Professional Documents
Culture Documents
UNIT I
Hospital Pharmacy
Such practice traditionally involves: Supplying medicines for In patient and outpatient Preparing of sterile medications Bulk compounding Pre-packing Drug formulation
Hospital Pharmacy
Research Drug therapy information
Words to know:
Procurement Manufacturing Storage Compounding Packaging Controlling Assaying Dispensing Distribution and drug monitoring
Definition
The practice of pharmacy in a hospital setting including its organizationally related facilities or services.
Maybe defined according to its form; physical make-up, quantitative nature of service Maybe also define according to its purpose/ mission
Hospital Pharmacy It serves as a focal point for the coordination and delivery of patient care to its community
DEVELOPMENTAL HISTORY
Urdang (hospital pharmacist) -first recognized representative of the pharmaceutical profession -were employed in the hospitals which were a part of many early monasteries -Description apothecary shop and its garden for the cultivation of medicinal herbs
DEVELOPMENTAL HISTORY
ANCIENT PERIOD
AMERICAN ERA
DEVELOPMENTAL HISTORY
1752 Pennsylvania Hospital- first hospital in North America Jonathan Roberts- hospital pharmacist
DEVELOPMENTAL HISTORY
1565- Hospital Militar, cebu 1571- Hospital Militar, Manila 1577- Hospital de San Juan de Dios 1577- Hospital de San Lazaro 1588- Hospital de San Gabriel 1891- Chinese general Hospital 1911- Philippine general Hospital
DEVELOPMENTAL HISTORY
1957- Government Hospital Association 1960- Private Hospital Pharmacist Association Philippine Society of Hospital Pharmacist (PSHP)
CLASSSIFICATIOS
1. TYPE OF SERVICE General Hospital- provides care to patients with any type of illness Special Hospital- those which restrict the care they provide to the special conditions such as cancer, psychiatric etc
CLASSSIFICATIOS
2. LENGTH OF STAY -Short term hospital (less than 30 days) -Long term hospital (30 days or longer) 3. OWNERSHIP -Government hospitals a. Federal (armed forces, public health services) b. State c. County
CLASSSIFICATIOS
d. City ( Municipality) e. City county f. District -NON-GOVERNMENT HOSPITALS a. Non-profit b. For profit
CLASSSIFICATIOS
4. BY BED CAPACITY Pattern Under 50 beds 50-90 beds 100-199 beds 200-299 beds 300- 399 beds
FUNCTIONS of Hospitals
1. PATIENT CARE Diagnosis, preventive and treatment, rehab, dental, personalized serices. 2. EDUCATION- Patient and colleagues 3. RESEARCH -advancement of medical knowledge against disease -improvement of hospital services 4. ADMINISTRATION
GOVERNING BODY
Administrator Director Superintendent Medical Director Chief Administrative Officer
Standing Committees
EXECUTIVE COMMITTEE HOSPITAL COMMITTEE FINANCE COMMITTEE PUBLIC RELATIONS COMMITTEE Infection Control committee Pharmacy and Therapeutics committee
DEPARTMENTS OF HOSPITAL
A. Departments which the services involve primarily the professional care of the patient. -Ambulatory care, Anaesthesia, Blood Bank, Central Sterile supply, Clinical laboratory, Dental Service, Dietary & Nutrition service, ECG, ER, Medical library, Medical records, Medical social service, nuclear medicine, nursing service, OT, Pharmacy, Physical Medicine, Radiology and X-ray therapy. Respiratory therapy
DEPARTMENTS OF HOSPITAL
B. Departments which deal with the business management or administrative side of the Hospital -accounting, admitting, biomedical engineering, business office, cafeteria and coffee shop, central transportation, credit and collection, computer services, engg and maintenance, housekeeping, information service, personnel and payroll, post office, purchase and store room, telephone switchboard, volunteer service
MEDICAL STAFF
Duties Providing professional care of the sicj and injured in the hospital Maintaining its own efficiency Participating in the educational program of the hospital
Categories
Honorary staff Composed of physicians who have been active in the hospital but who are retired and those to whom it is desired to do honor because of outstanding contribution
Categories
Consulting Medical staff Consist of specialists who are recognized as such by right of passing specialty boards or belonging to the rational organization of their specialty, and who serve as consultants to other members of the medical staff.
Categories
Active or attending Medical staff The group primarily concerned with regular patient care. It is the group most actively involved in the hospital.
Categories
Associate Medical Staff Composed of junior or less experienced members
Categories
Courtesy medical staff Consists of physicians who desire the privilege of attending.
Categories
Resident Medical staff Composed of residents who are full time employees of the hospital. Provides specific services, for which they receive education and experiences.
Pharmacy Department
Manpower requirements and Responsibilities
HOSPITAL FORMULARY
Formulary - Continually revised compilation of pharmaceuticals that reflects the current clinical judgement of the medical staff.
HOSPITAL FORMULARY
Formulary system Is a method whereby the medical staff of an institution, working through the PTC, evaluates, appraises, and selects from among the numerous available drug entities and drug products those that are considered most useful in patient care
HOSPITAL FORMULARY
Potential benefits 1. Therapeutic 2. Economic 3. Educational
PTC
Drugs Approved Drug Inclusion in the Hospital Formulary Stock donations to precede regular stocking Regular evaluation & review every 3 months during PTC meeting (history of drug adverse events/ reactions, sales movement) Drugs Not Approved
Re-application (submission of letter of Re-application with completed requirements) Drug review on PTC Meeting Drug Approved
List presented to the PTC during the regular Meeting Involved companies are informed in writing regarding the status of their drugs. A grace period of 3 months is given to allow for improvement in sales.
NO IMPROVEMENT
Formal deletion from the Formulary on the next PTC meeting All stakeholders (drug companies/proponent physicians/ concerned medical staff) are informed through letters, postings at Pharmacy Bulletin Board, information provided at Nurses Stations
one brand shall be carried per generic of a dangerous drug at a time. Attending physicians are encouraged to utilize the formulary drugs. Non-formulary drugs are purchased upon request of the attending physicians when as the following have been made or approved: When referrals for available formulary drugs have been made to attending physicians who still opt to use the specific non-formulary drug of their choice. Non-formulary form is completely filled up and passed to the pharmacy. Indicating the concrete advantage the drug has over the available formulary drugs we have in the pharmacy.
Formulary Drugs are the only drugs that can be stocked in the Pharmacy A maximum of 5 brands per generic entity excluding the innovator brand can be included in the Formulary Drug list.
Endorsements from different medical departments will no longer be entertained if the maximum slot has been filled. If a drug is deleted in the same category, the slot shall be open.
Staffing
100 beds- 1 pharmacist 300 beds- director, assistant director, 7-12 staff pharmacist, 5-15 non-pharmacist, secretary 700 beds- director, assistant director (2 or more), supervisor pharmacist (2 or more), 40-60 staff pharmacist
Competencies of Pharmacist
INPATIENT PHARMACY
UNIT II
Recommended Practices
1. RPh reviews M.D order before initial administration. 2. Ready to use medications to be administered. 3. Facilities & equipment accessible only to medical practitioners. 4. Facilities & equipment designed for routine inspections.
Recommended Practices
5. Provisions are made to provide suitable pharmaceutical services. 6. Repacking from manufacturers original container should meet standards of good pharmacy practice. 7. Distinguishing accounting practices vs. dispensing practice.
Comparisons
Individual Rx
Combination
UD
Advantages
Reviewed by RPh
Interaction Inventory
Availability
Drug Returns Rx personnel Medication errors Pilferages Drug inventory
Disadvantages
Advantages of UD
1. 2. 3. 4. 5. 6. 24 h medicines More time of nurses for patients care Check medication order/ prescription Paper work decreased Eliminates credit ( decrease cost) Iv preparation and drug reconstitution procedures to the pharmacy 7. Profession utilization
Advantages of UD
8. Prevents revenue losses 9. Nursing units conserved 10. Eliminates pilferages and drug waste 11. Extends pharmacy coverage 12. Communication of medication order Improved 13. Drug consultants
EXEMPTED in UD
IV Fluids Ointment gargle ( without definite dose or cc ) PRN Medications Dangerous Drugs TPN ( esp. large volume TPN ) Once a week refrigerated drug
Procedures in UDDDS
Px entered into the system Medication order sent to pharmacist Pharmacist check drug order Dosing schedule Dispensing medicines Medication carts Pharmacist check carts Nurse administers the drug then log Cart is rechecked
COMMON ABBREVIATION
tablet capsule intravenous thru tubing IM intramuscular SQ subcutaneous OD once daily QO_OD every other day Bid twice daily Tid three times a day Qid four times a day 5x a day five times a day Q4hrtc every four hours round the clock Q4hprn every four hours as needed Q6h every six hours Q8h every eight hours Q12h every twelve hours
T/C to consider //t/c to consume //d/c discontinue meds //DC discharge //shift is use when a previous order in IV and changed into oral //revise is use if theres a change in meds with same therapeutic //complete used to indicate a completed regimen //filled used to indicate if the ordered med has been fully dispensed MGH may go home Arrow up increase Arrow down decrease
ADDICT
S Retail of DP/s containing Table I - Controlled Chemical/s 1 S Retail of DD/DDP/s & /or DP/s containing - Table I Controlled Chemical/s 3 S Wholesale/Distribution of DD/DDP/s/Table - 1 Controlled Chemical/s used in the 4 manufacture of drug preparation/s/ &/or their preparation/s S C Compounding/Manufacture of DD/ DDPs - &/or D P/s containing Table I Controlled 5 Chemical/s
500.00
1,000.00
3,000.00
5,000.00
S-2
IN-Patient Prescription
Out-patient Prescription
The official prescription form comes in 3 copies. This is called the DDB form 1-72.
Original (Yellow) shall be retained by the Drugstore/ Hospital Pharmacist for a period of 1 yr. From the of sole or delivery.
date
Duplicate (Yellow) shall be retained by the buyer or by the person to whom the drug is delivered until such drug is consumed. Triplicate (Blue) shall be retained by the person issuing the prescription.