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institutional pharmacies
refers to pharmacies or institutions, organization and or corporations that provide a range of pharmaceutical service, given exclusively to the employee and/or their qualified dependents.
institutional pharmacy practice
includes the provision of distributional and clinical pharmacy services at a broad range of institutional settings including hospitals, long-term care, hospice, correctional facilities, and others
Typically, the institutions that pharmacists serve are linked together formally or informally into integrated health systems.
Health system
collection of organizations and institutions whose mission is to positively impact health outcomes.
integrated health systems
integrate all care under the umbrella of a central organization, and often include inpatient/acute care, primary care/outpatient care, long-term care, and home care.
prescribing
often viewed as something that only physicians are authorized to do.
However, the reality is that many other health-care professionals are authorized to prescribe by state law or through a formalized process in hospitals known as privileging.
privileging
the process by which an oversight body of a health care organization or other appropriate provider body, having reviewed an individual health care provider's credentials and performance and found them satisfactory, authorizes that individual to perform a specific scope of patient care services within that setting.
transcribing
Refers to the process by which a prescriber's written order Is copied and either manually or electronically entered into pharmacy records.
represents an opportunity for error, especially when done manually.
Role is that pharmacists must understand potential breakdowns in the transcribing process and help hnd wavs to minimize errors.
dispensing
Refers to the act of physically transferring the drug product following review and approval of the prescription to the area responsible for administering the medication to the patient.
an area where medication errors can occur, including, but not limited to wrong drug, wrong dose, wrong dosage form errors
administration
Typically managed by nurses
The last step before patients are given their medications, and errors at this point cannot be corrected Nurses usually serve as the final check in the medication -use process.
monitoring
a critical phase where pharmacists plav a vital role.
Includes reviewing laboratory values that are correlated with the expected medication-therapy outcomes, as well as other objective and subjective factors that indicate whether the therapy is effective or may be having a toxic effect.
practice models
Operational structure that defines how and where pharmacists practice, including the type of drug distribution system used, the layout and design of the department, how pharmacists spend their time, practice functions, and practice priorities.
The most important factor determining the role and effectiveness of the pharmacy department.
It sets the stage and defines the roles.
The term practice model describes how pharmacists, pharmacy technicians and automation interrelate to provide pharmacy services.
hospital type institution type patient population pharmacy services delivery
may vary based on
drug distribution centered
Pharmacists primarily distribute drugs and process new medication orders.
Role is REACTIVE: responds to requests of physicians and nurses but rarely initiates major changes in therapy.
Pharmacist is not actively involved with the health care team or in development of therapeutic plans for the patient.
Pharmacists are not accountable for the health outcomes of patients and exert little leadership in influencing the medication-use process.
clinical pharmacists
are chiefly involved in clinical activities associated with medical teams on the nursing units.
Primary responsibility: assisting physicians and other health professionals in avoiding and solving clinical problems exclusive of the distribution process.
distributive pharmacists
are those who spend most of their time in drug distribution reviewing orders and verifying the accuracy of medication preparation by technician. Little or no collaboration occurs between clinical and distributive pharmacists in the extreme of this model, so these pharmacists are selectively accountable for the medication-use process.
patient centered integrated
All pharmacists in the department accept responsibility for all elements of the medication-use process and therefore spend their time on both clinical and distributive functions.
Pharmacists' roles in drug distribution are often limited, because many distribution tasks are delegate to well-trained pharmacy technicians.
Pharmacists are able to expand their clinical roles to more active engagement in medication selection and drug use as part of an interdisciplinary team.
Pharmacists exhibit a high degree of ownership of and accountability for the entire medication- use process
pharmacy automation
serves to increase efficiency and accuracy of dispensing.
Important to the practice mode because utilization of many of the available technologies can influence what the pharmacist and pharmacy technician do in support of medication dispensing.
Advantage: full use of automation can re-direct stat time away from routine technical tasks and towards more direct patient care activities
unit based cabinet
These cabinet-based technologies are usually located strategically in the patient care area and contain compartments where individual medications are stored.
The compartments only open and give access to the medication when the user is authorized to do so
Usually this authorization is based on the computer in the cabinet verifying that the medication has been approved through an interface with the pharmacy computer system.
Have been successful because they place medications much closer to the user, but still allow electronic verification that the medication and dose is correct for the patient
Simplify billing and documentation of medication administration.
pyxis omnicell
unit based cabinet example
pharmacy robot
These systems contain hundreds of bar coded packages placed in designated spaces on long rods. The robot moves to the designated space, verifies that it is the correct medication using the bar code, and removes the number of doses needed.
Usually used to prepare a 24-hour supply of oral and prepackaged injectable medications.
Pharmacist and technician time needed to prepare and check these medications is greatly reduced when this technology is used.
mckesson robot rx
pharmacy robot example
sterile compounding automation
Ranges from small pumps used to fill syringes and prepare parenteral nutrition solutions to large systems with robotic arms capable of preparing all types of sterile IV solutions and infusions.
Improve the efficiency of sterile product preparation while improving the accuracy of the preparation and minimization or potential contamination
medication-related technology outside pharmacy
Medication-related technology used outside of the pharmacy is usually focused on safety
These systems have a direct impact on the pharmacy and require active involvement by the pharmacy in making sure that systems are designed and used optimally to realize their safety benefits.
bar coded medication administration systems
requiring pharmacy involvement in assuring that drug packages have appropriate readable bar codes and that information systems capture and document information.
computerized prescriber order entry
require an interface or integration with pharmacy information systems so that medication ordering information is able to transfer between the prescriber and the pharmacy.
Standard order sets and verification mechanisms also require pharmacy for these systems
smart pumps
programmable pumps that allow the user to predefine minimum and maximum rates of administration, preventing errors where patients are under- or over-dosed with medication.
Pharmacy plays an important role in making sure that the limits contained in the "drug library" are clinically appropriate
critical care
Patients are of a higher acuity level, meaning that they have greater needs for care. Patients are, by definition, critically ill and therefore their clinical status is constantly changing - They must be monitored closely and their drug therapy is often changed or adjusted Typically, these patients are on multiple intravenous medications, thereby creating a high potential for incompatibilities, drug interactions, and errors.
Patients also may have declining organ function, such as kidneys or liver, which affects drug dosing.
general care unit
The acuity of patients is less. Drug therapy is more likely to be stable and many times is a combination of oral and intravenous medications, depending on the patient's treatment regimen.
medication reconciliation is the process of/comparing a patient's medication orders to all of the medications that the patient has been taking.
critical care general care unit
in patient care
dispensing pharmacy
Most common and perhaps most visible, similar to community pharmacies without general merchandise.
Many hospitals have at least one outpatient dispensing pharmacy which cater to clinic patients, patients being discharged from inpatient settings, and patients with prescriptions written in emergency departments.
emergency department
drug therapy consultation with providers
error prevention and patent safety - monitoring adherence to practice guidelines - medication counseling
reviewing patient profiles
participating in resuscitation efforts
ambulatory care clinics
Clinics may be general in nature (e.g., primary care, medication adherence or specialized e.g. anticoagulaton, palliative care).
In these settings, medication therapy is managed by a pharmacist and usually patients see the pharmacist one-on-one by appointment.
Pharmacists have great potential to improve medication-therapy outcomes, reduce errors, and reduce readmissions in outpatient clinic settings.
home health care
most specifically home infusion services, have evolved as a way for patients to be treated in a non-hospital setting, usually their home.
These pharmacy services are unique in that they provide infusion therapy for both short term and long-term chronic conditions.
antimicrobial therapy pain management, parenteral nutrition chemotherapy administration
common therapies
accreditation
Is a voluntary process by which the quality of care provided by a hospital is assessed by an outside accrediting body on a routine basis.
accreditation organizations
different from regulatory bodies in that their primary purpose is to assess and improve the quality of patient care (i.e., when they identify a quality of care problem they work with the hospital to make improvements)
have no authority to impose fines or bring forth legal action.
regulatory bodies
law enforcement bodies whose purpose is public protection, and are therefore tasked with imposing fines and taking other legal actions.
practice standards
are those practices that a profession develops and imposes on itself.
should be based on the best scientific evidence, and should ideally strive to surpass minimum requirements established by law or regulation.
licensure
process by which a governmental authority grants permission to an individual practitioner or health care organization to operate or to engage in an occupation or profession.
protect basic public health and safety
certification
a process by which an authorized bod, either a governmental or non governmental organization, evaluates and recognizes either an individual or an organization as meeting pre-determined requirements or criteria.
hospital
a complex organization utilizing combination of intricate, specialized scientific equipment, and functioning through a corps of trained people educated to the problem of modern medical science These are all welded together in the common purpose of restoration and maintenance of good health.
hospital
community institution which is an instrument of society.
It serves as the focal point for coordination and delivery of patient care to its community.
While the hospital was once considered only as a place where patients were treated, today it is considered as a viable institution which extends its services to patients wherever they may be located.
patient care
hospital is involved with inpatient services, outpatient services, medications and otner relevant services intended directly to patients.
education
hospital can be utilized as training sites or internship for future health care workers and ensuring the continuing education for staff as well.
research
hospital can participate in a review and or documentation of cases. administration of clinical trials.
public health
make the public more aware by conducting information dissemination via posters and other printed media
general hospital
a hospital that provides services for all kinds of illnesses, diseases, injuries or deformities.
shall provide medical and surgical care to the sick and injured, as well as maternity, newborn and child care.
specialty hospital
hospital that specializes in a particular disease or condition or in one type of patient.
Treatment of patients suffering from diseases of a particular organ or groups of organs.
Treatment of patients belonging to a particular group such as children, women, pregnant, elderly, and others.
acute short term
admits patients who have either temporary or acute illnesses that can be treated in a relatively short period of time
chronic long term
provides for patients requiring either permanent or prolonged hospitalization for rehabilitation, or inability to be managed in the ambulatory setting (usually greater than 30 days).
government hospital
non-profit hospital owned by federal, state, or municipal governments (country and city hospitals). This type of hospital generally receives some funding from a branch of the government and are responsible to it.
non government hospital
hospital that is responsible for their own funding. It is typically owned and private operated by religious organizations. nonsectarian organizations, or other corporations, or associated with universities .
this toe can be identified further based on;
profit
profits or dividends are paid to owners or shareholders whether individual partnership (at least 3, or as corporation (at least 15).
non-profit
there is no profit or dividends involved (church, community, private)
primary care hospital
this hospital is the starting point for entry into the health care system.
Primary care patients are typically admitted by a family practitioner, pediatrician or general surgeon
secondary care hospital
type of hospital in which referral services are immediate in intensity (that is, referral to a specialist)
tertiary care hospital
hospital setting where patients are referred for very intensive subspecialty care. It requires the services of a physician and a hospital equipped to treat extremely complex problems less frequently seen or managed in a community hospital setting.
small hospital
less than 100 beds
medium hospital
more than 100 less than 300 beds
large hospital
more than 300 beds
teaching
hospital that operate residency training programs in medicine, surgery, pediatrics, and other specialty areas.
Resident physician (the one receiving specialized clinical training in a hospital) provide patient care under supervision of the hospital's medical staff.
teaching affiliated
a hospital that do not operate their own residency training programs but serve as a training site for residents or students from a nearby university hospital.
non-teaching
offers no residency training programs and no university hospital affiliation
governing body and management
Has the over-all responsibility for the conduct of the hospital in a manner consonant with the hospital's objective of making available high-quality patient care.
The management adopts by-laws identifying the management of the hospital and the means of fulfilling them.
They are considered the policy making and provide the overall mission and goals of the hospital.
administration
Provides the active management of the hospital.
This level establishes an organizational structure to carry out the programs of the hospital to meet the needs of patients, implement hospital policies and procedures.
The administration oversees budgeting and finance.
board of trustees
composed of interested community members who donate their time in the hospital in being responsible for philosophy, personnel, policies and standard of care.
administrator
appointed by the Board, he/she is responsible for the overall operational of the hospital to see that the policies and standards set for the by the Board are maintained,
medical director
approved by the Board after careful consideration if each application.
supervises all the staff members who are responsible for student doctors and rescents.
department directors
responsible or the particular function of the specific department, it also includes hiring and firing personnel, supervising department personnel, and maintaining policies and standards.
medical staff
Responsible for quality of all medical care provided to patients
This level is composed of physicians or doctors.
They are responsible for the delivery of majority of medical services within the hospital.
open staff
which certain physicians, other than those on the attending or active medical staff, are allowed to use the private room facilities. - These staff comply with all rules and regulations of the institution.
closed staff
one in which all professional services, private and charity are provided and controlled by attending or active medical staff.
active medical staff
Responsible for the delivery of majority of medical services within the hospital.
Most involved in the organizational and administrative duties pertaining to the medical staff.
Regular patient care, responsible for taking care of patient who has direct involvement with staff organization and administrative duties.
They are resident Medical staff which are full time employees that provide patient services in exchange for training/experience.
associate medical staff
Individuals who are being considered for advancement to the active medical staff appointed and assigned to the various services in the same manner as the members of the active medical staff.
courtesy medical staff
May neither vote nor hold office in the medical staff organization.
They are given privileges to admit an occasional patient to the hospital. They are considered not a member but allowed to attend a private patient.
consulting medical staff
Medical practitioners of recognized professional ability.
honorary medical staff
Former staff members, retired or emeritus, and other practitioners whom the medical staff chooses to honor.
department of medicine
Medicine is the field of health and healing. It includes nurses, doctors, and various specialists.
It covers diagnosis, treatment, and prevention of disease, medical research, and many other aspects of health.
internal medicine
apply scientific knowledge and clinical expertise to the diagnosis, treatment and compassionate care of adults across the spectrum from health to complex illness
allergy and immunology
diagnose, treat and manage allergies, asthma and immunologic disorder. including primary immunodeficiency disorders
cardiology
provides medical care to patients who have problems with their heart or circulation.
endocrinology
concerned with the structure, function, and disorders of the endocrine glands
infectious diseases
prevent disease, disability, and death caused by a wide range of infectious diseases.
The center focuses on diseases that have been around for many years, emerging diseases and zoonotic diseases
gastroenterology
investigates and treats digestive and upper and lower gastrointestinal diseases.
geriatrics
deals with the problems and diseases of old age and the medical care and treatment or aging people
nephrology
monitors and assesses patients with various kidney (renal) problems and conditions
pulmonology
concerned with the anatomy, physiology, and pathology of the lungs
rheumatology
treat patients for musculoskeletal disorders such as: bones, joints, ligaments, tendons, muscles and nerves
neurology
a specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems
pediatrics
dealing with the health and medical care of infants, children, and adolescents from birth up to the age of 18
psychiatry
deals with mental, emotional, or behavioral disorders
dermatology
dealing with the skin, its structure, functions, and diseases
obstetrics and gynecology
capability in the medical and surgical care of the female reproductive system and associated disorders
department of surgery
The department is mostly involved in preoperative diagnosis of the patient, for performing the operation, and for providing the patient with postoperative surgical care and treatment.
general surgery
focuses on surgical treatment for gastrointestinal diseases. In particular, it offers hepatectomy for liver cancer (primary, metastasis) and laparoscopic surgery for colonic and rectal cancer and gallstones
orthopedic surgery
concerned with conditions involving the musculoskeletal system
neurologic surgery
deals with cerebrovascular diseases, brain tumors, spinal cord tumors, and - CraniotomY diseases related to the craniospinal nerves such as cranial injuries. It also treats functional disorders such as trigeminal neuralgia and facial spasms
ophthalmology
involving complex surgical procedures, such as reconstructive surgery or - cataract advanced vision repair
dental and oral
refers to a broad range of medical procedures that involves the gums and teeth
otolaryngology
medical specialty which is focused on the ears, nose, and throat, it involves
head and neck surgery because specialists are trained in both medicine and surgery