Pharm 6a Module 6 - Hospital Pharmacy Forms

Hospital Pharmacy Forms

These forms are essential for managing medication distribution, patient records, and compliance with health regulation.

Hospital pharmacy

____ must adhere to strict regulatory standards which include maintaining accurate records and ensuring that all forms are properly filled out and stored.

patient safety

Hospital Pharmacy Forms are not only vital for operational efficiency but also play a critical role in ____ and care quality within the hospital.

Purchase Order Form, Stock card, Pharmacy Inventory Sheet, Hospital Formulary Inclusion Request Form, Patient Medication Profile, Temperature Monitoring Form, Adverse Drug Reaction Form

What are the common forms available in the Hospital Pharmacy?

Purchase Order Form

This hospital pharmacy form is used for purchasing all the medicines needed by the pharmacy

Dosage form, Price of the product

The purchase order form contains the name of the product, ____, dosage strength, quantity to be purchased, _____, and total amount of the order.

Supplier

The purchase order form is submitted to the ___ for order processing.

Inventory sheet

This hospital pharmacy form helps keep track of drugs used or sold.

Inventory sheet

This form keeps track of how much of the product is coming into the pharmacy and how much is going out…

Stock card

This hospital pharmacy form allows pharmacist to account and monitor the movement of drugs in the stockroom over a period of time.

Stock card

This form is used to calculate the quantities of drugs that need to be ordered.

Hospital Formulary Inclusion Request Form

It is the hospital pharmacy form that must be accomplished and submitted by the supplier to the pharmacy department for their product inclusion in the hospital formulary.

Supplier

Who submits the Hospital Formulary Inclusion Request Form?

Hospital Formulary

The hospital formulary inclusion request form is submitted by the product supplier for their product to be included in the ____?

Chief Pharmacist

Who prepares the Hospital Formulary Inclusion Request Form for the inclusion of a product into the hospital formulary?

Pharmacy and Therapeutics Committee

Who approves the inclusion of a product into the hospital formulary?

Patient Medication Profile

This is a hospital pharmacy form that serves as an updated list of all medication prescribed for a patient.

Clinical Pharmacist

Who prepares the patient medication profile and updates it daily?

Adverse Drug Reaction Report Form

This hospital pharmacy form is intended to be accomplished completely if there is an occurrence of adverse drug reaction.

Food and Drug Administration

The Adverse Drug Reaction Report Form is an official form prepared by what organization?

15 calendar days

The Adverse Drug Reaction Report Form must be submitted immediately as soon as possible but no later than ____ to the FDA for proper action.

Requisition Sheet,
Controlled Drug Administration Sheet,
Dangerous Drugs Recording (PDEA S Register 2-14),
Dangerous Drugs Reporting (PDEA Report Form 1-14)

What are the forms for dangerous drugs?

Automatic Stop Policy Alert Form,
Restricted Antimicrobial Pre-approval Form

What are the forms for the Antimicrobial Stewardship Program?

Record of Filled Prescriptions,
Senior Citizen/PWD Record Book,
Compounding Record Book,
Vials Destruction Logbook

What are the other hospital pharmacy forms?

Hospital pharmacy

The _____ is the main source of the medications given to the patient in a hospital setting, it is considered the most reliable source of drug information within the hospital.

Drug information

The Hospital pharmacy is the most reliable source of _____ within the hospital to render effective clinical care to the patient.

Pharmacy library

There must be a ____ located within the hospital and become an integral division of the department of pharmacy.

Monographs

The pharmacy library must contain the latest collections of ____, journals, books, and other reference materials related to the field of pharmacy.

Electronic data processing equipment

Pharmacy libraries may also be equipped with ____?

Food, Drugs, Devices, and Cosmetics Act

R.A. 3720 is also known as?

RA 3720

An act to ensure the safety and purity of foods and cosmetics, and the purity, safety, efficacy, and quality of drugs and devices being made available to the public.

Bureau of Food and Drugs (BFAD)

RA 3720 entrusts ____ with the authority to enforce this act.

Food and Drug Administration Act of 2009

RA 9711 is also known as?

2009

What year was the RA 9711 passed?

RA 9711

This act has provisions on the medicines that should be available inside the pharmacy according to the Philippine National Drug Formulary.

Philippine National Drug Formulary

In the provisions of RA 9711, the medicines available inside the pharmacy should be according to the ____?

Generics Act of 1988

RA 6675 is also known as?

1988

What year was the Generics Act (RA 6675) passed into law?

RA 6675

The act that promotes, require, and ensure the production of an adequate supply, distribution, use, and acceptance of drugs and medicines identified by their generic names.

Philippine Pharmacy Act

RA 10918 is also known as?

RA 10918

This act regulates the practice of Pharmacy and setting standards of pharmaceutical education in the Philippines and of other purposes.

Special Law on Counterfeit Drugs

RA 8203 is also known as?

RA 8203

This act prohibits counterfeit drugs, providing penalties for violations and appropriating funds.

Universally Accessible Cheaper and Quality Medicines Act of 2008

RA 9502 is also known as?

RA 9502

An act that have provisions on the availability of safe, cheap and good quality medicines.

WHO Annex 5 Guide to Good Distribution Practices (GDP) for pharmaceuticals, WHO Annex 9 Guide to Good Storage Practices (GSP) for pharmaceutical products

_______ serves as the standards for the different aspects of the distribution and storage processes for pharmaceutical products, respectively.

Philippine National Formulary

It is a list of essential medicines for the Philippines prepared by the NFC in consultation with experts and specialists from organized professional medical societies, medical academe, and pharmaceutical industry.

National Formulary Committee (NFC)

Who prepared the Philippine National Formulary with the help of experts, speicalists from organized professional medical societies, medical academe, and pharmaceutical industry?

DOH Administrative Orders, DOH Advisories, FDA Circulars, FDA Advisories

What issuances provide specific, detailed guidelines and legal requirements for product registration, licensing, and importation?

United States Pharmacopeia/National Formulary (USP–NF)

What is the most comprehensive source of global quality standards for medicines and their ingredients?

Handbook of Injectable Drugs

Which reference is the premier source for compatibility, stability, storage, and preparation of parenteral drugs?

Lexicomp

Which drug information database provides detailed medical drug information as a subscription service?

Monthly Index of Medical Specialties (MIMS)

What leading resource provides trusted, independent medicine information and prescription screening tools for error detection?

National Antimicrobial Stewardship (AMS) Program

What Philippine program promotes systematic, multidisciplinary interventions to ensure appropriate antimicrobial use and prevent antimicrobial resistance (AMR)?

Antimicrobials, Antimicrobial Resistance

The National AMS Program aims to improve the use of ___ to prevent the emergence and spread of ___.

Leadership, Policies/Guidelines/Pathways, Surveillance (AMU & AMR), Action, Education, Performance Evaluation

What are the six core elements of the National AMS Program?

Leadership

What is the first core element of the National AMS Program?

Policies, Guidelines, Clinical Pathways

What is the second core element of the National AMS Program?

Surveillance of Antimicrobial Use and Resistance

What is the third core element of the National AMS Program?

Action

What is the fourth core element of the National AMS Program?

Education

What is the fifth core element of the National AMS Program?

Performance Evaluation

What is the sixth core element of the National AMS Program?

Leadership

Which core element ensures hospital administration is responsible for implementing, performing, and monitoring the AMS Program?

Policies, Guidelines, Clinical Pathways

Which core element ensures antibiotic policies and standardized guidelines provide evidence-based treatment and prophylaxis guidance?

Surveillance of Antimicrobial Use and Resistance

Which core element tracks prescribing patterns and evaluates AMS interventions?

Action

Which core element uses a coordinated, multidisciplinary approach to optimize antimicrobial use and influence prescriber behavior?

Education

Which core element requires healthcare professionals to gain competency through training and education on judicious antimicrobial use?

Performance Evaluation

Which core element measures process and clinical indicators to assess AMS effectiveness and guide improvement?

IV antifungals, Aztreonam, Carbapenems, 4th Generation Cephalosporins, Colistin, Linezolid, Vancomycin

Which antimicrobials are classified as “restricted”?

Fluconazole

Which IV antifungal is not considered a restricted antimicrobial?

Restricted Antimicrobial

What antimicrobials require a completed Restricted Antimicrobial Order Form and hospital approver authorization before prescribing?

Restricted Antimicrobial Order Form + Approver Authorization

What requirements must be met before prescribing a restricted antimicrobial?

Pharmacist

Who must confirm authorization before dispensing restricted antimicrobials?

Monitored antimicrobials

Which class of antimicrobials undergoes prospective clinical audit with immediate prescriber feedback from the AMS Program?

3rd Generation Cephalosporins, Fluoroquinolones, Aminoglycosides, Clindamycin, Extended-Spectrum Penicillins, Fluconazole

What antimicrobials are classified as “monitored”?

National Antibiotic Guidelines

What reference provides prophylaxis and treatment recommendations for common infections and antimicrobial use?

Adapted hospital-specific antibiotic guidelines

What is another name for the National Antibiotic Guidelines?

Department of Health (DOH)

Where can the National Antibiotic Guidelines be accessed?