12 key trends in hospital pharmacy from the ASHP annual survey

The American Society of Health-System Pharmacists released its annual survey of pharmacy directors from nearly 5,000 hospitals across the country. 

The survey — which was conducted before the COVID-19 pandemic and published June 23 —  asked the directors questions about prescribing, opioid stewardship, staffing and the use of mobile technology. 

Twelve key trends in hospital pharmacy, according to the survey: 

Formulary management strategies: 

  1. Thirty-one percent of hospitals reported rationing medications due to expected patient outcomes and cost of therapy, up from 25 percent in 2016. 
  2. Seventy-three percent of hospitals have a limited strict formulary and tight restrictions on non-formulary medication use, up from 63 percent in 2016. 
  3. Eighty-nine percent of hospitals indicated that pharmacists have the authority to write medication orders. Among this group, 94 percent can modify or initiate therapy by policy or protocol and 6 percent are authorized to prescribe. 


  1. Half of hospitals are including pharmacogenomics in formulary decision-making, up from one-third in 2013. 
  2. Of hospitals surveyed, 5.4 percent indicated recommending or scheduling pharmacogenomics testing to aid in the process of drug and dosage selection, while 90 percent said pharmacist involvement is limited to the dispensing of products related to pharmacogenomics drug therapy management.

Opioid stewardship: 

  1. Eighty-five percent of hospitals have educational programs or guidelines on opioids, up from 71.4 percent in 2018. 
  2. Eighty-five percent of hospitals have a prescription drug monitoring program database, up from 65.3 percent in 2018. 
  3. Sixty-one percent of hospitals limit the supply of home discharge opioid prescriptions, up from 46.3 percent in 2018. 
  4. Sixty-five percent of hospitals indicated that pharmacists have leadership and accountability roles in their opioid stewardship programs. 

Hospital pharmacy staffing: 

  1. The number of full-time pharmacist positions has continued to grow overall with a mean of 19.2 positions per 100 occupied beds. 
  2. Pharmacists had a low vacancy rate, less than 3 percent, while the vacancy rate for pharmacy technicians was 6.5 percent. 
  3. The majority of pharmacists are using smartphones, tablets or laptops as part of providing patient care services, an increase that the survey's authors said can be attributed in part to the near universal electronic health records.

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