The Hospital Pharmacy

Department
• There was a separation of the pharmacy from the
practice of medicine
• Pharmacy was recognized as a different discipline
from medicine
• The division was first done inside the hospital
• The hospital pharmacist was the first recognized
practitioner of the profession of Pharmacy
 Organization of the Hospital Department

• One of the many divisions of the hospital

• Exerts a great deal of influence on the professional stature
of the hospital
In the community
DOCTOR

PATIENT

PHARMACIST
In the hospital
PHARMACIST

DOCTOR PATIENT NURSE

OTHER HEALTH
CARE
PROFESSIONALS
THE PHYSICAL PLANT REQUIREMENT AND EQUIPMENT

1. LOCATION
2. FLOOR SPACE
3. EQUIPMENT
LOCATION
• Convenient area for providing the services
• Situated where it can render the in-patient
pharmacy services:
• Storage
• Dispensing
• Manufacturing
• Parenteral solutions
• Etc.
Location
• For clinical pharmacy, it is advised to develop
satellite pharmacies on the patient pavilions
• To respond to clinical needs
• Making it available to patients, nurse, doctors, and all
other health care professionals
• Easier to take patient drug histories, maintain patient-
drug profiles, observing the patient for drug interactions
and toxicities
• Dispensing unit-doses and intravenous with additives
Floor Space
•Great variations
•General Hospital Pharmacies

Areas in Square Feet 50 Bed 100 Bed 200 Bed

Compounding and Dispensing Lab 205 320 495
Parenteral Solutions Laboratory 185 200
Active Store Room 125 200
Manufacturing Laboratory 120
Office and Library 105
Circulation 50
TOTAL 205 630 1180
Floor Space
• There should be an additional of approximately 170 square
feet per 100 beds provided for bulk-storage area
• For a small hospital with only one pharmacist, only one
room is required for complete pharmaceutical service.
• When sterile products are to be prepared– there should be
a separate room.
Equipment

• FDA- AO No. 56 – 1989

Equipment
u Other Considerations
1. Equipment electrical safety
2. Refrigeration Facilities / Cold Room
3. Build-in Equipment – Cabinet
Counters
1. Ventilation
2. Conveyor and Pneumatic Tube
3. Plumbing (consider the waste products)
The pharmacy library
uMust be well-planned for medical education

uLocation:
uwithin the department
uAvailable for on-spot consultation
uWhen clinicians work require data concerning drug therapy
uAs reference for toxicity or contraindications for existing
products
• Physical Facilities
•the area depends on the size of the utilizing staff and
the available resources.
• Selection of Contents
• Volumes, monographs, and journals about pharmacy and
allied sciences
• Drug Information Center
• separate section
• Contains a large number of reference texts and journals,
brochures, reprints and electronic data for counselling.
 Pharmacy staff and responsibilities

9/5/22
1. IN-patient staff responsibilities

9/5/22
A. Dispensing Area
• Ensures that established policies and procedures are
followed
• Check for accuracy of doses prepared
•IV Admixture
•Unit Dose
• Provides for proper drugPatient-Care
control Area
Ensures that:
•Drugs are stored and dispensed properly
•All drug laws are followed
•Good techniques are used in compounding IV Admixtures and
extemporaneous preparations
•Provides for proper record keeping and billing
a. patient-medication records
b. Extemporaneous compounding records
c. Intravenous Admixture records and billing
d. Investigational-drug records
e. Reports
•Maintains professional competence
• Drug stability & compatibility
•New personnel are trained properly in the policies and procedures
of the dispensing area
•Coordinates the activities of the area with the available staff to
make best possible use of personnel and resources
• Provides drug information as necessary to the
pharmacy, medical, and nursing staff
• Coordinates the overall pharmaceutical needs of the
patient care area with the central dispensing area
b. Patient-Care Area
• Supervision of drug administration:
• Reviews and interprets each unit dose and IV
admixture and medication order to ensure accurate
unit-dose or IV admixture system
• Reviews each patient’s drug administration form
periodically to Ensure that all doses are being
administered and charted correctly
• Confirms periodically that administered doses are
noted correctly on patient’s chart
•Ensures that records for administered narcotics are
kept correctly and that the physician is informed of all
automatic stop procedures
•Ensures that proper drug administration techniques
are used
•Acts as a liaison between the pharmacist and the
nursing and the medical staff
•Communicates with nurses and physicians concerning
medication-administration problems
uPeriodically inspects the medication area on nursing
units to Ensure that adequate levels of floor-stock
drugs and supplies are maintained
uEnsures that drugs and supplies are procured from
the dispensing are as required
uEnsures that other supportive services performed
by the department of pharmacy are carried out
correctly
uCoordinates all pharmacy services on the nursing
unit level
• Ensures that all the medication area is neat and
orderly
• Ensures that proper security is maintained in the
medication area to prevent pilferage
2. Direct patient care

• Identifies drugs bought into the hospital by patient

• Obtain patients medication histories and
communicate all pertinent information to the
physician
• Assists in drug product and entity selection
• Assists the physician in selecting dosage regimens
and schedules, the assigns drug-administration
times for these schedules
uMonitors patient’s total drug
therapy for:
1. Effectiveness
2. Side-effects
3. Toxicities
4. Allergic drug reactions
5. Drug interactions

uCounsels patients on:

1. Medication to be self-administered in the hospital
2. Discharge medications
•Participates in cardiopulmonary
emergencies by:
1. Procuring and preparing needed drugs
2. Charting all medications given
3. Performing cardiopulmonary resuscitation, if necessary
3. General responsibilities

uProvides in service education to:

1. Pharmacists, pharmacy interns, residents, and students
2. Nurses and nursing students
3. Physician and medical students

uProvides drug information to physicians,

nurses, and other health care personnel
Ambulatory pharmacist’s
responsibilities
A. Dispensing Area

• Ensures that established policies and procedures are

followed
• Checks the accuracy in the work of supportive
personnel
• Ensures that proper techniques are used in
extemporaneous compounding
•Provides adequate record keeping
with billing

A. Patient medication records

B. Investigational drug records
C. Outpatient billing
D. Reports
E. Prescription files
• Maintains professional competence

• Ensures that new personnel are trained properly in the policies and
procedures of the ambulatory pharmacy

• Coordinates the activities of the area with the available staff to make the
best use of personnel and resources

• Keeps the ambulatory pharmacy are neat and orderly at all times
B. Patient care area
•Inspects periodically the medication areas on the nursing unit to Ensure
that an adequate supply of stock drugs and their proper storage

•Identifies drugs bought into the clinic by patients

•Obtains patient medication histories and communicates pertinent

information to the physician

•Assists in drug-product and entity selection

• Assists the physician in selecting dosage regimens and schedules

• Monitors patient’s total drug therapy for

1. Effectiveness
2. Side-effects
3. Toxicities
4. Allergic drug reactions
5. Drug interactions

• Counsels patients on proper use of their medication

• Prepares medications of IV Admixtures

C. General responsibilities
• Provides drug information necessary to pharmacy, medical and nursing
staff

• Coordinates overall pharmaceutical needs of the ambulatory service area

• Provides adequate drug control

• Ensures that drugs are handled properly
• Ensures that all state and federal laws are followed

• Maintains professional competence in area

•Participates in cardiopulmonary emergencies by:
1. Procuring and preparing needed drugs
2. Charting all medications given
3. Performing cardiopulmonary resuscitation, if necessary

•Provides in-service education to

1. Pharmacists, Pharmacy interns, residents, and students
2. Nurses and Nursing students
3. Physician and medical students
Staffing
• It varies, depending on the scope and quality service being
offered

•The bigger the size of the hospital– the more personnel is

needed in the pharmacy

• Ex. In a 300-bed progressive hospital

uEx.
In a 300-bed progressive hospital
> Chief Pharmacist
> Assistant Chief Pharmacist
> 5-10 Staff Pharmacists
> 8-10 non-pharmacists
> full-time department secretary
•Ex.
In a very large hospital
ØPharmacy Director
ØAssociate Director
Ø2 or more assistant directors
Ø1 or more supervisor pharmacist
Ø40-50 staff pharmacist
Ø10-16 pharmacy residents
ØNon-pharmacist helpers, technicians,
secretarial personnel
The pharmacy procedural manual

•Series of administrative and professional

policies
•Serve as a guide to the hospital pharmacist
• Development and execution of effective and proficient pharmaceutical
services
•The first operational manual of any pharmacy department
must contain:

üRecorded development of the operation of the department from the very

beginning
üObjectives
üPhilosophy
üMotivation
üPolicies
üRegulations
üDepartmental procedures
üStaffing pattern

üJob specifications
üOrganizational plan and chart

üFloor plans

üPlot plans
üIts Pharmacy and Therapeutics Committee and its activities

üGuidance manual for internship and/or residency program

üDescription of the department

üListing of physical facilities and library holdings
üIntra and interdepartmental relationships
üDescription of the Formulary system
Suggested divisions of the procedural manual

1. ORGANIZATION
2. FACILITIES
3. PERSONNEL
4. SERVICES AND ACTIVITIES
1. ADMINISTRATIVE
2. PROFESSIONAL
Organization

1. Of the hospital
2. Of the pharmacy
3. Services offered by department
4. Intra and interdepartmental relationships
5. PTC
6. Antibiotics Committee
EQUIPMENT AND PHYSICAL PLANT
1. Policies relating to the use, maintenance, and repair
of equipment
2. Policy and procedure governing the loan of
pharmacy equipment
3. Obtaining engineering department services for the
pharmacy
4. Policy governing the use of Central Sterile Supple
department autoclaves and sterilizers
5. Policy governing the use of laboratory equipment in
control procedures
Personnel policies

1. Job description
2. Fringe benefits
a. Sick leave
b. Vacation leave
c. Holidays
d. Attending seminars of convention, etc.
Services and Activities
1. Administrative
a. hours of operation
b. Purchasing procedure
c. Pricing policy
d. Refund policy
e. Handling cash receipts
f. Requisition of:
-Charge floor stock
-Non-charge floor stock
-Special patient charge drugs
-Ancillary surgical and medical supplies
g. Alcohol records and control
h. Controlled substances records and controls
i. Inventory taking and its records
j. Compounding records
k. The monthly and annual report, etc.
2. Professional
a. Narcotic regulations
b. Use of research drugs
c. Automatic stop orders
d. Formulary system
e. Policy governing drugs brough to the hospital
by patients
f. Labels and labelling
g. Use of the metric system
h. Repackaging of bulk drugs
i. Dispensing policies
j. On-call service
k. Bulk-compounding
l. Sterile compounding
m. Residency program
n. Poison control center
o. Information services
- Pharmacy Library
- Pharmacy Bulletin
- Lecture Service
- Drug Displays
p. Addition of drugs to IV solutions by nurses
Pharmacy and Therapeutics Commitee
PTC

• An advisory group
• Serves as a line of communication between the medical staff and pharmacy
department
• It is a policy recommending body on matters related to drug use
• This is composed of physicians and other health care professionals
Purposes of the PTC

• Advisory
• Recommends the adaptation of broad professional policies regarding evaluation,
selection, and therapeutic use of drugs in the hospital
• Educational
• Recommends or assists in the formulation of programs assigned to meet the needs of
the professional staff for complete current knowledge on matters related to drugs and
drug use
Organization and Operation

• The PTC should be composed of at least 3 physicians, a pharmacist, a nurse, and

an administrator.
• A chairman should be appointed from the physician representatives
• A pharmacist is usually delegated as secretary
• Committee should meet at least six times yearly
• The committee should invite to its meetings persons within and outside the
hospital who can contribute specialized or unique knowledge, skills, and
judgments
• Agenda and supplementary materials should be prepared by the secretary and
submitted to the committee members in sufficient time before the meeting
• Minutes of the meeting should be prepared by the secretary and maintained for
permanent record
• Recommendations of the committee shall be presented to the medical staff or its
appropriate committee for adaptation and recommendation
• Liaison with other hospital committees concerned with drug use shall be
maintained
 Department of
Medical Staff
Pharmacy

Pharmacy and Therapeutics Committee

Subcommittee on Subcommittee on Anti- Subcommittee on

Gastrointestinal Agents
Antineoplastic Agents Infective Agents
-Antacids
Autonomic Agents
Laxatives

Subcommittee on Subcommittee on
Cardiovascular Agents Subcommittee on Centeral
Endocrinology Agents
-Diuretics Nervous System Agents - Antidiabetic Agents
-Cardiac Glycosides -Analgesics & Antipyretics - Anti-inflammatory Agents
-Hypotensive Agents -Anticonvulsants
- Hormones
-Psychotherapeutic Agents - Thyroid Preparations
-Vasodilators Respiratory & Cerebral Stimulants
-Spasmolytics -Sedatives and Hypnotics
-Anticoagulants
Functions and Scope

• To serve as advisory staff pertaining the use of drugs (including investigational

drugs)
• To develop a formulary of drugs
• To establish programs and procedures to help ensure cost-effective drug therapy
• To establish a suitable educational program for the hospital professional staff on
matters regarding drug use
• To participate in Quality Assurance activities related to distribution,
administration, and use of medications
• To review adverse drug reactions in the hospital
• To initiate or review drug use review programs
• To advice the pharmacy in the implementation of effective drug distribution and
control procedures
• To make recommendations concerning drugs to be stocked in hospital patient-
care areas
Policies of the Committee

• New drug for the hospital formulary must be submitted on a Formulary Request
Form
• Request shall be submitted by any member of the medical staff
• The committee will evaluate the request and notify the proposer as to acceptance
or rejection
• Drugs evaluated by the committee will be assigned to one of the Four Categories
a. Formulary Drugs – An FDA approved drug which is recommended as being
essential for good patient care
b. Drugs Approved on a Conditional Trial Period – a drug approved by FDA for the
general use but which the Committee will evaluate for a 6 to 12 month period
before final consideration
c. Specialized Formulary Drug – an FDA approved drug which is recommended for
use in specialized patient care
d. Investigational Drugs – a drug which has been approved by the FDA for
specific use by its principal investigator and designated associates. Such drugs
are not commercially available. A protocol of the study must be submitted.
The drug is not necessary a new chemical substance but may be:
i. An old or approved drug proposed for a new use
ii. A new combination of 2 or more old drugs
iii. A combination of old drugs in new proportions
iv. A new dosage form or method of administration
e. Non Formulary Drugs – drugs which does not qualify for the four categories
listed and will not be stocked in the pharmacy. If prescribed, the pharmacy will
obtain and dispense a limited quantity of the drug.
• Pre-signing or blank prescribing or drug orders for any purpose is prohibited
• Formulary dictates that all drugs will be dispensed on the basis of generic name
• brand name selection is c/o Pharmacy Dept
• in a case of Drug recall, the drugs notified will be removed upon the receipt of
recall notice.
• It will be replaced and information willbe sent to all staff and pertinent hospital
depts
In-Patient Prescribing

a. Routine Drug orders

• A doctors medication order written on a patient order form is deemed a legal
prescription
• A legible copy must be forwarded to the pharmacy
• Orders written by medical students must be countersigned by medical staff
• Quantity of the drugs to be dispensed need not to be specified since the pharmacist
will determine optimum amounts to be dispensed
b. IV Orders
- orders for intravenous medications must be written the same manner
as routine drugs and must include the following information:
i. exact quantity of drugs which must be added
ii. Exact volume and name of the infustate solution
iii. Specific directions for administration such as IV drip(infusion),
IV Bolus(push)
iv. Specific times to hang infustate solution and drip rate
v. specific directions for continuing or discontinuing any IV
medications
c. Total Parenteral Solution (TPN)
- designated to serve as a nutritional infusion providing essential amino acids,
carbohydrates, and electrolytes for patients incapable or ingesting, digesting, or
absorbing food substances given by mouth.
- the pharmacy department shall be in-charge of preparing these solutions
d. Self Medication
- only nitroglycerin and antacids may be left to the patient’s bedside for self-
administration if so ordered by the physician
- quantitiy should be limited to 10 tablets
- administration of antacids should be charted
e. Automatic Stop Orders
- applies to instances when the physician did not specify the exact number of
doses or duration of therapy
- serves as a protection against indiscriminate and indefinite open ended drug
orders that can be harmful to the patient and at the same time ensures continuous
therapy if so desired by the physician
• Automatic stop order requirements for medications are
• 24 hours for controlled drugs
• 7 days for all other drugs
f. a new medication order must be written by the physician if a change is wanted in
route of administration or in dosage
g. Discharge Prescription
- separate prescription is required for each medication which the patient is to
take home
- this must be received by the pharmacy prior to discharge, so that they may
be processed and returned to the nursing station
h. Emergency (STAT) orders
- bonafide emergency orders should be rare and in most cases obtained from
the nursing station emergency drug supplies.
- when necessary, these orders should be transmitted in writing on the
pharmacy copy of the patients order form
Drug Utilization Review

• DRUG UTILIZATION
• Defined as the prescribing, dispensing, administering, and ingesting of prescription drugs

• Medication Histories
• Patient Drug Profile
• taken by pharmacist from patients by interview or questionaire
• information elicited:
• medications (taken at time of admission, during recent past, antibiotics
• home remedies used (OTCdrugs)
• drug allergies
• lab tests performed outside the hospital to w/c diagnostic agents were ingested
• idiosyncrasy towards food products
Patient Durg Profile - purposes

• improve prescribing practices

• detect and prevent potential drug interactions and ADRS, IV additive
incompatibilities and drug toxicities
• detect drug-induced lab test abnormalities
• detect possible drug-induced diseases
Adverse Drug Reactions

• ADRs are any response to a drug which is noxious or unintended, and which
occurs at doses used in man for prophylaxis, diagnosis, or therapy.
• All drugs has the potential to cause harm in susceptible individuals
Investigational Drugs

• It is the prime responsibility of the pharmacy and therapeutics committee to

establish policies and procedures relative to the handling and control of
investigational drugs in the hospital
• Problems with investigational drugs:
1. Legal problems
2. Nurses, as agent of the hospital, are responsible for administering
investigational drugs.
3. Investigational drugs are usually not labeled sufficiently
4. Needs written consent from patients
5. Proper recording (FDA)
6. Availability to avoid interruption of dosage schedule
Drug Defect Reporting

• Inadequate packaging
• Confusing or inadequate labels
• Deteriorated
• Contaminated
• Defective dosage forms
• Inaccurate fill
• Faulty drug delivery apparatus
Emergency Drug Listing

• PTC should develop a list of supplies and drugs which ought to be in an

emergency box