Introduction to Hospital Pharmacy

PharmD
Pharmacy Practice-IVA (Hospital Pharmacy)
Dr. Syed Saad Hussain
 Content

• Introduction to Hospital Pharmacy

• Role of Pharmacist in Hospital

• Minimum standards for pharmacies in Institutions/Hospitals

• Research in Hospital Pharmacy

 Hospital Pharmacy

• Hospital pharmacy is one of the most important department among several

departments of a hospital.
• Hospital pharmacy may be defined as that department of the hospital
which deals with procurement, storage, compounding, dispensing,
manufacturing, testing, packaging and distribution of drugs.
• It is also concerned with education and research in pharmaceutical services.
A hospital pharmacy is controlled by a professionally competent and a
qualified pharmacist.
 Historical Background

• 1752 Pennsylania hospital

Pakistan
• Professional recognition
1999
Pharmaceutical project
• 1940 ASHP Pharmacist Hierarchy
P & TC
• AJHP
 Objectives of Hospital Pharmacy

• To ensure the availability of right medication, at right time, in the right dose at
the minimum possible cost.
• To professionalize the functioning of pharmaceutical services in a hospital.
• To act as a counseling department for medical staff, nurses and for patient.
• To act as a data bank on drug utilization.
• To participate in research projects.
• To implement decisions of the pharmacy and therapeutics committee.
• To co-ordinate and co-operate with other departments of a hospital.
• To plan, organize and implement pharmacy policy procedures in keeping with es
tablished policies of the hospitals.
 Functions of Hospital Pharmacy

• To provide & evaluate pharmaceutical services and thereby supporting the

medical staff, with due consideration of the objectives and policies of the
hospital.
• To draw a plan for hospital administration and to evolve responsibilities of
each category of personal involving pharmaceutical services like assistant
pharmacist, storekeeper, nursing staff etc.
• To establish liasion between administrative authorities and medical doctors
who will order medicines and ancillary products in the hospital.
• To estimate the requirements of the department and enforce the policies and
procedures of the recruitment of adequate and competent staff.
 Functions of Hospital Pharmacy
• To develop and maintain an effective system of clinical and administrative records
and reports.
• To participate in and adhere to the financial plan of the operation for the hospital.
• To estimate the needs for facilities, supplies and equipment and to see that there is
proper control of inventory, stocks, dispensing and manufacturing of the
medicaments (if carried out in hospital).
• To initiate, utilize and participate in research projects designed for the improvement
of a patient care and of other administrative and hospital services.
• To participate and adhere to the safety programs of the hospital.
• To participate and/or facilities all educational programmes which include student
experiences in the department.
Functions of Hospital Pharmacy
 Roles & responsibilities of a
Hospital Pharmacist
• Dispensing/supply of drugs
• Promotion of rational drug use
• Patient counselling
• Health promotion
• Improving medication adherence
• Providing drug information
• Managing pharmacy store
 Roles & responsibilities (Contd)
A. Pharmacists role in dispensing/supply of drugs
• One of the most important duties provided by the hospital pharmacist is the
dispensing of drugs after due verification of the prescription.
• Patient confidentiality shall be maintained at all times.
• Appropriate information shall be provided to the patient or the care giver and
when possible, understanding of this information should be checked.
• For all prescription handled by the pharmacy,
i. Patients details shall be checked and confirmed.
ii. Proper documentation shall be maintained.
 Roles & responsibilities (Contd)
Assessment of Prescription
i. The prescription is legally valid
ii. The prescription includes an appropriate dosage form and appropriate route of
administration.
iii. Prescription is appropriate to the patients condition.
iv. Duration of treatment is correct
v. Prescription is compatible with other medications.
vi. Possibility of adverse drug reactions exist.
vii. Contraindications.
viii. Potential for misuse and inappropriate use of the medicines in prescription by
patient exist.
 Roles & responsibilities (Contd)
Inpatient or indoor Pharmacists Responsibilities
A. Central Dispensing Area
➢ To ensure that all drugs are stored correctly
➢ To check the accuracy of the dosages prepared especially of (a) intravenous ad
mixtures and (b) Unit doses.
➢ To keep proper records and preparation of bills, if any
➢ To co-ordinate the over all pharmaceutical needs of the “patient care” areas with
the central dispensing area.
➢ To ensure that the established policies and procedures laid down are followed.
➢ To communicate with all pharmacy staff regarding new developments in the
area.
 Roles & responsibilities (Contd)
Inpatient or indoor Pharmacists Responsibilities
➢ To maintain professional competence- Keep update with information regarding
drugs in current use in the hospital, with special reference to their side effects, d
rug interactions, therapeutic efficacy etc., as well as their incompatibilities and s
tability.
B. Patient Care Areas (Wards, Operation Theatres and other departments of
the hospital where drug of special categories are used)
➢ To maintain a liasion with nurses who are involved in the drug administration.
➢ Reviewing of drug administration in each patient periodically to ensure that all
doses are being administered and charted accordingly.
 Roles & responsibilities (Contd)
B. Pharmacists role for promotion of rational drug use

• To promote rational use of drugs, the pharmacist shall involve himself in

activities such as:
i. Preparation of formularies
ii. Critical assessment of promotional materials prepared by the drug
companies.
iii. Updating the knowledge of drugs through continuing education
programmes and also to organize educational programmes for health
professionals.
iv. Preparation and dissemination of patient information leaflets.
 Roles & responsibilities (Contd)
C. Pharmacists role in patient counselling
• Upon receipt of a prescription and following a review of the patients record,
a registered pharmacist shall personally initiate discussion of matters that will
enhance or optimize drug therapy with each patient or care giver of such
patient. It should include appropriate elements such as:
i. Name and description of drugs
ii. The dosage form, route of administration and duration of drug therapy.
iii. Intended use of the drug and expected action.
iv. Special directions and precautions for the drug.
v. Common side effects or interactions and therapeutic contraindications.
 Roles & responsibilities (Contd)
C. Pharmacists role in patient counselling

vi. Techniques for self monitoring drug therapy

vii. Proper storage of the drugs
viii. Actions to be taken in case of missed dose.
– Pharmacies providing patient counselling shall have regard to the following:
i. Only Registered Pharmacist are involved in counselling.
ii. Patient information leaflets are provided.
iii. Proper documentation is made.
iv. Unnecessary counselling should be avoided.
v. Facilities are provided for confidential conversation and patient confidentiality is
maintained.
 Roles & responsibilities (Contd)
D. Pharmacist role in health promotion
• The pharmacist should be involved in health promotion campaigns, on health top
ics. Pharmacists should be involved in particularly drug related-topics (alcohol
use, tobacco use, poison prevention etc).
E. Pharmacists role in improving medication adherence
• Reviewing how patients are using medications can result in suggestions for
changes in medication, dosing, or additional therapies that improve patient
adherence.
F. Pharmacists role in providing drug information
• To provide for in service education & training for pharmacists, pharmacy
students and other health care professionals
 Roles & responsibilities (Contd)
G. Pharmacist role in managing pharmacy store

• Management of the stores which include: Purchase of drugs and medicines

and other allied stores as per the recommendations of the Pharmacy and
Therapeutics Committee(PTC).
• Providing instructions for proper storage of such drugs and medicines.
Maintenance of proper records of the drugs purchased and the distribution
thereof. Storage and dispensing of narcotic and biological products.
• Supply and storage of ancillary products and articles required in the hospital.
 Minimum Standard for Hospital
Pharmacy
• Standard I: Administration
• Standard II: Facilities
• Standard III: Drug Distribution and Control
• Standard IV: Drug Information
• Standard V: Assuring Rational Drug Therapy
• Standard VI: Research
 Minimum Standards
Standard I: Administration
• The pharmaceutical service shall be directed by a professionally competent,
legally qualified pharmacist. He or she must be on the same level within the
institution's administrative structure as directors of other clinical services.
The director of pharmaceutical services is responsible for:
(1) Setting the long- and short-range goals of the pharmacy based on
developments and trends in health care and institutional pharmacy practice and
the specific needs of the institution.
(2) Developing a plan and schedule for achieving these goals.
 Minimum Standards
Standard I: Administration
(3) Supervising the implementation of the plan and the day-to-day activities
associated with it.
(4) Determining if the goals and schedule are being met and instituting corrective
actions where necessary.
• The director of pharmaceutical services, in carrying out these tasks, shall
employ an adequate number of completent and qualified personnel
 Minimum Standards
Standard II: Facilities
There shall be adequate space, equipment, and supplies for the professional and
administrative functions of the pharmacy.
• The pharmacy shall be located in an area (or areas) that facilitate (s) the
provision of services to patients. It must be integrated with the facility’s
communication and transportation systems.
• Space and equipment, in an amount and type to provide secure,
environmentally controlled storage of drugs, shall be available.
 Minimum Standards
Standard II: Facilities
• There shall be designated space and equipment suitable for the preparation of
sterile products and other drug compounding and packaging operations.
• The pharmacy should have a private area for pharmacist-patient consultations.
The director of pharmaceutical services should also have a private office or
area.
• Current drug information resources must be available. These should include
appropriate pharmacy and medical journals and texts and drug literature
search and retrieval resources.
 Minimum Standards
Standard III: Drug Distribution and Control
• The pharmacy shall be responsible for the procurement, distribution, and
control of all drugs used within the institution.
• This responsibility extends to drugs and related services provided to
ambulatory patients.
• Policies and procedures governing these functions shall be developed by the
pharmacist with input from other involved hospital staff (e.g. nurses) and
committees (pharmacy and therapeutics committee, patient-care committee,
etc.).
• Pharmacist routinely be present in all patient-care areas,
 Minimum Standards
Standard IV: Drug Information
• The pharmacy is responsible for providing the institution's staff and patients
with accurate, comprehensive information about drugs and their use and shall
serve as its center for drug information.
 Minimum Standards

Standard V: Assuring Rational Drug Therapy

An important aspect of pharmaceutical services is that of maximizing
rational drug use. In this regard, the pharmacist, in concert with the
medical staff, must develop policies and procedures for assuring the
quality of drug therapy.

Standard VI: Research

The pharmacist should conduct, participate in, and support medical and
pharmaceutical research appropriate to the goals, objectives, and resources
of the pharmacy and the institution.
Research in HospitalPharmacy
 Research Characteristics

• Research is creative and systematic work undertaken to increase the

stock of knowledge, including knowledge of humans, culture and
society, and the use of this stock of knowledge to devise new
applications.
• Neutrality
• Reliability
• Validity
• Generalization
 Research

1. Pharmaceutical

2.Operational

3. Clinical research

4. Problem Research
Research Design
 Observational studies

1. 2. 3. Cohort
Exploratory Descriptive

4. Case - 5. Cross
control sectional
 Observational studies

Exploratory research
Exploratory research is the systematic investigation of relationships
among two or more variables.

Descriptive observational study

Descriptive studies are observational studies which describe the patterns
of disease occurrence in relation to variables such as person, place and
time. They are often the first step or initial enquiry into a new topic, event,
disease or condition.
 Observational studies

Cohort research
Cohort studies are observational. This means scientists observe what
happens to a group of people without intervening. This allows researchers
to study potential risk factors for disease as they naturally occur..

Cross Sectional
Descriptive studies are observational studies which describe the patterns
of disease occurrence in relation to variables such as person, place and
time. They are often the first step or initial enquiry into a new topic, event,
disease or condition.
 Qualitative Research

Qualitative research involves collecting and analyzing non-numerical data

(e.g., text, video, or audio) to understand concepts, opinions, or experiences.
It can be used to gather in-depth insights into a problem or generate new
ideas for research.
• Usually used in optimizing policies of pharmacy working
 Systemic Reviews

A systematic review is a
summary of all of the literature
on a particular topic, that meets
pre-defined eligibility criteria.
 Experimental design

• Randomized control trials.

• In vivo

• In - vitro
 Research in Hospital Pharmacy
• Aims and Objective
1

• Methodology
2

• Observation
3.

• Conclusion
4.
Thank you