A Global Strategic Plan for Hospital Pharmacy Practice

Overview • Brief introduction to FIP, the International Pharmaceutical Federation • Describe the FIP Global Survey of Hospital Pharmacy Practice • Describe the FIP Global Conference on the Future of Hospital Pharmacy • The Basel Statements on the Future of Hospital Pharmacy 2

• • International Comprised of 120 member organizations in 82 countries Pharmaceutical In total, represents 2 million pharmacists, world-wide Federation Over 4000 individual members (FIP) Headquarters, The Hague, The Netherlands • Off-site office in Geneva, Switzerland • Relatively small staff (12) • FIP Mission Statement: • “To improve global health by advancing pharmacy practice and science to enable better discovery, development, access to and safe use of appropriate, cost-effective, quality medicines worldwide. ” 3

Structure of FIP 4

• Summary of Structure of Bureau, the FIP board of directors – Chair, FIP President, Kamal Midha (Canada) FIP • Executive Committee – President, Scientific Secretary (Vinod Shah, India) and Professional Secretary (Henri Manasse, USA) • General Secretary, CEO of FIP – Ton Hoek (The Netherlands) • Board of Pharmaceutical Science (BPS) – Chair, Mitsuru Hashida (Japan) • Board of Pharmaceutical Practice (BPP) – Chair, Phil Schneider (USA) – 9 Sections, including Hospital Pharmacy Section (HPS) – Young Pharmacists Group 5

• FIP Global Representation FIP serves as liaison between pharmacy and other NGOs of Pharmacy • In ‘official relations’ with WHO • In ‘working relations’ with UNESCO • Recent achievements • WHO UNESCO FIP: Global Tripartite Education Action Plan 2008 – 2010 • FIP Collaborating Center for Pharmacy and Health, School of Pharmacy, University of London 6

FIP Global Representation of Pharmacy • Recent achievements • A Core Competency Framework for International Health Consultants (publication) • BE AWARE: Helping to Fight Counterfeit Medicines, Keeping Patients Safer (publication) 7

• • • Current FIP Activities WHO International Medical Products Anti-Counterfeiting Taskforce (IMPACT) Global Network of Pharmacists Against Tobacco International Alliance for Patient Safety Good Pharmacy Practice Guidelines and implementation initiatives Annual Congress • 2008, Basel, Switzerland • 2009, Istanbul, Turkey • 2010, Lisbon, Portugal • Each sections within BPP has active agenda, programming, etc. 8

FIP Global Survey of • FIP Board of Pharmaceutical Practice Special Project Hospital • Support from Cardinal Health also acknowledged Pharmacy • Objectives Practice – Conduct an exhaustive survey of hospital pharmacy practice describing and measuring the breadth and scope of hospital pharmacy practice worldwide – Establish a global comparative benchmark for hospital pharmacy practices – Provide background information for the Global Conference and future HPS programming 9

Methods • Survey methods developed in collaboration with Global Conference Steering Committee and HPS officers • Drew from regional, national and international surveys from Europe (EAHP), UK, USA (ASHP) and Australia • Sample frame was national respondents from every United Nations-member country – Sought broadest representation in sample, with understanding that depth of response would be lacking • Waiver of approval granted by Human Subjects Committee at University of Wisconsin – Madison, USA • Principal Investigators, Lee Vermeulen and Fred Doloresco, University of Wisconsin – Madison and UW Hospital and Clinics 10

• Methods, Draftcontinued instrument developed and reviewed extensively – Questions drawn from previous surveys, Joint Commission International accreditation standards and other sources – Definitions of terms developed and included with survey – Designed to inform all 6 Global Conference working group themes • Instrument pilot tested by respondents who were native speakers of English, French, Spanish, and Mandarin • Final instrument included 75 questions examining scope and breadth of hospital pharmacy practice – Survey instrument translated from English to French and Spanish 11

Methods, continued • Survey evaluated aspects of practice in 2 dimensions • Scope of practice – Activity is not in the scope of hospital pharmacy practice in my country – This activity is in the scope of hospital pharmacy practice in my country but is not a requirement – This is within the scope of pharmacy and is a legal/ regulatory requirement in my country • Breadth of practice; how common is the practice? – – – <3% (very few) of hospitals 3 – 40% (few) of hospitals 41 – 60% (some) of hospitals 61 – 97% (most) of hospitals >97% (nearly all) of hospitals 12

Methods, continued • Respondents were recruited to complete the survey – FIP member organizations initially – HPS members – Widespread recruitment effort with support of EAHP and many other organizations and individuals • Respondents agreeing to participate in survey were sent instrument for completion • Recruitment and response collection occured from July 2007 to April 2008 • Analysis included comparisons of responses by geographic region, WHO region and level of economic development (HDI) 13

Results • Responses received from 85 of 192 UN-member countries (44%) – Responses received from countries representing 5. 4 billion people (83% of global population) • Wide range of national characteristics included in respondent sample – Approximately 1/3 of countries from each of the World Health Organization regions – Range of population size, from 40, 000 to 1. 3 billion – Approximately 1/3 of countries from each Human Development Index classification 14

• • • • Results Respondent Algeria Argentina Nations Australia Austria Bahamas Belgium Bosnia and Herzegovina Brazil Brunei Darussalam Canada Chad China-Taiwan Costa Rica Côte d'Ivoire Croatia • • • • • Czech Republic Democratic Republic of the Congo Denmark Ecuador Eritrea Estonia Ethiopia Finland France Germany Ghana Greece Guyana India Indonesia Iran (Islamic Republic of) Iraq 15

• • • • Results Respondent Ireland Nations Japan Kenya Latvia Lebanon Lesotho Luxembourg Madagascar Malta Mexico Namibia Nepal Netherlands New Zealand Nigeria Norway • • • • • Pakistan Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Romania Russian Federation Rwanda Saint Kitts and Nevis Serbia Sierra Leone Singapore Slovakia Slovenia 16

• • • • Results Respondent South Africa Spain Nations Sudan Suriname Sweden Switzerland Thailand The former Yugoslav Republic of Macedonia Timor-Leste Trinidad and Tobago Turkey Uganda United Arab Emirates United Kingdom of Great Britain and Northern Ireland • • • United Republic of Tanzania United States of America Uruguay Venezuela (Bolivarian Republic of) Viet Nam 17

Results: Source of Response Information 18

Results: Practice Model • Pharmacist practice model used in hospitals in respondent nations 19

Results: Spending on HIV Spending • Proportion of the nation’s total (pharmacy and non-pharmacy) healthcare budget spent on HIV care 20

Results: Spending on Tuberculosis • Proportion of the nation’s total healthcare budget spent on tuberculosis care 21

Results: Spending on Malaria • Proportion of the nation’s total healthcare budget spent on malaria care 22

Results: Pharmacist Vacancies • There are current vacancies that cannot be filled with qualified pharmacists due to a lack of qualified individuals in my country. 23

Results: Gender Mix of Pharmacists • Please describe the percentage of female pharmacists in hospitals in your country. 24

Results: Technician Workforce • The pharmacy department includes technical staff in addition to pharmacists. – The use of technicians to augment the pharmacy workforce is widespread. 25

Results: Ability to Obtain Medicines • With the exception of limited, temporary medicine shortages, hospitals are able to easily obtain medications that are on the formulary or essential medicines list. – Increasing HDI category correlates with an increased ability to obtain medications – AFRO and EMRO nations reported difficulties in obtaining medications 26

Results: Unit Dose Dispensing • Hospitals distribute the majority of medicines to patients in the hospital as unit doses. – A high proportion of low HDI nations require and have implemented unit dose dispensing – A third of low HDI nations report using unit dose dispensing in >97% of hospitals 27

Results: Access to Medical Records • Pharmacists in hospitals have access to patient files (such as the medical chart or record). – Little variation across HDI category – Similar results for population and WHO region 28

Results: Medical Libraries • Pharmacists in hospitals have access to a medical library with medicine references while they are working. – Pharmacists in a majority of hospitals in high HDI score nations, but not in medium or low HDI score nations, have access to medical libraries or medicine references 29

Results: Pharmacist Prescribing • Pharmacists in hospitals are able to prescribe only under certain circumstances (such as under an agreement with a doctor). – Pharmacist prescribing (with or without an agreement with a doctor) is not employed in a majority of hospitals 30

Survey Limitations • Difficult for any one respondent to reflect upon the nature of pharmacy practice in an entire country – Future HPS should include national sub-samples for more accurate representation of practice patterns • Definitions that we all sometimes take for granted are often not consistent from country to country (not simply a language issue!) 31

• Next Steps for the Global Targeted survey results will be used to inform discussion Survey of consensus statements during Global Conference • Results will provide guidance to HPS leadership in developing future programming for Section sessions in years to come • Full technical report to be made available and manuscript will be part of Global Conference proceedings • Istanbul Congress, 2009, session to be held to identify future plans for more detailed survey efforts on targeted aspects of hospital pharmacy practice, and to monitor trends in practice development over time 32

globalhosp@fip. org www. fip. org/globalhosp 33

• • Background: FIP Global In Conference international leaders in hospital pharmacy December 2005 on met in New Orleans at the ASHP Midyear Clinical Meeting the Future of Common concerns were observed, common global standard of Hospital practice was missing Pharmacy • The FIP Hospital Pharmacy Section was chosen as host for global consensus conference • A steering committee was formed – Several subcommittees started to work • Meeting took place 30 – 31 August 2008 in Basel 34

• • Objectives: FIP Global To. Conference on build a shared vision among hospital pharmacy opinion leaders around the world about the preferred future of hospital pharmacy the Future of practice. Hospital To identify strategic goals for global advancement of hospital pharmacy that are relevant to the needs of each participating Pharmacy country, and to identify opportunities for global cooperation that will allow every country to achieve their goals for hospital pharmacy. • To develop consensus statements on how to best prioritize practice advancements and offer guidance on the development of tools, timelines and tactics for achieving those advancements. 35

• Global Honorary Conference Co-Chairs Conference EAHP – Jacqueline Surugue (France), Leadership – Henri Manasse (USA), ASHP • Steering Committee – – – – Lee Vermeulen (USA), Chair William A. Zellmer (USA), Vice Chair Satu Siiskonen (The Netherlands), Conference staff Toby Clark (USA), Chair, Finance Subcommittee Stephen Curtis (UK) Andy Gray (South Africa), HPS President, Chair, Delegate Selection Subcommittee Stefan Mühlebach (Switzerland) Philip J. Schneider (USA), ex officio BPP representative Thomas S. Thielke (USA) Dick Tromp (The Netherlands ), ex officio BPP representative Arnold G. Vulto (The Netherlands), Chair, Programming Subcommittee Eduardo Savio (Uruguay) Zhu (China) 36

• Global Six facilitators were recruited for one of six themes, each Conference focused on a different components of hospital pharmacy Structure and practice – Literature reviews written Faculty – Develop draft consensus statements – Lead working groups via internet and “live” at the conference • Facilitator assignments: – Procurement of medicines (Eva Ombaka, Kenya, Africa) – Prescribing of medicines (Lisa Nissen, Brisbane, Australia) – Preparation and distribution of medicines(Ryo Oishi, Japan) – Administration of medicines (Rita Shane, Los Angeles, USA) – Monitoring outcomes (David Cousins, UK, Europe) – Human resources and training (Tana Wujili, FIP) 37

Global Conference Fundraising and scholarships Recruitment and selection of official representatives (delegates) Process • • • Initial development of literature reviews and draft consensus statements • Preliminary consensus development amongst working groups began Summer 2008 • Conference occurred 30 th - 31 st August, 2008, Basel Switzerland – Nearly 350 delegates (22 scholarship recipients) attended from over 90 countries – Over 80 countries were represented by official representatives • • Plenary session Working group sessions Editing of statements Voting process for consensus statements 38

Voting Scale • As each consensus statement is read, official representatives voted using audience response system • The voting scale used as follows: A = I strongly agree with the statement B = I agree with the statement C = I disagree with the statement D = I strongly disagree with the statement 39

Voting Process 1. 2. 3. A consensus statement was read by the facilitator for the group that developed the statement, and if necessary, brief comments were also made Official representatives were be asked to vote on the statement and the results of the vote were shown If a clear consensus was reached (simple majority of votes are A (“strongly agree”) or B (agree), the statement was accepted 40

Results! • A total of 74 consensus statements were developed • • A total of 82 countries cast a vote on at least 1 statement Across all statements, an average of 64. 1 votes per statement were cast All statements were approved with consensus Across all statements, the average level of consensus (proportion of votes cast as “strongly agree” or “agree”) was 97. 5% Of 5, 259 votes cast • • Overarching statements Statements from each working group 3, 821 (62. 8%) were “strongly agree” 1, 314 (21. 7%) were “agree” Only 111 were “disagree” and 22 were “strongly disagree” A total of 26 statements (35%) had 100% consensus (“strongly agree” or “agree”) 41

• Themes in Basel The definition of “hospital pharmacist” needs additional Statements development. Current definitions vary worldwide, based on traditions and national regulations and ambitions, but in general: • • • Pharmacist working in a hospital; Specialized training, generally post-graduate (including residency); The overarching goal of hospital pharmacists is to optimise patient outcomes through the judicious, safe, efficacious, appropriate and cost effective use of medicines. Hospital pharmacists should take responsibility for all medicine logistics in hospitals. Hospital pharmacists should provide orientation and education to nurses, physicians and other hospital staff regarding medication use, using best practice recommendations. 42

Next Steps • • Feedback forms provided to gather additional written comments on any consensus statements, additional statements and final editing underway now (17 th September 2008) Draft Basel Statements at www. fip. org/globalhosp Full proceedings to be published in American Journal of Health-System Pharmacy in February 2009 with free, open access worldwide Future programming planned for HPS, including additional survey activity and action plan to implement Basel Statements 43

The ‘Moment’ www. fip. org/globalhosp 44