IN PATIENT PHARMACY SERVICES

HOSPITAL PHARMACY 1
FAREZA HANUM MOHD RADZI
PHHP 4123
 Learning Outcomes
To explain the process of dispensing medication
A to patients at the inpatient pharmacy and the terms used
in in-patient dispensing

To compare the different in the roles and responsibilities

B of a Pharmacist and Pharmacy Assistant.

To list steps involved in dispensing process to

C In-patient.

To describe the IDDS currently applied in the govern-

D ment hospital pharmacies.
 RESPONSIBILITIES
Complete
Prescribe
dispensing Take medication
medications.
process according to
Decide the best
Drug counseling instruction
treatment for
Drug Report side
patient based on his
reconciliation effects
health condition.

Prescriber Pharmacist P. Assistant Nurses Patient

Intervention Drug
Drug interaction administration
Drug counseling Drug counseling
Drug
reconciliation
 PROCEDURE MANUAL
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IN PATIENT PHARMACY
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 Receiving of Prescriptions/TTA/Medication Charts

WORKFLOW Manual / KCIS

INPATIENT PHARMACY Screening of Prescriptions/TTA/Medication Charts

Problem ?
KCIS

YES Print prescription

NO

Prepare medication Verification / Confirmation with doctor/

pharmacist/nurse

OUTPATIENT INPATIENT WARDS

Call Patient Medication despatched/collected by ward

BILLING ACCOUNT DEPARTMENT

Dispensing of medication
 WorkProcesses

RECEIVING & LABELLING & CHECKING & ADMINISTERING &

SCREENING PREPARING DISPENSING EDUCATION
 Receiving
& Screening
 Receiving & screening of
medication chart

 Receiving of medication cart (some hosp)

 Receive medication chart
and / or individual
prescription from nurses.
Medication Cart
A trolley with small
compartments
meant for keeping
medications for
individual patient
 Receiving & screening of
medication chart
 Check the patient’s name against the bed
number and allocate a compartment in the
medication cart to the patient.
 Arrange the prescriptions according to
patient’s profile.
 Check the prescription for completeness.
 Check prescription for correct drugs dosage,
possible interactions, incompatibility or
polypharmacy.
 Ensure drugs prescribed are in stock.
Preparing &
Labelling
 Preparation of medication

• The prescription / TTA / medication chart is

prepared in the following manner :-
– Calculate the quantity required
– Prepare the medication
– Reconstitute the medication as instructed
by manufacturers (where appropriate)
– Pack and place the medication in suitable
containers
Supply of medications by unit of use
Unit of use system (UoU)
• Supply of medication by
prescriptions to patients on
an individual basis for a
fixed period of time.
• prepare the required
medication over a duration
of 3 to 5 days (depend on
hosp policy) – for injection
supply only 1 day
• nurses will re-request to
the pharmacy for medica-
tions top-up.
Unit dose system (UDS)
• pharmacy coordinated
method of dispensing and
controlling medications
• characterized by
 medications contained in
unit dose packages,
 dispensed in ready-to-
administer form
 not more than 24-hour
supply.
• quantity of medication dis-
pensed should be according
to the dosage regimen
Supply of medications by unit of use
Unit of use system (UoU) Unit dose system (UDS)
 Floor stock

 Definition: Stock of medication in the ward meant for

new order after office hours and for urgent cases.
These included stocks of injections, tablets, mixture,
lotion and intravenous drips for use in the ward.
 small pharmacy located at the nursing unit whereby
nurse can have easy access to use these medications
than rather than relying on the collection and process
by the inpatient pharmacy unit which may take a longer
time.
 restocking medications in the nursing unit and
preparing the medicines based on the floor stock drug
list and quantity predetermined for each ward – usually
by weekly indent form
Floor stock
 Floor stock

Preparation made upon

request:
• Hibitane Aquoues
• Hibitane In Spirit
• Cord Spirit
• Extemporanous syrup
 Floor stock

PSYCHOTROPIC DRUGS
 Supplies are carried out
on as schedule on weekly
basis by the pharmacist.
 Kept under lock and key
in the ward as floor stock
– managed by ward
manager / appointed staff
nurse
 The staff nurse will
maintain a record of
usage in the ward
 Labelling of medication

Label medication with :-

a) Name of patient
b) Name of medication and strength
where appropriate
c) Date
d) Usage instructions if any
e) Indicate special storage condition /
warnings for chemical if any
Checking &
Dispensing
 Checking & Dispensing of medication

 Record all supplies of medications in patient’

s medication chart and/or bin card (for floor
stock)
 Fill the medications into the appropriate con-
tainers and place medication into the respect
-tive compartment of the medication cart.
 Countercheck to ensure the medications in
the compartment are the correct quantity and
for the right patient
 Despatch / Collection

 Despatch cart to the ward or call nurses for

collection at the pharmacy
 Obtained acknowledgement of medication
received from nurse
Administering
& Education
 Administration of medication

 Drug administration will be done by staff

nurses according to policy and drug administ
ration guideline
 Pharmacy is responsible in maintaining the
procedures or establishing guidelines on
drug administration
 Ensure 5R Rules is adhered to before admi-
nistration of drugs
 Patient Education

 Nurses are encouraged to educate patient on

medication prior to administration
 Basic education given involved content of
medication, indication and how to use the
medication if self administration required.
 Record must be
maintained for self
administration drugs
 Patient Education

Bedside Counseling
 Education given to patient as and when required
 Counseling of outpatients by Pharmacist or PA will be
conducted for the following cases; as and when required by
patients or prescribers:
 Techniques of using devices e.g. inhaler, insulin pen
 Management of antithrombotic agents such as
Warfarin
 Teaching on medications that have specific direction of
use such as Fosamax
 Poor concordance to medications regimen
 OTHER ACTIVITIES
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IN PATIENT PHARMACY
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TTA Definition: prescription in
(To Take Away) which the physician will
prescribe the list of
Prescription medication for discharged
patient.
 TTA Procedures

 Receive the prescription through the system/manual and

screen the prescription.
 If there is any error or problem regarding the frequency/dura
tion/strength of the medication, the pharmacy staff will call
the doctor to confirm the medication.
 Print out the KCIS prescription and label. Pharmacy staff will
charge the medication to patient.
 Prepare, pack and label the medication. Double check the
medication and put into a plastic bag
 Put into the respective ward’s basket.
 A porter will send the medication to the ward or a nurse will
come to the pharmacy to collect the drug.
 TTA Procedures

 Discharged medication list will be given for future reference

of patient.
Unpacking Definition: Balance
medication used for the
Ward Return patients return by nurses
from ward to inpatient
Supply pharmacy department.

Condition of drug that can be

returned
• Not loose item
• Syrup /iv /eye drop/ inhaler that
not being used.

Condition of drug that cannot

be returned
• Loose item (discard into yellow
bin)
• Opened syrup / iv /eye drop/ in
haler.
 Ward Return Procedures

 Receive drug return from ward by the nurse / care assistant

 Find for patient’s files.
 Check the balance drug and key in the details in system
 Place the returned drugs in the basket provided.
 Return back the drug to the origin bin.
  Definition: The process of
Medication ensuring that a hospital
Reconciliation patient's medication list
is as up-to-date as
possible.

 It is usually undertaken by a
pharmacist/ pharmacy
assistant and may include
consulting several sources
such as the patient, their
relatives or caregivers.

 Patient usually are required

to bring their own medica-
tions from home for this
process.
 Patient Own Medications

 Medication brought in by patient / relative into the hospital

 Criteria:
 Medication is identifiable
 Must be in original dispensed container / pack
 Loose tab / mix tabs NOT TO BE USE eg in pillbox
 Condition good, no contamination
 Specific storage condition eg fridge item / eye drop NOT TO BE
USE
 Expiry date available. If no expiry,<3 months dispensing date

 Must be validated by Pharmacy staff

– Orange sticker on packaging
– Without orange sticker, medications NOT TO BE USE
 ADDED SERVICES
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IN PATIENT PHARMACY
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  Refers to a decentralized
SATELLITE operating unit which has
Pharmacy similar function with the
central inpatient pharmacy.
Advantages
 Provides specialised
To reduce workload at the central inpatient unit. medication distribution
To reduce medication errors in drug supply to services for hospitalised
patients in ward during peak hours.
patients.
To reduce storage at nursing facility.  The operation of the satellite
To improve drug inventory and achieve cost
pharmacies relies on
effective operations administration, staffing, and
To dispense drugs to individual ward patients in drug procurement from the
an effective and timely manner. main inpatient pharmacy
Expansion of pharmacy services department.
 Usually do not offer direct
Increased physician and nursing satisfaction
services to the public.
AUTOMATED  Automated dispensing
machines is a decentralized
Dispensing medication distribution
systems that provide
computer-controlled storage
, dispensing, and tracking of
medications

 have been recommended as

one potential mechanism to
improve efficiency and
patient safety

 widely used in many

hospitals in US, Malaysia
only in few private hospitals
Ward dispensing systems
 D
D
Thank you