Hospital Pharmacy

Introduction
“Hospital pharmacy is the health care service, which comprises the art, practice, and profession
of choosing, preparing, storing, compounding, and dispensing medicines and medical devices;
and advising patients, doctors, nurses and other healthcare professionals on their safe, effective
and efficient use”.
Hospital pharmacy is a specialized field of pharmacy which forms an integrated part of patient
health care in a health facility.
Hospital pharmacy is the profession that strives to continuously maintain and improve the
medication management and pharmaceutical care of patients to the highest standards in a
hospital setting.
It is also concerned with education and research in pharmaceutical services
Objectives
1. Teach hospital pharmacists about the philosophy and ethics of hospital pharmacy to assume
responsibility for professional practice.
2. Ensure the availability of right medication at reasonable cost
3. Develop the scientific and professional aspects of the practice of hospital pharmacy including
his/her consulting role, teaching role and participation in the research
4. Develop the administrative and management skills and other aspects essential to the hospital
pharmacist in his/her role as a departmental head.
5. Attract greater number of pharmacists in hospital practice
6. Utilize the resources of hospital to help in improvement of the department and profession as
a whole
7. Plan, organize, and implement pharmacy policies to develop the department while keeping
the hospital policies of the hospital
8. Coordinate with other departments of a hospital
Functions
1. Dispensing of drugs, chemicals and pharmaceutical preparations
2. Preparation and sterilization of injectable drugs when manufactured in the hospital
3. The filling and labelling of all drug containers issued to other departments from which
medication is to be administered
 4. Inspection of all pharmaceutical supplies in other departments
5. Dispensing of all narcotic drugs and maintenance of perpetual inventory of these.
6. Maintenance of approved stock of antidotes and other emergency drugs
7. Maintenance of specifications of all drugs, chemicals, and pharmaceutical preparations
used in the hospital
8. Dissemination of information of drugs to the doctors, nurses and other healthcare
professionals
9. 9. Establishment and maintenance of satisfactory system of records for:
10. Charging patients for drugs and pharmaceutical supplies, and
11. Maintaining adequate control over dispensing of all drugs and pharmaceutical supplies
12. 10. Planning, organizing, and directing pharmacy policies and procedures in accordance
with established policies of the hospital
13. 11. Maintenance of the facilities of the department
14. 12. Cooperation in teaching courses to student nurses and medical internees training
program
15. 13. Implementation of the decisions of Pharmacy & Therapeutic Committee
16. 14. Preparation of periodic reports on the progress of the department for submission to
hospital management.
Minimum Standards for Hospital Pharmacy
Pharmaceutical services in institutions have numerous components, the most prominent being
1) The procurement, distribution, and control of all pharmaceuticals used within the facility.
2) The evaluation and dissemination of comprehensive information about drugs and their use
to the institution's staff and patients.
3) The monitoring, evaluation, and assurance of the quality of drug use.
These functions are carried out in cooperation with other institutional departments and
programs.
The primary function of this document is to serve as a guideline for the development and
provision of pharmaceutical services in health care settings.
Standard I: Administration
The pharmaceutical service shall be directed by a professionally competent, legally qualified
pharmacist. He or she must be on the same level within the institution's administrative
structure as directors of other clinical services. The director of pharmaceutical services is
responsible for:
1) Setting the long- and short-range goals of the pharmacy based on developments and trends
in health care and institutional pharmacy practice and the specific needs of the institution.
2) Developing a plan and schedule for achieving these goals.
3) Supervising the implementation of the plan and the day-to-day activities associated with it.
4) Determining if the goals and schedule are being met and instituting corrective actions where
necessary.
The director of pharmaceutical services, in carrying out these tasks, shall employ an adequate
number of competent and qualified personnel
Standard II: Facilities
There shall be adequate space, equipment, and supplies for the professional and administrative
functions of the pharmacy.
 The pharmacy shall be located in an area (or areas) that facilitate (s) the provision of
services to patients. It must be integrated with the facility's communication and
transportation systems.
 Space and equipment, in an amount and type to provide secure,

 environmentally controlled storage of drugs, shall be available.

 There shall be designated space and equipment suitable for the preparation of sterile
products and other drug compounding and packaging operations.
 The pharmacy should have a private area for pharmacist-patient consultations. The
director of pharmaceutical services should also have a private office or area.
 Current drug information resources must be available. These should include appropriate
pharmacy and medical journals and texts and drug literature search and retrieval
resources.
Standard III: Drug Distribution and Control
The pharmacy shall be responsible for the procurement, distribution, and control of all drugs
used within the institution. This responsibility extends to drugs and related services provided to
ambulatory patients. Policies and procedures governing these functions shall be developed by
the pharmacist with input from other involved hospital staff (e.g. nurses) and committees
(pharmacy and therapeutic committee, patient-care committee, etc.). In doing so, it is essential
that the pharmacist routinely be present in all patient-care areas, establish rapport with the
personnel, and become familiar with and contribute to medical and nursing procedures relating
to drugs.
Standard IV: Drug Information
The pharmacy is responsible for providing the institution's staff and patients with accurate,
comprehensive information about drugs and their use and shall serve as its center for drug
information.
Standard V: Assuring Rational Drug Therapy
An important aspect of pharmaceutical services is that of maximizing rational drug use. In this
regard, the pharmacist, in concert with the medical staff, must develop policies and procedures
for assuring the quality of drug therapy.
Standard VI: Research
The pharmacist should conduct, participate in, and support medical and pharmaceutical
research appropriate to the goals, objectives, and resources of the pharmacy and the
institution.
Abilities Required for Hospital Pharmacists
The qualified hospitals pharmacists must have:
1. Knowledge of Drugs and their Actions
Hospital Pharmacist is always associated with the medical staff, so he/she must have the
knowledge in chemistry, pharmacology, route of administration, stability and other information
relating to drugs.
The hospital pharmacist must be able to provide information and assistance in the proper
handling of drugs, for example radioisotopes and experimental drugs
2. Development of Pharmaceutical Manufacturing Program
Hospital pharmacist must be able to develop formulations not available commercially. Hospital
pharmacist should possess an adequate understanding of the principals involved in
formulations and preparation of dosage forms.
3. Knowledge of Control Procedures
Hospital pharmacist must be able to develop quality assurance program for quality services of
pharmacy department and products dispensed. Hospital pharmacist must be able to develop
control program for distribution of drugs throughout the hospital.
4. Participation in Research Activity
Hospital pharmacist must be prepared to participate in clinical research initiated by medical
staff and to conduct pharmaceutical research himself. Hospital pharmacist must be able to
establish database for drugs being used and patients participating in studies. Hospital
pharmacist must have ability to collect appropriate data, interpret it and make conclusion from
data.
5. Teaching Training Program
Hospital Pharmacist must be capable of organizing teaching/training programs in hospital. He
may prepare lectures and demonstrations for the nursing staff covering such topics as storage
of drugs, their usage, dosage forms and dose calculations. Topics such as prescription writing,
drug usage and incompatibilities may be presented to the medical staff
6. Administration and Management
Hospital pharmacist should be thoroughly familiar with organization of hospital, with staff and
with appropriate channel of communication. Hospital pharmacist should be capable of planning
and integrating services, budgeting, inventory control, cost review, cost effectiveness, audit,
maintenance of records and preparation of reports.
Research in Hospital Pharmacy
The hospital pharmacist who possesses adequate education and training can conduct a
protracted investigation in the various scientific disciplines which comprise the profession of
pharmacy. In addition, the hospital pharmacist may become involve in research pertaining to
packaging, distribution, manufacture and storage of pharmaceutical preparations. There exists
also the opportunity to develop new dosage forms, improve existing ones and to develop new
and more accurate methods for analyzing the final product.
Many hospital pharmacists become involved in pharmacokinetic and drug interaction studies.
Hospital pharmacists are capable of conducting research into problems of pharmaceutical
administration, quality control, professional practice, and the sociological aspects of patient
care as they relate to the practice of hospital pharmacy.
Hospital and Its Organization
Hospital-Introduction
The word "hospital" comes from the Latin hospes, signifying a stranger or foreigner, hence a
guest.
Another noun derived from this, hospitium came to signify hospitality, that is the relation
between guest and shelterer, hospitality, friendliness, and hospitable reception.
Hospital is a health care institution comprises of dedicated staff consisting of physicians,
surgeons, and technical staff to provide the facilities for the prevention, diagnosis, treatment,
and rehabilitation to all patients regardless of race, color, creed, or economic status.
As per WHO expert committee 1963, Hospital is residential establishment which strive to
provide short term and long term medical facilities comprises of diagnostic, therapeutic and
rehabilitation services for the suspected patients who are suffering from disease or injury.
Sometimes, the hospital may or may able to provide the services to ambulatory patients
Basic Role and Functions of a Hospital
Patient Care
Patient care refers to the prevention, treatment, and management of illness and the
preservation of physical and mental well-being through services offered by health
professionals.
Public Health Care
Public health is the science of protecting and improving the health of people and their
communities. This work is achieved by promoting healthy lifestyles, researching disease and
injury prevention, and detecting, preventing and responding to infectious diseases.
Education Services
It is secondary function and concerned with training and educational courses for professional
and technical personnel who provide health services
Research
It is secondary function and concerned with conducting health related research that focus on
the improvement of health and / or prevention of diseases
General Functions of a Hospital
Medical Services
Medical services mean care and treatment provided by the hospital directed at preventing,
diagnosing, treating, or correcting a medical problem.
Administrative Services
Hospital administration encompasses organizing and supporting the patient's total medical care
during an episode of illness in the hospital, and is responsible for integrating the various
functions and services.
A hospital is a multifaceted organization comprising many committees, departments, types of
personnel, and services. It requires highly trained employees, efficient systems and controls,
necessary supplies, adequate equipment and facilities, and, of course, physicians and patients.
Patient Care & Education
Patient care refers to the prevention, treatment, and management of illness and the
preservation of physical and mental well-being through services offered by health
professionals.
Patient education can be defined as the process of influencing patient behavior and producing
the changes in knowledge, attitudes and skills necessary to maintain or improve health
Diagnosis
The act or process of discovering or identifying a diseased
condition by means of a medical examination, laboratory test, etc.
Rehabilitation Services
Special healthcare services that help a person regain physical, mental, and/or cognitive
(thinking and learning) abilities that have been lost or impaired as a result of disease, injury, or
treatment. Rehabilitation services help people return to daily life and live in a normal or near-
normal way.
Convalescent Care
To convalesce means to recover or recuperate. So, convalescent care for the elderly
(sometimes referred to as rehabilitation care) involves care while recovering from an illness,
injury or medical procedure.
General Classification of Hospitals
Organization Structure and its Functions
Organization refers to levels of management within a hospital
Levels allow efficient management of hospital
An organizational structure is a system that outlines how certain activities
are directed in order to achieve the goals of an organization. These activities can include rules,
roles, and responsibilities. The organizational structure also determines how information flows
between levels within the organization.
The functional organization is based on grouping individuals into
organizational units, according to the function they perform, such as orthopedics, surgery,
physical therapy, etc. In a functional organization, people who share common expertise and
responsibility are grouped into independent units.
Some form of organization within and between hospitals is necessary to provide effective and
integrated care to patients, to ensure that medical, nursing and paramedical services develop
efficiently and coherently, and to ensure that needs of the community are met.

Organization Structure of a Hospital

A healthcare facility will often have one group of executives who oversee
employees directly involved in care, and other executives who oversee non-medical
administration.
Hospitals typically have a combination of a hierarchical and divisional
organizational structure.
The hospital as an organization provides special facilities and trained personnel to facilitate the
work of doctors in his/her primary position involving care of the patient who is the focal point
about which all activities of the hospital revolve.
Organization is a process of achieving the objectives by grouping people in order to get the
health care work done.
Hospital organization is based upon the following principles:
1. Team Coordination
An individual supervises the professional team of medical / technical staff. All the services are
integrated and coordinated.
2. Division of Services
Hospital undertakes a number of activities-diagnosis, treatment, rehabilitation, prevention, and
education. These activities are further sub-classified. Groups and sub-groups are formed to
carry out these activities. The whole workload is divided into manageable units of healthcare
services. Each unit contributes to the total spectrum of the health services.
3. Homogeneous Approach
 The hospital to both inpatients and outpatients. The organization should form a homogeneous
approach with integrated services.
4. Evaluation of Services
Services provided by the hospital should be rated in terms of quality and adequacy for meeting
the patients and community health related requirements
5. Administrative Responsibility
The working relations amongst the various people and tasks in a hospital must be carefully
maintained by assigning the responsibility followed by accountability regarding performance to
ensure a high quality of patient care.
6. Budget Preparation and Financing
The hospital should design an effective organization and techniques to optimize their
resources. There should be budgeting and a planned program for capital financing.
7. Talent Search
The hospital should be staffed by competent medical experts and non-medical staff. The
organization should formulate a program to attract the professionally skilled medical and
technical staff as well as the patients.
8. Governing Body
Each hospital has the top management to decide its course of action and policy guidelines and
to exercise overall supervision and control. It is responsible to patient staff community and
sponsoring body

Organizational Pattern of a Typical Hospital

The functional department of clinical services is the most important division of a hospital which
needs supportive services like pharmacy and nursing, and administrative support of office.
Suitable departments of pharmacy, nursing, and administration are commonly found in all
hospitals. The hospital needs maintenance and safety. It should have sound house-keeping and
maintenance heads.
The top management of hospital is responsible for its overall policies and control. It is
constituted by the governing board and the administrator. The administrator is the CE or
Director of the hospital. The heads of individual services are responsible to the administrator
Management or Governing Body
Each hospital has an organized governing body-board of trustees / board of governors. The
legal status of a hospital is maintained by a government, society, trust or a company: named as
board of trustees, board of governors, board of directors, etc.
Objectives of the governing body is responsible for the functioning of a hospital providing high
quality of patient care.
Functions of the governing body are to:
1. Determine the policies of the hospital within the context of community needs,
2. provide equipment and facilities to conduct patient care program,
3. monitor that proper professional standards are define and maintained,
4. coordinate professional interests with administrative, financial and community needs,
5. provide adequate financing by securing sufficient income and by enforcing business to
control expenditure,
6. provide safe administration of funds given,
7. maintain accurate record of its finances and activities, and
8. surround the patient with a safe environment

Administration
The management or governing body delegates hospital active management to an administrator
and his staff of associates, assistants, supervisors and departmental heads.
The hospital administrator must know and understand his community, its people, their
historical traditions, the value structure that is at work, the resources available and the
weakness to be reckoned with any course of action
Functions
1. Enforce management policies in routine activities
2. Establish organizational structure to carry out programs of the hospital and to meet needs of the
patients.
3. Implement governing body policies on the financial management of the hospital.
4. Develop and implement a comprehensive management reporting system throughout the4 hospital.
5. Provide, maintain, and safeguard appropriate physical resources in the institution
6. Look at the weakness influencing aspect of institution