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Chapter 9
Hospital Pharmacy
Practice
HOSPITAL PHARMACY
SERVICES
• Inpatient Drug Distribution Systems:
Hospital pharmacies carry out a number of unique
activities such as unit dose drug distribution
system, repackaging, floor stock, and an IV
admixture/TPN service. Also, a unit dose drug
distribution system saves money and reduces the
chance of medication errors.
Functions of a Hospital
1. Diagnosis and testing
Multiple roles some we take for
granted
Table 9.1
Edited by Dr. Ryan Lambert-Bellacov
Functions of a Hospital
2. Treatment and therapy
Table 9.1
Functions of a Hospital
3. Public processing (including
admissions, record keeping, billing,
and planning for post-release patient
care)
Table 9.1
Functions of a Hospital
4. Public health education and
promotion, done through a variety of
programs, including smoking
cessation programs, weight loss
programs, support group programs,
and screening of community
members (including mammographies
and testing of blood pressure and
cholesterol)
Table 9.1
Functions of a Hospital
5. Teaching (i.e., training health
professionals)
Table 9.1
Functions of a Hospital
6. Research (i.e., carrying out
programs that add to the sum of
medical knowledge)
Table 9.1
Hospital Pharmacy Issues
Safety Note!
• Only unopened unit doses can be returned
to stock.
Hospital Pharmacy Services
Services Similar to Community Pharmacy Services
1. Maintaining drug treatment
records
Lots of similar aspects!!!
Table 9.2
Edited by Dr. Ryan Lambert-Bellacov
Hospital Pharmacy Services
Services Similar to Community Pharmacy Services
2. Ordering and stocking medications
and medical supplies
Table 9.2
Hospital Pharmacy Services
Services Similar to Community Pharmacy Services
3. Repackaging medications
Table 9.2
Edited by Dr. Ryan Lambert-Bellacov
Hospital Pharmacy Services
Services Similar to Community Pharmacy Services
4. Dispensing medications
Table 9.2
Hospital Pharmacy Services
Services Similar to Community Pharmacy Services
5. Providing information about the
proper use of medications
Table 9.2
Edited by Dr. Ryan Lambert-Bellacov
Hospital Pharmacy Services
Services Similar to Community Pharmacy Services
6. Collecting and evaluating
information about adverse drug
reactions and interactions
Table 9.2
Edited by Dr. Ryan Lambert-Bellacov
Hospital Pharmacy Services
Services Similar to Community Pharmacy Services
7. Preparing medications in various
dose forms for dispensing
Table 9.2
Edited by Dr. Ryan Lambert-Bellacov
Hospital Pharmacy Services
Services Similar to Community Pharmacy Services
8. Educating and counseling patients
about their drug therapies
Table 9.2
Edited by Dr. Ryan Lambert-Bellacov
Hospital Pharmacy Services
Services Similar to Community Pharmacy Services
9. Preventing, identifying, and
resolving medication-related
problems
Table 9.2
Edited by Dr. Ryan Lambert-Bellacov
Hospital Pharmacy Services
Services Provided by a Hospital Pharmacy
1. Preparing and maintaining a
formulary
This is where the differences start to
diverge.
Table 9.2
Edited by Dr. Ryan Lambert-Bellacov
Hospital Pharmacy Services
Services Provided by a Hospital Pharmacy
2. Conducting drug use evaluations
Especially state hospitals
Table 9.2
Hospital Pharmacy Services
Services Provided by a Hospital Pharmacy
3. Following universal precautions
More diseases
Table 9.2
Hospital Pharmacy Services
Services Provided by a Hospital Pharmacy
4. Preparing products using aseptic
techniques
So sterile
Table 9.2
Edited by Dr. Ryan Lambert-Bellacov
Hospital Pharmacy Services
Services Provided by a Hospital Pharmacy
5. Ensuring that hazardous agents are
handled and disposed of properly
Table 9.2
Edited by Dr. Ryan Lambert-Bellacov
Hospital Pharmacy Services
Services Provided by a Hospital Pharmacy
6. Filling medication orders (as
opposed to prescriptions)
Table 9.2
Edited by Dr. Ryan Lambert-Bellacov
Hospital Pharmacy Services
Services Provided by a Hospital Pharmacy
7. Routinely preparing 24-hour
supplies of patient medications in a
form appropriate for a single
administration to a patient (as
opposed to a 30- or 90-day supply)
Table 9.2
Hospital Pharmacy Services
Services Provided by a Hospital Pharmacy
8. Stocking nursing stations with
medications and supplies
Table 9.2
Edited by Dr. Ryan Lambert-Bellacov
Hospital Pharmacy Services
Services Provided by a Hospital Pharmacy
9. Delivering medications to patients’
rooms
Table 9.2
Edited by Dr. Ryan Lambert-Bellacov
Hospital Pharmacy Services
Services Provided by a Hospital Pharmacy
10. Maintaining a drug information
service, and providing drug
information to the other healthcare
professionals in the institution
Table 9.2
Hospital Pharmacy Services
Services Provided by a Hospital Pharmacy
11. Educating and counseling
inpatients and outpatients about their
drug therapies
Table 9.2
Edited by Dr. Ryan Lambert-Bellacov
Hospital Pharmacy Services
Services Provided by a Hospital Pharmacy
12. Monitoring patient outcomes
Like ICU
Table 9.2
Hospital Pharmacy Services
Services Provided by a Hospital Pharmacy
13. Preventing, identifying, and
resolving medication-related
problems
Table 9.2
Edited by Dr. Ryan Lambert-Bellacov
Hospital Pharmacy Services
Services Provided by a Hospital Pharmacy
14. Participating in clinical drug
investigations and research
Table 9.2
Edited by Dr. Ryan Lambert-Bellacov
Hospital Pharmacy Services
Services Provided by a Hospital Pharmacy
15. Providing in-service drug-related
education
Table 9.2
Edited by Dr. Ryan Lambert-Bellacov
Hospital Pharmacy Services
Services Provided by a Hospital Pharmacy
16. Reviewing or auditing
prescription services for evaluation of
service accuracy and quality
Table 9.2
Edited by Dr. Ryan Lambert-Bellacov
Hospital Pharmacy Services
Services Provided by a Hospital Pharmacy
17. Providing expert consultations in
such areas as pediatric pharmacology,
nutritional support, and
pharmacokinetics
Table 9.2
Edited by Dr. Ryan Lambert-Bellacov
Hospital Pharmacy Issues
Safety Note!
• As in the community pharmacy, in the
hospital pharmacy the technician works
under the direct supervision of the
pharmacist.
Figure
9.1
Figure 9.2
Figure
9.3
HOSPITAL PHARMACY
SERVICES
• Clinical Services: Many hospitals offer clinical
and consultative services such as nutrition support,
pharmacokinetics, critical care, and other specialties.
• Drug Information Services: Most hospitals
have a drug information service that is primarily
responsible for making recommendations on a drug
formulary. A hospital pharmacy may maintain a drug
information center, containing reference works,
including books, periodicals, microfilm, CDs, DVDs,
and access to computerized or Internet databases.
HOSPITAL PHARMACY
SERVICES
• Outpatient Pharmacy Services: Many
large hospitals operate an outpatient
pharmacy to serve the medication needs of
patients discharged from the hospital, as
well as for those patients who are seen in
the emergency room or other ambulatory
clinics adjoining the hospital.
AUTOMATION IN THE
HOSPITAL PHARMACY
Technology is used in the hospital pharmacy to
increase accuracy and improve efficiency and
quality of pharmacy services. Automated
pharmacy services are replacing some of the
routine, time-consuming filling procedures.
For instance, large automated robots are now
being used to perform some of the filling
procedures with near 100% accuracy
Hospital Pharmacy Issues
Safety Note!
• All computer systems must protect patient
privacy.
Hospital Pharmacy Issues
Safety Note!
• Although automation reduces errors,
technical errors must still be monitored.
Hospital Pharmacy Issues
Safety Note!
• Expiration dates must be included on all
repackaged medications.
INVENTORY MANAGEMENT
An important part of the technician’s position is
the receipt, storage, and ordering of
pharmaceuticals; discrepancies in the order
from the wholesaler or pharmaceutical
manufacturer should be resolved. Automation
from the pharmacy wholesalers is making
inventory management more accurate and less
costly.
ORGANIZATION OF THE
HOSPITAL
• Pharmacy Administration: The director of
pharmacy is the pharmacist-in-charge, with overall
responsibility for the hospital’s pharmacy services.
Depending on the hospital size, additional
assistant or associate directors may work under the
director. In small rural hospitals, only one or two
pharmacists may make up the pharmacy staff.
ORGANIZATION OF THE
HOSPITAL
• Joint Commission on Accreditation of
Healthcare Organizations: The JCAHO is
an independent, non-profit group that sets the
standards by which quality of healthcare is
measured. The primary mission of JCAHO is to
ensure quality care and patient safety in the
hospitals that are accredited. They evaluate levels
of safety and the quality of care in more than
15,000 healthcare organizations.
Hospital Pharmacy Issues
Safety Note!
• Almost 50% of JCAHO standards relate
directly to safety.
ORGANIZATION OF THE
HOSPITAL
• Pharmacy and Therapeutics Committee:
The P&T committee is primarily responsible for
making the final decision on drug formulary
decisions.
• Infection Control Committee: The major
role of the infection control committee (ICC) is
the prevention of nosocomial infections in the
hospital. Universal precautions are used to
prevent infection when a hospital worker comes
into contact with blood or other bodily fluids.
ORGANIZATION OF THE
HOSPITAL
• Institutional Review Board: The IRB is
responsible for protecting the patient in
investigational studies undertaken in the
hospital.
Universal Precaution Guidelines
1. Universal precautions apply to all
persons within the hospital.
Table 9.3
Universal Precaution Guidelines
2. Universal precautions apply to all
contact or potential contact with
blood, other bodily fluids, or body
substances.
Table 9.3
Universal Precaution Guidelines
3. Disposable latex gloves must be
worn when contact with blood or
other bodily fluids is anticipated or
possible.
Table 9.3
Universal Precaution Guidelines
4. Hands must be washed thoroughly
after removing the latex gloves.
Table 9.3
Universal Precaution Guidelines
5. Blood-soaked or contaminated
materials, such as gloves, towels, or
bandages, must be disposed of in a
wastebasket lined with a plastic bag.
Table 9.3
Universal Precaution Guidelines
6. Properly trained custodial
personnel must be called if cleanup or
removal of contaminated waste is
necessary.
Table 9.3
Universal Precaution Guidelines
7. Contaminated materials such as
needles, syringes, swabs, and
catheters must be placed into red
plastic containers labeled for disposal
of biohazardous materials. Proper
institutional procedures generally
involve incineration.
Table 9.3
Universal Precaution Guidelines
8. A first-aid kit must be kept on hand
in any area in which contact with
blood or other bodily fluids is
possible. The kit should contain, at
minimum, the following items:
• adhesive bandages for covering small
wounds
Table 9.3
Universal Precaution Guidelines
• alcohol
• antiseptic/disinfectant
• bottle of bleach, which will be diluted
at time of use to create a solution
containing 1 part bleach to 10 parts
water, for use in cleaning up blood spills
• box of disposable latex gloves
• disposable towels
Table 9.3
Universal Precaution Guidelines
• medical tape
• plastic bag or container for
contaminated waste disposal
• sterile gauze for covering large wounds
Table 9.3
Edited by Dr. Ryan Lambert-Bellacov
Discussion
a.
Communicating in the hospital setting often means
working with a wide variety of other healthcare
providers. Understanding what role they play in
the patients’ healthcare is essential to effective
communication. What duties do each of the
following have?
g. social services aide or
primary care physician
b.
anesthesiologist
c.
registered nurse
d.
practical nurse
e.
nurse’s aide
f.
housekeeping aide
worker
h.
respiratory therapist
i.
phlebotomist
j.
medical lab technician
k.
pharmacist
l.
pharmacy technician
Discussion
Write out a complete description, not
using abbreviations, of the
medication orders given in Figure 9.2
and Figure 9.3.
Edited by Dr. Ryan Lambert-Bellacov