Minimum Standard for Pharmacies in Hospitals

Minimum Standard for Pharmacies in Hospitals

Lecture Information

• Presenter: Dr. Fatima Balquis

• Qualifications: Pharm-D, M.Phill

• Position: Lecturer at Shifa Tameer-e-Millat University, Islamabad

Learning Objectives

1. Quality Pharmacy Services

   • Understand the basic guidelines for provision of quality pharmacy services in hospitals.

2. Leadership and Practice Management

   • Understand leadership and practice management rules.

3. Medication Use Policies

   • Describe the policies for Medication Use.

4. Optimization of Medication Therapy

   • Understand standards for optimization of Medication Therapy.

5. Drug Procurement and Inventory Management

   • Enlist standards of Drug Procurement and Inventory Management.

6. Medication Dispensing Standards

   • Review Medication Dispensing standards.

7. Monitoring Medication Use

   • Describe standards of Monitoring Medication Use.

8. Preparing & Packaging Medications

   • Describe standards for Preparing and Packaging Medications.

9. Evaluating Effectiveness of the Medication-Use System

   • Review standards for Evaluating the Effectiveness of the Medication-Use System.

10. Clinical & Practice Research Standards

    • Understand the clinical and practice research related standards.

Standard I: Practice Management

• Effective leadership and practice management skills are necessary for delivering pharmacy services aligned with hospital and patient needs.

A. Pharmacy and Pharmacist Services

• Mission, Goals, and Scope:

  • The Pharmacy shall have a written Mission, Goals, and Scope of Services.

• 24-Hour Pharmacy Service:

  • Should be provided when possible.

B. Policies and Procedures

• Manual Requirements:

  • There shall be a Policy and Procedures Manual governing pharmacy functions.

• Employee Involvement:

  • Pharmacy employees are to be involved in developing Personnel Safety plans for hospitals.

• Emergency Medication Kits:

  • The pharmacy shall participate in hospital decisions regarding the contents of Emergency medication kits and trays.

• Immunization Programs:

  • The pharmacy shall assist in the development of Immunization Programs.

• Substance Abuse Education:

  • The pharmacy shall assist in the development of hospital Substance Abuse education, prevention, identification, and treatment.

C. Human Resources

• Position Descriptions:

  • Must be clearly defined.

• Director of Pharmacy Qualifications:

  • Should possess extensive knowledge and experience in hospital pharmacy practice and management.

• Education and Training:

  • Necessary for fulfilling responsibilities.

• Recruitment Process:

  • Personnel to be recruited and selected by the pharmacy director based on education and experience.

• Work Schedules and Assignments:

  • The director of pharmacy shall ensure established work schedules and assignments.

• Communication Methods:

  • There should be established methods for communicating important information to staff.

D. Facilities Pharmacy

• Facility Requirements:

  • Adequate space, equipment, and supplies must be available for all professional and administrative functions.

  • Must comply with all applicable laws and regulations.

  • Facilities shall be located conveniently for patient, nurse, prescriber, and other healthcare provider access.

• Medication Storage Areas:

  • Must enable receipt, storage, and preparation of medications under proper conditions (sanitation, temperature, light, moisture, ventilation, segregation, and security).

• Compounding Areas:

  • Should adhere to quality assurance procedures.

• Patient Assessment and Consultation Area:

  • Dedicated area for patient assessment is necessary.

• Administrative and Educational Space:

  • Space for office, meeting, education, and training activities is essential.

• Information and Communication Technology:

  • Adequate current resources must be available to facilitate the provision of drug information.

Standard II: Medication-Use Policy Development

A. Policy Development

• Committees and Membership:

  • All committees making decisions about medication management and use shall include at least one pharmacist as a member.

B. Formulary Management

• Formulary Maintenance:

  • A well-controlled formulary of approved medications must be maintained and regularly updated by the Pharmacy and Therapeutics (P&T) committee.

Standard III: Optimizing Medication Therapy

• Pharmacist's Responsibility:

  • Optimizing medication use is a crucial responsibility of the pharmacist.

  • Collaboration with medical and nursing staff is essential for policy and procedure development based on best practices for quality medication therapy.

A. Creating a Relationship with the Patient

• Pharmacist Role in Direct Patient Care:

  • Includes continuity of care for a patient’s medication therapy and maintaining patient confidentiality.

• Consultations with Other Health Professionals:

  • Pharmacists engage in consultations with other health professionals regarding medication therapy.

Standard IV: Drug Product Procurement and Inventory Management

• Pharmacy Responsibilities:

  • The pharmacy is responsible for the procurement, distribution, and control of all drug products used in the hospital, including those for inpatient and ambulatory patients.

A. Selecting Sources of Pharmaceutical Products

• Medication Acquisition:

  • Includes procurement from pharmaceutical manufacturers and suppliers.

B. Managing Inventory

• Medication Storage:

  • Proper medication storage protocols must be followed, addressing issues such as drug shortages and controlled substances.

• Storage Areas and Inventory Items:

  • Regular inspection of storage areas and inventory items is necessary.

• Returns Management:

  • Protocol for returning recalled, expired, and other unusable items must be established.

Standard V: Preparation & Packaging Medications

A. Preparing Medications

• Compounding:

  • Includes sterile preparations tailored to specific patient needs.

B. Packaging Medications

• Unit Dose Packaging:

  • Requires the implementation of bar-coding for unit dose packaging to enhance accuracy and reduce medication errors.

Standard VI: Medication Dispensing

A. Medication Dispensing

• Prescribing:

  • Involves reviewing medication orders and ensuring accuracy.

• Medication Orders Record:

  • A process exists for maintaining a record of medication orders.

• Review of Medication Orders:

  • Continuous review protocols are necessary for better patient outcomes.

Standard VII: Monitoring Medication Use

A. Reviewing Patient Responses to Medication Therapy

• Monitoring Responsibilities:

  • Medication therapy monitoring shall be conducted by pharmacists to assess various aspects of therapy.

  • Key elements include:

    • Therapeutic Duplication or Omission:

    • Ensuring that there is no unnecessary duplication in therapy or missing essential medications.

    • Appropriateness of Medication Dose, Route, Frequency, and Method of Administration:

    • Evaluating whether the dosage and administration methods align with clinical guidelines.

    • Patient Adherence:

    • Assessing the patient’s adherence to therapy.

    • Medication Interactions:

    • Identifying potential interactions between the medications prescribed.

    • Adverse Drug Reactions:

    • Monitoring and managing any adverse effects experienced by patients.

    • Patient Medication Allergies or Sensitivities:

    • Awareness and management of patient allergies or sensitivities to specific medications.

    • Effectiveness of the Patient’s Medication Therapy:

    • Evaluating the overall effectiveness of the treatment provided.

B. Educating and Counseling Patients and Family

• Pharmacist Availability:

  • Pharmacists shall actively participate in patient education programs to ensure understanding of medications and therapy.

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

• Quality Assessment Program:

  • There shall be an ongoing, systematic program for quality assessment and improvement of pharmacy services and the medication-use system.

  • Areas of focus include:

    • Medication-Use Evaluation:

    • Regular evaluation of medication use processes and outcomes.

    • Medication Safety:

    • Programs aimed at enhancing medication safety protocols within the hospital.

    • Antimicrobial Stewardship and Infection Prevention and Control:

    • Strategies aimed at optimizing the use of antimicrobials and preventing infection.

Standard IX: Research

• Role of Pharmacist in Research:

  • Pharmacists should initiate, participate in, and support clinical and practice-related research aligned with the goals and objectives of the hospital.

• Policies and Procedures:

  • Establish protocols for the procurement, distribution, and control of investigational drugs to facilitate research activities.