MODULE 1: INTRODUCTION TO HOSPITAL PHARMACY PRACTICE

Hospital Pharmacy Practice

service in a hospital that is under the direction of a professionally competent, legally qualified pharmacist.

Clinical Pharmacy

A health science discipline in which pharmacists provide patient care that optimizes medication therapy and promotes health, and disease prevention.

HOSPITAL PHARMACY

Department or service in a hospital that is under the direction of a professionally competent, legally qualified pharmacist.

HOSPITAL PHARMACY

Where all medications are supplied to the nursing units and other services.

HOSPITAL PHARMACY

Where prescriptions are filled for ambulatory patients and outpatients.

HOSPITAL PHARMACY

Where pharmaceuticals are manufactured in bulk.

Unit Dose Drug Distribution System (UDDDS)

Hyperalimentation

Educational Program

Intravenous Additives

Administrative and Scientific Research

Clinical Pharmacy Program

NEWER AREAS OF INSTITUTIONAL PHARMACY PRACTICE ENUMERATE

Unit Dose Drug Distribution System (UDDDS)

Preparation and dispensing of unit dose/package medication to patient floors

Hyperalimentation

Preparation of parenteral nutrition

Intravenous Additives

Preparation of injectable medications

Educational Program

Provision of training/lectures to other health professionals and practicing pharmacists

Clinical Pharmacy Program

Preparation of patient profiles, recording patient drug history, monitoring patient’s medication, and patient counseling

Administrative and Scientific Research

Member of several committees in creating guidelines to ensure the safe use of medication PTC, Research Committee Participation in clinical research

INTERNAL FORCES

EXTERNAL FORCES

UNIQUENESS OF HOSPITAL PHARMACY PRACTICE

INTERNAL FORCES

Organizational Structure, What uniquenes of hospital practice?

Accreditation agencies

Licensing agencies

Third-party payers

Government

Social agencies and governmental welfare agencies

Governing board and public opinion

EXTERNAL FORCES Enumerate

Accreditation agencies

exert their influence on professional standards of practice asthey affect patient care

Licensing agencies

exert legal influence on hospital operations

Third-party payers

exert their influence on the methods by which hospitals may bill and be reimbursed forservicesrendered to patient

Government

Imposesstandards and regulations on hospitals

Social agencies and governmental welfare agencies

influence the services provided to medically indigent patients

Governing board and public opinio

exert their influences over the policies, objectives, and philosophies of hospital operations and practices.

Joint Commission on Accreditation of Hospital (JCAH)

Example of External Force

1952

North American medicine and hospitals.

oint Commission on Accreditation of Hospital (JCAH) was incorporated in ___ through a joint effort of the primary association of____

To establish standards for the operation of hospitals and other healthcare facilities and services

Purpose of Joint Commission on Accreditation of Hospital (JCAH)

Teach hospital pharmacists by word and precept the philosophy and ethics of hospital pharmacy as one of the healing arts and their personal, individual accountability to assume responsibility for professional practice.

Strengthen and expand the scientific and professional aspects of the practice of hospital pharmacy.

Strengthen and perfect the administrative or management skills and tools essential to the hospital pharmacist in this role as a department head.

Attract a greater number of well-trained pharmacists to hospital practice, including those with specialized education and training in hospital pharmacy.

Promote payment of realistic salaries to hospital pharmacists in both staff and managerial positions in order to attract and retain the services of career personnel.

Utilize the resources of hospital pharmacy to assist in the development and improvement of the profession

GOALS FOR HOSPITAL PHARMACY

Standard I – Practice Management

Standard II – Medication Use Policy Development

Standard III – Optimizing Medication Therapy

Standard IV – Drug Product Procurement and Inventory Management

Standard V – Preparing, Packaging, and Labeling Medications

Standard VI – Medication Dispensing and Delivery

Standard VII – Monitoring Medication Use

Standard VIII – Evaluating the Effectiveness of the Medication-Use System

Standard IX – Research

ASHP Guidelines: Minimum Standard for Pharmacies in Hospitals

Pharmacy Mission, Goals, and Scope of Services.

24-hour Pharmacy service

After-Hours Pharmacy Access

Practice Standards and Guidelines

Pharmacy and Pharmacist Services of Standard I

Policy and Procedures Manual

Personnel Safety

Emergency Preparedness

Medical Emergencies

Immunization Programs

Substance Abuse Programs

Laws and Regulations Policies and Procedures of Standard I

Position Descriptions

Director of Pharmacy

Support Personnel

Education and Training

Recruitment, Selection, and Retention of Personnel

Orientation of Personnel

Work schedules and assignments

Performance evaluation

Effective communication

Ethical conduct

Human Resources of Standard I

Pharmacy

Medication Storage and Preparation

Compounding Areas

Patient Assessment and Consultation

Office and Meeting Space

Automated Systems

Information Technology

Drug Information

Record Maintenance

Facilities of Standard I

PTC

Infection Prevention and Control

Medication Safety

Committee Involvement of Standard I Examples

Pharmacy and Pharmacist Services

Laws and Regulations Policies and Procedures

Human Resources

Facilities

Committee Involvement

Standard I – Practice Management Enumerate the division under

Policy Development

Formulary Management

Drug Information

Standard II – Medication-Use Policy Development Enumerate the division under

Formulary

Medication Therapy Monographs

Nondrug substances

Formulary Management of Standard II

Drug Information Requests

Dissemination of Drug Information

Drug Information of Standard II

Creating a Relationship with the Patient

Acquiring Essential Patient Data

Consulting with other Health Professionals about Medication

Therapy

Standard III – Optimizing Medication Therapy Enumerate the division under

Pharmacist Role in Direct Patient Care

Continuity of Care

Patient Confidentiality

Creating a Relationship with the Patient of Standard III

Pharmacist’s Consultations

Medical Record Documentation

Medication Therapy Decisions

Therapy of Standard III

Selecting Sources of Pharmaceutical Products

Managing Inventory

Inspecting Storage Areas and Inventory Items

Returning Recalled, Expired, and other Unusable Items

Standard IV – Drug Product Procurement and Inventory Management Enumerate the division under

Medication Acquisition

Pharmaceutical Manufacturers and Suppliers

Pharmaceutical Manufacturer’s Representative

Selecting Sources of Pharmaceutical Products of Standard IV

Medication Storage

Drug Shortages

Samples

Patient Care Area Stock

Controlled Substances

Patient’s Own Medications

Managing Inventory of Standard IV

Preparing Medications

Packaging Medications

Standard V – Preparing, Packaging, and Labeling Medications Enumerate the division under

Compounding

Sterile Preparations

Hazardous Drug Products

Preparing Medications of Standard V

Unit Dose Packaging

Bar-Coding of Unit Dose Packaging and Point of Care Administration

Packaging Medications of Standard V

Drug Delivery Systems, Administration Devices, and Automated Distribution Devices

Medication Administration

Medication Delivery and Administration of Standard VI

Prescribing

Diagnostic or Therapeutic Purpose

Medication Orders

Review of Medication Orders

Medication Dispensing of Standard VI

Medication Dispensing

Medication Delivery and Administration

Enumerate the division under Standard VI – Medication Dispensing and Delivery

Reviewing Patient Responses to Medication Therapy

Educating and Counseling Patients and Family

Standard VII – Monitoring Medication Use Enumerate the division

Assessing the Pharmacy Services and Practices

Improving the Medication-Use Process

Standard VIII – Evaluating the Effectiveness of the Medication-Use System Enumerate the division

Policies and Procedures

Procurement, Distribution, and Control of Investigational Drugs Institutional Review Board

Information Regarding Investigational Drugs

Standard IX – Research Enumerate the division

Organization

Policies

Personnel

Facilities

Responsibilities

Pharmacy and Therapeutics Committee (PTC)

MINIMUM STANDARD FOR PHARMACIES IN HOSPITAL

Organization

Managed by a professionally competent, legally qualified pharmacist

Director of Pharmacy

responsible to the proper administrative authority for developing, servicing, and coordinating all the activities of the department

Policies

The director of the pharmacy with approval of the director of the hospital/PTC, shall initiate and develop rules and regulations pertaining to the administrative policies of the department.

Rules on wrong dispensing of drugs i.e. suspension

Rules on accepting donated drugs.

Policies examples

Personnel

The director of the pharmacy must be well-trained in the specialized functions of a hospital pharmacy

Personnel

All members of the pharmacy shall be competent, of good moral character, and mentally and physically fit to perform their duties acceptably

Licensed pharmacists, Assistant pharmacists, Clerks

Maintains membership in American Pharmaceutical Association

Personnel examples

Facilities

Equipment for compounding, dispensing and manufacturing of pharmaceuticals and parenteral preparations

Facilities

Bookkeeping supplies and related materials

Facilities

Adequate library and filing equipment to make information concerning drugs readily available to both pharmacists and physicians

Facilities

Modern Pharmaceutical Library What minimum standard?

USP, National Formulary, United States Dispensatory, American Hospital Formulary Service

Latest edition of the following Modern Pharmaceutical Library

Pharmacy: Theoretical and practical

Chemistry: General, Organic, Pharmaceutical and Biological Pharmacology, Toxicology and Therapeutics, Biological stains and staining techniques, Sterilization and disinfection, Medical dictionary

Recent edition of text and reference books Modern Pharmaceutical Library

Facilities

Special locked storage space to meet the legal requirements for storage of narcotics, alcohol and other prescribed drugs.

Facilities

Refrigerator for the storage of thermolabile products

Facilities

Adequate floor space for all pharmacy operations and the storage of pharmaceuticals at a satisfactory location provided with proper lighting and ventilation.

Preparation and sterilization of injectable medication when manufactured in the hospital

Compounding

Dispensing of drugs, chemicals, and pharmaceutical preparations

Filling and labeling of all drug containers

The pharmacists shall be responsible for the?

Responsibilities

Necessary inspection of all pharmaceutical supplies on all services

Responsibilities

Maintenance of an approved stock of antidotes and other emergency drugs

Responsibilities

Dispensing of all narcotic drugs and alcohol and the maintenance of all perpetual inventory

Responsibilities

Charging patients for drugs and pharmaceutical supplies.

Responsibilities

Specifications both as to quality and source for purchase of all drugs, chemicals, antibiotics, biological and pharmaceutical preparations used in the treatment of patients

Responsibilities

Furnishing information concerning medications to physicians, interns and nurses

Responsibilities

Establishment and maintenance, in cooperation with the accounting department, of a satisfactory system of records and bookkeeping in accordance with the policies of the hospital.

Responsibilities

Maintaining adequate control over the requisitioning and dispensing of all drugs and pharmaceutical supplies

Responsibilities

Planning, organizing and directing pharmacy policies and procedures in accordance with the established policies of the hospital

Establishing the mission, vision, goals, and scope of services of the pharmacy

Developing, implementing, evaluating, and updating plans and activities to fulfill the mission, vision, goals, and scope of services of the pharmacy

Actively working with or as a part of hospital or health-system leadership to develop and implement policies and procedures

Mobilizing and managing the resources, both human and financial, necessary for the optimal provision of pharmacy services.

Ensuring that patient care services provided by pharmacists and other pharmacy personnel are delivered in adherence to applicable laws and regulations, hospital requirements, and practice standards.

The director of the pharmacy shall be responsible for the?

Responsibilities

Cooperation in teaching courses to students in the school of nursing and in the medical intern training program

Responsibilities

Implementing the decisions of the Pharmacy and Therapeutics Committee

Responsibilities

Preparation of periodic reports on the progress of the department for submission to the administrator of the hospital

2 regular meetings

• secretary

Pharmacy and Therapeutics Committee

• Director of Pharmacy – ___

• PTC shall hold____ annually

Develop a formulary of accepted drugs for use in the hospital

Serve as an advisory group to the hospital pharmacist on matters pertaining to the choice of drugs to be stocked

Evaluate clinical data concerning drugs requested for use in the hospital

Purpose of Pharmacy and Therapeutics Committee

Hospital pharmacists

____ are encouraged to participate in research

institutional pharmacy

Promote scientific research in____

educational background

Pharmacists must have adequate____ in research methodology and in the preparation of research report

Scientific Research

Systematic, controlled, empirical, and critical investigation of hypothetical propositions about the presumed relations among natural phenomena

Scientific Research

Method of acquiring knowledge based on the faith that there are real things whose characteristics are entirely independent of our opinions about them

Research in institutional pharmacy

more accurately described as problem-solving using research methods

Development of new pharmaceutical dosage forms

Identification of unknown drugs in poisoning cases

Development of new drug tests and assays

Exploratory studies of various aspects of the pharmacist’s work role

Drugs use and ADRs

Subject matters of Research in Institutional pharmacy

Hospital Pharmacists

____ must possess or develop minimal skills in each area and become experts in any one or several of them.

Continuous education

____ is necessary to keep pace with the rapid progress in the pharmaceutical and medical sciences.

Research

____ is necessary to be able to adapt to an ever-increasing rate of change.

local

international standards

Pharmaceutical department/service is governed by ___ and ____