HOSPITAL PHARMACY.pptx

Hospital Pharmacy plays an important role in the health care system.

1. HOSPITAL PHARMACY AMEENA KADAR K A FIRST YEAR M PHARM DEPT. OF PHARMACY PRACTICE SANJO COLLEGE OF PHARMACEUTICAL STUDIES 1

2. Hospital pharmacy It may be defined as the department of the hospital which deals with procurement, storage, compounding, dispensing, manufacturing, testing, packaging and distribution of drugs. Or 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. 2

3. 3 FUNCTIONS OF HOSPITAL PHARMACY 1. Providing specifications for the purchase of drugs, chemicals, biologicals , etc . 2. Proper storing of drugs. 3. Manufacturing and distribution of medicaments such as transfusion fluids, parenteral products. tablets, capsules, ointments, and stock mixtures. 4. Dispensing and sterilizing parenteral preparations which are manufactured in the hospital. 5. Dispensing of drugs as per the prescriptions of the medical staff of the hospital. 6. Filling and labeling of all drug containers from which medicines are to be administered. 7. Management of stores which includes purchase of drugs, proper storage conditions and maintenance of records.

4. 4 8. Establishment and maintenance of " Drug Information Centre " which will provide information regarding medications to the physician, nurses or any other competent person who deals in drugs. 9. Patient counseling service while supplying drugs especially from out-patient department. 10. Maintaining liaison between medical staff, nursing staff and patients. 11. Providing cooperation in teaching and research programs of the hospital. 12. Discarding the expired drugs and containers with worn and missing labels. 13. Providing drug monitoring services by studying various effects of drugs administered to the patients especially the indoor patients from 'Patient charts' maintained in the wards etc.

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6. 6 OBJECTIVES 1. To ensure the availability of the right medication, at the right time, in the right dose at the minimum possible cost. 2. To professionalize the functioning of pharmaceutical services in a hospital. 3. To act as a counseling department for medical staff, nurses and for patient. 4. To act as a data bank on drug utilization. 5. To participate in research projects. 6. To implement decisions of the pharmacy and therapeutics committee. 7. To co-ordinate and co-operate with other departments of a hospital. 8. To plan, organize and implement pharmacy policy procedures in keeping with established policies of the hospitals.

7. 7 RELATIONSHIP OF HOSPITAL PHARMACY WITH OTHER DEPARTMENTS Membership of professional associations Co-operation with medical research staff Co-operation with local pharmacists Co-operation with nursing staff Drug information services Participation in administrative works Pharmacist role in infection control Accepting speaking engagements Hospital pharmacy displays Special promotional efforts Drug rehabilitation programme Hospital pharmacists participation in continuing education programme

8. 8 ORGANIZATIONAL STRUCTURE The pharmacy manager identifies a relatively standard organizational design that most closely fits the pharmacy’s needs. The design is molded to match with unique requirements of the pharmacy and hospital administrator . A professionally competent and legally qualified registered pharmacist having at least a degree in pharmacy should head the hospital pharmacy department. The director of hospital pharmacy services shall be responsible to proper administrative authority of the hospital for developing, supervising and coordinating all the activities of hospital pharmacy department. The hospital pharmacy department may be subdivided into several sub-departments based upon the general services of the hospital . The organisational structure of the pharmacy department is defined by the services offered by the pharmacy department and the type of the hospital.

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10. 10 Departmental Organization in a Hospital Administrative Services Division 1. Plan and coordinate departmental activities. 2. Develop policies. 3. Schedule personnel and provide supervision. 4. Coordinate administrative needs of the Pharmacy and Therapeutics Committee. 5. Supervise departmental office staff. Education and Training Division 1. Coordinate programs of undergraduate and graduate pharmacy students. 2. Participate in hospital-wide educational programs involving nurses, doctors etc. 3. Train newly employed pharmacy department personnel.

11. 11 Pharmaceutical Research Division 1. Develop new formulations of drugs, especially dosage forms not commercially available, and of research drugs. 2. Improve formulations of existing products. 3. Cooperate with the medical research staff of projects involving drugs. In-Patient Services Division Provide medications for all in-patients of the hospital on a 24-hour per day basis. 2. Inspection and control of drugs on all treatment areas. 3. Cooperate with medical drug research. Out-Patient Services Division 1. Compound and dispense out-patient prescriptions. 2. Inspect and control all clinic and emergency service medication stations. 3. Maintain prescription records. 4. Provide drug consultation services to staff and medical students.

12. 12 Drug Information Services Division 1. Provide drug information on drugs and drug therapy to doctors, nurses, medical and nursing students and the house staff. 2. Maintain the drug information center. 3. Prepare the hospital's pharmacy newsletter. 4. Maintain literature files. Departmental Services Division 1. Control and dispense intravenous fluids. 2. Control and dispense controlled substances. 3. Coordinate and control all drug delivery and distribution systems. Purchasing and Inventory Control Division 1. Maintain drug inventory control. 2. Purchase all drugs. 3. Receive, store and distribute drugs. 4. Interview medical service representatives.

13. 13 Central Supply Services Division Develop and coordinate distribution of medical supplies and irrigating fluids. Assay and Quality Control Division 1. Perform analyses on products manufactured and purchased. 2. Develop and revise assay procedures. 3. Assist research division in special formulations. Manufacturing and Packaging Division 1. Manufacture wide variety of items in common use at the hospital. 2. Operate an overall drug packaging and prepackaging program. 3. Undertake program in product development. 4. Maintain a unit dose program. Sterile Products Division 1. Produce small volume parenteral. 2. Manufacture sterile ophthalmologic, irrigating solutions etc.

14. 14 3. Prepare aseptic dilution of lyophilized and other "unstable" sterile injections for administration to patients. Radiopharmaceutical Services division Centralize the procurement, storage and dispensing of radioisotopes used in clinical practice. Intravenous Admixture Division 1. Centralize the preparation of intravenous solution admixture. 2. Review each 1.V. admixture for physio -chemical incompatibilities

15. 15 LEGAL REQUIREMENTS Staff Requirements Chief pharmacist : He should be preferably a post graduate in pharmacy or equivalent with sufficient training and experience. He is responsible for development, supervision and coordination of all the activities carried out in pharmacy department. One registered pharmacist for average of 133 patients including inpatients and out- patients. However, a team of four pharmacists is required to provide round-the-clock services for hospitals with average of less than 500 patients. Depending upon the load of work, there should be adequate number of assistants , attendants and sweepers . There should be one typist cum clerk for each hospital pharmacy. Interns Cashier

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17. 17 2. Facilities Adequate floor space for all pharmaceutical operations with proper electrification and ventilation. Waiting area Office – administrative area Sufficient storage area for the drugs with proper conditions of sanitation, temperature, light, ventilation, segregation and security. Necessary equipments Special storage space for narcotics and dangerous drugs with lock and key facilities. Separate store for alcohol and methylated spirit. Refrigerators or cold room Sterile product room Manufacturing area Bulk compounding room Prepackaging room Research lab Library and filling equipment for reference, books and journals. Records.

18. 18 3. Location , space and layout of Hospital pharmacy Ideally the pharmacy should be located on the ground floor for easy access to patients and for receiving and storing medicaments. If the hospital is multistoried, the pharmacy, especially the dispensing unit for the outpatient should be located on the ground floor. It should be accessible to all clinics and should be close to the natural exit of hospital for outpatient services. The space required for the hospital pharmacy department depends upon the size of the hospital and the functions that hospital pharmacy carries out. On an average 6 square feet to 10 square feet of an area per bed of hospital is ideal for effective and efficient functioning of pharmacy department. The space for hospital pharmacy department should be minimum 250 sq . feet as per schedule N.

19. 19 Depending upon the bed capacity of the hospital the area for hospital pharmacy department is as follows: For 100 bed hospital, 10 sq. feet per bed For 200 bed hospital 6 to 8 sq. feet per bed. According to the capacity of hospitals, type of work and workload norms, the requirement of pharmacist is fulfilled. At least 3 pharmacists should be appointed for any small hospital. According to bed capacity the no. of pharmacists required are: Up to 50 beds – 3 pharmacists Up to 100 beds – 5 Pharmacists Up to 200 beds – 8 pharmacists Up to 300 beds – 10 pharmacists Up to 500 beds – 15 pharmacists Generally Outpatient attendance and bed strength ratio is 3:1. One pharmacist can be recommended for maximum 10 patients.

20. 20 4. Layout The walls should be of non-porous material and plastered on both sides. The indoor wall finishing should be of washable antifungal  paint  and the outdoor finishing should be of weather-proof paint . 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 equipment used. The ceiling should be of fire-retardant, asbestos-free, and non-shedding materials or mineral fibers. The roof should be pitched or sloped to prevent heavy rain damage. The doors should be of fire-retardant material. The exit doors should be purposefully located and fitted with luminous emergency exit signage.

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22. 22 The windows should be available at workstation, office, and staff areas, but not in storage areas . Floor Space Requirements The floor space should be in accordance with the norms laid down by the Drugs and Cosmetics Act (under Schedule N). The floor area should be a minimum of 250m . The area requirements increase to 10m per bed for 100 beds, 6m per bed for 200 beds, and at least 5m per bed for larger hospitals. Teaching institutes demand a greater area.

23. 23 Equipments Prescription case Drug stock cabinets with proper shelves and drawers. Sectional drawer cabinets with cupboards bases. Work tables and counters for routine dispensing. Sink with drain board. Cabinet to store mortar and pestles Cabinet for glass utensils, flasks, funnels and beakers. Refrigerator of suitable capacity. Narcotics safe with individually locked drawers. Office desk with telephone connection and file cabinet. Dispensing window for nurses and outpatients. Safety and security equipment Eg: Fire extinguishers, fire blankets, fire sprinklers and fire showers.

24. 24 Abilities Required Technical ability Ability to develop a manufacturing section Administrative ability Ability to control inventory Ability to conduct and participate in research Ability to conduct teaching programs.

25. 25 WORK LOAD STATISTICS Pharmacist’s workload can be viewed in terms of work characteristics and of professional responsibilities. It is a function that’s performed by the pharmacy staff in an assigned pharmacy area. On a monthly basis, the total workload per section is collected for included in departmental report. Head of pharmacy is responsible for approving the statistics and sending it to hospital administration . POLICY FOR DETERMINING WORK LOAD STATISTICS Determine standard time for every activity in pharmacy. All activities involved in drug distribution are identified and collected in work load data reporting sheets. Collection of data is performed at beginning of each month.

26. 26 Final report will be submitted to head of pharmacy department. Total workload in each section is collected and included in department report and submitted to hospital administration Report is used for adjustment of shift or shifting based on comparative monthly statistics. PROCEDURE TO DETERMINE WORKLOAD STATISTICS Activate the following reports from the pharmacy computer system to obtain print-outs: Number of unit doses processed. Number of bulk doses processed. Collect the following log sheets located in the Inpatient Pharmacy areas: Nursing Unit Inspection Guide. TPN Record Sheet (unit bags prepared).

27. 27 Count the number of medications prepared in the Extemporaneous Compounding Log Binder for the indicated time frame . Report the workload of the outpatient pharmacy: Number of single item prescription processed per month. Number of multiple items prescription processed per month. Indicate total workload for the following: Unit Dose/ bulk Items TPN bags prepared. Extemporaneous compounded bulk items. CPR box check crash cart inspection. Floor stock inspection. Floor stock narcotic temporary sheet. Time spent in Pharmacy interventions in the nursing units. Time spent on answering telephone call for drug inquiries.

28. 28 Time spent on Narcotic drugs issuing/ return/ inspection. Time spent on inspection for expiration date. Time spent in Pharmacy in-services and lectures. Time spent on Patient counseling. Outpatient pharmacy workload. Record the total workload statistics of all areas in the pharmacy departments in one Workload Data Reporting sheet. Turn in the completed Monthly Workload Data Reporting Sheet to the department Head. The workload statistics to be announced and presented to P&T committee Pharmacy head to approve the statistics and send it to hospital administration .

29. 29 FORMS REQUIRED FOR WORK LOAD STATISTICS Workload Data Reporting Sheet. Nursing Unit Inspection Guide. TPN Record Sheet. Extemporaneous Compounding Log Binder. INFRASTRUCTURAL REQUIREMENTS 1. Located in the ground floor or in the first floor. 2. Sufficient space for seating of patients. 3. Waiting room for out-patients. It should contain educative posters on health , hygiene and offer literature for reading. 4. Suitable space – routine manufacturing of bulk preparations (stock solutions, bulk powders and ointments etc. 5. Office of the chief 6. Packaging and labeling area 7. Cold storage area 8. Research wing 9. Pharmacy store room 10. Library 11. Radio isotope storage and dispensing area  

30. 30 REFERENCES Merchant & Goyal’s A Textbook of Hospital Pharmacy by Dr. Ramesh K. Goyal , Dr. R.K. Parikh. Page No. 21-28. Hospital Pharmacy by H.P Tipnis and Amrita Bajaj. Page No. 49-66. Hospital Pharmacy, W.E Hassan https://solutionpharmacy.in/hospital-pharmacy/ https ://pharmacyinfoline.com/hospital-pharmacy-location-layout-staff/  

31. 31 THANK YOU Have a Good Day !