Study Notes on Hospital Pharmacy Dispensing to Outpatients and off hours

Hospital Pharmacy Dispensing to Outpatients

Dr. Fatima Balquis, Pharm. D, M. Phil.

Lecturer at Shifa Tameer-e-Millat University, Islamabad
Reference: Hospital Pharmacy by Nadeem Irfan Bukhari

Learning Objectives

  • Drug Management for Outpatients: Understanding how to manage medications specific to outpatients including the systems in place to ensure safety and efficacy.

  • Understanding of Dispensing During Off-Hours: Insight into how medications are dispensed when normal pharmacy operations are not available.

  • Need for Dispensing During Off-Hours: Discussion on the necessity of having a system that allows for pharmacy services outside regular hours.

  • Means for Dispensing During Off-Hours: Various methods such as on-call pharmacists, emergency supplies, and methods used for dispensing.

  • Extending Pharmacy Services Hours: Strategies to broaden the accessibility of pharmacy services.

  • Dispensing from Pharmacy by a Nursing Supervisor: Roles of nursing staff in medication dispensing during off-hours.

  • Emergency Box: Utilization of emergency supplies for urgent care.

  • Night Drug Cabinets: Stockpiling medications for after-hours access.

  • Dispensing by Physicians: Understanding the physician's role in medication provision during off-hours.

  • Purchased Service/Part-Time Pharmacist Service: Contracting external pharmacy services for coverage during off-hours.

Outpatient Definition

  • Outpatient: Refers to patients who do not occupy hospital beds and receive care at clinics, health centers, and other healthcare settings.

Categories of Ambulatory Patient Care

  1. Primary Care:

    • A range of essential services to meet daily personal health needs.

    • Acts as an entry point into a comprehensive healthcare system.

  2. Emergency Care:

    • Advanced and comprehensive care provided in urgent situations.

  3. Tertiary Care:

    • Intensive or specialty medical care that comes after primary care to ensure continuity.

Location of Outpatient Dispensing

  • Ideally located on the ground floor for accessibility.

  • Should include necessary patient seating arrangements.

  • Receives regular supplies weekly from distributors, but emergency supplies can be obtained at any time.

Office Layout of Outpatient Department (OPD)

  • Racks for drug storage

  • Refrigeration for medications

  • Windows for dispensary transactions

  • Patient seating areas

  • Dedicated dispensary space

Locations for Outpatient Dispensing

  1. Independent Outpatient Pharmacy:

    • Separate setup under the main pharmacy, serviced on outpatient pharmaceutical functions.

  2. In and Outpatient Pharmacy:

    • Can provide services for both inpatients and outpatients via:

      • Combined pharmacy with a single service counter.

      • Combined pharmacy with separate service counters for each patient type.

Outpatient Activity Chart

  • Process Flow:

    1. Rx written by doctor

    2. Reviewed by pharmacist

    3. Filling of prescription

    4. Dispensing to patient

    5. Payment transaction

    6. Receipt generation

    7. Regular prescription filing

    8. Handling of narcotic prescription filing

Types of Prescriptions Received in Pharmacy

1. Clinic Patients

  • Patients receiving care from institutional outdoor departments.

  • Resembles community pharmacy operations where the physician prescribes, and the prescription is filled by the pharmacist.

2. Inpatient Discharges

  • Discharged patients requiring take-home drugs are equivalent to outpatients.

  • The dispensing process mirrors that of clinic patients.

3. Employees

  • Hospital employees can acquire their medications through the outpatient pharmacy section.

4. Research Patients

  • Involves patients in studies requiring special prescriptions with additional information for investigational and correlated medications.

5. Emergency Patients

  • Patients treated in an emergency department may receive prescriptions which are filled as outpatient medications.

  • May include a system for dispensing from cabinets containing limited medication supplies, recorded on billing cards for reorder purposes.

Drug Distribution to Outpatients

  • No medication should be dispensed without a prescription.

  • Quantity dispensed must be recorded accurately.

  • Outpatient medications are provided from the pharmacy located within the outpatient block.

Dispensing During Off-Hours

  • Refers to the dispensing of medications when the pharmacy is closed, such as during weekends or holidays.

Importance of Off-Hour Dispensing

  • Pharmaceutical services represent a crucial component of overall patient care, necessitating pharmacist availability at all hours.

  • Factors impacting this include:

    • Sufficient staffing levels

    • Budget constraints

    • Size of the healthcare facility

Means for Off-Hour Dispensing

  1. Pharmacist on Call:

    • In cases of staffing shortages, pharmacists may be made available on call.

    • Incentives like bonuses or extra pay may be introduced to encourage participation.

  2. Extending Pharmacy Service Hours:

    • Extending pharmacy hours broadens service coverage, but requires additional staff, posing challenges for smaller hospitals.

    • Aims include maintaining continuity in programs like I/V admixture, drug information, and medication monitoring to avoid errors.

  3. Dispensing by Nursing Supervisors:

    • Although dispensing is generally not a nursing function, it may occur in staffing shortages under strict guidelines:

      • Written procedures must be established.

      • Only the most commonly needed drugs should be dispensed in limited quantities and pre-packaged doses.

      • A log must be maintained for doses and drugs dispensed.

  4. Emergency Box:

    • Essential for immediate treatment scenarios:

      • Must be adequately sized, compact, and kept accessible.

      • Requires regular checks for inventory management and outdated medications.

  5. Night Drug Cabinets:

    • A support system for medication availability after pharmacy hours:

      • These cabinets vary in complexity, often including special sections for narcotics and refrigerated items.

      • Stocked with pre-packaged medications and utilized via proper documentation by nursing staff.

  6. Physicians as Dispensers:

    • Physicians may dispense medications directly if necessary, but this may pose risks like time wastage and added workload.

  7. Purchased Service/Part-Time Pharmacist Service:

    • Contracting local pharmacies to fill staffing gaps during nights, holidays, or vacations offers a safe and effective solution.

    • Structured bidding or selection process for local pharmacies based on their capabilities and services.

Conclusion

  • The effective management of outpatient pharmacy services, especially during off-hours, is crucial for patient safety and medication management. By incorporating multiple strategies and ensuring adherence to regulations, healthcare facilities can enhance accessibility to pharmaceutical care.