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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