmacists comprise approximately 20 per cent of the pharmacy workforce.
SHPA supports hospital pharmacists to meet medicines-related service needs so that both optimal health outcomes and economic objectives are achieved for individual Australians, for the community as a whole and for healthcare facilities.
Hospital pharmacists provide clinical pharmacy services at the bedside to inpatients, as well as other clinical areas such as emergency departments and outpatient clinics alongside doctors and nurses. They primarily work in hospitals however, innovation in hospital pharmacy practice has led to the emergence of pharmacists working in community health services, aged care facilities, rehabilitation facilities and general practice clinics.
Roles can vary to suit the organisation and clinical needs of the hospital pharmacy. The majority of hospital pharmacists provide clinical services in their area of speciality however, they can apply their skills in other roles including directors of pharmacy, procurement officers, hospital pharmacy consultants. Education roles are also prevalent such as lecturing pre-registered trainees, delivering presentations to other medical staff or providing tutorial support to undergraduate pharmacy students.
Hospital pharmacists ensure the safe and effective use of medicines by:
- carrying out medication reconciliation on admissions and during changes in the level of care. Many hospital patients require complex and specialised medicines which are often not seen outside a hospital. These patients rely on the hospital pharmacist for information to ensure they know how to use their medicines. This is a vital aspect of the provision of healthcare, as it can reduce medication errors and hospital readmission resulting in an overall improvement in patient satisfaction.
- working in multidisciplinary teams with other health professionals such as doctors and nurses to advise on prescribing and address medicines-related problems.
- dispensing medicines.
- compounding and manufacturing medicines when ready-made preparations are not available.
- conducting medication chart reviews, therapeutic drug monitoring and managing adverse drug reactions to ensure medicines work as required.
- providing comprehensive counselling to patients when they leave the hospital, to ensure patients leave with their medicines, updated medication list and medication management plan to aid the transition back into the community.
- undertaking and contributing to hospital-wide governance activities through medication safety and Quality Use of Medicine activities, eg drug use evaluations, stewardship programs for high-risk medicines.
Activities beyond clinical patient care include:
- educating and training healthcare staff at various levels and patients about medicines management, common drug interactions and appropriate medicines administration
- providing specialised services in medicines information, procurement, quality assurance of medicines
- working at the forefront of innovative and experimental care by investigating medicines in clinical trials.
Most patients will see a pharmacist during their hospital admission. Patients often experience significant changes to their medicines in hospital, and hospital pharmacists are an important source of information.
Hospital pharmacists are usually the last health professional a patient sees before leaving the hospital and are tasked with ensuring patients understand how to manage their medicine.Hospital pharmacists can help educate patients:
- about complex drug therapies, the purpose of the medicine and how to take them
- potential adverse effects and how to manage them
- on the use of medicines in smoking cessation plans, cardiac rehabilitation, disease management and other public health programs.
Hospital pharmacists are an important resource for doctors, nurses and allied health practitioners. They:
- attend ward rounds with doctors and nurses to provide advice on appropriate prescribing and medicines selection
- advise appropriate medicine administration routes and procedures, appropriate dosing and provide solutions which are tailored to individual patient’s needs
- review discharge prescriptions written by doctors to ensure that they are accurate and that the doctor has satisfied all legal and PBS requirements so that it is appropriate for dispensing.
To become a practising hospital pharmacist, individuals need to complete a pharmacy degree at university. A pharmacist must then obtain a Provisional Registration and complete 1,824 hours of supervised practice under an internship. A pharmacist can then apply for General Registration with the Pharmacy Board of Australia after passing their final exams, which allows them to work independently as a pharmacist in Australia.
Pharmacy is a career which requires continual education; the profession is always evolving, therefore, is it important to keep up-to-date with new medicines, new treatments and new skills. In order to be a registered pharmacist, annual Continuing Professional Development (CPD) is mandatory.
The skills required to carry out the role include:
- excellent oral and written communication skills for interacting with patients and other healthcare professionals
- ability to interpret and apply evidence-based research and scientific knowledge to solve problems and make decisions
- teamwork skills to be able to work in multidisciplinary teams
- ability to lead and train others
- attention to detail.
Due to the various roles carried out, many hospital pharmacists specialise in areas of practice such as oncology, haematology, compounding and medicines information after acquiring clinical skills and knowledge specific to an area of practice.
SHPA has formally recognised 26 areas of specialty practice in Australia.
Hospital pharmacy technicians are employed in 95% of hospital pharmacies across Australia. They work under the supervision of hospital pharmacists in dispensing and preparing medicines in hospitals for both inpatients and outpatients. They play an important role in the delivery of hospital pharmacy services and quality patient care.
The practice of hospital pharmacy is expanding in Australia. Economic pressures and increased burden of disease and illness place a demand on the health workforce for effective and efficient use of resources. Non-clinical work currently accounts for 44% of a hospital pharmacist’s workload. As hospital pharmacists are progressively moving away from non-clinical dispensing and medicine supply roles and transitioning to clinical and patient-centred roles, the need to utilise the pharmacy technician workforce is required to support advancing hospital pharmacy services. This support will allow hospital pharmacists to increase the amount of time they have to deliver clinical pharmacy services to patients at the bedside whilst also expanding the role of hospital pharmacy technicians
SHPA continues to advocate for pharmacy technician and assistant members and the broader technician and assistant workforce as part of its overall strategy for pharmacy workforce transformation. To build capacity and to develop advanced practice roles in integrated care, there is a need to build capability not just in the pharmacist workforce but also through developing and expanding the scope of practice of pharmacy technicians and assistants. This is consistent with international strategies for the pharmaceutical workforce promoted by the International Pharmaceutical Federation (FIP) in its Pharmaceutical Workforce Development Goals.
- maintain hospital ward imprest
- assist in the delivery of medicines and supply across the hospital
- enter discharge prescriptions and medication orders into hospital pharmacy dispensing software and prepare medicines to be checked by hospital pharmacists
- compounding and manufacturing injections, infusions, mixtures, creams and ointments for patients
- support communication channels between hospital pharmacists and other health professionals
Technicians’ roles in other countries have expanded substantially to include more clinical activities. This role expansion has also been reflected in Australia where studies report that about 10% of hospital pharmacy technicians now spend time on clinical activities.
Clinical activities relate to tasks that are carried out at the bedside of a patient to optimise the use of medicines and improve health outcomes. These activities in the context of technicians include:
- identify discrepancies between medication orders and items in bedside drawers
- screen medication charts for changes
- assist hospital pharmacists with medication reconciliation and medication chart reviews of patients
- basic medication counselling.
It is important to note the expanded roles are not uniformly exercised by all pharmacy technicians across the country and are at the discretion of pharmacy management.
There are also extended roles in non-clinical settings which technicians can undertake:
- perform final check on medicines in ‘tech-check-tech’ activities.
- manage roles (managing a team, performance reviews, KPIs etc).
A pharmacy technician may have the following qualifications, or equivalent training and experience:
- Certificate III in Hospital/Health Services Pharmacy Support
- Certificate IV in Hospital/Health Services Pharmacy Support
Pharmacy technicians may be required to undertake validation or credentialing in specialised activities such as compounding (non-sterile, aseptic, and cytotoxic), procurement, inventory management, provision of ward-based supply, tech-check-tech or clinical support roles, clinical trials etc depending on institutional or state-based legislative requirements.
The skills required to carry out the role of a hospital pharmacy technician include:
- good communication skills for interacting with other healthcare professionals and patients
- ability to follow directions and instructions in a team environment but also have the ability to work autonomously and manage own workload when required
- high level of accuracy when dispensing prescriptions and supplying inpatient medicines
- strong teamwork skills to work in hospital pharmacy dispensaries.
Comparised with other countries, Australia is less advanced in its use of hospital pharmacy technicians. The future of the role involves formal upskilling of technicians and a clear pathway to career progression. This will standardise the pharmacy technician role across the country to deliver equitable care to improve patient outcomes.
- National Pharmacy Technician Network (NPTN) established to provide a unified and nationally consistent approach to the issues facing pharmacy technicians and assistants in both a professional and educational context
- Pharmacy Technician and Assistant Role Redesign within Australian Hospitals Project (Phase 1 2016)
- SHPA White Paper: Exploring the role of hospital pharmacy technicians and assistants to enhance the delivery of patient-centred care (November 2016)
- Constitutional change: expanded voting membership for technicians/assistants (September 2017)
- Pharmacy Technician and Assistant Role Redesign within Australian Hospitals Project (Phase II, 2017–18): delivering on the five recommendations from the White Paper arising from the Phase 1 Redesign Project
Hospital pharmacy departments are embedded in hospital sites and are an integral part of patient care in hospitals.
A hospital pharmacy department typically comprises of pharmacists and pharmacy technicians, who undertake a variety of clinical and non-clinical tasks including:
- procuring, compounding and dispensing medicines
- advising healthcare professionals and patients on safe, effective and quality use of medicines.
Hospital pharmacy departments usually consist of:
- inpatient and outpatient dispensaries
- manufacturing and compounding facilities
- drug information services
- Quality use of Medicine services
- stewardship services
- clinical trial services.
A hospital pharmacy departments provide different services based on their relative size, ie a large metropolitan hospital may employ many pharmacists and pharmacy support staff and deliver a broad range of services, whereas, a small rural hospital pharmacy department may have only one or two pharmacists on site.
SHPA members lead the pharmacy departments at the vast majority of the 31 principal referral hospitals in Australia, as well as the vast majority of both Public Acute A and Public Acute B hospitals. Therefore, members are concerned with not only the provision of service but the patient outcomes attributable to the practice of hospital pharmacies.
Hospital pharmacy departments offer vast opportunities for SHPA members who want to practice in an environment which draws on the full range of their professional education and training.
Given that 22% of PBS expenditure was accounted for by public and private hospital pharmacy departments in 2016–17, hospital pharmacy plays important role in supporting equitable medicine access and providing high-quality, innovative clinical pharmacy care for all Australians to achieve objectives outlined in the National Medicines Policy.
Hospital pharmacies are where most Australian clinical pharmacy research is undertaken and are involved with the education and training of pharmacists and pharmacy students.
Key functions include:
- ensuring the availability of the right medication, at the right time, in the right dose, for inpatients, outpatients and patients when leaving the hospital
- maintaining hospital formulary to procure medicines, vaccines and intravenous fluids and storing them according to legal, regulatory and storage requirements
- manufacturing and distributing imprest and non-imprest medicines
- compounding specialised injections, infusion and oral mixtures
- dispensing discharge prescription medicines and providing education and counselling to patients
- providing hospital pharmacy residency programs for early-career pharmacists
- providing intern training programs and student placements for prospective pharmacists in training
- undertaking hospital-wide governance activities related to the use of medicines through quality use of medicines and medication safety activities such as drug use evaluations and stewardship programs for high-risk medicines, e.g. opioids, antimicrobials, anticoagulants
- managing and administering clinical trials and participate in research projects
- providing medicines information services to the entire hospital.
Hospital pharmacy departments are led by a director of pharmacy or chief pharmacist.
The structure of a pharmacy department varies to suit the organisational and clinical needs of the hospital. Pharmacists account for the bulk of pharmacy departments and are integral to hospital pharmacy departments. Pharmacy department support staff – such as pharmacy technicians, PBS claims officers and procurement officers – are also important to support the operations of a hospital pharmacy department.
Hospital pharmacy departments are usually only open business hours with variable and limited after-hours services, often due to limited staff resources
This means it is not always possible for all inpatients to be seen and reviewed by a clinical pharmacist which can impact the care delivered to a patient and can also be a barrier to patients receiving medicines supply at discharge. SHPA supports the need for seven-day hospital pharmacy services.
Hospital pharmacy practice fundamentally differs from community pharmacy practice in the following ways:
- a higher level of interaction between prescribers and other health professionals in hospital pharmacy
- greater involvement of hospital pharmacists in the treatment and prescribing decisions, being able to provide direct advice to prescribers
- a large team of hospital pharmacists working together at the same institution
- hospital pharmacists are specialised in specific areas of practice in line with medical specialisations like oncology, respiratory and renal medicine.
Adverse drug reaction
A negative and unintended drug response that occurs at doses normally tested in humans.
A limited stock of medicines that are frequently used in a hospital ward. These medicines are stored in the ward for easy access when they are needed
Medication chart review
A clinical review of the record of orders and administration of medicines to a patient to determine its appropriateness and identify issues or suggestions to improve the quality of care
Process of obtaining, verifying and documenting an accurate list of a patient’s current medications on admission to ensure it is consistent with their therapy at all transition points within the hospital.
Providing information to patients about their medicines, how to take medicines and what adverse effects to anticipate and monitor.
Therapeutic drug monitoring
Interpreting and monitoring of measured drug concentrations in patients to optimise medicine efficacy and minimise toxicity.
Programs ensure the best possible use of high-risk medicines such as antimicrobials, anticoagulants and opioids, across the hospital, by monitoring their use and coordinating interventions.