Dispensing To Ambulatory

Outpatients

Definition of Outpatients

• Outpatients are individuals who do not occupy beds in a hospital.

• They are also referred to as ambulatory patients.

• Primarily, outpatients need primary care.

• Outpatient dispensing is one of the fundamental functions of the pharmacy department in any hospital.

Contents of Outpatient Pharmacy Overview

• Location

• Layout

• Receipt and Issue System

• Recovery and Service Charges

• Professional Fee

• Prescription Prices

• Pre-packing

Location of Outpatient Pharmacy

1. Separate Facility: It is always preferable to have a dedicated outpatient pharmacy.

2. Shared Spaces: When a separate facility is not possible, services may be combined and provided from the same or separate window.

3. Guidelines for Location: There are no strict rules for the location of an outpatient pharmacy, but it should be positioned to minimize disturbances to in-patients and the routine operations of the hospital and its pharmacy.

Layout of Outpatient Pharmacy

1. Importance of Layout: The layout significantly affects the impression that outpatients form about the hospital, based on the services they receive.

2. Essential Features:

   • A prescription receiving window and a delivery window must be present.

   • A waiting area should be available.

   • The waiting area should be:

     • Elegant

     • Clean

     • Well-ventilated

     • Equipped with comfortable seating.

   • Relevant publications related to medicine and pharmacy, as well as newspapers and magazines, may be provided for the patients.

Receipt and Issue System

1. Registration Requirement: For a first-time visit, registration is mandatory.

2. Patient Direction: Patients are directed to specific departments based on their symptoms.

3. Physician Role: The physician prescribes the medication which includes:

   • Patient’s name

   • Age

   • Registration number

   • Diagnosis

4. Prescription Submission: The prescription must be submitted to the pharmacist at the prescription receiving counter.

5. Clarifications: Any clarifications regarding the prescription must be made by contacting the physician.

6. Compounded Prescriptions: These should be filled in a container and labeled with:

   • Patient's name

   • Age

   • Registration number

   • Directions for use and storage.

7. Call Check System: This system may be employed for delivering compounded drugs.

Recovery and Service Charges

1. Patient Charges: In charitable hospitals, patients are required to pay for medications and services.

2. Pricing Methods: There are three important methods of pricing medications:

   • (a) Fee based on dosage form and number of doses supplied.

   • (b) A simple markup procedure that depends on the cost of the drug.

   • (c) A professional fee system, which is most widely used.

Professional Fee

1. Concept Overview: The professional fee is designed to cover the cost of providing services along with a reasonable profit for the pharmacist.

2. Pricing Methodology: The professional fee is identical for all types of prescriptions, regardless of the cost of the ingredients.

Prescription Prices

1. Calculation: Prescription prices can be calculated using the formula:
   $Prescription\, Price = Drug\, Cost + Professional\, Fee$

2. Variability: Professional fees may vary based on the practitioner's setting.

3. Variable Notation:

   • $PFi = CODi + PROFIT$
     where $CODi = professional\, services + overhead$

4. Operating Expenses: The professional fee based on operating expenses can be calculated as follows:
   $Professional\, Fee = A + \frac{(B * C)}{D} + E$

5. Definitions of Variables:

   • A = Manager's salary.

   • B = Prescription sales to total sales.

   • C = Expenses minus manager's salary.

   • D = Total number of prescriptions.

   • E = Net profit per prescription.

Pre-packing in Outpatient Pharmacy

1. Definition and Convenience: Pre-packing is a method utilized to enhance the standard of dispensing in hospital pharmacies. It is especially useful for:

   • Fast-moving items.

   • Items that take considerable time for packaging.

2. Requirements: It necessitates accurate procedures, controls, and records to trace the identity of the drug.

3. Policy Considerations: The pre-packing policy should consider:

   • Demand for the product.

   • Size of units to be packaged and number in each unit.

   • Type of containers and closures to be used.

   • Special labeling requirements, if any.

   • Available packaging facilities (manual or mechanical).

   • Stability of the product and its expiry date.

   • Unit cost of pre-packaging.

Advantages of Pre-packing

1. Improvement of Standard: It helps to improve the standard of dispensing.

2. Reduction of Waiting Time: This method cuts down patient waiting times.

3. Equipment Requirements: No special equipment is necessary for pre-packing.

4. Applicability: Pre-packing can be employed for both inpatient and outpatient dispensing.

5. Package Size Considerations: In most hospitals, 20 or 25 tablets are considered a standard pre-packaged size for inpatients. For outpatients, the size depends on the number of appointments in a month.

Conclusion

• This document has provided a comprehensive overview of outpatient care and the operational aspects of an outpatient pharmacy, including definitions, protocols, and pricing mechanisms.

Thank you for your attention!