Hospital Pharmacy's North Star: How Basel Statements Guide Better Patient Care
"Updated and relevant, the Basel Statements offer a roadmap for improving hospital pharmacy practices worldwide, ensuring better patient outcomes."
In 2008, the International Pharmaceutical Federation (FIP) convened a landmark World Conference on the Future of Hospital Pharmacy in Basel, Switzerland. This pivotal meeting culminated in the creation of 75 consensus statements, known as the Basel Statements, which articulated a shared vision for hospital pharmacy practice. These statements quickly became a touchstone for professionals worldwide, guiding efforts to enhance pharmaceutical services and patient care.
Recognizing the need to stay current with evolving practices, leaders and practitioners of hospital pharmacy undertook a comprehensive review of the Basel Statements in 2014. This revision aimed to ensure the statements remained relevant and applicable to contemporary challenges. The review process involved a multi-phased approach, including a global online survey, an online forum for in-depth analysis, and a 'World Cafe' style workshop to foster collaborative discussion.
The meticulous revision process reaffirmed the enduring value of the Basel Statements while incorporating new insights and addressing emerging issues. The updated statements provide a robust framework for hospital pharmacies to optimize their operations, enhance patient safety, and contribute to improved healthcare outcomes. Let's delve into how these statements have evolved and why they remain essential for every hospital pharmacist.
Hospital Pharmacy at a Glance
Hospital pharmacy services vary considerably across settings, with a survey of 48 hospitals in Saudi Arabia's Riyadh region achieving a 60.4% response rate while assessing dispensing and administration practices. An international analysis of scope of practice identifies three core elements—pharmaceutical care practice, clinical pharmacy practice, and public health services—shaped by influences at the individual, interpersonal, institutional, community, and public-policy levels. Looking ahead, a survey of anticipated changes by 2025 projected that a majority of hospital pharmacists will work in collaboration with other professionals, with remuneration tied to the number of professional activities performed. Together, these findings suggest hospital pharmacy is expanding from a dispensing function toward broader clinical and collaborative roles.
From Dispensing to Patient-Centred Care
Professional practice standards exist to assess whether a pharmacist's performance enables delivery of safe, high-quality, reliable, and clinically effective healthcare services, supporting medicine safety and quality use of medicines. For hospital settings specifically, minimum standard guidelines outline the level of services that most hospital pharmacy departments should consistently provide. Historically, however, the pharmacist's role was defined narrowly by accurately dispensing prescription medications, verifying doses, and allergy checking—a view many consider insufficient in light of the modern view of pharmacists as providers of patient-centred care. These accepted methods are not always easy to implement, as a qualitative study using semi-structured interviews with pharmacists practising in community pharmacies and primary healthcare facilities illustrates.
From Valetudinaria to a Recognised Profession
The roots of institutional pharmacy reach back to antiquity; the first hospitals in Britain where pharmacy is known to have been practised were the Roman military hospitals known as valetudinaria, and as Britain converted to Christianity, the Church began to care for the sick and needy. In the United States, John Morgan, a former Pennsylvania Hospital pharmacist from 1755 to 1765, attempted to solidify the practice of writing prescriptions, marking the beginnings of American professional pharmacy in the period from 1700 to 1865. In Britain, the modern history of pharmacy is often dated from the late 1800s; the seventy years leading up to the beginnings of the welfare state in 1911 saw the increasing professionalisation of pharmacy. Together these milestones trace pharmacy's evolution from a dispensing trade into a recognised profession.
The Basel Statements: A Roadmap for Modern Pharmacy Practice
The initial phase of the review, conducted in late 2013 and early 2014, involved a survey distributed to hospital pharmacy stakeholders worldwide. Participants were asked to evaluate each statement, indicating whether they agreed with the current wording, believed it should be eliminated, or suggested revisions. Those proposing revisions had the opportunity to offer specific wording changes, and respondents could also submit entirely new statements. The survey garnered 334 responses from 62 countries, reflecting a broad consensus on the need for updates.
- The role of technology assessment
- The accountability of hospital pharmacies in ensuring the integrity of outsourced sterile products.
- The training of specialized hospital pharmacists
Evidence, Logistics, and the Clinical Future
Recent work evaluating hospital pharmacy setup in government and private hospitals underscores pharmacists' responsibility for ensuring the safe, suitable use of medicines. Complementary research using structured secondary data analysis of peer-reviewed literature, international reports, and healthcare market and health system data finds that logistics management provides greater efficiency in hospital pharmacy, linking logistics, medication safety, and automation. Other reviews chart pathways toward independent clinical pharmacy practice as the future direction of the field. Educational programmes are responding: at least one UK postgraduate course in clinical pharmacy practice combines the latest research and discoveries with hands-on clinical experience, including placements within NHS hospital settings.
Limits of Expanded Roles and New Technology
Expanding scope of practice does not come without limits. The Ontario Pharmacists Association notes that even with broader authority for minor ailments, pharmacists may still find themselves limited in the options available to their patients because they must select from defined American Hospital Formulary Service (AHFS) drug categories for each minor ailment. Meanwhile, the introduction of technologies such as artificial intelligence raises its own challenges, with discussions in Nigeria highlighting concerns around pharmacy education, ethics, and regulation even as AI shows promise in areas like medication review and counterfeit detection. These examples show that both expanded clinical roles and technological innovation carry practical constraints that must be managed.
Practice Across Income Levels
Comparative analyses of pharmacy practice examine community pharmacy practice, hospital pharmacy practice, and pharmacy practice issues in high-income, middle-income, and low-income developing countries. A recurring theme in such comparisons is drug safety and how it is approached differently depending on a country's resources, regulatory environment, and development level. Educational materials in this area also emphasise structural topics, such as the organisation of the hospital and how its pharmacy relates to the wider institution. These comparisons make clear that there is no single model of hospital pharmacy, only contexts that shape how care is organised and delivered.
Embracing the Basel Statements: A Call to Action
The FIP Hospital Pharmacy Section leadership believes that these statements offer a valuable roadmap for hospital pharmacy practice, with a truly global reach and reflection of ideal standards. We urge you to explore these statements, identify areas for improvement, and share your successes with the broader pharmacy community. By embracing the Basel Statements, we can collectively elevate hospital pharmacy practice and optimize the value pharmacists bring to patient well-being. Take the first step today – review the statements and implement changes that will enhance pharmaceutical care in your setting.
The Science-and-Service Dual Mandate
Commentators observe that pharmacy is the only degree that combines hard science with clinical applicability—something medical studies do not—and that it therefore produces graduates who are experts in drugs and medicines. Within hospital settings, pharmacists may specialise in an area of clinical expertise, while primary care practice pharmacists are increasingly part of a multi-disciplinary healthcare team. The boundaries of the profession are widening further, with debate over whether topics such as veterinary pharmacy deserve greater coverage in undergraduate curricula, a discussion that engages students, community pharmacists, and hospital pharmacists alike.
Standards-Driven, Patient-Facing Pharmacy
Global standards such as the Basel Statements (2008–2024) provide an international framework for system-based safety in hospital pharmacy, helping to unify practice and address inconsistent medication use, procurement, and administration risks. Looking to the next decade, forecasts for India (2026–2035) project very high demand as the role of pharmacists in hospitals shifts from dispensing to direct patient care, with clinical pharmacists playing a major role in medication therapy management. Together, international frameworks and national workforce trends point toward a future in which pharmacists are central, patient-facing members of the care team.
Systems, Education, and Emerging Science
Hospital pharmacy operates within wider systemic pressures, and industry leaders point to trends that directly affect the pharmacies and bottom lines of hospitals and health systems. Education is evolving to meet these demands, with postgraduate programmes in pharmacy practice offered by Indian pharmacy colleges designed to prepare pharmacists for an expanded role in the healthcare system. At the same time, emerging fields such as pharmacogenetics raise questions about how new science will affect the everyday work of pharmacists practising in both community and hospital settings.
People Behind the Practice
The journal Pharmacy Practice, a free full-text journal focused on the practice of pharmacy, regularly surfaces the human realities of healthcare delivery. One illustrative study examines the factors affecting conflict between managers and healthcare providers in UAE hospitals, drawing perspectives from nurses, pharmacists, and physicians. Such research underscores that hospital pharmacy's impact is shaped not only by standards and systems but by the relationships, communication, and collaboration among the people delivering care.