Doh Hospital Pharmacy Management Manual 1pdf PDF Free

HOSPITAL P CY
MANAGEMENT MANUAL
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Second Edition
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Department of Health
Republic of the Philippines
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The second edition of the Hospital Pharmacy

Management Manual is a publication of the
Health Finance Development Project of the
Department of Health.
This publication was made possible through

support provided by the U.S. Agency for ••
International Development (ALD.), under the
terms of Contract No. 492-o44~o-2114-00. The
opinions expressed herein are those of the
author(s) and do not necessarily reflect the views
of the U.S. Agency for International Development.
•
TABLE OF CONTENTS
. AUTHORIZATION
MESSAGE
FOREWORD
PREFACE
ACKNOWLEDGMENTS
LIST OF FORMS
LIST OF ILLUSTRATIONS
irsr OF TABLES
LIST OF ABBREVIATIONS
INTRODUCTION
Definition
. Objectives
PART ONE
DEPARTMENT OF HEALTH HOSPITAL PHARMACY SERVICE \
Chapter Page No.
I. GENERAL STATEMENT/PRINCI\"LE
Institutional Goals for Hospital
. Pharmacy Service
Objectives 4
I
II. ORGANIZATION A!'iD PERSONNEL 5

Organization 5
Personnel -, W
Relationship 11
Job Descriptions 13
.. General Qualifications and Standard
Requirements for Hospital Pharmacists
and Pharmacy Personnel 18
III. PLANT, FACILITIES, EQUIPMENT

AND OTHER MATERIALS 21
IV: FUNCTIONS AND POLICIES 27
PART TWO
. PHARMACY SERVICE OPERATIONS AND PROCEDURES
v. ADMINISTRATIVE AND
TECHNICAL SERVICES 31
A. Pharmacy and Therapeutics Committee 32
Purpose 32
Organization and Operation 33
Functions and Scope 33
Other Policies 40
Policies on Dangerous Drugs 40
Development of Emergency Drug List 47
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Page No.
. Adverse Drug Reactions Reporting Program 47

Drug Utilization Review 47
Infection Control 54
Antidotes for Poisoning 59
Disaster Plan for Pharmacy Service 62
B. The Hospital Formulary System 64
Definition 64
Purpose 64
Formulary Content and Organization 65
Detailed Parts of the Formulary 66
Typical Format and Appearance
of a Formulary 67
Keeping the Formulary Current 68
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VI. INVENTORY AND PURCHASING
Inventory Management ,
69
69
I Functions 69
Objectives and Requirements 70
Purchasing and Inventory Control 70
Taking a Physical Inventory 71
Purchasing 72
Purchase Through Public Bidding 72
Emergency Purchase 72
Negotiated Purchase 73
Procurement from Duly-Licensed
Manufacturers/Distributors 73
Procurementthrough the ProcurementService 74
. Procurementfrom Other Philippine

Gmm1ment Agencies or FOreign Governments
Purchase Through Repeat Order
74
74
Control on Purchase 75
Semestral Submission of Required Drugs
and Medicine for Official Price Schedule List 76
Regular Requisition and Procurement
of Drugs and Medicines 77
VII. STORAGE 79
VIII. DISTRIBUTION 87
J In-patient Drug Distribution
Individual Prescription Order System
87
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Floor Stock System 90
Combination of the Individual Prescription
Order and Floor Stock Systems 90
Unit Dose Drug Distribution System 90
Filling of Prescription for In-Patients 94
Out-Patient Drug Distribution 95
Guidelines on Generic Labelling in
Accordance with the Generics Act of 1988 97
Violative, Erro'neous and Impossible
iJo Prescriptions in Accordance with
the Generics Act of 1988 97
Page No.
IX. FINANCIAL MANAGEMENT 101

Definition 101
Financial Management Consideration
for the Hospital Pharmacy 102
Developing a Data Collecting System 103
Financial Analysis 106
Budgeting 106
X. PHARMACY REPORTING 111
Attributes of Reports '111
Reports and Record Maintenance 112
Administrative Reports Submitted 113
. Regulatory Reports Submitted 113
.. PART THREE
OTHER PHARMACEUTICAL SERVICES
Xl. DRUG INFORMATION SERVICE 117
XII. RESEARCH AND EDUCATIONAL

ACTMTIES 123
XIII. CLINICAL PHARMACY 131

Definition 131
Qualifications of a Clinical Pharmacist 132
Requirements for Implementation 132
A Comprehensive Pharmacy Service 132
Flowchart for Clinical Pharmacy 134
Aspects in Clinical Pharmacy 137
XIv. INTRAVENOUS ADMIXTURE

PREPARATIONS AND TOTAL
PARENTERAL NUTRITION 141
xv: QUALITY ASSURANCE FOR THE

PHARMACY SERVICE 147
APPENDICES
Department Order Creating the Committee to Revise the 1977 Hospital

Pharmacy Service Manual
Department Order Creating the Committee to Critique the Draft Manual
on Hospital Pharmacy Management and Research on Costing of Most
Commonly Used Drug Precautions for Hospitals
Administrative Order on Revised Policies, Procedures and Guidelines
Governing Affiliation and Training of Students in the DOH Hospitals,
Rural Health Units and Other Hospital Agencies
\ Adrninstrative Order on the Implementing Guidelines for the DOH
r Compliance with the Generics Act
Memorandum Circular on BFAD General Guidelines on the Donation
of Pharmaceutical Products
National Budget Circular on General Guidelines and Related Procedures
for the Establishment of Funds for Medicines and Drugs in Hospitals/
Sanitaria
Administrative Order on Amending Authorized Ceiling of Medicines
and Drugs that can be Maintained in Stock by Hospitals/Medical
Centers and Sanitaria under Administrative Order No. 81 s. 1980
Administrative Order on the Amendment of the Authorized Ceiling of
the Drugs and Medicines Maintained in Stock by Hospitals, Medical
Centers and Sanitaria under the DOH pursuant to the joint National
Budget Circular No. 321 and COA Circular No. 80-128
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REFERENCES
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Republic of the Philippines SAN LAZARO OOMPOUND
Department of Health RIZALAVENUE, STA.CRUZ
MANILA, PHIUPPINES
OFFICE OF THE SECRETARY TEL NO. 711-60-80
AUTHO:RIZATION
January 6, 1994
In accordance with the authority vested on the Secretary of Health, I hereby declare the policies,
regulations, and instructions in this Hospital Pharmacy Management Manual shall govern the
organization, management, and activities of the Pharmacy Service in government hospitals until
modified by order of the Department of Health or by law.
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Republic of thePhilippine.
DEPARTMENT OFHEALTH
OFFICE FOR HEALTH FACILITIES,
STANDARDS AND REGULATION
san Lazaro Cmpd., Sla. Cruz Manila
rei No. 711·91>-72, Fax No.711-86-09
MESSAGE
January 6, 1994
The Hospital Operations and Management Service of the Department of Health has been
tasked to develop operations manuals specifically for DOH hospitals that may be of use to other
public and private hospitals.
These manuals would serve as standard reference materials for DOH hospitals to aid
administrators and practitioners in following standard operating procedures in the management and
• practice of the different hospital services or units. Likewise, it may also serve as a reference guide for
other public and private hospitals.
These manuals provide guidelines in the performance of duties and responsibilities of hospital
personnel as well as outline steps necessary in the effective .and efficient operation of each unit or
service. The procedures in these manuals will assist them in the process necessary to operate an
effective and efficient hospital.
This is an attempt to develop standards and achieve uniformity of procedures in different
hospitals.
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~AGAS. M.D.
Underse etary on Health
Facilities, Standards
and Regulations
Republic of the Philippines SAN LAZARO COMPOUND
Deportment of Health RIZAL AVENUE. STA.CRuZ
MANIlA,PHIUPPINES
OFRCE OFTHE SECRETARY TEL NO. 711-8G-80
FOREWORD
The combined efforts of the members of a special committee led by a Hospital Operations
and Management Service(HOMS) adviser, with an extensive professional experience and rigid research
work, resulted in the completion of the Hospital Pharmacy Management Manual.
This manual, which is flexible in nature, is an indispensable, ready reference and guide for
government pharmacists, hospital pharmacists, pharmacy student affiliates, and other health personnel.
Every health institution, therefore, is enjoined to have a copy of this manual. It would be
helpful if, from time to time, the institutions provide those concerned with progress reports, indicating
therein portions of the procedures that have been adopted and put into practice as well as those that
have not been used. They should also report the difficulties which they may have encountered in
implementing the procedures contained in this manual.
Recommendations for changes should likewise be submitted· for the purpose of improving
the Pharmacy Service as embodied in this manual. Nevertheless, it is expected that this will be a real
help for those concerned under the current situation.
MA. MAR~ GALON, MD,MHA

Director III
Hospital Operations and
Management Service
·PREFACE
The Pharmacy Service is an important and essential facet of the total
hospital care delivery system.
Pharmacy, like any other field of medicine or science, is dynamic and
ever-changing. The pharmacist therefore: must keep pace with the latest
trends in pharmacy practices.
Innovators of the profession have introduced changes in all aspects of
the practice of pharmacy that would bring about a more efficient and
professional Pharmacy Service. Such professional, societal, governmental
and economic factors will continue to force further changes and the
pharmacist must be ready not only to adapt to these changes but to take the
lead in introducing them.
Initiatives toward the development of this Hospital Pharmacy
Management Manual began through Administrative Order No. 112 s. 1963
which was amended to Administrative Order No. 286 s. 1975 dated 12
November 1974. The first edition was released in 1977 under the Bureau of
Health and Services of the Department of Health.
This manual has been prepared to provide the hospital pharmacists
with guidelines and standard procedures that would. aid them in the
development and provision of good hospital pharmacy practices geared
toward the actual dynamics of better patient care. It may also be used as a
criteria in evaluating the scope and quality of Pharmacy Services. Thus,
hospital pharmacists and pharmacy student affiliates will find this manual
handy and useful in the practice of their profession.
I hope that pharmacists .and pharmacy student affiliates will find this
manual handy and useful in the practice of their profession and information
for other hospital technical personnel.
. ~~B~f~ Pharmacy Adviser

Management Service
ACKNOWIEDGMENTS
The Committee on Revision of the Department of Health Hospital
Pharmacy Management Manual acknowledges, with sincere thanks and
gratitude, the following:
DR. ANTONIO O. PERIQUET, former Undersecretary for

Office for Hospital and FacilityServices, and DR. ALEJANDRO
DE LEON, former Assistant Secretary ofthe Office for Hospital
and Facility Services, for their support;
DR. MA MARGARITA M. GALON, Director III, Hospital

Operations and Management Service (HOMS), Office for
Hospital and Facility Services (OHFS) for her unwavering
support, encouragement and proper guidance in the preparation
of the manual;
MISS BERNADETTE G. IPAC, Supply Officer III, and MISS

MELANIE A. JOAQUIN, Management and Audit Analyst III,
HOMS with MRS. CRESENCIA S. CRUZ, Assistant Secretary
of Financial Operations and Frontline Service Audit as adviser,
for their assistance in budgeting, accounting and auditing
procedures;
DR. MELCHOR R. LUCAS, Division Chief, and the Advisers

of the Support Division and other consultants, namely: MS
PURITA R. TUAZON and THELMA N. AGUILAR, for their
assistance and advice on related matters;
The Chiefs of Hospitals who have allowed the pharmacists who

were members of the committees, to attend all the meetings
held during the preparation, review, critiquing and the revision
of the manual;
MISS GLADYS A. ALVAREZ and MRS. ALMA Q SORRA of
HOMS for their patience in printing the manuscript and
manual; and
To everyone who have contributed to the successful preparation

of the manual.
USTOF FORMS
Form No. . Page No.
1. PTC Hospital Form for the Addition of a

Non-Formulary Drug to the Hospital formulary 15
2. PTe Hospital Form on the Proposal
for Deletion of a Drug in the Hospital Formulary 36
3. Recommended Drug for Inclusion in the PNDF rl
4. Recommendation of the PTe on Drugts)
for Inclusionin the PNDF 38
5. DDB Form No. 13-73 44
6. DDB Form No. 14-73 45
7. Report of Waste Meterial 84
Certificate ofInspector 85
8. Summary of Report ofIssuances and
Balances of Drugs and Medicines 114
Pharmacy Monthly Report of Issuances
of Drugs and Medicines Used 115
UST OF ILLUSTRATIONS
Figure No. Page No.
I. Position Chart of Pharmacy Service 6

2. Secondary Level 7
3. Tertiary Level 8
4. Functional Chart 9
5. Patient Care Team 133
6. Cycle of an Effective Quality Assurance 148
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LIST OF TABLES
Table Page No.
1. Staffing Pattern 11
2. Physical Plant and Facilities 22
3. Utensils, Apparatus and
Other Equipment and Materials 23
4. Reference Books and Other Pertinent Documents 25
5. . Typical N Orders (Parenteral Prescriptions) 144
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LIST OF ABBREVIATIONS
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AO Administrative Officer
ADR Adverse Drug Reaction
ADPP Annual Drug Procurement Program
BFAD Bureau of Food and Drugs
BLR Bureau of Licensing and Regulations
COA Commission on Audit
COE Current Operating Expenses
COH Chief of Hospital
CRI Cross Reference Index
CSC Civil Service Commission
• DO Dangerous Drug
DDA Dangerous Drug Administration
DDB Dangerous Drug Board
DECS Department of Education, Culture and Sports
DIS Drug Information Service
DO Department Order
DPC Drug Procurement Committee
DOH Department of Health
DR Delivery Room
OUR Drug Utilization Review
EO Executive Order
EOQ Economic Order Quantities
ER Emergency Room
FDDCA Food, Drugs, Devices and Cosmetics Act
HMDTS Health Manpower Development and Training Services
HOMS Hospital Operations and Management Service
ICC Infection Control Committee
lCU Intensive Care Unit
N Intravenous
LTO License to Operate
• MOOE Maintenance and Other Operating Expenses
MSW Medical Social Worker
NAAM National Accounting and Auditing Manual
NCATS National Committee on Affiliation and Training of Students
NDC National Drug Committee
NF National Formulary
OHFS Offices for Hospital and Facility Services
OR Operating Room
PACOP Philippine Association of College Pharmacy
PNDF Philippine National Drug Formulary
PLS Procurement Logistic Service
PO Purchase Order
PRC Professional Regulation Commission
PTC Pharmacy Therapeutics Committee
QbP Quali ty Assurance Program
RA Republic Act
RCATS Regional Committee on Affiliation and Training of Students
RNs Requisition Issue Vouchers
RR Recovery Room
RQL Reorder Quality Level
TPN Total Parenteral Nutrition
UNDP United Nations Development Program
USP United States Pharmacopeia
WHO World Health Organization
WL Ward Liaison
WMR Waste Material Report
• INTRODUCTION
The Hospital Operations and Management Service (HOMS) assessment
and monitoring of the Department of Health (DOH) Hospital Pharmacies
conducted in 1988-1991 and the inputs of the hospital pharmacy' participants
in the trainings held in fourteen (14) regions in 1989-1991, revealed the need
to improve and strengthen the operations and management of the
• government hospital pharmacies. Thus, the second edition of the DOH
Hospital Pharmacy Management Manual was revised to' contribute to a
higher standard of patient care through improved hospital pharmacy practices
and management. .
A decision was taken by the ASEAN Ministers of Health during the
32nd World Health Assembly in Geneva in May 1979, on the Technical
Cooperation among ASEAN countries on pharmaceuticals which is within
the context of the national health development plans and priorities.
In the latter part of 1985, ten areas of technical cooperation with various
still ongoing activitiesand other new proposals were endorsed and supported
by the United Nations Development Program (UNDP) and the World Health
Organization JWHO). One of these new proposals was the Hospital
Pharmacy Management and Development covering three (3) phases. One
phase is the development of an ASEAN Guidelines/Manual. A HOMS
Pharmacy Adviser participated as the DOH delegate to the meeting held in
Bangkok, Thailand in 1989 on its review and adoption.
In the spirit of ASEAN cooperation on hospital pharmacy practices,
the adoption of the ASEAN Guidelines/Manual as one of this manual's
references is very timely in the pursuit of its implementation.
The administration of a pharmacy in an institution involves planning,
organizing, coordinating, controlling, and implementing general institutional
policies as well as establishing hospital pharmacy procedures for the end
purpose of good patient care. This also includes knowledge about the
hospital- its purpose and plan of operation, organization, administration,
and many aspects of inter-hospital component service cooperation.
DEFINmON
The DOH Hospital Pharmacy Management Manual is a document of
administrative and professional policies which serves as the management
guide in the development and execution of effective and efficient
pharmaceutical services in a hospital.
GENERAL OBJECTNE OF THE MANUAL

This manual aims to provide a common reference document for the
general improvement of hospital pharmacy practices and management, and
their development as an appropriate and efficient component in health care
delivery..
SPECIFIC OBJECTIVES:
1. To define the roles and responsibilities of the Pharmacy Service and
the pharmacist consonant with the present trends in pharmacy practice
and management in the delivery of health care to all patients;
2. To delineate new aspects of pharmacy practices and define the
professional relationships between the pharmacy and its staff, vis-a-
vis the medical and other hospital staff, as well as its medico-legal
implications;
3. To delineate the area of supply management that should be within the
purview of the hospital pharmacists;
4. To provide the necessarybasic facilities and systems/procedures required
for the discharge of the responsibilities of the hospital pharmacy;
5. To establish a foundation for planning, developing and reviewing
existing and new services;
6. To disseminate procedures used in assuring rational drug use;
7. To design processes for monitoring and evaluating the quality and
appropriateness of all pharmaceutical services, and;
8. To serve as a venue for the educational training/post training for
newly-hired employees, pharmacy student affiliates, etc.
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PART I
DEPARTMENT OF HEALTH
.. HOSPITAL PHARMACY SERVICE·
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DEPARTMENT OF HEAlTH
HOSPITAL PHARMACY SERVICE
GENERAL STATEMENT/PRINCIPLE
• The hospital shall maintain a Pharmaceutical Service that conforms
with ethical and professional standards and legal requirements.
The organization of a hospital pharmacy must satisfy the need for
pharmacists performing their role as the vital link in the chain of health
professionals dedicated to patient care. The pharmacist's role is to provide
at all times, an adequate supply of safe, effective and good quality drugs in
appropriate dosage forms consistent with the needs of the patients and to
rationalize drug utilization in collaboration with the medical staff.
INSTITUTIONAL GOALS
FOR THE HOSPITAL PHARMACY SERVICE
1. To provide the benefits of a qualified hospital pharmacist to patients
and to the allied health professionals and institutions;
2. To assure a high quality of professional practice through the
establishment and maintenance of standards of professional ethics,
I education and attainment and promotion of economic welfare;
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3. To promote research in hospital pharmacy practices; and
4. To disseminate pharmaceutical knowledge by providing exchange of
information among hospital pharmacists and members of allied
specialties and professions.
1
Hospital Pharmacy Management Manual
In order to transform these goals into realities, all hospital pharmacists

should broaden and strengthen their abilities in the following areas:
L Effective Administration and Management
of a Pharmaceutical Service in a Hospital
The chief ofthe Pharmacy Service or personnel specializing in its
administration, must be familiar with the health care system and the
specific functions of the hospital so that objectives can be achieved
in cooperation with other hospital services and with other programs
that ensure continuity of patient care.
Broad areas of administrative and management responsibilities
include planning and integrating professional services, budgeting,
inventory control, cost review, cost effectiveness, audit, maintenance
of records and preparation of reports. As a basis for this responsibility,
pharmacy personnel must be thoroughly familiar with the organization
of a hosp.ita\, staff and line relationships and the appropriate lines of
communication.
Pharmacy activities must be coordinated with medical, nursing
and other services and with the administrative elements of the hospital.
The chief of pharmacy or his/her designate is responsible and
accountable for all pharmaceutical services related to patient care
and expenditure offunds. He! she must be able to analyze and interpret
prescribing trends and the economic impact of new drug developments,
which, for budgeting purposes, are translated into forecast for future
drug expenditures. The chief of pharmacy or his/her designate must
maintain an adequate system of stock and inventory control and must
have the ability to control operational cost without compromising
services,
The chief of pharmacy is responsible for recording all other
pharmacy operations which may be legally or administratively required.
2. Development and Provision of Patient-Oriented Services

Pharmacy, as practiced in the hospital setting, is developing a
wide spectrum of clinical services which have become part of the
overall pharmaceutical services although it may not be directly
associated with drug dispensing. Fundamental to these clinical services
is the pharmacist's knowledge of drugs, diseases, patient and drug
variables, and his ability to interact closely on a personal basis with
other health professionals and patients. Academic training in areas
such as toxicology, pathophysiology and therapeutics, as wellas clinical
experience, provide the background for a pharmacist to function in
this clinical role.
The service includes:
a. Drug information, which encom passes the collection,
organization, retrieval, interpretation and evaluation of the
applicable literature in appropriate fashion;
b. Collection of the pharmacy patient data base;
c. Patient education;
d. Monitoring and auditing of therapeutic regimens;
e. Drug-use review; •
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f. Monitoring/reporting ofspecific adverse drug reactions to

decrease their incidence; and
g. Performing other similar functions designed to improve
patient care by maximizing drug use. Clinical functions may
also extend to the pharmacist's role in primary care as well as
in the management of chronic care patients. '
3. Development and Conduct of Compounding Extemporaneous and

other Pharmaceutical Preparations and Packaging Program
The hospital pharmacist must frequently respond to the need for
special dosage forms and formulations not available in the market.
. This would require an adequate understanding of the principles
involved in the' preparation of pharmaceutical dosage forms. This
would involve the concepts of biopharmaceutics, bioavailability/
bioequivalence, stability, microbiology and techniques of medication
administration. In some instances, as in the case of intravenous
'admixtures ahd total parenteral nutrition, the pharmacist must be
famili~r with patient variables such as electrolyte and fluid balance,
and other factors such as personal hygiene, environmental control,
and equipment performance.
.. 4. Provision of Comprehensive Information of Drugs and their Action
Fundamental to the pharmacist's contribution to health care is
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the knowledge of drugs and their actions. Being the primary source
of information concerning drugs, the Pharmacy Servicemust maintain
the appropriate information sources as well as develop mechanisms
for evaluating information and transmitting it to the institution's
professional staff and patients.
The pharmacist must know the effects of drugs on biological
systems in assessing determinants of every action such as absorption,
distribution, metabolism and excretion of a drug; drug interactions
with other drugs, food or diagnostic agents; effects of a disease state
on the drug's action; and miscellaneous patient and drug variables.
This would require knowledge in chemistry, pharmacology, toxicology,
pathophysiology, pharmaceutics, therapeutics, and patient care
techniques as well as some background in the social sciences.
5. Conduct and Participation in Pharmaceutical Research

. The hospital pharmacist must be prepared to participate in clinical
research designated by the medical staff and to conduct pharmaceutical
research or initiate it. The pharmacist may act as the principal or co-
investigator or may use the resources of the pharmacy to support a
particular research study. Equally important, is the pharmacist's ability
to collectappropriate data, interpret them, apply the conclusions drawn
from the data, and transmit the results effectively.
An educational background with an appropriate orientation and
training in research methodology including criteria for the structure
of a research report, is therefore' recommended.
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6. Conduct and Participation in Educational Programs/Activities
t A wide rangeof educational programs/activitiesinvolvingall health
practitioners and students of various health professions is performed
routinely in the hospital. The chief of the Pharmacy' Service or his/
her designate, is responsible for coordinating the pharmacy's
contribution to these educational programs. He/she is also responsible
for training new personnel and carrying on continuous educational
programs for pharmacists, pharmacy support personnel, pharmacy
students, etc.
7. Development and Conduct of a Quality Assurance Program for

Pharmaceutical Services.
A major responsibility of the Pharmaceutical Service is the
assurance of the quality of its services and products dispensed, strictly
following the hospital's control program for drug dispensing.
The pharmacist must conduct audits to assure that patients are
provided with appropriate benefits of all pharmaceutical services and
that quality patient care services are rendered to them.
GENERAL OBJECTIVE:
To properly utilize the Pharmacy Serviceto the maximum geared toward
the actual dynamics of better patient care.
SPECIFIC OBJECTIVES:
1. To provide at all times, medications of the highest standard in

appropriate dosage forms consistent with the needs of the patients in
collaboration with,the medical staff;
2. To rationalize drug utilization and procurement in collaboration with
the Pharmacy and Therapeutics Committee;
3. To render effective and efficient professional service to in and out-
patients of all economic levels;
4, To utilize resources of the hospital pharmacy in the development and
improvement of the profession as a whole;
5. To conduct and support medical and pharmaceutical researches
appropriate to the goals, objectives and resources of the pharmacy
and hospital;
6. To maintain the appropriate information sources and develop
mechanisms of evaluating and transmitting information to the
institution's professional staff and patients; and
7. To maintain the Pharmaceutical Quality Assurance Program.
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ORGANIZATION AND
PERSONNEL
A. ORGANIZATION
The hospital pharmacy should be properly organized meeting the
minimum requirements prescribed by the Bureau of Food and Drugs (BFAD),
the Licensure Act of the Bureau of Licensing and Regulations (BLR), and
the enhancement standards of the HOMS based on the capabilities of
hospitals. The organization of a hospital pharmacy must satisfy the needs
of the pharmacists performing their role as the vital link in the chain of .
health providers dedicated to patient care. -
The hospital Pharmacy Service shall be under the general supervision of
. the administrative officer or Chief of Hospital (COH); it will directly be

administered and supervised by a licensed pharmacist. -
The organization serves to establish the authority relationships between
positions and to assign special tasks that achieve the pharmacy's objectives.
The pharmacy head practices the five essentials of good management,
namely, planning, organizing, directing, coordinating and controlling.
An organizational chart showing the flow of administrative authority is
essential to the selection and categorization of employees. The chart should
be designed to meet the specific requirements of the Pharmacy Service. (See
Figure I).
In addition to the chart, an outline showing the subdivisions of the
service and the responsibilities assigned to each subdivision may also be
prepared for larger pharmaceutical services. (See Figure IV)
I It is imperative to list all functiohs:of the Pharmacy Service in the
I planning of personnel requirements of various work systems (e.g., a unit
dose system will require more personnel for dispensing in-patient drugs
than a floor stock system); the estimate .of work load units per function
(e.g., a number of out-patient prescriptions, number of drug information
requests, etc.); the time required to complete each workload unit, etc.
5
PHARMACY SERVICE
CHIEF PHARMACIST
SUPERVISING
PHARMACIST
SENIOR
PHARMACrST(S)
PHARMACrST(S)
I STOREKEEPER I
C CLERK(S) IIII
I: AIDE(S) II
UTILITY WORKER(S)
FIGUREr
PHARMACYSERVICE
POSITION CHART
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.Hospital Pharmacy ManagementManual
.,.,
I CHIEF OF HOSPITAL
I
ADMINISTRATIVE
OFFICER
SENIOR
PHARMACIST
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STAFF STAFF STAFF
PHARMACIST PHARMACIST PHARMACIST
FIGURE II
SECONDARY LEVEL
(25-BEDS)
NOTE: Provided with a support personnel of one Pharmacy Aide

(laboratory Aide) per HOMS Staffing Pattern Enhancement Standard
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• Hospital
,. Pharmacy
. Management Manual
I CHIEF OF HOSPITAL
I ADMINISTRATNE OFFICER
CHIEF PHARMACIST
SUPERVISING
PHARMACIST
SENIOR SENIOR SENIOR

PHARMAQST PHARMACIST PHARMACIST
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l STI\FF STI\FF
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STI\FF STI\FF STI\FF STI\FF
PHAR PHAR PHAR PHAR PHAR PHAR
FIGURE III
TERTIARY LEVEL
(200-BEDS)
NOTE: Provided with support personnel of3 PharmacyAides (Laboratory

Aides), 2 Clerks, 1 Storekeeper and 1 Utility Worker as per HOMS
Staffing Pattern Enhancement Standard
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Hospital Pharrifa'cy Management Manual
PHARMACY
DISPENSING COMPOUNDING
PURCHASING & RECORDS &

INVENTORY REPORTS
CONTROL
TRAINING QUALITY
RESEARCH ASSURANCE
DRUG
INFORMtillON
• - OPD
- IN-PATIENT EXTEMPORANEOUS -
- PERSONNEL BULK -
- MEDICAL SUPPLIES ANTISEPTICS/ .
- WARD & FLOOR STOCKS DISINFECTANTS -
- ALCOHOL & OTHER IRRIGATING FLUIDS -
FLAMMABLES SMALL VOLUME
- DANGEROUS DRUGS PHARMACEUTICALS -
- EMERGENCY DRUGS & MISCELLANEOUS -
ANTIDOTES
- DONATED DRUGS
FIGUREN
FUNCTIONAL CHART OF THE
PHARMACY SERVICE·
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$...- - - - - - - - - - - - - - - - - - - - - - l
B. PERSONNEL
To carry out the broad scope of Pharmaceutical Service in a hospital, there
should be an adequatenumber of competent and qualified personnelthat conforms .
with the established staffingpattern ofthe DOH (See Table 1). Sufficient supportive
personnel (technical, clerical and other non-technical) are needed to prevent
pharmacists from performingnon-judgmental tasks. Appropriate supervisory controls
for supportive personnel must also be maintained.
All personnel must possess the required education and training needed.
Their competence must be maintained through relevant continuing education
programs and activities.
A set of hospital policies, wherein the component service objectives of
the hospital are reflected, should be formulated. Written policies to govern
the procedural conduct of the pharmacy should exist and these should be
kept current. Implementing policies should be clearly understood and
complied with, when applicable.
The Pharmacy Service should be under the su pervision of a
professionally-competent and legally-qualified pharmacist whose training
conforms with the standard qualifications established by the DOH.
The head ofthe Service shall perform both technical and administrative
functions associated with the operation of the pharmacy. In the performance
of these duties, the pharmacist is expected to coordinate the activities of
the pharmacy with other hospital services and to work within the overall
policies of the hospital and the DOH.
The management of a pharmacy in a hospital utilizes the same concepts
common to all organizations whether it be in industries, offices, etc. As a
manager or supervisor, the pharmacist must plan, organize, direct, coordinate
and control people, supplies and equipment in a manner that would produce
a drug service that is efficient and economical.
One resource available to a manager or supervisor which he/she is least
conscious of, is the resource of TIME. But time, along with money and
people, limits the output ofany manager because of all the resources available
to him/her, time is the most scarce, for it cannot be rented, hired nor
bought.
The higher the manager is in an organization and the larger the
organization, the more demands are made on his time. But, whatever is
his/her level or the size of his organization, it is crucial to his/her productivity
that he/she develop effective techniques in dealing with time and getting
things done.
Top time management specialists agreeon two basic concepts to maximize
time: (1) the direct and controlled use of time, and (2) setting of priorities
and the allocation of time based on these priorities.
10
Hospital Ph'armacy Management MaI!uaJ
STAFFING PATTERN"
• Table 1
B E D S
10-15 25 50 100 200 . 200 300
TERTIARY REGL MFD
LOW CTR
Chief Pharmacist 1 1
Supervising Pharmacist 1 1 1 1
. Senior Pharmacist(s)
Pharmacist(s) 2
1
3
1
4
1
7
2
8
3
8
3
12
Lab. Aide(s) 1 1 1 1 3 3 3
Clerk(s) 1 1 2 2 2 2
Storekeeper 1 1 1 1 1
Utility Worker 1 1 1 1
• HOMS Enhancement Standard
RELATIONSHIP
The Pharmacy Service shall expect the following services from:
1. The Office of the Chief of Hospital
- Supports and approves all offic~al requirements relevant to the
I
pharmacy activities/programs.
~ 2. Administrative Services
Attends to the following financial matters:
a.' budget - budget requirements
b. supply - actual drug procurement and turn-over of delivered'
drugs properly documented to the pharmacy.
c. accounting - availability of funds and replenishment of
revolving fund.
d. billing - report on all drugs paid by the patient based on
forwarded charge slips.
Plus other personnel, housekeeping, engineering and maintenance
requirements.
3. Medical Social Work Service
- Responsible for patient -elassificarion, and assistance for drug
availability to patients.
4. Nursing Service
- Responsible tor the patient's drug needs and all other drug-related
matters.
11
5. Medical Service
- Coordinates with the PTC on drug and drug-related matters.
- Provides the drug requirements of patients in coordinating efforts:
a. Assistance in the preparation of the hospital formulary based
on the Philippine National Drug Formulary (PNDF) and the
Generics Act of 1988.
b. Assistance in the preparation of the Annual Drug Procurement
Program (ADPP) and the semi-annual drug requirement for
the DOH bidding.
c. Active participation and inputs on drug and drug-related.
matters such as Adverse Drug Reaction (ADR), Drug
Utilization Review (DUR), Infection Control, etc.
6. Dietary Service
- Provides referrals on request for hyper-alimentation diet and/or total
parenteral nutrition.
Z Resident Commission on Audit (COA) Auditor
- Responsible for auditing matters
Pharmaceutical Services expected by other hospital service components:

1. Chief of Hospital (COH)
- Provides an adequate supply of safe, effective and good quality drugs in
appropriate dosage forms consistent with the needs of the patients and
rationaIizes drug utilization in collaboration with the medical staff.
2. Administrative Service
~ Submits budgetary requirements
- Submits monthly report to the accountant for the reimbursement of the
Maintenance and Other Operating Expenses (MOOE)Fund ofthe hospital
issued to charity/service patients.
- Forwards charge slip to the billing section for drug payment of patients
prior to their discharge.
- Supply Office - prepares Requisition Issue Vouchers (RIVs) with the
specifications, quantity and cost of drugs based on the Official Price
Schedule with attached individual stock position sheetof each item for the
actual procurement of drugs.
3. Medical Service •,
- Coordinates closely with the medicalstaff on drug and drug-related matters:
- Provides the drug requirements through the PTC.
- Prepares the final ADPP and the semestral drug requirements tor bidding.
- Establishes the Hospital Drug Formulary.
- Disseminates information on other drug-related matters.
- Participates actively in committee activities as ADR, DUR. Infection
Control, etc.
4. Nursing Service
- Provides drugs needed by patients by doctors' orders and other related
matters that affect the Nursing Service. oJ
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5. Medical Social Service

- Assures availability of drugs for deserving patients.
6. Dietary Service
- Disseminates drug information on food-drug interaction.
Z Medical Records Service
- Prepares monthly report on the number of prescriptions filled;
- Prepares statement of expenses on drugs/medicines.
8. Resident COA Auditor
- Establishes a Good InventoryControl System - such as no overand under
stocking of drugs, expired and deteriorated drugs, breakages, etc.
9. Services the drug requirements of personnel and the general public
including referrals to health facilities and the "Murang Gamot Project"
of selected hospitals. .
Relationship with other agencies relevant to the practice of pharmacy:

1. BFAD in compliance with the legal requirements of the BFAD based
on the Food, Drugs, Devices and Cosmetics Act as amended; RA
3720 in the issuance of the License to Operate (LTO) and regular
inspection/monitoring and in compliance with the Generics Act of
1988 (RA 6675), and the Pharmacy Law (RA 5921) as amended.
2. The Dangerous Drugs Board (DDB) in compliance with the legal
requirements of the Dangerous Drugs Act (DDA) as amended (RA
6425) relevant to the practice of pharmacy. - .
3. Bureau of Licensing and Regulations in compliance with the legal
requirements for hospital pharmacy based on the Hospital Licensure'
Act (RA 4226).
4. Professional Regulation Commission (PRe) in compliance with the
ethical and professional practices and the continuing education
program requirement,
5. HOMS and other services under the OHFS consultative/advisory
services on Hospital Pharmacy enhancement standards, Hospital
Operations and Management of hospital pharmacy, etc.
JOB DESCRIPTIONS
CHIEF PHARMACIST
Provide the overall supervision of the activities of the Pharmacy Service of
comparatively large general or special hospitals and perform other related functions.
Specifically, the Chief Pharmacist shall:
1. Esr.blish and implement policies and procedures of the pharmacy in
accordance with the policies of the hospital and of the DOH;
2. Instuct, train and supervise all employees of the Pharmacy Service;
3. Review and approve schedule of duties of the pharmacy staff;
4. Prepare requisitions for awarded drugitems and other supplies for
procurement based on the approved price schedule;
13
Hospital Pharmacy Management Manual .
5. Provide information concerning drugs and drug therapy to physicians,

nurses and other health personnel of the hospital;
6. Participate actively as member and secretary of the hospital's Pharmacy
and Therapeutics Committee (PTC); .
Z Assist in the evaluation of reports on ADR, DUR and Infection
Control Programs;
8. Plan and prepare research activities on behavioral and socio-economic,
pharmaceutical operational and clinical researches;
9. Supervise the posting and checking of deliveries to bulk storeroom of
the pharmacy for safekeeping and proper storage.
10. Prepare reports and memoranda to the COH, Administrator and other
departments of the hospital on pharmacy matters;
11. Plan suitable educational and training programs for professional
staff and pharmacy interns in accordance with the requirements of
the DOH National/Regional Committee on Affiliation and Training
of Students (NCATS/RCATS);
12. Prepare/conduct the Quality Assurance Program (Qb.P) Review of the
Pharmacy Service and participate in the Qb.P of the hospital multi-
disciplinary committee;
13. Attend meetings/seminar-workshops/consultative meetings related to
drugs and hospital pharmacy practices;
14. Recommend pharmacy development or improvements to the COH;
15. Check and evaluate overall performance of the pharmacy staff and
approve performance ratings of the pharmacy personnel;
16. Check the maintenance of the drug inventory control program;
lZ Control dangerous and regulated drug distribution and drug
dispensing activities; and
18. Perform other related functions.
SUPERVISING PHARMACIST
Supervise aaivitiesofthe PharmacyService ofsmaller general or special hospitals
. and/or supervise theactivities ofemployees in the PharmacyService ofa comparatively
large general or special hospital, and perform other related funaions.
Specifically, the Supervising Pharmacist shall:
1. Assume the duties and funaions of the chief pharmacist in hisjher absence;
2. Assist in the planning of special projects, training of pharmacy interns
and personnel in different areas of the Pharmacy Service;
3. Assist in the preparation ofpolicies and procedures ofthe Pharmacy Service;
4. Supervise clerical and record-keeping activities;
5. Supervise the preparationofdelicate prescriptions not commercially available;
6. Collate ADR,Infection Control and OUR reports;
Z Supervise the receiving, checking and proper storage of all drugs,
biological and medical supplies;
8. Check the prepared schedule of duties of pharmacists and other personnel;
9. Supervise the maintenance of drug inventory control program;
14
Hospusl-Phermecy Management Manual
10. Assist in the preparation of requisitions through the RNs on the

awarded drug items for procurement;
11. ASsist in the planning and preparation of research activities;
12. Assist in the preparation of suitable educational pharmacy programs
for professional staff and pharmacy interns;
13. Supervise dispensing of drugs to in and out-patients;
14. Check completed work of pharmacist before issuance;
15. Assist in the preparation of the QAP of the Pharmacy Service;
16. Attend meetings/seminar-workshops and consultative meetings related
to drugs and hospital pharmacy practices;
17. Assist in the evaluation of the overall performance ofthe phatmacy staffand
• review performance appraisal forms of pharmacy personnel; and
SENIOR PHARMACIST
Under general supervision, the Senior Pharmacist shall supervise the
activities of a small group of employees of the Pharmacy Service of a
general hospital or special hospital and perform other related functions.
Specifically, the Senior Pharmacist shall:
1. Assume the functions and responsibilities of the supervising
pharmacist in his/her absence;
2. Assist the supervising pharmacist in the supervision of Pharmaceutical
Service activities or perform other duties relating to the preparation,
care, distribution, disposition and inspection of drugs and supplies;
. 3. Assist the supervising pharmacist in planning, organizing and
. implementing pharmacy policies and procedures in accordance with
established policies of the hospital and the DOH;
4. Guide subordinates in work prioritization and specific tasks to be
performed and reviewed;
5. Record controlled drugs to registered opium and additional opium books;
6. Supervise bulk compounding activities;
7. Supervise the maintenance of the Drug Information Center with
updates, journals and literature files, etc.;
8. Prepare prescriptions not commercially available;
\
9. Supervise the bottlingand labelling of stocks from bulk compounded stocks;
10. Inspect and monitor drugs in all treatment areas;
11. Participate in all research activities;
12. Discuss performance report with subordinate employees;
II 13. Inspect stocks, equipment and requisitions as needed;
r 14. Supervise the preparation of intravenous admixtures;

15. Assist in the training of pharmacy interns;
t
b
16. Participate in the Q!.P of the PharmacyService; and
15
PHARMACIST
Under general supervision, the pharmacist fills and dispenses drugs and
medical supplies to in-patients and out-out-patients ordered or prescribed
by a licensed physician, dentist or veterinarian.
Specifically, the Pharmacist shall:
1. Fill prescriptions and dispense drugs;
2. Compound preparations not available commercially;
3. Label all drug containers issued to various services;
4. Check the manufacture and expiration dates and labels of drugs;
5. Post delivery receipts and record issuances of drugs to ledger cards
and accomplish issue report forms after every shift;
6. File prescriptions and maintain them for the required number of
years as prescribed by law;
7. Participate in medical rounds when deemed necessary for medication
history of patients in promoting rational drug therapy;
8. Notify physicians of any therapeutic incompatibilities, potential drug
interactions and duplicate prescriptions;
9. Make certain that the right patient takes the right drug and right
dosage at the right time;
10. Maintain follow-up inventory weekly;
11. Prepare/check/sign charges to pay/Medicare patients on medications;
12: Participate in research activities;
13. Attend scientific seminar-workshops/consultative meetings and continuing
education on drug-related mattersand hospital pharmacy practices;
14. Participate in the Q!>.P of the Pharmaceutical Service;
15. Prepare performance appraisal report; and
PHARMACY AIDE
Under supervision, the pharmacy aide shall:
1. Perform work incidental or preparatory to the work of the pharmacist;
2. Clean empty bottles, cylinders, funnels, mortars and other pharmacy
equipment!apparatus;
3. Assist the pharmacist on drug inventory control;
4. Pre-package drugs and pharmaceuticals and arrange them in shelves;
5. Inform the pharmacist of out-of-order equipment;
6. Assist in the preparation of charges for pay/Medicare patients;
7. Participate in the Q!>.P of the Pharmacy Service;
8. Attend staff development programs/seminar-workshops relevant to
his/her work:
9. Accomplish the performance appraisal report;
16
CLERK
• Under general supervision, the clerk shall:
1. Do all the typing/filing/safekeeping of documents, receiving and
releasing papers pertinent to the operation of the Pharmacy Service;
2. Counter-check submitted issue forms of the pharmacy staff on duty
for entry to stock/supplies ledger cards;
3. Record issuances of drugs daily in the ledger cards;
4. Prepare adjustment sheets as the basis for the statistical report on the
monthly consumption and balances of stocks in the pharmacy;
5. Participate in the QbP of the Pharmacy Service;
0
6. Attend staff development programs and seminar/workshops relevant
to his/her work; .
Z Accomplish the performance appraisal report; and
STOREKEEPER
Under general supervision, the storekeeper shall:
1. Receive/check/post drugs on ledger cards for safekeeping and proper
storage in the bulk storage area and record releases for pharmacy
stocks in the active storage area;
2. Transfer/withdraw drug items from bulk storeroom to active storeroom
of pharmacy for distribution assisted by the utility worker;
3. Conduct regular and weekly follow-up of physical inventory of drugs;
4. Inspect drugs stored at the bulk storeroom as to expiry dates, slow
and fast moving drugs, etc.;
5. Attend seminar/workshops, and other staff development programs
relevant to the work;
Z Accomplish performance appraisal report; and
UTILITY WORKER
Under general supervision, the utility worker shall:
I. Maintain housekeeping and sanitation of the pharmacy as well as its
bulk and active storage areas;
2. Maintain facilities of the pharmacy;
3. Attend to the administrative needs in the operationofthe PharmacyService;
4. Assist the storekeeper in the transfer or withdrawal of drug items
from the bulk storage area to the active storage area of the pharmacy
for eventual distribution;
6. Accomplish the performance appraisal report; and
Z Perform other related functions.
17
g
GENERAL QUALIFICATIONS
OF A HOSPITAL PHARMACIST
The person who takes charge of the Pharmacy Service of a small or big
institution must have the same qualifications. A hospital pharmacist should
be able to command respect from his/her co-workers, as well as the medical,
nursing, administrative staff and other clients.
It is important for the hospital pharmacist to be physically and mentally
fit to perform his/her duties. He/she should be enthusiastic, resourceful
and alert in order to be dependable, available, and progressive. The hospital
pharmacist should be dynamic, conscientious, industrious and helpful. .
He/she must observe good public relations and be generous with his or her
time and ability.
The hospital pharmacist must be knowledgeable in chemistry,
. pharmacology, pharmacokinetics, toxicology, pathophysiology,
pharmaceutics, therapeutics, patient care techniques, and must have a
background in social sciences and the theory and practices of pharmacy.
The hospital pharmacist should know the laws, rules and regulations
pertinent to the practice of pharmacy, and be abreast with the updated list
of dangerous drugs. He/she should be familiar with medical terminologies
and must be able to interpret doctor's medication orders. He/she should be
regularlyinformed on matters relating to medications, uses, doses and other
drug-related matters and must be able to communicate these information
with other health practitioners.
PHARMACY PERSONNEL QUALIFICATION

STANDARD REQUIREMENTS
CHIEF PHARMACIST •
1. B.S. Degree in Pharmacy;

2. Duly licensed by law to practice pharmacy;
3. M.S. in Pharmacy or its equivalent;
4. With 6 years experience - 3 years supervisory workand 3 years as dispensing
pharmacist; with on-the-job training!continuing education; and
5. Physically, mentally, emotionally, and morally fit to work.
SUPERVISING PHARMACIST
3. With 4 years experience - with 2 years of supervisory work in a
pharmacy and 2 years as dispensing pharmacist; v -ith at least 12 units
of M.A. and on-the-job training/continuing education; and
4. Physically, mentally, emotionally, and morally fi . to work.
-~. .
Hospital. Pharmacy Management Manual
. SENIOR PHARMACIST
3. With at least three (3)years experience, 1 year on supervisorywork and 2 years
as dispensingpharmacistwith on-the-job training!continuing education;and
STAFF PHARMACIST
.. 2. Duly licensed by law to practice pharmacy;
3. New graduate/or at least 1 year pharmacy practice, orientation with
further on-the-job training/ continuing education; and
PHARMACY AIDE
1. Completion of at least two (2) years of college studies;
2. Two (2) years experience in a pharmacy; and
CLERK
1. Completion of two (2) years of college studies;
2. One (1) year experience in the preparation of routine office
correspondence, endorsements, reports or other related clerical work;
3. Career Service (Subprofessional) Relevant Eligibility for First Level
Position; and
STOREKEEPER
1. Completion of two (2) years of college studies;
2. One (1) year experience in recording and storing of supplies;
3. Career Service (Subprofessional) Relevant Eligibility for First Level I
I
.Position; and
I
I
I
UTILITY WORKER
I
I
I
1. Completion ofelementary school courseor must be ableto read,write, count, I
and interpret verbal or written instruction of normal complexity; Ii
I
2. Six (6) months of experience in manual work; I
I'
3. Civil Service Eligibility not required; and I
I
4. Physically, mentally, emotionally, and morally fit to work. I
I
I
I
19
I
,
I
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20
PLANfS, FACJIII1ES, EQUIPMENT
AND 01HER MATERIALS
Plants, facilities,equipment and other materials of the hospital pharmacy
must comply with the BFAD minimum standard requirements for the
issuance of LTO in the establishment of the hospital pharmacy. However,
• these are further standardized based on the hospital's capability levels, size,
and scope of service. .
Adequate spaces,equipment and supplies are provided forthe professional
and administrative functions of the Pharmacy Service to assure' patient
safety through the proper storage, preparation (compounding, packaging
and labelling) and dispensing of drugs. .
Drugs are stored under proper condition of sanitation, temperature,
light, ventilation, segregation and security.
The pharmacy must develop a design which would be accessible to both
in and out-patients, business offices and frontline services.
Premises must be well-ventilated and should have concrete tiles or wooden
flooring.
There must be suitable areas for compounding, manipulating parenteral
medications, dispensing, adequate storage of drugs with wooden pallets for
drug boxes and biological products as specified in the label, for flammables
and for administrative functions. .
It must be provided with suitable cabinets for storing poison and/or.
dangerous drugs with sectional type of cabinets and must have an adequate
supply of water.
I
-- ----~-
•
111111I11111 ~II~
0334 21
H108."'5H79p
. Hospital Pharmacy Management Manual
PHYSICAL PLANT AND FACILITIES·

Table 2
PLANT AND FACILITIES BED S

10-15 25 100 TERTIARY
as the basis for
adjustment to
bigger bed capacity
Area 15.00 sq.m. 30 sq.m.

Main (optional)
Office 9.00 sq.m.

Toilet
Staff working area 9.00 sq.m.

Patient dispensing
and drug information
service areas 9.00 sq.m.
Receiving/Breakout/
Inspection Area 8.00 sq.m.
Flammables 3.50 sq.m.
Bulk 9.00 sq.m.
Extemporaneous
Prep. room 6.00 sq.m.
Distribution area
Parenteral admixture
area 9.00 sq.m.
• Proposed HOMS Enhancement Standard in coordination with Health

Infrastructure Service subject to change.
22
Hospital pharmacyManagement Manual
UTENSILS. APPARATUS AND OTHER

EQUIPMENT AND MATERIAlS
Table 3
10 25 100 tertiary and

basis for adjustment
to biggerbed cap.
Refrigerator for biological and

other drug products requiring
refrigeration / / /
• Prescription balance.
and a set of weights / / /
Glass volumetric measures and set
of not less than 6 pcs. from 15 ml
to 1000 ml capacity / / /
Mortar and pestle - a set not less
than 3 in assorted sizes / / /
• Funnel, plain or ribbed - ser of
not less than 3 pes of different
capacities / / /
Hot plate, double element,
3 heat control / / /
Label moistener / / /
• Ring stand / / /
Typewriter / / /
Calculating machine / / /
Filing cabinet / / /
Computer x x /
Rough Balance with set of
. weights from 0.01 gram to 1000 grams / / /
Analytical balance x x /
Distilling apparatus x x /
Mixer - 2 liter capacity x x /
• Minimum basic requirement for all levels in accordance with BFAD
rules and regulations and HOMS Enhancement Standards.
23
Hospital Pharmacy Managemem,Manual
Table 3 continuation:
10 25 100 tertiary and

to bigger bed cap.
Brewer's cart for drug

distribution (unit dose
distribution system) x x /
Tablet counter/dispenser / / /
Laminar flow - horizontal
with designed Laminar down
flow unit x x /
Tank glass, distilled water
5 gal or 12 gal x x /
Utility cart / / /
The pharmacy must provide adequate space for up-to-date
pharmaceutical reference materials which. is important to good
pharmaceutical practice in relation to patient care. This includes official
pharmaceutical compendia, periodicals and current editions of text and
reference books, etc:
* Minimum basic requirement for all levels in accordance with BFAD
rules and regulations and HOMS Enhancement Standard.
24
REFERENCE BOOKS
AND PERTINENT DOCUMENTS
Table 4
10-15 25 100 tertiary and

to bigger bed cap.
Reference books and documents / / /

- PNDF Vol. I current edition / / /
-CR! / / /
- USP and NF latest edition / / /
'. - RA 3720 as amended FDDC Act / / /
- RA 6675 Generics Act of 1988 / / /
- RA 5921 as amended Pharmacy Law / / /
- RA 4226 Hospital Licensure Act / / /
- RA 6425 DDA as amended / / /
- Rules and Regulations pertinent / / /
to the above stated laws / / /
- Remington's Pharmaceutical
,
Sciences, latest edition / / /
- Goodman and Gilman -
Pharmalogical Basis of
Therapeutics / / /
- Martindale's Extra
Pharmacopoeia x x /
- Myler's, Side Effects of Drugs x x /
Basic books duly registered
with BFAD/DDB
- Dangerous Drug Book / / /
- Exempt Preparation Book / / /
- Poison Book . / / /
- Record book for selected non-
prescription drugs subject to
abuse as determined / / /
Text on toxicity such as clinical
toxicology of commercial products
and "Handbook of Poisonings,
• Diagnosis and Treatment" /
. Text on clinical pharmacy such as
"Clinical Pharmacy Handbook for
Patient Counselling" and "Clinical
Pharmacy and Therapeutics" /
Medical Dictionary by Portland /
Text on Diagnostic Laboratory Test
such as "Clinical Laboratory
Medicine" and "Effects of Drugs
...
on Clinical Laboratory Tests" /
Other secondary literature if available /
. 25
26
•
.. FUNCTIONS AND POUCIES OF

THE PHARMACY SERVICE
I. GENERAL FUNCTIONS:
.. 1. Practice the effective and efficient management of an organized
pharmacy in accordance with ethical and professional practices and
legal requirements;
2. Provide pharmaceutical services at all times to patients, through an
adequate supply of safe, effective and good quality drugs in appropriate
dosage forms consistent with their needs in collaboration with the
medical staff;
3. Promote optimum standards for rational drug therapy by establishing
• a hospital formulary based on the Philippine National Drug Formulary
(PNDF) VoL I, current edition through the PTe;
4. Provide product formulation and pre-packaging;
5. Provide drug information service;
6. Provide patient-oriented services;
Z Develop and conduct a Quality Assurance Program;
8. Participate in research activities; and
9. Avail of continuous educational programs and trainings.
•
SPECIFIC FUNCTIONS
1. Responsible for the effective and efficient administration and

management of an organized hospital pharmacy in accordance with
ethical and professional practices and legal requirements. (RA No.
3720 as amended, 5921 as amended, Generics Act of 1988, Hospital
Licensure Act, Dangerous Drugs [DD] Act, RA 4226, as amended);
2. Ensure continuous supply of drugs and medicines of the highest
standards to patients by maintaining an adequate quantity of stocks
in the hospital pharmacy;
27
3. Conduct the preparation and compoundingof bulk sterile and non-

sterile pharmaceuticals approved by the PTC;
4. Conduct the screening, filling and proper dispensing of drugs in
accordance with the laws, rules and regulations pertinent thereto, (See
enclosures on Republic Act Nos. 5921, 3720, 6425, 6675);
5. Manage the distribution of floor stock (e.g., disinfectants, antiseptics,
etc.) to the different units;
6. Fmurethe avaiIabiIityofc!rug5 and medicinesforemegency cases and trearmenrareas .
sum as the Emergency Room (ER), Recovery Room (RR), Oper.uing Room (OR),
DeIMry Room (DR), 1ntmsive Care Unit QClJ), etc, and provision of antidotes fur
~ (See Antidotes, Chapter 5,pp. 59 - 61)
7. Provide the necessarydrugs to emergencycases for the first24 hours regardless
of the patient's capacity to pay (AO 89 s. 1990 dated 20 March 1990);
8. Prepare and. develop the Annual Drug Procurement Program of the
hospital and semestral drug requirements for bidding;
9. Prepare and sign the Requisition Issue Vouchers (RNs) with complete
specifications of drugs indicating the quantity and cost based on the
official Price Schedule for actual procurement. (See DOH Procedure
on the Regular Requisition and Procurement of Drugs and Medicines);
10. Maintain records, files and submit reports on dangerous drugs and •
other pharmaceuticals as required by law. (Article IV, Section 34, RA
5921; Section 25, RA 6425);
Il. Recommend the emergency procurement of drugs not available in the
pharmacy;
12. Control the labelling and packaging of drugs that complies with
standards and legal requirements. (AO 63 s. 1989 dated 9 March 1989,
Section 3, 3.2);
13. Serve as Drug Information Center to all hospital personnel, students,
,
•
and patients;
14. Participate in the detection, reporting and monitoring of ADR in the
hospital in cooperation with the PTC;
15. The pharmacy together with the medical and nursing staff should
jointly conduct a Drug Utilization Review (DUR);
16. Participate in the activities of the Infection Control Committee;
17. Prepare and submit the pharmacy monthly report on drug issuances and
balance of stock (Special provision of -the General Appropriations Act);
18. Submit other required reports as summary report on the daily number
of prescriptions filled and reports on the training of student affiliates
in teaching and training hospitals, and other statistical reports needed
as costing for research and studies and budgetary planning;
19. Prepare and submit the performance appraisal report of the staff (Civil
Service Commission [CSC] requirement);
20. Provide appropriate drug-related programs to the professional staff;
21. Conduct training ofpharmacy students affiliated with the hospital that meet
the requirements of the DOH NCATS/RCATS (AO 7l}A s. 1989);
22. Ensure the proper storage and preservation of drugs;
23. Provide intravenous (IV).admixture program; and
24. Provide a QbP for Pharmaceutical Service
28
GENERAL POLICIES
• 1. There should be a well-organized Pharmacy Service conducted in
accordance with ethical and professional practices and properly licensed
by the BFAD in the issuance of an LTO in accordance with the Food,
Drugs, Devices and Cosmetics Act ([FDDCA] RA 3720 as amended)
and the Bureau of Licensing in accordance with the Hospital Licensure
Act (RA 4226) and the Dangerous Drugs Act.
2. The physical presence of a licensed pharmacist should be ensured
especially when the pharmacy is open for service and/or the pharmacy
renders 24 hours service (RA Nos. 3720, [AO 56 s. 1989], 5921, 6675).
3. Pharmacists should be properly bonded for property accountability
as required by law (Section 101 PD 1445).
4. The required equipment and facilities should be maintained.
5. There should be a PTC that would provide rational drug therapy at
affordable cost (AO 51 s. 1988; DO 104-C s. 1991).
5.1 Hospital formulary in generics based on the PNDF Vol. I
current edition recommended by the PTe and approved by
the Director of the Hospital shall be established (Operating
on Hospital Formulary System).
6. There should be an ADPP and a list of the semestral drug needs for
bidding based on DOH Policy.
7. As requisitioning officer on drugs. the pharmacist must prepare and
sign the RIVs with complete specifications of drugs, indicating the
quantity and cost based on the official Price Schedule with an attached
stock position sheet for each drug item for actual procurement (See
DOH Procedure on Regular Requisition and Procurement of Drugs
and Medicines). .
8. There should be a proper implementation of the Medical Social Service
classification of in and out-patients in the issuance of drugs (DO 435-
B s. 1990).
9. Drugs and medicines for emergency cases should always be made
available in hospital treatment areas such as ER, RR, OR, DR, ICU,
etc., and provision of antidotes for poisoning.
10. All necessary drugs must be provided to emergency cases for the first24hours
I regardless of the patient's capacity to pay (AO 89 s. 1990).
I
~ 11. There should be an official pharmacy monthly operation report on
drug issuances and balance of stocks as per the Special Provision of
the General Appropriations Act to be submitted to the accountant for
reimbursement of the Maintenance and Other Operaiing Expenses
(MOOE) fund of the hospital at an amount issued to charity/ service
patients and other pharmacy program reports required by the hospital
administration.
12. Prohibited drugs in vials. should be issued to patients with duly
accomplished required form through the nurse on duty (DDB Form
No. 13-73).
13. Records, files and reports on dangerous drugs and other
- pharmaceuticals should be maintained in compliance with pertinent

laws, rules and ·regulations. (Article N Section 34 R.A. 5921; DDB
Board Regulation No.3 s. 1988 dated 20 July 1988).
29
r---------------------~
14. Outdated and deteriorated drugs, broken IV fluid bottles, etc., should
be properly discarded/condemned in accordance with the policy on
waste material with an accomplished form on Waste Material Report
prescribed under the National Accounting and Auditing Manual
(NAAM) and the Government Auditing Code of the Philippines.
15. There should be a standard marku p on drugs issued to patients and
personnel based on the DOH policy (Memorandum Circular No.
115 dated 24 April 1990).
16. For institutions selling medicines, the issuance of official receipts
must be handled by the cashier or cash clerk.
17. There should be a policy for refunds on paid drugs issued to patients
upon their discharge from the hospital.
18. The pharmacist should handle and dispense donated drugs in
accordance with BFAD/DDB regulations and shall keep adequate
records and report of issuances of the same (BFAD Memorandum
Circular No. 004-88 dated 2 May 1988; AO 50-A s. 1988).
19. Drugs and medicines delivered to the hospital should be inspected
and checked in the presence of a pharmacist.
19.1 All drug products should be subjected to random testing by
BFAD, with the manufacturers shouldering the test analysis
cost.
19.2 Delivery of a drug product should be confined to a single lot/
batch number.
19.3 Drug products received should not have less than a 12-month
interval between its delivery and its expiration date.
20. Procured drugs should immediately be turned over to the pharmacy I
for proper storage and preservation generally at 25° C. Other
thermolabile drug products should be stored at its required temperatures
j
and code colors should be utilized for expiration dates.
21. A drug inventory system should be maintained adopting the first-in-
first-out method in dispensing and distributing drug stocks (Section
511 of the National Accounting and Auditing Manual [NAAM]Vol.II).
22. The institution should develop a pharmaceutical research.
23. As the hospital's information center, the pharmacy should maintain
appropriate drug information service to the hospital staff, students
and patients.
24. There should be a provision for continuing education for pharmacy
staff and support personnel.
a
25. There should be provision for training pharmacy interns affiliated
with the hospital in accordance with the DOH policy on Affiliation
and Training of Students (AO 70-A. s. 1989).
26. A Quality Assurance Program for the Pharmacy Service should be
developed.
27. A pharmacist on duty must always wear the prescribed uniform
(Memorandum Circular No. 658).
30
OPERATIONS AND PROCEDURES
ADMINISTRATIVE AND TECHNICAL SERVICES
The basic foundation of an effective drug control system is its adherence
to policies and procedures. Procedures are established to carry out policies,
specifies how control will be achieved and outlines the full cycle of a task
until it is satisfactorily completed. Effective policies and procedures serve
to improve communications and promote understanding among persons
involved in the system. Both written and oral communications must be
conveyed through the framework of a written policy and procedure manual.
This serves not only as a control tool by defining procedures and ensuring
that a task has been performed within the parameters of the system, but also
promotes consistency and continuity and help assert crisis situations.
Intra- and inter-departmental in-service education and training are
• important to the effective implementation of policies and procedures, and
the institution's drug control system in general. Training provides all persons
involved with a better understanding of the system and the reason behind
its existence.
The pharmacistis obliged to complywith allthe laws, regulations and standards
governingthe practice of his/her profession. Although medication accountability
ispart ofthe responsibilities ofevery discipline within the institution, the pharmacist
is the person primarilyresponsible for allfacets ofdrug-use control throughout the
institution. The pharmacist must therefore take a lead role in the control of drugs
• subjectto diversion or misuse.
In the operation of a hospital pharmacy, the pharmacist should perform
the following: .
1. Set the long and short-range goals of the pharmacy based on
development and trends in health care, hospital practices and specific
needs of the hospital;
2. Plan and schedule these goals and coordinate activities and
communications;
3. Develop policies;
4. Schedule duties of personnel;
5. Provide supervision;
•
~ 6. Coordinate administrative needs of the PTC;
r ..
I;
31
Plllll.- - - - - - - - - - - - - - - - - - - -
7. Prepare/submit statistical data/monthly report on releases,

procurement, and other reports requiredby the hospital administration;
8. Participate in hospital general staff meetings;
.9. Conduct pharmacy staff meetings; and
10. Discuss performance appraisal with staff.
DRUG SUPPLY AND MANAGEMENT

The importance of drugs as a special item of supply is recognized by
the DOH as a vital component of health care. As health care organizations,
it is imperative for hospitals to maintain an adequate and continuous supply
of quality, safe, and efficacious drugs at the most economical cost consistent
with the needs of the patients to achieve rational drug therapy.
The pharmacist.under the Drug and Supply Management should perform
the following:
1. Participate in meetings/evaluations and deliberations of P'FC on drug
requirements and policy recommendations on drug-related matters;
2. Prepare hospital formulary based on the PNDF;
3. . Prepare and submit the ADPP of the hospital;
4. Submit the semestral drug needs for bidding;
5. Assist in the ADR reporting/monitoring activity of the hospital;
6. Participate in the Infection Control Committee (ICC) and the DUR;
7. Participate in the Poison Control Committee and make antidotes
available in the ER;
8. Participate in the Disaster Plan Committee, etc.
A. PHARMACY AND THERAPEtmCS CDMMlTTEE (PIC)
With the abundance of therapeutic agents, it becomes necessary to

establish systems that would alert physicians on the best medicinal agents
available and assist them in the proper selection of therapeutic substances
for the treatment of their patients. This calls for the formation of an effective
Pharmacy and Therapeutics Committee (PTC). As an advisory group, the
committee serves as the organizational line of communication between the
medical staff and the Pharmacy Service. It serves as a policy recommending
body to the medical staff and administration of the hospital on matters
related to drugs and drug use.
PURPOSE
The primary purposes of the PTC are as follows:
1. Advisory
The committee recommends the adoption of or assist in the
formulation of policies regarding the evaluation, selection, and
therapeutic use of drugs in hospitals.
32
Hospital Pharmacy Managemenr Manual
2. Educational
The committee recommends or assistsin the formulation of programs
designed to meet the needs of the professional staff (physicians,
pharmacists, nurses and other health care practitioners) for complete
and· current knowledge on matters related to drugs and drug use.
ORGANIZATION AND OPERATION

While the composition and operation ofthe PTC may vary from hospital
to hospital, the .general organizational and operational procedures guided
by the DOH policy are the following:
1. The PTC shall be composed of at least three physicians, a pharmacist,
a nurse, and an administrator. Generally, large hospitals have more
physicians represented in the committee. The committee may also
invite to its meetings, persons within or outside the hospital who can
contribute specialized or unique knowledge, skills, and judgment.
Thereare varying opinions regardingthe optimal size and composition
of the committee. Smaller committees may be more productive while
larger committees have greater potential in terms of staff
representation. This may be valuable in hospitals with large medical
staff in several specialties withdiffering needs, perspectivesand expertise.
Furthermore, the workload expected from a given committee member
will be less in a large committee. The important consideration is that
medical staff members are represented and are interested in the
committee activities that involve major medical services at the
mnumum.
2. A chairman coming from the representative. physicians shall be
appointed. The pharmacist who is usually designated the secretary,
should also be a voting member of the committee. .
3. The committee shall meet regularly, at least six (6) times a year and
when necessary while those in larger hospitals, should meet 10-12
times a year. The agenda for each meeting should be prepared by the
secretary (pharmacist) in coordination with the chairman. Notices of
meeting and the accompanying agenda should be distributed in time
to assure attendance and knowledgeable participation of all in the
discussion of the agenda items.
• 4. Minutes of the meeting shall be prepared by the secretary (pharmacist)
and maintained in the permanent records of the hospital.
5. Recommendations of the committee shall be presented to the medical
staff or its appropriate authority for adoption.
6. Liaison with other hospital committees concerned with drug use shall
be maintained. This includes the ICC, the OUR, etc.
FUNCTIONS AND SCOPE
1. To serve as an advisory group to the medical staff, pharmacy, and

hospital administration in all matters pertaining to the use of drugs
• including investigational drugs. 'Actions taken by the committee are
subject to the review and approval of the hospital authority;
33
2. To develop a formulary .of accepted drugs for use in the hospital

based on the PNDF, Vol. I, current edition, and provide for its constant
revision. The committee should minimize duplication of the same
basic drug or drug products. It should evaluate, approve or reject new
drugs or drug dosage forms, which have been proposed by members
of the medical staff for inclusion or deletion of drugs from the
hospital formulary. However, if new drugs proposed for inclusion
are not found in the PNDF, the committee should officially request
the DOH National Drug Committee (NDC) for its approval;
3. Toassist the Pharmaceutical Service in thedevelopment and review ofpolicies,
rules and regulations regarding the use of drugs in the hospital;
4. To review drug utilization in the hospital and promote optimum
standards for rational drug therapy;
5. To collect and review ADR reports,DUR, InfectionControl reports, etc;
6. To develop and disseminate pertinent educational materials and
programs on drugs to members of the hospital staff concerned; and
7. To formulate policies pertinent to the above functions which should
be reviewed periodically to ensure that the same are current.
THE COMMITTEE AGENDA

A successful meeting dependson the preparationofa functional agendawhich
has been distributed to committeemembers way in advance of thescheduled meeting.
A typical agendamay consistof the following general categories:
1. Minutes of the previous meeting;
2. Review of specified section(s) of the formulary for updating and
deletion of drugs;
3. Hospital non-formulary drugs and new drugs proposed for inclusion
with the approval of the DOH-NDC.
4. Evaluation of an investigational drug protocol;
5. Review of the reports of ADR/DUR committees for appropriate plan
and action; and
6. Drug safety in the hospital.
POLICIES OF THE COMMITTEE
To avoid misunderstanding among members of the committee, and

subsequently by the entire medical staff, it is essential that the committee
establish policies that would control the use of drugs in the hospital. These
policies should be comprehensive and should be reviewed periodically to
ensure that they are current. Some of the committee policies are as follows:
1. Proposal for inclusion of a drug in the hospital formulary already
listed in the PNDF should be made using the Formulary Drug Request
Form (Form No.1). This form may be submitted by any member of
the medical staff. The committee will evaluate the request and notify
the person who proposed the inclusion of its acceptance or rejection.
The proponent will be given the opportunity to appeal for •
reconsideration. Requests for deletion from the hospital formulary
should use Form No.2.
34
FORM NO.-l
PTC HOSPITAL FORM
PROPOSAL FOR THE ADDITION OF A NON-HOSPITAL FORMULARY DRUG

LISTED IN THE PNDF TO THE HOSPITAL FORMULARY
1. Generic name of the Drug _
2. Composition of the proposed dosage form. (Active and inactive constituents)
•
3. Is there any similar acting drug in the Formulary? -----:,---_--:-=--:--,-
If yes, specify the drug(s). State its advantage(s) over the specified drug(s).
4. Available pharmacological data (including toxicity, contra-indications and precautions with

reference).
5. Summary of clinical experience with the drug.
6. Suggested directions for use to be included in the monograph for the drug in the Formulary,
if accepted.
Proposed by: _ Date:

Physician
Endorsed by: _ Date:

Head/Chairman of Department/Service
Pharmacy and Therapeutics Committee Action:
_ _ _ _ _ _ _ Approved Disapproved
_ _ _ _ _ _ _ Approved for further evaluation
Secretary; Pharmacy and TherapeuticsCommittee Date

i"
FORM NO. 2
PTe HOSPITAL FORM
PROPOSAL FOR DELETION OF A DRUG

IN THE HOSPITAL FORMULARY
1. Generic name of drug: _
2. Reasons for the proposal: _
3. Available pharmacological data with reference:
Proposed by: _ Date:

Physician
Endorsed by: _ Date:

Head/Chairman of Department/Service
Pharmacy and Therapeutics Committee Action:
_ _ _ _ _ _ _ Approved Disapproved
_ _ _ _ _ _ _ Approved for further evaluation
Secretary, Pharmacy and Therapeutics Committee Date

".
FORM NO.3
Name of Hospital
Address
RECOMMENDED DRUG FOR INCLUSION IN THE PNDF
The following drug(s) is/are recommended by ~
Service/Department
for inclusion in the PNDF.
•
GENERIC NAME
Reasons for the inclusion of the said drug(s) in the PNDF is/are the following:
a.
•
b.
c.
d.
Prepared by:
r
Secretary/Member, PTC
Date: ~ _
Recommending Approval by:
DR. _
Chairman, PTC
Date: _ _-----'-----' _
FORM NO. 4
Name of Hospital
Address
Date: _
RECOMMENDATION OF THE PHARMACY AND THERAPEUTICS COMMITTEE

ON DRUG'S) FOR INCLUSION IN THE PNDF
Respectfully endorsed to the Chairman, National Drug Committee (NDC), of the National Drug
Policy (NDP), Department of Health, the recommendation of the Chairman, PTC
DR. the drug(s) stated therein for inclusion to the PNDF.
Chief/Director of Hospital
New drugs not listed in the PNDF but are being proposed for inclusion
in the hospital formulary should likewise be submitted to the PTC
who would then forward it to the DOH-NDC. It should be
accompanied by an endorsement of approval from the hospital chief
using Drug Request Forms No.3 and 4. .
2. Investigational Drugs or drugs for investigation purposes must be
approved by the appropriate regulatory agency for the specific use of
its principal investigator through the COHo It must be approved by
the hospital's Human Subjects/Ethical Committee and by the PTC,
for the patient's safety. A protocol of the study must be submitted to
the. pharmacy and the drug may be stored and dispensed in
coordination with the principal investigator.
It shall be the responsibility of the pharmacy to prepare and to make
available to the nursing service, summaries of the basic information
on investigational drugs. .
3. The pre-signing of prescription blanks on drug orders, for any purpose,
is prohibited.
4. To make it easier for both patients and prescribers, and for accounting
purposes, prescribing should follow a one item per prescription form
process.
5. The Pharmaceutical Service shall dispense drugs in accordance with
the implementing rules of the Generics Act of 1988 and the formulary
system to avoid duplication of inventory and achieve cost containment
6. Product defects or problems encountered with drug suppliers should
be reported to the NDC/Bids and Awards Committee of the DOH
through the PTC for appropriate action.
7. Drugs and medicines dispensed to in-patients:
7.1 The amount and/or quantity of oral medications to be
dispensed should preferably be sufficient for a whole day's
supply during workdays (Monday through Friday) and for
the entire weekend.
7.2 Injectables and expensive medications should be dispensed
every eight (8) hours only.
7.3 All drugs not used because of death or changes in prescribed
medication should be returned to the pharmacy for appropriate
disposition. It may be destroyed or if there werechanges made,
these should be indicated and reported to the business office.
7.4 To eliminate pilferage of medications, oral liquids, infusion
solutions, and antibiotics, vials for injection should be
dispensed marked with indelible ink showing the hospital's
name and the phrase "NOT FOR SALE" on its original label
with the tlaps removed.
7.5 Before filling and dispensing drugs, prescriptions must be
checked against doctor's medication order in the patient's
chart to avoid inconsistencies on medication prescribed, (e.g.,
continuance of drug beyond-a reasonable period). Findings
must be reported to the PTG
39
Z6 Automatic cancellation of all other medications should be

made, except when the order specifically indicates otherwise,
on: a) Delivery of patient to the OR
b) .Transfer of patient to another service.
A new order shall be written subsequent to these cancellations.
Consultation by a medical staff member representing another
service does not automatically cancel medication orders.
Z7 The physician may telephone orders to the nurse-in-charge in
the event that orders have been omitted or when it is impossible
for the physician to personally write the orders. The orders
shall be recorded in the physicians's order sheet followed by
the name of the physician giving the order and the name of
the nurse receiving the order.
Z8 Dual orders shall be checked or repeated to the physician by
the person receiving the order. Particular care shall be given
to see to it that the dose and route of administration are
included in the order.
Z9 Any question thai may arise regarding medication orders
should be referred to the physician writing the order. ,
i
8. Reporting Medication Errors
If an error occurs in the administration or application of medication,
the proper official should be informed immediately. Medication errors
should not be discussed with the patient. A detailed account of the
error, whether of omission or commission, should be prepared with
duplicate and forwarded to the proper official.
9. Other policies that may be considered:
9.1 The Pharmacymust maintain an up-to-date listof dangerous drugs.
9.2 Policies on Dangerous Drugs
The PTC shalldevelop policies on the proper administration
of dangerous drugs under reasonable medical staff control
such as:
9.2.1 All drug orders for dangerous medication (prohibited
and regulated) such as narcotics, sedatives, hypnotics
and anticoagulants shall be automatically discontinued
after 48 hours, unless
a. The order indicates an exact number of doses to be
administered;
b. An exact period of time for the medication is
specified; or
c. The attending physician reorders the medications.
9.2.2 Dangerous drugs shall be dispensed only upon receipt
of a duly signed prescription form issued by the DDB
and in case of exempt preparation (those containing
negligible quantities of dangerous drugs), the ordinary
prescriptions shall be used, including 52 license and
PRC registration numbers.
9.2.3 In cases of emergency: Pursuant to Board Regulation
No.4 s. 1973, dated 03 April 1973;
40
Hospital Pharmacy Management Manu3J
Subject:
Emergency cases under which prescriptions need
not be accomplished on the prescribed prescription
forms (DDBForm No. 1-72) for dangerous drugs.
Pursuant to the powers vested in the
DDB under Section 36 (a) ofRA 6425, as amended,
and for the purpose of Section 25 (b), also of the said
Act, relating to emergency cases under which
prescriptions need not be issued in the official'
.prescription forms for dangerous drugs;
Board Regulation No.4 s. 1973 dated 4 April 1973,
Section 1
The following are specified as fulling within the
category of emergency cases:
a) Where the prescription has to be issued to a patient
whose need for dangerous drugs is immediate and
urgent and has been brought about by the effects,
or during the course of natural and other
calamities, such as typhoons, earthquakes,
conflagration, etc., df such a .magnitude as to
preclude prompt access to the official prescription
forms for dangerous drugs;
b) Wherethe needfor prescribing the dangerous drugs has
risen as a result of a serious accident necessitating the
administration of thedrugsat the scene or in the vicinity
of the accident and the required prescription forms are
not readily available;
c) Where the need for the dangerous drug is urgent
and its ready availability may, in the opinion of
the prescribing physician, spell the difference
between the life and death of the patient, and for
unavoidable and justifiable reasons, the prescribed
prescription form is not within access.
Board Regulation No.4 s. 1973 dated 4 April 1973,
Section 2
In every case where the exempting provision of
Section 25 (b) of RA 6425, as amended, is availed of,
the prescribing physician shall certify, at the back of
the ordinary prescription physician form utilized, as
to the nature, time and place of the emergency
conditions and the name and address of the patient,
and shall see to it that his (physician's) full name and
address is indicated in printed form beneath his signature.
He shall also. strictly comply with the requirement
in said Section 25 (b) that the prescribing physician
shall, within three (3) days from issuing such
• prescription, inform the Board of the same in writing.
41
r
9.2.4 Procedural Requirements in Case of Loss of Dangerous

Drugsas stated in Board Regulation No.3 s. 1983 dated
20 July 1983.
Section 1
General Requirements -Where the dangerous drugs
are lost by theft or robbery, through breakage of the
container or through other accidents, the person with
whom possession and responsibility for the drugs
repose at that time, shall inform the Dangerous Drugs
Board, by telephone or other possible means, of such
loss within twenty-four (24) hours from the time the
breakage or accident occurred or from the time the
theft or robbery was discovered. He shall also
immediately execute an affidavit in quadruplicate
indicating the kinds and quantities of the dangerous
drugs destroyed and the circumstances involved, with
affidavit together with a copy of the invoice covering
the purchase of such drugs, shall be forwarded to the
DDB within seventy-two (72) hours from the date of
occurrence or discovery of the breakage or other
accidents, theft, or robbery.
Section 2
Additional Requirements in case of loss due to
theft or robbery - Documentary evidence that the local
police authorities were notified shall accompany the
affidavit.
Section 3
Ocular inspection and investigation by Drug
Regulation Officers and referral to the National Bureau
of Investigation - upon receipt of the information
made through the telephone or any other possible
means referred to in Section 1 hereof, Drug Regulation
Officers of the Board shall immediately undertake an
initial ocular inspection and investigation at the site
where the loss occurred to verify the reported
circumstances. The results of such inspection and
investigation together with the affidavit and other
documentary evidences shall be referred to the National
Bureau of Investigation (NBI) by the DDB for
investigation as to the veracity of statements and the
liability, if any, of the person involved in the loss.
Section 4
Procedures in case the loss occurs outside the Metro
Manila Area - The provisions of Section 1 - 3 hereof
shall apply except that the required report by telephone
or other means shall be made directly to the Regional
Drug Regulation Officer of the DOH deputized as
such by the DDB under Board Order No.2, series of
42
·,l
1983, copy attached, and having jurisdiction in the

region. The required referral for investigation shall
be made by the said Drug Regulation Officer to the
head of the nearest branch of the NBI. Said NBI
Official shall thereafter cause the conduct "of the
necessary investigation and· submit his
recommendations to the DDB.
Section 5
Records - Copies of the affidavit and the
documentary evidence shall be retained and filed with
the records of the Board on the person, establishment,
agency or institution involved.
,
9.2.5 DDB Form No. 13-73 (see p. 44), shall be .used by

pharmacists in hospitals in keeping records of
dangerous drug dispensed in the in-patient wards of
the hospital;
9.2.6 When dangerous drugs are issued as stocks,
replenishments are made only upon presentation of a
duly accomplished form conforming to DDB Form
No. 13-73.
9.2.7 DDB Form No. 14-73 (see p. 45) shall be submitted to
the DDB by the hospital pharmacists dispensed to
.inpatients of the hospital every 6 months.
9.2.8 .All original prescriptions of dangerous drugs should
.be kept for one year from the date of sale or delivery
of such drug;
9.2.9 Maintain and keep an original record of sales,
purchases., acquisitions and deliveries of dangerous
drugs indicating therein the:
a. License number and address of the pharmacist;
b. Name, address, and license number of
manufacturers, importers or wholesalers, from
whom the dangerous drug(s) has been purchased;
c. Quantity and name of dangerous drug purchased
or acquired;
d. Date of acquisition or purchase;
e. Name, address, residence certificate number of the
buyer;
f. Serial number of the prescription;
g. Nameof doctor,dentist, veterinarian issuing the same;
h. Quantity and name of the dangerous drug sold or
'delivered;
I. Date of sale or delivery.
I 43
I
FORM NO.5
DDB FORM NO. 13-73
Name of Hospital
Address
RECORD OF DANGEROUS DRUGS DISPENSED FOR

IN-PATIENTS IN HOSPITALS AND SIMILAR INSTITUTIONS
GENERIC
Name of Dangerous Drug Dispensing Pharmacist _ Date _
Amount Receiving Nurse'--:- _
Amount Carried Over _
FUll NAME OF PATIENT BED DOSE TIME DATE FUll NAME OF NARro11C DDB SIGNA1URE OF IlAIANCE
NO. o OF OF PRESCRIBING uc NO. I'RESClUPIlON ADMINISTERING
ADM. ADM. PHYSICIAN FORM NURSE
Serial No.
,
FORM NO. 6
DDB FORM NO. 14-73
Name of Hospital
Address
SEMI-ANNUAL REPORT OF DANGEROUS DRUGS DISPENSED IN IN-PATIENT

WARDS OF HOSPITALS AND SIMILAR INsrrnJTIONS FOR 1HE
PERIOD ENDING , 19 _ _
NAME OF DRUG STOCK AMOUNT FROM WHOM AMOUNT BALANCE

ON HAND PURCHASED PURCHASED (DURING
(AT THE THE SEMS)
START OF
THE PERIOD)
..
SUBMITTED BY: _
Hospital Pharmacy Man.agement Manual
92.10 Board Regulation No. 6A s. I9ll9 dated 19 October I9ll9

Subject:
Increasing the Quantity of Morphine or Pethidine
that can be Prescribed Exclusively for Cancer Patients
in one (1) DDB Prescription Form or Acquired
Through Local Purchase Form for Dangerous Drugs,
and Other Conditions.
Section 2
A physician shall not prescribe in one (1) yellow
prescription form (DDB Form No. 1-72) Morphine
or Pethidine in excess of the following quantities:
a. Tablets (oral) - 42 pieces
-not to exceed 2.1 g ofPethidine or 840mg. of Morphine
b. Vials / Ampules - 28 ml
- not to exceed 1.4 g (Pethidine)
- not to exceed 448 mg. (Morphine)
If the dangerous drugs prescribed exceed the above
quantities dispensing thereof shall be done through
DDB Form No. 8-72.
a. Tablets (oral) - 84 pieces but not to exceed:
- 4.2 g of Pethidine
- 1.68 g of Morphine
b. Vials / Ampules - 56 ml
- not to exceed 2.8 g (Pethidine)
- not to exceed 896 mg. (Morphine)
Section 3
The provisions of the Generics Act of 1988
notwithstanding, prescriptions for dangerous drugs
such as Morphine and Pethidine shall continue to be
filled in accordance with Board Regulation No. 11, s.
1973, dated 31 July 1973 (Filling of Prescriptions for
Dangerous Drugs);
Section 4.
Morphine or Pethidine shall be prescribed in only
one (1) dosage form in one prescription.
Section 5
If no instance shall Morphine and Pethidine be
prescribed together at one time.
Section 6
If neither Morphine nor Pethidine is available,
another prescription for the other drug may be issued
but only after the first prescription.has been retrieved,
canceled and retained by the physician.
46
:"9. IV-len";... --,.---
Ifboth are not available, then the prescription shall

be canceled by the physician. In the case of dangerous
drugs covered by DDB Form No. 8-72, the form shall
be returned to the Board or the RegionalHealth Office,
as the case may be for cancellation. After its
cancellation, a new form shall be issued to obtain the
available drug of choice and the same procedure
indicated in Section 2 of Board Regulation No.6, s.
1989 shall be observed.
Section 7
In prescribing dangerous drugs for cancer patients,
the physician shall in clear and unequivocal terms,
indicate in the prescription the diagnosis of cancer.
10. Development of Emergency Drug List

Time is of the essence in most emergencies such as cardiac arrest, etc.,
therefore, it is a must for emergency drug boxes/cabinets to be readily
available for the patients. Its daily checking is a joint responsibility
of the pharmacist and nurse supervisors.
• 11. Adverse Drug Reaction (ADR) Reporting Program
Several countries in the world conduct national reporting programs
for ADRs. Most programs rely on voluntary reporting by physicians,
and in some cases, reporters are appointed to coordinate this activity
in hospitals. This is one of the responsibilities of the PTe. However,
a subcommittee can be organized to work closely with the PTC. The
PTC should be the repository for adverse drug reaction reports since
the committee is the one responsible for accepting and deleting drugs
• in the hospital formulary. As such, the committee should be provided
with continuing feedback of significant drug therapy problems in
the hospital.
These reports can in turn be reported to the entire medical staff
through the pharmacy bulletin or other hospital publications.
Problems related to drug administration can be solved through close
coordination with the nursing staff in establishing parameters for
monitoring drug therapy, collaborating in-patient education and
. discharge planning, and providing routine drug information.
• 12. Drug Utilization Review (DUR)
With the abundance of drug products which do not reflect the actual
health needs of patients in hospitals and considering the limited
financial and manpower resources, it is important to improve the
quality of drug use within a health care organization. The development
of an evaluation process would lead to corrective measures in drug
utilization for patients and reduction in cost of care.
Drug utilization is defined as an authorized, structured, and
continuing program which reviews, analyzes and interprets patterns
of drug use in a given health care delivery system against a
predetermined standard.
The predetermination of standards of care provides both scientific
validity to the work and in most cases, acceptability by the hospital
staff.
47
Hospitsl Pharmacy Management Manual
MEDICATION AND RELATED ACCESSORIES

FOR EMERGENCY TREATMENT
AMINOPHYLLINE 25 myml, IOml amp (IV) 2 amps
ATROPINE S04 lmg/ml, Iml amp (1M, IV) 3 amps
CALCIUM GLUCONATE 10mylOml 3 amps
CHWRPROMAZINE 25myml, 2ml amp (1M, IV) 2 amps
as Hel
DEXAMETHASONE 4myml, 2ml vial (1M, IV) 2 vials
as Naphosphate
DIAZEPAM Smg/ml, 2ml amp 3 amps
DIPHENHYDRAMINE SOmyml amp, I ml as Hel 3 amps
DIGOXIN 250mcyml, 2ml amp (1M, IV) 3amps
as Hel
DOPAMINE 4Omyml, 5ml vial/amp (IV) 3 vials
as Hel
EPINEPHRINE lmg/ml, Iml amp (SC, 1M) 3 amps
as Hel
FUROSEMIDE IOmyml, 2ml amp (1M, IV) 3amps
as Sodium
HEPARIN 1000 IU/ml, 10ml vial (IV) 2vials
as Sodium
HYDRALAZINE 2Omyml, 1ml amp (1M, IV) 2 amps
as Hel
HYDROCORTISONE SOmyml, 2ml vial (1M, IV) 3 vials
as Na Succinate
HYOSCINE N-BUTYL 20myml amp (IY, 1M) 3 amps
BROMIDE
LIDOCAINE 100myml, 5ml amp . 2amps
(N Infusion as Hel)
•
LIDOCAINE 1% & 2%, 50ml vial as HcI 2 vials
MAGNESIUM S04 25% amp (1M, IV) 2 amps
MANNITOL 20%m 250ml bottle 2hots
METOCLOPRAMIDE Smg/ml, 2ml (1M, IV) as HcI 3amps
MORPHINE 10myml, 1ml amp (SC, 1M, IV) 3 amps
as S04
NALOXONE 400mcyml, lml amp (SC, 1M, IV) 3amps
as HcI
•
48
Hospital Ph.armacr Mana$ement Manual

•
NAWXONE 400mcg/ml, lml amp (SC, 1M, IV) 3 amps
as Hc1
OXYTOCIN 5 lU/ml, lml amp (IV) 2 amps
(SYNTHETIC) 10 IU/ml, lml amp (IV) 2 amps
PHENOBARBITAL 60 mg/ml, 2ml amp (1M, IV) . 2 amps
SODIUM
PHENYTOIN SOmg/ml, 2ml amp (IV) 2 amps
as Sodium
PETHIDINE Hcl SOmcg/ml, 2ml amp (SM, 1M, IV) 2 amps
PHYTOMENADIONE IOmg/ml, Iml amp 2 amps
(ViI. Kl) as Sodium Diphosphate
POTASSIUM 2mEcVml, 20ml vial 2vials
CHLORIDF (IV Infusion)
RANITIDINE or 25mg/ml, 2ml amp (1M, IV) 3amps
• CIMETIDINE 100 mg/ml Zml amp (1M, IV) 3amps
SODIUM lmeq/ml, IOml vial (pedia)
BICARBONATE 84meg(lmeq/ml) 50ml vial (adult) 4 each
(IV Infusion)
SODIUM CHLORIDE 2.5Eq/ml, 20 ml vial (IV) 2vials
TERBUTALINE S04 500mcg/ml, 1ml amp 1vial
(IV Infusion)
PYRIDOXINE Hcl 100 mg/ml, 10 ml vial (1M, IV) 3 vials
NIFEDIPINE 5 mg capsules 20 caps
(use sublingually) 10 mg capsules each
FLUIDS WITH SETS
DEXTRAN 70 500mi 2 bots
(High Molecular WI.)
DEXTRAN 40 500mi 2 bots
(Low Molecular WI.)
DEXTROSE 5% LR 500mi & I liter 2 bots
1000 ml 2 bots
DEXTROSE 5% NSS 500mi 2 bots
DEXTROSE 5% H2O 500mi 2 bots
1000 ml 2 bots
LACTATED RINGER'S 500mi 2 bots
. SOLUTION 1000 ml 2 bots
49

DEXTROSE 50% SOml 2vials
DEXTROSE5% IN 250 ml 2 bats
.3 %Nacl 500 ml 2 bats
PLAIN NSS 1000 ml 2 bats

BALANCED MULTIPLE
MAINTENANCE SOLUTION
WITI-l DSW
PEOIA (Infants) 250ml + 500 ml 2 bats each
ADULT &CHILDREN 1000ml 2 bats
BLOOD ADMINISTRATION
SET 2 sets
N ADMINISTRATION SET
WI AIR VENT FILTER
ADULT 2 each
PEDIA 2 each
N CATI-lETER 14, 16 &18 G, 22 &25 2 each
SCALPVEIN 19, 21, 23, 25 G 2 each
NASo-PHARYNDIAL
AIRWAY, SMALL,
MEDIUM, LARGE 1each
INTRACARDIAC NEEDLE 18&20G 2 each
SUCTION CATI-lETER 2each
SYRINGES 2ml 2 each
5ml 2 each
20ml 1each
50ml 2 each
WATER FOR INJECTION
(Triple Distilled Water) 50ml or 100ml I vials
NEEDLES 16, 18, 20 &22 G 2 each

FILES FOR AMPS
TORNIQUET RUBBER
RESUSCIli\NTS/ANTISEPTICS
ALCOHOL 70% 1Gal
"
( POVIDONE-IODINE PAINT 10% lOml bot
•
50
,
Hospital-Pharmacy Management ManuaJ-

POVIDONE·IODINE 10% 1Gal
SOLUTION
POVIDONE·IODINE
SlJF[;ICAL SKIN CLEANSER 7.5% 1Gal
HYDROGEN PEROXIDE 3% (480 ml) 2 bots
SOLUTION
POTASSIUM PERMANGANATE 2 liters
CRYSTALS FOR SOLUTION
1:1000 - 1:10,000 for
wounds and ulcers
(freshly prepared)
NOTE: These are to be used only in life-threatening situations. Once

they have been used, immediate replenishment must be made
• by the pharmacy to ensure their availability at all times.
51
i-
Drug usage in hospitals is divided into three stages:

1. The first stage consists of the discovery and introduction of
new drugs which have played an important role in the
treatment of illness.
2. The second stage is drug standardization necessitated by the
influx of duplicate brands and similar type drugs which is
achieved through a hospital drug formulary based on the'
PNDF.
3. The third stage involves an evaluation of the utilization of
drugs which have been accepted into the formulary. For
example, was the correct antibiotic selected by the physician?
Could a less expensive antibiotic be used? Was the drug
continued on the patient for a longer period of time than was
necessary?
The goals of drug utilization review should be neither

regulatory nor punitive but rather" educational in nature and
purpose. Drug utilization review should not seek to identify
isolated instances but should rather identify overall trends. Review
of these data base usually leads to the study of drugs that are of
substantial clinical or financial importance. The result revealed
the need to develop appropriate educational programs. The
authority for a drug utilization review program should come
from the hospital administrator and the medical staff, and it can
be carried out as a function of the PTC or its subcommittee. In
planning for drug utilization review, the needs of the hospital
and its program objectives should be considered. Consideration
should be given to whether the program will be separate or part
of an overall hospital utilization review; whether it will cover all
drugs in the hospital or a specificdrug category or just a particular
drug; whether it will cover the entire hospital or only a portion of
it; and whether it will be prospective, concurrent or retrospective.
Selection of a drug category to initiate a drug utilization
program is usually not difficult, with few exceptions. Most drug
utilization review programs throughout the world have already
began by reviewing antibiotics within a hospital. Several reasons
were cited:
1. Antibiotics is one of the most widely prescribed categories of
drugs in the hospital. It is estimated that 40-50% of the
patients in general hospitals receive antibiotics;
2. Antibiotics are used by almost all of the medical departments of a
hospital; .
3. Antibiotics can be seeoed on thebasis of objertive criteria in most cases;
4. Objective therapeutic endpoints, such as fever, heart rate,
etc., can be used to monitor efficiency;
5. Antibiotics represent a frequent and sometimes serious cause
of adverse drug reactions;
6. Antibiotics represent the single greatest expense within the
pharmacy department's drug budget.
•
52
Hospital-Pharmacy Management Manual
A system should be established for collecting and orgaruzmg

data. This refers to the process of collection, sorting, storing, and .
retrieving data. It may be done manually, semi-automated or
automated, and the source documents may be prescriptions, chart
orders, patient profile records and physician's order forms. When
data have been made available for a systematized collecting,
sorting, retrieving and arranging process, they can be translated
into patterns of utilization.
Data on antibiotics dispensed for patients by the hospital
pharmacy will be developed for computer storage and retrieval.
The data will be collected by a pharmacist and a physician
specializing in infectious diseases.
The following types of data files can be developed and obtained:

I. Antibiotic file - those used in the hospital
2. Infection file - those seen .in the hospital
3. Microbiologic file obtained from diagnostic laboratory to
include antibiotic sensitivity data
~. Patient file identifying medical record number, name, service,
sex, age, race, and diagnosis
• 5. Physician file identifying physicians on clinical services
responsible for patient care
6. Patient drug profile - identifying medications with corresponding
dosageand allergy if any, name, sex, age, race, physician, diagnosis,
and laboratory test/diagnostics used if any
Files will be interlocking to facilitate the retrieval of the

following information:
• I. Total antibiotic usage in the hospital by dosage and cost;
2. - Antibiotic usage by medical service;
3. Antibiotic usage by physician;
4. Microbiological isolates by type and antibiotic sensitivity; and
5. Infections diagnosed in the hospital by medical service. ,
The basic requirements of a OUR Program are as follows:
I. Authority for the program (from the medical staff or hospital
administration).
2. Adequate data base for study.
3. Use of predetermined criteria.
4. Use of appropriate audit methodology in data retrieval.
5. Analysis of data.
6. Educational or corrective action or both (when appropriate).
7. Re-audit
8. Documentation and report of all activities and results.
53
i·
Responsibilities of the pharmacist in these include the following:

1. Preparing, in cooperation with the medical staff, drug use
criteria and standards.
2. Obtaining quantitative data on drug use (e.g., information on
the amounts and types of drugs used, prescribing patterns by
medical services, and of patients). These data will be useful
in setting priorities for the review program.
3. Reviewing medication orders against the drug use criteria
and standards.
4. Consulting with prescribers on the results obtained from the
first three (3) items. .
5. Participating in the follow-up activities of the review programs (e.g.,
educational programs directed at prescribers, development of
recommendations for the formulary and changing drug control
procedures in response to the results of the review process).
The intent of guidelines is to provide a framework which

pharmacists could follow in developing individual DUR programs
or in participating in patient care audits at their hospitals.
Pharmacists should assume an active role in quality assurance
activities in their institution that deal with the use of drugs.
In summary, a drug utilization review program can achieve
the following hospital goals:
1. Improvement in the levelof patient care and often a reduction
in the cost of care;
2. Improvement in the management and utilization of hospital
resources;
3. Improvement in terms of the clarification of the drug
component of patient care; and
4. Improvement in the fact-finding capacity thai can contribute
to both the identification and solution of hospital problems.
13. Infection Control

The importance of infection control programs in hospitals is widely
recognized, which requires the maintenance of an active multi-
disciplinary infection control committee.
•
The basic responsibilities of the committee are as follows:
I. Development ofwritten standards forhospital sanitation and asepsis;
2. Development and promulgation of procedures and techniques for
meeting these standards and monitoring compliance with them;
3. Development and implementation of a system for eliciting,
reporting and evaluating data concerning infections in the
hospital's patient and personnel populations; and
4. Development and implementation of a system for the routine
surveillance and review of antimicrobial use within the hospital
. in cooperation with the PTe.
54
a u=OI(
As health care providers, the pharmacists have a clear responsibility

toparticipate in infection control programs ~ responsibility borne
out of their education and training, particularly, from their
understanding and influence over antibiotic use in the hospital.
Furthermore, the pharmacist's effectiveness in infection control and
antibiotic use/review can best be realized through this Committee.
These responsibilities extend to the following areas:

1. The Control of nosocomial infection
2. Promotion of the rational'use of antimicrobial agents
3. Reduction in the cost of care
4. Education'
RESPONSIBILITIES AND PARTICIPATION

OF PHARMACISTS IN THE:
1. Control of Nosocomial Infection
I.I Participate in the affairs of the Infection Control
Committee/program.
1.2 Advise the hospital in the selection and use of appropriate
antiseptics, disinfectants and sterilizers.
I.3 Establish pharmacy policies, procedures and quality control
programs to prevent contamination ofdrugs products prepared
in or dispensed from the Pharmacy Service. Of paramount
importancein this area is the preparationand handling ofsterile
products. Other considerations include (but not limited to)
provisions for cleaning various articles from the phannaceutical
equipment such as trays, laminar-airflow hoods, bulk
• compounding equipment, counting dispenser, etc.) and
establishment of appropriate personnel policies (e.g., limiting
the activities of staff memberswho exhibit symptoms of cold,
flu or other infectious condition).
1.4 Encourage the use of single dose packages of sterile drugs
instead of multiple dose containers.
1.5 Recommend policies for the frequency of changing N
sets and other N administration equipment and dressings.
1.6 Recommend proper storage of sterile and reconstituted
• products and multiple dose containers (if used).
2. Promotion of Rational Use of Antimicrobial Agents
This responsibility extends to the establishment of measures
foe minimizing the development of resistant strains of
microorganisms as well as maximizing the chance of successful
, therapeutic outcomes in individual patients. Functions related
to this responsibility include the following:
2.1 Work within the PTC structure to control the number and
types of antibiotics and other antimicrobial agents
admitted to the formulary. Both therapeutic and
microbiological factors and cost-containment
. considerations should justify such decisions.
55
2.2 Collaborate with the medical staff in establishing policies

related to prophylactic antibiotic use, restricted use of
specific antibiotics and other antimicrobial agents.
2.3 Establish and operate (in coordination with the medical
staff) an ongoing concurrent-prospective antibiotic use
review program for assessing and improving the quality
of antimicrobial therapy.
2.4 Generate and analyze quantitttive data on antirniaobial drug use.
2.5 Work with the microbiology laboratory to improve microbial
sensitivity screening tests and the reporting of their results.
2.6 Workwith the concerned individuals and committees within the
institution responsible for selecting and controlling N sets,
infusiondevices and other equipment and paraphernalia related
to N and antibiotic administration.
3. Educational Activities
This responsibility extends to other health professionals,
patients and the public.
Specific Functions include the following:
3.1 Conduct in-service educational programs, clinical
conferences, and other types of presentations for health J
professionals on appropriate topics including (but not
limited to) the following:
3.11 Antimicrobial therapy;
3.U Decontaminating agents (disinfectants, antiseptics,
sterilizers);
3.13 Aseptic technique and procedures; and
3.14 Sterilization methods
3.2 Educational and counselling in-patients, ambulatory care
patients in the following areas:
3.211mportance of compliance with prescribed directions
for antibiotics (and all other drugs);
.3.22 Other information necessary for safe and appropriate
drug use (e.g., whether or not to take the drugs with
meals);
3.23 Instructions on storage conditions, including drug
administered through home care programs; and
3.240ther infection control procedures to be followed in
a home care patient's household.
3.3 Establish and conduct ongoing quality assurance activities
and in-service presentations to pharmacy staff on
appropriate topics including but not limited to:
3.11 Aseptic techniques and procedures;
3.3.2 Sterilization methods; and
3.3.3 Environmental quality control (e.g., laminar-airflow
hood checks)
3.4 Participate in public health education and awareness campaigns
concerning control of the spread of infectious diseases.
56
14. Antidotes for Poisoning

When poisoning occurs,the physician must be preparedto give appropriate
treatment immediately. A delay of 30 minutes is often fatal
The pharmacist's responsibility is to make the General Antidote and
specific antidotes available at the Emergency Room.
FIRST-AID MEASURES IN POISONING

These first-aid treatments can be performed by anybody. However,
for ingested poison; treatment laymen should not attempt treatment.
Treatment should be done by experienced medical personnel especially
if the patient is coI?,vulsing or unconscious.
The following may be performed for specific emergency treatments:
Inhaled Poisons:
I.Bring the victim to open air immediately and loosen tight
clothing.
2. Give artificial respiration by direct inflation, if respiration is
depressed. Remove vomitus and objects from the patient's
mouth, hold chin-up, tilt the victim's head back as far as
possible, and blow into mouth or nose until chest rises. Repeat
20 times per minute. There is a need for medical aid unit to
facilitate oxygen administration.
3. Conserve body warmth by wrapping the patient in blankets,
if necessary.
Skin Contamination
•
(Avoid contaminating operator)
I. Drench skin with water in tub or shower.
2. Drench skin with a stream of water while removing clothing.
3. Cleanse skin thoroughly with soap and water.
4. Do not attempt to use chemical antidote.
Eye Contamination
I. Holding the lids apart, wash the patient's eye for 5 minutes
with running water at eye fountain or with gentle stream of
water from a hose or tap to dilute and remove the poison.
2. Do not attempt to use chemical antidotes.
Snake Bite
I. Immobilize patient and bitten part immediately.
2. Transport patient with as little movement as possible to the
nearest treatment facility. Speed is essential.
3. Give specific antiserum as.soon as possible.
4. Incision and suction of the bite area is too hazardous for
emergency use.
57
Subcutaneously Injected Overdose of Drugs:

1. Keep patient reclined.
2. Apply a rubber band tourniquet (1 x 50 em) near the site of
the injection. The pulse beyond the tourniquet should be 10
beats for every minute.
3. Transport patient to treatment facility.
Identification of Unknown Toxic Agent:

The following information is useful in attempting to identify a
toxic agent. -
1. Physical state (solid, liquid, gas)
2. Odor
3. Trade name
4. Use
5. Presence of poison level
6. Inflammability warning
NOTE: Containers should be availablewhen calling the Poison
Information Center 1
Emergency Telephone Numbers if available
Hospital _
Police
Pharmacy _
58
;
Hospital Pharmacy Management Manual,
LIST OF ANTIDOTES
L General Antidotes: Core
Activated Charcoal, USP
Oral: Powder given as slurry
Sodium Sulfate
Oral: Powder (10 g & 30 g packets)
2, Specific Antidotes; Core

Acetylcysteine
(for paracetamol [acetaminophen] poisoning)
Oral: 200/0 solution (plain) 2 ml & 5ml ampule
Alcohol, Ethyl
(for methyl alcohol poisoning)
Ini: absolute 1ml ampule (IV)
Antivenom (Cobra Antivenom)
(for snake bite poisoning)
Inj: . 800 m.u.j5 ml ampule (IM,IV)
Ascorbic Acid (Vitamin C)
(for methemoglobinemia)
Inj: 500 mg/2 ml, ampule (IV)
Atropine
(for organophosphate and carbamate insecticide poisoning)
Oral: 600 meg, (0.6 mg.) tablet ) (as sulfate)
lnj: 1mg.jml ampule (1M, IV)
'Deferoxamine (I)
(for iron poisoning)
Inj: 500 mg. vial (IV) (as mesylate)
'Dicobalt Edentate (I)
(for cyanide poisoning)
Ini: 15 mg./ml, 20 ml ampule (IV)
'Dimercaprol (1)
(for mercury and arsenic poisoning)
Inj: (in oil) 50 mg.jml, 2 ml ampule (1M)
Diphenhydramine
(for phenothiazine extrapyramidal side effects)
Inj: 10 mg.jml, 10 ml vial (1M, IV) )
50 mg.jml, 1 ml ampule and }
10 ml vial (1M, IV) )
(as hydrochloride)
• Not available in the market

(1) specific expertise, diagnostic precision, or special equipment required for proper use,
59
Hospital. Pharmacy Management Manual
LIST OF ANTIDOTES
Edrophonium
(adjunct for cobra bite)
Inj: 10 mg/ml, 1 ml ampule (1M IV)
(as chloride)
Flumazenil
(for benzodiazepine poisoning)
Inj: 100 mcg/ml, 5 ml ampule (slow N infusion)
Leucovorin Calcium (folinic acid)
(for drug induced megaloblastic anemia)
Inj: 3 mg.fml, 1ml & 10 ml ampule (1M, IV)
50 mg. and 100 mg. vial (1M, IV) ,
'N-Acetyl Penicillamine (I)
(for copper poisoning)
Oral: crystals
Naloxone
(for opioid poisoning)
Inj.: 20 mcg (0.02 mg.) ml, 2 ml ampule (neonatal)
(as hydrochloride)
400 mcg (0.4 mg.) ml, I ml ampule (SC, 1M, IV)
(as hydrochloride)
'Penicillamine (I)
(for heavy metal poisoning such as mercury and copper)
Oral: 250 mg. tablet/capsule
Physostigmine
- ;;
(for atropine poisoning) •
Inj: 1mg.fml ampule (1M, IV), (as salicylate)
Phytomenadione
(Phytonadione, Vitamin KI)
(for warfarin poisoning)
Inj: 10 mg/ml, 1 ml ampule (1M, IV)
(as sodium diphosphate)
Protamine Sulfate
(for heparin overdosage)
Inj: 10 mg/ml, 5 ml ampule (IV)
Pyridoxine (Vitamin B6)
(for Isoniazid poisoning)
Inj: 50 mg.fml, 10 ml vial (1M, IV)
100 mg.fml, 10 ml vial (1M, IV)
(as hydrochloride)
Sodium Calcium Edentate (I)
(for lead poisoning)
In]: 200 mg.fml, 5 ml ampule (1M)
Not available in the market

(I) Specific expertise, diagnostic precision, or special equipment required for proper use.
60 j
\ !'
Hospital Pharmacy Management Manual i"
I
I
I
II
LIST OF ANTIDOTES
I
I
COMPLIMENTARY LIST I
I
Colestyramine I
(for organochlorine insecticide poisoning) I
I
Oral: Powder, 4 gsachet i
I
I
Menadione (Vitamin IG)
I
(for warfarin poisoning) I
Oral: 10 mg. tablet I
(as sodium bisulfate and sodium diphosphate) I
lnj.: 10 mg. ampule I
• (as sodium diphosphate)
I
I
I
Methylthioninium Chloride
(Methylene Blue) (I)
(for methemoglobinemia)
lnj.: 30 mg/ml, 10 ml ampule (IV)
'Pralidoxime Chloride
not available
(for organophosphate insecticide poisoning)
Inj.: 50 mg/ml, 20 ml vial (IV)
'Sodium Nitrite
Inj: 30 mg/ml, 10 ml vial (IV)
'Sodium Thiosulfate
Inj: 250 mg./ml, 50 ml ampule (IV) .
• Not available in the market

(1) Specific expertise, diagnostic precision, or special equipment required for proper use.
61
I', Hospital Pharmacy Management Manual
15. Disaster Plan for the Pharmacy Service

Disaster may occur at anytime and can result from natural
phenomena such as earthquakes, hurricanes, floods, tornadoes,
volcanic eruptions and tidal waves, or from accidental or nuclear
disasters. A disaster has been defined as a sudden calamitous event
bringing great damage, loss or destruction.
Hospitals have traditionally acknowledged their responsibility to
have developed plans for handling mass casualty emergencies in
accordance with their responsibility to provide the best possible care
and treatment to the communities they serve.
Each type of disaster, whether natural, accidental or nuclear,
requirespecificpersonnel and material resources and facilities different
from one another.
Any plan dealing with a major disaster should follow these basic
principles:
1. It must be simple
2. It must be capable of taking effect immediately
3. It must be flexible to allow for variations in the type of disaster
4. It must be adaptable to nights and weekends when the number
of available staff is less than during the normal day staffing
5. It should follow normal hospital procedure, as much as
possible to avoid the confusion of a disaster situation and
because only a small number to whom the disaster plan is
issued will actually read it.
In consideration of these broad principles, institutions have used

a number of options in writing their disaster manuals in the
establishment of procedures for disaster preparedness. Disaster
manuals should be concise and are best expressed in lists, charts, or
in a loose-leaf form for ease of updating.
Specifically, the disaster goals for a Pharmacy Service can be

outlined as follows:
1. To contact and provide sufficient pharmacy personnel to
perform the required pharmaceutical services for both disaster
victims and the patient needs within the hospital; and
2. To establish a method of obtaining and providing an efficient
supply of pharmaceuticals meeting the disaster needs.
The disaster alert plan may follow a format similar to that of the
service organizational chart. The plan may outline the following:
1. Reference to the possible number of casualties of the disaster.
2. Pharmacy personnel and their telephone numbers.
3. The sequence of telephone calls that are to be made by the
respective pharmacy personnel on duty when the disaster alert
is called.
4. Areas of service responsibility once the pharmacy personnel
arrive within the hospital. •
62
I
Disaster Communications and Personnel Assignments:
Disaster communications for the Pharmacy Service follow the same

basic principles outlined above in case of disaster. The service disaster plan
can be described as follows:
SIMPLE - It is similar in format to the Pharmacy Service organizational
chart. Personnel assignments and responsibilities are almost identical
to that of the organizational chart.
FLEXIBLE - type of disaster (and potential number of casualties) can be
easily adapted and communicated followingthe format ofthe disaster
alert plan. Roman numerals adjacent to each of the names of
pharmacy personnel indicate the type of disaster condition called
(ex. Condition I - 5 to 50 victims. Condition II-50 to 100 victims,
Condition III - over 100 victims). Following this format, the
appropriate number of specific pharmacy staff can be summoned
depending on the type of disaster.
.A DAPTABLE - It must be adaptable to days, nights and weekends.
Depending on when the disaster alert is called, pharmacy personnel
may be on duty at the hospital, staffing their respective positions, or
if they areoff-duty, once they arrive at the hospital, they assume
their responsibilities as outlined and/or as assigned in the disaster
alert plan.
NORMAL HOSPITAL PROCEDURE - Since the plan follows the outline
of the pharmacy organization chart, it allows the pharmacy staff to
follow normal hospital procedures and to automatically assume their
respective positions. As such, the disaster plan can be easilyadapted
even in the confusion, noise, and tragedy that goes with disaster
situations.
Supply of Pharmaceuticals
The second goal of the pharmaceutical disaster plan which is to obtain

and provide an efficient supply of pharmaceuticals, can be met by observing
the following:
A. Emergency room and disaster chart medications
B. Emergency procurement
1. Pharmaceutical manufacturers
a. Pharmaceutical and N solutions
b. Drug information
2. Drug wholesalers
3. Local community and hospital pharmacies.
Note: List their telephone numbers
Pharmaceuticals that may be considered for a disaster cart, solely for

immediate treatment and use in triage areas,are those in the list of emergency
drugs. (See Medication and Related Accessories for Emergency Treatment,
chapter 5, p. 48 - 51.)
63
-
Hospital Ph.armacy Management Manual
B. lHE HOSPITAL FORMULARY/

FORMULARY SYSlEM
Since the treatment of patients in hospitals depend on the effective use
of drugs, a program of objective evaluation, selection, and use of medicinal
agents in hospitals, should be established., Such program is the basis of
rational drug therapy and the hospital formulary concept is a method for
providing such program. The formulary is the document while the formulary
system is the way by which the document is developed. It is a powerful tool
for improving the quality and controlling the cost of drug therapy in the
hospital.
DEFINITION:
HOSPITAL FORMULARY - is a continually revised compilation of
pharmaceuticals which reflects the currentclinical judgement ofthe medicalstaf£
A hospital formulary is useful to the medical staff since without this,
they become dependent on the exaggerated claims of medical salesmen.
HOSPITAL FORMULARY SYSTEM - is the method wherebythe medical
staff of a hospital, working through a PTe, evaluates, appraises, and selects
from among numerous available medicinal agents and dosage forms those
that are considered most useful in patient care.
Basic nomenclature in the understanding ofthe formulary system requires

knowledge of the following terms:
GENERIC NAME OR GENERIC TERMINOLOGY- is the identification
of drugs and medicines by their scientifically and internationally
recognized active ingredients or by their official generic name as
determined by the BFAD of the DOH.
INN - is an abbreviation for International Non-proprietary Name (generic
name).
CHEMICAL NAME - is the description of the chemical structure of the
drugs or medicines and serves as the complete identification of a
compound.
ACTNE INGREDIENT - is the chemical component responsible for the
claimed therapeutic effect of the pharmaceutical product.
BRAND NAME -It is the proprietary name given by the manufacturer to
distinguish its products from its competitors.
PURPOSE OF TI-lE HOSPITAL FORMULARY SYSTEM
I. Serves to educate the physicians concerning the relative merits of the

multitude of available drugs, and, thus, provide rational therapeutics
and eventually promote better patient care.
2. Serves as a teaching aid to the interns and other medical staff by
providing a well-classified arrangement of therapeutically known
medicinals which have been chosen after careful consideration by
experienced members of the hospital staff.
3. Preventsunnecessary duplication, waste, confusion and, thus, promote
economy both to the hospital and to the patient.
4. Supplies essential information to the medical/nursing staff on the

multitude ofavailable therapeuticagents which they cannot be expected
to remember.
5. Serves as a valuable teaching tool to the interns, resident physicians,
pharmacists, students, and graduate nurses, and provides some
semblance of standard nomenclature for medical records.
6. Promotes safe, intelligent, and eff<;,ctive therapy in a hospital.
THE HOSPITAL FORMULARY
One of the functions of the PTC is to develop and constantly revise a

drug formulary accepted for hospital use.
Since the formulary is the vehicle by which the medical and nursing
staff make use of the system, it is important that it is complete, concise and.
easy to use. This section of the manual will serve as an aid to the pharmacists
in the preparation of a formulary for their hospital as well as for those who
wish to improve an already existing hospital formulary based on the
Philippine National Drug Formulary (PNDF).
Formulary service gives the hospital pharmacists time: time to work with the
medical staffin the selective evaluation of newdrugs, time to really organize and
,plan for interesting and stimulating meetings of the PTC; time to work with the
nursing staff in the elimination of practices and procedures which may lead to
medication errors; time to encourage the medical staff to undertake an objective
audit of the discriminate use of therapeutic agents, and to enter other' areas for
promotion of rational drug therapy; and time to cooperate with the medical and
nursing staff in numerous areas involving broad policies concerning the use of
drugs in the hospital.
The formulary system does not replace but rather complements the work
of the PTe. It is a working tool which can be used by physicians and
pharmacists to make the formulary system of each hospital a dynamic and
ever-changing compilation of modern medicinals selected with
, discrimination.
•
FORMULARY CONTENT AND ORGANIZATION
The primary objective of the formulary is to provide the hospital staff

with the following:
1. Information on what drug products have been approved by the PTC
for patient use.
2. Basic therapeutic information about each approved item.
3. Information on hospital policies and procedures governing the use of
drugs.
4. Special information about drugs as drug dosing guidelines, hospital
approved abbreviations, sodium content of various formulary items, etc,
65
f
DETAILED PARTS OF THE FORMULARY:
1. Information on hospital policies and procedures concerning drugs:

I.1 Categories ofdrugs including formulary drugs, investigational
drugs. Investigational drugs include such items as restrictions
on use and procedures for requesting that drug should be
added to the formulary,
1.2 Brief description of the PTC, including its membership,
responsibilities and operation.
1.3 Hospital policies governing the prescribing, dispensing and
administration of drugs including policies to be followed by
pharmaceutical company/suppliers representatives, standard
drug administration times and the reporting of adverse drug
reactions and medication errors.
1.4 Pharmacy operating procedures such as hours of service, out-
patient prescription policies, pharmacy charging system,
prescription labelling and packaging practices, in-patient drug
distribution procedures, the handling of drug information
requests and other services as patient education programs
and pharmacy bulletins.
15 Information on using the formulary, including how the
formulary entries are arranged, the information contained in
each entry and the procedures for looking up a given drug
product. Reference to sources of detailed information on
formulary drugs should be included here.
2. Drug Product Listing
This part is the heart of the formulary. It consists of one or more
descriptive entries for each formulary item plus one or more indexes
to facilitate use of the formulary.
Formulary Item Entries - the entries can be arranged in several ways:

1. Alphabetically, by generic name;
2. Alphabetically, within therapeutic class;
3. A combination of the two systems whereby the bulk of the
drugs are contained alphabetically in a general section which
is supplemented by several specialsections such as ophthalmic/
otic drugs, dermatological and diagnostic agents; or
4. Dosage form as oral tablets and capsules, oral liquid/syrups/
suspension/parenteral injectables as ampules/vials, etc.
Information to be included in each entry willvary. At a minimum,

each entry must include the following:
1. Generic name ofthe basic drug entity or product/combination
products;
2. Dosage form(s), strength(s) packaging(s) and size(s) stocked
by Pharmacy; and
3. Formulation (active ingredients) of a combined product.
66
Indexes to the Drug Products Listing:

There are two indexes which can be included at the beginning or
end of this section which will facilitate the use of the formulary.
a. Generic name of drug items
b. Therapeutic/Pharmacologic index
This is a listing of all drug items within each therapeutic
category. It is useful in ascertaining what therapeutic
alternatives exist for a given situation such as patient allergy
to a particular drug.
3. Special Information
The material to be included should be of general interest to the hospital
staff not readily available in other sources such as:
a. List of Hospitals - approved abbreviations
b. Rules for calculating pediatric dosages
c. Table of sodium content of antacids
d. List of the contents of emergency cart/boxes/cabinets (See
Medication and Related Accessories for Emergency Treatment)
e. Dosage guides for patients with impaired renal functions
f. Metric conversion scales and tables
g. Examples of formulary request forms and prescription blanks
h. Important provisions of the Generics Act on prescribing and
dispensing especially thorough erroneous violative and
impossible prescriptions
I. Tables of drug interactions
J. Poison antidote charts
TYPICAL FORMAT AND APPEARANCE OF A FORMULARY
The physical appearance and structure of a formulary is an appearance

which would exert an influence on its users although elaborate, expensive
artwork and materials are unnecessary. The formulary should be visually
pleasing, understandable, and must appear professional. The need for
proper grammar, punctuation, correct spelling and neatness is obvious.
A typical formulary might have this composition: .

1. Title page
2. Names and titles of the members of the PTC
3. Table of Contents
4. Information on hospital policies and procedures concerning drugs
a. Objectives and operation of the formulary system
b. Hospital regulations' and procedures for prescribing' and
dispensing drugs
c. Hospital pharmacy services and procedures
d. Directions on how to use the formulary
67
,
\ '.
.
5. Products accepted for use at the hospital

a. Items added, deleted and requested for inclusion to PNDF \
consistent with the revision made by the NDC;
b. Pharmacologic/therapeutic index;
c. Description of formulary drug products by pharmacologic/
therapeutic class.
6. Appendix
a. Rules for calculating pediatric doses.
b. Schedule of standard drug administration times
c. Forms for addition to/deletion from formulary and other
important forms.
Suggestions that can be used to improve the appearance and ease of use
of the formulary are:
I. Making use of different colors of paper for each section of the
formulary;
2. Making use of an edge index;
3. Developing a pocket-sized formulary that can fit laboratory coat/uniform
pockets. A small-sized book formulary is also recommended sinoe it can be
carried in the physician's bag along with prescription blanks;
4. Printing the generic name ofeachdrug entry in boldface type or using some
other method for making it stand out from the rest of the entries.
KEEPING THE FORMULARY CURRENT
Generally, the formulary will need to be revised annually. Additions

and deletions to the formulary, changes in drug products, removal from/
addition to PNDF of current edition and changes in DOH policies, laws,
rules, and regulations related to drugs, hospital policies and procedures will
necessitate periodic revision of the hospital formulary. Any changes in the
current edition of the hospital formulary and formulary supplement sheets
can be attached to the inside back covers of the formulary book. For ease of
information regarding brand names, the pharmacist can put up a list of
brand name drugs cross-indexed with that ofthe generic index ofthe hospital
formulary (see section on Drug Information Service).
68
INVENTORY AND PURCHASING
A. INVENTORY MANAGEMENT
Inventory Management refers to the sum total of those activities necessary
for acquisition, storage, sale, disposal, or use of materials. .
FUNCTIONS:
1. Operational" to ensure the adequate supply of drugs conforming
with the requirements of the hospital turn-over at a reasonable rate -.",
without carrying excess quantities.
2. Financial" to optimize the inventory investment at a given time,
reduce the cost of handling, storage, issuance, interest and at the
same time avoid losses from deterioration, expiry dates, pilferages
and fulling prices.
The general objectiveof all inventory policies must be to keep investment

at the lowest level with the needs of the hospital. In requisitioning the drug
needs, a pharmacist must think in terms of: .
The information on the balance of the revolving fund;
The conditions such as seasonal, etc.;
Transportation and delivery time problems;
Availability of alternate drugs; and
The ratio of supply and demand.
The problem of overstocking and understocking of drugs can be

attributed to the following: :,. r
\. ,!!',
1. Ineffective purchasing administration without any control system;
2. Lack of technical requirements attached to the
documents (e.g., BFAD Test Results);
3. Poor storage facilities;
4. Problem of availability;
69
/.---------------------~
5. Transportation and delivery problems, etc.;

6. Geographical and climactic conditions; and ,
7. Time lag between requisition and purchase. \ •.
/
OBJECTIVES AND REQUIREMENTS

OF INVENTORY MANAGEMENT
I. To have the stock available when and where needed;

2. To reduce undue strain on the government's scarce resources;
3. To maximize utilization of available storage facilities;
4. To provide area for cost reduction on drugs without compromising
quality; and
5. To ensure minimal waste/expired drugs through proper storage
management.
PURCHASING AND INVENTORY CONTROL

As provided for in the policies of hospital operation and as per PTC
policy, the pharmacist is responsible for checking the drugs to be stocked in
the hospital. He/she is held responsible and accountable for all drugs
purchased. The pharmacist is also responsible for developing an effective
system in the control of purchase, inventory, and adequate maintenance of
raw materials used for compounding and for pharmaceuticals.
In the discussion, the constant use of the following terms are to be
defined:
I. Purcbsse- to obtain by paying money or its equivalent, to buy for a price.
2. Inventory- an itemized list of goods with their estimated worth: The
cost of medicines and drugs transferred to the pharmacy for sale/
issuance to patients; specifically an annual account of stock taken in
any business
3. Control- to exercise directing, guiding or restraining of power over.
This serves to point the subject of the pharmacist's role in the purchase
and inventory control of drugs and related supplies. Considering the
purchase of drugs and related supplies as a specialty, the pharmacy is the
only service in the hospital where purchasing is done without implying that
pharmacist performs the function of actual procurement totally independent
of the supply officer. The pharmacist and the supply officer should work
hand-in-hand, each recognizing the importance of the function of the other.
As the requisitioning officer, a pharmacist is responsible for the preparation
of the complete specifications of all necessary drugs for the actual purchase
based on all pertinent data available in the pharmacy. The pharmacist is
the key link between the medical staff through the PTC and the DOH
Bidding Committee, to ensure that the hospital receives for its patients,
drugs which are purchased with greater consideration on quality, economy
and optimum inventory control.
70
As per NationalBudget CircularNo. 321 COA Circular No. 80-128:

1. All Chiefs of Hospitals/Sanitaria shall determine the quantity of
medicines and drugs to be kept in stock by their respective units.
This information shall be submitted to the Health Secretary who is
authorized to fix the amount from appropriation for MOOE in every
hospital/sanitarium to be 'earmarked for the purchase of medicines
and drugs for stock and resale;
2. The ceiling fixed by the Health Secretary shall mean the total cost of
medicines and drugs that shall be in stock at any given time including
undelivered purchases;
3. The cost of medicines and drugs for initial stocking purposes shall be
funded out of appropriation for the MOOE fund of the hospital/
sanitarium and thereafter, shall not exceed the cost of consumption
of drugs and medicines for three (3) months based on the average
quarterly consumption of the immediate preceding twelve (12) months
plus the current official government inflation rate;
4. All proceeds (cost plus profit) from sale of medicines and drugs shall
be deposited in an authorized government depository bank and shall
be made available for the procurement of medicines and drugs for
replenishment or for increase in the ceiling previously authorized.
Withdrawals from the bank account shall be done bearing the joint
signatures of the representatives of the hospital/sanitarium concerned
and the COA;
5. Cost of medicines and drugs dispensed to charity patients shall be
reimbursed with an equivalent amount from the regular appropriation
of the hospital/ sanitarium concerned;
6. Any increase in the amount of the ceiling previously authorized by
the Secretary of Health shall be subject to the approval of the Budget
Secretary. Such increase shall be taken first from the excess of the
fund if any, and the appropriation for MOOE of the hospital
concerned shall only be used when there is no excess available.
TAKING A PHYSICAL INVENTORY

The taking of total physical inventory in the pharmacy is a COA
requirement. It ensures that the hospital's fiscal operation is properly recorded
and that adequate inventory is maintained. A spot check type inventory is
sometimes performed on high cost and fast moving items.
To avoid faulty inventories, the actual physical inventory should be
undertaken placing a great deal of emphasis on planning and giving due
attention to details. . '
Drug items' ordered prior to the dateof the inventory and received on
the day of the inventory or shortly thereafter, should not be counted and
should be clearly marked received "post inventory". Maintaining a perpetual
inventory is still ideal if the record-keeping can be kept up-to-date,
Perpetual Inventory - a perpetual inventory system may be applied to
the bulk storage areas. This means that when an item is removed from the
bulk storage areas to the active storage area for use in the dispensing area, it
is recorded as being rer~oved from inventory. Inventory supply is used as
the determining factor of when to reorder.
71
,----------------:'---------
A perpetual system may be facilitated either through a manual system

ofvisible index cards (still the current practice) or by means of an electronic
data system. The use of any of these systems would provide a hospital with
a record of all inventory items, a maintained balance in quantity and
monetary value.
B. PURCHASING
1. PURCHASE TIiROUGH PUBLIC BIDDING
In the national government agencies, contract shall be generally awarded
to the most attractive offer. In making the award, the following factors
should be considered:
a. Conformity with the specifications stated in the invitation to bid;
b. Price quoted, considering the Flag Law; Commonwealth Act 138, as
amended, and other laws and policies pertinent to procurement. .
c. When time is the deciding factor, the bidder who offers to deliver
within the period stipulated in the invitation to bid shall be awarded
the contract, provided that the price is not unreasonably higher than
the lowest price offered;
d. All other things being equal, the bidder shall be preferred, in order to
obtain uniformity in quality, tensile strength, color shade, etc.; and
e. Reliability of bidders as supplier or contractor.
Division of award may be made only in either of the following cases:

1. In case of tie offers and the supplies are divisible; the award may be
divided equally unless the interest ofthe servicedemands that it should
be given to only one dealer;
2. In case the lowest bidder offers to supply a limited or partial quantity
only, therefore, the balance may be awarded to other acceptable bidders
in the order of advantage of their offers.
2." EMERGENCY PURCHASE

• In the national and corporate government agencies, emergency purchases
are allowed only in cases where the need for supplies, materials, furniture,
equipment or repair of an equipment is exceptionally urgent or absolutely
indispensable to prevent immediate danger to, or loss of, life and/or property,
or to avoid detriment to public service. They should be based on a canvass
of prices of at least three bonafide dealers (EO 302 s. 1940).
. An emergency purchase shall be invariably supported by a certification
.' by the agency head or his duly authorized representative (a)as to the necessity/
justification for said purchase and (b) that the price paid or contracted for
is reasonable and was the lowest obtainable at the time of the purchase or
order (COA Cir. 78-84, Aug. I, 1978):
The amount involved in an emergency purchase should not exceed the
limitations provided for in the corresponding Annual Appropriations Act,
board resolutions or regulations (COA Cir. 78-84, supra).
.72
3. NEGOTIATED PURCHASE
Negotiated purchase is a system of purchase which dispenses with the
stringent requirements of public bidding. Purchases through this mode
may be allowed in the following cases (Sec. I, EO 301 s. 1987).
a. Whenever the supplies are urgently needed to meet an emergency
which may involve the loss of, or danger to life and/or property;
b. Whenever the supplies are to be used in connection with a project
or activity which cannot be delayed without causing detriment
to public service;
c. Whenever the materials are sold by an exclusive distributor or
manufacturer who does not have sub-dealers selling at lower prices
and for which no suitable substitute can be obtained elsewhere;
d. Whenever the supplies under procurement have been unsuccessfully
placed on bid for at least two consecutive times, either due to lack of
bidders or the offers received in each instance were exorbitant, or do
not conform to specifications;
e. Whenever it is apparent that the requisition or the needed supplies
through negotiated purchase is most advantageous to the government
to be determined by the department head concerned;
f. Whenever the purchase is made from an agency of the government.
4. PROCUREMENT FROM DUIY-llCENSED

MANUFACTIJRERS AND FXCLUSIVE DISTRIBUfORS
Procurement may be made directly from duly-licensed Philippine

manufacturers. In cases where there are two or more producers/suppliers of
the supplies desired, bids of the known manufacturers/distributors should
be made to obtain the lowest price for the quality of supplies desired (Sec.
370, RA 7160).
Procurement from exclusive Philippine agents or distributors.
Procurement in the case of supplies of foreign origin, may be made
directly from the exclusive or reputable Philippine distributors or agents
subject to the following conditions: .
a. That the exclusive Philippine distributor has no sub-dealers selling at
lower prices; and
b. That no suitable substitutes of substantially the same quality are
available at lower prices.
The foregoing transaction shall, however, be invariably supported by.

the following certificates:
I. A certificate executed by the supplier that he is the exclusive
manufacturer or dealer of a specific supply, duly-attested by the foreign
or local principal, and that there are no sub-dealers selling at lower
pnces;
2. A certificate by the requisitioning officer (approved by the agency
head) that there are no suitable substitute of substantially the same
quality available for the supplies/materials/equipment which are
exclusively manufactured or distributed.
73
5. PROCUREMENT1HROUGH
TIlE PROCUREMENT SERVICE
Byvirtue of the abolition of the General Services Administration under

Executive Order No. 285, dated 27 July 1987, the functions of the Supply
Coordination Office have been transferred to the Procurement Service,
under the Department of Budget and Management (DBM), with respect to:
a. Operation of a government-wide procurement system for common-
use office supplies; and
b. Monitoring of prices for common-use supplies, materials and equipment
However, agencies are allowed to procure directly for emergency needs

whenever there is a significant delay in the delivery of urgently needed supplies
by the procurement service, subject to existing accounting and auditing
. rules and regulations.
6. PROCUREMENT FROM OTIIER

PHILIPPINE GOVERNMENT AGENCIES
OR FOREIGN GOVERNMENTS
a. Procurement from other Philippine government entities.

Procurement may be made direct from government entities producing
supplies to fill the needs ofthe government (Sec. m., RA 7160).
Thus, schooldesks and office furniture may be procured from government
schools ofarts and trades or vocationalschools or from the Bureau ofPrisons.
For standard and accountable forms of national, provincial, city
and municipal governments, including government corporations, the
printing, binding and distribution thereof, shall be undertaken by
the National Printing Office (Sec. 6, EO 285 s. 1987).
b. Purchase from foreign government entities.
Procurement of supplies may be made through foreign government
entities with which the Philippines maintains diplomatic relations.
Purchases under this mode shall be made only upon prior authority
from the Office of the President (Sec. 372, RA 7160).
7. PURCHASE THROUGH REPEAT ORDER
Purchase through a repeat order is a procurement where an agency buys

from the same supplier the same items at the same prices in addition to the
quantity in the original contract, subject to the following conditions:
a.· The price must be the same or lower than the original price.
b. The repeat order will not result in splitting of requisitions or purchase
orders.
c. Repeat orders may be availed of only within a six (6) month period
from the date of the original purchase.
d. The repeat order should not exceed the quantity in the original order.
e. - The total price of items covered by the repeat order should not exceed
P 50,000 except when the previous purchase was done through public
bidding. (COA Cir., 85-55(A), supra).
74
Hospital·Pharmacy·Management Manua].
CONTROL ON PURCHASE
In determining how much drug should be ordered at a given time, It IS
important that it is achieved through a satisfactory inventory turnover.
The hospital pharmacist should control purchase volume and inventory
considering the use/or the consideration of the following:
1. Balance of stock - balance of stock on hand at the pharmacy plus
those stocked in the storeroom.
2. Establishment of the Ordering Point orReorder Quantity Level (RQ!..)
utilizing the form Stock Position Sheet for slow and fast-moving drug
items.
To arrive at this stage of the process, the average consumption rate per
day is determined. e.g., Beginning month balance stock of 5,400
vials with an end balance of 1,800 vials; 5,400 vials - 1,800 vials =
3,600 vials consumed in a month.
3,600 vials.
120 vials/day consumption
30 days
To finally accomplish the Stock Position Sheet for each drug item to
be attached to the RIVs prior to actual procurement, the factor to
consider is the LEAD TIME. Lead Time means from the time the
pharmacist prepares the RIVs and the whole process of purchasing to
the time of the delivery of drugs to the hospital, (e.g., if it takes 15
days as the lead time, with the rate of 120 vials/day, there is a need to
have at least a balance on hand of 1,800 vials to be able to maintain
the continuity of supply). Generally, stock balance of drugs and
medicines is maintained at 50% for fast-moving items.
3. Dead Inventory - refers to expired and damaged drugs. For proper
disposition/condemnation, use the Waste Material Form.:
Given these factors, the pharmacist can proceed making orders not
exceeding the three (3) month consumption allowed by the General
Appropriations Act. While it is true that the recent development in
computer science have made inventory control easier, a computer is a
pre-requisite for tertiary level hospitals, but not necessarily for small
hospitals. The concept of inventory control may also be applied to a
manual system. At present, the ledger type is still used in most
government hospitals. This type has an advantage since it allows re-
checking by the recorder.
The government hospital pharmacies may adopt the simpler method

which is a very workable one other than the scientific methods as:
a. ABC stratification (separating stock items of small, medium and
high value items)
b. Determination of the Economic Order Quantities (EOQ}
c. Determination of re-order points and safety stocks
,•
75
Hospital PharmacY Management Manual
Semestral Submission'of Required Drugs

and Medicines. for Official Price List
ReSPQnsibility ActiQn
Department Heads/Pl'C 1. Submits list of drugs and medicines

needed by the respective departments
to the PTC, for evaluation and
endorses the same to the Pharmacist
Pharmacist 2. Consolidates drug and medicine

requirements Qf departments
indicating therapeutic classifications
on generic nomenclature with complete
drug and medicine specifications,
initials and forwards it to the
Chairman, PTC for recommendation
Chairman, PTC 3. Recommends approval Qf list and

forwards it to the COH
Chief of Hospital (COH) 4. Approves list and returns to Pharmacist
Pharmacist 5. Forwards list of hospital request tQ the

DPC or the Region or the DOH-PLS
Procurement and Logistic 6. Consolidates lists and

Service (PLS)jDrug prepares bid documents
Procurement Committee (OPe)
DPC/CBA 7. Conducts bidding and submits results

tQ the Evaluation Committee
Evaluation Committee (EC) 8. Evaluates and submits recommendations

ro DPC/CBA
DPC/CBAjPLS 9. Prepares awards and price list for

dissemination
"or DOH Therapeutics Committee
76
Hospital Pharmacy MiUlagement Manual
Regular Requisition and Procurement

• of Drugs and Medicines
Responsibility Action
Pharmacist 1. Determines stock level and prepares
stock position sheet and Requisition
Issue Vouchers (RNs) of needed drugs
and medicines' with complete
specifications based on the official
price list
• 2. Forwards RIVs to Chief, Medical
Professional Staff or his designate for
review/ initial
Medical Professional 3. Initials RNs and

~I Staff/Chief Designate
Professional Staff
forwards it to the Staff/Designate
Officer or AO
po. Administrative Officer (AO) 4.: Reviews/initials RNs and forwards it

to the COH
Chief of Hospital (COH) 5. Approves and forwards R'Y~o the

Supply Officer
Supply Officer 6. Prepares action documents and

processes it accordingly
•As a general rule, re-ordering point should be at 50% stock level.
.
I-
I
~
77
I'
. Name of Hospital
Address
STOCK POSITION SHEET
Standard Stock Level _ •
Unit _
Quantity
1. Balance on hand
..
2. Items in transit
.,3. This Requisition No. _
4. Total expected stock

. (Sum of Line 1-3)
J
5. Monthly Average Consumption
6. Estimated Number of months

to consume (Line 4 & Line 5)
I hereby certify to the fairness and reasonableness of the above data.
Date Head of Section
NOTE: Attach written justification for requisition in excess of normal requirements.
GAO GEN Circular No. 89 dated May 18, 1989

STORAGE
CENTRAL STORAGE YS.
PHARMACY STORAGE
Storage is an extremely important aspect of the total drug control system
regardless of its location in the hospital. Proper environmental control like
temperature, light, humidity, condition of sanitation, ventilation, segregation,
and security must be maintained whenever drugs and medicines are stored
in the institution. Unless proper storage conditions are consistently and
strictly observed, the medications may accidentally reach the patient in
deteriorated sub-potent state. This will be hazardous to the patient because
the desired therapeutic response will not be achieved and an adverse effect
may be produced by toxic decomposed products.
In most government hospitals, pharmacy inventory is stored centrally
in the supply section of the hospital and proponents to this say that:
There is reduction in labor, accountability and record keeping as well
as tight control; and
Storage space is too small and crowded especially with no proper
ventilation to maintain the potency of the drugs.
. '.
It should therefore be emphasized that the responsibility for the storage
of drugs should be with competent, educated, trained, and licensed persons
like the pharmacists to assure the proper supervision of the storage of
pharmaceuticals. This has been established as one of the DOH policies
with the following advantages:
Allows the proper preservation of drugs to maintain potency for
expected therapeutic value;
Institutes inventory control;
Allows freedom of stock arrangement (alphabetical arrangement is
followed where possible but therapeutic usage is preferred); and
F~cilitates location of the item during the taking of physical inventory
which makes the preparation of inventory cost reports easier.
79
All products ordered by the pharmacy should therefore be delivered

directly to the pharmacy, and if received by the hospital's supply section,
requires the presence of the pharmacist for technical inspection and
immediate transfer to the pharmacy in unopened containers. Other technical
requirements to be considered are as follows:
L Whenever possible, delivery of a drug product must be confined to a
single lot number;
2. As stipulated in the bidding conditions, delivery date of a drug product
should not be within twelve (12) months from its expiration date
except for biologicals; and
3. A small number of the products taken at random sampling from the
delivered products shall be subjected. to laboratory test/analysis by
BFAD at no cost to the institution, chargeable to the supplier/
distributor.
Upon receipt in the pharmacy, the receiver should compare the delivery
receipt with the copy of the Purchase Order (PO) and request for a receiving
slip RNs to be kept on file and posted on ledger cards.
Security is another important aspect of storage. Fixtures and equipment
used to store drugs should be constructed in such a way that drugs are
accessible only to designated and authorized pharmacists and at the same
time designed to facilitate routine inspection of the drug prior to dispensing.
In designing a pharmacy storeroom, the following four distinct areas
should be considered:
,
L Normal Storage Area
Contain the largest pharmacy inventory of liquids, tablets. capsules.
injectables, erc., maintained at 25"C.
<,
2. Refrigerated Storage
Contain all drugs requiring regular refrigeration. Biologicals and
other drugs below freezing temperature would require a separate
freezing compartment.
3. Narcotic Cabinet/Vault
The security of this cabinet/vault should conform with the regulatory
standards of the DDB's Dangerous Drug Act. This includes other
controlled substances as hypnotic and sedatives.
4. Flammable Storage
Contain spark-proof electrical fixture;
There should be a drainage in the room;
Door with protective barrier to prevent liquids from leaking out;
Fire extinguisher
80
MARKING OF STORAGE SHELVES

AND DRUG CONTAINERS
To facilitate inventory and induce orderliness, one must observe the
first-in-first-out system which- shall:
Provide shelf stripping tape with the name, strength, unit size
Each container marked with the date received, cost price and -se1ling price
ANTIBIOTICS/BIOLOGICALS
It requires special control in order to ensure potency at the time of
dispensing and to make certain that the pharmacy is not carrying worthless
stocks in inventory.
Use a form as a record of dated pharmaceuticals.
This includes the name of drug, date of purchase, expiration date, and a
check mark in the box of the appropriate month with the aid ofcolor Codes,
which, at a glance, can show which product is about to expire.
81
HospitalPharmacy Management MailUaI
. Acceptance of Deliveries, Storage

and Preservation of Drugs and Medicines
Supply Officer Receives deliveries in the presence of
the Pharmacist and a representative
from COA and Agency Inspection
Committee
Agency Inspection 2. Takes random samples and forwards it

Coinmittee to BFAD for testing
3. Prepares inspection report, attaches

BFAD test result and forwards it to the
Supply Officer
Supply Officer 4. Prepares voucher for payment, and

attaches inspection reports and other
supporting documents
5. Issues drugs and medicines to the

pharmacist
":.--
Pharmacist 6. Receives drugs and medicines for

proper storage, preservation and
records these accordingly
1I
82
i I
Hospital Pharmacy Management Manual I'

I'
I
I
I
Disposal of Expired or Damaged Drugs and Medicines I
I,
II,
Responsibility Action I
I
Pharmacist 1. Segregates expired or damaged drugs I
and medicines with their specification I
I'
and value in the WasteMaterial Report
(WMR) Gen. Form No. 33 (Use Form \
I'
No.7) I,
I
~ I'
2. Signs and submits WMR to the AO I,
I'
II
Administrative Officer (AO) 3. Reviews and recommends the approval
\' ,
of WMR to-the COH
I'
Chief of Hospital (CO H) 4, Approves and forwards WMR to the

\ :
I,
Resident Auditor I
I
I
Resident Auditor 5. Verifies actual condition of the drugs ,I,,
and medicines recommended for
I'
,
condemnation
I
6. Recommends proper way of disposal, I
signs and returns WMR .to the \
pharmacy for appropriate action" I

I
I
I
Pharmacist 7. Informs Disposal Committee I
I
I
Disposal Committee 8. Conducts proper disposal as I
recommended and forwards WMR to I
I
the Accounting Section for dropping I
from the books of accounts
Pharmacist 9. Drops from the records quantity and

value of disposed drugs and medicines
83
FORM NO. 7
Name of Hospital
Address
REPORT OF WASTE MATERIALS

On hand at ~ _
(State Place ofStorage) (Bureau, Province City orMunicipality)
_ _ _ _~,19_
OUANTITY UNIT DESCRIPTION RECORD SALES

Official Receipt Amount
Number
'1.
2. --
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
TOTAL
Property Clerk or Storekeeper

First Endorsement
_ _ _ _~,19_
Respectfully forwarded to the

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _~, for action.
(Signature of Chief of Bureau or Office)
(Official Title)
r
CERTIFICATE OF INSPECTOR
_ _ _ _ _~.19_
I HEREBY CERTIFY that this property was disposed of as follows:
Items Destroyed
Items Sold at public auction
Items Sold at private sale
Items Transferred without cost to
Items Continued in service
WITNESS TO DISPOSITION:
(Signature) Property. Inspector
(Official Designation)
Second Endorsement
Respectfully returned to the _:---;-:--:-:-----=-_--,_ _--,-::-----'-_= hereby approving the

action of the property as contained in his foregoing certificate. The proceeds from the
sale should be taken up as credit to _
(Signature of Chief of Bureau or Office)
(Official Title)
..
J
,I
86
•
DRUG DISTRIBUTION
IN-PATIENT DRUG DISTRIBUTION
Drug distribution is one of the primary responsibilities of the hospital
pharmacist. It eats up a major portion of a pharmacist's time. Drug
distribution in filling and dispensing prescription drugs should be in
accordance with the Generics Act of 1988, DD Act, Food, .Drugs, Devices
and Cosmetics Act and the Pharmacy Law.
To ensure that patients receive the correct drugs at the proper time, the
pharmacist must be responsible for the following:
1. The distribution and control of all drugs within the hospital on a 24
hour service, including controlled substances as narcotics,
investigational drugs, and those brought in by patients;
2. The procurement and maintenance of an adequate supply of drugs
throughout the hospital;
3. Compounding, manufacturing, packaging and labelling of drugs; and
4. Preparation of drug formulations needed (for drugs not commercially
available),
Considering the various steps of a pharmaceutical service system, this

manual provide topics on PTC and Hospital Formulary focused on the
selection of the appropriate drugs for hospital use. The same goes for
Purchasing and Inventory Control especially the involvement of the
pharmacist in the procurement of drugs, and the development of a rational
and systematic approach to delivering the drugs' to the patients. It is
important that a dispensing process be developed which will ensure that an
effective form of the correct drug is delivered to the right patient, in the
prescribed dosage and quantity with clear instructions and in a package
which maintains the potency of the drug.
Various methods will be presented for dispensing drugs to in-patients,
so that the hospital pharmacy may select the system or systems that would
best meet the needs of the hospital.
87
DISPENSING PRACTICES
The principles of good dispensing fall into five categories:
1. Interpreting the request (either by prescriptionor by physician's orderform)
2. Retrieval
3. Formulation (compounding, counting, pouring);
4. Processing/labelling
5. Delivery (distribution)
Before dispensing a drug product, the dispenser must clearly know

which drug is being requested. The dispenser must make certain that the
drug order, if written, is legible and decipherable or, if orally received, that
it was clearly understood. Repeating the drug's name to the patient or
physician making the oral request is one way of ensuring that the dispenser
has correctly perceived the drug requested.
Once the dispenser is satisfied and certain of what drug should be
dispensed, the retrieval process begins. A commonly accepted practice
which guards against the dispensing of incorrect dosage forms is to shelve
similar dosage forms together and physicallyseparate them from other dosage
forms. Characteristically, a pharmacy will shelve oral solid dosage forms •
(tablets, capsules) together, all oral liquid dosage forms together, and all .
ophthalmic, topical or insert dosage forms together. This would significantly
reduce the likelihood of inadvertently dispensing the wrong dosage form.
The retrieval process requires that the dispenser carefully read the label
on the stock bottle which includes the product name, strength, dosage form
)
and expiration date. Since many drug names look alike and/or sound alike,
the initial careful reading of the stock drug packagelabel is a critical safeguard
against dispensing the wrong drug. Most pharmacists will repeat this label-
reading process two or more times during the dispensing activity; once,
immediately before the formulation (counting, pouring, compounding) takes
place, and once, immediately after. Stock drugs which are used should be
returned to its original shelf position immediately after formulation. A
third label reading is usually performed at this point.
The accurate formulation or preparation of drugs is of importance both
to the pharmacy and the patient. Pre-manufactured drugs, those not requiring
compounding, generally require either counting, pouring or reconstituting.
The task of counting must be performed accurately since short counts may
result in drug therapy failures. Similarly, over-counts can also spell a
.significant financial loss for the pharmacy operation. Repeated over-counts
can deplete inventory and the loss of revenue can adversely affect the cash
reserve requirements for maintaining an adequate inventory.
Similarly, issuances of drugs must be in controlled quantities for
emergency purposes and not in big quantities to treatment areas most
particularly OR, RR, DR, ICU, etc., which must be avoided to maintain
proper drug distribution system (e.g., issuance of all anesthetics to the
anesthesia service).
88
Issuances in big quantities are already considered consumed and

eventually dropped from the inventory report which will cause:
1. Understatement ofinventory accounts because such items are definitely
still on hand and unused;
2. No control mechanism can be applied which may result in pilferage
and losses; and
3. Non-factual data are reflected in the monthly report on the actual
consumption of drugs for accountability. .
Compounding medications require the special consideration of mixing

order, selection of adjuvant, and the need for special techniques. Once the
compounding procedure has been selected, all necessary materials should
be assembled in a single location on the dispensing counter. As each
ingredient is used, it should be moved to some other established location
on the counter. The use of this technique provides the dispenser with a
mechanical check on the introduction of each ingredient. After completing
the compounding, and allstock drugs are being returned to the shelf, the
dispenser should once again read the drug label to verify the accuracy of the
compounded medication.
The pharmacists' traditional role of dispensing drugs has taken on a
broader meaning in hospitals. The term, "drug distribution systems" is
now used to describe the various methods by which the pharmacy receives
drug orders, prepares the drug for distribution and in turn, distributes the
drugs to the patient care areas.
The methods of drug distribution to hospital in-patients are the

following: .
1. Individual Prescription Order System
Under this system, all drugs are retained in the pharmacy until
receipt of the physician's initial order. The nurse remains responsible
for most aspects of the preparation of the unit doses. Commonly.a
3-5 day supply of medication is dispensed. However, for purposes of
control, this practice varies from hospital to hospital. Some hospital
policies established through the PTC may dispense medication by
shifts or 24 hours supply. This system facilitates a convenient method'
for instituting patient drug charges, and it provides individualized
patient service. Inherent in this system is the possible delay in
obtaining the required medication and the increased personnel
requirements of the Pharmacy Service which are necessary for the
individual prescription dispensing function. However, there are
definite advantages to the system:
a. All medication orders are directly reviewed by the pharmacist;
b. It provides for the interaction of pharmacists, physicians,
nurses, and patients;
c. It provides for a closer control of inventory; and
d. It provides a convenient method for instituting patient drug
charges to maintain good accountability.
89
r.
2. Floor Stock System

Under this system, a bulk supply of each drug product is stored
in the nursing station in advance and the nurse is totally responsible
for all aspects of unit dose (production) preparation as well as
administration. There are advantages and disadvantages to this system.
Advantages:
a. Ready availability of the required drugs for the patient;
b. Eliminates unused drug returned to the pharmacy;
c. Reduces the number of drug order transcriptions for the
pharmacy; and
d. Reduces the number of pharmacy personnel required.
Disadvantages:
a. Medication errors may increase because the pharmacist does
not review the medication orders;
b. Increase drug inventory at each nursing station or other patient
care area;
c. Greater opportunity for pilferage of drugs;
d. Increased hazards associated with drug deterioration;
e. Additional capital funds may be necessary to provide proper
storage facilities for drugs in every patient care area; and
f. Additional nurse's time-required for handling drugs.
3. Combination ofIndividual Prescription Order and FloorStock System

Under this system, the primary means of dispensing is the use of
the Individual Prescription Order System but combined with a limited
number of Floor Stock Items (common non-prescription drugs as
aspirin and other drug products not suitable for individual
prescription order such as rubbing alcohol and other disinfectants,
. erc.). Restricting floor stock drugs to such items provides the best
control to reduce the chance of error.
Deciding which drug(s) should be placed on the floor stock list
rests on the PTC, with inputs from the Pharmacy Service and Nursing
Service. This system is the most commonly used in hospitals which
charge their patients individually for drugs.
4. Unit Dose Drug Distribution System (UDDDS)

The drug distribution systems described above are known as the
traditional systems. The newest system which has received the greatest
amount of study and investigation in recent years is the UDDDS.
Although the concept of unit dose was introduced more than twenty
years ago, most hospitals were slow to implement it, mainly because
of its large initial cost. Furthermore, unlike the traditional systems,
the UDDDS requires a radical increase in pharmacy staff. This would
require a considerable refinement of the Individual Prescription Order
System which is the safest and most economical method for
distributing drugs to health care tacilities. After the intensive cost-
benefit studies of many hospitals in developed countries like the
90
U.S., they found the system favorable for its reduction of medication
errors and the involvement of nurses in medication preparations.
Under this system, the pharmacist prepares every dose of medication
ready for administration, rather than issuing containers of drugs to
nursing units where the nurse prepare the drug for administration.
The term "unit dose", as used by hospitals, refers both to a type
of packaging as well as to a system for distributing the package. Unit
dose medications have been defined as "those medications which are
ordered, handled, administered, and charged in multiples of single
dose units containing a predetermined amount of drug or supply
sufficient for one regular dose, application or use." The concept of
unit dose packaging was used by the pharmaceutical industry for
many years, particularly for sample medications, but it was not until
recent years that it was incorporated into prescription products sold
to hospitals. One of the early dosage forms to be introduced as a
unit dose package was the individual ampule or single dose vial.
Although unit dose drug distribution is the responsibility of the
pharmacy, it cannot be instituted without the cooperation of the
nursing, administrative, and medical staff. Leadership in this system
should come from the hospital pharmacist who should educate the
other members in the concept of unit dose drug distribution.
Advantages of a UDDDS:
I. Patients receive improved Pharmaceutical Service 24 hours a
day and are charged for only those doses which are
administered to them.
2. Since all doses of medications required at the nursing station
are prepared by the pharmacy, the nurses are allowed more
time for direct patient care.
3. Creates a doublechecksystem by allowing pharmacists to interpret
or checka copyof the physician's originalorderbefore dispensing,
and nurses to checkthe dispensed medications befure administering,
thus, reducing medication errors.
4. Eliminates excessive duplication of orders and paper work at
the nursing station and pharmacy.
5. Eliminates credits.
6. Transfers N preparations and drug reconstitution to the pharmacy.
7. Promotes more efficient utilization of professional and
nonprofessional personnel.
8. Reduces revenue losses.
9. Conserves space at nursingstationsby eliminatingbulk floorstocks.
10. Eliminates pilferage and 'drug waste.
11. Extends pharmacy coverage and control throughout the
hospital from the time the physician writes the order to the
time the patient receives the unit dose.
91
Hospital Pharmacy Management Maniial
12. The unit dose package is individually labelled with drug's name,
strength, control number and the package remains intact until the
medication is ready for administration to the patient This reduces
the chance for medication errors and alsoassists in retrieving the
package in the eventof a drug recall
13. Communication of medication orders and delivery systems is
improved.
14. The pharmacists can get out of the pharmacy and on to the
nursing stations where they can perform their intended
function as drug consultants and help provide the team effort
that is needed for better patient care.
The UDDDS may be operated following any ofthese three (3) methods:
1. Centralized, where all drugs are stocked and distributed from
the Central Pharmacy.
2. Decentralized, where the pharmacy is decentralized into
satellite pharmacies, each serving one or more nursing stations.
Each satellite stocks and distributes its own supply of drugs.
3. A combination of centralized and decentralized where the
pharmacy operates with satellites as in No.2 but only starter
doses and emergency doses are issued from the satellites. Refill
doses are issued from the central pharmacy. All other
centralized operations such as packaging and N additive
preparations also emanate from the central pharmacy.
The following outline illustrates the many considerations and steps

involved in planning a UDDDS:
1. Planning overview
1.1 Listing the advantages of the system
1.2 Enlisting support
1.3 Choosing the system
1.4 Establishing baseline
1.5 Setting up a planning body
1.6 Planning and designing the system
1.7 Preparing the policy and procedures manual
2. The demonstration on pilot program
2.I What is it?
2.2 Why do you need it?
2.3 How many beds or nursing units should it cover?
2.4 How long should it run?
. 2.5 Pre and post implementation cost studies
3. Personnel and space
3. I Personnel needs
3.2 Space needs
92
Hospital Pharmiicy Mimagement Manual
4. Drugs, equipment, and forms

4.1 Availab~lity of commercially packaged unit dose drugs
4.2 Unit dose equipment
a. Medication carts
b. Transfer carts
c. Packaging equipment
4.3 Forms
a. Physician's order form
b. Pharmacy patient profile
c. Nurse's medication administration record
5. Drug order and delivery
5.1 Methods of delivery
5.2 Frequency of delivery
5.3 Filling orders
5.4 Intravenous admixture program and its relationship
to unit dose
6. Cost considerations
6.I Where unit dose may raise pharmacy costs
6.2 How unit dose may lower the total drug distribution
costs
7. Charges and billing
7. I Charges under the unitdose system
7.2 Methods of billing under a unit dose system
8. Action time table
9. Expanding the system
9.1 Operating two drug distribution systems at once
9.2 How to expand
93
,.
Filling of Prescriptions for In-patients
Nursing Attendant (NA)I 1. Presents prescription signed by the

Ward Liaison (WL) attending physician to the Pharmacist
Pharmacist 2. If drugs and medicines are not

available, instructs NA/WL/patientl
client accordingly
3. If drugs and medicines are available,
3.1 Fills prescription if patient is

indigent
3.2 Notes prices on prescription if it is
a partial/full pay. Any problem in
the classification of patients
referred to the MSW
MedicaI Social Worker (Msw) 3.3 Reclassifies patients accordingly
Cashier 3.4 Receives payment and issues

official receipt
Pharmacists 4. Indicates OR number in the

prescription and fills the same
5. Records medicine issued and files

prescription
Note: For dangerous drugs, follow procedures for Dangerous

Drugs and Generics Acts.
94
OUT-PATIENT DRUG DISTRIBUTION
A hospitalized patient is usually confined in a specific section where his

environment is controlled, vital signs are routinely recorded, and medications
are scheduled and administered by trained professionals. In contrast, the
ambulatory patient is usually in an uncontrolled environment where vital
signs are not routinely recorded between clinic visits, and medications may
sometimes be taken erratically by the patient. It becomes' apparent that the
medication-related problems of ambulatory patients may often differ from
those typified by hospitalized patients. The ambulatory patient may often
be responsible for his/her own health care. In addition, with regard to
prescribed drugs, it is possible that the patient may be taking over-the-counter
medications obtained from outside pharmacies or other retail outlets or
medications obtained from family members or friends. Therefore, it is
likely that no single health professional may be completely aware of the
patient's total medication regimen.
Faced with these potential problems, the hospital pharmacist should, in
addition to properly dispensing prescription, provide extended
pharmaceutical services like drug counselling. This type of service will guide
the patient in the proper use of medication and a better understanding of
the medication he/she is taking.
Location of Out-Patient Dispensing Area:
There a~ three equally suitable provisions for this area:

1. A separate out-patient pharmacy;
2. A combined in-patient and out-patient unit with service provided
from the same window; and
3. A combined in-patient and out-patient unit with service provided
from separate windows.
The most important consideration should be for the out-patient

pharmacy to be close to the out-patient clinics. If the clinics are distantly
removed from the in-patients area, it is necessaryfor the out-patient pharmacy
to be isolated from the in-patient pharmacy. This will require planning for
transporting drugs and supplies from the main pharmacy to the out-patient
pharmacy. It will also require additional staffing as well as extended
management control by the chief pharmacist.
DISPENSING PRACTICES
Dispensing .pattern in filling out-patient and discharge prescriptions is

similar to that of the community pharmacy. The difference particularly
lies in large volume out-patient pharmacy which follows this assembly line
procedure:
1. One person receives the prescription from an "in window"
2.' Another person types the labels
3. Passes to the pharmacist who fills the prescription
4. Hands it to the patient at the"out window"
95
Although this procedure facilitates speed, it allows for errors if proper

checks are not instituted. The use of nonprofessional personnel may be
incorporated in this assembly line assisting the pharmacist in dispensing
large volume although there has been a debate as to what functions the
non-pharmacist may perform. While it is generally accepted that a
nonprofessional can type prescription labels, in the interest of the patient's
safety, it is a good practice for a pharmacist to receive the prescription from
the patient discussing any necessary information about the prescription,
before the assembly line procedure begins. It is likewise advisable for the
pharmacist to hand the completed prescription to the patient and discuss
the directions and any precautionary information. It is sometimes necessary
for the pharmacist to improve upon the directions which the physician has'
specified. For example, a sign of "one Q!D" would indicate, "take one
capsule 4 x a day." It may be necessary to expand this to "For infection,
take one capsule 4 x a day before meals and at bed time until all capsules are
consumed."
In addition to the assembly line procedure, there are two (2) other
systems which greatly hastens the overall dispensing of out-patient
prescriptions as well as reduces staffing needs.
1. Strict adherence to the hospital formulary which is the practice in
.DOH hospitals; and
2. Efficient pre-packaging program.
In utilizing the formulary system, the medical staff should be made aware that
the pharmacy will carry only one brand of each drug and that only a minimal
number of essential drugs in each therapeutic category will be stocked.
Once formulary standardization is achieved, this will go hand-in-hand
with a pre-packaging program. Specific quantities of standard prescriptions
should be determined by the PTC. Example: A week therapy of 21 capsules
of an antibiotic represents a required therapy to treat an infection. Once
determined, a list of commonly prescribed medications with their pre-
packaged quantities should be posted in each clinic examining room. The
physician should write in these quantities and the pharmacy should have
these pre-packaged containers available, thus, eliminating the counting and
pouring procedure at the time of filling the prescription. Only the
prescription labels need to be affixed to the container.
Additional Extended Pharmaceutical Services
The out-patient pharmacy may provide one or more services depending

on the available staff and time,
1. Counselling patients - A special counselling area or room may be
used and reserved initially for those patients having the potential for
certain medication- related problems such as patients taking multiple
medications or having certain diseases.
2. Patient education - Because the pharmacist is intimately involved with
medications, it is logical that educational services may be provided
to patients receiving potentially dangerous medications, those
prescribed on confusing schedules or administered by unusual means.
For example, a program may be designed to teach hemophiliac's to
self-administer medications in their home.
96
3. Developing patient medication profiles - The pharmacistmay develop

medication profiles for out- patients. This will enable the pharmacist
to evaluate the patient's entire drug regimen which will be of particular
value for the routinely-seen patient in the out-patient pharmacy.
Potential drug interactions may be detected by the pharmacist and
reported to the prescribing physician.
4. Providing drug inFormation - The pharmacist may provide general
drug information which will assist patients in gaining a better
understanding of their medications and how to take them.
GUIDELINES ON GENERIC LABELLING IN

ACCORDANCE WITH THE GENERICS ACT OF 1988
In dispensing unit dose products which are no longer in their original

containers but have been transferred to small bottles, cans, boxes, plastic
and/or paper envelopes and the like, the pharmacist shall place legibly on
the label the following information:
1. Name of the patient
2. Generic name of the drug
3. Manufacturer
4. Dosage strength
5. Expiration date
6. Directions for use, and
7. Name of pharmacist
VIOLATIVE, ERRONEOUS, AND IMPOSSIBLE

PRESCRIPTIONS IN ACCORDANCE WITH THE
REGULATION OF THE GENERICS ACT OF 1988
Violative Prescriptions:
1. Where the generic name is not indicated;
2. Where the generic name is not legible and a brand name which is
legible, is indicated; and
3. Where the brand name is undirected and instructions added (such as
the phrase "no substitution" which tend to obstruct, hinder or prevent
proper generic dispensing).
Violative prescriptions shall not be filled. The pharmacist shall advise

the prescriber of the problem to be able to get the proper prescription.
Erroneous Prescriptions:
1. Where the brand name precedes the generic name;
2. Where the generic name is the one in parenthesis; and
3. Where the brand name is not in parenthesis.
Erroneous prescription shall be filled. Such prescriptions shall be kept and

reported by the pharmacist to the authorized official for appropriate action
97
Hospital
, . Pbarmacy. Management
. .
Manual
Impossible Prescriptions:
1. When only the generic name is written but it is not legible;
2. When the generic name does not correspond to the brand name;
3. When both the generic name and the brand name are not legible; and
4. When the drug product is not registered with the BFAD.
Impossible prescriptions shall not be filled. The pharmacist shall advise

the I'rescriber of the problem to be able to get the proper prescription.
Section 6 of the Generics Act of 1988 provides that "All government

health agencies and their personnel as well as other government agencies
shall use the generic terminology or generic names on all transactions related
to purchasing, prescribing, dispensing and administering drugs and
medicines".
Since government hospitals operate on a Formulary System plus the
provision of the law stated above, hospital pharmacists rarely encounter
erroneous, violative, and impossible prescriptions.
98
T
Hospital Pharmacy Manag~ri:"entManua1
Filling of Prescriptions for Out-Patients
Responsibility Action ",
Patient/Client 1. Presents prescription signed by a

physician to the pharmacist
Pharmacist 2, Notes prices on prescription and

instructs' patient/client to pay to the
Cashier
2,1 If patient cannot afford to' pay,

refers the patient to MSW
Medical Social Worker (MSW) 2.2 Evaluates and classifies patient!clients
and advises accordingly
Cashier 2.3 Receives payment and issues OR .
to patient/client
Patient/Client 3. Presents OR and prescription to the

Pharmacist
Pharmacist 4, Indicates OR number 01, the

prescription and fills the same
5, Issues medicine to the patient/ client
6, Records medicine issued and files

prescription,
Note: For dangerous drugs, follow procedures for Dangerous

Drugs and Generics Acts,
99
I.
100
FINANCIAL MANAGEMENf
Health care cost containment and financing efforts are exerting increased
pressure on all hospital departments to justify their cost and improve their
services.
Pharmacists in organized hospital settings are faced with the problems
of a rapidly increasing drug budget due to the escalating cost of drugs and
the pressures to contain or reduce these costs. This is compounded by the :
increasinglyscarce resources allocated within the institution and the increased
pressure to reduce not only the cost of drug therapy, but also the total cost
of providing pharmaceutical services.
It is important that pharmacy managers develop a knowledgein financial
management and assume more of its responsibility for an effective
pharmaceutical financial management. This may be done by identifying
areas for cost reduction without compromising quality.
This would require know-how in the methods of collecting financial
information and preparing financial reports to be reviewed and how these
reports can be used by the pharmacy manager in analyzing their expenses
and participate more effectively in the necessary cost-containment programs.
The early submission of a financial report will help the decision-makers.
WHAT IS FINANCIAL MANAGEMENT?

Financial management in a hospital setting is the process of seeking the
optimal financing, allocation, and control of all resources of the health
care organization.
Accounting and medical records provide an overall picture of an
organization's experiences in financial management. It is through the
accumulation of financial data and its results, that month-end and year-end
accounting and statistical reports are prepared. Financial outcomes would
be useful in evaluating, controlling, and planning the respective activities
of any department or organization.
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Hospital Pharmacy Managemen.t Manual
FINANCIAL MANAGEMENT CONSIDERATIONS

FOR TIlE HOSPITAL PHARMACY
Hospital pharmacists must assist in identifying methods to achieve
reduction in drug expenditures. They must act appropriately on the financial
impact of inventory carrying costs, addition of new items to the formulary,
and change in turnover rates. In effect, the hospital pharmacists should
consider the following activities:
1. Recognize the Pharmaceutical Service as the major financial
component of the hospital's operating costs. Substantial financial
growth has occurred in the hospital pharmacy caused by factors such
as improved quality of drug-handling systems and improved
therapeutic effectiveness of drugs. As a result, more money is now
being invested. The pharmacy chiefs have assumed more of the
responsibilities in the delivery of an effective hospital financial
management.
2. Realize that pharmaceutical services are unique from other hospital
services because they entail both large product cost and service cost.
3. Stimulate thinking within the hospital about the total financial
implications of the complete drug handling system.
4. Expand the service database to enhance the ability to make sound
financial decisions for the hospital.
5. Establish hospital service components objectives based on thorough
financial evaluation as follows:
a. Ensure minimal waste in drug-product preparation.
For example: many N fluids are wasted after drugs are added
to them.
b. Review all pharmacy systems to ensure that they are effective,
efficient and justifiable from a financial point of view.
c. Be flexible as to consider trade-offs instead of continuing to
add resources.
d. Consider which services can be cut with the least effect on
quality.
6. Develop a long-range strategy to control drug product costs.
The steps outlined below is the procurement system being
.implemented by the DOH nationwide. This would require increased
coordination and support from outside the service, and each will
have an increasing financial payback to the hospital.
a. Streamline the purchasing and inventory control system,
maximize turnover and minimize inventory carrying costs
by assuring an optimum purchasing system. (See Inventory
Management, p. 68).
b. Capitalize on group purchasing. This is implemented through
the DOH Central Office and Regional Health and committees
on bulk procurement.
c. Establish an effective formulary approval process that gives
substantial consideration to the total economic impact of each
drug examined. A level of review should be reached that
effectively balances therapeutic effectiveness and cost
102
effectiveness of newer drug products. The greatest challenge

posed to the Pharmacy Service is gaining the support of the
medical staff in the creation of a "financially focused
formulary". This would require support from the hospital
administration and a high degree of endorsement from the
medical staff.
This is achieved through Administrative Order 51 in the
Organization of the PTC and the establishment of a hospital
formulary based on the PNDF.
d. Ensure the appropriate use of drugs, through the selection of
therapeutic alternatives. This area is increasingly becoming
important because of the subtle yet substantial differences
between the many new drugs available. This is achieved in
DOH hospitals through the hospital formulary system and
the mandatory use of the PNDF as the basis for procurement.
7. Acknowledge that this is the "financial" era for the health care industry
and hospirals. Skills and understanding should be developed to become
effective financial managers. Continuing education programs should
be conducted in financial management, and these programs should
be made available to all hospital pharmacy practitioners.
DEVELOPING A DATA-COLLECTING SYSTEM
Individual data forms the foundation for all financial management

systems. In order to provide effective financial management control; the
pharmacy head must know the following:
1. Data needed
2. Methods of obtaining data
3. What to do with the data once obtained
The subsection on Financial Analysis explains how a narrative report

may be used to analyze actual expenses compared to budgeted expenses.
This subsection provides further explanation on the use of data to compare
actual financial performance with budget.
A financial system without any accurate method of measurement,
collection, and collation, is of little use and may be detrimental to good
management. Development of data collection systems should be a priority
of every hospital Pharmacy Service. Initially, the desired output and use of
the data must be determined and revisions made as information needs
changes. For example: a report on drug expenses may be developed, and
later, this report may need to be supplemented with additional data to manage
more of the detailed processes.
Data collection system should include the following characteristics:

1. .Maximum accuracy- An auditor should be able to review the written
procedures for data collection and effectively track expenses, revenue
or workload through the system.
2. Maximize personnel rime - Utilizing the time of the staff to the
maximum in the absence of an automated system.
103
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. Pharmacy Management
. Manual
l' Monitor financial performance - Each facet of pharmaceutical services

should be monitored and analyzed.
4. Highlight trends - The head pharmacist manages on the basis of
trends instead of an isolated period of data and the hospital
administrator should be made aware of these trends.
5. Standard reporting periods and nomenclature - Data should be
collected using the standard terminology and reporting periods that
are common to most hospitals and pharmacies. The pharmacy should
collect, collate and report data on the time period required. While
the data collected will be primarily used by the pharmacy for internal
management, the hospital administration should be provided with
reports on key factors on a regular basis.
Example:
The regular monthly report on issuances and balances of drugs
with their peso values submittedto the accountant after every 5 days
ofthe preceding month. This will be used for justifying new programs,
defending current programs and analyzing proposed hospital changes.
This data should be collected in a format that is easily understood by
both the pharmacy and the administration.
The source of data and the methods used for collection varies. The best
data source is a hospital's computerized report, if any. If this is not available,
the second best source is the manual data collection and collation.
Data should be collected for expenses, revenues (if applicable) workload,
transfers and credits, drug use and hospital indicators. This can be explained
as follows:
I. Expense Data
Expenses are expired costs or costs that have been used or
consumed in carrying out certain activities.
Analysisof expensesshould be the primary focus ofdata collection.
Data should be collected on:
a. Drug Supply Expenses
These should be maintained on a daily, weekly, monthly, .
and fiscal year to date basis. Data may be collected by vendor
or by therapeutic purchasing category. The therapeutic/
purchasing category is preferable over the vendor category
since it is easier to code. The number of purchasing categories
should be limited to major groupings such as antimicrobial,
antineoplastic drugs, N solutions, blood derivatives, disposable
supplies, etc. Categories comprising less than five percent
(5%)of purchases should be eliminated. Thisprocess of coding
facilitates the budget process and permits tracking of drugs
and supply expenses from purchase to patient issue.
Example: ..
Suppose the hospital purchased drugs worth P1,000.00 then
P1,000.00 in cost of drugs should be issued to patients. Any
difference between purchases and cost of drugs is accounted
for by inventory expansion or shrinkage, waste, pilferage, or
clinical error.
104
b. Personnel Costs
Data collected should include the number of full-time
personnel. .
c. Equipment Purchase and Maintenance
Most hospital equipment is purchased from the capital
outlay budget which is separate from the operating budget
(MOOE fund). Pharmacy services have low capitalequipment
requirements.
2. Revenue Data
Revenue refers to additions to current assets such as cash, which
do not increase liabilities or reserves of the government.
If revenue is obtained from the issue of drugs and supplies, this is
generated primarily from the charge or issue entry. Whether or not
there is a charge, the issue systems should identify the cost of goods
sold. This will allowpurchases of drugs/supplies to be tracked through
the system and budget changes to be implemented. This is achieved
through costing of all issuances to the· different classifications of
hospital patients and departments.
3. Workload data
This needs to be accurately quantified.
4. Transfer and Credits Data
Cost of drugs and supplies may be transferred to other pharmacy
cost centers. External transfers may account for a certain percent of
the total purchases.
Example:
An inter-departmental transfer of drugs to the ER creates a credit
in pharmacy and a debit to the ER room. This credit reduces the
inventory assets for the pharmacy but does not affect the total hospital
costs.
5. Drug-use Data
This should meet the following conditions:
a. All drug-use of patients should include data by drug name,
dose, route, quantity, therapeutic category and date. The source
of the data may be the nurse charting systems or charge entry
(where applicable).
b. Drug-use data should be analyzed from all directions.
6. Hospital indicators
Hospital indicators needed are in-patient days, admissions, and
average length of stay. In addition, it should also include out-patient
clinic visits.
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Hospital Pharmacy Management Milnual
FINANCIAL ANALYSIS
Following the accumulation of the data and the preparation of the
reports, the pharmacy head should be able to analyze these information.
The analysisshould be prepared in narrative fonn to be used by the Pharmacy
Service and the hospital director. The narrative report should include an
analysis of the actual expenses as against the budgeted expenses. The report
should also include comments regarding the impact the changes would
have on the future financial picture of the service.
BUDGETING
The meaning and appropriate use of a budget must be clearly understood
by those in the management position whose participation and cooperation
is essential in serving the function of a control device over operations.
Prior to embarking on a plan, management must first define the purpose of
the unit, establish policies for its operation, and project the hospital's growth.
. The pharmacy staff must be able to analyze and interpret prescribing
trends as well as the impact of new drug developments, which for budgetary
purposes, are translated in terms of forecasts on future drug expenditures.
Its plan must be reasonable, realistic and based on statistics that would
assist management in accurately predicting the volume of activity of the
Pharmacy Service, taking in utmost consideration, the three months
consumption.
'j 06
DOH PROCEDURE ON BUDGET PREPARATION
Budget Officer/ 1. Arranges a budget meeting with the AO,
Administrative Officer (AO) COH and Unit Heads
2. Gives instructions on the details of the
Budget Call
3. Requests unit heads to submit their

respective operational plans
Unit Heads 4. Submit operational plans based 'on ...,."

specific objectives including'
justifications for proposals to the
Budget Officer
Budget Officer 5. Discusses plans and proposals with the

respective unit heads to ensure
conformity with hospital objectives
and targets .
Unit Heads 6. Prepares and submits the final plans

and proposals to the Budget Officer
Budget Officer 7. Reviews, consolidates plans and

proposals, and accom plishes Budget
Preparation Forms
8. Forwards accomplished forms to the AO
~Oflicer(AO) 9. Recommends approval and forwards

it to the COH
Chief ofHospital (COH) 10. Signs budget and returns it to the

Budget Officer.
Budget Officer 11. Gets file copies and sends it to the

Central/Regional Office
107
L
BUDGETARY REQUIREMENT
1. Personal services for staffrequirement
2. MOOE - One of the expense items is drugs and medicines intended
for indigents
3. Equipment Outlay - based on legaltechnical requirements and HOMS
enhancement standards.
BUDGETING FOR EXISTING OPERATIONS
The operating budget is a roll-up of several cost centers within the

pharmacy, such as out-patient, in-patient, etc. Two steps that must precede
budget preparation are as follows:
1: Establish goals and objectives including factors such as patient mix,
changes in therapeutic modalities, additions or discontinuation of
various medical services, projected census including patient days,
admissions, out-patient visits.
z Review established historical data; workload data from previous periods
must be maintained.
PREPARING THE OPERATING BUDGET
A hospital budget is a planning tool or guide which expresses in monetary

figures the hospital's operational objectives for a set period of time or a
short-range plan for future operations. In turn, hospitals require their
individual services to develop budgets that reflect specific operational
objectives within the individual service. The Pharmacy Service often
represents the hospital service with the highest supply to personnel ratio in
its budget.
One of the most important tasks in the fiscal operation of the service is
the preparation of the annual budget. More often than not, many
administrators and chief pharmacists take the development of the pharmacy
budget too lightly thereby producing a document which do not serve its
true purpose.
Since it has been a common practice among pharmacists to rely on the
accounting service for many of its data base figures, close rapport between
the pharmacist and accountant should be maintained. .
For the budget to be useful and effective, it must possess the following
basic characteristics:
1. Oriented toward achieving goals and objectives
2. Realistic
3. Implemented by the one who prepared it
4. Contain certain internal mechanisms for review and analysis
5. Use consistent measurement tools and reporting periods
108
r '3
PREPARING THE EXPENSE BUDGET
The first step is to obtain the budget estimate from the current year's
expenses and patient days. To calculate for budget estimate figures, divide
the Current Operating Expense (CaE) by the fraction of the fiscal year
those days represent.
CaE - is the appropriation spent for the purchase of goods and services
for current consumption within the calendar year including the acquisition
of furniture and equipment usually used in the conduct of normal
government operations.
The budget for a Pharmacy Service includes the salaries ofthe pharmacists
and other personnel, office supplies, store supplies, and at times,equipment
necessary in running a Pharmacy. The amount necessary for drugs and
medicines is taken from the revolving fund and from the general fund if
issued to indigents.
PREPARING THE REVENUE BUDGET

Two basic methods in the development of charges or revenues based on
the projected expense budget:
1. A percentage of revenue needed over the projected expense budget.
2. The revenue can be converted into a service fee per workload unit;
To reach a total monetary amount of revenue, use the workload in
different areas of the service as a denominator to establish different
service fees per workload unit. By dividing the number of workload
units into the revenue needed, one can establish the service fee per
workload unit.
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Hospital Pbarmacy Management Manual
110
PHARMACY REPORTING
ATTRIBUTES OF REPORTS
Until groupings, totals and well-organized reports are produced, data is
nothing but mere isolated facts, A written analysis is needed to place the
organized data in perspective. Four basic attributes should be considered:
I. Organizational methods
These should coincide with the hospital organizational methods.
A common method uses cost centers and sub-accounts. The pharmacy
may have one to five cost centers like drug and supply purchases,
pharmacy administration (personnel and other non-drug and supply
expenses) and out-patient pharmacy expenses. Cost centers and sub-
accounts are organized tools in the hospital chart ofaccounts necessary
for budgeting, management of expenses and assessment of trends.
2. Timely
The sooner the information is available. the sooner decisions can
be made. Reports that are not available for months after the completion
of a period lose much of its value.
3. Reporting Period
Pharmacy reports should cover the period required. Standard
reporting periods are usually monthly, semi-annually and fiscal years.
Each report developed by the pharmacy should provide monthly and
fiscal year to date information.
4. Summary and Details
Pharmacy expense, workload and revenue data are usually part of
hospital data.
The administrator to whom the Pharmacy Service reports receives a

summary report of all cost centers in his/her area of responsibility. The
administration has a budget consisting of multiple hospital service
components. The administrator's greatest need is for summary or "bottom
line" data.
III
I
REPORTS AND RECDRDS MAINTENANCE

One of the responsibilities of the pharmacist is the maintenance of
records and the submission of reports legallyand administratively required.
The data prepared and collected are translated into regular, periodic, and
special reports.
Records maintained are:
. 1. Records of drug deliveries indicating (in a record book) the following:
a. Date of receipt
b. Name and description
c. Invoice number
d. Name of supplier
e. Purchase Order number
f. Unit price
g. Total quantity and value
2. All invoice and/or receipt documents filed for future reference;
3. Copies of the request of drugs filed in the pharmacy so that in cases
of unusual delay in the delivery, the attention of the supply officer
can be called for necessary action;
4. Compilation of test analysis results of samples tested by BFAD for
reference;
5. Supplies ledger cards for all stock items and the balance in the ledger
card checked against the actual physical count from time to time.
This will facilitate the preparation of reports taking all the necessary
data posted in the ledgercards. Separate ledgercards should be prepared
for regular funds, trust funds and donations. Although donations
are given free, costing should also be accomplished. Costing is utilized
for research and studies on drug utilization review, drug movements,
interpretation of prescribing trends of the drug developments which,
for budgetary purpose and economic impact, is translated as a forecast
for future drug expenditure;
6. Properly recorded and accomplished required forms for Dangerous
Drugs (DDs) issued to in-patients;
7. Recorded additional DDs used by patients;
8. Ordinary prescriptions exempt from recording but maintained on
file in consecutive numbers for two (2) years as required by law;
9. Dangerous drug prescriptions such as narcotics and their derivatives
recorded in the Opium Book registered with BFAD and maintained
on file for one (I) year as required by law;
m Physical Inventory report of all stocks/items;
11. Waste Material Report (WMR) on deteriorated, expired, or broken
fluid bottles and other parenterals not in use from the active stock of
drugs wherein their total value and quantity is subtracted from the
balance in stock; and
12. All other communications pertinent to the pharmacy activities, PTC
documents and other committees, progress reports, and all other
administrative and techriical reports.
112
ADMINISTRATIVE REPORTS SUBMITTED

1. Monthly report on the issuances and balance with the corresponding
quantities and peso values.
This is a regular and timely submission ofreport ofdrug issuances
and balance of stocks as per Special Provision of the General
Appropriations Act to the accountant five days after the preceding
month for the reimbursement of the MOOE Fund of the hospital at
amounts issued to charity/service .patients (See Form No.9, p. 114). It
is an important report because:
a. It serves as the basis for the reimbursement of the revolving
fund to assure a continuous supply of drugs in the hospital;
b. It is factual and should match the accountants' report to attain
the objective of proper accountability;
c. It serves as the basis for auditing, leading to good inventory
control; and
d. It serves as the basis for statistical data report to the DOH
central office.
2. Annual Drug Procurement Program.
3. Quarter/Annual report on drugs procured/delivered to the pharmacy.
4. Annual and semi-annual physical inventory report at least twice a
year. (COH creates an Inventory Committee and the final report
signed by the COH, COA representative and committee members).
5. Annual or semi-annual accomplishment report ofthe pharmacy which
includes targets and failures and reason(s) for the failures.
6. Performance rating report as required by the CSC.
7. Other accomplishment and activity reports which include:
7.1 Summary of daily number of prescriptions filled to in and
out-patients, pay, Medicare, submitted monthly to the Medical
Records Service.
72 Staff progress report (leaves/tardiness) to the Records Section.
7.3 Number of nursing unit baskets filled (Floor Stock).
7.4 Manufactured/extemporaneous and simple compounded
preparations including savings realized.
7.5 Educational programs/activities
Hospital trainings attended and participated in
Reports on conduct of training of student affiliates
with annexes on requirements in compliance with the
Pharmacy Law (160 hrs. or 480 hrs.)
7.6 Preparation ofWMR, if any.
REGULATORY REPORTS SUBMITTED

1. Exempt preparations for the regular inspection of the BFAD regulatory
officers.
2. Semestral report of issuances of dangerous drugs to the DDB.
113
FORM NO. 9
.' Name of Hospital
Address
PHARMACY DEPARTMENT
SUMMARY REPORT OF ISSUANCES AND BALANCES
OF DRUGS AND MEDICINES
FOR THE MONTH OF 19_
PARTICULAR RECEIVED ISSUED BALANCE
Balance as of
Received from Property
Total Stock
Issued to:
Payward
Medicare
Cash Sales
Indigent
Balance as of
Prepared by:
CHIEF PHARMACIST
I
NOTED BY:
CHIEF OF HOSPITAL
',- ,.
Name of Hospital
Address
PHARMACY MONTHLY REPORT ill ISSUANCES ill DRUGS Mill MEDICINES ISSUED
MONTH OF . 19_
, PA'lWARD MEDICARE CASH SALES INDIGENfS GRANDTOrAL

QUANIlTY ron;
~~
NAME OF UNIT QUANIlTY lDTAL QUANIlTY lDTAL QUANIlTY lDTAL QUANIlTY lDill
MEDICINE PRICE COST COST COST COST COST
, ,
GRANDlDTAL
Prepared by.
CHIEF PHARMACIST
... - ... :
PART III
OlliER PHARMACEUTICAL
. -
SERVICES .
:,
r
,f .
•
DRUGINFORMATIONSER~CE
l
Development in research over the past years brought about the significant
increase in pharmaceutical literature. The continuous influx of new drugs
and the changes in pharmaceutical care have given rise to the problem of
communicating the latest information on drugs and their use to the health
practitioners and the public.
The Study Commission on Pharmaceutical in the U.S. recognized that:
"One of the deficiencies of the health care system, is the unavailability of
adequate information for those who CONSUME, PRESCRIBE, DISPENSE,
AND ADMINISTER drugs". This deficiency has resulted in inappropriate
drug use and an increase in the frequency of drug-induced diseases. There
wasalso an increasing awareness that adversedrug reactions were the frequent
cause of morbidity and mortality.
One of the most important skills to drug information transfer is the
ability to recognize relevantdata and transmit it effectively. This responsibility
restson trained pharmacists who must provide accurate, unbiased, and factual
information or consultations given in response to drug problems received
from physicians, nurses, pharmacists, and other health professionals.
This section focuses on the need to ensure the effective utilization of
the pharmacy-based drug information services as well as provide guidelines
to the pharmacist in establishing a drug information center in the hospital.
DRUG INFORMATION SERVICE (DIS)

Encompasses the collection, organization, retrieval, interpretation,
evaluation, and dissemination of information pertaining to all aspects of
medicine.
FUNCTIONS
Therapeutic decision-making should be the level of involvement and

focus for the Drug Information Service(DIS), whether for individual patients
or for institutional drug committees.
DIS aims to promote current data and knowledge of medicines to promote
safe, effective and economic use thereof.
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HospitafPharmacy Management Manual
To perform these functions effectively, the information pharmacist needs

a.distinctive blend of expertise considering that DI activities are dynamic
and centers are' evolvingin response to the rapidly changing social, economic
and professional environment of the health care service. Expertise in the
following areas are therefore needed:
information science (for effective storage and retrieval of drug data)
data evaluation (skills in clinical trial design, statistics and drug
epidemiology to enable the validity of published reports to be assessed)
clinical skills (for effectiveapplication of retrieved data to therapeutic
problem-solving)
DRUG INFORMATION RESOURCES
To establish a DIS, it is necessary to assess the entire environment

including the available resources, such as :
Documents - refers to textbooks, compedias, journals, and publications
such as drug newsletters and drug monographs.
Facilities and agencies- include pharmaceutical manufacturers, hospitals,
the Department of Health Schools of Pharmacy, Medicine,
pharmaceutical organizations and medical reference libraries, etc.
People - physicians, dentists, pharmacists, nurses and allied health
personnel.
It is necessary for those who establish a DIS to learn not only what DIS
are available to them, but also how to best utilize these resources.
ESTABLISHING AND ORGANIZING THE DIS
Formation of a DIS requires administrative approval as well as support

from the medical and nursing staff. The proposal should contain a review
of literature and include sections on:
Space requirements .
Personnel
Resources required
Scope of activities planned
Timetable for implementation
Financial commitment i
Expected impact on patient care
Teaching or research
Hours of service
Since one of the functions of a DIS is to provide support to the PTC,it

would be best to submit the proposal initially to the committee for their
support before submitting it to the hospital administration.
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HospitaJPharmacy Management Manual
SCOPE OF SERVICES
Due to limitations in time, money, and resources, a careful selection of

the types of services to be offered should be considered. Examples include
the following:
1. Answers to specific questions through telephone, mail, or in person
2. Monthly newsletter or bulletins
3. Reprint services
4. Consultation regarding adverse reaction surveillance systems,
investigational drug protocols, or drug utilization review systems
5. Education and training functions such as pharmacology and
r therapeutic lectures, drug literature evaluation or utilization courses
6. Research
7. PTC support such as the review of new drugs submitted for the hospital
formulary .
8. Liaison with pharmaceutical company representatives, medical staff
committees and medical libraries
9. Poison control
Another consideration is the geographic scope of coverage. Most drug

information centers provide either local or regional coverage: Local means
within the confines of one particular hospital, while regional covers the
surrounding areas, such as, other hospitals in the area or region.
SPACE
There are no set figures for space since this will depend upon the space
availability of the particular hospital.
PERSONNEL
(Would depend upon the particular hospital)
1. One individual responsible during normal business hours
l
2. All staff share during normal business hours
EQUIPMENT
The type and amount of equipment will vary due to the availability and
proximity of necessary equipment. The following are suggested items:
1. Bookcases or bookshelves
2. Periodical shelves
3. Display cases
4. File cabinets
5. Card files
6. Desks and chairs
~ 7. Reading or conference table
I
119
'l. Microfilm and microfiche storage cabinets

9. Typewriter
10. Audio-visual equipment or computer terminal
11. Telephone
FlUNG AND RETRIEVAL SYSTEMS
Most DIS maintain standard letter files for (a) articles; (h) correspondence;
(c) package inserts; and (d) reprints.
Scope would be limited to clinical materials eliminatingthosewhich relate to
priceor advertising matters: Information areseparated according to:
drug entity
disease entity
neither of the above categories
In general, filing and retrieval methods are based on

Alphabetical scheme - generic name with cross-index of brand name, or
Numerical/filing method- adapted from the "List of the National Essential
Drugs" (PND F)
Services that are availed from the DIS:

Patient, physician, pharmacist, nurse, and drug consultation services
Educationalleetures
Question and answer services
Interviewing
Reviewing
Disseminating pharmaceutical manufacturer's information
ADR reporting
Patient-drug monitoring
Investigational drug data
Literature searches
Publication of newsletters
Poison control information
INFORMATION TO BE SUPPUED
A. To the patient
I. Importance of the drug
2. Approaches and techniques
3. Proper utilization of the drug.
4. Side effects
5. Reinforcement of the physicians instructions
6. Over the Counter counselling
7. Drug histories & patient profiles
B. To other Health Professionals •
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Hospitsl Pharmacy Management Manual
ACTIVITIES
I. Collection and keeping of DI in the form of:

1.1 Kardex system
1.2 File system
1.3 Computer.
1.4 Microfiche
Haveaccess to external data basesuch as IOWA system, MEDUNE

& PHARMAl1NE These data base are complete with micro-disc
slides. This can be supplied monthly as abstracts.
2. Entering data into file and computer

3. Management of inquiries on matters pertaining to drugs.
4. Using computer printouts - information and data of the drug entered
into the computer and retrieval if needed.
5. Publications:
Drug Monograph - a profile on drugs describing their
pharmacology and pharmacokinetics indications, contra-
indications, ADR, toxicology, etc.
NDC is in the process of preparing Vol. II (Drug Monograph).
Drug Newsletter - bulletin that contains news on BFAD
activities, registration, licensing, ADR and other information
pertaining to drugs.
Pharmacy bulletin and newsletters
These communications serve two primary purposes:

I. Continuing education through information dissemination, and
2. Official notice for new pharmacy policies, programs, procedures, or
drug utilization. The following is a list of items which make up a
bulletin.
a. Drug reviews - complete reviews of medical and pharmaceutical
literature or specific drugs or drug categories.
b. Report on newly-accepted drugs into the formulary and drugs
deleted from the formulary.
c. Abstract - summaries of significant journal articles dealing
with drugs.
d. Announcements - new drug distribution procedures, new
pharmacy laws, amendments to Generics Act, drug recalls,
special decisions of the PTe.
e. Drug use problems as noted in the literature such as side
effects, bio-availability data, special warnings, new methods
of administration.
f. Report on ADR observed in the hospital.
g. A sample of the drug information inquiries which have been
received during the past month by the Drug Information
Center.
121
122
•
RESEARCH AND
EDUCATIONAL ACTIVITIES
RESEARCH
The hospital pharmacist must participate and support clinical research
conducted by the medical staff as well as initiate research directed towards
achieving the goals and objectives of the pharmacy and the hospitaL In
doing so, the pharmacist may act as the principal or co-investigator or may
use the resources of the pharmacy to support a particular research study.
Equally important, is the pharmacist's ability to collect appropriate data,
interpret them, apply the conclusions drawn from the data, and transmit
the results effectively.
An educational background with appropriate orientation and training
. in research methodology, including criteria for the structure of a research
report is therefore recommended,
The pharmacy should maintain a file of all investigational drug studies
and similar research projects involving drugs in which the facility's patients
are participants,
The pharmacist should be represented in the hospital's Clinical
Investigational Committee or its equivalent, if there is one. Alternately, the
pharmacy should receive a copy of the research protocol for any study
involving drugs and the hospital's patients.
r
,
Researches on formulation improvement and/or extemporaneous
compounding of simple preparations are performed with their corresponding
conclusions especially on cost containment studies and advantages obtained
from the same.
EDUCATIONAL ACTIVITIES
With the DOH commitment, hospitals have been catapulted into a
variety of teaching and training programs which include undergraduate
and graduate teaching and training programs for health practitioners and
students.
123
The chief pharmacist or his designate is responsible for coordinating

the service's contribution to these educational activities such as the training
of new personnel, continuing education program for pharmacists, and
pharmacy supportive personnel.
With established hospital training programs, the chiefpharmacist should
devote his/her efforts in keeping abreast with comprehensive training in
biological, chemical, and pharmaceutical sciences in order to develop special
skills and competency in hospital pharmacy exceeding the legal requirements
for licensure.
PHARMACY AIDES (LABORATORY AIDES)

TRAINING PROGRAM
j
Most countries utilize supportive personnel in various capacities in the
operation of a hospital Pharmacy Service. The term "supportive personnel"
has been used in referring .collectively to all nonprofessional hospital
pharmacy staff. A pharmacy aide, one category of supportive personnel,
assists in various activities of the Pharmacy Service under the direct
supervision of a licensed pharmacist. Such duties include, but are not
limited to:
setting-up packaging and labelling medications
maintaining inventories of drug supplies
setting-up pre-packaging and preparing of medications used in the
hospital as floor stocks etc.
Training for other supportive personnel such as clerks, storekeepers and

utility workers should be supported and coordinated with other hospital
services. Continuing education programs should be undertaken for updates
on matters related to their functions in the operation of the hospital.
PROVISION FOR CONTINUING EDUCATION
Aside from integrity, competence is a fundamental moral responsibility

of any profession that is reinforced through years of practice. With recent
development in the field of hospitalization as well as the remarkable progress
and advancement in hospital pharmacy practices, hospital pharmacists are
expected to keep pace with rapid changes and progress in medical care, the
passage of new laws, their pertinent rules and regulations.
PREAMBLE
In an era marked by rapid changes in health care delivery, the roles of
hospital pharmacists are constantly undergoing change. As roles emerge,
competency requirements change, and as a practitioner assumes the increased
responsibilities demanded in these new roles, practitioners must make a
corresponding commitment to improve their professional competence.
Continuing education is the primary means by which practitioners can
gain the knowledge and skills necessary to maintain and improve their
performance.
124
The purpose of a continuing education for health professionals is the

improvement of patient care and health maintenance, and the enrichment
of health careers. Every hospital pharmacist should set his/her personal
educational objectives based on his/her performance needs and career goals.
While every practitioner should assume personal responsibility for
maintaining and improving his/her professional competence through
lifelong, self-directed education, he/she may also require assistance in
identifying gaps between actual and desired performance, in setting
educational objectives and establishing their relative priorities, and in
selecting learning activities which will contribute most toward achieving
his/her objectives.
OBJECTIVES
1. To help hospital pharmacists develop a more comprehensive
understanding of the importance and methods of continuous
education and to encourage and assist them toward these goals;
2. To help evaluate their professional performance, identify areas where
improvement is needed, and set realistic, attainable educational goals;
3. To provide the hospital pharmacists with available information on
the regional and national educational resources available which will
help them achieve their personal educational objectives;
4. To assist in. selecting educational resources which would best meet
their individual needs;
5. To provide continuing education resources in a variety of formats
and media best suited for the subject matter and the needs of the
greater number of learners; and
6. To assist in evaluating the effectiveness of their continuing education
expenences.
IMPLEMENTATION
1. The multi-sectoral approach in the planning and conduct of
continuing education activities must be adopted within the hospital.
2. Coordination with the Regional Food and Drug Regulation Officers
on the updates/information on drugs.
3. Financial support.
4. Collaboration with organizations such as the Philippine
Pharmaceutical Association, Philippine Society of Hospital
Pharmacists, DOH League of Pharmacists, Philippine Association of
Pharmacists in Pharmaceutical Industry, and other scientific
organizations of allied professions offering continuing education
125
2
programs relevant to pharmacy practices.
GUIDELINES ON PHARMACY INTERNSHIP

AFFILIATION AND TRAINING IN
ACCORDANCE WITH THE DOH POLICIES
ON AFFILIATION AND TRAINING
OF STUDENTS IN DOH HOSPITALS
1. Policy Statement
Agreement between the affiliating Colleges of Pharmacy and the
DOH in providing Pharmacy Internship Program to pharmacy
students is in accordance with Article III, Section 18, paragraph (c) of
RA 5921, as Amended (Pharmacy Law). The agreement shall be based
on reciprocity mutually beneficial to the contracting parties. The
colleges utilize the hospital pharmacy services for the practical training
of their students. In return, the hospital can avail ofthe professional
expertise, research and library facilities, and continuing education
program of the affiliating colleges.
2. General Requirements
There should be a formal organized training program of affiliation
prepared by the training hospital in consultation with The Philippine
Association of Colleges of Pharmacy (PACOP) through the
representative of the NCATS.
GENERAL OBJECTIVE
To provide the pharmacy interns with the necessary practical training
in all the basic aspects of hospital pharmacy management and practice
geared towards orientation on the actual dynamics of better patient care.
SPECIFIC OBJECTIVES
1. To acquaint and orient the pharmacy interns with the objectives and
philosophy of a hospital and the hospital pharmacy and to make
them aware of their responsibilities and the demands made on their
specialty by actual experience in all phases of hospital pharmacy
operations.
2. To provide them with the learning experience of coordinating the
Pharmaceutical Service with the needs of the total institution; and
3. To provide them with broad experiences that will advance the level of
their knowledge and foster their ability to conceptualize new and
improved service practices.
Course Contents
The training hospital venue for pharmacy interns should be under the
supervision of the pharmacist, who, in turn, is in charge of providing
teaching/training activities. The course content should include the following:
a. Orientation •
126
b. DOH and the hospital organization
c. Inter-departmental relation in the application of professional duties

and ethics to physicians, nurses, patients and others.
d. Pharmacy operational procedures:
Compounding and dispensing to in and out-patients
Procurement and inventory control
Ward and emergency drug stock services and monitoring
Drug storage and preservation
Dangerous drugs control
Records required by law and other records according to their
importance.
•
Bookkeeping, accounting and reporting systems
e. Pharmacy and Therapeutics Committee
Organization
Functions
Formulary System (Generics)
ADR report on collected ADR information from clinicians
f. Drug Information Center
I. g. Patient interview and rounds
Methodology
a. Lecture/discussion/demonstration .
b. Observation of the actual coordination of the Pharmacy Service with
the different departments/services of the hospital
c. Actual hospital pharmacy work
r d. SeminarsjWorkshops
Training Schedule
Student affiliates shall arrange their training schedule with the pharmacist
in charge of monitoring their required 160 hours/or 480 hours internship.
Monitoring and Evaluation

... a. Performance evaluation instrument
,
I Under the supervision of a staff pharmacist, spot checking of

~ actual documentation of records ";
Ability to answer questions-raised
Ability to answer questions during the open forum
Ability to chart transcription of patient's drug requirements
, and interview
b. Assessment/evaluation of the activities of the student affiliates,
presentation and discussion of problems encountered during training
and other matters.
127
c. PACOP should work closely with the NCATS or the duly authorized
representative on the evaluation of the pharmacy internship program.
Rules and Regulations

a. The records of training of each pharmacy intern must be prepared by
the chief pharmacist/pharmacist in charge approved by the COH at
the end of the internship program.
b. The intern should be provided with a certificate of internship training
at the end of his/her training period as a prerequisite for submission
to the Board of Pharmacy prior to the board examination.
c. The hospital report should include the number of internship credit
hours of each pharmacy student. Activities pertaining to affiliation
and training should be submitted to the Executive Secretary of the
NCATS and the College of Pharmacy concerned.
Requirements for Hospitals

a. It should have a duly licensed hospital pharmacy in compliance with
the requirements prescribed by RA 3720, known as Food, Drugs,
Devices, and Cosmetics Act of RA 4226 known as the Hospital
Licensure Act; the amended RA 5921, known as the Act Regulating the
Practice of Pharmacy and Setting Standards of Pharmaceutical
Education in the Philippines and for Other Purposes; and RA 6425
as amended, known as the Dangerous Drugs Act.
b. The hospital should be duly accredited by the DOH as a teaching and
training hospital.
c. There should be an organized Pharmacy Servicewith staff pharmacists
rendering 24 hours service.
d. There should be an adequate space to accommodate the pharmacy •
interns and library facilities with an up-to- date DIS, pharmaceutical
journals and other pertinent books for the use of the pharmacy
affiliates.
e. The pharmacist responsible for the training program must have
undertaken an on-the-job training on Master Trainers Course offered
by the Health Manpower Development and Training Service(HMDTS),
DOH, or any management course or trained in the specialized function
of hospital pharmacy.
f. The pharmacist responsible for this training program must plan and
prepare suitable training programs for the 160-hour and 480-hour
internship activities in coordination with the training officer of the
hospital to be submitted to the NCATS or the RCATS with the
Contract of Affiliation. .
g. The records of training of each pharmacy intern must be prepared by
the chief pharmacist/pharmacist in-charge approved by the chief of
hospital at the end of the internship period. .
h. The intern shall be provided with a certificate of hours of internship
,
training at the end of his/her training period as a prerequisite for
submission to the Board of Pharmacy prior to the board examination.
I
!
128
1. The hospital must submit a report on the number of internship credit

hours of each pharmacy student and activities pertaining to affiliation
and training to the ExecutiveSecretary of NCATS or RCATS and the
College of Pharmacy concerned.
Requirements for Colleges/Students
a. The College of Pharmacy must be duly recognized by the Department

of Education, Culture and Sports (DECS).
b. The admission of pharmacy interns in the 3rd and 4th levels shall
follow the ratio of a maximum of 3 to 4 students for every staff
pharmacist.
• c. Affiliates should report to their training hospital in their school
uniform or in white dress/gown.
d. Affiliates must pay/replace an amount commensurate to the damage
or loss of hospital supplies, equipment or other properties.
e. Affiliates must comply strictly with the rules and regulations of the
hospital. .
f. Each student affiliate shall pay a specificinternship fee of one hundred
• pesos (PlOO.OO) for a 160 hour internship period within the first five
(5) days from theonset of training and three hundred pesos (P300.00)
for the additional 480 hours in case the student selects this as his/her
major field.
PATIENT EDUCATION
The fundamental problem of the patient's noncompliance remains
". significant to the management of disease processes. Time, effort, and money
are wasted in diagnosis and selection of the appropriate drug therapy to be
used. The responsibility of ensuring therapeutic compliance among patients
rests with the physicians and the pharmacists. To improve therapeutic
compliance, health professionals must appreciate the incidence, the clinical
implications and the variable causes of noncompliance and put these into
proper perspective, in order to combat this public health menace.
ROLE OF THE PHARMACIST
Patient drug-related education and counselling should be the mutual

responsibility of the pharmacist and other health practitioners.
The following activities should be the responsibilities.of the pharmacist:

1. Educate the patient both verbally and in writing on the importance
of their drug therapy.
2. Provide drug-related patient counselling.
3. Participate in the development of alldrug-related patienteducationmaterials.
4. Participate in educational programs for health care practitioners
involved in patient education.
5. Organize and present the drug-related aspects of the institution by
sponsoring community health education programs.
129
r~--------------------
. . Essential elements of information that might be provided to patients

or their representative or guardian for each medication in the therapeutic
regimen shall include:
1. Name of the medication
2. Intended use and expected action
3. Route. dosage form. dosage and administration schedule
4. Special directions for preparation
5. Special directions for administration
6. Precautions to be observed during administration
7. Common side effects that may be encountered. including their
avoidance and action required. if they do occur •
I
I
8. Techniques for self-monitoring the drug therapy I
9. Proper storage
10. Potential drug-drug or drug-food interactions or other therapeutic
contra-indications
11. Action to the event of a missed dose
12. Any other information peculiar to the specific patient or drug
. Instructions must be communicated at a level the patient can

comprehend. Questions and comments from the patient should be
encouraged so that an assessment of comprehension can be made.
Fundamental to an understanding of proper medication use are appropriately
written and labelled prescriptions with verbal written instructions
supplemented by counselling. Failureto voluntarily communicate therapeutic
information deprives the public of a vital health service and leads to the
public's less than favorable view of the pharmacist.
These essential elements of information are applicable to both
prescription and non-prescription drugs.
Safe and effective drug therapy most frequently occur when patients are
well-informed about medications and their use. Knowledgeable patients
exhibit increased compliance with drug regimens. resulting in improved
therapeutic outcomes.
The pharmacist's drug consultations with patients should be aimed at
improving therapeutic outcomes by maximizing the proper use of
medications.
.
130
I
CliNICAL PHARMACY
In recent years, pharmaceutical services have expanded significantly
beyond drug preparation and distribution. These evolutionary changes are
the pharmacists' involvement in drug-related decision making and patient
care activities.
Fundamental to these clinical services is the pharmacist's knowledge of
drugs, diseases and patients, drug variables, and the pharmacist's close
interaction with other health professionals and.patients, Academic training
in areas such as toxicology, pathophysiology and therapeutics as well as
clinical experiences, provide pharmacists with the background needed.to
function
. in this clinical role. . . .-
The principle behind this practice is patient orientation combined with
the safe and rational use of drugs in a clinical setting.
The course objectives can be achieved by:
1. Observing patient care by learning the duties and techniques of the
health team and investigating the disease of actual patients: .
2. Having access to the patient's medical record to note the start,
changes, and final steps of drug therapy, understand the
selection, administration, interaction, toxicity, incompatibility
of drugs, and learn medical abbreviations, terminology,
laboratory and function tests.
3. Interacting with the medical and paramedical staff of the hospital.
He/she should develop an appreciation of the art of serving others
and observing the functions and teamwork of other hospital
departments. He/she should develop skills in communication and
contribute his/her role and education to the care of patient as an
active member of the health team.
Clinical Pharmacy consist of the following components:

Physical presence of the pharmacist in the patient-eare area to perform
his/her functions in close coordination with the nurse and the doctor.
Direct interpretation of the doctor's medication orders by the
pharmacists
Unit dose distribution system
131
t..
Drug information in the patient care area. (Patient education and

counselling)
Preparation of a patient drug profile
Monitoring of drug therapy
Participation in the cardio-pulmonary resuscitation activity.
QUALIFICATIONS OF A CLINICAL PHARMACIST
1. Comprehensive knowledge in the following areas:

pharmacology
pharmacokinetics
medical chart
patient care routine
nursing procedures
diseases
. medical terminologies and pronunciation
therapeutics
toxicology
drug interactions
social and physiological aspects of patient-eare
·2. Basic knowledge of laboratory tests and results
3. Good communication skills
REQUIREMENTS FOR IMPLEMENTATION

A comprehensive Pharmacy Service
Drug distribution system
Responsibility from the time of interpretation of doctor's medication
orders to the time of administration of the medication
A COMPREHENSIVE PHARMACY SERVICE MEANS

1. A complete and adequate in-patient Dispensing Service
safeguards against mistakes
standardization of procedures
correct interpretation of doctor's medication orders
quality control for stocks
combination of individual order system and floor stock
system
2. Adequate Out-patient Dispensing
3. Narcotics and Dangerous Drugs Control
4. Inventory Control
5. Drug Information
\
Service
6. Intravenous admixture service
132
_l
I
DIAGNOSE
MD~-- THERAPEUTIC PLANS
RATIONAL DRUG THERAPY
MONITORING DRUG THERAPY

(Through drug profile)
Ph
DRUG INFORMATION
UNIT DOSE DRUG DISTRIBUTION (UDDD)
N - - - DIRECT PATIENT CARE
PATIENT CARE TEAM

Figure No 5
In this concept, there is a shared responsibility between the doctor,

nurse and the clinical pharmacist in the ward, the three working as a team.
For drug management in the ward,.there will be a shift of responsibility
from the nurse staff to the clinical pharmacist. This shift in the role would
result in better drug management in the ward as well as reduction in the
workload of the nurses, thus, conserving valuable nursing time.
WHY IT IS NEEDED
It creates a double check system by allowing clinical pharmacists to
interpret or check the physician's order before dispensing while the
nurses check the dispensed medicines before administering to patients,
thus, reducing medication errors.
It enables the clinical pharmacist to spot the following:

> drug/drug interactions
> drug-laboratory test interactions
> drug-food interaction
> drug duplication, overlapping therapy
> drug that is contra-indicated because of allergies the patient
may have
All doses of medications required at the nursing station are prepared
by the clinical pharmacist, thus; allowing the nurse more time for
direct patient care.
Reduces revenue losses
Eliminates pilferage and drug waste
Improves communication of medicine orders and delivery systems.
133
L

l
FLOW CHART FOR CLINICAL PHARMACY IMPLEMEN)"ATION
\
1. PHYSICIAN
11 .Reviews the patient chart in terms ofmedications administered
to the patient either on a 24-hour therapy. or that of the
preceding day's therapy.
U Performs patient rounds, together with nurses and clinical
pharmacists who can interact with the physician or furnish
the needed drug information.
13 Prepares prescription orders in two-copies
original - pharmacy
duplicate- file copy for ward nurse •
2. NURSE - Endorses the prescriptions to the clinical
pharmacy after patient rounds.
3. CLINICAL PHARMACIST
11 Reviews all the prescription orders for each patient
12 With the prescription orders:
a. Interprets the drug orders from the chart.
b. Matches the prescription order with that of the
medication order in the chart.
e. Prepares the Medication Cards using color index.
d. Prepares daily Medication Administration Sheet.
e. Accomplishes the Patient Drug Profile.
f. Orders medication supplies from the main pharmacy.
g. Prepares unit dose of drugs and places them in the
individual medication drawers of the Brewer's cart
properly labelled.
h. Checks medication drawers for all patients and
endorses to nurse.
i. Medication Cart is-brought to the ward.
4. NURSE - Receives prepared unit doses from the clinical pharmacist
referring to the corresponding medication cards, patient drug profile
and carded.
Administers the medications received at the proper time to
the patient.
Charts down medications administered during the procedures
in the daily Medication Administration Sheet
. 5. CLINICAL PHARMACIST - Return Brewer's (medication) cart to
the medication room.
Monitors drug therapy using the patient profile which includes
N fluids.
Updates patient drug profile daily.
Provide drug information to the patient
134
Prepares duplicate copies of take-home medications with

instructions. Original copy is given to the patient.
NOTE: Drugs issued out to the patient during the
whole course of confinement are credited based
on the daily Medication Administration Sheet.
PATIENfDRUG PROFILE is a form used by the pharmacist to:
• Review medication therapy
• Prepare medications for delivery to the nursing
stations and to keep accurate medication. records
of the patient
Sample of a Patient Drug Profile:
Patient's Name: Provisional Diagnosis/Chief

Complaint:
Age: Sex:
Final Diagnosis:
Bed No. Ward:
Address: Allegies (to Drugs & Foods)
• ro;a ROUTE OF
DRUG & DATE PHYSICIAN IV FLUIDS IPRN
STRENGTH ADMINI5- ORDERED
TRATION
PRN
MEDICNION
,
Drug History Interview Discontinued Medication
135
1
COLOR INDEXES OF. MEDICATION CARDS
Name of Hospital
Ward _ STARTED
Bed No. Room No.
Name
Rx
,I
,•
LAST DOSE
Sign:
Date Signature
(Front) (Back)
O.I.D. - green
T.I.D. - pink (dark color)
T.I.D. - pink color
P.O.
PER OREM ROUND THE CLOCK - white
AT BED TIME - white (red ink)
TID A.C. - pink
0.0. DAILY - yellow
BID (2x a day) - yellow
SINGLE DOSE PARENTERAL
SINGLE DOSE-PER OREM
TREATMENT CARD (as in skin ointment, eardrop, nebulizer) - orange
ROUND THE CLOCK PARENTERAL - orange
PRN PARENTERAL - blue
PRN or (if needed) PER OREM - Blue
ASPECTS IN CLINICAL PHARMACY

• FACTORS AFFECTING DRUG THERAPY:
A PATHOLOGY (Disease state)
1. Type of disease
2. Cause of disease
3. Resistance patterns (if there are any)
4. Location of the disease
5. Acute, chronic or relapsing state
• 6. Consequences of the disease state and/or mistreatment of the disease'
..
..
1
4. How often? How long?
a. Pathology
b. Physiology
c. Pharmacology
5. How do you monitor the patient?
a. Physical signs and symptoms
b. Laboratory tests
Drug Effects on Clinical Laboratory Test Results:
The effects of drugs on clinical laboratory test results can be divided

into two categories:
1. Test interference - the drug or its metabolite becomes a contaminant
which may interfere with the value or measurement obtained.
2. Pharmacologic interference - is a function of pharmacologic or toxic
activity of the drug and depends on dosage, duration of intake,
condition of patient, etc.
LABORATORY TESTS
A. RADIOLOGICAL PROCEDURES
I. Arteriogram - X-ray of the brain as in Aneurysm radiopaque substance

(dye) injected in the carotid or brachial artery
2. Barium Enema (BE) - Barium S04 + instilled in rectum (largeintestine
or rectum) colon carcinoma, etc.
3. Barium Swallow- Ba S04 meal (esophagus, stomach and duodenum)
carcinoma, ulcers, obstruction, etc.,
4. Chest X-ray
5. Cholangiogram - radiography of gall bladder and associated ducts
(presence of stone or calculi in the bile duct)
6. Cholecystogram - radiography of gall bladder after specification with
contrast media (telepaque)
7. lntravenous Pyelography (IVP)- injection of radiopaque solution into
the antecubital veins to kidneys to calces, pelvic ureters and bladder
of the urinary system are visualized (KIDNEY or URINARY DISEASE)
8. Myelogram - injection of gas or radiopaque solution in the
subarachnoid in the lumbar area distortion in the subarachnoid
(LESION OF SPINAL CORD OR CANAL)
9; Pneumocephalogram (PEG) - x-ray of brain with air as contrast media
10. Retrograde pyelography- radiograph examination of kidneys ureters,
urinary bladder and urethra with the use of contrast media through
urethralcatheters (stones calcification, tumors, etc.)
11 Upper GI (UGI) - barium sulfate swallowas contrast media (ULCERS,
NEOPLASMS, DIVERTICULA detected)
138
j
T
Hospital
. Pharmacy Management Manual,
B. NUCLEAR MEDICINE
1.
Brainscan - procedure to evaluate the presence of intracranial lesions
(tumors, cerebrovascular accident or subdural hematoma)
2. Liverscan- distribution of radioactivity in either the reticuloendothelial
or parenchymal (hepatic cells which are functioning normally and
shows approximate shape and size of the liver).
3. Lung scan - to ensure that the distribution of puhnonary perfusion is
homogenous-to aid diagnosis of puhnonary infraction particularly when
there is strong clinical suggestion in the presence of normal chest x-ray.
4. Thyroid scan - evaluate the distribution of radioactivity in the thyroid
• gland (multinodular goiter, autonomous modular goiter and in young
patients to detect presence of non-functioning thyroid tissue).
5. Thyroid uptake - routinely carried out at 6 and 24 hours after the patient
has digested an approximatedoseof131 iodine orally. Help in elucidatingthe
patient who may be hyperthyroid from those who are normal or euthyroid
C. ANCILLARY TREATMENTS. DIAGNOSTIC

PROCEDURES. AND EQUIPMENTS
1. Cardiology
J 1.1 Electrocardiography (ERG-ECG) - graphic record of electrical
potentials produced by the heart. .
a. Recognitionand identification of all cardiac arrhythmias
b. All cases of myocardial infection can be detected
c. Evidence ofmyocardialdamagein nearlyall typesofdiseases
d. Aids diagnosis of digitalis intoxication, pericarditis,
pulmonary embolism,leftand rightventricularhypertrophy
auricular enlargement, hypokalemia and hypocalcemia
1.2 Electric Cardioversion - treatment of atrial fibrillation with
brief discharge of high energy electrical shock across chest of
the patient used to revert to normal sinus rhythm
1.3 Cardiac Catheterization - Inserting a catheter into a distal
artery and threading it into the heart. .
- It measures the following parameters of heart functions:
• > Blood pressure
> Cardiac output
> Blood oxygen content
> Shunt flows
> Valve areas and vascular. resistance
Indicated in
* Mitral stenosis
* Aortic stenosis
* Congenital disease
* Complete atrioventricular block
* Pulmonary artery occlusion
.. *
*
*
Dissecting aneurysm
Pericardial effusion
Left ventricular outflow
139
1.4 Master's Test-Diagnoses angina pectoris by having the patient

do a controlled amount of exercise. Angina produces
characteristic ECG changes and a lag in return to normal
pulse and blood pressure.
D. GASTRC-INTESTINAL
1. Cantor tube - tube with mercury - containing rubber bag which the
patient swallows. Used for intestinal decompression studies and to
determine location of intestinal obstruction.
2. Centesis - a passage into a cavity for the purpose of removing fluids.
The operation is designated according to the cavity punctured.
Abdominal - paracentesis
Chest - thoracentesis
3. Nasal-gastric tube (NGT)- a suction catheter to removegastric contents;

blood, etc., from the stomach
E. OPHTHALMOLOGY
1. Fundus photographs - taken of the retina utilizing color fundoscopic

camera. Enlarged 'retina show enlarged blood vessels, retinal
detachments and other ophthalmic pathological conditions.
I .'
2. Photocoagulation (photocoag) -Iaser beams used for treating diabetic
retinopathy.. Also for correcting detached retinas provided detachment
is not over 1 mm elevation.
3. Tonography - determination of intraocular pressure by means of an
instrument which measures corneal impressibility.
140
• IN1RAVENOUS (IV) ADMIXnJRE
PREPARATIONS AND TarAL
PARENTERAL NlITRlTION/
HYPER-ALIMENTATION
•
The implementation of N admixture service can serve as a foundation
for providing comprehensive pharmaceutical services in hospitals,
considering the availabilityof space, personnel and equipment. This service
must have sufficient control to ensure product safety for patient use. In N
admixtures and total parenteral nutrition, the pharmacist must be familiar
with patient variables such as electrolyte and fluid balance, and other factors
such as personalhygiene, environmentalcontrol and equipment perfomiance.
FLOW CHART FOR INTRAVENOUS

ADMIXTURE PREPARATION
1. Physician - writes admixture order and includes N fluids wanted, additives
and their concentration, rate of flow, starting time and length of therapy.
2. Pharmacy - the order is checked for proper dosage, incompatibility,
drug allergies, and stability.
.. Checking whether the proper dosage has been given requires a knowledge of
milieu equivalent calculations. Order is checked for compatibility, and
admixtures are given the maximum expiration period of 24-hour therapy.
Drugs such-as ampicillin require shorter expiration period.
3. Clerical Work - label and profile worksheet
The label contains the bottle number, patient's name and room no., date
prepared, and expiration date. N and additives with the amounts,total time
forthe infusion, milliliters perhour and drops perminute, and space for the
nameof thenurse who hangs thecontainer are included. Thelabel is affixed
upside down in order that it can beread when hung. A profile work sheet is
prepared so that the admixture can be recycled whennecessary. It isfiled so
that thepharmacist will be alerted when thenext bottle is dueforpreparation.
141
4. Preparation of admixture by pharmacist

In handling the sterile products, the aseptic techniques involved must
maintain the characteristics and integrity of the product. Additive
caps are affixed before delivery to the floor/wards.
5. Completed Admixture is checked by the Supervising Pharmacist
Label is checked with the original order. The empty containers are
checked to confirm the additives. It is also checked for color changes,
or particulate matter.
6. Delivery to patient area
Completed admixture may be delivered by a messenger or by the pharmacist
on a centralized unit STAT ordersareusuallypicked-up by the nursing staff.
7. Storage in patient care
If the admixture is not to be infused immediately, (within 1 hour)
storage under refrigeration is required; if refrigerated, it must be used
within 24 hours.
8. Administration to patients
The nurse checks for the correctness of the patient's name, drugs and
concentration plus solution, expiration date, time started, and clarity.
Infusion of admixtures can run ahead of or behind schedule,
necessitating the pharmacist to modify the preparation of continued
orders. (Examples of N orders are shown in Table 4.)
Recommended clinical procedures for safe parenteral hyper-alimentation:

1. Strict asepsis must be used in inserting and maintaining catheters.
2. Withdrawal ofblood or direct administration of medication through
the infusion catheter is discouraged.
3. Patients should be weighed dailyfor strict intake and output measurement
4. Appropriate hemoglobin and hematocrit levelsshould be maintained
at appropriate intervals.
5. Laboratory studies of the following must be done:
a. Urine test for sugar four (4) times a day.
b. Electrolytes checked twice a week.
c. Blood sugar twice a week.
d. Blood culture as indicated.
e. Blood Urea Nitrogen (BUN) and Complete-Blood Count
(CBC) once a week.
f. Occasional urine and serum osmolality, as indicated
To be considered comprehensive, the Pharmacy Reporting of every

hospital should have an N admixture service in its program.
TOTAL PARENTERAL NUTRITION (TPN)

Total Parental Nutrition is the intravenous administration of calories, nitrogen,
and other nutrients in sufficientquantities to achieve tissue synthesis and anabolism.
The term hyper-alimentation was originally used to describe the procedure, but it is
now replaced by TPN, the term being more descriptive of the technique.
142
Thenormal calorie requirement foran adultisapproximately 2,500 calories per

day. If these were to be provided totally by Dextrose Injection, five percent (5%),
approximately 15 liters would be required. Each liter contains 50 grams dextrose,
which isequivalent to rillcalories. However, it is only possible to administer three
or fourliters perday without causing fluid overload. To reduce this fluid volume,
the concentration of dextrose would have to be increased. By increasing the
dextrose to twenty-five percent (25%), it is possible to administer five times the
calories in one-fifth thevolume. Twenty-five percent (25%) of the dextrose injection
is hypertonic and cannot be administered in large amounts into a peripheral vein
without sclerosing the vein
Fluids for TPN may be administered through the subclavian vein into
the superior vena cava where the solution -is rapidly diluted by the large
• volume of blood available. This technique developed minimizes the
hypertonicity of the solution. For administration of the TPN fluids, a
catheter is inserted and retained in place in the subclavian vein. TPN is
indicated in patients who are unable to ingest food due to carcinoma or
extensive burns; patients who refuse to eat, as in the case of depressed
geriatrics or young patients suffering from anorexia nervosa; and surgical
patients who should not be fed orally.
Carbohydrate dextrose is the preferred source for calories in TPN fluids,
Although fat emulsions and alcohol are caloric sources, they are not used
in TPN fluids. In N fluid kits commercially available for the preparation
of the TPN solutions, fifty percent (50%) of dextrose injection is provided.
For a dilution with protein hydrolysate or amino acid injection, the resulting
dextrose concentration is approximately twenty-five percent (25%). It is this
concentration that is administered.
Thesource of nitrogen in TPNfluids iseither protein hydrolysate or crystalline
amino acids. Protein hydrolysate are obtained from casein or fibrin and contain
polypeptide which must be broken down before they can be utilized. Although
available at lower cost thancrystalline aminoacids, they contain higher amounts of
ammonia and free chloride. In thecase of hydrolysate, the exact amountof protein
being administered isnot known. Thecrystalline aminoacid injections contain all
the essential and nonessential aminoacids in the L-form. They are more expensive
than the protein hydrolysate but contain less ammonia arid free chloride. For
optimum utilization ofamino acids for promoting tissue regeneration, thenitrogen-
to-calorie ratio should be 1:150. Calories are needed to provide energy for the
metabolism of nitrogen
Electrolyte requirements varies for every individual patient The electrolytes
present in protein hydrolysate injection or amino acid injection are given on the
• label and must be taken into consideration when determining the quantities to be
added. Usual electrolyte considerations required full within the following ranges:
sodium,lOO-ZOO mEq; potassium, 8().120 mEq; magnesium, S-16 mEq; calcium, 5-10
mEq; chloride, 100-IZO mEq; and phosphate, 40-60 mEq. It is better to keep a 1:1
ratio between sodium and chloride ions. In adding potassium, the acetate salt is
preferred over thechloride type. Ifthecombination of calcium and phosphate ions
exceeds 20 mEq, precipitation occurs.
In addition to the electrolytes, the daily requirements for both water-
soluble and fat-soluble vitamins may be added, usually in the form of a
multivitamin infusion concentrate. Iron, folic acid,and vitamin BI2 should -
be administered separately from the TPN fluids. Trace elements such as
zinc, copper, manganese, and iodide are a concern only in long-term cases
and can be added when required.
143
.----
\
Table 5 - Typical N Orders (Parenteral Prescriptions)
Prescription Comment
1. Rx
NSS 1000 mL Sodium Chloride Injection(Normal Saline
125 mL/hr Solution) 1000 ml; is to be administered
at the flow-rate of 125 mL per hour. It will
require approximatelyeight hours.
2. Rx •
1000 D5 + NSS + Dextrose Injection 5%,1000 ml, containing
Vits 12 hr 0.9% sodium chloride and vitamin B
complex with vitamin C is to be
administered over a 12-hour period.
3. Rx
500 D5 + 1/2NSS Dextrose Injection5%, SOO ml, containing
KVO 0.45% sodium chloride is to be
administered at a rate of flow to Keep
the Vein Open (KVO). The flow rate
will be approximately 10 mL per hour,
4. Rx
1000 cc D5 + 1/2 Dexnose Injection :P/o, 1000 ml, containing
NSS 0.45% sodium chloride, the contents of
Add 1 amp Vits to one ampule vitamin B complex with
each + 100 mg. vitamin C and sufficient volume of
Thiamine Thiamine Hydrochloride Injection
Each to run 6 hr to give 100 mg. thiamine, is to be
administered over a 6-hour period
(approximately 170 mL per hour).
Additional orders of the same can be
anticipated.
5. Rx
1000 cc D5 + 1/2 Dextrose Injection 5%, 1000 ml, is to be'"
NSS + 20 mEq KCl provided containing 0.45% sodium
chloride and 20 mEq potassium •
chloride.
6. Rx
1000 Hyperal + 10 One Lofthe hospital'sbasicTPN solution
NaCI + 10 KCl + is to be provided with the addition of
5MgS04 + 10 10 mEq sodium chloride. Insulin 10 mEq
potassium chloride,S mEq magnesium
sulfate, and 10 unit regular zinc insulin.
144
Hospital Pharmacy Management ManiJal
r
Continuation of Table 5
Prescription Comment
7. Rx
1000 cc Hyperal One L of the basic TPN solution,
(FreAmine) + FreAmine II, is to be provided with the
40 mEq NaHC03 + addition of 40 mEq NaHC03, 30 mEq
30 mEq KCl + potassium chloride, the contents of
Vits + 5 u Vitamin B complex with vitamin C
Reg. Insulin to plus 5 units of regular zinc insulin. It
run 80 cc/hr is to be administered at the flow rate
of 80 mL per hour (approximately 12
hours).
8. Rx
1000 Hyperal + One (1) of the hospital's basic TPN
40 mEq NaCI + solution is to be provided with the
10 KCl + 10 addition of 40 mEq sodium chloride,
Insulin + 10 10 mEq potassium chloride, 10 units
• Cal Glue. regular zinc insulin, and 10 mL
Calcium Gluconate Injection.
9. Rx
Keflin 2 g + Cephalothin, 2 g, is reconstituted with
100 mL D5 W q 6hr Sterile Water for Injection and added
to a mini-bottle containing 100 mL
Dextrose Injection 5%. This dose is
given every 6 hours using piggyback
technique with a flow rate requiring 30
to 60 minutes for delivery.
10. Rx
Gentamicin 80 mg. Gentamicin, 80 mg., is added to a mini-
IVPB q 8 hr bottle containing 100 mL Dextrose
Injection 5%. This dose is given every
8 hours using the piggyback technique
(IVPB) with a flow-rate requiring at least
.. 80 minutes (not less than 1 mg. per
minute).
145
, ,
146
: I
QUAIIfY ASSURANCE FOR

PHARMACY SERVICE
Quality Assurance is a planned program of systematic approach to
monitor and assess the service provided as well as identify opportunities
and provide mechanisms for improvement. .
Quality Assurance is basically nothing more than deciding what needs
to be done, doing it, measuring how it was done, and if the service or
product was found unacceptable, undertaking some correctional activity to
ensure that future product or service will be acceptable. Quality Assurance
assesses the value of the service provided, not the performance of individuals.
Quality assurance should encompass evaluation of structure, process
and outcome.
Structure factors concerning resources which include components, such
• as, staffing, funding, and risk factors.
Process on the other hand, includes care and its improvement in terms
of diagnostic, therapeutic and aftereffects of care.
An outcome factor involves health status using components such as
physical functioning, patient or physician satisfaction level.
The essential elements of Quality Assurance activities are as follows:
1. Planned and Systematic approach - quality assurance plan
should exist and address the following:
a. Scope of the Program
b. Objectives
c. Methods to be used
d. The individuals to be involved in the program
2. Monitoring - this should be a systematic on-going process of collecting
information on clinical and non-clinical performance..
3. Assessment - the periodic analysisand interpretation ofthe information
or collection in order to identify. important or potential problems or
related concerns in the care of patients.
147
4. Action - at this stage, important problems in patient care or

opportunities to improve care are identified and action/studies are
undertaken.
5. Evaluation - the effectiveness of actions taken is evaluated to ensure
long-term improvement.
6. Feedback - to be effective, results of activities should be regularly
communicated to the staff or people involved in the program.
I 1
FOLLOW-UP MONITORING
1 --,I ...------1
I
FEEDBACK
,-- ----'1 1..... -----,
I I
ACTION ASSESSMENT
I I
Cycle of An Effective Quality Assurance

Figure No.6
Benefits Derived from the Quality Assurance Program (QAP)
1. The highest level of care can be achieved by assuring the quality and
appropriateness of care/or improved patient care.
2. The institution can save money by increasing efficiency and/ or reducing
risks for cost containment purposes/or reducehospitaland patient carecosts.
3. The program will result in the effective utilization of resources, and
4. Will prevent adverse effects/or reduce hospital liability.
THEPHARMACYSER~CEAND
QUALITY ASSURANCE PROGRAM
The Q'\P for the Pharmacy Services' shall be a continuous program. It
must look into the effectiveness of the services offered and resource
utilization. The main concern of Quality Assurance is to subject structure,
process, and outcomes of health delivery to objective professional scrutiny.
A major responsibility of the Pharmacy Service must be the assurance of the
qualityofitsservices and ofproducts dispensed, coupledwith a control program for
the distribution of drugs throughout the institution. The pharmacist must conduct
audits to assure the quality of patient care services rendered and to assure the
appropriate patient benefit of all pharmaceutical services offered.
Consciously or unconsciously, most pharmacists have a deep commitment
to quality assurance. They make certain that medication orders are filled
accurately, they remove outdated drugs from stock, and they head off
problems in the pharmacy before they have a chance to happen. They serve
in the infection control, pharmacy, and therapeutics and other committees
concerned with patient care. They assist the medical staff in performing
antibiotic usage reviews. They enforce automatic stop orders.
•
148
Hospital Pharmacy Management ManuaI
They help the nursing service to review medication errors. They note and
solve problems in carrying out medication orders. More than anybody else
in the hospital, they are the ones who are knowledgeable in terms of how
medications are actually being used. They know which physicians are aware
of the popularity trends in drugs, perhaps, because of the new and
personalized medical representatives assigned to the area. The pharmacist
is awareof the problems in the hospital and solves those that concern himself
and his department and assists in those that concern other services or
practitioners.
The objectives of the QbP of the Pharmacy Service should reflect the
overall objectives of the organization/institution.
OBJECTIVES:
I. To achieve good health care by continuously supplying safe, effective,

and quality drugs to facilitate the delivery of patient care;
2. To attain cost-effective Pharmacy Service management;
3. To see to it that all the procedures and practices of the Pharmacy
Service conforms with acceptable staridards;
4. To be able to assess and determine the quality of service delivered and
determine areas which need improvement to attain the delivery of
excellent service;
5. To further improve the Pharmacy Service for the attainment of the
institutional goals and objectives; and
6. To institute staff development by providing feedback which facilitates
corrective action and identifies in-service training needs.. Recognizing
the excellent performances would encourage employees to strive harder.
Pharmacy Quality Assurance Activities:
A. Pharmacy-based Quality Assurance Activities

I. Drug Distribution Service
2. Drug Information Service
3. Intravenous Admixture Service
4. Clinical Pharmacy Service
5. Departmental Administrative Service
• 6. Manufacturing and Packaging Service
7. Purchasing and Inventory Control Service
8. Ambulatory Service
9. Staff development and education
B. Inter-departmental-based Quality Assurance - Activities to promote
l Rational Drug Therapy:

1. Drug Use review
l
a. How drugs are prescribed
b. How drugs are administered
c. How drugs are monitored
149
Hospital Pharmacy Managemtllt Manual
Steps Involved in Developing a Q!Iality Assurance

for the Pharmacy Service
The development' of a QAP in the Pharmacy involves the following
steps and procedures:
1. Identifying the problem and determining the specific processes or
main activities involved in pharmaceutical management.
• The main activities involved in Pharmaceutical Management
as stated in A & B.
• An ongoing QAP shall also be done to study other identified
problems.
2. Establishing the objectives
The general objective of the QbP is to improve the service giving
due emphasis on quality patient care.
The objective should specify what should be achieved and how it
should be achieved.
In stating the objective, use phrases such as "to ascertain", "to
examine", "to assess", "to determine", and "to investigate".
Example:
To determine the accuracy of prescriptions filled through
Quali- and Quanti- Analysis, (right dosage form, strength,
right patient with the right bed in the right time and ward
number)
To assess the effectiveness of the follow-up system employed.
3. Choosing the Assessment Method and Selecting the sample:
At this stage, the sample size is chosen and the time span of the
program is set. Choices take the form of document, questionnaire,
direct observation, or assessment.
Example:
What percentage of the daily in-patient dispensing is to be
assessed?
Until what month should the assessment be done?
4. Developing the Criteria and Setting the Standards
Identify the established standards, regulations and performance
criteria that would have an impact on pharmacy services.
The standard for each may be set individually according to what
can realistically be expected or what the goal is (e.g., 80-90%) rather
than setting it habitually at the optimum (i.e, 100%),
There should be instructions regarding .acceptable standard
deviations. This standard may be reset after the initial survey, if
circumstances warrant.
In developing the criteria, select those which could be
compared to an existing standard. Criteria should be measurable
150
--- ._-.~--------------------------------
!
rather than descriptive.
Example:
Element Standard
Total prescription filled for in-patients 80-100%
No. of Extemporaneous/compounded 80-100%
preparations
5. Assessing the Actual Procedure
Actual procedure done is assessed against the criteria set and the
difference is noted. Assessments are done through:
* observation
* statistical data
* random sampling
* reports
6. Analyzing Results
Results should be properly analyzed. Procedural differences,
compared with the set criteria, shall be noted properly to determine
whether variation is justifiable.
Since individuals absorb information in different ways, it would
• be helpful to summarize results using more than one method.
7. Instituting Appropriate Action
Appropriate action taken on identified problems must be directed
toward instituting changes, such as:
* change in systems and procedures -
* change in policies, rules and regulations
* change in forms format
* better and effective line of communication
8. Re-evaluating the corrective actions taken should be done to document
its effects and benefits. .
It is necessary to conduct a follow-up study on the same topic to
determine whether the problem has been corrected or nolo
The following should be considered in setting priorities in Q!>P:

I. Severity of the problem
2. Potential impact or service provided on patient care
3. Anticipated benefits (including cost benefits)
4. Staff and money resources required for the study and time required to
analyze data and correct identified-problems
5. The potential for correction of the problem
Expected Outcomes of a QAP
* Demonstrable and higher standards of clinical and non-clinical care

and service.
* Identification of barriers in the achievement of higher quality patient care.
I
I
. 151
r
Motivated staff more aware of, and interested in standards of patient

care and service.
Delivery of safe and efficient patient care and service.

Efficient and effective allocation and use of resources.
Commitment from staffwhich will ensure that the program is ongoing,
and improved standards are long-lasting. .
Construction input, from stafflevels, into the continuing education
program of the complex.
Communication at all levels about problems related to standards of
quality care and service
Cooperative problem-solving where a service involves more than one
area in the complex.
Pharmacy Service Effectiveness Standard

1. The hospital shall maintain a Pharmaceutical Service under a
competent and legallyqualified pharmacist with a sufficient number
·of competent staff consistent with the size and scope of the service of
the hospital.
2. The scope of the Pharmaceutical Service shall be consistent with the
safe, effective, and quality medical needs of the patients in collaboration
with competent medical staff.
3. Policies and procedures that pertain to the drug distribution system
in concurrence with the medical staff, should be appropriate to other
disciplines.
4. Policies and procedures governing the rational use of drugs and
biologicals shall be developed by the medical staff with the
pharmaceutical and nursing services, and if necessary, representatives
from other disciplines.
5. The Pharmacy Service should have adequate plant facilities, supplies,
and equipment required to promote patient safety through proper
storage, preparation, dispensing and administration of drugs.
6. Planned and systematic process for the monitoring and evaluation of
the quality and appropriateness of patient care services and for resolving
identified problems.
.,
;
Pharmacy Service Efficiency Standard

1. Workload units and utilization rate
2. Errors and waste
3. Accountability/liability - prompt submission of reports and documents
necessary (e.g., Monthly Report on Drug Consumption and balance
of stock, Annual DrugProcurement Program, slow-moving drugs,
152
emergency drug list, antidotes, etc.}

4. Cost effective management of the Pharmacy Service.
THE QUALITY ASSURANCE PROGRAM SPECIFIC

FOR THE CLINICAL PHARMACY PRACTICE:
1. All orders for medication must be interpreted by a Clinical Pharmacist

from the physician's order sheet before any medication is dispensed.
2. All medications shall be delivered to the nursing unit prior to the
time it is scheduled to be administered.
3. All medications shall be dispensed in properly-labelled unit of dose
packaging.
4. All medication profiles shall be checked daily with the nursing
administration records for order interpretation accuracy. - -
5. Drug therapy information shall be provided on request.
6. Unsolicited drug therapy information shall be provided when
indicated. .
7. Drug history shall be obtained by the Clinical Pharmacist from all
patients upon admission except those specifically exempted by policy.
8. Patient profile monitoring shall be done daily for the purpose of
identifying irrational drug therapy, irrational intake, irrational dosage
forms, drug interactions and drug contra-indications.
9. Each patient for whom medication is prescribed at discharge shall be
counselled by a Clinical Pharmacist prior to discharge concerning his
medication.
This is an example of setting-up a criteria and standard for the Pharmacy

Service:
Criteria Standard Audit Audit Corrective

Procedure Results Action
No patient 0% Check 100 patient 5% Re-instruct

IS receiving medication profile pharmacist
duplicate for duplicate drug on profile
drug entities entities review
Criteria used for Screening Charts during Drug Usage Review:

•
DRUG PRESCRIBING DRUG ADMINISTRATION
Was drug therapy indicated? Was drug ordered/not given?
Optional drug for situation? Was drug given/not ordered?
Optional route for situation? Was drug administered by
proper schedule?
Optional dosage for situation? Was the correct dose
administered?
Proper course of therapy? Was the correct route used?
Was therapy properly Was drug given on schedule?
monitored?
Approval indication?
Therapeutic incompatibilities?
Overlapping therapy)
Efficacious use?
Culture and sensitivities taken?
153
QUALITY ASSURANCE STUDY
Name of Hospital
FORM A - CRITERIA
lDPIC: _ Date _
C S
r t
1 a
t n Instructions
e Criteria d Exceptions for
r a retrieval
I r of
a d data
N Ofo
o.
6 •
10
.
OUALITY ASSURANCE ACTMTY
SUMMARY SHEET
FORMB
TOPIC:
Problems Identified:
Action:
Follow-up:
Review Date: _
QA. Coordinator -'- _

Date signed: -----,-_ _
I
I
I
I
NOTE: Analysis and evaluation of the findings, likewise the recommendations, must appear on
a separate sheet for the information of the members of the Qf\P
r
I
This is an example of a Quality Assurance instrument which should

be modified to suit your institution's needs.
Q!Jality Assurance Program - Administrative Services

Pharmacy Therapeutics Committee (PTe)
CRITERIA STD. CRITERIA AUDIT CORRECTIVE

AUDIT RESULTS ACTION
PROCEDURE !yES NO
PLANNING A
PTCMEETING
1. There is a standard 1000/0 Review the protocol

protocol for schedu- to ensure that:
ling a PTC meeting.
1. Chairman is consulted in
the selection of date;
2.The calendar of events is
checked to avoid conflicts;
3. Members are called to
confirm their attendance to
ensure a quorum;
4.The meeting room is
scheduled, dietary dept. is
called to provide
appropriate service;
5. Meetings are scheduled
monthly or when there are
sufficient items for an
agenda.
2. There is a standard 1000/0 Review the protocol to

protocol for prepuing ensure that:
the agenda and back-
ground material 1. Chairman was contacted
prior to the meeting. and agrees with the
proposed agenda;
2.The Chairman and secretary
discuss the strategy for
conducting the meeting;
3. The agenda is typed accurate~
in the standard format;
4. The background material,
drug monographs, reports,
and other data are typed
accurately in the standard
format and indexed.
Resource staff or consultant
was invited, the agenda and
background. material was
distributed at least three (3)
days before the meeting.
•
156
r
Quality Assurance Program - Administrative Services

continuation:

PROCEDURE YES NO•
.
3. Last minute details 10(1'/. The following data ""'" medal: -
were checked prior
to the meeting. \. Meeting room reservation
-
confirmed:
2. Last minute agenda
additions prepared for
distribution;
3. Call member's secretary to
confirm their attendance
prior to the meeting;
4. Prepare for pharmacy's
verbal input regarding
agenda items;
5. Gather materials necessary
for cond ucting meeting
(tape recorder, background
material) and set it up in
the meeting room.
CONDUCTING
THEPTC
MEETING
4. The basic essentials The following have been
for conducting an provided for:
effective meeting -.
haw been provided for; 1. An agenda and background
material available for
eacb member;
2. Tape recorder's in operating
condition and placed in
appropriate places;
3. Visual aids provided,
Chairman and secretary
know. which agenda
. items
.
require committee action;
4.Secretary elicited member's
support on key issues.
5. The committee meeting 90% \. The meeting is conducted

is umluced acconling according to an agreed time
to the previously schedule;
accepted protocol. 2. The motions tor action,
recording the motion and
• the voting pnxrduns follow a
romminee aaepud protocol
157
j ..

1
Q!Jality Assurance Program - Administrative Services
continuation:

PROCEDURE YES NO
IMPLEMENTiNG,
DECISIONS' <:
OFPTC
6. The secretary lOlJO/o Compare the minutes IWh the
prepares the minutes standardized format for
according to the conformity of heading,
standardized style agenda items, appendix
and format within material, voted actions, proof-
48 hours after the read for accuracy.
meeting.
7. The drafted minutes lOlJO/o Comments received from

are submitted to members (if any) are reviewed
members of the with the Chairman for
committee for aa:uracy appropriate change in the
of interpretations minutes. Other members are
and for their approval called for their approval.
within three (3) days.
8. The appo\\'l:l minutes lOlJO/o Check with the seoetary ofthe

are distributed to the Executive Committee about
rrc and thehospital the placing of the P&T
executive committee Committee minutes on agenda
for final approval. of the next Executive
Committee meeting.
9. Implement the lOlJO/o I. Obtain copy ofthe minutes

approved actions talen of theExecutive Committee
and check on actions taken
onP&TCommittee minutes;
2. Actions taken by the P&T
Committee are distributed
to Medical and Nursing staff
by memo or Pharmacy
Newsletter;
3. Phannacy staff(Purchasing,
Dispensing, and Clinical
staff);
158
r
Quality Assurance Program - Administrative Services
.
continuation:

PROCEDURE YES NO
4. Physicians who requested

drugs headded to the
Formulary;
5. Other departments (where
applicable);
6. Update master revision
copy of Formulary;
7. Update drug data base for
manual or computer
charging;
8.Set-up purchasing and
inventory levels for
additions;
9. Remove deleted drugs and
return for credit.
..
159
This is an example of a Quality Assurance instrument on;
QUALITY ASSURANCE FOR DRUG DISTRIBUTION SYSTEM:
TO PROVIDE COMPREHENSIVE PHARMACY SERVICES FOR ALL

PATIENTS WITHIN THE INSTITUTION WITH A DRUG
DISTRIBUTION SYSTEM THAT MINIMIZES IMMEDIATE ERRORS
AND PROVIDE A SYSTEM WHERE MEDICATIONS ARE AVAILABLE
TO THE NURSE FOR ADMINISTRATION TO THE PATIENTS.
OBJECTIVES:
1. Provide 24 hours per day service.

2. Dispense all medications within 4 to 7 minutes/hour after receipt of
order.
3. Immediate stat doses required within 4 minutes after receipt of order.
4. Medications storage is monitored in all patient care areas at least on a
monthly basis.
5. Medications are stored in a secured fashion in the nursing units.
6. Medication dispensing system with less than 1% error.
7. There is a feedback mechanism to immediately correct deviations with
the distribution system.
8. A modified drug distribution system is provided to the Intensive Care
Unit.
9. A system for emergency medication is available.
CRITERIA STD. CRITERIA PROCEDURE CORRECTIVE

AUDIT RESULT ACTION
PROCEDURE
ORDER PROCESS
I. Ph~cian's order taken 100% Review each nursing 100% in all units
offthe chart within 15 unit area on a date
minutes. periodic basis
2. Order accurately trans- moo/. Review MAR' or -do-
cribed onto medication physician's order on
administration record a random basis tor
each nursing unit
3. Order sent to the moo/. Review time order 95% all units Nurse or unit
pharmacy within 30 was written \IS. except unit 2 clerk reoriented
minutes ofwriting phannacy receipt on a on order process
random basis for cuh
nursmg unit
• Medication Administration Record

•
160
Hospital PhilTlnacy Management Manual
QUALITY ASSURANCE FOR DRUG DISTRIBUTION SYSTEM:
continuation:
CRITERIA STD. CRITERIA PROCEDURE CORRECTIVE

AUDIT RESULT ACTION
PROCEDURE
DRUG ADMINISTRATION
16. Mdattim ahniIiI1md to 1000/, Review medication lOoo/,

the right patient with error reports and
the right medication, review doses not
right dose, right time administered report
and right route
17. Dose charted aaurately 1000/. Randomly review lOoo/,

at point of adminis- patient chart (MAR)
tration unit vs contents on each nursing
of medication cabinet
18. "Dose not Administered 1000/, Review "Dose not 95%

Forms" completed administered" for
presence of form
PHARMACY MONITOR
19. Doses not administered 1000/, Randomly check 95%

checked vs pharmacy medication cabinet
dispensed order with pharmacy
dispensed orders
20. N:l unalmnistered doses moo/. Review pharmacy 95%

remaining in medication doses not adrni-
cabinet without form nistered document
21. All patient charges moo/. Review the required 1IlOO/.

correct number ofrandomly
selected ch arge
documents for correct-
ness of dose totals
and charges
162
Hospital Pharmacy Management Manu'al .
This is an example of.Quality Assurance instrument on :
QUALITY ASSURANCE FOR PROCUREMENT AND STORAGE:
CRITERIA STD. EXCEPTIONS INSTRUCTIONS
UNIT HEADS
Submitted list of needed 100"10 Preparation of semi-annual drug

drugs to PTC based on the requirements
PNDF Vol. I current Edition
PHARMACIST
a) Consolidated drug 1000/0 Consolidate/deliberate and

requirements according to evaluate drugs in accordance
therapeutic classification with therapeutic classification
with complete drug with complete specifications. .
specifications and quantity the quantity based on hospital
consumption
h) Forwarded official 1000/0 Forwards official list to all

hospital drug request concerned
to Drug Procurement
Committee (DPC) of
Region DOH Procurement
& Logistics Services (PL~)
c) Official Price schedule 1O(JO/o Distributes official price

received and copies schedule to all concerned
distributed to all
concerned
d) Requisitioned needed j{)(JO/o Prepares requisition based on

drugs based on DOH/ official Price Schedule for
regional Price Schedule actual procurement
for actual procurement
1. Prepared and signed

RlV w/ quantities
• & cost based on
official Price Schedule
2. Stock position sheet

for each drug requested
3. Follow-up of RIVs • Inquiries on status of R1Vs
e) Presence of Pharmacist j{)OO/o Checks specifications of drugs

during drug deliveries delivered against P.O. including
expiration dates
,163
QUALITY ASSURANCE FOR PROCUREMENT AND STORAGE:
continuation:
f) Proper documentation mo% Receives drugs form S.O. with

received from supply proper documentation
officer for immediate
turnover of delivered
drugs to pharmacy
g) Drugs stored under mo% Using required temperature,

proper conditions and systematically store drugs for easy
security withdrawal of stocks
AO 51
D.O. 104-C s. 1991: Exec. Order No. 49
Budget Circular 321
AOs 15, 116
Generics Act of 1988
..,
164
This is an example of Quality Assurance:instrument on :
QUALITY ASSURANCE FOR DRUG UTILIZATION REVIEW

PARTICULARLY ANTIBIOTICS:
CRITERIA STD, EXCEPTIONS lNSTRUCTIONS
I. Physician's Responsibility
a) All in-patient orders for

antibiotics shall be
ordered on official
prescription form
b)Antibiotic prescriptions
should contain the following
additional information: time
of order, route, strength and
frequency of administration
and length of use on number
ofdoses to beadministered
c) Change, if any, in antibiotic

therapy must require anew
written prescription order
II. Pharmacist's Responsibility
a) Check completeness of Pharmacist initials on

required information of prescription indicates it'
presciption received has been checked, Refer to
hospital list of interaction
b)Check for possible drug and procedure for dealing
interaction, if any with the interaction, notify
prescriber
c) All drugs dispense" will

he checked against the
prescription order and
label of container
d)Verify that patient's Pharmacists initials prescription

ward, room and bed order indicating that all elements
numbers correspond to in the criteria were met
the label ofdrug
container
It Provision for drug interaction

list
e) Drug container is placed

in correct pick-up box
. t) No expired drugs are

placed in pick-up box
165
QUALITY ASSURANCE FOR DRUG UTILIZATION REVIEW

PARTICULARLY ANTIBIOTICS:
continuation:
III. P & T Committee Responsibilities

a) Review all statistical infor-
mation, susceptibility and
resistance trend, studies all
ADR reports and other
appropriate hospital reports
to identify areas associated
with antibiotic use.
b)Establish clinically valid

for theassessment of
potential problem areas
c) Review the assessment results

and make recommendations
to the Q!\Committee for
problem resolution.
d)Evaluate the Antibiotic Usage

Review Prograro annually to
assure that theprograro
is ongoing, comprehensive,
effective in improving patient
care and clinical performance
and conducted with cost
efficiency.
..
166
. '.
APPENDICES , " .
. . ' .'
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•
OFFICE OF THE SECRETARY
November 16, 1988 .
ADMINISTRATIVE ORDER
No. 51 s. 1988
Implementing Guidelines for the Department of Health

Compliance with Republic Act 6675
(Generics Act of 1985)
1. Title: This order shall be known as "Implementing Guidelines for the Department of Health
Compliance with Republic Act 6675 (Generics Act of 1988)"
2. Authority: This order is issued to implement R.A. 6675 guided by pertinent provisions of R.A 3720
and related laws as well as E.O. 119 (Reorganization Act of Ministry of Health).
3. Purpose: This order provides guidelines and instructions for the Department of Health to comply
with R.A 6675 and implement its provisions.
4. Scope: This order applies to all agencies and entities within the supervision of the Secretary of
Health that perform the functions of procuring, prescribing, 'dispensing and administering
drugs and medicines as well as promoting, regulating and practicing the use of generic
games of drugs. While R.A 6675 covers agencies and entities other than the Department
of Health, this order does not apply to such agencies and entities. Separate issuances shall
expressly provide for guidelines applicable to non-DOH agencies and entities.
5. Specific Roles of the DOH in implementing R.A. 6675
This order provides guidelines and instructions for the proper, orderly and efficient performance
of the DOH of its various roles under R.A. 6675.
5.1 DOH is the agency tasked with the promulgation of rules and regulations to implement
R.A. 6675 Sec. 9 and 12 (c).
5.2 DOH is also one of the key government agencies that shall have to comply with the use of
generic terminology or generic names in all transactions related to purchasing, prescribing,
dispensing and administering of drugs and medicines Sec. 6 (a).
5.3 DOH is also one of the key government agencies mandated to promote use of generic
terminology through public information and continuing education of health professionals
(Sec. 11).
5.4 DOH is also one of the key government agencies mandated to insure that drugs are
generically labelled (Sec. 7) and that generic drugs production are encouraged and promoted
(Sec. 8 and 10).
This order specifically addresses how DOH shall perform the role defined in 5.2 above, but shall
also outline how the performance of the other roles shall be guided .
..
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6. Guidance and Implementation
The task of guiding the implementation of R.A. 6675 shall be undertaken principally by the
Secretary of Health with the staff assistance of the National Drug Policy Implementation Team
created in A.O. No. 46, series 1988, which is headed by the Assistant Secretary for Standards and
Regulations. The various units this staff shall formulate recommendations for policy guidelines
and operational instructions on all matters regarding the implementation of R.A. 6675. These'
drafts shall be revised by the Executive Committee for National Field Operations. All issuances
shall be approved by the Secretary and disseminated prior to effectivity.
In drafting of recommendations, the following guidelines shall be observed.
6.1 Recommendations should be clear, reasonable, itnplementable, consistent with legal

provisions and facilitates the achievement of policy goals. .
6.2 Suggestions, comments and similar inputs form affected as well as interested parties
should be solicited and considered.
6.3 Discussions in various committees, conferences and meetings should be maximized.
6.4 Formulation ofguidelines should proceed promptly, observestated deadlines and schedules
and decisively disposed.
7. Implementation by Field Units of DOH
To carry out the rules and regulations in implementing R.A. 6675, the following officials are
responsible:
7.1 The regional Health Directors for all agencies under their supervision in the regions.
7.2 The provincial Health Officers for all agencies under their supervision in the provinces.
7.3 The Chiefs of District Hospitals in their respective hospitals and catchment areas
7.4 The City Health Officers for units under their supervision in the cities
7.5 The Chiefs of national medical centers, special research centers and hospitals, regional
medical centers and regional hospitals and sanitaria in their respective institutions.
8. Duties and Functions of Responsible Officials
The above-mentioned officials for the implementation of R.A. 6675 in their respective areas of
jurisdictions shall perform the following duties and functions.
8.1 Issue the necessary office orders and instructions to carry out R.A. 6675 based on
implementation guidelines.
8.2 Organized and mobilize their offices and institutions to assure compliance by DOH
personnel
8.3 Establish and activate mechanism for promoting compliance, eliminating barriers or
difficulties to such compliance and initiating supportive activities. .
•
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8.4 'Manage their organizations towards active and effective observance of laws, rules and regulations
8.5 Recommend, proposals, modifications to existing instructions and otherwise give feedback
on the implementation
8.6 Assume other functions and responsibilities that may be required in related issuances.
9. Therapeutic Committees
At all DOH field agencies, a therapeutic committee shall be organized to assist the head of the
agency in performing task under this order.
9.1 Requirement: Therapeutics Committee shall be organized at the Regional Health Offices,
Provincial Health Offices, District Health Offices, City Health Offices, special hospitals,
national medical centers, regional medical centers, regional hospitals and sanitaria. At
the Regional Health Office, the Technical Committee for Drugs and Medicine created
under A.O. No. 28, S. 1987 shall dissolved and its functions absorbed by the Regional
, Therapeutic Committee.
9.2 Functions: In support of the agency head, Therapeutic Committees shall havethe following
functions in support of the agency head:
9.2.1 Based on the DOH Drug formulary (For hospitals and RHO's), regularly maintain
a list, specified in generic terminology, of the drugs that the agency will keep on
stock, use, buy or prescribe. The list shall be limitedto those items in the DOH
formulary. Any new item outside the formulary should be recommended to the
National Drug Committee for inclusion in the DOH formulary before the agency'
can include such item in its own list. The list shall be regularly and circulated to
procurement and supply units, pharmacies and medical staff of the agency. The
Therapeutic Committee shall be responsible' for clarifying any technical issue
regarding use of generic terminology.
9.2.2 Based on the DOH Formulary, recommend drug selection,utilization, procurement

and stocking policies. Such policies may include establishing allocation criteria in
use of resources for different generic items of drugs; resolving problems regarding
drug availability and quality; disseminating reliable drug information; proposing
measures to facilitate generic prescribing and dispensing; ensuring proper and
equitable distribution of drug supplies within the agency; identifying other similar
initiatives.
• 9.2.3 Evaluate and recommend appropriate action on :
(a) requests for inclusion or exclusion of any drug product in the DOH
formulary as well as in the agency drug list. '
(b) reports of adverse drug reactions and other incidents related to safety,
efficiency or quality drugs.
(c) use of agency resources for drug products. '
On the lastmatter, theTherapeutic Committees shallbe empowered to require budgetand

finance units to provide data showing how much ofthe agency resources are allocated to
drugs and medicines and other information on prices, products and suppliers;
~
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I
9.2.4 Identify and define information, education or training needs of the agency related to the
implementation ofRA 6fiI5, thenational drugpolicy pharmacological science, and rational
druguse. In thisregard, theTherapeutics Committee is instructed to specify theiragency
needs for technical information and make proposals for raising the level of knowledge,
attitudes and skills needed for effective implementation ofRA 6fiI5.
9.2.5 Plan an orderly, systematic and thorough process of institutionalizing rational drug use, .
Such plans should have immediate, medium and longtermdimensions. Theplans should
target 1000/0 adoption of generic terminology in procurement, prescribing and dispensing
within DOH agencies within the shortest possible time. Subsequently, the plans should
identify specific problems, obstacles and difficulties to widespread use ofgeneric terntinology
in the community and propose appropriate solutions. Finally, the plans should seek to
promote rational use of drugs.
9.3 Composition
9.3.1 Therapeutic Committees shall haveat least5 members except at District Hospitals
which may have atleast 3 members
9.3.2 The members shall be designated by the head of the agency and shall have a mix of the
following professionals: physicians, pharmacist and nurse. A dentist maybeincluded as
a non-voting member to be consulted on drugs and medicines affecting dental services.
9.3.3 The head of the agency shall not be a member.
9.3.4 The members shall elect their chairman.
9.3.5 TheNDP compliance officer mentioned below shall be a non-voting member

who can attend committee deliberations.
9.3.6 Regional Directors are instructed to contact pharmacologistscoming from medical

schools to serve as consultants to the Regional Therapeutic Committee or the
Therapeutic Committee of the Regional Medical Centers.
9.4 Organization and Reporting:
Heads of agencies shall designate and organize their respective therapeutic committees
not later than December 30, 1988. All heads of agencies shall report the composition of
their committees on the first staff meeting in 1989.
10. NDP Compliance Officer
At all regional offices and all special hospitals, the head of agency shall designate an NDP
compliance officer.
10.1 Functions: TheNDPCompliance Officer is tasked with gathering, analyzing and reporting
the data on that agency's compliance with all issued instruction such as
(a) Organization and activation of therapeutic committees.

(b) Issuances of related internal orders and instructions
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..
I (c) reports of specific failures and successes.
(d) report of overall progress or setbacks.
10.2 Qualifications : The NDP Compliance Officer shall be a DOH employee in a

position to understand the technical and administrative aspect for compliance
with R.A 6675.
10.3 Reporting: Regional Directors and Chiefs of special hospitals shall report their
designated NDP compliance officer not later than December 30~ 1988.
11. Procurement of Drugs and Medicines
• 11.1 In addition to existing regulations on procurement, drugs and medicines shall be procured
on the basis of their generic use. For this purpose, all heads of agencies that procure
drugs and medicines from regular budget, local aid or trust funds shall specify all drugs
and medicines items in their generic names. All documents relating to procurement and
disbursement, such as RIV's, bid documents, purchase orders, vouchers and others, shall
specify drug product items in their generic names. This shall coverboth regular as well as
emergency procurement, bidding as well as canvass.
"
11.2 Any issueregarding generics terminology shall be resolved by the TherapeuticsCommittee.

• Any issue that it cannot decide shall be referred to the National Drug Committee. Upon
referral, the Therapeutic Committee can adopt a temporary decision until action by the
NDC.
11.3 All DOH agencies shall adopt generic specifications in all procurement of drugs and
medicines effective March 1, 1989.
11.4 Procurement made on the basis of generic specifications may lead to purchase of drug
products that are also identified by brand names provided price and availability
• considerations make it unavoidable. In such cases, products for a generic use are also
identified by brand names may be kept on stock provided that its identification and use
remain exclusively on the basis of generic specification. .
12. Prescribing and Ordering
12.1 All prescription and orders for drugs and medicines in DOH facilities shall be specified in generic
terminology. In all written orders, the generic nameof the drug's active ingredients shall be stated.
Brand names may also be added initiallybut eventually all orders shall use generic names exclusively.
12.2 Each DOH agency shall set a date not later than March I, 1989, for the effectivity of mandatory
generic prescribing in that agency. Prior to such date, generic prescribing shall be introduced,
promoted andencouraged. Information shall beprovided toall concerned sothatgeneric prescribing
canbefacilitated. On thedate forstarting mandatory generic prescribing, there should belaunching
activities to bringthe decision to the attention of professionals and the public.
12.3 All DOH agencies shall report not later than December 3D, 1988 the date mandatory
generic prescribing will start in the agency.
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¢
13. Dispensing and Administering
13.1 All persons and units that dispense drugs and medicines in DOH agencies (Pharmacies,
clinics, other serviceoutlets) shall adopt and practice generic dispensing i.e. filling doctors'
prescription and orders on the basis of the specified generic name of the active ingredient,
dose level, dosage form and delivery mode. If no drug preparation is available to comply
with what was prescribed, the prescribing physician shall be duly informed so that the
prescription can be changed to one that can be filled.
. 13.2 Allied medical and nursing staff in hospitals, health centers and health stations shall use
generic terminilogy in patient charts and all drugs and medical records.
13.3 Upon effectivity of mandatory generic prescribing, mandatory generic dispensing shall •
also take effect.
13.4 All patients should be duly informed when generically dispensing to avoid
misunderstanding.
13.5 Branded products may be dispensed and used provided such is based on providing the
same generic active ingredient as well as same dose, form and delivery mode specified in
the prescription.
14. Public Information
14.1 All heads of agencies shall take the necessary and sufficient steps to inform the public
about measures to implement R.A. 6675 and the rationale for these measures.
14.2 Whenever public complaint arise, the head of agencies shall take action to resolve such
complaints within the means available while observing. rules and regulations.
14.3 The Public Information and Health Education Service at the central office shall produce •
and disseminate information materials necessary to inform the public-on these matters.
All agencies are authorized to reproduce these materials for public distribution. All
agencies are encourages to translate, summarize, accept or adopt materials from PIHES
aside from developing their own materials. Copies ofall informational materials developed
by field agencies on their own shall be sent to PIHES for information.
15. Professional Promotion
15.1 Heads of agencies, assisted by their respective Therapeutic Committees, shall plan and
undertake promotional activities among DOH personnel, particularly physicians and
nurses. These activities should a) clarify the provisions of the law and the implementing
regulations; b) explain the reasons for generic names in drug use; c) answer the most
common misinformation, apprehension and complaints.
15.2 The central staff for NDO implementations shall organize and deploy well qualified
resource persons for lectures and seminars on NDP implementation. Agencies may access
these for their promotional activities through the office of the Secretary for Standards
and Regulations.
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/
15.3 PIHES shall procure and produce the necessary technical references for the use of
Therapeutic Committee. These shall be distributed to <ill committees in due course.
16. Central Office Support and Monitoring
16.1 All communications regarding the implementation of this order shall be coursed to the
Office of the Assistant Secretary for Standards and Regulations. On the basis of the
progress and problems, adequate guidance, support or assistance shall be extended.: The
principal responsibility, however, remains with the heads of agency and their superiors in
the chain of command of DOH.
16.2 NDP Compliance officers shall identify areas, both geographic and functional, where
technical weaknesses are noted. In these cases, recommendations regarding what support
is needed are expected. A mechanism for sharing should be' established by the Assistant
Secretary for Standards and Regulations. -
17. Violations
Repeat of substantial violations of this order shall be regarded as violations of administrative

discipline under Presidential Decree 807. Subject personnel shall be liable to administrative action
in addition to penalties provided by R.A 6675.
18. Effectivity
The rules and regulations shall take effect after its publication in the official gazette, or in a
newspaper of general circulation and shall supersede all issuances inconsistent thereof.
(SGD.) ALFREDO R.A. BENGZON, M.D.

Secretary of Health
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,.
T

18 May 1989
Administrative Order
No. 7Q-A s. 1989
REVISED POLICIES, PROCEDURES AND GUIDELINES GOVERNING AFFILIATION AND

TRAINING OF STUDENTS IN THE DEPARTMENT OF HEALTH HOSPITALS, RURAL
HEALTH UNITS AND OTHER HEALTH AGENCIES
Sec. 1. Title - These policies, Procedures and Guidelines shall be known as "Revised Policies,
Procedures and Guidelines governing Affiliation and Training of Students in the
Department of Health Hospitals, Rural Health Units and other Health Agencies".
Sec. 2. Rationale - The development of Health Manpower is necessary for the promotion,
maintenance and delivery of health services. The Department of Health is making available
its hospitals and community health resources for the learning and training of students for
health professional schools. To maintain and quality ofthis relationship, certain guidelines
were promulgated under Administrative Order No. 26 - C, s. 1982 governing affiliation
and training of students.
Due to changing needs of society and advances in science and technology, the policies,
procedures, rules and regulations governing affiliation and training of students in the
Department of Health hospitals, rural health units and other health agencies embodied
in Administrative Order No. 26- C s. 1982 as amended is hereby revised.
Sec. 3 National Committee on Affiliation and Training
3.1 A National Committee on Affiliation and Training of Students (NCATS) shall be

created, composed of representatives from various health professional groups and
administrative support services in the Department of Health
3.2 Functions :
The National Committee shall :
3.2.1 Be responsible for the administration and supervision of all affiliation

and training activities.
3.2.2 Formulate policies, standards, rules and regulations on affiliation and

training of students.
3.2.3 Plan programs and activities on affiliation and training.
3.2.4 Monitorand evaluate programs and activities of affiliation and training of students..
.. - 1-
3.2.5 Supervise Regional Committees on the' implementation of policies and
standards on affiliation and training.
3.2.6 Recommend for approval to the Secretaryof Health contracts of affiliation

from Specialand Specialtyhospitals and other agencies/institutions directly
under the Office of the Secretary of Health.
3.2.7 Maintain a list of Department of Health Hospitals, Laboratories and Rural

Health Units capable of providing the necessary resources for the student's
learning.
3.2.8 Keep records and reports.
Sec. 4 Regional Committee on Affiliation and Training
4.1 A Regional Committee on Affiliation and Training of Students (RCATS) shall be

created and composed of representatives from the technical and training staff of
the region, the hospitals, the laboratories, provincial health offices and financial
services, to be appointed by the Regional Health Director.
4.2 Functions:
The Regional Committee (RCATS) shall :
4.2.1 Supervise activities of affiliation and training of students at the regional

level.
4.2.2 Monitor and evaluate programs and activities of affiliation and training.
4.2.3 Recommend for approval to the Regional Health Director contracts of

affiliation form hospitals and rural health units within the region.
4.2.4 Maintain a list of DOH Hospitals, Laboratories, and Rural Health Units
capable of providing the necessary resources for student learning. The list
shall be approved by the National Committee on Affiliation and Training.
4.2.5 Keep records and reports.
4.2.6 Submit quarterly reports to the National Committee on the following:
4.2.6.1 Name of college, number and category of students ..
4.2.6.2 Name of Hospital, Area/Department utilized for training
Sec. 5 The Regional Health Director is authorized to approve contracts of affiliation within the
region.
Sec. 6 Procedures in: applying for affiliation with the Department of Health Hospitals and Rural
Health Units.
6.1 Hospitals and Rural Health Units shall make available copies of affiliation contracts
to schools, colleges and universities.
(
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I
6.2 All contracts of affiliation shall be duly accomplished and signed by both parties.
6.3 All duly accomplished contracts for hospitals under the Office of the Secretary
shall be forwarded to the Executive Secretary of the National Committee for
evaluation, recommended by the Chairman, for approval by the secretary of Health
or his authorized representatives.
6.4 For hospitals and rural health units in the region, all duly accomplished contracts
shall be submitted to the Regional Committee for evaluation, recommended by
the Chairman, for approval by the Regional Health Director or his authorized'
representatives.
6.5 Application for affiliation shall be filed two (2) months before the start of the
actual affiliation.
6.6 Affiliation contracts shall be renewed yearly for the first two (2) years and every
two (2) years subsequently.
Sec. 7 Standard Rates of Fees for Affiliation:
7.1 The following shall be the standard rate of fees to be collected by all agencies of
the Department of Health from affiliating students from various disciplines:
7.1.1 Dentistry - P360.00 per student per semester
7.1.2 Hospital Dietetics - P250.00 for 192 hours
7.1.3 Public Health Nutrition - P250.00 for 288 hours
7.1.4 Med. Technology - P60.00 per student per month
7.1.5 Medicine - P5.00 per hour per student

- PIO.OO per day per student
7.1.6 Midwifery - P40.00 per student
7.1. 7 Nursing - P60.00 per student for 50-80 hours

(maximum of \80 hrs.)
7.1.8 Occupation,IPhysical Therapy - P80.00 per student per month
7.1.9 Pharmacy - P300.00 for 480 hours

- PIOO.OO for 160 hours
7.1.10 Psychology - P 3.00 per student per hour for

Baccalaureate level
- P4.00 per student per hour for Masteral
- P5.00 per student per hour for Doctoral
7.1.11 Radiologic Technology- P70.00 per student per month
... 7.1.12 Med. Social Work

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- P50.00 per student per month
The affiliation fees shall be collected by the affiliating agencies.
7.2 These fees shall be treated as trust receipts in the books of collecting agencies,
deposited in an authorized government depository bank.
Sec. 8 Distribution of Affiliation Fees:
The collected affiliation fees shall be used for the following purposes:
8.1 5% of the total collection shall be remitted by Metro Manila hospitals and agencies
to the National Committee on Affiliation and Training, Department of Health,
San Lazaro Compound, Manila.
The regional offices and provincial health offices shall remit 5% of their collection
to the Regional Committee.
The remittances shall be used by the Committee to meet the operating requirements:
8.1.1 1% - meetings and conferences of the Committee
8.1.2 1% - supplies and materials needed by the Committee
8.1.3 1% - honorarium of members, provided the share of employees may not

in aggregate exceed fifty percent of their annual salary.
8.2 40% - to procure supplies and equipment that will improve the facilities of the
respective training centers, hospitals and rural health units.
8.3 55% - honoraria or incentives to personnel
8.3.1 40% - In charge of training and staff of the particular service conducting
such training.
8.3.2 2% - Department Head (Head ofSurgery, Pediatrics, Chief Dietitian, Chief

of Laboratory, Chief Dentist, Chief Medical Social Work, Chief Therapist,
Chief Pharmacist, Chief of Radiology and Chief Nutritionist and his
Assistant to which the particular training belongs.
8.3.3 5% - Speaker, resource persons, consultants
8.3.4 8% - Administrative support of regional office, medical center, provincial

health office, district hospitals. This shall be divided as follows:
1% - Chief of Hospitals/Medical Center DireetorjProvincial Health Officer

1% - Chief of Services (Medical, Medical Ancillary, Nursing,
Administrative, etc.) to which training Dept.jSection belongs
1% - Administrative Office
1% - Finance Office
1% - Accounting Office
1% - Budget Office
1% - Cashier's Office
1% - Auditing Office
•
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Sig. 27-Fronl :
8.4 An official or employee is entitled to a share in the affiliation fees collected in accordance
with the rate indicated for specific position,!designation where he/she belongs.
Sec. 9 Disbursement
9.1 The honorarium herein authorized shall be paid to employees after each training
9.2 The Officer-In-Charge of training shall prepare his recommendations to the Chief
of HospitaljDirector of Medical Center/Provincial Health Officer, thru their Ser-
vice Chiefs or Department Head as to the employees who participated in the
training and are entitled to honorarium.
9.3 The Administrative Officer of Offices shall prepare his recommendations to the
Chief of Hospital/Director of Medical Centers/Provincial Health Officer. The
Personnel will come from Administrative Office, Finance, Budget, Accounting,
Cashier and Auditing.
9.4 These recommendations when approved by the respective head of office will b~
the basis for the preparation of payroll by- the Cashier's Office after remitting the
amount to the National/Regional Committee on Affiliation.
9.5 The Accounting Office, to support the payroll, shall prepare the status of Affilia-
tion Fees Collection will provide the following in information:
Nature of Affiliation
Period Covered
No. of Affiliation
Total Collections
9.6 The statement will validate the amount in the payroll for each office/service.
•
9.7 In cases where there are no Department Head and Asst. Department Heads in a
hospital, the 2% share of these officials shall be given to the Hospital Training
Officer or shall be added to the Training Staff of the Department. Other undis-
tributed honoraria shall be added to pool for each other hospital personnel.
9.8 The amount placed in the pool shall be divided equally among the hospital em-
ployees on a quarterly basis.
9.8.1 5% - due to National/Regional Committee on Affiliation

P
9.8.2 40% - Due to the hospital P _
9.8.3 55% - Due for Honorarium P _
9.8.4 55% - Due for Honoraria - P ~ _
(a) 40% training Staff and In-Charge

P_----
(b) 2% - Department Head of Training Department
P_-----
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r
(c) 5% - Resource Speakers/Consultants
P _
(d) 8% - Administrative Support
p-------
'1% Chief of Hospital/Director/PHO
P
1% Chief of Service
P
1% Administrative Officer
P
1% Finance Office
P
1% Budget Office
P
1% Cashier's Office
P
1% Auditing Office
P
9.9 The disbursement of funds shall be reported to the National/Regional.Commit-

tee on Affiliation semi-annually,
Sec. 10 Guidelines for each discipline
The guidelines for affiliation of students for each discipline are attached in the following
annexes:
A. Dentistry
B. Hospital Dietetics
C. Public Health Nutrition
D. Medical Technology
E. Medicine
F. Nursing and Midwifery
G. Occupation and Physical Therapy
H. Pharmacy
I. Psychology
]. Radiologic Technology
K. Medical Social Work
Sec. 11 Special Provision
Other government-owned or controlled schools or colleges shall be required to pay the

affiliation fees to the Department of Health hospitals and rural health units/health centers,
except the University of the Philippines shall be required to accomplish the necessary
contract of affiliation.
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Sec. 12 Repealing Clause
Administrative Order No. 26-C s. 1982, as amended, A.O. No. 13, s. 1986 and all orders
inconsistent with the provisions of this Administrative Order, are hereby repealed.
Sec. 13 Effectivity
This Administrative Order shall take effect immediately.
(Sgd.) ALFREDO R.A. BENGZON, M.D.

Secretary of Health
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February 6, 1980
NATIONAL BUDGET CIRCULAR NO. 321

COMMISSION ON AUDIT CIRCULAR NO. 80-128
TO .The Minister of Health, Regional Health Directors, Chiefs of Hospitals/Sanitaria, MOH

Chief of Financial and Management Services, Chief Accountants/Heads of Accounting
Units/Budget Officers, Auditors and others Concerned
SUBJECT General Guidelines and Related Procedures for the Establishment of funds for Medicines
and Drugs in Hospitals/Sanitaria.
1.0 PURPOSE
This circular is issued to prescribe the general guidelines and related procedures for the
establishment of a fund for medicines and drugs for stock and resale to implement Section 9,
Special Provisions of the Ministry of Health, Batas Pambansa BIg. 40, and to institute control
measures on stocking operations.
2.0 GENERAL GUIDELINES
2.1 All Chiefs of Hospitals/Sanitaria shall determine the quality of medicine and drugs to be
kept in stock by their respective units for submission to the Minister of Health who is
authorized to fix the amount from appropriation for maintenance and other operating
.expenses in every hospital/sanitarium to be earmarked for the purchase of medicines and
drugs for stock and resale;
2.2 The ceiling fixed by the Minister of Health shall mean the total cost of medicines and
drugs that shall be in stock at anyone time including undelivered purchases;
2.3 The cost of medicines and drugs for initial stocking purpose sh~1l be funded out of
appropriation for maintenance and other operating expenses of the hospital/Sanitarium
and shall not exceed the cost of consumption of drugs and medicines for three (3) months
based on the average quarterly consumption of the immediate preceding twelve (12) months
plus the current official government inflation rate;
2.4 All proceeds (cost plus profit) from sale of medicines and drugs shall be deposited in an
authorized government depository bank and shall be made available for the procurement
of medicines and drugs for replenishment of for increase in the ceiling previously
authorized. Withdrawals from the bank account shall be done on joint signatures of the
representatives of the hospital/sanitarium concerned and the Commission on Audit;
2.5 Cost of medicines and drugs dispensed to charity patients shall be reimbursed with an
equivalent amount from the regular appropriations of the hospital/sanitarium concerned;
2.6 Any increase in the amount of the ceilings previously categorized by the Minister of
Health shall be subject to the approval of the Budget Ministry. Such increase shall be
taken first form the excess of the fund if any, and the appropriation for maintenance and
other operating expenses of the hospital concerned shall only be used when there is no
excess available;
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2.7 The Chief of Hospital/Sanitarium shall submit to the Budget Ministry a quarterly report
ofthe Status ofOperation (appendix "N') indicating the actual stocks on hand, undelivered
purchases, and information on items purchased and sold. For non-submission of the
above reports, the Commission on Audit, upon recommendation of the Minister of
Budget shall suspend transactions in the operation until the hospital/sanitarium complies
with the foregoing requirements:
3.0 OPERATING PROCEDURES
3.1 Hospitals/sanitaria shall submit not later than February 28,1980 to the Minister of Health,
a request for authority to acquire medicines and drugs for stocks and resale. The request
(original and copy) shall indicate among others, the following:
3.1.1 Balance of the following inventory accounts as of December 31, 1979
a. ~72-100 Inventories of Medicine and Drugs on sale
b. ~72-360 Inventories for Sale (Medicines and Drugs)
c. ~72-700 Inventories Charged to Appropriation (Medicines and Drugs)
3.1.2 Issues of medicines and drugs in CY 1979 with the following information:
a. sold to hospital patients
b. given out/administered to charity patients
3.1.3 Estimated consumption of medicines and drugs for three (3) months.
3.2 The Minister of Health, based on the above information shall:
3.2.1 Authorize and fix the ceiling or amount of medicines and drugs for stock and
resale;
3.2.2 Advise the Ministry of Budget, Commission on Audit, Regional Health Office,
hospital/sanitarium concerned of the ceiling established for control/reference
purposes.
3.3 The COA representative in each hospital/sanitarium shall:
3.3.1 See to the balances of inventory accounts
8-72-861 Medicines and Drugs for Sale

8-72-701 Medicines and Drugs Charged to
Appropriations shall not at anyone
time exceed the authorized ceiling;
3.3.2· Cause the suspension of the transactions in the operation of the fund, upon
recommendation ofthe Budget Ministry, in case of non-submission ofthe required
reports by hospital/sanitarium concerned.
-2-
3.4 Property/Accountable Officers for supplies including the Pharmacist shall submit a
monthly report to the Accounting unit in two (2) copies (original and duplicate) not later
than the 5th day after the end of each month indicating among others the following:
3.4.1 Inventory of existing stocks of medicines and drugs as of the beginning of the
month;
3.4.2 Purchases/acquisitions for the month;
3.4.3 Issuesof medicines and drugs from stock segregating medicines sold from medicines
administered to charity patients as reflected in the Supplies Adjustment Sheets;
3.4.4 Balance of drugs and medicines at the end of the month.
3.5 The Accounting unit of the hospital/sanitarium shall reconcile the monthly balance of
the inventory accounts appearing in the books of account with the report of the Property/
Accountable officers including Pharmacist. This will serveas basis for the ChiefAccountant
in preparing the-quarterly Status of Operations to be submitted to the National Accounting
Office, Ministry of Budget not later than 20 days after the end of each quarter.
4.0 ACCOUNTING PROCEDURES
4.1 For purposes of this circular, the following sub-accounts shall be identified as follows:
8-70-801 Cash-Other Banks - Medicines and Drugs

8-74-901 Receivables - Medicines and Drugs
8-72-361 Medicines and Drugs for Sale
8'72-701 Medicines and Drugs Charged to Appropriations
8-84-901 Trust Liability - Medicines and Drugs
8-86-701 Miscellaneous Liabilities and Deferred Credits
Mise. Medicines and Drugs Charged to Appropriation
8-86-901 Miscellaneous Liabilities and Deferred
Credits -Misc. Medicines and Drugs
Credits - Medicines and Drugs for Sale
4.2 Stock Inventory as of December 31, 1969 shall form part of the initial ceiling of medicine
and drugs for stock and resale;
4.3 Proceeds (cost and profit) from sale of medicines and drugs for resale deposited in an
authorized depository bank shall be accounted for as a credit to a trust liability account;
4.4 Accounting entries
Assumption
Minister's authorized ceiling - PIOO,OOO.OO·

Inventory and contra accounts balances as of December 31,1979
8-72-100 Inventories Supplies and Materials

(Medicines and Drugs) P 5,000.00
~ -3-
8-72-360 Inventories for Sale
8-72-700 Inventories

Credits - Inv. Charged to Appropriations
. (Medicines and Drugs) P 15,000.00
4.4.1 Release of regular allotment for the operation of fund for medicines and drugs in
the amount of PI00,000.00
a. For provincial and emergency hospitals receiving funding checks issued

by the Regional Health Office.
8-70-800 100,000.00
0-90-000 100,000.00
b. For general hospitals receiving sub-allotment with Sub-Notice of Cash

Disbursement Ceiling (CDC) from the Central Office, Ministry of Health.
8-71-199-2 100,000.00
0-90-000 100,000.00
c. For special hospitals receiving direct releases of allotment with Notice of

CDC from the Ministry of the Budget.
0-99-200 100,000.00
0-90-000 100,000.00
4.4.2 Transfer to the appropriate accounts, the balances of stocks of medicines and
drugs on hand as of December 31,1979 based on the Report of Physical Inventory
certified correct by the Auditor for identification purposes by drawing a journal
voucher with the following entries:
a. To transfer inventory accounts 8-72-100 and 8-72-360
0-90-000 25,000.00
0-82-000 25,000.00
0-83-000 25,000.00 •
8-72-100 (5,000.00)
8-72-360 (20,000.00)
Corollary entry
8-72-701 5,000.00
8-72-861 20,000.00
8-86-701 5,000.00
8-86-961 20,000.00
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b. To transfer inventory account 8-72-700
8-72-701 15,000.00
8-86-701 15,000.00
8-72-700 . (15,000.00)
8-86-700 (15,000.00)
4.4.3 Obligation for the purchases of medicines and drugs chargeable against the stock
ceiling.
0-90-000 60,000.00
0-82-000 60,000.00
4.4.4 Receipt of medicines and drugs for stock
8-72-701 60,000.00
8-86-701 60,000.00
4.4.5 Liquidation of obligation
0-83-000 60,000.00
8-70-300 or
8-70-703 60,000.00
4.4.6 Transfer of medicines and drugs to the Pharmacy Unit.
8-72-861 30,000.00
8:S6-961 30,000.00
8-86-701 30,000.00
8-72-701 30,000.00
4.4.7 Issuance to pay patients with profit - Cash basis
cost of medicines 20,000.00

Proceeds 22,000.00
Profit 2,000.00
a. collection of Proceeds
8-70-400 22,000.00
• 8:S4-901 22,000.00
b. Deposit of proceeds from sale
8-70-301 22,000.00
8-70-400 22,000.00
Proceeds shall be deposited in a separate checking account with the

same bank where the regular allotment is being deposited. sub-responsibility
codes shall. be provided to distinguish it from the regular Cash other
Banks (8-70-300) of the hospital.
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c. Dropping ofinventory account for the cost of medicines and drugs issued/ \
I
sold.
8-86-%1 20,000.00
8-72-361 20,000.00
4.4.8 Issuance - Sale on account to Pay Patients
The usual billing practice shall be observed for issue/sale of medicines and
drugs to pay patients.
However, a separate bill shall be prepared for medicines and drugs and the
usual subsidiary records shall be maintained for the purpose. Account ,"8-71-901"
Receivables - Medicines and Drugs shall be debited and contra-account "8-86-901"
- Miscellaneous - Liabilities and Deferred Credits - Miscellaneous - Medicines and
Drugs shall be credited, the latter to be adjusted to the trust liability account only
upon collection, as shown below:
a. Billing of medicines and drugs
8-71-901 22,000.00
8-86-901 22,000.00
b. Collection of Bills
8-70-400 22,000.00
8-71-901 22,000.00
8-86-901 22,000.00
8-84-901 22,000.00
c. Deposit of collections
8-70-801 22,000.00
8-70-400 22,000.00
d. Dropping of inventory account
8-86-961 20,000.00
8-72-861 20,000.00
4.4.9 Issuance to Charity Patients - P 5,000.00
a. If issued from of charge
8-86-961 5,000.00
8-72-861 5,000.00
b. If issued with donation or token payment of PI,OOO.OO
-6-
c.
4.4.10 For disbursement of stocks issued to Charity Patients
a. Obligation for the reimbursement of Stocks
0-90-000 5,000.00
0-82-000 5,000.00
b. Receipt of medicines and drugs
8-72-701 5,000.00
8-86-701 5,000.00
c. Liquidation of obligation
0-83-000 5,000.00
8-70-300 or
8-70-703 5,000.00
4.4.11 For replenishment of stocks
a. Receipt of medicines and drugs
8-72-361 20,000.00
8-86-961 20,000.00
b. Payment of medicines and drugs received
8-84-901 20,000.00
8-70-301 20,000.00 ..
5.0 REPORTING REQUIREMENTS
Hospitals/sanitaria shall submit to the National Accounting Office of the Ministry of the
Budget a quarterly Status of Operation in accordance with the prescribed format as shown in
appendix" N' not later than Twenty. (20) days after the end of each quarter.
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6.0 REPEALING CLAUSE
The provisions of all Budget Circulars and Instructions which are inconsistent with the
provisions of this circular are hereby rescinded/repealed and/or modified accordingly.
ZO EFFECTMTY
This Circular shall take effect immediately.
(Sgd.) JAIME C. LAYA

Minister of Budget
(Sgd.) FRANCISCO S. TAN'DJICO Jr.

Acting Chairman, Commission on Audit
"
REPUBLIC OF THE PHILIPPINES
MINISTRY OF HEALTH
OFFICE OF THE MINISTER
Manila
January 27, 1987
ADMINISTRATNE ORDER
No. 15 s. 1987
To The Chiefs of Hospitals, Sanitaria and all others concerned.
Subject Amending Authorized Ceiling of Medicines and Drugs that can Be Maintained in Stock
by Hospitals/Medical Centers and Sanitaria under A.O. No. 81 s. 1980.
You are hereby authorized to increase the Fund Ceiling of Drugs and Medicines in your Hospitalj
Medical Centers/Sanitarium (H/MC/S) to three (3) times provided that:
1. The increase shall be applied on the original fund ceiling authorized in 1980;
2. Hospitals/Medical Centers/Sanitaria that already increased their Fund Ceiling after 1980
may increase their ceiling again as long as the resulting Fund Ceiling does not exceed
three times 1980 levels.
It is understood that the authorized ceiling for drugs and medicines shall cover the value of all drugs
and medicines in stock at the hospital at anyone time plus the value of undelivered purchase orders.
Attached is a copy of the letter of the Budget Ministry and Management regarding this authority to
increase the ceiling of drugs and medicines for your information, guidance and compliance.
In this regard, please make a report to this Office regarding the following:
1. If your new ceiling is still inadequate given your respective situation. Indicate the fund
ceiling desired and the justification..
2. The result of the implementation of this Administrative Order, i.e, your new Drug Ceiling.
Strict compliance with the guidelines and procedures prescribed under Joint National Budget Circular
No. 321 and COA Circular No. 80-128 is hereby enjoined.
(Sgd.) ALFREDO RA BENGZON, M.D.

Minister of Health
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MINISTRY OF BUDGET AND MANAGEMENT
Malacaiiang, Manila
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December 19, 1986
!
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Honorable Alfredo R.A Bengzon ·1

Minister of Health
Ministry of Health
Rizal Avenue, Sta. Cruz
Manila
Dear Minister Bengzon:
This refers to your request for a blanket authority to increase the Fund Ceiling of Medicines and
Drugs (M & D) three times to present ceiling of the various hospitals/medical centers/sanitaria (M, MC
& S) under the Ministry of Health.
Based on the result of the study made by the National Accounting and Finance Bureau-A (NAFB-A)
of this Ministry and in view of the authority granted in Sec. 2.6 of NBC - 321 re: Guidelines and
Procedures for the Establishment of Fund for M & D in Hospitals/Sanitaria, I hereby authorize the
Minister of Health to increase the fund ceiling three times provided that this shall be applied on the
original fund ceiling authorized in 1980. These M, MC & S that have already increased their fund ceiling
thereafter shall no longer be given a three time increase, instead a corresponding reduction from this rate
shall be observed. It is also available in this case to consider the actual bed occupancy and population of
the catchment area of concerned hospitals.
It is no understood that no additional allotment shall be issued for this purpose. Such increase be
taken first from the excess fund if any, and the appropriation for MOOE of the H, MC & S concerned
shall only be used when there is no excess available pursuant to Sec. 2.6 of aforesaid circular.
Please inform us accordingly on the result of the implementation of this authority to enable us to .
monitor effectively the fund's operation.
Very truly yours,
(Sgd) ALBERTO G. ROMULO

Minister of the Budget
I

i
DEPARTMENT OF HEALTH II
BUREAU OF FOOD AND DRUGS
2 May 1988
Memorandum Circular
No. 004-88
Re: BFAD General Guidelines on donation of Pharmaceutical Products
For the information, guidance and com pliance of all concerned, the following guidelines on donation
of pharmaceutical products are hereby issued:
1. No pharmaceutical product intended for donation shall be accepted or distributed, unless it is

registered with the Bureau of Food and Drug, in accordance with the provision of R.A 3720, as amended
and its implementing rules and regulations.
2. All donated drugs, issued clearances by BFAD, are subject to monitoring of its usage by BFAD
representatives and should not find its way in commercial outlets.
3. The use of donated drugs in the Philippines is without prejudice to tariff rules and customs regulations.
4. Exemption from BFAD registration requirements can be granted only by the Secretary of Health
for pharmaceutical products intended solely for investigational use by experts qualified by scientific
training and experience to investigate the safety and effectiveness of drugs, in which case a local clinical
trial must be conducted, and the following additional requirements must be complied with:
1. Investigators brochure.
2. Protocol duly approved by a Technical Group of the Department of Health
3. A detailed report on the pharmacological, clinical and other medical testing performed to show
efficacy and safety ofuse of the drug when administered as indicated to man or animal
A. The kind and extent of observed side-effect.
5. Patient Consent form.
5. BFADshall exert every effort to acceleratethe registration of all donated pharmaceutical products,
especially those intended for Government agencies and its instrumentalities and accredited charitable
institutions, as certified by Department of Social Services and Development or other appropriate
government agencies.
6. BFAD reserves the right to impose such other conditions as it may deem necessary in order to
protect the health of the people.
This Memorandum circular shall take effect immediately.
(Sgd) CATALINA C. SANCHEZ

Director
Approved:
(Sgd) ALFREDO R.A. BENGZON, M.D.
Secretary of Health
MINISTRY OF HEALTH
OFFICE OF THE MINISTER I
I.
I
Manila
January I, 1992
ADMINISTRATIVE ORDER
No. 116 s. 1992
To The Chiefs of Hospitals, Medical Centers, Sanitaria and all others concerned
Subject Amendment of the Authorized Ceiling of the Drugs and Medicines Maintained in Stock
by Hospitals, Medical Centers and Sanitaria under the Department of Health Pursuant
to Joint National Budget Circular No. 80-128.
In view of the authority granted by the Secretary of Budget and Management per attached letter dated
September 23, 1991, you are hereby authorized to increase the current fund ceiling for Drugs and Medicines
(D&M) being maintained in stock by your respective Pharmacies to one hundred percent (100%) effective
January 1, 1992.
The authorized increase shall be taken first from the excess of the fund, if any, and the appropriation
for maintenance and other operating expenses of the hospital concerned shall be used when there is no
excess available.
Relative to the Project "Gamot Sa Presyong DOH" of this Department, you are enjoined to continue i~
i I
carrying in your stocks the following ten (10) essential D&M under their generic names: ,I
1. Cotrimoxazole 6. Diphenhydramine I:
2. Amoxicillin 7. .Nifedipine I'
3. Rifampicin 8. Aluminum Hydroxide/ I~
4. Isoniazid Magnesium Hydroxide
5. Salbutamol 9. Paracetamol
10. Furosemide
In this regard, please submit a report to the office of the Assistant Secretary Management Services,
the result of the implementation of this Order not later than February 10, 1991.
Strict compliance with the guidelines and procedures prescribed in Joint National Budget Circular
No. 321 and Commission on Audit Circular No. 80-128 for the operation of this Fund for D&M is hereby
reiterated.

Secretary of Health
DEPARTMENT OF BUDGET AND MANAGEMENT
MALACANANG, ·MANILA
September 23, 1991
Hon. Alfredo R. A. Bengzon

Secretary of Health
Sta, Cruz, Manila
Dear Secretary Bengzon:
This pertains to your request for a blanket authority to double the current ceiling of the Revolving
Funds for drugs and Medicines of DOH hospitals nationwide.
Based on the justifications submitted and in view of the authority granted to the Minister of the
. Budget in Section 2.6 of NBG-321 re: Guidelines and Procedures for the Establishment of Fund for
Medicines and drugs in Hospitals/Sanitaria, authority is granted to the Secretary of Health to double the
current ceiling as previously set by DBM per letter dated December 19, 1986, to take effect on thedth
quarter of CY 1991.
It is understood that no additional allotment shall be issued for this purpose. Any increase shall
be taken from DOH allotment for Primary Health Care Program. Function A.7.i, General Appropriations
Act, RA 7078.
It is also understood that actual NCA utilization/disbursement out of this authority shall be
subject to existing accounting and auditing rules and regulations.
Very truly yours;
(Sgd.) GUILLERMO N. CARAGUE

Secretary
, ,
I,
I,
March 8, 1989
DEPARTMENT ORDER
No. 94B s. 1989
SUBJECT Creation of a Committee for the revision of the 1977 Hospital Pharmacy Service Manual.
With the new legislations and amendments to various laws relevant to the development of hospital
services; revision and updating of the 1977 Hospital Pharmacy Service Manual is necessary.
An Ad Hoc Pharmacy Standards Committee is hereby organized, composed of the following:
1. Ms. Amor Cita M. Pallera - Pharmacy Adviser

Management Service .1
I
2. Ms. Purita Tuazon Supervising Pharmacist

San Lazaro Hospital
Member
3. Ms. Herculani Pacaldo Chief Pharmacist

Jose R. Reyes Memorial
Medical Center
4. Ms. Felisa E. Nolasco Supervising Pharmacist

Quirino General Memorial
Hospital
5. Ms. Julieta Custodio Senior Pharmacist

Bulacan Provincial Hospital
6. Ms. Milagros Dacocos Senior Pharmacist

Dr. Eulogio Rodriguez
Memorial Hospital
Z Guest experts by invitation
-1~
Functions of the Committee:
1. To review and make studies on the 1977 Manual for Hospital Pharmacy Service
2. To collate updated data pertinent to hospital pharmacy practices
3. To organize meetings and invite experts/resource persons on the subject
4. To prepare schedules for critiquing and edition for the finalization of the new manual
5. To prepare the amended manual
6. To recommend approval of the manual.
The Committee shall meet from time to time at a designated place, date and time. The Chief of
Hospital concerned are requested to authorize the personnel involved to attend the Committee meetings.
Under this Order, they shall be entitled to per diems, traveling and other allowable expenses
pursuant to joint MBM-COA General Circular No. 86-1 dated November 12, 1986, chargeable against
their respective agencies, subject to availability of funds and the existing accounting and auditing rules
and regulations. .

Secretary of Health
-2 -
September 24, 1992
DEPARTMENT ORDER
No. 107 s. 1992
SUBJECT Creation of a Committee for the critiquing!editing of the draft Manual on Hospital
Pharmacy Service Management and Research on Coating of most commonly used Drug
Preparations for hospitals.
. .
. ., .
The above stated committee is hereby organized, composed of, the following:.
1. MS. AMOR CITA M.PALLERA - Chairni~n

Pharmacy Adviser
Hospital Operations and Management service .. ,
2. MS. ESTER DE BORJA - Member

.Chief Pharmacist
Philippine Heart Center
3. MS. LANI PACALDO-LEPASANA - Member

Pharmacist V i
Jose R. Reyes Memorial Medical Center I
4. MS. CYNTHIA URGEL - Member I

Chief Pharmacist i
II
National Kidney Institute : I
I,
5. MS. NEAL MESA UMBAC - Member .I',,
Pharmacist N
Quirino Memorial Medical Center
6. MS. PURITA R. TUAZON - Guest Expert
7. MS. THELMA N. AGUILAR - Guest Expert

,
I'
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II
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Functions of the Committee:
I. To critique and edit the Hospital Operations and Management Service (HOMS) draft Manual on
Hospital Pharmacy Management.
2. To prepare schedules for critiquing and the edition for the finalization of the HOMSdraft
manual.
3. To prepare the edited revised manual.
4. Submission of the recommended manual for approval.
5. To study the most commonly used drugs in the hospitals.
6. To establish with costing, the commonly used drugs in hospitals.
Z To make a final report on the costing of the most commonly used drugs in the hospitals.
The committee shall meet from time to time at a designated place, date and time. The Chiefs of
Hospital concerned are requested to authorize the personnel involve to attend Committee meetings.
Under this Order, those entitled shall avail of per diems, traveling and other allowable expenses
pursuant to joint MBM-COA General Circular No. 86-1 dated November 12, 1986, chargeable against
their respective agencies, subject to the availability of funds and the usual accounting rules and regulations.
(Sgd.) JUAN M. FLAVIER, M.D., MPH

Secretary of Health
REFERENCES
BOOKS
American Society of Hospital Pharmacists, Inc. (1986). Practice Standards
of the American Society of Hospital Pharmacists. Maryland,
American Society of Hospital Pharmacists.
Donabedian, A. (1982). The Criteria' and Standards of Ouality. An

Arbor: Health Administration Press. .
Dreisbach, Robert H. (Tenth Ed.) (1980). Handbook of Poisoning.

California: Lange Medical Pub. Maruzen Asia Ltd.
Graham, N.O. (19&2). OualityAssurance in Hospitals: Strategies fur Assessment

and Implementation Maryland: AspenSystems Corporation
Hassan, William E. (Fourth Ed.) (1981). Hospital Pharmacy. Philadelphia:

Lea & Febiger. '
Joint Accreditation Commission. USA, 1983, 1988.
McGibony, John R. (2nd Ed.) (1969). Principles of Hospital

Administration.
Miller, M.e. & Knapp, R.G. (1979). Evaluating Ouality of Care.

Maryland: Aspen Systems Corporation.
Miller, Susan G A Medical Record Handbook fur HospiCe Programs: Assuring

High Quality Care ThroughHigh Quality Documentation. Chicago: AMRA
National Drug Committee, National Drug Policy Implementation Team.

DOH (Ist Ed.) (1989). Philippine National Drug Formulary. Manila:
NDC, NDP Implementation Team, DOH. (Vol. I).
National Drug Committee, National Drug Policy Implementation Team.

DOH (2nd Ed.) (1990). Philippine National Drug Formulary..
Manila: NDC, NDP-Implementation Team, DOH. (Vol. I).
Sanderson, Edward D. (1982). Hospital Purchasing and Inventory

Management. Maryland: Aspen Systems Corporation.
DOCUMENTS
Bureau of Medical Services (1971). Hospital LicensureAct CRepublicAct 4226)
and its Implementing Rules and Regulations. Manila: BMS-DOH.
Dangerous Drugs Board. (1990). A Guide For Physicians. Dentists.

Veterinarians. Pharmacists. Drugstore Owners and others
concerned. Manila: DDB.
r~~-~-----
HANDOUT
The Effective Management of Time. Manila: Handout UpJohn. Inc.
MANUALS
DOH Committee on HospitalPharmacy Service Manual (1977). Hospital
Pharmacy Service Manual. Manila: DOH-Bureau of Health and
Medical Services.
Lantos, Robert L., et al (1989). ASEAN Guidelines/Manual For Good

Hospital Pharmacy Practices and Management. Thailand: The
ASEAN Technical Cooperation on Pharmaceutical: .:
",
!!
Department Of Health
I~~II~~I ~11\\~~
0334 ,
H108.45H19p' Hospilal phannacy managemenl menu

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HOSPITAL P CY

The second edition of the Hospital Pharmacy

This publication was made possible through

II. ORGANIZATION A!'iD PERSONNEL 5

III. PLANT, FACILITIES, EQUIPMENT

IV: FUNCTIONS AND POLICIES 27

. Adverse Drug Reactions Reporting Program 47

. Procurementfrom Other Philippine

IX. FINANCIAL MANAGEMENT 101

Xl. DRUG INFORMATION SERVICE 117

XII. RESEARCH AND EDUCATIONAL

XIII. CLINICAL PHARMACY 131

XIv. INTRAVENOUS ADMIXTURE

xv: QUALITY ASSURANCE FOR THE

Department Order Creating the Committee to Revise the 1977 Hospital

MA. MAR~ GALON, MD,MHA

. ~~B~f~ Pharmacy Adviser

DR. ANTONIO O. PERIQUET, former Undersecretary for

DR. MA MARGARITA M. GALON, Director III, Hospital

MISS BERNADETTE G. IPAC, Supply Officer III, and MISS

DR. MELCHOR R. LUCAS, Division Chief, and the Advisers

The Chiefs of Hospitals who have allowed the pharmacists who

To everyone who have contributed to the successful preparation

1. PTC Hospital Form for the Addition of a

I. Position Chart of Pharmacy Service 6

GENERAL OBJECTNE OF THE MANUAL

In order to transform these goals into realities, all hospital pharmacists

2. Development and Provision of Patient-Oriented Services

f. Monitoring/reporting ofspecific adverse drug reactions to

3. Development and Conduct of Compounding Extemporaneous and

5. Conduct and Participation in Pharmaceutical Research

7. Development and Conduct of a Quality Assurance Program for

1. To provide at all times, medications of the highest standard in

. the administrative officer or Chief of Hospital (COH); it will directly be

NOTE: Provided with a support personnel of one Pharmacy Aide

SENIOR SENIOR SENIOR

NOTE: Provided with support personnel of3 PharmacyAides (Laboratory

PURCHASING & RECORDS &

• HOMS Enhancement Standard

Pharmaceutical Services expected by other hospital service components:

5. Medical Social Service

Relationship with other agencies relevant to the practice of pharmacy:

5. Provide information concerning drugs and drug therapy to physicians,

10. Assist in the preparation of requisitions through the RNs on the

r 14. Supervise the preparation of intravenous admixtures;

PHARMACY PERSONNEL QUALIFICATION

1. B.S. Degree in Pharmacy;

PHYSICAL PLANT AND FACILITIES·

PLANT AND FACILITIES BED S

Area 15.00 sq.m. 30 sq.m.

Office 9.00 sq.m.

Staff working area 9.00 sq.m.

• Proposed HOMS Enhancement Standard in coordination with Health

UTENSILS. APPARATUS AND OTHER

10 25 100 tertiary and

Refrigerator for biological and

10 25 100 tertiary and

Brewer's cart for drug

10-15 25 100 tertiary and

Reference books and documents / / /

.. FUNCTIONS AND POUCIES OF

1. Responsible for the effective and efficient administration and