Hosptal pharmacy management

Hospital pharmacy management by Pravin Vaishnav

1. Hospital Pharmacy Management Pravindas Vaishnav M.Pharm Goa college of pharmacy Pharmacology Dept .

2. Contents Responsibilities of hospital staffs Organization of hospital pharmacy services Hospital drugs and therapeutic committee Inpatient medication management Small scale hospital pharmaceutical production Pharmaceutical disposal Controlling leakage and drug abuse

3. Responsibilities of hospital staffs Hospital pharmacist- expert on medicines who advises on prescribing,administering,monitoring Supply manager-ensures that medicines are available through procurement,storage,distribution,inventory control,& quality control,assurance .

4. Responsibilities of hospital staffs The responsibility for establishing policies & procedures realated to medication selection , procu , distri & use often lies with DTC The medicine process is multidisciplinary,the committee should include representatives from all functional areas involved; Medical staff Pharmacy Quality assurance coordinator Hosp administrator Nursing Subcommittees are often formed for in-depth analysis of particular issues

5. Purchasing and stock management In some hospitl a separate dept manages all hosptl purchasing This dept called- medical stores or material management In such cases chief pharmacist prepares an annual budget request for pharmaceutical purchases and places orders for medicines through the medical stores Pharmacy dept manages pharmaceutical purchasing Designated committee review & approve all purchases DTC may manage

6. Medication use The medication-use process can be divided into 4 components- Prescribing Preparation and dispensing Medication administration Monitoring the effects of medications on the patient & ordering appro changes in therapy Govt agencies and licensing boards regulate medications through laws and professional practice standards

7. Organization of hospital pharmacy In organizing hospital pharmacy services , both the way in which the staff is organized and the physical layouts of the building must be considered- Personnel Can be divided into 3 major categories; Management Professional staff Support staff

8. Physical organization Extent of pharmacy’s physical facility - the size of the hospt & service provided. Large pharmacy dept -- sections within one physical space or in separate locations throughout the hospt - Administrative offices Bulk storage Narcotics or dangerous drug lockers Manufacturing & repackaging IV soln compounding Inpatient and outpatient dispensing Medicine info resource center After –hours pharmacy Emergency medical storage

9. Hospital Drug & therapeutics committee(DTC) DTC is responsible foe developing policies & procedures to promote rational medicine use Its functions include- Management of the approved medicine list & hospital formulary Ongoing drug use review Adverse drug event reporting & implementation of safe medication practices

10. DTC membership An effective DTC requires that members participate in meetings and assist with other committee activities Members –representative from:- Medical staff ( from each dept) Pharmacy (chief pharmacist often serves as the secretary) Nursing Hospital administration Quality assurance staff 8-15 members Invite specialist to make presentation or provide advice on particular issue

11. Hospital formulary management Cornerstone of medication management Should be the principal concern of the DTC Issues related to medication selection

12. Guidelines for the hospital setting Limit the formulary list to conserve resources-stocking all medicines on the national formulary is usually not necessary Eliminate generic duplication-only one brand or label of each generic medicine should be routinely stocked Minimize the number of strengths stocked can be same medication;multiples of lower strengths can be used for frequently needed higher strengths Select medications for the formulary based on disease and conditions treated at the facility Include second-line alternatives to medicines of choice as needed,but minimize therapeutic duplication Ensure that the hospital formulary corresponds with any national or regional standard treatment guidelines that have been formally approved by the health system

13. In addition to the basic formulary process, many hospitals add two more features — therapeutic substitution and use restrictions for certain medication in the formulary

14. Inpatient medication management Medication distribution systems Medication distribution has long been the primary function of hospital pharmacy services 4 basic types of medication distribution systems exist— Bulk ward stock replenishment Individual medication order system Unit-dose system Automated medication dispensing

15. Patient medication profiles Patient medication profile are necessary if hospital pharmacists are to monitor inpatient medication therapy Each profile contains data on the patient’s current & recent pharmaceutical therapy, allergies , diagnosis,height,weight,age,sex Profile allows the pharmacist to review all medications that a patient is taking before dispensing the first dose and with each new medication order Problems with pharmaceutical therapy can be detected and avoided or corrected

16. Medication treatment record

17. Small scale hospital pharmaceutical production Include secondary production from existing raw material  imported packaging or repackaging of finished goods into smaller dispensing packs & course-of-therapy(COT) packages (tertiary production) SSP divided into sterile & non-sterile production or compounding

18. Pharmaceutical disposal Hospitals ,health-care—generates Expired goods, Damaged pharmaceuticals Improper disposal—>contaminate water supplies,resale poor quality of medicine,air pollution from improper incineration

19. Hospital- return products to the facility from where they were obtained If this option is not available then, Proper disposal plan & regularly monitored Depending on property –pharmaceutical waste  incineration, land disposal, inertization (product is mixed with cement)

20. Special care must taken— Narcotics Toxic drugs Anticancer medicines Before disposal technique is instituted any govt laws & regulations relevant to health care waste management and environmental protection should reviewed

21. Controlling leakage and drug abuse Systematic approaches for detecting,analyzing & preventing pharmaceutical losses caused by theft,bribery and fraud Applicable to hospitals and healthcare facilities The control of narcotics – concerns in hospital because it may be the only type of institution regularly stocking,dispensing,administering them Drug addiction among physician,pharmacists,nurses is quite common

22. To avoid drug abuse and prevent leakage Be alert to changes in performance,injuries,mood swings in workers Ensure double-witness & double-signature procedures for wastage of narcotics Limit access to narcotic storage areas Check patient charts & medication administration records for patterns of consumption; be suspicious if patients receive noticeably more narcotics during a particular shifts

23. Ask patients if they received medication s Use locked boxes or wire cages to ensure security for medication moved from the pharmacy to the wards Issue individual narcotics boxes to each anesthesiologists daily,and make sure that the box is returned to the pharmacy at the end of the day with a written record of quantities used for each patient Count narcoti stocks daily and reconcile with inventory records Sometims –for antibiotics Antiretroviral to treat HIV/AIDS

24. THANK YOU