Hospital pharmacy specialisation

EAHP position paper on hospital pharmacy specialisation

Making a difference in medication by advancing the hospital pharmacy profession

Hospital pharmacists are the key stakeholders responsible for medication management and safety in the hospital environment, covering both inpatient and outpatient services and supporting the seamless transition of care for patients moving within the healthcare system. To provide the best treatment for all patients, hospital pharmacists must be able to operate in a complex hospital setting and work collaboratively within multidisciplinary healthcare teams. The undergraduate education, that every pharmacist has to undergo, provides an excellent background for further specialisation to work in one of the many possible roles within the profession. Specialisation is required to be up-to-date on specific treatment regimens. In the case of hospital pharmacists, this means being trained to work with patients in situations that are subject to complex medication regimens.

To prepare the hospital pharmacy profession for the future, the European Association of Hospital Pharmacists (EAHP) adopted the European Statements of Hospital Pharmacy¹ in 2014. They express commonly agreed objectives that every European health system should aim for in the delivery of hospital pharmacy services. To further enhance the quality, safety and equity of access to patient care in every European country, EAHP additionally created the Common Training Framework (CTF) project for hospital pharmacy education in Europe. This project not only fosters the further development of hospital pharmacy practice, but also seeks to guarantee the access of European citizens to the highest available standard of care and the freedom of movement of the hospital pharmacy profession which is currently not accessible to all.

Advancing the profession by harmonising the recognition of hospital pharmacy education

Literature published in peer reviewed and particularly high impact journals demonstrates clear evidence that only qualified pharmacists with postgraduate education can provide the right services to improve patient outcomes. Similar findings were observed for other healthcare professionals, such as physicians and nurses.² In light of these findings, EAHP believes that postgraduate education in the hospital setting, with a final assessment of individual competency, is essential to ensure that patients and healthcare systems can benefit from the highest levels of expertise.

Several EU Member States, including Austria, Belgium, the Czech Republic, France, Germany, Hungary, Italy, Portugal, Slovakia, Spain and the Netherlands, have already formally recognised the need for specialisation in hospital pharmacy and how this improves patient care. Others, such as Bulgaria, Greece and Romania, are working on establishing a specialisation for pharmacists working in hospitals. However, despite these national movements, the lack of EU level mutual recognition of hospital pharmacy education as a structured specialisation creates substantial differences in the qualifications of pharmacists working in hospitals across Europe. To minimise this discrepancy and to increase the freedom of movement of fully trained hospital pharmacists, EAHP has initiated the CTF project in accordance with the Professional Qualifications Directive.³ In the first phase of the project, EAHP has already finalised the development of a competency framework that ensures that the current provision of hospital pharmacy education in different countries is well accounted for. Together with the national competent authorities, EAHP is seeking to put this framework into practice via a bottom-up approach.

Significant progress has already been made. However, to fully exploit the potential of the opportunities provided to hospital pharmacists under the provision for CTFs in the Professional Qualification Directive, EAHP calls on the European Commission and the Member States to assist the association in setting up a CTF through the adoption of a delegated act.

Enhancing the role of the hospital pharmacist

The traditional role of the pharmacist has evolved tremendously over the last decades. Hospital pharmacists are nowadays not only the professionals responsible for ensuring timely and equal access of patients to safe medication and high-quality pharmaceutical care in the hospital sector, they are also in charge of guaranteeing successful pharmacotherapy,⁴ helping to prevent avoidable iatrogenic risks⁵ and ensuring that hospital budgets are well-managed. To this end, many countries have created education programmes that further enhance the specialised competencies of hospital pharmacists in areas such as pharmacotherapy, pharmaceutical care and technology, medicines quality assurance and clinical pharmacy. Also, EAHP’s European Statements of Hospital Pharmacy have recognised this shift and are consequently not only focusing on traditional roles such as compounding and dispensing, but also acknowledging that the hospital pharmacist has become an integrated member of the clinical team who makes therapeutic recommendations on effective and safe medicines use and contributes within the care team to the delivery of higher quality patient care.

In several countries, hospital pharmacists are increasingly present on the wards and at the interface of care which not only improves patient outcomes, in particular in relation to polypharmacy and drug adherence, but also leads to additional cost savings.⁶ Specialist knowledge that hospital pharmacists have obtained during their postgraduate education and through continuing education programmes, on for example pharmacoeconomics and pharmacoinformatics, is in this regard of the utmost importance. To adapt to their new and enhanced role, hospital pharmacists require adequate training and support within integrated teams and open approaches to information sharing.⁷ Member States need to recognise the changing role of hospital pharmacists and further foster their implementation.

Preparing the profession for future challenges

In view of the challenges that ageing populations and increasing healthcare budgets are posing to health systems, it is of the utmost importance that hospital pharmacists’ expertise in medicine optimisation is fully utilised along the care pathway. Interdisciplinary teams have become indispensable for the management of the complex and demanding healthcare of patients, in particular for the seamless transfer of care between sectors. A study carried out in the UK looked into issues such as delays to discharge and medication problems which often arise after discharge from the hospital, resulting in some cases in patient harm and hospital readmission.⁸ The innovative model of care for the supply of medication at hospital discharge that was tested engaged the hospital pharmacist, used community pharmacies in the supply process and encouraged patient follow-up after discharge. Overall, the results of this study showed a significant improvement in patient outcomes. To further promote the uptake of such cross-sector tools, inter-sector communication, coordination and multidisciplinary collaboration in all healthcare facilities should be strengthened.

As recognised by the WHO, many aspects need to be tackled in relation to the overall global health workforce to ensure its resilience.⁹ Problems linked to resource planning are not only affecting doctors and nurses across the globe but also hospital pharmacists both in and outside Europe. International bodies, such as the International Pharmaceutical Federation (FIP), have already recognised the need for coordinated and multifaceted efforts to advance workforce planning which ensures that adequate numbers of pharmacists are trained and educated to fulfil their roles in the health system.¹⁰ To adequately address future challenges linked to the ageing society, changing healthcare needs and other unknown factors, such as future pandemics, EAHP urges Member States to invest in better workforce planning for the hospital pharmacy profession, including the availability of hospital pharmacy services for all patients of each hospital.

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Ethics approval

This study does not involve human participants.