Hospital pharmacy in Canada: ahead of the curve.

In 2008, the American Society of Health-System Pharmacists (ASHP) and its Research and Education Foundation initiated the Pharmacy Practice Model Initiative (PPMI), the goal of which is to “significantly advance the health and well-being of patients in hospitals and health systems by developing and disseminating optimal pharmacy practice models that are based on the effective use of pharmacists as direct patient care providers.” Some of the primary objectives of the PPMI for hospitals and health systems are to describe optimal pharmacy practice models that support the provision of safe, effective, efficient, and accountable medication-related care for patients; to enhance the capacity of pharmacy technicians; to identify core patient-care-related services that should be consistently provided by departments of pharmacy; to foster understanding of and support for optimal pharmacy practice models by patients and caregivers, health care professionals, health care executives, and payers; to identify existing and future technologies required to support optimal pharmacy practice models; and to identify specific actions that hospital pharmacists should take to implement optimal practice models. In November 2010, ASHP held an invitational conference, the Pharmacy Practice Model Summit, at which over 100 pharmacy leaders met to reach consensus on the types of pharmacy practice models that would best serve the needs of both patients and the hospitals and health systems that deliver care to those patients. The consensus recommendations from the summit are numerous, but the following are some of the more noteworthy: • Hospital and health-system pharmacists must be responsible and accountable for patients’ medication-related outcomes. • Drug therapy management should be provided by a pharmacist for each hospital inpatient. • Through credentialling and privileging processes, pharmacists should include in their scope of practice prescribing as part of the collaborative practice team. • All distributive functions that do not require clinical judgment should be assigned to technicians. • Pharmacists providing drug therapy management should have completed an accredited residency program or have equivalent experience. • Pharmacists who provide drug therapy management should be certified through the most appropriate Board of Pharmacy Specialties certification process. The Pharmacy Practice Model Summit did not result in specific recommendations for one or more distinct practice models, but rather led to calls for “bold actions that will propel health-system pharmacy into the future”, with an emphasis on “the imperative for pharmacy departments to reform their deployment of pharmacist, technician, and technology resources.” The Summit’s proceedings included examples of what were referred to as “cutting-edge practice models”. The example of a “cutting-edge” practice model provided for a small community hospital was the deployment of a pharmacist to participate on a collaborative health care team that also includes a physician, nurse, and care manager. However, such models have been in place at many institutions for decades, and it could be argued that describing such practices as “cutting-edge” sets the bar very low. The example of a “cutting-edge” practice model for a large academic medical centre was a decentralized model in which undefined “clinical staff or specialists” were deployed, along with decentralized pharmacy technicians, to multiple patient care areas, with the goal of minimizing pharmacists’ nonclinical work through the expanded use of technology and pharmacy technicians. Although these strategies are important,