Introduction to hospital

pharmacy
1st chapter
 Definition
• The department or service in a hospital,
which is under the direction of a professionally
competent, legally qualified pharmacist and
from which all medication are supplied to the
nursing units and other services are
performed such as
- where Prescription are filled for in- and out-
patient
- Where Pharmaceuticals are manufactured
in bulk
- where narcotics and other prescribed drugs
are dispensed
- where biological are stored and dispensed
- where special prescription are filled for
patients in the hospital
- where injectable preparation should be
prepared and sterilized and
- where professional supplies are often
stocked and dispensed
 Definitions-contd
• “The department in a hospital where the
Procurement, Storage, Compounding,
Packaging, Controlling, Dispensing,
Distribution and Monitoring of medication to
hospitalized and ambulatory patients are
performed under the supervision
professionally competent and legally qualified
pharmacist.” OR
• “The practice of pharmacy in a hospital setting
including its organizationally related facilities
and services.”
 Definitions-contd
• Clinical pharmacy is that area of pharmacy concerned
with the science and practice of rational medication
use.  OR
• Clinical pharmacy is a health science discipline in
which pharmacists provide patient care that optimizes
medication therapy and promotes health, wellness,
and disease prevention.
• Rational use of medication- "Patients
receive medications appropriate to their clinical needs,
in doses that meet their own individual requirements,
for an adequate period of time, and at the lowest cost
to them and their community." (WHO, 1985).
 Definitions-contd

• Extemporaneous prep: the mixing together of

the ingredients of a prescription or drug formula
and generally refers to a manual process
performed for individual orders by a dispenser or
pharmacist
(Handbook of Extemporaneous Preparation, A Guide to
Pharmaceutical Compounding by Jackson, Mark; Lowey, Andrew.
First edition)
 Historical background of Hosp. pharm

• 1752– Jonathan Robert was appointed as hospital

pharmacist in Pennsylvania hospital (the 1 st hospital
in north America)
• Aug 21, 1942– ASHP was established
• 1n 1940s—other contributing factors were the
publishing of American journal of hospital pharmacy,
the acceptance of ASHP as member of U.S
pharmacopoeial convention and the establishment
of minimum standards for pharmacies in hospital
• In the last 5-6 decades the professional development
progress revolutionary and forecast the very bright
future of hospital pharmacist in the future
 Role of pharmacist in the hospital
• To promote the safe and effective use of
medication by working with health care team to
ensure the selection of best medication at the
correct dose for appropriate duration.
• Monitoring and preventing (or minimizing) side
effects and drug interaction.
• Providing medication counseling to patients
• Manufacturing extemporaneous compounding
 Role of pharmacist in the hospital-contd

• Strelie prep: prep. and sterilization of inj:

• Drug info to health care proff:
• Specification both to quality and source of drugs,
chemicals, biological and pharmaceutical
preparations used within institution for the
treatment of patients
• Necessary inspections of all pharmaceuticals
• Maintenance of an approved stock of antidotes
and other emergency drugs
 Role of pharmacist in the hospital-contd

• Dispensing of pharmaceutical prep:

• Dispensing of narcotic drugs and maintenance
of their inventory
• Implementing the decisions of P &T committee
• Maintenance of the facilities of the department
• Planning , organizing and directing pharmacy
policies and procedures in accordance to the
established policies of the hospital.
 Conclusion/Intervention

• The pharmacy practice has been evolved from

drug orientation to patient orientation,
-where pharmacist is not only involved in
stocking and dispensing of drugs, but also
provide other significant services for better
patient care/patients quality of life.
-important capacities for pharmacist are, such
as therapeutic expert, drug information
specialist, nutritional service member and
pharmacokinetic consultant etc.
 Minimum standards for pharmacies in institutions/hospital

• Originally adopted and developed by American college

of surgeons in 1935
• A revised version was adopted by ASHP in 1950, and
approved by American pharmaceutical association.
• These standards are
- Administration
- Facilities
- Drug distribution and control
- Drug information
- Assuring rational drug therapy
- Research
 Administration
• Directing body-
• Administration levels-
• Responsibilities of director of pharmacy:
- setting the short & long term goals of pha
- developing a plan- for achieving the goals
- supervising implementation of the goals and
associated daily activities
- evaluation of goals
 Admin-contd

• The director of pha must be aware of hospital

pharmacy practice and management
• Sufficient supportive personnel (technical, clerical
and secretaril)
• Personnel for specific task
• Procedure for routine evaluation of pha
personnel performance
• Lines of authority and area of responsibilities
shall be clearly defined
 Admin-contd

• Written position description for all categories

• CME program---for competency of staff
• Policies & procedures regarding drug expenditures
should be established, such as controlled
formulary, drug-use review programs and cost
effective clinical services etc
• Service of full time pharmacist should be
maintained. Drug dispensing by non-pharmacist
minimized or eliminated if possible
 Facilities
• Adequate space, equipment and supplies for
the proff: and admin: functions of pharmacy
• Location of pharmacy—communication,
lightning, ventilation and transportation system
• Space and equipments—reserved space for
narcotics, for sterile and extemporaneous
compounding and packaging, refrigerator for
thermolabile drugs
 Facilities-contd

• Current drug information resources

-medical software (e.g. micromedex)
- recent editions of pharmacy & medical
reference and text books
Reference books: USP, BP, PP, BNF, USD (united
state dispensatory) etc
Journals: JAMA (j of Am med ass), AJHP (Am j.
of health-system pharmacy),
 Drug distribution and control
• The pharmacy shall be responsible for the
procurement , distribution and control of all
drugs used within the institution.
• Policies & procedures regarding these functions
shall be developed by the pharmacist, with
coordination from other hospital staff, such as
nurses, P&TC and patient-care committee etc
 Drug distribution & control-contd

• The pharmacist shall maintain an upto date

formulary of drug product—approved by P&TC
• Policies & procedures for investigational drugs
shall be developed and followed.
• The pharmacist is responsible to keep all the
record from procurement—till admin to patient
• Providing drugs and pharmaceutical services
during the events of disaster
 Drug distribution & control-contd

• Written policies regarding activities of medical sale

rep—approved by P&TC
-drug samples must be controlled and distributed
only through the pharmacy
• The pharmacist must review the physician original
order prior to dispensing (except for emergency
use)
• Computerized physician order entry (POE) system
must be secure
• Unit dose dispensing system—and if possible ready
to administer form
 Drug distribution & control-contd

• Medication profile for all inpatient and for (all or

selected) outpatient shall be maintained.
• Prep of chemotherapeutics inj, other IV prep,
formulation, strength and dosage form of
extemporaneous compounding
• Policies & procedures regarding the identification
and use of medication within the institution
brought by patient or his/her attendant from
outside
• A system for removing of any drug from further
use which are subjected to a product recall
 Drug information
• The pharmacy is responsible to maintain the
upto date drug information resources
• The pharmacy must provide the accurate and
comprehensive information about the drug to
the patients and health care practioner within
the institution
• The pharmacist must inform the institutional
staff regarding the drug, strength and dosage
form-their dosage, therapeutic use and adverse
effects
 Drug information-contd

• The pharmacist must ensure that all patients

(particularly the ambulatory, home-care and
discharge patients) are given adequate
information about the drugs they receive.
• The patient education activities shall be
coordinated with the nursing and medical staff
and patient education department (if existing)
 Assuring rational drug therapy
The hospital pharmacy shall be responsible for
maximizing the rational drug therapy by
developing clear cut policies & procedures to
assure the quality of drug therapy. This can be
achieved by:
• Collection of sufficient information, maintaining
and review of these information to ensure
meaningful and effective participation in patient
care
• Review of physician orders for appropriateness
prior to dispensing of first dose
 Assuring rational drug therapy-contd

• Developing a mechanism for reporting and

review of ADRs
• Establishing a patient-care evaluation program
• Developing and maintaining of hospital
formulary system
 Research
Research in health-care institution may be
categorized as pharmaceutical, operational,
problem or clinical research
• Pharmaceutical research- it involve the
investigation on Packaging, Distribution,
Manufacture, Q.C , Storage and Stability of
pharmaceutical preparation. It may also involve
development of a new dosage from, improve
existing ones and to develop new and more
accurate methods for analyzing the final product
 Research-contd

• Operational research- include assessment of

pharmaceutical services and system, problems in
pharmaceutical administration, pharmaceutical practice
and sociological aspects of patient care
• Problem research may include the inquiry into the
problem of pharmaceutical administration, Q.C.,
professional practice and the sociological aspects of
patient care as related to the practice of hospital
pharmacy.
• Clinical research- it is a collaborative research involving
pharmacist (clinical) and medical staff to evaluate the
ADME of drugs and their metabolites
 Research-contd
• A pharmaceutical product can lead to an improved
drug product as a result of:
-problem research
-pharmaceutical research
-clinical research and
-operational research
• A pharmacist can conduct pharmaceutical research,
problem research and operational research, can
participate in, and support medical/clinical research
originated by the medical staff
 Research in hospital pharmacy
• The hospital pharmacist possesses adequate
education and training, thus can participate in
research with full confidence
- to improve the existence therapy or operation
-to formulate a new drug or dosage form
- to confirm some aspects of drugs
• In pharmaceutical research, a hospital
pharmacist can act as the principal or co-
investigator
 Research in hospital pharmacy-contd
• Pharmacoeconomic evaluation
- economic evaluation is needed to ensure the
best choices of medications that should be used
• Approval of research from “committee on human
use in research” if human subjects are involved on
whom research is conducted
-Research may be in-vitro or in-vivo, pre-clinical
(lab animals) or clinical (human)
- every kind of research should enlist the problem,
planning, study design, observations/results and
conclusion