Role of
hospital pharmacy and its relationship with other department
Content
• Basic functions of hospital
pharmacist
• Constitution and functions of
pharmacy and therapeutic committee
Objective
After completion of this lecture, student will be able to:
• Explain the basic functions of
hospital pharmacist
• Explain the constitution and
functions of pharmacy and therapeutic committee
Definition
• Hospital
Pharmacy is managed under the direction of a professionally qualified
pharmacist, where drugs and medicines are purchased, stored and dispensed to
outpatients and inpatients and manufacture various dosage forms that are widely
used in hospitals and does pharmaceutical services
Functions and its Relationship with other Departments
Administrative Service Division:
• Plan and coordinate departmental activities
• Develop
policies
• Schedule
personnel and provide supervision
• Coordinate
administrative needs of pharmacy and therapeutic committee
• Supervise
departmental office staff
Education and Training Program
• Coordinate
programs of UG and PG pharmacy students
• Participate
in hospital wide educational programs involving
nurses, doctors etc
• Training
the newly employed pharmacy personnel
Pharmaceutical Research Division
• To
develop new formulation of drugs and research of drugs
• Improve
formulation of existing products and
cooperate with medical research staff
Inpatient Service Division
• Provide
medications for all in patients of the hospital on 24 hrs basis
• Inspection
and control of drugs on all treatment areas
Out Patient Service Division
• Compound
and dispense outpatient prescriptions
• Inspect
and control of drugs in all clinic and emergency service stations
• Maintain
prescription records
• Patient
counselling
Drug Information and Service Division
• Providing
drug information of drugs and drug therapy to all health professions
• Prepares
hospitals news letter
• Maintain
literature files
Purchase and Inventory Control Division
• Purchase
and maintain the drug inventory control
• Receive,
store and distribute drugs
• Interview
with medical representatives
• Distribution
of medical supplies and irrigating fluid
Assay and quality control division
• Perform
analysis on products manufactured and purchased
• Develop
and revise assay procedures
• Check
the expiry date drugs
Manufacturing and Package Division
• Manufacture
wide variety of drugs in common use at the hospital
• Operate
an overall drug packaging and prepackaging program
• Maintain
unit dose
Sterile Products Division
• Produce
small volume parenterals
• Manufacturing
sterile opthalmologics, irrigating solutions
• Centralize
the procurement ,storage and dispensing of radio isotopes used in clinical
practice
• Review
each IV admixture for physio-chemical incompatibilities
The Pharmacy and Therapeutic committee
INTRODUCTION:
One of the mode (or) methods of ensuing the proper
rationality in the use of drugs is that the hospital organize and constitute ‘The
pharmacy and Therapeutic Committee’
Definition
•
A multi-disciplinary committee that advises medical staff and hospital administration on
matters relating to the therapeutic use of drugs
ASHP Statement on Pharmacy and Therapeutic Committee:
•
The Pharmacy and Therapeutic Committee’ is an
advisory group of medical staff and services as the organizational line of
communication between the medical staff and pharmacy department
This committee is composed of
•
Physicians
•
Pharmacists
•
Other health professionals selected with the
guidance of the medical staff
Roles
The ‘Pharmacy and Therapeutic Committee’ has three major
roles :
• Advisory
• Educational
• Drug
safety and Adverse Drug monitoring
Advisory
Recommends the adoption of policies or assists in the
formulation of broad professional regarding evolution, selection and the
therapeutic use of drugs in the hospital
• It
involves recommendations concerning drugs to be stocked in hospital patient
care areas
• Advises
the pharmacy in the implementation of effective drug distribution and control procedure
Educational
It recommends (or) assists in the formulation of
• Functions
designed to meet the needs of the professional staff for complete current
knowledge of matters to drugs and its
use
• It
evaluates problems related to the distribution and administration of
medications including medication incident
• It
reviews ADR occurring in the hospital and to initiate (or) direct the drug
activity studies activity and to review and study the results of stock
activities
Drug safety & Adverse drug monitoring
• With
the advent and increase of each new class of therapeutic agents, the scope
knowledge and responsibility of hospital pharmacist increases proportionally
• The
pharmacist also has the moral legal and professional obligations of ensuring
safety in handling and administration of drugs
Operation of Pharmacy and Therapeutic Committee
• This
committee should meet regularly at least six times in a year and also as and
when necessary
• The
committee can invite its meeting persons within (or) unique, knowledge skills
and judgments
• The
agenda and the supplementary materials should be prepared by the secretary and
furnished to the committee members, well in advance
• Members
can study them preparing when and before meeting
Functions
• To
serve in an advisory capacity to the medical staff and hospital administration
in all issues pertaining to the use of drugs
• To
develop formulae of drugs accepted for
use in the
hospital and provide for its constant revision
• The
committee should minimize the duplication of some basic type of drug entity
(or) drug products
• To establish programmers and procedures that
helps to ensure cost of effective drug therapy
• To
establish a plan of suitable educational programs for the hospital professional
staff
• To
participate in quality assurance activities, related to the distribution,
administration and use of medications
• To
review ADR occurring in hospitals
• To
initiate (or) direct, drug use review programs and studies and to review the
results of such activities
Composition of Pharmacy and Therapeutic Committee:
The composition might vary from hospital to hospitals, it is
composed of:
1) At least 3 physicians from the medical staff
2) A pharmacist
3) A representative of the nursing staff
4) A hospital administrator
The pharmacist functions usually as the secretary of
committee
Guidelines
• The
hospital must employ a qualified, at least, a registered pharmacist, which at
least B.Pharm degree as the chief pharmacist
• The
hospital must provide adequate safe, work space and storage facilities for the
pharmacy
• The
pharmacy should have equipment necessary to safely and adequately carry out the
modern practice of pharmacy
• The
hospital must have an automatic stop order regulation for dangerous drugs
• Eg.narcotics,
hypnotics anti-coagulant etc
• The
hospital should have the firm policy regarding the use of research drug, in the
hospital and its clinics
• The
hospital should have a drug formulary, which as to be periodically revised and
kept updated
• The
external use of preparations should be separated from internal use of medication in the pharmacy and in
wards
• The
pharmacy manufactured products for patients use if any must have adequate
quality control measures and follow good manufacturing practices; during the processing
and also in the final products
• The
hospital should provide (or) to the chief pharmacist sufficient help to permit
him/her to engage in a teaching programme
• The
nursing drug statistics should be periodically inspected for the purpose of
removing deteriorated and out dated drugs as well as to check all labels for
legibility
• The
pharmacy should have an adequate reference library’s
• The
poisons and poisons materials should be adequately separated from non-poisons
materials in the pharmacy and in wards etc
Role of PTC in Adverse Drug Reactions Monitoring
Programme
- The
PTC must assign the responsibility for developing and initiating a
procedure for the purpose of committee - An ‘Adverse
drug reaction’ is defined as any unusual of unexpected harmful
reaction including acute prolonging by narcotics, barbiturates and
amphetamines as well as industrial poisonings
Automatic Stop Orders for Dangerous Drugs
• All
drug orders for narcotics sedatives, hypnotic, anticoagulants and antibiotics
shall be automatically discontinued after 48 hrs
• Unless
the order indicates an except number of doses to be administered, or the attending
physician; reorder the medication
• All
orders for narcotics, sedatives and hypnotics must be re/written every 24 hours
Role of PTC in Developing Emergency Drug Lists
• Since
time factor is of every great urgency to most true emergency situations, it is
absolutely necessary for the pharmacy and therapeutic committee of a hospital
to get prepared
• Boxes
containing emergency drugs which should be always available ready for use at
the bedside
• List
of such drugs and other supplies should be complied by the committee and it
should find their place in ‘emergency kits’
Supplies to be maintained by Emergency Box
• Syringes
of various range two each of 1ml ie.tubercelin (or) insulin syringe; 2ml
syringe and 5ml syringe, and one each of 10 ml and 20 ml syringe
• Needless,
preferably two each of 16;18’;20’;21’;23’; and
26’
• Files
for breaking, the ampoule, torniques
• Airway Equipment
Supplies for Cabinet Utility Room:
[I] Venous cannulation set
[ii] Each set 12 and venous catheters
[iii] Pieces 6” shock blocks
[iv] Oxygen catheters
[ v] Sterile suction catheters
[vi] Razor with blades
[vii] Package sterile gelatin sponge
Formulary
Management
• Formulary
Definition: a
continually revised compilation of pharmaceuticals that reflects the clinical
judgment of the medical staff
Theory: a well-designed
formulary can guide physicians to prescribe the safest and most effective
agents for treatment of a particular condition
• Principles
– Drug
product selection
• Comparison
of all aspects of an agent to that of similar medications
• Should
be based on scientific evidence
• Consider
effectiveness, safety and cost
– Formulary
Maintenance
• Addition/deletion
• Newly
approved agents
• New
information available (i.e. safety, efficacy)
• Tracking
use of non-formulary agents
• Single
drug review
• Compare
single drug to other drugs that are similar
• Focus
is on a single drug
• Objectives
– Decrease
drug cost
– Assure
high quality care
– Provide
information on drug products
– Provide
information on organizational policies/procedures
– Development
of institution specific guidelines/protocols
• Purpose for ongoing management
– Removal/addition
of drugs from/to the market
– Changes
in hospital policies/procedures
– New
clinical information available
• Clinical
trials
• Guidelines
• Safety
• Advantages
– Ensure
quality and appropriateness of drug use
– Educational
for staff regarding most effective agents
– Economic
benefits
• Disadvantages
– Only
reduces cost
– Compromises
patient care
– Limits
physician prescribing authority
Summary
• Hospital
Pharmacy is managed under the direction of a professionally qualified
pharmacist, where drugs and medicines are purchased, stored and dispensed to
outpatients and inpatients
• One of the mode (or) methods of ensuing the
proper rationality in the use of drugs is that the hospital organize and
constitute ‘The pharmacy and Therapeutic Committee’
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