Chapter 9

Hospital Pharmacy
Practice

Learning Objectives
Describe the various inpatient drug
distribution systems.
Explain the proper procedure for
repackaging of medications.
Identify the process of medication
dispensing.
Describe specialty services such as
intravenous admixtures and total parenteral
nutrition.

Learning Objectives
Identify the various roles of clinically
trained pharmacists in the hospital.
Describe the functions of a drug
information center.
Discuss the origins and purpose of the
hospital formulary.
Discuss the role of automation and
inventory control in the hospital.

Learning Objectives
Describe the classifications and functions of
a hospital.
Identify the roles of major hospital
committees.
List common universal precautions to
protect hospital employees.

HOSPITAL PHARMACY
SERVICES
Inpatient Drug Distribution Systems:
Hospital pharmacies carry out a number of unique
activities such as unit dose drug distribution
system, repackaging, floor stock, and an IV
admixture/TPN service. Also, a unit dose drug
distribution system saves money and reduces the
chance of medication errors.

Functions of a Hospital
1. Diagnosis and testing

Table 9.1

Functions of a Hospital
2. Treatment and therapy

Table 9.1

Functions of a Hospital
3. Public processing (including
admissions, record keeping, billing,
and planning for post-release patient
care)

Table 9.1

Functions of a Hospital
4. Public health education and
promotion, done through a variety of
programs, including smoking
cessation programs, weight loss
programs, support group programs,
and screening of community
members (including mammographies
and testing of blood pressure and
cholesterol)
Table 9.1

Functions of a Hospital
5. Teaching (i.e., training health
professionals)

Table 9.1

Functions of a Hospital
6. Research (i.e., carrying out
programs that add to the sum of
medical knowledge)

Table 9.1

Hospital Pharmacy Issues

Safety
Note!
Only unopened unit doses can be returned
to stock.

Hospital Pharmacy Services

Services Similar to Community Pharmacy Services

1. Maintaining drug treatment records

Table 9.2

Hospital Pharmacy Services

Services Similar to Community Pharmacy Services

2. Ordering and stocking medications

and medical supplies

Table 9.2

Hospital Pharmacy Services

Services Similar to Community Pharmacy Services

3. Repackaging medications

Table 9.2

Hospital Pharmacy Services

Services Similar to Community Pharmacy Services

4. Dispensing medications

Table 9.2

Hospital Pharmacy Services

Services Similar to Community Pharmacy Services

5. Providing information about the

proper use of medications

Table 9.2

Hospital Pharmacy Services

Services Similar to Community Pharmacy Services

6. Collecting and evaluating

information about adverse drug
reactions and interactions

Table 9.2

Hospital Pharmacy Services

Services Similar to Community Pharmacy Services

7. Preparing medications in various

dose forms for dispensing

Table 9.2

Hospital Pharmacy Services

Services Similar to Community Pharmacy Services

8. Educating and counseling patients

about their drug therapies

Table 9.2

Hospital Pharmacy Services

Services Similar to Community Pharmacy Services

9. Preventing, identifying, and

resolving medication-related
problems

Table 9.2

Hospital Pharmacy Services

Services Provided by a Hospital Pharmacy

1. Preparing and maintaining a

formulary

Table 9.2

Hospital Pharmacy Services

Services Provided by a Hospital Pharmacy

2. Conducting drug use evaluations

Table 9.2

Hospital Pharmacy Services

Services Provided by a Hospital Pharmacy

3. Following universal precautions

Table 9.2

Hospital Pharmacy Services

Services Provided by a Hospital Pharmacy

4. Preparing products using aseptic

techniques

Table 9.2

Hospital Pharmacy Services

Services Provided by a Hospital Pharmacy

5. Ensuring that hazardous agents are

handled and disposed of properly

Table 9.2

Hospital Pharmacy Services

Services Provided by a Hospital Pharmacy

6. Filling medication orders (as

opposed to prescriptions)

Table 9.2

Hospital Pharmacy Services

Services Provided by a Hospital Pharmacy

7. Routinely preparing 24-hour

supplies of patient medications in a
form appropriate for a single
administration to a patient (as
opposed to a 30- or 90-day supply)

Table 9.2

Hospital Pharmacy Services

Services Provided by a Hospital Pharmacy

8. Stocking nursing stations with

medications and supplies

Table 9.2

Hospital Pharmacy Services

Services Provided by a Hospital Pharmacy

9. Delivering medications to patients

rooms

Table 9.2

Hospital Pharmacy Services

Services Provided by a Hospital Pharmacy

10. Maintaining a drug information

service, and providing drug
information to the other healthcare
professionals in the institution

Table 9.2

Hospital Pharmacy Services

Services Provided by a Hospital Pharmacy

11. Educating and counseling

inpatients and outpatients about their
drug therapies

Table 9.2

Hospital Pharmacy Services

Services Provided by a Hospital Pharmacy

12. Monitoring patient outcomes

Table 9.2

Hospital Pharmacy Services

Services Provided by a Hospital Pharmacy

13. Preventing, identifying, and

resolving medication-related
problems

Table 9.2

Hospital Pharmacy Services

Services Provided by a Hospital Pharmacy

14. Participating in clinical drug

investigations and research

Table 9.2

Hospital Pharmacy Services

Services Provided by a Hospital Pharmacy

15. Providing in-service drug-related

education

Table 9.2

Hospital Pharmacy Services

Services Provided by a Hospital Pharmacy

16. Reviewing or auditing

prescription services for evaluation of
service accuracy and quality

Table 9.2

Hospital Pharmacy Services

Services Provided by a Hospital Pharmacy

17. Providing expert consultations in

such areas as pediatric pharmacology,
nutritional support, and
pharmacokinetics

Table 9.2

Hospital Pharmacy Issues

Safety
Note!
As in the community pharmacy, in the
hospital pharmacy the technician works
under the direct supervision of the
pharmacist.

Figure
9.1

Figure 9.2

Figure
9.3

HOSPITAL PHARMACY
SERVICES
Clinical Services: Many hospitals offer clinical
and consultative services such as nutrition support,
pharmacokinetics, critical care, and other specialties.

Drug Information Services: Most hospitals

have a drug information service that is primarily
responsible for making recommendations on a drug
formulary. A hospital pharmacy may maintain a drug
information center, containing reference works,
including books, periodicals, microfilm, CDs, DVDs,
and access to computerized or Internet databases.

HOSPITAL PHARMACY
SERVICES
Outpatient Pharmacy Services: Many
large hospitals operate an outpatient
pharmacy to serve the medication needs of
patients discharged from the hospital, as
well as for those patients who are seen in
the emergency room or other ambulatory
clinics adjoining the hospital.

Terms to Remember

unit dose
medication fill list
unit dose profile
floor stock
Total parenteral nutrition (TPN)
satellite pharmacy
protocol
formulary

AUTOMATION IN THE
HOSPITAL PHARMACY
Technology is used in the hospital pharmacy to
increase accuracy and improve efficiency and
quality of pharmacy services. Automated
pharmacy services are replacing some of the
routine, time-consuming filling procedures.
For instance, large automated robots are now
being used to perform some of the filling
procedures with near 100% accuracy

Hospital Pharmacy Issues

Safety
Note!
All computer systems must protect patient
privacy.

Hospital Pharmacy Issues

Safety
Note!
Although automation reduces errors,
technical errors must still be monitored.

Hospital Pharmacy Issues

Safety
Note!
Expiration dates must be included on all
repackaged medications.

Terms to Remember
stat medications

INVENTORY MANAGEMENT
An important part of the technicians position is
the receipt, storage, and ordering of
pharmaceuticals; discrepancies in the order
from the wholesaler or pharmaceutical
manufacturer should be resolved. Automation
from the pharmacy wholesalers is making
inventory management more accurate and less
costly.

Terms to Remember
Investigational drugs

ORGANIZATION OF THE
HOSPITAL
Pharmacy Administration: The director of
pharmacy is the pharmacist-in-charge, with overall
responsibility for the hospitals pharmacy services.
Depending on the hospital size, additional
assistant or associate directors may work under the
director. In small rural hospitals, only one or two
pharmacists may make up the pharmacy staff.

ORGANIZATION OF THE
HOSPITAL
Joint Commission on Accreditation of
Healthcare Organizations: The JCAHO is
an independent, non-profit group that sets the
standards by which quality of healthcare is
measured. The primary mission of JCAHO is to
ensure quality care and patient safety in the
hospitals that are accredited. They evaluate levels
of safety and the quality of care in more than
15,000 healthcare organizations.

Hospital Pharmacy Issues

Safety
Note!
Almost 50% of JCAHO standards relate
directly to safety.

ORGANIZATION OF THE
HOSPITAL
Pharmacy and Therapeutics Committee:
The P&T committee is primarily responsible for
making the final decision on drug formulary
decisions.

Infection Control Committee: The major

role of the infection control committee (ICC) is
the prevention of nosocomial infections in the
hospital. Universal precautions are used to
prevent infection when a hospital worker comes
into contact with blood or other bodily fluids.

ORGANIZATION OF THE
HOSPITAL
Institutional Review Board: The IRB is
responsible for protecting the patient in
investigational studies undertaken in the
hospital.

Universal Precaution Guidelines

1. Universal precautions apply to all
persons within the hospital.

Table 9.3

Universal Precaution Guidelines

2. Universal precautions apply to all
contact or potential contact with
blood, other bodily fluids, or body
substances.

Table 9.3

Universal Precaution Guidelines

3. Disposable latex gloves must be
worn when contact with blood or
other bodily fluids is anticipated or
possible.

Table 9.3

Universal Precaution Guidelines

4. Hands must be washed thoroughly
after removing the latex gloves.

Table 9.3

Universal Precaution Guidelines

5. Blood-soaked or contaminated
materials, such as gloves, towels, or
bandages, must be disposed of in a
wastebasket lined with a plastic bag.

Table 9.3

Universal Precaution Guidelines

6. Properly trained custodial
personnel must be called if cleanup or
removal of contaminated waste is
necessary.

Table 9.3

Universal Precaution Guidelines

7. Contaminated materials such as
needles, syringes, swabs, and
catheters must be placed into red
plastic containers labeled for disposal
of biohazardous materials. Proper
institutional procedures generally
involve incineration.
Table 9.3

Universal Precaution Guidelines

8. A first-aid kit must be kept on hand
in any area in which contact with
blood or other bodily fluids is
possible. The kit should contain, at
minimum, the following items:
adhesive bandages for covering small
wounds
Table 9.3

Universal Precaution Guidelines

alcohol
antiseptic/disinfectant
bottle of bleach, which will be diluted
at time of use to create a solution
containing 1 part bleach to 10 parts
water, for use in cleaning up blood spills
box of disposable latex gloves
disposable towels
Table 9.3

Universal Precaution Guidelines

medical tape
plastic bag or container for
contaminated waste disposal
sterile gauze for covering large wounds

Table 9.3

Terms to Remember
Joint Commission on Accreditation of
Healthcare Organizations (JCAHO)
accreditation
pharmacy and therapeutics (P&T)
committee
infection control committee (ICC)
nosocomial infection

Terms to Remember

sharps
universal precautions
institutional review board (IRB)
informed consent

Discussion
Communicating in the hospital setting often means
working with a wide variety of other healthcare
providers. Understanding what role they play in
the patients healthcare is essential to effective
communication. What duties do each of the
g. social services aide or
following have?
a. primary care physician
worker

b.

anesthesiologist

c.

registered nurse

d.

practical nurse

e.

nurses aide

f.

housekeeping aide

h.

respiratory therapist

i.

phlebotomist

j.

medical lab technician

k.

pharmacist

l.

pharmacy technician

Discussion
Write out a complete description, not
using abbreviations, of the
medication orders given in Figure 9.2
and Figure 9.3.