hospital pharmacy 2010

Apr 8, 2023 Aleth Therese L. Dacanay, RPh, MSc Phar 1

Aleth Therese L. Dacanay, RPh, MSc Phar

UST Faculty of Pharmacy

HOSPITAL PHARMACY


Good Morni

ng


Historical Overview of the Evolution of Pharmacy Practice

A. Early 20th century – (1900-1960)Traditional role (drug-oriented)Apothecary, compounding, dispense supply of pharmaceuticals


B. 1960-1985 - focus → patient-orientedUnit doseIV admixture services (TPN)Drug informationDevelopment and growth of “Clinical Pharmacy Practice” and the role of the pharmacist as therapeutic advisor.


C. 1985-presentRe-professionalization – a new purpose of pharmacyDefinition and conceptualization of Pharmaceutical Care→1989

improved patient care → focus is totally on patient


Pharmaceutical Care

responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient quality of life.Monitoring the regimen’s effect

Outcome:1. cure of a disease2. elimination or reduction of patient symptomatology3. arresting a disease process4. preventing a disease or symptoms


THE HOSPITAL PHARMACYThe separation of pharmacy from medicine took place in charitable institutions operated under governmental or ecclesiastic authority. The fact that business intervals played no part in the delivery of care to patients in these institutions led to an eventual division of labor in order to improve the quality of care.


THE HOSPITAL PHARMACY

This division of labor in the physician-apothecary function led to the recognition of pharmacy as a separate discipline from medicine. Since the division occurred in hospitals, the hospital pharmacist was the first recognized practitioner of the profession of pharmacy.


The development of hospital pharmacy in different countries was vitally affected by educational standards and by the caliber of its practitioners.


Thus hospital pharmacy as an important professional specialty was virtually neglected in America for almost 169 years, from the time that Jonathan Roberts became first hospital pharmacist at the Pennsylvania Hospital (Philadelphia) in 1752, to approximately 1920.


After naming: Charles Rice (1841 – 1901) of

Bellevue hospital in New York City Martin I Wilbert (1865 – 1916) of the

German Hospital in Philadelphia

it is difficult to recall other equally prominent contemporary hospital pharmacist of the same period.


A National Professional Society

1. The American Journal of Hospital Pharmacy – one of the best professional publication in international pharmaceutical circles.

2. The International Pharmaceutical Abstract


3. The American Hospital Formulary Service – is a comprehensive unbiased source of information on drugs provided on a supplemented basis annually. It serves as the basis for the pharmacist to extend his role as pharmaceutical consultant to the medical profession.


4. Mirror to Hospital Pharmacy – provided the findings from an exhaustive study of hospital pharmacy in the US to find out existing practices in hospital pharmacy and to improve the quality and expand the scope of its pharmaceutical service.


5. Institutes – a continuing education program served to help the hospital pharmacy practitioner keep up with current trends of professional practice.


STANDARDS OF PRACTICE

The movement to develop standards of practice in the hospital was initiated by the American College of Surgeons during the early 1900s.As a result of their initiative, the 1st Minimum Standard for Pharmacies in Hospitals was presented to the 18th Hospital Standardization Conference of the ACS in 1935.


In 1942, when the ASHP was organized, a standing Committee on Minimum Standards was appointed for the purpose of maintaining and developing better Minimum Standards.In 1950, the original standard of the ACS was revised by the ASHP.


The Minimum Standard for Pharmacies in Hospitals with Guide to Application has been revised periodically, resulting in the ASHP Guidelines: Minimum Standard for Pharmacies in Institutions.


To assist hospital administrators and hospital pharmacists to review their pharmacy service in terms of expected qualitative performance, The JCAHCO has continued to revise its standards for hospital pharmacy.


Hospital Pharmacy

One of the most important department among several departments of a hospital.


Hospital PharmacyDepartment or division of the Hospital wherein the procurement, storage, compounding, manufacturing, packaging, controlling, assaying, dispensing, distribution, and monitoring, of medications to hospitalized and ambulatory patients are performed by legally qualified, professionally competent pharmacists.


Hospital Pharmacy

The hospital pharmacy exerts a great deal of influence on the professional status of the hospital as well as the economics of the total operational cost of the institution.


Hospital Pharmacy

Modern day hospital pharmacy also provides:

Clinical pharmacy servicesDrug monitoringDrug delivery information system


Hospital Pharmacy: Functions & Objectives

Pharmacy is recognized as an essential hospital service in all the major hospitals.

Managed by professionally qualified pharmacists.


Hospital Pharmacy

It has been realized that only trained pharmaceutical personnel are capable of purchasing, storing, handling, pricing and dispensing of medications.


Hospital Pharmacy

It is the pharmacist who is an expert to provide all information regarding drugs to the health professionals and also the public.Therefore, he acts as a link between the physician and the patient


Hospital Pharmacy

A pharmacist is required to perform various functions in hospital pharmacy which are as follows:


Hospital Pharmacy: Functions

1. Providing specifications for the purchase of drugs, chemicals, biologicals, etc.

2. Proper storing of drugs.3. Manufacturing & distribution of

medicaments such as transfusion fluids, parenteral products, tablets, capsules, ointments and stock mixtures.



4. Dispensing and sterilizing parenteral preparations which are manufactured in the hospital.

5. Dispensing of drugs as per the Rxs of the medical staff of the hospital.

6. Filling and labelling of all drug containers from which medicines are to be administered.



7. Management of stores which includes purchase of drugs, proper storage conditions and maintenance of records.

8. Establishment and maintenance of “Drug Information Centre” which will provide information regarding medications to the physician, nurses or any other competent person who deals in drugs.



9. Patient counseling service while supplying drugs especially from OP department.

10. Maintaining liaison between medical staff, nursing staff and patients.

11. Providing cooperation in teaching and research programs of the hospital.



12. Discarding the expired drugs and containers with worn and missing labels.

13. Providing drug monitoring services by studying various effects of drugs’ administered to the patients especially the indoor patients from ‘Patient Charts’ maintained in the wards, etc.


Functions of Hospital Pharmacy

Dispensing Manufacturing

Purchasing & Inventory Control

Statistics and reports

Teaching ControlResearch

OP

Alcohol

Narcotics

Med, Surgical & Lab suppliesWard or Floor stock

IP LV Parenterals

Bulk

SV Parenterals

Surgical Irrigation Fluids


Hospital Pharmacy Organization

Within the organizational structure of the hospital the director of pharmacy, as a department head, reports to the administrator of the hospital on the proper operation and management of pharmacy.



The Director of Pharmacy: formulates and implements departmental administrative and professional policies of the pharmacy subject to the approval of the administrator.



The profession and clinical policies relating to the hospital pharmacy practice that have a direct relationship to the medical staff are formulated and developed through the Pharmacy and Therapeutics Committee & are subject to administrative approval.


The Organizational Structure

The chart attempts to illustrate that coordination and integration of all the technical elements of practice must be implemented effectively into a total pharmaceutical services. For example, there are technical and professional elements of a clinical-pharmacy service.


On the other hand, there are clinical components of professional, technical and clinical implications to the research and supportive components to a pharmacy service.


Therefore, one should look at the organizational structure of a modern hospital pharmacy in terms of the overall elements compromising its services rather than viewing it from a clinical versus an operational standpoint.


This philosophical approach to the organizational and operational aspects of hospital pharmacy is essential for effective use of all the pharmaceutical sciences that underlie the profession of pharmacy.


A close examination of this organizational chart shows the many ramifications of the practice of pharmacy in today’s modern hospital.


There follows a comprehensive job description of the pharmacist’s responsibilities in general hospital pharmacy activities and in clinical function and responsibilities.


ADMINISTRATIVE STRUCTURE OF THE HOSPITAL PHARMACY

A. Director of Pharmacy

Sometimes known as the Chief Pharmacist or Pharmacy Manager, the pharmacy

director has varied leadership responsibilities




1.Like all hospital department managers, the pharmacy director oversees both personnel and budgetary (fiscal) matters.




2.The director also serves on various hospital committees, typically acting as secretary of the pharmacy and therapeutics committee.




3.As a member of a hospital team, the

pharmacy director may be involved in community out reach programs.




4. The pharmacy director sets quality standards for the department, evaluating policies and procedures and implementing changes and innovations as necessary.




5. The director is responsible for developing management strategies to assure cost effective pharmaceutical services and for implementing total quality management (TQM) concepts




6. Compliance with accrediting and regulating agencies (e.g., the joint Commission on Accreditation of Healthcare Organization, the Department of Public Health, the Board of Registration in Pharmacy).


B. Associate or Assistant Director of Pharmacy

Depending on department size, the pharmacy have one or more associate or assistant directors



1. The associate or assistant director aids

the pharmacy director in the operation

of the pharmacy.



2.Specific tasks include overseeing day-to-day pharmacy operations,

supervising the sterile products rooms, and directing pharmacy purchasing.



3. When the pharmacy director is absent, the associate or assistant director

assumes administrative responsibility.


C. Staff pharmacists. The employees have daily responsibility for the pharmacy’s distributive and clinical duties.

1. Distributive duties include:a. Physician order review and fillingb. Unit-dose chart checkingc. Extemporaneous compounding of

parenteral admixture, oral solution,

and topical preparations.d. Specific assigned tasks, such as purchasing, inventory control, and narcotic distribution and control.


2. Clinical duties of staff pharmacists are varied.a. Therapeutic assessment. In addition to evaluating the appropriateness of prescribed drugs and dosages, staff pharmacist monitor for drug-drug interactions and adverse drug effects.


2. Clinical duties of staff pharmacists

are varied.b. Staff pharmacist also advise physicians, participate in physician rounds, and may serve on the nutritional support team.


2. Clinical duties of staff pharmacists

are varied.

c. Other clinical duties of staff pharmacist include pharmacokinetic monitoring, patient discharge counseling and in service education.


D. Clinical pharmacists. Because of their specialized education and training, these pharmacist are responsible for providing clinical activities for the hospital pharmacy.


D. Clinical pharmacists. 1. Most clinical pharmacists have an advanced degree, such as master of science (MS) in clinical pharmacy or a Doctor of Pharmacy degree (PharmD). some also may have completed a residency of fellowship in clinical specialty.


2. the clinical pharmacist play a major role in monitoring and evaluating drug therapy and intervening when appropriate.3. Depending of departmental organization and hospital size, the clinical pharmacist also may have drug distribution duties.


4. Some clinical pharmacists hold appointments at colleges or schools of pharmacy, serving as preceptors to graduate and undergraduate students.


E. Hospital pharmacy residents. As graduates of pharmacy programs, these staff members have a special interest in hospital practice.1. Generally, pharmacy residencies are 1-year or 2-year programs offered by hospitals alone or in conjunction with a college or school of pharmacy.


2. Hospital pharmacy residents gain intensive experience in the distributive, clinical and administrative aspects of institutional practice.

3. Many pharmacy residents go on to graduate school, clinical fellowships, or entry-level hospital pharmacy management positions.


4. The ASHP matches potential pharmacy residents with ASHP residency programs to facilitate the selection process for both residency candidates and hospitals.


F. Technicians and other support personnel play an important part in hospital pharmacy operation. 1. Technicians may be pharmacy students fulfilling their internship requirements, or they may be high school graduates.


F. Technicians and other support personnel

2. Technicians work under the direct supervision of a pharmacist. In fulfilling their primary duty (i.e., helping to carry out the pharmacist’s responsibilities) technicians perform the following tasks:

a. Fill unit-dose cartb. Fill floor stock pharmacy suppliesc. Extemporaneously compound and

prepare intravenous admixtures for approval by a pharmacist.


PHARMACIST REQUIREMENT

Bed Strength # of pharmacist required

Up to 50 beds 3

Up to 100 beds 5

Up to 200 beds 8

Up to 300 beds 10

Up to 500 beds 15

hospital pharmacy 2010

Documents

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