Hospital Pharmacy Assignment

Assignment on Hospital PharmacyAssignment on Hospital Pharmacy

Submitted to:Submitted to:

Prof. Sk. FerozUddinProf. Sk. FerozUddin

Department of PharmacyDepartment of Pharmacy

Submitted by:Submitted by:

Md.Imtiaz ibne alamMd.Imtiaz ibne alam BPH-02505147BPH-02505147Batch: 25Batch: 25thth © ©

Hospital Pharmacy

Chapter-1

Date: 03.07.06

Health-care services to patients are provided primarily through physicians' offices

(clinics) and in hospitals.

Pharmaceutical services to patients that are seen in physicians' offices have been

provided through community pharmacies, while patients in hospitals normally receive

pharmaceutical services through the hospital pharmacy.

Hospital Pharmacy: Hospital pharmacy may be defined as the practice of pharmacy

in hospital setting including organizational facilities and services.

Date: 05.07.06

Hospital: A hospital is may be defined in terms of its form, that is, its physical

makeup and the quantitative nature of its services.

To be registered as an institution, it must meet certain requirements.

A hospital may also be defined in terms of its broad purpose or mission instead of its

physical form.

It may be viewed as an organized structure that pools together all the health

professions, the diagnostic and therapeutic facilities, equipment and supplies, and

the physical facilities into a coordinated system for delivering health care to the

public.

Clinic: A clinic is a facility or area where ambulatory patients are seen for

appointments and treated by a group of physicians practicing together, and where

the patient is not confined, as in a hospital.

The term clinic also is used to indicate the ambulatory patient diagnostic facility

operated by a hospital and also facilities operated by other agencies for the care of

indigent and medically indigent patients.

In the past the term clinic usually has been reserved for facilities of a teaching nature

where medical students and resident staff offered treatment to patients unable to

afford private practitioners.

Date: 10.07.06

REQUIREMENTS FOR ACCEPTING GENERAL HOSPITALS

DEVELOPMENT AND EXPANSION OF HOSPITALS

Date: 12.07.06

CLASSIFICATION OF HOSPITALS:

¨ Hospitals may be classified in four different ways, by

Type of service Ownership

Length of stay Bed capacity

¨ Hospitals are classified by type of service as either general or special hospitals.

¨ General hospitals provide care to patients with any type of illness: medical,

surgical, pediatric, psychiatric, and maternity.

¨ Special hospitals are those that restrict the care they provide to special

conditions, such as cancer, psychiatric, or pediatric cases.

¨ Hospitals are classified by length of stay as either short term or long-term.

¨ A short-term hospital is one in which the average length of stay of the patient is

less than 30 days. Patients with acute disease conditions and emergency cases

usually are hospitalized for less than 30 days.

¨ Usually, general hospitals are short-term, since acutely ill patients usually

recover in less than 30 days.

¨ A long-term hospital is one in which the average length of stay of the patient is

30 days or longer.

¨ Such patients have long-term illnesses, such as

Psychiatric conditions.

¨ Hospitals are classified by ownership usually as governmental or

nongovernmental.

¨ Nongovernmental hospitals may be:

1. Nonprofit hospitals

2. Profit earning hospitals.

Hospitals generally are classified by bed capacity according to the following pattern:

Under 50 beds

50-99 beds

100-199 beds

200-299 beds

300-399 beds

400-499 beds

500 beds & over

Date: 19.07.06

GENERAL FUNCTIONS OF HOSPITALS:

¨ Traditionally, the hospital's basic purpose for existence has been the treatment and

care of the sick and injured.

¨ In conjunction with this basic function, hospitals have been concerned with

teaching, particularly of medical students ever since the pre-Christian Era of

Greek medicine.

¨ Research has been another function of the hospital. In modern times a fourth

function has been assumed by hospitals, namely, public health (preventive

medicine or wellness).

¨ Thus, the four fundamental functions of hospitals are patient care, teaching,

research, and public health.

ORGANIZATION AND ADMINISTRATION OF HOSPITALS:

There is always a governing body of some sort to which the administrator, Chief

Executive Officer (CEO), president, director, superintendent, medical director, and

chief administrative officer must report.

The duties of the governing board which are performed through the chief executive

officer are:

1. The responsibility for the selection of competent personnel.

2. Control of hospital funds.

3. Supervision of the physical plant.

4. Establish the working hours and conditions, salary schedules, and proper checks

on personnel.

5. Establish a schedule of room rates and other charges for hospital inpatient and

ambulatory care.

6. Devise methods for obtaining endowments and other grants to supplement

income from paying patients and help to balance the hospital budget.

7. Invest endowment funds and other grants, from which the interest is to be used

for operating or other expenses wisely.

8. Make certain that there is an adequate accounting system and provide for routine

audit of the accounts.

9. Determine the needs for additional or replacement construction of the physical

plant of the hospital.

10.Contract with the most advantageous bidder.

Date: 24.07.06

¨ The governing board has its own internal organization, consisting of a president

or chairman, vice-chairman, secretary, and treasurer. On many boards the chief

executive officer of the hospital serves as the secretary.

¨ There are usually certain standing committees appointed, such as

The Executive Committee.

The Hospital Committee dealing with personnel appointments

and with other activities of a departmental nature.

The Finance Committee, which is concerned with the hospital

budget, room rates, and other financial matters.

A Public Relations Committee, which is concerned with

educating the community on the value of the hospital and with

maintaining a desirable relationship with the community.

¨ There may be other committees appointed as the need arises, such as an

expansion and development committee when the hospital is concerned with the

need for construction of additional hospital beds.

Date: 26.07.06

DEPARTMENTAL FUNCTIONS OF A HOSPITAL PHARMACY:

¨ Within the organizational pattern, the functions of the department are:

1. To provide and evaluate service in support of medical care pursuant to the

objectives and policies of the hospital.

2. To implement for departmental services the philosophy, objectives, policies and

standards of the hospital.

3. To provide and implement a departmental plan of administrative authority which

clearly delineates responsibilities and duties of each category of personnel.

4. To participate in the coordination of the functions of the department with the

functions of all other departments and services of the hospital.

5. To estimate the requirements for the department and to recommend and

implement policies and procedures to maintain an adequate and competent staff.

6. To provide the means and methods by which personnel can work with other

groups in interpreting the objectives of the hospital and the department to the patient

and community.

7. To develop and maintain an effective system of clinical and/or administrative

records and reports.

8. To estimate needs for facilities, supplies and equipment and to implement a

system for evaluation, control and maintenance.

9. To participate in and adhere to the financial plan of operation for the hospital.

10. To initiate, utilize and/or participate in studies or research projects designed for

the improvement of patient care and the improvement of other administrative and

hospital services.

11. To provide and implement a program of continuing education for all personnel.

12. To participate in and/or facilitate all educational programs which include student

experiences in the department.

13. To participate in and adhere to the safety program of the hospital.

Date: 31.07.06

SPECIAL QUALITY OF HOSPITAL PHARMACISTS:

¨ The setting within which the hospital pharmacist practices requires special

education or experience to practice with maximum effectiveness.

¨ Unlike the pharmacist in community practice, the hospital pharmacist must

function within an organization that has additional responsibilities beyond patient

care.

¨ These additional responsibilities include education, research, and public

health.

ORGANIZATION AND ADMINISTRATION OF HOSPITAL PHARMACY:

¨ 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 the pharmacy.

¨ The director of pharmacy formulates and implements departmental

administrative and professional policies of the pharmacy, subject to the approval

of the administrator.

¨ The professional and clinical policies relating to hospital pharmacy practice,

which have a direct relationship to the medical staff, are formulated and

developed through the pharmacy and therapeutics committee and are subject to

administrative approval.

Date: 02.08.06

¨ Molecular Pharmacy

¨ Unit dose dispensing system

¨ Ambulatory care and home care services

¨ Intravenous admixture division

¨ Sterile product division

Date: 07.08.06

¨ Educational and technical services

¨ Drug administration and poison control services

Chapter-2

HOSPITAL PHARMACISTS’ RESPONSIBILITIES

Central Pharmacist's Responsibilities:

A. Dispensing area

Date: 09.08.06

1. Ensures that established policies and procedures are followed.

2. Checks for accuracy of doses prepared: a. Intravenous admixtures

b. Unit dose

3. Provides for proper drug control:

a. Ensures that drugs are stored and dispensed properly (eg,

investigational drugs).

b. Ensures that all state and federal drug laws are followed.

4. Ensures that good techniques are used in compounding

intravenous admixtures and extemporaneous preparations.

5. Provides for proper record keeping and billing:

a. Patient-medication records

b. Extemporaneous compounding records

c. Intravenous admixture records and billing

d. Investigational-drug records

e. Reports (eg, monthly workload report)

6. Maintains professional competence, particularly in knowledge of drug stability and

incompatibilities.

7. Ensures that new personnel are trained properly in the policies and procedures of

the dispensing area.

8. Coordinates the activities of the area with the available staff to make the best

possible use of personnel and resources.

9. Keeps the dispensing area neat and orderly.

Date: 14.08.06

B. Patient-care Area

1. Supervision of drug administration.

a. Reviews and interprets each unit dose and IV admixture medication order to

ensure that it is entered accurately into the unit-dose or IV-admixture system.

b. Reviews each patient's drug administration form periodically to ensure that all

doses are being administered and charted correctly.

1. Reviews all doses missed, reschedules the doses as necessary and signs all

drugs not given notices.

2. Ensures that new drug-administration forms are transcribed accurately for

continuity of drug therapy and that drug charges are assessed correctly.

c. Confirms periodically that administered doses are noted correctly on the patient’s

chart

d. Ensures that records for administered narcotics are kept correctly and that the

physician is informed of all automatic stop orders.

e. Ensures that proper d rug-administration techniques are used.

Date: 21.08.06

2. Direct patient care

a. Identifies drugs brought into the hospital by patients.

b. Obtains patient medication histories and communicates all

pertinent information to the physician.

c. Assists in drug-product and entity selection.

d. Assists the physician in selecting dosage regimens and schedules,

then assigns drug-administration times for these schedules.

(Pharmacokinetic service.)

e. Monitors patients' total drug therapy for

(1) Effectiveness/ineffectiveness, (2) Side effects,

(3) Toxicities, (4) Allergic drug reactions,

(5) Drug interactions,

(6) Appropriate therapeutic outcomes

Date: 23.08.06

3. General Responsibilities

a. Provides education to

(1) Pharmacists, pharmacy externs, clerkship students, residents,

and other students

(2) Nurses and nursing students

(3) Physicians and medical students

b. Provides drug information to physicians, nurses, and other health-care

personnel.

FACILITIES OF A HOSPITAL PHARMACY:

¨ There are great variations in the amount of floor space of the pharmacy in

hospitals of the same size and type.

¨ Such variations have a direct bearing on the scope of service that can be

developed in the pharmacy.

¨ Most hospitals with fewer than 100 beds employ a pharmacist on a full time

basis. As the size of the hospital increases, so do the personnel in the

pharmacy.

¨ In hospitals with several hundred beds, hospital pharmacy consist of a director

of pharmacy, an associate director, two or more assistant directors, one or more

supervisor pharmacists, as many as 40 to 60 or more staff pharmacists (many

of whom are clinical specialists), 10 to 16 pharmacy residents, and about as

many non-pharmacist helpers, technicians, and secretarial personnel as

professional personnel.

¨ In addition, several clinical pharmacy faculty associated with a college of

pharmacy also may be active within the department.

Date: 28.08.06

As the hospital size advances to 500, 1000, or more beds, hospital pharmacy

include, the following:

(1) waiting room, 2) office of the chief pharmacist; including a library and drug

information center, (3) office for the secretary and bookkeeper, (4) inpatient

dispensing laboratory, (5) outpatient dispensing laboratory plus a consultation area

to instruct outpatients on the safe an appropriate use of prescription medication, (6)

manufacturing laboratory, (7) sterile products laboratory, divided into a "clean-up"

room and a "sterile techniques" room, (8) product formulation, control, and research

laboratory, (9) prepackaging and labeling laboratory; (10) allergenic products

laboratory; (11) pharmacy storeroom (active stock),. (13) alcohol and volatile liquids

vault or room, (14) narcotic, investigational drugs, and other restricted drug vault or

safe, (14) additional bulk storage facilities either separate or as apart of the general

storeroom, and (15) a radioactive pharmaceuticals laboratory.

Pharmacy &Therapeutic Committee

Rational Utilization of Drugs:

¨ The multiplicity of drugs available and the complexities surrounding their safe

and effective use make it necessary for hospitals to have a sound program for

maximizing rational drug use.

¨ The pharmacy and therapeutics (P&T) committee, or its equivalent, is the

organizational keystone to practice rational drug use in a hospital.

¨ The P&T committee evaluates the clinical use of drugs, develops policies for

managing drug use and drug administration, and manages the formulary

system.

¨ It is a policy recommending body to the medical staff and the administration of

the organization on matters related to the therapeutic use of drugs.

Purposes of P & T Committee:

The primary purposes of the P&T committee are:

Policy Development: The committee formulates policies regarding evaluation,

selection, and therapeutic use of drugs and related devices.

Education: The committee recommends or assists in the formulation of programs

designed to meet the needs of the professional staff (physicians, nurses,

pharmacists, and other health-care practitioners) for complete current knowledge on

matters related to drugs and drug use.

Date: 04.09.06

Organization and Operation of P & T Committee:

While the composition and operation of the P&T committee might vary among

specific practice sites, the following generally may apply:

1. The P&T committee should be composed of at least the following voting members:

physicians, pharmacists, nurses, administrators, quality-assurance coordinators, and

others as appropriate. The size of the committee may vary depending on the scope

of services provided by the organization. Committee member is to be appointed by a

governing board or authorized official of the organized medical staff.

2. A chairperson from among the physician representatives is to be appointed. A

pharmacist is to be designated as secretary.

3. The committee should meet regularly, at least six times per year, and more often

when necessary.

4. The committee should invite to its meetings persons within or outside the

organization who can contribute specialized or unique knowledge, skills, and

judgments.

5. An agenda and supplementary materials (including minutes of the previous

meeting) should be prepared by the secretary and submitted to committee members

in sufficient time before each meeting for them to review the material properly.

6. Minutes of committee meetings should be prepared by the secretary and

maintained in the permanent records of the organization.

7. Recommendations of the committee should be presented to the medical staff or its

appropriate committee for adoption or recommendation.

Functions and Scope of P&T. C:

1. To serve in an evaluative, educational, and advisory capacity to the medical staff

and organizational administration in all matters pertaining to the use of drugs

(including investigational drugs).

2. To develop a formulary of drugs accepted for use in the organization and provide

for its constant revision. The selection of items to be included in the formulary should

be based on objective evaluation of their relative therapeutic merits, safety, and cost.

The committee should minimize duplication of the same basic drug type, drug entity,

or drug product.

3. To establish programs and procedures that help ensure safe and effective drug

therapy.

4. To establish programs and procedures that help ensure cost-effective drug

therapy.

5. To establish or plan suitable educational programs for the organization's

professional staff on matters related to drug use.

6. To participate in quality-assurance activities related to distribution, administration,

and use of medications.

7. To monitor and evaluate adverse drug (including, but not limited to, biologics and

vaccines) reactions in the health care setting and to make appropriate

recommendations to prevent their occurrence.

8. To initiate or direct (or both) drug use evaluation programs and studies, review the

results of such activities, and make appropriate recommendations to optimize drug

use.

Date: 09.10.06

¨ Rational use of drug

¨ Factors underlying irrational use of drug

¨ Impact of inappropriate use of drug

Date: 10.10.06

AMBULATORY PATIENT CARE:

Ambulatory patients are those who are able to walk; ie, those who are not bedridden

in any institution. Therefore, ambulatory patients are not confined to any bed of an

institution.

MEDICATION RELATED NEEDS OF AMBULATORY PATIENTS:

1. Overdosage:

a. Taking more than the prescribed dose at any one administration.

b. Taking more than the prescribed number of doses in any 1 day.

c. Taking a dose, prescribed as needed, at a time other than when needed.

d. Taking the same medication from two or more different bottles simultaneously.

2. Underdosage:

a. Taking less than the prescribed dose at any one administration.

b. Omitting one or more doses.

c. Discontinuing the drug before the prescribed duration of time.

d. Omitting the dose of a medication, prescribed as needed, when it is needed.

3. Taking a dose at a different time if a time has been specified in the directions.

4. Taking a dose in a form other than that specified in the directions.

5. Using the wrong route of administration.

6. Taking medication that has been discontinued.

7. Taking outdated medications.

8. Taking someone else's medications.

9. Taking two or more medications that are contraindicated therapeutically.

10. Failing to get the prescription filled.

Date: 16.10.06

Patients also frequently discontinue medicines inappropriately for a variety of

reasons. In this context, a recent study identified the most common reasons for

patients not having prescriptions refilled. These reasons, in decreasing order of

importance were that the

1. Medication was not working.

2. Medication was causing side effects.

3. Condition improved.

4. Patient received negative information about the medication.

5. Cost of the medication was too high.

6. Patient was confused about how to take the medication.

PHARMACIST'S RESPONSIBILITY

These outcomes may include:

1. Cure of the disease.

2. Elimination or reduction of symptoms.

3. Arresting or slowing the disease process.

4. Prevention of disease.

5. Diagnosis of disease.

6. Desired alterations in the physiological processes.

Pharmacists, who are providers of pharmaceutical care, assume responsibility to

identify, prevent, and resolve medication related problems on behalf of their

patients. These problems have been defined broadly as undesirable events that

are of psychological, physiological, social, or economic origin and may be the

function of a patient:

1. Needing pharmacotherapy but not receiving it,

2. Taking or receiving the wrong medication,

3. Taking or receiving too little of the correct medication,

4. Taking or receiving too much of the correct medication,

5. Experiencing an adverse reaction to a medication,

6. Experiencing a drug-drug or drug-food interaction,

7. Not taking or receiving a medication that has been prescribed, or

1. Taking or receiving a drug for which there is no valid indication.

Date: 18.10.06

Establishment of a Committed Relationship with Individual Patients:

¨ The first step in the provision of pharmaceutical care is the establishment of a

committed relationship with the patient.

¨ For that, pharmacists must seek and be granted authority by their patients to

intervene on their behalf.

¨ The key to doing so in all instances is effective communication.

Committed relationships are rarely the result of a single interaction.

Pharmaceutical care is an iterative (i.e. repeating) and ongoing process, as long

as the patient has unresolved medication-related problems.

Therefore, once a report (i.e. communication) has been established, the

pharmacist must interact regularly with the patient to strengthen the relationship

and to collect additional data necessary to ensure that the patient's

pharmaceutical-care needs continue to be met.

Collection, Synthesis, and Interpretation of Relevant Patient Information:

Pharmacist’s primary responsibility in the delivery of pharmaceutical care is to

identify, prevent, and resolve medication problems.

A key factor in the fulfillment of this obligation is the availability of essential

patient data.

To make appropriate decisions about patient therapy, pharmacists must

understand the utility of different types of information in the decision-making

process.

Patients must realize that different decisions require different types of patient

information.

Thus, an appropriate and comprehensive database for a specific patient is to be

maintained.

Date: 06.11.06

Implementation of Individualized Pharmacotherapeutic and Monitoring Plans:

¨ One step in the pharmaceutical care process is to implement the

pharmacotherapeutic and monitoring plans developed by the pharmacist.

¨ This involves securing physician approval for any changes in the originally

prescribed therapy, counseling the patient about the proper use of the

recommended therapy, and collecting monitoring data to evaluate the efficacy of

the pharmacotherapeutic plan.

The pharmacist should ensure that the patient knows:

¨ The name and description of the medication.

¨ The dosage form, dosage, route of administration, and duration of drug therapy.

¨ Special directions and precautions for preparation, administration, and use by the

patient.

¨ Common severe side or adverse effects or interactions and therapeutic

contraindications that may be encountered-including their avoidance and the

action required if they occur.

¨ Techniques for self-monitoring drug therapy. Proper medication storage.

¨ Prescription refill information.

¨ Action to be taken in the event of a missed dose.

A pharmacist’s counseling on captopril therapy:

A sample:

¨ The name of the medication is captopril.

¨ The strength of each tablet is 12.5 mg.

¨ The doctor wants you to take one-half tablet by mouth 3 times a day.

¨ This medication is being used to treat high blood pressure and congestive heart

failure. It should be continued until the doctor decides otherwise.

¨ The tablets should be broken or cut in half at the score mark in the center of each

tablet. This medicine works best when it is taken on an empty stomach 1 hr

before a meal. Ideally, this medication should be taken at the same time each

day.

¨ If you miss a dose, take it as soon as you remember unless it is close to the time

of your next dose. In this instance, simply skip that dose and resume therapy with

the next scheduled tablet.

¨ Do not double doses.

¨ This medication may cause dizziness or lightheadedness, especially after the first

dose. Make sure you know how you will react to the medication before driving or

operating dangerous machinery.

¨ Minor side effects include coughing, changes in taste perception, and mild

diarrhea and stomach upset.

¨ Contact your physician if any of these symptoms become severe enough to

interfere with daily activities.

¨ Call your physician immediately if you experience fever, swelling of the face or

extremities, trouble breathing, irregular heartbeat, nervousness, or

tingling/heaviness in your legs.

¨ Keep regularly scheduled appointments for laboratory tests and physician

appointments. Consider use of a home blood-pressure monitoring device for

blood-pressure monitoring between physician visits.

¨ Store this medication in a cool, dry place that is out of the reach of children.

¨ Your doctor probably will adjust your dose before you run out of this medication;

therefore, there are no refills on your current prescription.

Date: 08.11.06

Purchasing and drug distribution system:

¨ Bidding system

¨ Prime vendor system

The principle role pf pharmacist in purchasing is to establish standards and

specification for all drugs, chemicals, diagnostic agents and their preparation used in

patients and pharmacist is responsible for the quantity of drugs dispersed to

patients.