Role of hospital pharmacy and its relationship with other department

Role of hospital pharmacy and its relationship with other department

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

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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