Prescribing and Transcribing Practices in Ministry of Health Hospitals: Findings From a National Cross-Sectional Survey, 2025.

IntroductionSaudi Vision 2030 and the Health Sector Transformation Program place medication safety, digital health, and an expanded clinical role for pharmacists at the center of hospital reform. National benchmark data on prescribing and transcribing practices across Saudi Ministry of Health (MOH) hospitals are limited. Objective: To benchmark formulary management, pharmacist authority, computerized prescriber order entry (CPOE) and electronic health record (EHR) integration, clinical decision support, pharmacogenomics, opioid stewardship, intravenous (IV) workflow technology, multi-hospital centralization, and residency-trained workforce across MOH hospitals.MethodsNational cross-sectional online survey of pharmacy directors at all 290 general and medical/surgical MOH hospitals, conducted October 2024-February 2025 using a questionnaire adapted from the American Society of Health-System Pharmacists (ASHP) National Survey of Pharmacy Practice in Hospital Settings, with six contact attempts. Descriptive statistics were analyzed in IBM SPSS Statistics v.26.ResultsFifty-nine hospitals responded (response rate 20.3%). Evidence-based guidelines informed formulary decisions in 83.1% and a closed or limited formulary was in place in 66.1%. CPOE/EHR was operational in 79.7%, but only 27.1% of hospitals authorized pharmacists to modify or initiate medication orders, 20.3% to order serum drug concentrations and laboratory tests, and 50.8% to document recommendations in the medical record. Pharmacogenomic testing was absent in 79.7% of hospitals. Active opioid stewardship programs existed in 6.8%. IV workflow management software was used in 15.3%. PGY1/PGY2-trained pharmacists numbered 0-10 in over 93% of hospitals.ConclusionSaudi MOH hospitals demonstrate strong formulary governance and growing digital uptake, but pharmacist clinical authority, decision-support depth, pharmacogenomics, opioid stewardship, and advanced workforce capacity remain limited. Targeted policy, EHR optimization, and expanded pharmacist scope of practice are required to align hospital pharmacy with Saudi Vision 2030 patient-safety and digital-health objectives.