Chapter

1: Institutional Pharmacy Practice o Serve the needs of patients suffering

from some particular disease, specific
Key Terms & Definitions organ, type of patient
• Accreditation – determination by an • Teaching hospital
accrediting body that an eligible health care o Serving patients’ needs & trains future
org. complies w/ the applicable standards health-care professionals
• Institutional pharmacy practice • For-profit hospital
o Includes the provisions of o Owned by corporations / grps of
distributional & clinical pharmacy private investors
services at a broad range of o Non-profit hospitals – do not seek a
institutional settings return of investment
• Integrated health systems – integrated all § Religious, volunteer,
care under the umbrella of a central community groups
organization • Government hospitals
• Practice guidelines – tools that describe o Owned / supported by federal, state,
processes found by clinical trials or by county, or other governmental entities
consensus opinion of experts
o Synonyms: clinical practice guideline, Pharmacy’s Roles in the Medication Use Process
practice parameter, protocol • Lead & influence the safety & quality of all
• Practice model – operational structure that aspect of the medication use process
defines how & where pharmacists practice, • Prescribing
type of distribution system & layout & design o Privileging – formalized process by
• Privileging – process by w/c an oversight w/c an oversight body of HCO having
body of a health care org reviewing an indiv. reviewed an indiv. Health care
Health care provider’s credentials & provider’s credentials as satisfactory
performance satisfactory o Indirectly influence prescribing
• Regulation – govt order having the force of § acting as information resources
law § provide feedback on quality of
• Smart pumps – infusion devices w/ clinical prescribing
decision support software & drug libraries § develop prescribing protocols ( by
that perform a test of reasonableness at the formulary system )
point of medication administration • Transcribing
o Process by w/c a prescription is
What is Institutional Pharmacy Practice? copied & manually / electronically
• Includes the provision of distributional & entered into pharmacy records
clinical pharmacy services at a broad range of o Computerized prescriber order entry
insti. Settings – minimize errors
• Integrated health systems – include • Dispensing
inpatient/acute care ; primary care/outpatient o Act of physically transferring the drug
care ; long-term & home care. product following review & approval
• Health systems – collection of orgs & of the Rx
institutions whose mission is to positively • Administration
impact health outcomes o Typically managed by nurses
o Interdependent & unified o RPh help improve the safety of
• Integrated model medication adminis. by:
o Creates the potential to provide § Clearly labeling medications
enhanced levels of pt.-care continuity § Using bar-coding systems & unit-
through access to medical records dose packaging
§ Reducing time involved in accessing
Types of Hospitals drugs ( decentralized automated
• Hospitals – focused on providing care to dispensing devices )
acutely ill patients that require constant care § Smart infusion pumps
by a team of highly skilled physicians • Monitoring
• Community hospital o Monitor patient’s response to
o Most common type & designed to deal medication
w/ an assortment of diseases & o Reviewing laboratory values
injuries correlated w/ expected med-therapy
• Specialized hospital outcomes

Practice Models Importance of Automation Technology
• Operational structure that defines how & • Serves to increase efficiency & accuracy of
where RPh practice dispensing
• Drug-distribution centered model • Pharmacy automation – important because
o Rph primarily distribute drugs & utilization of many of the available tech can
process new medication orders influence what the RPh do in med. Dispensing
o Reactive role – responds to requests of • Unit-base cabinet ( Pyxis, Omnicell )
physicians & nurses o Contain compartments where indiv.
o Not accountable for health outcomes Medications are stored
of patients ; little influence • Pharmacy robot ( McKesson Robot-Rx )
• Clinical-Pharmacists centered model o Hundreds of bar coded packages
o Clinical RPh – involved in clinical placed in designated spaces on long
activities assoc. w/ medical teams on rods
the nursing units o Prepare a 24-hour supply
§ Assist physicians in avoiding & • Bar-coded medication administration ( BCMA)
solving clinical problems o Require pharmacy involvement
§ Drug-laboratory ; drug-disease ; assuring that drug packages have
drug-drug ; drug-food appropriate readable bar codes
interactions • Computerized prescriber order entry ( CPOE)
o Distributive RPh – drug distribution ; o Require an interface or integration w/
review orders & verify accuracy of pharmacy info systems
medicine preparation o Standard order sets & verification
o RPh are selectively accountable mechanisms
• Patient-centered integrated model • Smart pumps
o Accept responsibility for all elements o Programmable pumps that allow user
of med-use process ; both clinical & to predefine min. & max. rates of
distributive functions ( limited ) administration
o More active engagement in med
selection & drug use as part of an Different Patient Care Areas
interdisciplinary team Inpatient care
• Critical care units – patients are of a higher
Key Individuals acuity level ; critically ill & clinical status is
• Pharmacists constantly changing
o Responsible for preparation of o Must be monitored closely & drug
medications therapy is often changed
o Dispensing RPh – verifying that o RPH makes sure that patients are
medications are prepared correctly receiving the right drugs & right dose
o Clinical RPh – interdisciplinary patient- o Surgical , medical , neurosurgery ,
care teams & interact directly w/ pediatrics , coronary care , neonatal
patients • General care – acuity of patients is less ; stable
§ Generalists – provide services drug therapy ; combination of oral & IV meds.
to a wide range of patients o Medication reconciliation – process of
§ Specialists – have defined resolving discrepancies as patient
expertise in one or more transition across departments /
areas locations
o Integrated practice – both dispensing & Outpatient Care
clinical roles • Outpatient dispensing pharmacy
o RPh usually serve as the supervisor for • Patients w/ Rx written in ER departments
pharma activities or as director of phar. • Ambulatory care clinics
dept. o General -- primary care, medication
• Pharmacy Technicians adherence
o Integral in purchasing, stocking, o Specialized – anticoagulation ,
preparation & compounding of palliative care
medications • Home health care – infusion services ;
o Taking on new & expanded roles antimicrobial therapy ; pain management ;
beyond prep & dispensing parenteral nutrition ; chemotherapy
o Maintenance of automated dispensing • Drug therapy consultation ; error prevention
tech ; assist clinical RPh in collection of & patient safety , monitor adherence to
lab. Values practice guidelines, medication counseling