HOSPITAL PHARMACY

BIRLA INSTITUTE OF TECHNOLOGY & SCIENCE PILANI, HYDERABAD CAMPUS

FIRST SEMESTER 2010‑2011

HOSPITAL

hospital

• Hospital is a complex organization and an institute which provides health to peoples through complicated but specialized scientific equipments and a team of trained medical staff educated in the problems of modern medical science

• Thus the hospital is a specialized body where the patient care is the focus point and about which all activities of the hospital revolve

CLASSIFICATION OF HOSPITALSCan be done on three ways

A) CLINICAL BASIS OF CLASSIFICATION• Maternity hospitals• Surgery (Surgical hospitals)

Gynaecological OrthopaedicOtolaryngological CardiothoracicGeneral surgery NeurologicalKidney

• MedicineGeneral Dental Pediatrics CancerCommunicable disease MentalDrug- addiction rehabilitation

B) OWNERSHIP OR CONTROL BASIS

• Government Public health centers or civil hospitalsMilitary hospitals

• Non GovernmentPrivate run Charitable trust

C) SYSTEM OF MEDICINE BASIS

Allopathic HomeopathicAyurvedic NaturopathyUnani

HOSPITAL PHARMACY AND ITS ORGANISATION

HOSPITAL PHARMACY

DefinitionHP is the department, service or a domain in the hospital

organization managed under the direction of a professionally competent, legally qualified pharmacist and deals with

• Supply of drugs, medicines and allied products to the nursing units• Filling of prescriptions for out-patients and dispensing as per intention of a

physician• Manufacturing of the drugs and formulations in bulk and in particular the

large volume parenterals which are required for use of indoor patients• Storage and dispensing of narcotic and biological products• Supply and storage of ancillary products and articles required in the hospital

PHARMACEUTICAL SERVICES

Comprises the services rendered to the patient through a number of activities

Major activities include

Dispensing of drugs and medicines as per the prescriptions of the doctor for the outpatients and the inpatients

Management of the stores which includes

Purchase of drugs and medicines and other allied stores as per the recommendations of the PTC

Providing instructions for proper storage of such drugs and medicines

Maintenance of proper records of the drugs purchased and the distribution thereof

Manufacture and distribution of medicaments and products such as Transfusion fluids and other parenteral products which are not

manufactured and marketed Tablets, Capsules External use preparations like ointments Stock mixtures as per hospital formulary

Providing therapeutic drug monitoring (TDM) Establishment and maintenance of Drug Information Centers (DIC) Patient counseling service Maintaining liaison with medical staff, nursing staff, and the patients To maintain the nursing department and the central sterile supply unit in the

hospital Participate in the teaching programs of the nursing and pharmacy students

FUNCTIONS OF A HOSPITAL PHARMACIST

• To provide and evaluate pharmaceutical services and thereby supporting the medical staff, with due consideration of the objectives and policies of the hospital

• To draw a plan for hospital pharmacy administration

• To establish a liaison between administrative authorities and medical doctors who will order drugs and ancillary products in the hospital

• To estimate the requirements of the departments and enforce the policies and procedures for the recruitment of adequate and competent staff

• To provide the means and methods by which the personnel can work with other groups in interpreting objectives and policies of the hospital

• To develop and maintain an effective system of clinical and administrative records and reports.

• To participate in and adhere to the financial plan of the operation of a hospital

• To estimate the needs of facilities, supplies, and equipments and to see that there is a proper control of inventory, stocks, dispensing and manufacturing of the medicaments

• To initiate, utilize, and participate in research projects designed for the improvement of patient care and other administrative and hospital services

• To provide and put into practice a program for continuity education to all personals

• To participate and adhere to the safety programs of the hospital

• To provide and to put into practice a program of continuing education of all personals

• To participate and/or facilitate all educational programme which include student experiences in the department

Set up of hospital pharmacy

DEPARTMENT OF PHARMACY

DEPARTMENT OF PHARMACY

Hospital’s committees

Hospital administration

Patients Hospital’s clinical staff

Hospital’s other departments

Hospital’s nursing staff

Functions and responsibilities of the HOD of pharmacy and his staff

• HOD have to ensure that pharmacists functioning in different areas carry out their assigned functions and duties efficiently and is aware of his responsibilities towards its staff and to the hospital administration

Suggested pattern of a setup of hospital pharmacy

THE DIRECTOR OR DEAN OR MEDICAL SUPERINTENDENTTHE DIRECTOR OR DEAN OR MEDICAL SUPERINTENDENT

DIRECTOR OF PHARMACEUTICAL SERVICES(M.PHARM PREFERABLY WITH PHARMACOLOGY)

DIRECTOR OF PHARMACEUTICAL SERVICES(M.PHARM PREFERABLY WITH PHARMACOLOGY)

PHARMACY IN-CHARGEPHARMACY IN-CHARGE

MANUFACTURING

M.Pharm with specialization in pharmaceutical technology

MANUFACTURING

M.Pharm with specialization in pharmaceutical technology

DISPENSING AND DISTRIBUTION OF DRUGS

Outdoor indoorBpharm assisted by Dpharm as junior pharmacist

DISPENSING AND DISTRIBUTION OF DRUGS

Outdoor indoorBpharm assisted by Dpharm as junior pharmacist

QC

M.Pharm with specialization in Analytical chemistry assisted by Bpharm trained in microbiology and pyrogen testing

QC

M.Pharm with specialization in Analytical chemistry assisted by Bpharm trained in microbiology and pyrogen testing

DRUG MONITORING SERVICES AND DRUGS INFORMATION SERVICES

M.Pharm with specialization in Pharmacology

DRUG MONITORING SERVICES AND DRUGS INFORMATION SERVICES

M.Pharm with specialization in Pharmacology

MEDICAL RECORDS AND MISCELLANEOUS DUTIES

(B.Pharm or D.pharm)

MEDICAL RECORDS AND MISCELLANEOUS DUTIES

(B.Pharm or D.pharm)

Inpatient or indoor pharmacists responsibilities

A) CENTRAL DISPENSING AREA

To ensure that all drugs are stored dispensed correctly To check the accuracy of the dosages prepared especially of intravenous admixture

and unit doses To keep proper records and preparation of bills To co-ordinate the overall pharmaceutical needs of the “patient care” areas within the

central dispensing area To ensure that the established policies and procedures laid down are followed To maintain professional competence particularly that keeps him updated with of

information To communicate with all pharmacy staff regarding new developments in the area and

assists in evaluations of employees of his section To ensure that the new personnel in his section are properly trained in the policies

and procedures of the central dispensing area To co-ordinates the activities of the area with the available staff to make use of the

best possible use of the personnel and resources

B) PATIENT CARE AREAS (wards operation theatres, and other departments where drugs of special categories are used)

The pharmacist in charge of this section has got following responsibilities

To maintain a liaison with nurses Reviewing of drug administration in each patient periodically To provide instruction and assistance to the junior pharmacists as needed

in dealing with difficult patients and new procedures To co-ordinates over all pharmaceuticals services on the running unit level.

C) DIRECT PATIENT CARE AREAS

His responsibilities involve Identification of drugs brought into the hospital by the patient Obtaining patients medication history and communicating all the information to the

physicians To assist in the selection of drugs products and their identities. Also to assist

physician in selecting dosage pattern and schedules and assigns the timings for the drug administration

To monitor patients total drugs therapy forEffectiveness(ineffectiveness), side effects, toxicities, allergic drug reactions,

drug interactions and as their distribution and concentration in organs and tissues by pharmacokinetic and pharmacodynamic methods

Counseling patients onMedications that are too be self administered in the hospitalRegarding the use of discharge- medicines

Participating in cardio pulmonary emergencies by Procurement or preparation of drugs needed.. Charting all medications given… Performing cardio pulmonary resuscitation, if necessary.

D) GENERAL RESPONSIBILITIES

• To provide in service training and education for the pharmacistpharmacy studentsnurses and nursing studentsphysicians and medical students

• He has to provide information regarding drugs to the physicians, nurses, and other health care personnel

Outdoor pharmacists responsibilities

• Divided into three categories• Those regarding

Central dispensing areaPatient care areasGeneral responsibilities

A) CENTRAL DISPENSING AREA

Pharmacist should ensure• Proper techniques are used for extemporaneous compounding

• Adequate record keeping and billing in respect of patient’s medication particulars, records of investigational drugs, records of outpatient bills, maintaining and preparing of all records

• Correctly maintaining of prescription files

• Keep the outdoor pharmacy in a neat and tidy manner

B) PATIENT CARE AREAS

• To periodically inspect the medication areas on the nursing unit and to make sure that they are always kept adequately supplied with drugs and other articles required

• To identify the drugs brought into clinic by the patient and record the patients medication history and communicating the same to the physicians concerned. He also assist them in selection of drugs regimen and schedules and selection of correct drug products and their entities.

• Monitoring of drugs

• To counsel the patients on proper use of their medication and prepare the medications for intravenous administration.

C) GENERAL RESPONSIBILITIES

To co-ordinate the overall pharmaceutical needs of the outdoor service area and exercise adequate control over such drugs

To ensure that all drugs are handled properly such as storage of investigational drugs

To participate in cardio-pulmonary emergencies

To provide for in service education and training for pharmacists, pharmacy items. i.e. pharmacy students send for practical training as a part of diploma or degree courses, nurses

Pharmacy and therapeutic committee (PTC)

PTC

• Is a policy framing and recommending body to the medical staff and the administration of hospital on matters related to the therapeutic use of drugs

• PTC is composed of physicians, pharmacists and other health professionals selected with the inclusion of medical staff

OBJECTIVES OF PTC

• ADVISORY

• EDUCATIONAL

• DRUG SAFETY AND ADVERSE DRUG MONITORING

Composition of PTC

Generally PTC is composed of

1) At least three physicians from the medical staff

2) A pharmacist

3) A representative of the nursing staff and

4) An hospital administrator with his/her designated an ex-officio member of the committee one of the physicians may be appointed as the chairman of PTC

Pharmacist functions usually as the secretary and therefore designated as the secretary of the committee.

Committee should meet regularly at least six times in a year and also when required

Role of pharmacists in PTC• Preparation of the agenda and supplementary materials required for

committee meeting and furnish it to the committee members in advance so that members can study properly before the meeting

• Review of contents of the Hospital Formulary for the purpose of bringing it up to date, and deleting of products not considered necessary for use

• Review and/or adoption of investigational drugs currently under processing in the hospital

• Review of side effects, adverse drug reactions, toxic effects, drug interactions of drugs reported by various units of the hospital and brought into the notice of the committee by the DIC

• Review of drug safety in hospital

• Drug safety is the moral, legal and professional obligation of the pharmacists in western countries

• Hospital must employ a qualified, at least, a registered pharmacist with B.Pharm degree as the chief pharmacist and the rest may be at least diploma holders in pharmacy

• Hospital should not permit a non pharmacist personnel to dispense drug and allied materials

• Engage in teaching programme to familiarize the nursing and resident staff with new drugs and to teach the student nurses the basic course of pharmaceutical mathematics and pharmacology

PREPARATION AND MAINTENANCE OF EMERGENCY KITS

To decide about the drugs and other supplies that should be present in the Emergency kits (boxes containing emergency drugs)

To place Emergency kits so that it is readily available for use at the bed side, specified place in clinic, emergency ward, and in the special procedure room of the department of radiology and its routine stocking

• HP is a continuously revised compilation of pharmaceutical dosage agents and their forms etc., which reflects the current clinical judgment of the medical staff

• Hospital formulary system is a method whereby the medical staff of a hospital with the help of PTC, selects and evaluates medicinal agents and their dosage forms which are considered to be most useful in the patient care

• HF system provides information for procuring, prescribing, dispensing, and administration of drugs under non-proprietary or proprietary names

National Formulary of India – by Ministry of Health and Family Welfare, Government of India

ROLE OF PHARMACIST IN PREPARATION OF HOSPITAL FORMULARY

HOSPITAL FORMULARY

• Pharmacist in the PTC have a key role in developing policies and procedures governing the H.F.

• The chief pharmacist have the primary responsibility for the preparation of H.F.

• Pharmacist with the advice and guidance of PTC, shall ascertain the quantity and source of supply of all drugs, chemicals, biologicals, and pharmaceutical preparations used for the diagnosis, and treatment of patients

• Pharmacist should ensure that quality of drugs is not compromised by economic considerations

ROLE OF PHARMACIST

CLINICAL PHARMACY

• Clinical pharmacy is a branch of Pharmacy where pharmacists provide patient care that optimizes the use of medication and promotes health, wellness and disease prevention.

• The Clinical Hospital Pharmacist is responsible for all clinical pharmacy activities within the pharmacy and wards Hospital.

• Clinical pharmacist is an important part of the healthcare team.

• Clinical pharmacists are a primary source of scientifically valid information and advice regarding the safe, appropriate, and cost-effective use of medications.

• The pharmacist works in coordination with the doctors for the better patient healthcare. They have very specific roles which aim at assuring patient safety.

Scope of clinical pharmacy:

• Drug Distribution Systems• Drug Information • Drug Utilization • Drug Evaluation and Selection • Medication Therapy Management • Formal Education and Training Program • Miscellaneous: Application of Electronic Data Processing(EDP)

ACTIVITIES OF CLINICAL PHARMACISTS

The principle activities of a clinical pharmacist include: • Consulting

Analysing therapies, advising health care practitioners on the correctness of drug therapy and providing pharmaceutical care to patients both at hospital and at community level.

• Selection of drugs Defining "drug formularies" or "limited lists of drugs" in collaboration with hospital doctors, general practitioners and decision makers

• Drug information Seeking information and critically evaluating scientific literature; organising information services for both the health care practitioners and the patients

• Drug use studies and research Drug use studies/ pharmacoepidemiology/ outcome research/ pharmacovigilance and vigilance in medicinal devices: collecting data on drug therapies, their costs and patient outcome through structured and scientific methods.

• Pharmacokinetics/ therapeutic drug monitoring Studying the kinetics of drugs and optimising the dosage.

• Formulation and preparation Formulation and preparation of medicinal products and devices according to acceptable standards to meet specific patients' needs

• Clinical Trials Planning, evaluating and participating in clinical trials.

• Pharmacoeconomy Using the results of clinical trials and outcome studies to determine cost- effectiveness evaluations.

• Dispensation & Administration studying and developing systems for the dispensing and administration of medicinal products and devices that can guarantee a higher security in administration, a reduction of expenditure and a reduction in medication errors.

• Teaching & Training Pre- and post-graduate teaching and activities to provide training and education programmes for pharmacists and other health care practitioners.

• Preparation of patient medication history chart

• It involves in increasing the knowledge about the disease and their drug therapy. He can guide the patient for proper use of drug therapy and possible drug interaction. He can also advice for the drug compliance.

• Participation in medical emergencies.

• It also provides the provision of consultation in various areas like total parenteral nutrition, intravenous therapy, clinical pharmacokinetics, selection of drug therapy and determination of therapeutic end point

• Management of chronic diseases

References

1. Merchant, S. H., Qadry, J. S., A Textbook of Hospital Pharmacy, B. S. Shah Prakashan, 2nd Ed., 1994.

2. Internet Sources