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Decentralized Pharmacy
Services
PHCL 471
Nouf Aloudah
Decentralized Pharmacy Services
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Hospital pharmacy departments are
responsible for the safe and effective use of
drugs and drug products within the
institution
Pharmacy personnel perform functions that
relate to drug distribution and drug
information in striving toward this objective
Decentralized pharmacy services have
proven over long period of time to be an
important action plan to achieve “safe and
effective use of drugs” for patients
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Decentralized Pharmacy Services
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Since the mid 1960’s, hospital pharmacy
services have evolved to meet these needs,
frequently by decentralizing operations and
staff in order to provide clinical services and
more efficient and less error prone
medication system
A decentralized pharmacy is an area located
in the patient care parts of a hospital from
which pharmacy personnel work and
provide pharmacist clinical services and drug
distribution service
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Decentralized Pharmacy Services
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Hospital pharmacies historically have been
centralized departments
A s hospital increased in size from 100-200
bed facilities to 400-500 bed institutions,
there has been a tendency to locate the
central pharmacy away from inpatient care
areas
Decentralized pharmacies have been an
effective method for bringing pharmacy
services closer to the patients and
professional staff
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Decentralized Pharmacy Services
The safe and effective use of drugs
requires clinically competent pharmacist,
system, and services to deal with all
patient care areas in cooperation with
physician and nurses
 A decentralized service component
maximize pharmacists’ communications
and contributions to the professional
staffs and the patient
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Decentralized Pharmacy Services
A completely decentralized pharmacy
staff puts pharmacists and drug close to
the end users and facilitates the provision
of necessary drugs and drug information
in an effective manner
 The rationale for providing “proactive”
pharmaceutical services is discussed today
in conjunction with the alternative
centralized and decentralized approaches
to providing these services
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Decentralized Pharmacy Services
Patient needs
 Nurse needs
 Physician needs
 And pharmacy needs
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Decentralized Pharmacy Services
Patient needs
 Hospital medication system have been
reported to have an 8-20 % medication
error rate
 Medication errors are defined as wrong
patient, wrong drug, wrong dose, wrong
route and wrong time
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Decentralized Pharmacy Services
Patient needs
 Complications in patients resulting from
drug use are
1. Adverse drug reaction, 5-30% of patients
2. Prolonged hospitalization from adverse
drug reaction
3. Drug modifying laboratory tests
4. Drug inducing blood dyspraxia
5. Drugs affecting liver function tests
6. And drug interaction and teratology
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Decentralized Pharmacy Services
Patient needs
 Medication prescribing errors with regard
to safe or effective dosage regimens,
ambiguous and incomplete orders,
inadequate laboratory test monitoring,
and misinterpretation of meaning of
serum drug level have been reported
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Decentralized Pharmacy Services
Patient needs
Pharmacist dispensing from a central pharmacy
has resulted
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in a high rate errors
Prolonged delays in receiving initial doses
Significant drug complications
Extended hospital stays
Increased expense
New drugs and drug delivery system
technologies will be more complicated and
more potent with high risks of toxicity
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Decentralized Pharmacy Services
Nursing needs
 Plays a major role in the hospital medication
system
 The nurse may order drugs from the pharmacy, prepare
and reconstitute doses for administration, administer
medications, record each drug administered, keep additional
records for the controlled drug received and administered,
and maintain drug floorstock
Without adequate pharmacy support, the nurse
would have to be knowledgeable about drug storage,
dosage forms and strengths, the effect of each drug administered,
and the safety of drugs IV administered….. As a result a
great deal of nursing time is required for
medication related activities!
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Decentralized Pharmacy Services
Nursing needs
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Generic drug names, therapeutic interchange of drug
products, variable dosage depending upon the drug’s salt
form, more dangerous drugs such as oncology agents ….
just examples of continuing area of confusion
and potential errors!
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Registered nurse shortage, high staff turnover…
make it
very difficult to maintain a consistently
experienced and a drug knowledgeable nursing
staff
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Decentralized Pharmacy Services
Nursing needs
A centralized pharmacy services frequently
leads to many unanswered drug related
questions by a busy nurse
 A decentralized pharmacy service more readily
provides the drug related activities and drug
information support to the nurse when needed
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Decentralized Pharmacy Services
Physician needs
The physician diagnoses the patient medical
problem and then prescribe a plan of therapy
 The prescribing of drugs is frequently a critical
aspect of inpatient care
 Drug complications illustrate the physician’s
need for general and specific clinical drug
information
 Pharmacist can reduce costly drug reactions
and quicken the discharge of the patient from a
hospital
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Decentralized Pharmacy Services
Physician needs
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Medical services representatives, Physician Desk Reference, journal
articles, textbooks, drug data, professional conferences are the
usual sources of physician drug information
 Theses sources are inadequate in meeting when
it relates to complex patients with multiple
healthcare problems and multiple drug regimens
 Pharmacist who practice in patient care areas
can provide clinical drug knowledge and
experience to help physician mange their
patients’ drug therapy
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Decentralized Pharmacy Services
Pharmacist needs
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In centralized pharmacy the time is devoted to
dispensing duties, professional relationship with the
nurse, physician and others are limited
In decentralized environments:
◦ the pharmacist is able to relate directly to a patent’s drug
therapy needs as a result of easy access to the patient,
nurse, physician
◦ Initial doses for new order can be provided quickly
◦ Drug information questions can be answered quickly
◦ Pharmacist can develop expertise for particular patient
areas… and more!
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Decentralized Pharmacy Services
Services And Expected Patient Benefits Of
A Decentralized Pharmacy
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Pharmacist practicing in hospitals have been
active in developing new pharmaceutical
services and systems (unit dose distribution system,
patient medication profile, drug information services, pharmacist
participating in patient care areas, clinical pharmacokinetics)
directed toward reducing the problems
associated with drug use
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Decentralized Pharmacy Services
Services And Expected Patient Benefits Of
A Decentralized Pharmacy
Characteristic of a pharmacist clinical practice
in decentralized pharmacy are:
Patient care round
Participating in teaching rounds by providing drug
information upon physician request or by
pharmacist initiation which usually result in
improving in the patient\s treatment plan
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Decentralized Pharmacy Services
Services And Expected Patient Benefits Of A
Decentralized Pharmacy
Characteristic of a pharmacist clinical practice in
decentralized pharmacy are:
Patient interviews
 Drug history information that obtained orally
 Prescription and OTC drugs, drug allergy, attitude
about drug as to which worked or did not work
 Previous patient drug therapy problems, attitude
and misconceptions as to what drugs worked or
did not work are identified
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Decentralized Pharmacy Services
Services And Expected Patient Benefits Of A
Decentralized Pharmacy
Characteristic of a pharmacist clinical practice in
decentralized pharmacy are:
Patient medication therapy monitoring
 Safe and effective drug therapy is determined by
reviewing medication charts
 Drug administered, pertinent laboratory tests, and
patient’s diagnosis and medical condition
 Changes in drug therapy, actual and potential drug
therapy problems are communicated to the
physician
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Decentralized Pharmacy Services
Services And Expected Patient Benefits Of
A Decentralized Pharmacy
Characteristic of a pharmacist clinical practice
in decentralized pharmacy are:
Physician inquiry
 Physician initiated and general drug information
questions are answered by the pharmacist
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Decentralized Pharmacy Services
Services And Expected Patient Benefits Of
A Decentralized Pharmacy
Characteristic of a pharmacist clinical practice
in decentralized pharmacy are:
Nurse Inquiry
 Nurse initiated questions about patient drug
therapy, general drug information, and drug
orders are answered by the pharmacist
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Decentralized Pharmacy Services
Services And Expected Patient Benefits Of A
Decentralized Pharmacy
Characteristic of a pharmacist clinical practice in
decentralized pharmacy are:
Drug Information
 The physician and pharmacist initiate a drug
information questions involving a patient’s drug
therapy problems requiring a search of the available
literature for information in order to provide a
response
 The answer should result in safer and more
effective drug therapy
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Decentralized Pharmacy Services
Services And Expected Patient Benefits Of
A Decentralized Pharmacy
Characteristic of a pharmacist clinical practice
in decentralized pharmacy are:
Cardiopulmonary Arrest Emergency Participation
 The pharmacist is a member of the hospital’s
cardiopulmonary resuscitation team and
participates by providing drug therapy
assistance and the needed drugs
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Decentralized Pharmacy Services
Services And Expected Patient Benefits Of
A Decentralized Pharmacy
Characteristic of a pharmacist clinical practice
in decentralized pharmacy are:
Pharmacist regulated drug therapy services
 Special services such as anticoagulation, dosing
of drugs in patients with compromised renal
status, drugs affecting the blood and liver,
amioglycoside dosing, pain control, nutrition
support, and aminophyllin therapies
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Decentralized Pharmacy Services
Services And Expected Patient Benefits Of
A Decentralized Pharmacy
Characteristic of a pharmacist clinical practice
in decentralized pharmacy are:
Clinical pharmacokinetics
 Schedules the appropriate time for drug levels
to help ensure that test results are usable.
Consultation services using the serum drug
level and kinetic knowledge can be provided to
modify the dose and/or dosing interval to
prevent toxicity and ensure therapeutic efficacy
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Decentralized Pharmacy Services
Services And Expected Patient Benefits Of A
Decentralized Pharmacy
Characteristic of a pharmacist clinical practice in
decentralized pharmacy are:
Drug usage evaluation
 Special drug case studies are conducted and
educational programs provided to the medical,
nursing, and pharmacy staff by the pharmacist
 Targeted incorrect and inappropriate drug
prescription of physician should be corrected via
educational programs
 Cost and cost reductions of drug therapy can be
defined and documented
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Decentralized Pharmacy Services
Pharmacist performance characteristics
Pharmacists who practice in a decentralized pharmacy
environment are able to greatly expand their
professional knowledge ad skills in the areas of patient
service, teaching, and research bec. Of the greater
opportunities for clinical experience
To be successful:
 Commitment to high standard patient care services
 Clinical knowledge and skills
 Commitment to lifelong learning
 Initiative; self accountability and productivity
 Specialization or concentration of time and energy into
selected areas of clinical drug use
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Decentralized Pharmacy Services
What departmental organizational plan or structure is
the most effective in providing services to meet
patient, nurse, and physical drug related needs?
Drug distribution system that maximize the use of
nonpharmacists in the inpatient drug distribution system of
the hospital
 Unit dose system are more just providing double checks,
reducing medication errors and eliminating the drug waste
seen in multiple dose systems, it allows the pharmacist to
delegate many of the nonprofessional drug distribution tasks
to technician and still maintain the necessary responsibility
and supervision, that resulted in more pharmacist time for
clinical services
 Patient drug profiles associated with unit dose system also
can provide a record that become the basis for the
pharmacist’s patient drug therapy monitoring system
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Decentralized Pharmacy Services
Advantages and disadvantages of a
decentralized pharmacy services?
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Pharmacy departments are usually referred to as
either “centralized” or “decentralized” this is
oversimplification, because most decentralized
pharmacy departments are a mix of centralized and
decentralized functions
Decentralized pharmacies frequently differ
considerably in exactly what is decentralized and
how
The way services are provided may also vary from
shift to shift, from weekday to weekend
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Decentralized Pharmacy Services
Advantages and disadvantages of a decentralized pharmacy
services?
Functions are
 New order review by the pharmacist
 First dose preparation
 Unit dose preparation of ongoing orders
 Unit dose checking by the pharmacist or trained technician
 IV order review by the pharmacist
 IV order preparation including admixture and total parenteral
nutrition
 IV piggy back (PB) order reconstitution
 IVPB order review by the pharmacist
 IVPB order distribution to the patient
 Prescription filing for discharge and special inpatients
 Unit dose packaging
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Decentralized Pharmacy Services
Advantages and disadvantages of a decentralized
pharmacy services?
Functions are (cont’)
 PK consults by the pharmacist
 Drug level order/or scheduling by the pharmacist
 Drug information questions directed to the pharmacist
 Responses to drug information questions
 Nonformulary drug request follow-up by the pharmacist
 Pharmacist –patient interviewing as needed
 Drug therapy regulation by the pharmacist
 Drug therapy monitoring by the pharmacist
 ADR monitoring by the pharmacist
 Pharmacy charge processing
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Decentralized Pharmacy Services
Advantages and disadvantages of a
decentralized pharmacy services?
These functions: some must be done by the
pharmacist, others by technician or clerk
 Some requires the pharmacist to be outside the
pharmacy
 Some nonpharmacist activities requires
immediate supervision others not
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Decentralized Pharmacy Services
Advantages and disadvantages of a
decentralized pharmacy services?
What is the scope of the pharmacy services?
What and when?
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Decentralized Pharmacy Services
Advantages of a decentralized pharmacy
services
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Drugs are immediately available for administration
to the patient
Drug control and accountability are greater
Pharmacist communicate directly to the nurse
and physician
There is more space for the pharmacy as a whole
and flexibility in reallocating or designing existing
space in the central pharmacy
Unique drug distribution systems are
implemented to issue drugs to the nurse
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Decentralized Pharmacy Services
Advantages of a decentralized pharmacy services
Pharmacist review of the chart or talk with the patient is
efficient
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Drug information from the pharmacist is readily available
to physician and nurses
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Nursing time is reduced in drug distribution bec. More
tasks are being performed by pharmacy personnel
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Pharmacist drug therapy specialization by patient care area
is accomplished more effectively as a result of focused
clinical experience
10. Specialized pharmacist clinical services can be developed
and efficiently provided
11. Pharmacists more readily perform clinical drug research
and patient drug therapy quality assessment studies
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Decentralized Pharmacy Services
disadvantages of a decentralized pharmacy services
1.
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5.
All clinical practice pharmacies must become proficient as
supervision to work effectively with technicians
Pharmacist are usually responsible for both drug
distribution and clinical services
Staffing flexibility id reduced when only one pharmacist
with or without a technician is providing all inpatient
pharmacy services for a specific patient car area when
census level are significantly above or below normal
Unrealistic expectation from nursing and physician and
excessive interruptions off the pharmacist and /or
technician can reduce efficiency
Drug inventory control within the department is more
complex because of multiple pharmacy location for the
same drug, particularity infrequently prescribed drugs
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Decentralized Pharmacy Services
disadvantages of a decentralized pharmacy services
6.
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Communications within the pharmacy department are
more difficult bec. the staff member practice in
multiple physical location
More equipment is required
Patient acuity and resulting drug distribution work
load may exceed the capacity of space and personnel
in the small decentralized pharmacy units
Use of technology to automate and mechanize the
drug distribution system component of pharmacy
service will require more hardware and software
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Decentralized Pharmacy Services
Relative cost of a decentralized and
decentralized pharmacy service
Cost is very impartment part in hospital decision
Cost is either patient benefits such as reduction
in mortality, morbidity, and hospital patient
days
Also it is the equipment, facilities, and personnel
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Decentralized Pharmacy Services
Relative cost of a decentralized and
decentralized pharmacy service
Equipment and facilities
Space, size, computer system
Personnel
Comparisons such as Centralized pharmacy
services personnel cost per patient day and
decentralized pharmacy services personnel
cost per patient day and other can help
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Decentralized Pharmacy Services
Forces that interfere with decentralized
pharmacy service
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Attitude ad behavior
Pharmacy department
Pharmacy time for information functions
Legal requirements
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Any volunteers!
Assignments
 Dermal fillers (previous lecture)
 Medication therapy management (MTM)
programs
Best Wishes!
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