INPI 411  Many started as occupational health clinics, treating

minor injuries and serving workplace health and

Module 1, Part 1: Institutional Pharmacy safety needs, but have expanded in to primary care
Practice (Definition and Functions) and other areas.

Institutional Pharmacy/Pharmacists

Defined as:

 Any pharmacy located within any hospital,

sanitorium, clinic or dispensary
in which drugs are compounded or dispensed to its
patients or patients of another
licensed in-patient health care facility with whom it
has a contract.
 Pharmacies of institutions, organization and/or
corporations that provide a range of pharmaceutical Integrated health services
service, given exclusively to the employee and/or
their qualified dependents according to RA 10918.  integrate all care under the umbrella of a central
 Former name for Hospital Pharmacy organization, and often include inpatient/acute care,
 Ex. Home care, Child care, Private (DSWD, Bahay long-term care, home care and other patient care
ampunan, Call center, Correctional, Prison). settings.
 pharmacy that will store and regulate that will be  It is where you will add automation, new
issued to a specific institution. technologies to the system like EMR (Electronic
 should have an adequate drug facility, supply, offer Medical Record), HER (Electronic Health Record),
drug review, counseling, checking of drugs and drug eMAR (Electronic Medication Administration
dispensing, even compounding. Record).
 Health care institutions include:  Telepharmacy
- Nursing homes  Integrated model creates the potential to provide and
- Extended care facilities enhance level of patient care continuity to through
- Neighborhood health centers access to medical records and patient care providers.
- Health maintenance organizations
o Examples: Government and private Institutional Pharmacy/Pharmacists
hospitals, National Center for Mental
According to IPAP (Institutional Pharmacist Association of
Health, Philippine Tuberculosis Institute
the Philippines)
(Quezon institute), leprosarium (Dr. Jose N.
Rodriguez Memorial Hospital and  Institutional pharmacy is also called Occupational
Sanitarium, Barangay health centers, on-site Health Pharmacy, a practice of pharmacy in the
clinics in private companies institutional, corporate, company or industrial setting.
 Any pharmacy located within any hospital,
Onsite Clinic
sanitorium, clinic or dispensary in which drugs are
compounded or dispensed to its patients or patients of
What is an Onsite Clinic?
another licensed in-patient health care facility with
 A workplace “onsite clinic” is a setting where an whom it has a contract.
employer offers one or more medical and wellness  Pharmacy services is part of the medical services
services, delivered by licensed providers, to all or a required from a private and government companies
designated portion of its active population and other  Employees and /or dependents receive the medical
eligible individuals. services as part of the company’s benefit
 Pharmacists are responsible for handling, storing and
 Today’s clinics are often referred to as “health and dispensing of ethical or prescription products
wellness centers,” due to the wide range of first aid,  Are organized under a corporate structure, following
occupational health, acute, primary, specialty, specific rules and regulations for accreditations in
condition management, wellness and ancillary like ISO, FDA or DOH.
services offered at the location.  A pharmacy associated with any organized healthcare
delivery state.
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  Functions Collaborative Practice
- Delivery
- Stocking Collaborative practice agreement – pharmacists enter
- Inventory into an agreement with other health care providers like
- Operate Manual Dispensing/Automated/ private clinics
Robotic Dispensing
 A formal agreement in which a licensed provider
 Pharmacists’ works in collaborative practice in health
makes a diagnosis, supervises patient care, and
care as required by law.
refers patients to a pharmacist under a protocol
- Collaborative practice agreement
that allows the pharmacist to perform specific
- Team based care
patient care functions.
 Purposes:
o Pharmacist provide educational materials, Medication Therapy Management (MTM):
carry out traditional compounding and medication therapy review, personal medication
delivery functions, prepare and provide record, medication-related action plan, intervention
infusions and infusion equipment must be and/or referral, and documentation and follow-up.
available for emergencies on a 24 hour
basis. Collaborative Drug Therapy Management (CDTM):
 Established good record keeping Pharmacists assume professional responsibility for
 Review drugs that may possibly performing patient assessments, counseling, and
have drug interactions. referrals; ordering laboratory tests; administering
 Monitor repacking drugs; and selecting, initiating, monitoring,
 Storage monitoring continuing, and adjusting drug regimens
 Monitoring expiration dates (FIFO,
FEFO) Managed Care Pharmacy
 First in First out (FIFO)
A practice of developing and applying evidence-based
 First expiry First out
medication use strategies that
(FEFO)
enhance member and population health outcomes
 Dispense drug properly
while optimizing health care resources.
 Regulatory compliance
 Must monthly check the patient Managed care pharmacists roles:
profile
 Creation of formulary - designed to optimize patient
Pharmacy Technician care and therapy management (HOW?)
 Creation of clinical program – designed to enhance
 log prescription, refill orders
patient care, particularly for those with chronic
 Maintains trays for emergency
conditions
 Package and Labeling
 Use of communication protocols to facilitate
 Deliver medications
exchange of necessary information (such as drug
 Conduct inspection
safety alerts)
Functions of Industrial Pharmacists  Pharmacists collaborate with other healthcare
professionals to design effective benefit structures
According to IPAP (Industrial Pharmacist Association of the that serve the clients’ needs:
Philippines) - Employers with health care insurance plans
 Facilitate DUR (Drug Utilization Review) – Using
 Procurement of medicines this, the following may be identified:
 Inventory of medicines - Drug/drug interactions
 Dispensing, with counseling - Duplication of therapy
 Secures license to operate - Known allergies
 Administrative works - Under- or overdosing
- Potentially inappropriate therapy
“Pharmacists contribute to the society by promoting an
 Manage the business side of the pharmacy
improved health of the workforce which is the building
- Negotiate with manufacturers for discounts
block of our nation”
on
Healthy people = healthy business

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 drug prices and establish networks of
pharmacies.
Reason to consider a nursing home
Training Program
 Managing a worsening and progressive disease such
 Academy of Managed Care Pharmacist as Alzheimer's
 PPGP (Pharmacy Preceptors Guild of the Philippines,  After a recent hospital admission and not ready to
transition to independently caring for oneself at home
Inc)  When medical needs at home become unmanageable
- PPGP is an organization at the forefront of by the primary caregiver at home
pharmacy preceptorship, which aims to
provide Staff
experiential training to pharmacists in
Medical Staff
various
internship sites.  Nurses
- This is to help ensure that pharmacists and  Nursing Assistants
drug establishments can comply with the  Physicians
CHED requirement for the presence of  Pharmacists
trained preceptors in all pharmacy practice
areas used as internship sites to be Non-Medical Staff
implemented in 2021.
 Administration
Module 1, Part 2  Housekeeping
 Recreational Staff
Nursing Homes
Drug Therapy in Nursing Homes
 Nursing homes provide custodial care, providing help
getting in and out of bed, and assistance with feeding,  In United States, there is a growing elderly
bathing, and dressing. Nursing homes offer the most population and an increasing level of frailty among
extensive care a person can get outside a hospital. its citizens living in long-term care facilities.
 is a facility for the residential care of elderly or  Routine medication orders in nursing homes increase
disable people by 14% from 1997 to 2000.
 It may be referred to as skilled nursing facility (SNF),  A 2000 study of nursing facilities revealed that
long term care facilities, old people’s homes, assisted individual nursing home residents receive an average
living facilities, care homes, rest homes, convalescent of 6.7 routine prescription medications per day and
homes or convalescent care. 2.7 additional medications on an “as needed” basis
 Nursing homes also provide shortterm rehabilitative
stays following surgery, illness, or injury. Services
may include physical therapy, occupational therapy,
or speech-language therapy. Nursing homes also offer
other services, such as planned activities and daily Supply of Pharmaceuticals to Nursing Facilities
housekeeping. Nursing homes may offer memory
care services, often called dementia care

Term Care Facilities/Long Term Care Facilities

 a variety of services which help meet both the

medical and non-medical needs of people with a
chronic illness (Alzheimer’s, Dementia, Parkinson’s,
bone problems) or disability who cannot care for
themselves for long periods.
o Alzheimer’s drug: Donepezil
 focused on individualized and coordinated services
that promote independence, maximize patients’ National Chains
quality of life, and meet patients’ needs over a period
of time.  Neighborcare Health
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  Genesis Health Ventures
 Amerisource Bergen
 Kindred Care Pharmacy
 PharMerica
Consultant Pharmacy
 Federal law requires all nursing homes to contract
with a consultant pharmacist, who is responsible for
ensuring that resident drug use is safe and effective
and that facilities are in compliance with federal and
state regulatory requirements.
Drug regimen review by Consultant Pharmacy
 Provides consultation on all aspects of the provision
of pharmacy services in the facility;
 Establishes a system of records of receipt and
disposition of all controlled drugs in sufficient detail
to enable an accurate reconciliation; and
 Determines that drug records are in order and that an
account of all controlled drugs is maintained and
periodically reconciled
Policy issues
Cost containment
 Ingredient cost reimbursement
 Dispensing fees
 Special reimbursement for institutional pharmacies
 Alternative risk sharing arrangement
Quality Improvement
 Limits in chemical restraints
 Limits on unnecessary and harmful drug use
 Efforts to discourage polypharmacy
 Disseminating best practice information to
physicians
Behavioral Health Unit
 Ideally the list of medication should be compiled on
admission or within the first 24 hours of admission.
Patient should be able to provide a complete written
or oral list of their medications or medication vials on
admission since the health care team uses information
as basis of initial pharmacotherapy.
 “Psychiatric Hospitals, Mental hospitals, Behavioral
units”
 specialize only in short-term or outpatient therapy for
low-risk patients.
 Types:
o Crisis stabilization unit – a small facility
with minimal beds used for people in crisis
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o Open psychiatric units – to make life as
normal as possible, they counsel patients.
 Problems such as:
- Patients are unable to provide a complete
information
- Poor memory recall
- Physical limitation of their illness
 Pharmacists are an ideal resource for obtaining
medication histories and assisting the medication
reconciliation process. They are knowledgeable and
trained necessary to identify incorrect dosage, route
of administrations, frequencies and therapeutic
duplications.
 Pharmacist working in the admission setting can
significantly improve the process of obtaining a
medication history.
Rehabilitation Facility
 Clinical pharmacy services provided by pharmacists
to patients in a rehabilitation facility through a
contracted arrangement with a local hospital are
described. Two staff pharmacists from a community
hospital oversee the drugdistribution process and
provide clinical services rehabilitation facility.
 During alternate four-week periods, each pharmacist
works at the rehabilitation facility; the other four-
week period is spent in traditional drug-distribution
activities at the hospital.
 Clinical pharmacy services include patient education,
drug-therapy monitoring and consultation, drug
information activities, and management of drug
therapy.
Hospice care facilities
 The continuum of care provided by palliative care
pharmacist incorporate concept of curative and
palliative care should co exist and the hospice care is
an extension that occurs when curative care is no
longer part of patient’s plan of care
 Pharmacist may support palliative and hospice care.
Pharmacist services in administrative role (policy and
procedure, formulary management) , consultative role
(order set development, best practice education) and
advanced clinical practice (medication theraphy
management services, pain and symptom
management consultation and inter disciplinary team
participation.)
Developmental Disabilities Facilities
 Developmental Disabilities are a group of conditions
due to an impairment in physical, learning, language,
or behavior areas. These conditions begin during the
developmental period, may impact day-to-day
 functioning, and usually last throughout a person’s with the agency or organization), including one or
lifetime. more physicians and one or more registered
 ADHD (attention deficit hyperactivity disorder), professional nurses, to govern the services which it
Intellectual disability, Cerebral palsy, Autism provides.
o ADHD drug: Memantine  Roles of Pharmacist
o Conduct medication review
Assisted Living Facilities (ALF) o Minimize medication error
o Prevent adverse drug reaction
 Assisted Living Residence - a housing facility for
people with disabilities or for adults who cannot or
Rural Hospitals and Clinics
who choose not to live independently.
 “Retirement home”  small hospital similar to a district general hospital but
is specifically trained and staffed to provide in remote
Rehabilitation Facilities and rural areas.
 Inpatient rehabilitation facilities – rehabilitation of  Losartan, Metformin
patient with various neurological, musculoskeletal, Adult and Other Day Programs
orthopedic and other medical conditions following
stabilization of their acute medical issues.  offer an alternative to nursing home care for those
 Types: who do not need 24-hour skilled nursing. Adult day
o Occupational services often assist working caregivers to balance
o Physical the needs of work and caregiving responsibilities as
o Speech well as respite for full-time family caregivers
 Role of Pharmacist:
o Determine discrepancies Correctional Facilities
o Medication errors  A prison, also known as a jail or a gaol, penitentiary,
detention center, correction center, correctional
Group Homes
facility, lock-up or remand center
 for individuals is a residence model of medical care  Inmates are confined and denies a variety of
for those with complex health needs. freedoms under the authority of the state as
 For children or young people who cannot live with punishment for various crimes
their families or afford their own homes, people with  Roles of Pharmacist:
chronic disabilities who may be adults or seniors, or o Provide evidence-based information
people with dementia and related aged illnesses. o Counseling and dose adjustment
Typically, there are no more than six residents, and
there is at least one trained caregiver. Services:
 Foster care facility
 Facility and Pharmacy System Integration
Hospice Care Facilities  Ordering and Electronic Medication Administration
Record (eMAR)
 provides a formal program of care for terminally ill o eMAR – technology that automatically
patients whose life expectancy is less than six records administered drugs.
months, provided on an inpatient basis and directed o EHR – national level
by a physician. o EMR – within the institution, hospital,
 Role of Pharmacist: computerized chart
o Advice palliative care  Production, Monitoring and Review
o Supportive care  Physician Order Processing
o Monitor drugs for terminally ill: Morphine,  Treatment Sheet Preparation
opioid analgesics o where the pharmacist log all the possible
that can be recommend to the patients
Home Health Organization  Outcomes Analysis and Review
 Formulary Analysis and Implementation
 primarily engaged in providing skilled nursing
o Formulary made by PTC
services and other therapeutic services. Has policies
 Hospital – all kinds of medicine are
established by a group of professionals (associated
in their formulary
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  Specialized – specific medications (e.g., discontinuation of futile or
only nonessential medications)
o Formulary 8th Edition -2017 - PNDF  Participate in or lead decisions on hospice or
 In-service Training Program Presentation outpatient palliative care appropriateness and referral
 Patient Care Servicing 24-hours-a-day  Guide transitions of care
 Emergency On-Call Pharmacists and Delivery  Assist in health-system policy as it relates to PHC
Technicians Accessibility  Educate patients, caregivers, and families regarding
 Customized Delivery and Distribution medications

Scope of Institutional Pharmacy Education

 There is a wide range of clinical pharmacy activities  Develop health profession students’ understanding of
performed throughout the world, which include but PHC
are not limited to:  Develop practicing health professionals’
o patient medication review understanding of PHC
o ward rounds
Scholarship
o therapeutic drug monitoring
o drug information  Contribute to the body of knowledge of PHC via
o inservice education writing, speaking, or research
o medication counseling
o medication histories Administrative Roles
o drug utilization evaluations
 Practice development and management
o adverse drug monitoring compounding and
 Interdisciplinary leadership
distributing
 They are also in charge of: Pharmacist role in PHC
o purchasing
o manufacturing  Participating in institutional committees and
o dispensing medication safety–reporting systems that address
o quality testing their medication stock along medication errors, adverse drug reactions, and the
with help from pharmacy assistants and safety of analgesics and symptom-management
pharmacy technicians agents,
 Acting as a resource and actively participating in the
Desirable Clinical and Administrative Roles, Practice pharmacy and therapeutics committee or similar
Activities, and Examples of Tasks, Skills, and Knowledge committees,
of the PHC Pharmacist  Serving as an institutional resource to healthcare
professionals, patients, and patients’ families on the
Direct Patient Care optimal use of medications in symptom management
and palliative care,
 Conduct advanced pain and symptom assessment,  Providing continuous evaluation and review of all
including comorbid conditions existing drug-related protocols and algorithms to
 Establish and maintain a collaborative practice ensure that they reflect current best practices, and
agreement with managing medical practitioner  Assisting in the development of urgency plans that
 Initiate, modify, and discontinue medication therapy address inappropriate use of emergency department
 Monitor medication therapy using patient and services or hospital admission. In addition, it is
caregiver history and order, recommend, or interpret essential that the PHC pharmacist assist the
laboratory and test results institution or health system in compliance with
 Develop an accountable role within the PHC accreditation, legal, regulatory, and safety
interdisciplinary team requirements related to the use of analgesics and
 Thoroughly understand scope of practice and roles of other symptommanagement agents.
nonpharmacist members of the PHC team
 Participate in or lead family meetings Rural Health Unit or Clinics (RHU)
- Establish goals of care and educate patient
and family on medication therapy decisions  Pharmacists play a critical role in dispensing these
medications, educating patients, and ensuring patient
safety.
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  Pharmaceutical care is an important aspect of the
spectrum of healthcare. Pharmacists are part of the
healthcare team and provide counseling to patients
and advice to medical staff and case managers. They
have an essential role in helping prevent medication
errors and in identifying drug interactions.
 Pharmacy services include more than just supplying
prescription drugs, a role that online mail order
pharmacies can, and increasingly do, fill. Pharmacists
also provide immunizations and advice on over-the-
counter medications and support other healthcare
facilities such as skilled nursing facilities, hospitals,
and hospice care. Furthermore, the rural population
tends to be older and have more chronic health
conditions than the urban population, which makes
access to pharmacy services important to the health
of rural residents.
 Older rural adults, who may have multiple
prescriptions, can particularly benefit from a
relationship with a pharmacist who, along with their
physician, can help them manage their medications.
However, regardless of patient age, pharmacy
services are essential components to meet the
healthcare needs of all rural residents.

Institutional Pharmacy in the Philippines

 Supreme Court
 PAGCOR
 House of Representatives
 Senate of the Philippines
 Meralco
 Philippine Airlines
 San Miguel Corporation

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