Almshouses for the sick poor Asylums for the care and confinement of orphans and the mentally ill Hospices for terminally ill Infirmaries for short-term acute care Aesculapius Greek God of medicine Temple of Aesculapius existed in 1134 BC Hippocrates Father of Western Medicine born about 460 BC Fabiola-a wealthy Roman woman; donated her palace for the care of the sick Bishops required to provide a shelter for the care of the sick in each diocese Maimonides famous rabbi, influenced health care by his teachings and works Monks primary health care practitioners during the middle ages. The Black Plague killed almost one-third of the inhabitants in Europe Hotel Dieu one of the finest hospitals in Europe during the Black Plague Hospital of the Holy Spirit founded in 717 Major site for the education of lay physicians Pennsylvania Hospital established in 1751 First incorporated hospital in the United States through the efforts of Dr. Thomas Bond

Massachusetts General Hospital first hospital to use general anesthesia in surgery Dr. Crawford Long performed the first operation with anesthesia Chloroform and ether standard anesthetic agents Union Hospital poor sanitation and depressing environment Louisa May Alcott described the Union Hospital in her published book Hospital Sketches Saint Dymphna patron saint for mental disorders May 15

Benjamin Rush Father of American Psychiatry Introduced new method of treatment for psychiatric patients based on moral principles

Deinstitutionalization large number of persons were discharged to communicate World War I y y y Major trauma, burns, poison gas & infections of all kinds Hospital designs Floating hospitals

Hospital of the Immaculate Conception first hospital on the American Continent built by the Spaniards in 1524 Name changed to The Hospital of Jesus of Nazareth in 1663

World War II y y y y Major advances in trauma surgery systemic sulfonamides, penicillin wide use of blood & plasma transfusion Volume of injured increased

Philadelphia General Hospital started in 1713 as an almshouse to give relief to the sick Jonathan Roberts first American hospital pharmacist

y y

Cadet nurse corps PT s and OT s came into being

delegates authority, and passes on responsibility to department leaders Department Leaders carry out the patient care, teaching research and public health objectives of the hospital The Business and Finance Department handles the financial affairs The Building Services Department provides the essential maintenance, housekeeping, and security functions The Human Resources Department implements personnel policies The Clinical Laboratory Department performs a multitude of patient laboratory tests and services The Nursing Service provides continuous care Accreditation Agencies exerts their influence on professional standards of practice as they affect patient care Licensing Agencies exert their legal influences on hospital operations The Federal Government imposes standards and regulation in hospitals Third-party Agencies exerts their influence on the methods by which hospitals may be reimbursed for services rendered to patients Social Agencies and Governmental Welfare Agencies exert their influences over the policies, objectives and philosophies of hospital operation and services Governing Board and Public Opinion exert their influences over the policies, objectives and philosophies of hospital operation and practice

Abraham Flexner American educator Florence Nightingale Lady with the Lamp Congress of the Hospital Survey and Construction Act Hill-Burton program This act provided federal funds for hospital construction on a matching basis with local communities

Social Security Amendments of 1965 had a long range impact on the development and expansion of hospitals Hospital has become a necessary instrument for providing the fourth basic element of survival health. Health care a right for all, rather than a luxury for few Hospital an institution where the ill or injured may receive medical, surgical, or psychiatric treatment, nursing care, food and lodging Function is to provide patient services, diagnostic and therapeutic

Institution a significant and persistent element (as a practice, a relationship, an organization) in the life of a culture Hospital Pharmacy- practice of pharmacy in hospital settings and includes the organizationally related facilities and services Division of hospital wherein the procurement, storage, compounding, etc, are performed by legally, qualified, professionally competent pharmacists and assistants

The Administrator highest hospital administrative position; implements policies,

National Hospital Week (August 6-12, 2010) DOH: Ospital na ligtas, handang magbigay lunas. General Hospital provide patient services, diagnostic and therapeutic, for a variety of medical conditions Special Hospitals for patients who have specified medical conditions, both surgical and nonsurgical Rehabilitation and Chronic Disease Hospitals for handicapped or disabled individuals requiring restorative and adjustive services Psychiatric Hospitals - for patients who have psychiatric-related illnesses Short-term less than 30 days Long-term 30 days or longer Federal owned and operated by various branches of the federal government State owned by the state and controlled by a board of control or division of the state government County owned by the county and financed and controlled similarly to state hospitals, only on county level City owned, financed and controlled by the city government Non-profit fees from paying patients or by contributions from the several religious orders or churches Patient Care involves the diagnosis and treatment of illness or injury, preventive medicine, rehabilitation, covalescent care, and personalized services

Education of the medical and allied health professions includes formal programs; inservice training programs Education of the patient includes providing general education for children confined to longterm hospitalization; special education in the area of rehabilitation 1988 JCAH JCAHO 2007 JCAHO TJC JCAHO Independent, voluntary agency and its actions are not subjected to ratification by the organizations represented by its component members Operates voluntary accreditation programs for hospitals Private sector, US based

1956 Pharmacy department was included among the essential services of the hospital Governing Body has total accountability with organization s structure CEO lead organization and make recommendations to the board Administrator/s assists the CEO; appoints leader to each department Department Leaders operate departments effectively and properly Open Staff certain physicians other than those attending or active medical staff are allowed to use the facilities Courtesy medical staff

Closed Staff all professional services, private and charity, are provided and controlled by the attending or active medical staff

Honorary Medical Staff physicians who have been active in the hospital but who are retired and those whom it is desired to honor because of outstanding contributions Consulting Medical Staff specialists who are recognized as such by right of passing specialty boards or belonging to the national organization of their specialty Active or Attending Medical Staff concerned with regular patient care

Myrrh a remedy used as an appetite stimulant, carminative, skin protective; with healing properties Olibanum (frankincense) oleogum resin Ebers Papyrus (1500 BC) Found in Egypt by George Ebers One of the 11 medical scrolls that preserve the knowledge of early Egyptian medicine 700 drugs w/ formulas for over 800 remedies Use of mortars & pestles, hand mills, mills, sieves & weighing scale

Most actively involved in the hospital -

Associate Medical Staff junior or lessexperienced medical staff Courtesy Medical Staff physicians who desire the privilege of attending private patients, but those who do not desire active staff membership Resident Medical Staff residents, who are full-time employees of the hospital Persons who provide specific services in the care of a patient

AHFS comprehensive unbiased source of information on drugs provided on a supplemented basis annually Institutes a continuing education program served to help the hospital pharmacy practitioner keep up with current trends of professional service 1910 End result system of hospital accreditation Medical Malpractice improper, negligent treatment of a patient by a health care professional ASHP formed during clinical years Patient as the focal point for existence of pharmacy practice

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


Separation of Pharmacy to Medicine took place in charitable institutions Hospital Pharmacist first recognized practitioner Materia Medica drug and medicinal remedies

IPA provides extensive coverage of the pharmaceutical literature

SSA ± Social Security Amendments AHA ± American Hospital Association PHA ± Philippine Hospital Association DOH ± Department of Health CEO ± Chief Executive Officer PRC ± Professional Regulation Commission SALAD ± Sound Alike Look Alike Drugs HAM ± High Alert Medications ACS ± American College of Surgeons JCAH ± Joint Commission on Accreditation of Hospitals JCAHO- Joint Commission on Accreditation of Health Care Organizations UDDDS ± Unit Dose Drug Distribution System ASHP ± American Society of Hospital Pharmacists (1942) - American Society of Health-System Pharmacists AJHP ± American Journal of Hospital Pharmacy IPA ± International Pharmaceutical Abstract AHFS ± American Hospital Formulary Service TJC ± The Joint Commission JCI ± Joint Commission International ACCP ± American College of Clinical Pharmacists AACP ± American Association of Colleges of Pharmacy APhA ± American Pharmacists Association ACCP ± Asian Conference on Clinical Pharmacy FAPA ± Federation of Asian Pharmaceutical Association PPRC ± Philippine Pharmaceutical Research Congress

Internal forces: y y Organizational structure of a hospital There is a physician pharmacist nurse patient relationship in the hospital y Service capability

Type of service: y y y y General Special Rehabilitation and Chronic Disease Psychiatric

Organizational Structure: y y y y y y y y The Administrator Department Leaders The Business and Finance Department The Building Services Department The Human Resources Department The Clinical Laboratory Department The Nursing Service Other

Length of Stay: y y Short-term Long-term

Ownership: y Governmental Federal State a. County b. City c. City-county Nongovernmental Nonprofit For profit a. Individual b. Partnership c. Corporation

External Forces: y y y y y y Accreditation Agencies Licensing Agencies The Federal Government Third-party Agencies Social Agencies and Governmental Welfare Agencies Governing Board and Public Opinion


Mission: y y y y Lead Enable Assist Protect Hospitals towards quality service

Bed Capacity: y y y y Large (above 1000) Medium (between 500-1000) Small (between 100-500) Very Small (less than 100)

Classification of Hospitals y y y y Type of service Length of stay Ownership Bed capacity

Service Capability y y y Primary Care Hospital Secondary Care Hospital Tertiary Care Hospital

PRIMARY Non-departmentalized hospital that provides clinical care and management on the prevalent diseases in the locality

SECONDARY Departmentalized hospital that provides clinical care and management on the prevalent diseases in the locality, as well as particular forms of treatment, surgical procedures and intensive care Clinical services provided in Primary care, as well as Specialty Clinical Care

TERTIARY Teaching and training hospital that provides clinical care and management on the prevalent diseases in the locality, as well as specialized and sub-specialized forms of treatment, surgical procedure and intensive care Clinical services provided in Secondary Care, as well as sub-specialty clinical care

Clinical services include: y General medicine y Pediatrics y Obstetrics and Gynecology y Surgery y Anesthesia Provides appropriate administrative and ancillary services (clinical, laboratory, radiology and pharmacy) Provides nursing care for patients who require intermediate, moderate and partial category of supervised care for 24 hrs or longer

Provides appropriate administrative and ancillary services (clinical, laboratory, radiology and pharmacy) Nursing care provided in Primary Care, as well as total and intensive skilled care

Provides appropriate administrative and ancillary services (clinical, laboratory, radiology and pharmacy) Nursing care provided in Secondary Care, as well as continuous and highly specialized critical care

Fundamental functions of Hospitals: y y y y Patient Care Education Research Public Health

Major purposes of Research: y y Advancement of medical knowledge against disease Improvement of hospital services

2 groups of services

Internal organization of Governing Board: y y y y President/Chairman Vice-Chairman Secretary Treasurer

Types of Hospital Staff: y y Open Staff Closed Staff

Categories of the Medical Staff: y y y y y y Honorary Consulting Active/Attending Associate Courtesy Resident

Committees appointed: y y y y Executive committee Hospital committee Finance committee Committee on Public Relations

Responsibilities of CEO: y y y Selection of Competent Personnel Control of funds Supervision of the physical plant

Sources of Income: y y y y y Patients Government Third-party Hospitalization Insurance Voluntary Contributions Endowment funds and Investments

Groups of Hospital Staff: y y Professional Care Business Management

Traditional Functions of Pharmacists: y y y y y y y y y y Procurement Packaging Storage Controlling Distribution Compounding Assaying Monitoring of Medication Manufacturing Dispensing

Residency Training Programs: y y y y y y y y y y Nuclear Community Pediatric Psychiatric Geriatric Drug Information Oncology Primary Care Critical Care Intensive Care

Developed Minimum Standards for Hospitals: y y Dr. Ernest Codman, MD Dr. Franklin Martin

NOT INCLUDED IN THIS REVIEWER: y Administrative Structure of the Hospital Pharmacy ASHP Guidelines: Minimum Standards for Pharmacies in Hospitals ((Ewan ko na)) :D

Objective: y y Health Care Provide safe and effective care of the highest quality and value


Significant Contributions of ASHP: y y y y y Development of standards of practice Continuing education Various publications to support practices Standard for residency training Residency accreditation services


-Kim Manlangit :)

DP = cost of drug + % markup DP = cost of drug + professional/dispensing fee DP = cost of drug + % markup + cost of supplies

Amoxicillin 10 mg = P9.50 from manufacturer DP = 9.50 + (9.50 x 0.50) = 9.50 + 4.75 = P14.25 / capsule A prescription calls for Cefalexin 500mg capsules (1 cap 3x a day fow 1 week). The acquisitor cost of Cefalexin 500mg/cap is P17.75. The % markup is 25%. Compute for the DP to complete the medication. DP = 17.75 + (17.75 x 0.25) = 17.75 + 4.4375 = P22.19 / capsule x 21 = P465.94 RX Drug A 325mg/pptab Dispense (1 pptab 3x a day) pptabs good for 3 weeks Commercially available: Drug A 625mg tab Acquisitor cost: P15.75 / tablet PE/pptab: P3.50 (ANO YUNG PE?????) Total Amount of Drug A 3x day x 21 days = 63 pptabs 325 mg drug : 1 pptab = x : 63 pptab X= 20,475 mg drug A 625 mg : 1 tablet = 20,475 mg : x X = 33 tablets 33 tablets x P15.75 = P519.75 DP = P519.75 + (63 + 3.50) DP = P740.25

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