Hospital Pharmacy

Introduction

  • What is a hospital?

  • Differences between Hospital and Community Pharmacy

  • Technician’s role

Functions of a Hospital

  • Diagnosis and testing: Labs, X-rays

  • Treatment and therapy: Surgery, chemo

  • Emergency services

  • Public health promotion: Smoking cessation, weight loss programs

  • Preventative health initiatives: Mammography, colonoscopy, blood pressure and cholesterol screenings

  • Research and training

Hospital Organization and Functions

  • Corporate Organizational Structure

    • Chief Executive Officer

    • Pharmacy and Therapeutics Committee

    • Institutional Review Board

Speaker Notes: A hospital is a facility that provides many different kinds of medical care, including emergency, trauma, surgical, medical, and public health services, so the facility’s pharmacy services must also be varied to support these functions. Quite often, hospitals establish an organizational structure that mimics a corporate framework. A president, or chief executive officer runs the hospital and reports to the hospital’s board of directors. The CEO guides the overall direction and long-range planning of the hospital. A hospital also requires committees of specialists to ensure the sharing of information and expertise for the best policies and solutions. The main committees relating to pharmacy include the Pharmacy and Therapeutics Committee, which oversees policies for all drug-related hospital issues such as monitoring medication error reports and the Institutional Review Board,  which reviews the proposed use of investigational drugs for hospital clinical studies and provides appropriate safeguards for the patients, such as confidentiality.

Pharmacy and Therapeutics Committee

  • Hospital formulary

  • Drug use policies and protocols

  • Reviewing studies

  • Monitoring medication errors

  • Reviewing and monitoring investigational drugs

Institutional Review Board

  • Also called Human Use Committee

  • Reviews use of investigational drugs

  • Implements safeguards for patients

  • Informed consent form

Hospital Pharmacy Department

  • Services

  • Location

  • Structure

Services Provided by Hospital Pharmacies

  • Satellite pharmacies in care units

  • Clinicalpharmacists

  • Drug consults

  • Drug information

  • Discharge pharmacy services

Hospital Organization and Functions

  • Positions

    • Director of Pharmacy

      • Day-to-day operations

      • Budget

      • Hiring/firing

      • Strategic vision

      • Policies/procedures

    Speaker Notes: The hospital pharmacy staff is typically composed of a director of pharmacy, pharmacists, and pharmacy technicians. Appointed by the CEO and hospital administrators, the director of pharmacy, also known as the pharmacist in charge, oversees the day-to-day operations of the department, such as managing the

    budget; handling the hiring and firing staffing, developing a strategic vision, and establishing department policies and procedures with

    the P&T Committee.

    • Hospital pharmacists

      • Oversee dispensing

      • Advising prescribers

      • Consulting patients and healthcare teams

      • Specialized pharmacists

    Speaker Notes: Hospital pharmacists oversee the accurate and safe dispensing of the medication orders. They also spend time advising hospital prescribers and nurses, and in clinical work consulting with patients and the healthcare teams for medication therapy management.

    • Hospital Pharmacy Technicians

      • Preparing/delivering drugs

      • Stocking

      • Monitoring inventory

      • Restocking crash carts

    Speaker Notes: The hospital pharmacy technicians support the pharmacists and nurses in preparing, packaging, and delivering the drugs to each nursing unit. Stocking the automated central pharmacy and floor dispensing units. And monitoring inventory and controlled substances in both the pharmacy and the nursing units. A pharmacist technician who wishes to specialize as an I-V technician must undergo a criminal background check, graduate from an A-S-H-P-accredited training program, and pass the P-T-C-B certification exam.


Hospital Pharmacy Technician

  • Tasks

  • Work Environment

  • Attire

  • Training

  • Advancement and Specializations

Special Skills of a Pharmacy Technician

  • Medication Reconciliation

  • Unit dose medication/repackaging

  • Floor stock

  • Narcotic inventory

  • IV/Chemo inventory

  • Technology - software and automation

Electronic Hospital Records and Medication Orders

  • Hospital management software systems

  • Interoperability

  • Electronic health records (EHRs)

  • Electronic medical chart (EMR)

Speaker Notes: Hospitals now utilize hospital management software systems that collect patient data and communicate between medical departments, billing, and finance, and with external healthcare providers. The capacity for these digital systems to work together is known as interoperability. This is the greatest advantage of keeping electronic health records.

  • Preventing medication errors

    • Bar-code scanning

    • Computerized prescriber order entry

    • Robotic dispensing systems

Speaker Notes: Electronic health records also offer several ways to prevent medication errors. Bar-code scanning technology at the patient’s bedside can ensure the correct meds are being given to the correct patient. Computerized prescriber order entry software can reduce transcription medication errors from the misinterpretation of a prescriber’s handwriting. Robotic dispensing systems more efficiently and accurately fill unit dose orders.

Intake Records

  • Wrist Band

  • Medication History

  • Admitting Orders

Medication Orders: An official hospital prescribed drug request

  • Types of medication orders

    • Admitting order

    • Daily order

    • Continuation order

    • Standing order

    • Stat order

    • Discharge

Speaker Notes: There are several other kinds of medication orders. A daily order is placed for any new medications that have not been requested through the admitting order. A continuation order is issued if a prescriber wants to continue the same daily drug regime over time. A standing order is a standard medication order for each patient who receives a common treatment or surgery in which the same set of medications and treatments applies. A stat order is an emergency order typically sent electronically or telephoned to the pharmacy. These orders must receive priority attention and be immediately input, digitally verified, and filled without delay.

Electronic Hospital Records and Medication Orders

  • Preventing medication errors

    • Bar-code scanning

    • eMAR

    • Computerized prescriber order entry (CPOE)

    • Robotic dispensing systems

Speaker Notes: Electronic health records also offer several ways to prevent medication errors. Bar-code scanning technology at the patient’s bedside can ensure the correct meds are being given to the correct patient. Computerized prescriber order entry software can reduce transcription medication errors from the misinterpretation of a prescriber’s handwriting. Robotic dispensing systems more efficiently and accurately fill unit dose orders.

The Unit Drug Packaging System

  • Unit Dose Packaging

  • Benefits of Unit Dose System

  • Unit Dose Cart

    • Filling of cart

Filling and Delivery of Medication Orders

  • Healthcare software

    • Reconciles medication history

    • Duplicate drugs

    • Incorrect doses

Speaker Notes: Healthcare software reconciles the medication order with the patient’s personal medication history, allergies, and other drugs being administered. The program looks for duplicate drugs, incorrect doses, and laboratory test results that may have an impact on the choice of drug or dose.