Hospital Pharmacy. | Questions with answers |

             Hospital Pharmacy

The hospital is a complex organization utilizing combination of sophisticated, specialized scientific equipment, and functioning through a group of trained people educated to the problem of modern medical science. These are all linked together in the common purpose of restoration and maintenance of good health.

 

Hospital Pharmacy

The department or service in a hospital which is under the supervision of a professionally competent, legally qualified pharmacist, and from which all medications are supplied to the nursing units and other services, where special prescriptions are filled for patients in the hospital, where prescriptions are filled for ambulatory patients and out-patients, where pharmaceuticals are manufactured in bulk, where narcotic and other prescribed drugs are dispensed, where injectable preparations should be prepared and sterilized, and where professional supplies are often stocked and dispensed.

 

Difference between In-Patient and Out-Patients

Out-patients means that the procedure does not require hospital admission and may also be performed outside the hospital premises.

In-patients means that the procedure require hospital admission and cannot be performed outside the hospital premises.

 

Parts of Prescription

•      • Inscription

•      • Praepositiom

•      • Prescription

•      • Subscription

•      • Signaturare

•      • Nomen Medicine

•      • Nomen Aegroti

 

Filling of Prescription

Filling of prescription means the act of dispensing medicines according to the given prescription.

 

Name any two injectable preparation

•      Ceftriaxone Sodium – Oxidil® – Sami Pharmaceuticals

•      Dimenhydrinate injection – Gravinate ® - Searle Pakistan

Specialized Prescription

Specialized prescription is that prescription that includes some specialized drugs such as anti- psychotic, narcotics, and hypnotis.

 

Various duties of Hospital Pharmacist

•      Consulting

•      Selection of drug for Hospital Formulary

•      Drug information

•      Medication Review

•      Attending Rounds

•      Research and Development

•      Pharmacoeconomical Studies

•      Teaching and Training to Staff and Nurse

•      Patient Education

•      Inventory Management

•      Prescription filling

•      Insuring Safe use of drug

•      Drug Dose Calculations

 

Goals of Hospital Pharmacy (Any Three)

•      To provide the benefits of a qualified hospital pharmacist to patients and health care institutions, to the allied health professions, and to the profession of pharmacy.

•      To assure a high quality of professional practice through the establishment and maintenance of standards of professional ethics, education, and attainments and through the promotion of economic welfare.

•      To promote research in hospital pharmacy practices and in the pharmaceutical sciences in general.

•      To disseminate pharmaceutical knowledge by providing for interchange of information among hospital pharmacists and with members of allied specialties and professions.

 

Generalized Hospital

These hospitals offer treatment for common diseases. The main objective of General Hospital is to provide medical care, whereas teaching is secondary.

•      Jinnah Hospital – Usmani Road, Lahore

•      Lahore General Hospital – Ferozpur Road

 

 

Specialized Hospital

These hospitals concentrate on giving medical and nursing care in a specific area, e.g., ophthalmic hospital (deals with eye related problems), orthopaedic hospital (deals with bone related problems), cardiac hospital (deals with heart related problems), etc.

Examples,

Cardiac

•      Punjab Institute of Cardiology – Jail Road, Lahore

•      Lahore heart and Chest Hospital – Gulberg Lahore

Cancer

•       Shaukat Khanum Memorial Cancer Hospital & Research Centre - R-3,، M.A. Johar Town، Lahore

•       INMOL Cancer Hospital – Wahdat Road, Lahore

Orthopedic

•       Suraya Azeem (Waqf) Hospital – Chowburji CHowk Lahore

•       Ghurki Trust Teaching Hospital – Barki Road, Lahore

Ophthalmic

•       Mughal Eye Hospital – Ali Ibn-e-Talib Road, Lahore

•       Chaudary Rehmat Ali Hospital– Chaudary Rehmat Ali Road, Lahore

 

Isolated Hospitals

This is a hospital in which clients requiring isolation or clients suffering from communicable diseases are taken care of.

•      Punjab Institute of Mental Health, Jail Road, Lahore, Pakistan

•       Lahore Psychiatric Hospital, Multan Road Lahore.

 

Difference between Teaching and Non-Teaching Hospital

A teaching hospital is a hospital or medical center that provides clinical education and training to future and current health professionals.

Examples

 

Mayo Hospital	King Edward Medicial College
Jinnah Hospital	Allama Iqbal Medical College
Services Hospital	Services Institute of Medical Services
Sir Ganga Ram Hospital	Fatima Jinnah Medical College
Combined Military Hospital	CMH Lahore Medical College
Sharif Medical City Hospital	Sharif Medicial and Dental College
Fatima Memorial Hospital	FMH College of Medicine and Dentistry
Shalimar Hospital	Shalimar Medical and Dental College
Avicenna Medical Hospital	Avicenna Medical College
Akthar Saeed Trust Hospital	Akhtar Saeed M&D College

 

A non-teaching hospital is a hospital or medical center that does not provides clinical education and training to future and current health professionals.

•      Defence National Hospital

•      Aadil Hospital

•      Fauji Foundation Hospital

•      Shaukat Khanum Memorial Cancer Hospital & Research Centre

•      INMOL Cancer Hopsital

•      Punjab Institute of Cardiology

•      Doctor’s Hospital

•      Mughal Eye Hospital

•      Suraya Azeem (Waqf) Hospital

•      Farooq Hospital

 

 

Rural Hospital in Lahore

·         DHQ Hospital, Kasur

·         DHQ Hospital, Sheikhupura

·         Municipal District Hospital, Kasur

Hospital o the basis of Numbers of Beds

•      Small – less than 200

•      Medium – 200-500

•      Large – 500+

 

Minimum Standard for Hospital Pharmacy

•      Administration

•      Facilities

•      Drug Distribution, Inventory Management and Control

•      Drug Information

•      Assuring Rational Drug Management

•      Research

 

Organizational Hierarchy for Hospital Pharmacy Setup

•      Director/ Chairman

•      Vice President

•      Manager Pharmacy

•      In Patient Pharmacy (Senior/Experience Pharmacist)

•      Graduate Pharmacist

•      Trainee Graduate Pharmacist

•      Qualified Personnel for Management

•      Delivery Boys

 

 

Facilities required for Hospital Pharmacy Setup

1.      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.

2.      Space and equipment, in an amount and type to provide secure, environmentally controlled storage of drugs, shall be available.

3.      There shall be designated space and equipment suitable for the preparation of sterile products and other drug compounding and packaging operations.

4.      The pharmacy should have a private area for pharmacist-patient consultations . The director of pharmaceutical services should also have a private office or area.

5.      Current drug information resources must be available. These should include appropriate pharmacy and medical journals and texts and drug literature search and retrieval resources.

 

Software for Inventory Management System (Any 2)

•      Abu-Zar

•      Buraq

•      Inflow

 

Inventory Management

Inventory Management is a science primarily about specifying the shape and percentage of stocked goods. It is required at different locations with a facility or within many locations off a supply network to precede the regular and planned course of production and stock of material.

 

Drug Information Center

Drug Information Center is a center of Pharmacy, under the supervision of Pharmacist, responsible for providing the institution's staff and patients with accurate, comprehensive information about drugs and their use.

 

Assuring Rational Drug Therapy

The pharmacist, in concert with the medical staff, must develop policies and procedures for assuring the quality of drug therapy. Such as:

 

Use of Clinical Guidance

•      Development and Use of National Essential Medicine List

•      Establishment of Drug and Therapeutics Committee

•      Supervision

•      Audit

•      Feedback

•      Public Education on Medicine

•      Avoidance of Preserve Financial incentives

Types of Research Activities that can be performed by Pharmacist

•      The pharmacist should initiate, participate in, and support clinical and practice-related research appropriate to the goals, objectives, and resources of the specific hospital.

•      Policies and Procedure for Conducting Research Activity

•      The pharmacist shall ensure that policies and procedures for the safe and proper use of investigational drugs and medication-related devices are established and followed and that these policies and procedures meet all applicable laws and regulations.

•      There shall be a procedure to assure that informed consent is obtained from the patient before the first dose of the study drug is administered.

 

Drug Procurements

Drug Procurement is the act of acquiring, buying drugs or goods, services or works from an external source related to drug.

 

Investigational Drugs

Investigational drugs shall be approved for use by an institutional review board and shall be dispensed and administered to consenting patients according to an approved protocol.

 

Institutional Review Board (IRB)

An institutional review board (IRB), is a committee that has been formally designated to approve, monitor, and review biomedical and behavioral research involving humans.

 

Responsible for disseminating the information regarding investigational drugs

The project tackling pharmacist will be responsilble for disseminating the information regarding investigational drugs.

 

Pharmacy and Therapeutic Committee

The pharmacy and therapeutics committee is an advisory group of the medical staff and serves as the organizational line of communication between the medical staff and pharmacy department.

 

Members of P&TC

•      Physicians

•      Pharmacists

•      Nurses

•      Administrators

•      Quality assurance coordinators

•      Epidemiologists/specialists

•      Ethicists

Functions of P&TC

•      to service in advisory capacity in all matters pertaining to the use of drugs

•      to develop formulary of drugs accepted for use in hospital and provide its constant revision

•      to establish programs and procedures to help ensure cost effective drug therapy

•      to establish and plan suitable educational, programs for hospital’s professional staff related to drug use

•      to participate in quality assurance activities related to distribution, administration and use of medications

•      to review adverse drug reactions

•      to initiate drug-use review programs and studies and review results of such activities

•      to advice the pharmacy in implementation of effective drug distribution and control procedures

•      to make recommendations concerning drugs to be stocked in hospital patient-care areas.

 

Organizational Hierarchy of P&TC

The pharmacy and therapeutics committee should be composed of at least three physicians, a pharmacist, a nurse, and an administrator. Committee members are appointed by a governing unit or elected official of the organized medical staff.

A chairman from among the physician representatives should be appointed. A pharmacist usually is designated as secretary.

 

Advisory Role of P&TC

The committee recommends the adoption of, or assists in the formulation of, policies regarding evaluation, selection, and therapeutic use of drugs in hospitals

 

Educational Role of P&TC

The committee recommends or assists in the formulation of programs designed to meet the needs of the professional staff (physicians, nurses, pharmacists, and other health-care practitioners) for complete current knowledge on matters related to drugs and drug use.

 

Formulary

It is continually revised list of medicines approved for use in the healthcare system by authorized prescribers.

 

Need of Hospital Formulary System

·         It ensure the quality drug use.

·         Controlling its cost.

·         It provides for the procuring, prescribing, dispensing and administering of drugs.

·         It has only those drugs that are considered most safe and useful in patient care.

Benefits of Hospital Formulary

·         Therapeutic

·         Economic

·         Educational

 

Standard Format of Hospital Formulary

A typical formulary must have the following composition:

·         Title page

·         Names and titles of the members of the pharmacy and therapeutic committee

·         Table of contents

·         Products accepted for the use at hospital

·         Appendix

 

Flow chart for Addition or Deletion of Medicine from Hospital Formulary

Major criteria for Selection of Any Drug for Hospital Formulary

·         Disease patterns

·         Efficacy and effectiveness

·         Safety

·         Quality

·         Cost and cost effectiveness

·         Well known medicines

·         Expertise to manage the medicine

Purpose of Compiling Patient Medical Record

Documentation in the medical records provides evidence of appropriate care. If a procedure is not documented, it is considered not done.

 

Contents of Patient Record Form

·         Patient registration number

·         Date

·         Name

·         Age

·         Sex

·         Address

·         Occupation

·         Past medical history

·         Chief complaint

·         Guess diagnosis

·         Allergies

·         Lab testing

·         Final diagnosis

·         Treatment

 

Preparation and Maintain Patient Records

·         Initial interview

·         Documenting patient statement

·         Completing medical history forms

·         Documenting test results

·         Examination, preparation and vital signs

·         Follow-ups

 

Common Approaches or Documentation of Information in Medical Records

1.      Source oriented medical records:

·         Conventional approach

·         Information is arranged according to who suppied the data

·         Problems and treatment are on the same form

·         Difficult to track the progress of specific events

2.      Problem oriented medical records:

·         It makes it easier to track progress of specific illness

·         Information include:

I.              Database

II.              Problem list

III.               Educational ,diagnostic and treatment plans

IV.               Progress note

 

Needs for Neatness, Timeliness, Accuracy and Professional tone in Medical Records

It makes the medical record legible and correct timeliness enables to retrieve the document on time in emergency situation. Accuracy is important for patient safety in medication use.

 

Correction of Mistake in Patient Record

•      When mistakes happen, correct them immediately

o   Draw a line through the original information

 It must remain legible

• 

•      Document why correction was made

•      Date, time, and initial correction

•      Have a witness, if possible

 

 

Conditions in which Medical Record is released

Medical records are considered highly confidential because of the very private, personal information they contain. With some exceptions, health care providers will release a copy of your records to others only with your written permission. Records are released to:

•      Health care workers who have a need for the records to care for a patient.

•      Qualified people or organizations that perform services such as data processing, medical record transcription, administrative functions, or other such related services and for approved research and education functions.

•      Certain government authorities, to investigate or regulate health related issues such as child abuse, communicable diseases, and prescription drugs.

Patient Record as Legal Document

Patient record is a legal document admissible in court as it is documented to provide an evidence of appropriate care and it provides complete information about patient care.

 

Patient Record as proof of Event or Procedure

Documentation in the medical record provides evidence of appropriate care. If a procedure is not documented, it is considered not done. Complete, accurate, and well-documented records are evidence of appropriate care

 

Importance of Patient Records

Patient records play an important role in patient education through test results, providing information on health issues, and treatment instructions to the patient. In research patient record serve as a source of data and in quality of treatment patient record provides peer review and helps in health care analysis and policy decisions.

 

Inform Consent

Inform consent forms verify that the patient understands procedures, outcomes, and options regarding a specific medical intervention. Patient may withdraw consent at any time.

 

 

Hospital Discharge Summary Forms

Hospital discharge summary forms include Information summarizing the patient’s hospitalization, Instructions for follow-up care, Physician signature.

 

Initiating and maintaining patient record through initial interview

•      Initiating and maintaining patient record through initial interview includes:

•      Completing medical history forms.

•      Examination, preparation, and vital signs.

•      Documenting test results.

•      Documenting patient statements.

•      Maintaining patient privacy during interview.

 

The six C’s of charting are

1.      Client’s words

2.      Conciseness

3.      Clarity

4.      Chronological order

5.      Completeness

6.      Confidentiality

Types of Medical Records

Source-Oriented Medical Records	Problem Oriented Medical Records
Conventional approach Information is arranged according to who supplied the data Problems and treatments are on the same form Difficult to track progress of specific events	POMR records make it easier to track specific illnesses Information included Database Problem list Educational, diagnostic, and treatment plans Progress notes

 

SOAP Note

It is an orderly series of steps for dealing with any medical case

•      Subjective data: Information the patient tells you.

•      Objective data: What the physician observes during the examination.

•      Assessment: The impression of the patient’s problem that leads to diagnosis.

•      Plan: The treatment plan to correct the illness or problem.

 

 

Temperature Zone

Product	Storage temperature
Refrigerated vaccines	+2°C to +8°C
Frozen vaccines	15°C to -50°C
Whole Blood, Red Blood Cells	1 to 6  ̊
Plasma, Cryoprecipitated AHF	-18 ̊C or colder
Platelets	20 to 24  ̊
Granulocytes	20 to 24  ̊
Total Parenteral Nutrition	36 to 46 ̊F

 

 

Chief Pharmacist at Hospitals

•        Imran Malick – DOW UNIVERSITY HOSPITAL

•        Abdul Haleem – Jinnah Hospital, Lahore

 

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