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Hospital Healthcare Europe
Hospital Healthcare Europe

Key issues affecting hospital pharmacists in Europe

5 June, 2009  

Hospital pharmacists should be key stakeholders in provision of hospital care,
but they need to fight for recognition of their role

Jacqueline Surugue

Catherine Hartmann
Executive Director

European Association of Hospital
Pharmacists (EAHP)

Hospital pharmacy, like many other health professions, has been undergoing major changes in the past decade: having
to face health systems turmoil, development of more and more constraining good pharmaceutical practices, and a never-ending adaptation to new technology, to name just a few elements that changed our practice. Looking ahead to the future of European hospital pharmacy, one may
be frightened by the hurdles one would find on the way to achieving our ultimate goal: to provide good pharmaceutical care to the patient.

One hurdle is the absence of recognition of the specialisation of hospital pharmacy by the EU authorities. The hospital is a complex environment. Patients are usually there because they can no longer be treated in the community. They often have co-morbidities or need complicated therapies, which makes the hospital pharmacist face sophisticated and sometimes risky medication processes. The basic diploma curriculum
does not include sufficient training for any pharmacist
to meet these challenges. This is acknowledged by all the association members of the European Association of Hospital Pharmacists (EAHP) and was one of the major conclusions of the Global Conference on the Future of Hospital Pharmacy organised by the Hospital Pharmacy
Section of FIP (International Pharmaceutical Federation) and held in Basel on 30–31 August 2008. Many EAHP country members have implemented this specialisation as postgraduate training, and, as the worldwide survey performed for the above-mentioned global conference demonstrates, so have many countries of the world. The
fact this qualification is not recognised on the European level does not allow a pharmacist holding this qualification freedom of movement and establishment as stipulated in the 2004 Directive for recognition of professional qualifications.

As the sole representative of the profession at the European level, the EAHP is actively working on getting the European Commission and the Member States to adopt the specialisation in hospital pharmacy. To this end, EAHP is a partner of the Pharmine project, a European project led
by the European Association of the Faculties of Pharmacy that focuses equally on pregraduate and postgraduate studies in pharmacy.

Another European project where EAHP has a partnership is the EUNet PaS project led by the European association HOPE. Since the Luxembourg declaration “Patient safety, making it happen!” patient safety is high on the political
and public agenda. Hospital pharmacists are experts in most aspects of safe medication practice – from drug selection by means of the hospital formulary; support for physicians regarding dosing/individual dose adjustments,
interactions and therapeutic drug monitoring; to
acquisition of high-quality drugs, either by purchasing
or inhouse production and quality control, logistics; and finally drug distribution to the patient. The hospital pharmacist is in the ideal position to overview this whole process and therefore be designated as the key stakeholder. Great emphasis was put on the issue of patient safety during the Global Conference on the Future of Hospital Pharmacy, with special highlight on preventable medication errors in hospitals.

One of the main developments that will affect all countries’ healthcare systems is the outstanding increase in information and communication technologies. The EU Commission, in its 356 Recommendation, has enhanced the
deployment of patients’ health electronic records and interoperability. EAHP is collaborating with the IHE initiative (Integrating the Healthcare Enterprise), especially in its European division. Pharmacy is now recognised as a domain within IHE Europe, besides the already existing medical specialities of radiology, cardiology, ophthalmology,
medical analysis laboratories and pathology. EAHP participates in the IHE Europe e-pharmacy group in designing use cases for pharmacy workflows with the aim of interoperability of information systems in hospitals as well as in the community.

The development of EU regulations by Brussels authorities encompasses further topics on the strategic agenda of our association. The freedom of movement of persons and services raises questions regarding the possible outsourcing of our activities. The revision of the European
Working Time Directive may be analysed as a threat to the quality of the work of hospital pharmacists who, in several Member States, have on-call duties. If the draft Directive is adopted as proposed by the European Council, then it may
mean longer hours at work, no remuneration for on-call time not actually spent on the work, and more importantly elevated risks of altered working conditions and, in turn, decreased patient safety.

Our association is also deeply concerned by pharmacovigilance and regrets the absence of a real operational pan-European system that would allow fast and adequate reaction in cases of adverse drug reaction. Several publications underscore the fact that adverse drug events account for a substantial percentage of hospital
admissions; reports demonstrate the importance of prevention and recording of adverse events occurring in hospitals, to control both the harmful effects and the costs resulting from these events. Hospital pharmacists, especially those directly involved in patient care, best accomplish oversight for this process. We hope the European Commission acknowledges this role in its final
draft of the Pharmaco Vigilance Directive.

About the EAHP

The European Association of Hospital Pharmacists is a working community of 29 national associations of hospital pharmacists. Its European membership includes more than 22,000 professionals working as pharmacists in hospitals and healthcare structures in Europe. EAHP’s aim is to establish a common pharmaceutical policy in Europe. It represents the interest of the profession at the European level, contributes to the scientific development of hospital pharmacy and to the advancement of the position and role of the pharmacists in hospitals.

EAHP assets include a high-quality journal, the European Journal of Hospital Pharmacy (EJHP) with a practice and a science editions, an annual congress gathering each year some 2,000 participants on an international level, a
foundation that organises hands-on seminars for the “new EU countries” which joined in 2004 and educational summits within the European Academy of Hospital Pharmacy.

The next congress of the EAHP will be hold in Barcelona, 25–27 march 2009, with the main theme “IT and automation in hospital pharmacy: tools for better care”.