[1.2] Healthcare as a System: Hospital Pharmacy

Hospital Pharmacy

The department wherein legally qualified and professionally competent pharmacists perform: procurement, storage, compounding, manufacturing, packaging, controlling, assaying, dispensing, distribution, and monitoring of medications through drug therapy management for hospitalized and ambulatory patients.

Hospital Pharmacy

The practice of pharmacy in a hospital setting and in any of its facilities or services.

Central Pharmacist and Ambulatory Pharmacist

The two main types of pharmacist in the hospital setting

Policy Statement

This dictates all that must be done.

Procedure

This answers how exactly a task shall be done.

IV Admixture

Intravenous fluids mixed with one or more sterile products.

Unit Dose

Ready-to-administer solid dosage drugs prepared for individual patient use, typically packaged using an Automated Dispensing Cabinet.

Automated Dispensing Cabinet (ADC)

An automated machine that repackages solid dosage forms into unit-dose strip packaging.

Biorefrigerator

Storage for biological substances.

Double-Locked Cabinet

Storage for drugs in need of proper security, such as narcotics.

A.O. No. 63 s. 1989

Department of Health rules and regulations implementing dispensing requirements under the Generics Act of 1988 (RA No. 6675), requiring patients or relatives upon admission to indicate in writing whether they submit to hospital drug policies or reserve the option to purchase medicines outside.

Pharmaceutical Manufacturing

Large-scale production of medicine; you do not care who the individual recipient is.

Extemporaneous Compounding

Small-scale preparation of a drug product tailored specifically for a patient or individual.

Dispensing Pharmacist

An entry-level hospital pharmacy position for a RPh, typically provided with training for the first 2 weeks.

Graveyard Shift

The hospital pharmacy dispensing shift operating from 10 PM - 6 AM noted for having the most available time to perform cleaning.

Regularization

Shift from probationary status to regular status upon passing the employee evaluation in 6 months, securing long-term employment.

Hospital Pharmacist

Person who supervises drug administration.

Registered Nurse

Person who performs drug administration.

Medication and Treatment Record (MTR) Form

The official form wherein the bedside nurse must note every administered dose.

Uncharted Dose

When a bedside nurse fails to note the dose administered in the MTR.

Unit Dose Pharmacist

The hospital pharmacist who accounts for all given doses daily and issues medication error forms for uncharted doses.

Automatic Stop Order Policy (ASOP)

Policy implemented when a patient goes to the operating room or is transferred to another hospital service.

7 days

The number of days for an ASOP to apply to antibiotics if the prescribing physician did not order its continuation.

Wrong Administration Technique Error

A citation issued when proper drug administration techniques are not performed.

Floor Stock Drugs

Medications stored directly within nursing units for immediate access, requiring continuous 24/7 replenishment and is subject to surprise inspections.

Inventory Pharmacist

The pharmacist who manages floor stock drugs in each nursing unit, ensures immediate 24/7 replenishment, and conducts surprise inspections.

Senior Nurse

The nursing personnel who holds the lock and key for floor stock drug cabinets to prevent pilferage.

Clinical Pharmacist

A pharmacist who handles direct patient care, conducts medication reconciliation, monitors therapies, and rounds with physicians.

Formulary Drugs

Drugs acquired from the hospital pharmacy department; Written on the MTR, which is an official document under the Patient chart.

Non-Formulary Drugs

Drugs brought into the hospital from outside by the patient; Administered by a private RN, which is recorded on an unofficial chart, usually pasted on the wall; clears the hospital of accountability.

Patient Medication Profile (PMP)

A clinical record that tracks all of the medications taken by a patient.

Antibiotics

Type of drug that is specifically counted on a daily basis in the PMP.

Medication Reconciliation (MedRec)

The formal taking of history of medications by a clinical pharmacist for each and every patient.

Patient Medication History

An official clinical form used to record all past and current prescription, nonprescription, complementary, and alternative medications taken by a patient.

Therapeutic Drug Monitoring (TDM)

A specialized clinical pharmacy service where patient blood samples are analyzed to determine whether drug concentrations are therapeutic, subtherapeutic, or toxic.

Drug Therapy Monitoring & Assessment Form

A clinical documentation form used to evaluate drug-drug interactions, food interactions, adverse reactions, and recommend dosing modifications to physicians.

Object

The drug displaced by the drug-drug interaction.

Precipitant

The drug that displaces the object in a drug-drug interaction.

Self-administered and Discharge medications

Types of medications that a pharmacist must counsel patients on before they leave the hospital.

Drug Information Sheet/Rx Acknowledgement

A sticker placed on the patient’s chart as proof that patient counselling service was provided by the Pharmacy Department to the patient.

Ambulatory Pharmacist

A hospital pharmacist whose unique responsibilities include checking supportive personnel's dispensing accuracy and preparing supplies and IV medications for patient home care.

Pharmacy Aide

Supportive hospital pharmacy personnel whose work in the dispensing area is checked for accuracy by the ambulatory pharmacist.

Philippine Practice Standards for Pharmacists 2.0 (PhilPSP 2.0)

Published by the Philippine Pharmacists Association to establish common competencies and standards across five pharmacy practice areas.

Common Competency 1 [CC 1]

Places client and patient’s welfare at the center of practice.

Common Competency 2 [CC 2]

Practices in an ethical, legal, and professional manner.

Common Competency 3 [CC 3]

Displays leadership, management, and entrepreneurial skills.

Common Competency 4 [CC 4]

Demonstrates cultural competence and communicates effectively.

Common Competency 5 [CC 5]

Exhibits effective collaboration.

Common Competency 6 [CC 6]

Commits oneself to continuing professional development.

Common Competency 7 [CC 7]

Engages actively in health product vigilance activities.

Common Competency 8 [CC 8]

Performs the role of an educator to support the professional development of colleagues and the future pharmacists.

Common Competency 9 [CC 9]

Optimizes digital health to deliver pharmaceutical services and advance pharmacy research.

Academic Pharmacy, Industrial Pharmacy, Community and Institutional Pharmacy, Hospital Pharmacy, Public Health Pharmacy

The five major practice areas of PhilPSP 2.0

Industrial Pharmacy Standard 1 [IP1]

Contributes to pharmaceutical product lifecycle management.

Industrial Pharmacy Standard 2 [IP2]

Participates in quality management system (QMS).

Industrial Pharmacy Standard 3 [IP3]

Participates in health product vigilance programs

Industrial Pharmacy Standard 4 [IP4]

Represents the organization to regulatory authorities.

Industrial Pharmacy Standard 5 [IP5]

Participates in the development and implementation of regulatory guidelines.

Hospital Pharmacy Standard 1 [HP 1]

Works in collaboration with other healthcare providers to optimize patient care in the hospital setting.

Hospital Pharmacy Standard 2 [HP 2]

Manages the hospital formulary and pharmaceutical inventory inside the hospital.

Hospital Pharmacy Standard 3 [HP 3]

Manages drug information services in the hospital setting.

Hospital Pharmacy Standard 4 [HP 4]

Distributes medicines and other health products appropriate to the needs of clients and patients.

Hospital Pharmacy Standard 5 [HP 5]

Compounds products in a manner that ensures product quality, safety, and efficacy in the hospital setting.

Hospital Pharmacy Standard 6 [HP 6]

Provides client- and patient-centered clinical pharmacy services at the point of care.

Hospital Pharmacy Standard 7 [HP 7]

Leads antimicrobial stewardship to prevent antimicrobial resistance and to control and prevent infection in the hospital setting.

Hospital Pharmacy Standard 8 [HP 8]

Participates in specialized pharmaceutical services in the hospital.

Managers, Administrators, and Department Heads

Workforce of Administrative Services Division

Responsibilities:

1. Plans departmental activities,

2. Develops policies,

3. Schedules and supervises personnel,

4. Coordinates administrative needs of the PTC,

5. Supervise departmental office staff.

Responsibilities of the Administrative Services [5]

Chief Pharmacist

The highest-ranking pharmacist who serves as the secretary of the Pharmacy and Therapeutics Committee (PTC).

Responsibilities:

1. Providing medications for all in-patients of the hospital on a $24\text{-hour/day}$ basis.

2. Inspecting and control of drugs in treatment areas.

3. Cooperating with medical drug research.

Responsibilities of the In-Patient Services Division [3]

Responsibilities:

1. Coordinates undergraduate (internship) and graduate (externship) pharmacy students.

2. Trains newly employed pharmacy dept. personnel.

3. Participates in hospital-wide educational programs involving doctors and nurses.

Responsibilities of the Education & Training Division [3]

Internships

Offered to Undergraduate Program Students

Externships

Offered to Graduate Program Students

Responsibilities:

1. Compounding and dispensing outpatient prescriptions.

2. Inspecting clinic and emergency stations.

3. Maintaining Rx records.

4. Consulting staff and medical students.

Responsibilities of the Outpatient Services Division [4]

Responsibilities:

1. Primarily led by the Clinical Trial Pharmacist.

2. Develops new formulations of research drugs.

3. Improves existing formulations.

4. Cooperates with medical research staff.

Responsibilities of the Pharmaceutical Research Division [4]

Clinical Trial Pharmacist

A hospital pharmacist who works in-hospital to monitor patients enrolled in clinical trials within the Pharmaceutical Research Division.

EITHER the company that owns the hospital implements the clinical trial

OR the company hires a Contract Research Organization to do it for them.

Possibilities Offered by the Pharmaceutical Research Division

Contract Research Organization (CRO)

A third-party organization hired by hospital owners to conduct clinical trials, offering high-paying roles (with salaries reaching $6\text{ digits}$ ) that may not require a registered pharmacist license.

Responsibilities: The hospital's mini-library facility

1. Preparing pharmacy newsletters.

2. Maintaining literature files.

3. Providing drug therapy consultations to health professionals.

Responsibilities of the Drug Information Services Division [4]

Responsibilities:

1. Develops and coordinates the distribution of medical supplies and irrigating fluids.

Responsibilities of the Central Supply Services Division [1]

True

True or False: The Pharmacy Department has its own dedicated Central Supply Services that is separate from the hospital’s

Responsibilities:

1. Controls and dispenses IV fluids and controlled substances.

2. Coordinates all drug delivery and distribution systems throughout the hospital.

Responsibilities of the Departmental Services Division [2]

Responsibilities:

1. Purchase drugs.

2. Maintain drug inventory.

3. Receive, store, and distribute drugs.

4. The only division permitted to interview medical service representatives.

Responsibilities of the Purchasing & Inventory Control Division [4]

Responsibilities:

1. Manufacture items commonly used in the hospital.

2. Manages drug packaging and prepackaging programs.

3. Product development programs.

4. Maintain a unit dose program.

Responsibilities of the Manufacturing & Packaging Division [4]

Responsibilities:

1. Produce up to 50mL parenterals (small-scale).

2. Manufacturing sterile ophthalmic and irrigating solutions.

3. Preparing aseptic dilutions of lyophilized and unstable sterile injections.

Responsibilities of the Sterile Products Division [3]

Aseptic Technique (No-Touch Approach)

A sterile compounding procedure used in the Sterile Products Division that requires a strict no-touch approach during the manipulation of sterile components.

Bunny Suit

A specialized full-body sterile garment donned in sterile processing that must remain sterile at all times by minimizing touches and keeping it completely off the floor.

Responsibilities:

1. Performs analytical testing on manufactured and purchased products

2. Develops and/or revises assay procedures.

3. Assists research formulations.

Responsibilities of the Assay and Quality Control Division [3]

Pharmacopeial Standards

Assay and Quality Control should always be in accordance with what supposed standard?

Responsibilities: Radio Pharmacy or Nuclear Pharmacy

1. Centralizes the procurement, storage, and dispensing of radioisotopes used in clinical practice. (Must be efficacious use)

Responsibilities of the Radiopharmaceutical Services Division [1]

Responsibilities:

1. Centralizes the preparation of IV admixtures,

2. Review each order for physicochemical incompatibilities

Responsibilities of the IV Admixture Division [2]

IV Pharmacist

Who is the dedicated compounder of IV admixtures?

Clean Room

Workplace of an IV Pharmacist