PHARMACY PRACTICE ISSUES. Directions for Clinical Practice in Pharmacy (Hilton Head Conference) Mae Kwong “American Society of Health-System Pharmacists, Bethesda, Maryland, USA, INTRODUCTION ‘The ASHP Research and Education Foundation and the American Society of Hospital Pharmacists (ASHP) conducted an invitational consensus conference entitled Directions for Clinical Practice in Pharmacy” on February 10-13, 1985. The conference was held in Hil- ton Head Island, South Carolina, and has come t© be known as the Hilton Head Conference." The conference included approximately 150 pharmacy practitioners and educators: in addition, others from medicine, nursing, and hospital administration were invited as observers SYNOPSIS ‘The goals for the development of consensus statements were to determine the slatus of the clinical pharmacy movement and 10 help the pharmacy profession t© von- sinue advancing clinical practice. The principal objectives of the conference were: 1) to examine to what extent the profession had established goals with respect to clinical practice, 2) to assess the current status of the clinical practice of pharmacy and pharmacy education, and 3) to identify practical ways by which clinical pharmacy could be advanced, ‘The keynote address, presented by Paul F. Parker, Se.D., a consultant and retired director of pharmacy at the University of Kentucky, was entitled “Clinical Pharma- y's First 20 Years."* Parker described clinical pharmacy as the most important practice, education, and profes- sional philosophy in the history of pharmacy. He noted that clinical pharmacy will advance only by meeting the goals of quality care, Accomplishing the conference goals required an ex- ploration of four key topics: 1) pharmacy as a elinical profession, 2) barriers to clinical practice, 3) the symbiosis Of clinical practice and education, and 4) building phar- esclopeti of Clinical Pharmacy DOI: 10.108U/E-ECP 120006191 Copyright © 2008 by Marcel Deer, Ine, All ights reserved macy's image. Plenary presentations were given on each topie, and these were followed by workshop discussions Charles D. Hepler, Pa.D., presented “Pharmacy as a Clinical Profession.*” His assessment of clinical pharmacy focused on the role of clinical pharmacy, how profes jonal services are provided. the need to obtain profes- sional authority, and the patienoriented focus of clinical pharmacy. The workshops were charged with two tasks: 1) tw determine whether there is a need for the term clinical pharmacy and, if so, to conceptually distinguish it from pharmacy and 2) to consider what steps are needed to establish pharmacy as a clinical profession. A total of, 18 consensus statements resulted, The statements with the highest consensus among participants emphasized that the profession of pharmacy has a fundamental purpose to serve society for safe, appropriate, and rational use of rugs: to provide leadership t0 other healthcare profes- sionals and the public to ensure responsible drug. use; to provide authoritative, usable drug information; and to ‘work collaboratively with other healtheare professions on health promotion and disease prevention through the op- imal use of drugs. According to another statement, phar- rmacists are the professionals ultimately responsible for dug distribution and control, and the use of technicians, automation, and technology should be maximized to free time for pharmacists to perform clinical services. UN mately, the purposes and goals of clinical pharmacy are the same as those of pharmacy, ut clinical pharmacy stresses patient-oriented services and the association with patient outcomes. To address the barriers to clinical practice, panel discussed the "Realities of Contemporary Practiee.”” The panelists were Chip Day, Robert P. Fudge, Teresa Volpone McMahon, Pharm.D, and Steven L. Smith, Pharm.D., and the session moderator was Dennis K. Helling, Pharm.D. Each panelist described routine activities in his or her practice and identified several bartiers to clinical phar- macy, notably a lack of time. Ultimately, the panelists 265266, agreed that practicing clinical pharmacy had become easier within the past few years, mosily because of increased recognition by other healthcare professionals of the pharmacist’s role in patient care. The workshop ‘sroups produced 37 consensus statements on barriers to clinical practice. According to the statements receiving the highest consensus, pharmacy directors are unable to provide effective leadership to their staff, a widely ag- teed-upon philosophy of pharmacy practice is lacking, there is no concurrence on what the standard of prac tice in pharmacy should be, consumer demand for cli- nical pharmacy services is weak because the public has a poor understanding of the services pharmacists can offer, ‘and the value of clinical pharmacy services has not been ‘adequately demonstrated. To discuss the symbiosis of clinical practice and edu- cation, Charles A. Walton, Ph.D., presented the educator's perspective and Marianne F. Ivey’ presented the practtio- net's perspective. The presenters believed that both pharmacy practitioners and educators should share in ad- vaneing the profession through the establishment and provision of clinical pharmacy services, through edu- cation and training of pharmacy students and pharmacists, and through clinical research. The objectives for the ‘workshop groups were: 1) (0 identify steps for making more effective use of clinical pharmacy faculty in im- proving the level and quality of clinical pharmacy ser- viees and 2) to use pharmacy staff more effectively in clinical education. A total of 33 consensus statements ‘were developed for objective 1 and 18 for objective 2. With respect to using clinical pharmacy faculty, it was agreed that there is a need to clearly define a shared philosophy between clinical faculty members and phar- ‘maceutical services staff, the clinical service responsi bilities of clinical faculty, and the clinical education missions of both the college and the pharmacy depart- ‘ment, In addition, orienting deans and other academics to the roles of clinical faculty would provide a basis for balancing teaching, research, and service responsibilities and would help acknowledge the scholarly activity and clinical research that occur in clinical practi ‘With respect to using pharmacy staff more effectively in clinical education, the major statements identified that stalf should be recognized for their teaching activites; that scaff involved in clinical instruction should partici- ppate in the evaluation of students; that hospital admi- nistrators, pharmacy directors, and staff should recognize their respective roles in pharmacy education and have a thorough understanding of the clinical faculty's respon- Directions for Clinical Practice in Pharmacy (Hilton Head Conference) sibilities: and that educational programs should be deve- oped to tain pharmacists to manage clinical services William A. Miller, Pharm-D., presented the final ple- nary session on building pharmacy's image. According to Miller, building pharmacy’s image asa clinical profession ‘would occur simply by providing clinical servis. Phar- macy would be advanced as a clinical profession by es- tablishing goals for pharmaceutical services; creating standards for pharmacy practice; planning, implementing, and managing pharmaceutical service, education, and research programs; providing financial management; and assessing the quality of pharmaceutical services and drug use within the institution. The workshop groups sought to characterize the type of relationship pharmacy should establish with medicine, nursing, hospital administration, and the public. Eight consensus Statements were written ‘The major consensus statement was that pharmacy should establish a public image of advocacy in all maters related to the use of drugs. Other statements expressed that phar ‘macist input should be a required component ofthe drug tase process, that pharmacy should be viewed asa clinical service, and that pharmacy is a colleague with nursing and ‘medicine in patient care. DISCUSSION The Hilton Head Conference affirmed that pharmacy is a clinical profession committed to clinical practice and the patient. Pharmacy is fundamentally a healthcare profes- sion with a responsibility for safe and effective drug use in society. The conference provided a forum for pharmacists to discuss the past, present, and future of clinical pharmacy. Even though the conference occurred in 1985, many of the conclusions reached still apply to practice today. For instance, some of the barriers identified with respect to leadership and substantiation of the value of clinical pharmacy services still exist. Also, there continues to be a need (0 educate the public and gain the support of other healthcare professionals for clinical pharmacy practice, REFERENCE 1. Proceedings from the conference were published in the ‘American Joumal of Hospital Pharmacy 1988, 42, 1287~ 132,