2. Hospital Pharmacy and its Organisation.pptx

Hospital pharmacy and its organization
Definition, functions of hospital pharmacy, Organization structure, Location, Layout and staff requirements, and Responsibilities and
functions of hospital pharmacists.

1. Hospital Pharmacy and its Organization MR. MANGESH BANSOD ASST. PROF. SDDVCPRC, PANVEL

2. Definition of Hospital Pharmacy Hospital pharmacy functions for receiving, storing and dispensing drugs and medicines to patients. The hospital pharmacy may also manufacture pharmaceuticals and parenteral products. The department provides a range of pharmacy services for the hospitalised and ambulatory patients, including purchase, manufacture, compounding, storage, dispensing, distribution, and maintaining record for the same. Hospital pharmacy is the health care service, which comprises the art, practice, and profession of choosing, preparing, storing, compounding, and dispensing medicines and medical devices, advising healthcare professionals and patients on their safe, effective and efficient use

3. Functions of Hospital Pharmacy It attains supply of drugs, chemicals, biological and pharmaceutical formulations only from licensed vendors and manufacturers. It inspects the received items and maintains an inventory for the same. It dispenses drugs, chemicals, and pharmaceutical preparations to the patients. The pharmacists repack the medicament in appropriate containers and label them. It keeps a record of all the narcotic drugs and alcohol received and issued. It predicts the demand for drugs, chemicals, antibiotics, biological, radio pharmaceuticals, etc. and takes suitable steps to fulfill the demand.

4. It keeps a record of each supply dispensed. It manufactures large volume parenterals and other drug preparations in case of unavailability, high cost, or lack of authentic vendors or cautious. It implements strict control on the quality of the supplies received, manufactured, and dispensed. It discusses about the drug related information with the medical staff, resident nurses, health care team, and the patients. It participates in minimizing the incidence of illness, and improves the general health of the population. It provides patient counseling . It implements the recommendations of pharmacy and therapeutic committee. Functions of Hospital Pharmacy

5. Organization Structure The hospital pharmacy has various divisions, like compounding and dispensing, manufacturing or production, quality control, central sterile supply, research, education and training, administration, and library. The Chief Hospital Pharmacist is the head of pharmacy who reports to the Administrator. The number of Assistant Chief Pharmacist , who assists the Chief in administration, depends on the work, nature and scope of operations, staff strength, etc. The Chief has a secretary and other office clerks to assist him. Staff pharmacists, technicians, pharmacy helpers, and other workers of hospital pharmacy are involved in compounding, dispensing, manufacturing, drug supply, central sterile supply, and library duties.

6. Location The pharmacy should be situated at the ground floor or the first floor to ease its accessibility and to provide adequate service to various departments and nursing stations. If the hospital has an out-patient department, the pharmacy or its branch should be near it. In a multi-storey hospital, each floor should have a pharmacy. The layout of floor pharmacies should be such that continuous flow of men and materials is maintained.

7. A complete unit of the hospital pharmacy includes 1) Office of the chief, 2) Out-patient dispensing unit, 3) Bulk compounding area, 4) Manufacturing unit for sterile and non -sterile preparations, 5) Packaging and labelling area, 6) Alcohol and volatile liquid area, 7) Narcotic vaults, 8) Radioisotope storage & dispensing area, 9) Central sterile supply area, 10) Cold storage area, 11) Research wing, 12) Pharmacy store room, 13) Library, and 14) Waiting room. Location

8. An out -patient pharmacy should look pleasant , and have enough space and seating arrangement for patients waiting for the medicine to avoid overcrowding. The waiting room in out-patient pharmacy should have a professional look, bear educative posters on health and hygiene , and hold light literature for reading to engage the visitors. This puts a positive impact of the pharmacy on the visitors. To manufacture bulk preparations (like stock solutions, bulk powders and ointments, etc.) routinely, a suitable space adjacent to the pharmacy or in the basement directly below the pharmacy should be provided. The medical stores of pharmacy should lie adjacent to the pharmacy or beneath the pharmacy. Location

9. Layout

10. Structural Design Wall: The walls should be of non -porous material and plaste red on both sides. The indoor wall finishing should be of washable antifungal paint and the outdoor finishing should be of weather -proof paint. The walls for cold room should be of a special building material and design to prevent condensation. Floor: The floor should be of concrete and smoothly plastered. The floor finishing should be of a non-slippery heavy duty material to withstand heavy loads and traffic. The floor should be non-porous, damp-proof, and resistant to detergent. The floor -to- ceiling height should range from 15 -30 feet according to the functional area and handling equipments used. Ceiling: The ceiling should be of fire-retardant, asbestos -free, and non -shedding materials or mineral fibres .

11. Structural Design Roof: The roof should be pitched or sloped to prevent heavy rain damage. Door: The doors should be of fire -retardant material. The doors should have two leaves, and should be sufficiently wide to allow free and easy movement of supplies and handling equipment (such as forklifts and stackers). The exit doors should be purposefully located and fitted with luminous emergency exit signage. Window: The windows should be available at workstation, office and staff areas, but not in storage areas.

12. Receiving Area Loading and Unloading Area: This area should be adequately spaced and properly sheltered by taking care of the vehicle height. Receiving Counter: It should have adequate waiting space and should be equipped with suitable office furniture and equipment. Sorting and Unpacking Area: This area should be adequately spaced to enable sorting and checking of goods. The space should be sufficient for the utilization of forklift. Transit/Holding Area: The transit/holding area should be adequately spaced for storing: Items requiring further clarification/investigation before receiving, Transit items not requiring special storage conditions, and Pallets. Disposal Room: This room should store discarded items (like , used boxes, wrappers and plastic covers).

13. Storage Area General Storage Requirement: The storage area should be provided with air - conditioning facilities for 24 hours. Its temperature should be effectively controlled between 16 -25°C. The electrical supply to refrigerators, freezers, cold room and air conditioning facilities should be linked to the hospital emergency power supply. A computerised alarm system should be connected to the main electrical control system of the hospital for detecting electrical failure of cold chain equipment. Adequate space should be provided for forklifts, stackers, and trolleys, and for accommodating IT facilities. The area should have sufficient numbers of pallets, shelves, and racks.

14. Drug Store: It should have adjustable, modular, heavy duty open racks for storing packages of different sizes. It should have a sufficient storage area for bulk items. It should be equipped with heavy duty plastic pallets for storing bulk items and larger cartons off the floor. These pallets should be designed to be used with forklifts to move around groups of larger items. The drug store should have designated area with cautionary signage and chemo-spill kit for cytotoxic drugs. Dangerous Drugs/Psychotropic Substances Store: This area is meant for storing dangerous drugs/psychotropic substances, thus should be kept under lock and key in a special room/cabinet with alarm system. Storage Area

15. Storage Area Cold Room/Pharmaceutical Refrigerator/Freezer Area: This area should be provided based on the functionality of hospital. It should be present within the drug store for storing drugs that require low storage temperature (like vaccines, antisera , and other biological products). Every cold room/pharmaceutical refrigerator/freezer should be equipped with a computerised temperature recorder system. Intravenous (IV) Fluid Store: This area should be adequately spaced to accommodate haemodialysis and peritoneal dialysis solution, and intravenous solutions. The space should also be sufficient for using forklift. Surgical Store: This area is designed for storing bulk surgical/consumable/disposable items/X -ray films. It should have adjustable, modular, and heavy duty open racks. It should be provided with adequate space to accommodate bulk items. Non-Drug Bulk Store: This area is designed for storing dispensing bottles, containers, labels, and envelopes. It should have adjustable, modular, and heavy duty open racks. It should be provided with adequate space to allow easy movements.

16. Store with Special Requirement Inflammable Store : This area should be located at minimum 10 feet distance away from other adjacent buildings. It should be designed for storing inflammable items (ethanol, methanol, acetone, etc.) and should be equipped with fire fighting equipments, smoke detectors, and exhaust fans for proper ventilation. The location and design of inflammable store should provide maximum air circulation so that accumulation of fumes or gases can be avoided. Corrosive Items Store: This area should be designed for the storage of corrosive items ( such as phenols and hypochlorites ). It should be equipped with special plumbing and drainage system, and eye wash station. Medical Gas Store: This area should be designed for the storage of portable medical gas cylinders. The floor should be reinforced to bear the weight of heavy gas cylinders. All electrical facilities should fulfill the requirements of the Fire Fighting and Rescue Departments and Department of Environment. Proper ventilation should be maintained. Quarantined Item Store: A designated area or cabinet should be provided and clearly labelled . Non-Conformance/Condemned Item Store: Designated store/cabinet for expired, obsolete or damaged items should be provided prior to disposal.

17. Issuing Area Temporary Holding Area: Supply to various departments is carried out in this area. Indents from various departments should be processed and prepared for supply and kept here till collected. Issuing Counter: It should have an adequate waiting space, and should be equipped with appropriate office furniture and equipment. It should provide a sufficient space for material handling equipment.

18. Administrative Area Pharmacist In-Charge Office: This area is provided for the pharmacist in -charge to perform the administrative work. It should be located to allow supervision. Pharmacist Work Station: This area is provided for the pharmacist. It should be half-glass panelled to allow supervision. Workstations and computer terminals should also be present here. General Office: This area is provided for the assistant administrative officers and administrative assistants. Work-stations with computer terminasl should be present here. Meeting/Discussion Room: This area should have sufficient space for discussion and routine administrative meetings. Document Room: This area should have sufficient space for storing files and records. Reception Counter and Customer Waiting Area: This area should be equipped with appropriate office furniture and equipments. The customer waiting area should have audio-visual facilities, water dispenser and settee.

19. Ancillary Area Personnel/Staff Rest Room: This room should be provided for staff rest, and should be equipped with staff lockers and domestic appliances such as refrigerator, electric kettle, water dispenser, microwave oven, table, chairs, and sofa. Wash Room: Separate wash rooms for male and female with separate changing rooms, toilets and shower facilities should be provided. A dedicated toilet for visitor should be made available. Housekeeping/Utility Room: This room should have sufficient space for storing cleaning materials and equipment. It should have good ventilation for washing and drying of equipment. Security Guard Post: This area should be located at the main entrance of the store. The room should be equipped with necessary equipments for the convenience of the security guard.

20. Floor Space Requirements Hospital pharmacy floor area depends on the range of its operations, number of divisions, medicaments manufactured, number of patients served (out -patient pharmacy), number of indoor patients, strength of the pharmacy staff, etc. The floor space should be in accordance to the norms laid down by the Drugs and Cosmetics Act (under Schedule M). The floor area should be minimum 250m 2 . The area requirements increase at 10m 2 per bed for 100 beds, 6m 2 per bed for 200 beds, and at least 5m 2 per bed for larger hospitals. Teaching institutes demand a greater area.

21. Staff Requirements The number of pharmacy staff members relies on the following factors: Number of beds, Service-out-patients and in-patients, Whether the pharmacy is involved in manufacturing drugs or formulations, and Whether the pharmacy is involved in stocking and dispensing of surgical and laboratory supplies. A hospital pharmacy should appoint the following staff personnel : One member as the Chief pharmacist or Director. Atleast 4 registered pharmacists in smaller hospitals so that one pharmacist handles 60 patients. Total patients involve (both in-patients and out-patients). Sufficient number of assistants, attendants, and sweepers. Pharmacist-cum-clerk or clerks depending on the hospital size. A hospital pharmacy manufacturing drugs and formulations should have manufacturing chemists and analytical chemists supported by additional assistant pharmacists.

22. Qualification The Chief Pharmacist or Director should be a post graduate degree holder in pharmacy (preferably in pharmacology or hospital pharmacy). The manufacturing chemist is required to have graduated in pharmacy and hold experience in manufacturing drugs and formulations for at least 18 months. The analytical chemist should be a post graduate in pharmaceutical chemistry or analytical chemistry. Registered pharmacist and pharmacist - cum-clerk require diploma in pharmacy and registration in state pharmacy council.

23. Responsibilities and Functions of Hospital Pharmacists Hospital pharmacists are engaged in hospital pharmacy services in public sector. They are skilled in practice of medicines and dispense prescriptions, purchase, manufactures, and performs quality test of all medicines used in a hospital. Being the members of healthcare team, they coordinate with medical and nursing staff for better treatment of patient. They help and refer knowledge to patients on their medicines. The responsibilities of a pharmacist vary with the departments and this has been discussed below.

24. In-Patient Pharmacist Responsibilities Dispensing Area: The responsibilities of the pharmacist in dispensing area are: Policies: He/she ensures that the framed hospital policies and procedures are being obeyed. Accuracy: He/she maintains proper control on the accuracy of dosages prepared (particularly for intravenous administration). Maintenance of Records: He/she maintains records of drugs supplied, returned bills of investigational drugs and intravenous admixtures, etc. Storage: He/she have adequate control over the stocked drugs. Working: He/she ensures the compliance of all the laws and rules, and that compounding is done by adequate techniques. Coordination: He/she manages all the conducts of dispensing area. Drug Information: He/she remains updated about the drugs in the hospital in terms of their side effects, therapeutic efficacy, stability, etc.

25. In-Patient Pharmacist Responsibilities Patient Care Area: This area indicates any site of a hospital where patients are examined. Parts of the patient care area where pharmacists are involved are: Coordination: He/she coordinates all the pharmacy service is in the nursing unit. Communication: He/she consults nurses and medical staff for medicine administration problems. Technical: He/she shares technical sections giving instructions to the technicians for new procedures and dealing with difficult patients. Pharmacist connects the technician, nursing, and medical staff, thereby ensuring that proper techniques are followed by the technician for drug administration. Supervisory: He/she supervises and re -checks all the prescriptions for their correct entry in the unit dose system. The pharmacist periodically inspects individual patient’s drug administration form for all doses being administered and charted correctly. He/she periodically ensures whether the administered doses are mentioned on patient’s chart and the drug charges are correctly calculated. He/she re-examines the missed doses, re-schedules them, and signs all “Drugs not given” notices. He/she timely checks the medication areas for maintenance of adequate level of floor stock drugs and supplies.

26. In-Patient Pharmacist Responsibilities Direct Patient Care: This relates to any facet of health ca re of a patient , like treatments, counseling, self -care, patient education, and drug administration. Parts of the direct patient care area involving pharmacists are: Patient’s Medication History: He/she takes down the patient’s medication history and forwards it to the physician. Identification of Drugs: He/she identifies the drugs brought in the hospital by patient. Patient Monitoring: He/she monitors the overall patient’s drug therapy for its effectiveness, side effects, toxicities, and allergic reactions.   Patient Counseling: He/she counsels the patient for self -administered drugs and discharge drugs. Selection of Drug: He/she supports the physician while selecting the drugs, dose regimens, and schedule the time for drug administration. Cardiopulmonary Emergencies: He/she gets involved in emergencies , like cardiopulmonary cases. General Responsibilities: He/she provides education and drug information to other health professionals.

27. Out-Patient Pharmacist Responsibilities Central Dispensing Area: The pharmacists perform the following tasks: He/she ensures the use of correct compounding techniques. He/she maintains adequate record and billing for patient’s medication particulars, records of tentative drugs, records of out-patient’s bills (charging of services and material), and maintaining and preparing all reports. He/she keep up with the prescription files. He/she maintains the tidiness of outdoor pharmacy. Patient Care Area: The pharmacists perform the following tasks: He/she regularly visits an d checks the medication areas in the nursing unit. He/she ensures adequate supply of required drugs and other articles. He/she identifies the drugs brought in the clinic by the patients. He/she pharmacist records the patient’s medication history and delivers it to the physician’s knowledge. He/she assists the physician n selecting the drug regimen. He/she also helps in selecting right drug products and their entities. He/she involves in patient counselling for use of medication and preparation for intravenous administration. General Responsibilities He/she understands and coordinates complete pharmaceutical needs of the outdoor service area. He/she makes sure that all drugs are properly managed. He/she takes part in cardiopulmonary emergencies. He/she offers in -service education and training to pharmacists, pharmacy students taking practical training for their diploma or degree courses, and nurses.