Role of hospital pharmacy and its relationship with other department

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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