Hospital

HOSPITAL is a complete organization utilizing

combinations of intricate, specialized scientific
equipment, and functioning through a corps of
trained people educated to the problems of modern
medical services.
Hassan, 2009
History and Evolution of Hospital
Pharmacy
1752 Pennsylvania Hospital 1752
- Pennsylvania Hospital,
the first hospital in
Colonial America was
established
* Jonathan Roberts –
apothecary
* medicine and pharmacy-
was practiced together
* medical apprentice -
prepared the drug
1800
-the U.S. had only 2
hospitals – in a 5 M
population early 1800s
- the drug therapy
consisted of :
* strong cathartics
* emetics
* diaphoretics
Mid 1800s
- used newer alkaloidal drugs:
* morphine
* strychnine
* quinine
- pharmacy service was not seen as
necessary except in large facilities
1830s – 1870s

clean air and good

food are used as
treatments which is
emphasized in the
hospitals rather than
medicines
1870s - 1880s
-the number of hospitals in cities doubled dueto
influx of immigrants  Roman Catholics
Era of hospital expansion
-coincided with:
*reforms in nursing
*development of germ theories
*rise of scientific medicine and surgery
1873
- the U.S. had only 178
hospitals with fewer
than 50,000 beds – in a
43 M population
- hospitals played a small
role in health care
- pharmacists played a
small role in hospitals
1890s
-hospital became the
center of medical care
due to general adoption
of aseptic surgery
 FACTORS INFLUENCING EXPANSION OF
HOSPITALS
✓Religious
✓Military
✓Flexner report on medical education
✓Florence Nightingale after Crimean War
✓Public interest
Requirements for registration for
Hospital by AHA
HOSPITAL

Requirements for registration

by AHA
-patients stay on the
average in excess of
24 hours / admission

-shall be equipped
and maintained to
ensure health and
safety to patients
*provide uncrowded, sanitary facilities
-provide patients with food service
*special diets – available
 Shall have an organized staff –to
maintain standards of medical care
THE PATIENT

-shall be:
*admitted on the authority of a
member of the medical staff
*the responsibility of a member of
the medical staff
*have prompt medical evaluation
The physician:-if graduate of
foreign medical
school shall
have:
*valid license to practice
medicine
*Certification by the
Educational
Commission for Foreign
Medical Graduates
CLASSIFICATION OF HOSPITAL
•Type of service
•Length of stay
•Ownership
•Bed capacity
 CLASSIFICATION: Type of Service

Based on AHA, the following are the

general classification:
A. General
B. Special
C. Rehabilitation and Chronic
Disease
D. Psychiatric
Type of Service:
A.) general – variety of medical
conditions: medical, surgical,
pediatric, psychiatric, and
maternity
B.) special – specialized medical
conditions both surgical and
nonsurgical (e.g. cancer, psychiatry,
or pediatric cases)
Refer to the notes for the DOH
classification:
 CLASSIFICATION: Length of Stay

A.) short-term hospital

B.) long-term hospital

•Ownership
CLASSIFICATION: Ownership
-Governmental hospitals
➢Federal (Armed forces, Veterans and
administration & Public Health services)
➢Sate [City (municipal) & County
(district)]
-Nongovernmental Hospitals
➢Non profit (Church related or operated)
➢For profit (individual, partnership,
corporation)
 CLASSIFICATION: Bed Capacity
Hospitals may be classified as:
*small – e.g., less than 100 beds
*medium – e.g., 200 beds
*large – e.g., greater than 300
beds
HOSPITAL

OTHER PATIENT CARE

INSTITUTION
 Other Patient Care Institutions
✓Long Term Health Care Facility
✓Resident Treatment Facility
✓Clinic
✓Ambulatory Surgery Center
Fundamental functions of hospitals
1.) Patient care
2.)Education (Medical and Allied health
professionals and Patient)
3.) Research
4.) Public Health
Fundamental functions of
hospitals:
1.) patient care
involves:
-diagnosis
-treatment
-preventive medicine
-rehabilitation
-convalescent care
-other personalized services
Fundamental functions of hospitals:
2.) education
2 major forms:
*education of medical and
allied professions
*education of the patient
Fundamental functions of
hospitals:
3.) research
2 major purposes:
a.) advancement of medical
knowledge against disease
b.) improvement of hospital
services
Fundamental functions of hospitals:
4.) public health
objectives:
a.) to assist the community in
reducing the incidence of illness
b.) to improve health
 Departments that deal with the
professional care of the patient
(diagnostic and therapeutic):
*Ambulatory care *Medical records
DIFFERENT *Clinical lab. *Pharmacy service
DEPARTMENT *Dietary and *Accounting
OF HOSPITAL nutrition service *Admitting
*Electrocardiograph *Business office
laboratory * Housekeeping
*Emergency room
 1.Internal factor (institutional
FACTORS organization)
AFFECTING 2. External factors (Licensing agencies, Office
HOSPITAL of Inspector General-compliance standards,
Social and governmental welfare agencies-
SERVICES medically indigent, accreditation agencies – exert
their influence on the practice of pharmacy)
 Institutional Accreditation

Accreditation body acknowledges that an

institution has meet their requirements

Advantages: Disadvantages:
•high quality care Loss of organization’s honor = legal
•high quality treatment difficulties
•high quality services Expensive services
•safety
 Institutional Accreditation
Accrediting body – organization or entity that establishes
standards for accreditation and determines that a healthcare
organization complies with the standards.

Certifying body - organization or entity that establishes

standards for certification and determines that a healthcare
organization complies with the standards.
Some Major Accrediting and certifying bodies:

Non-Government Organization:
✓Joint Commission on Accreditation of
Healthcare Organizations (JCAHO)
✓American Osteopathic Association (AOA)
✓Centers for Medicare and Medicaid Services
(CMS)
 Some Major Accrediting and certifying bodies:

✓Joint Commission on Accreditation of

Healthcare Organizations (JCAHO) is the principal
accrediting body for the operation of hospitals and other
healthcare organizations improves the safety and quality of care
in organized healthcare settings
 Some Major Accrediting and certifying bodies:

Federal and State Government Entities:

✓Food and Drug Administration (FDA)
✓Drug Enforcement Administration (DEA)
✓ Department of Health (DOH)
✓Occupational Safety and Health Administration (OSHA)
✓National Institute for Occupational Safety and Health (NIOSH)
✓Centers for Disease Control and Prevention (CDC)
Hospital Pharmacy

A field of pharmacy practice within the

framework of the hospital’s organizational
structure that accommodate the needs of
admitted patients (in-patients) and out
patients of the hospital (ambulatory).
Hospital Pharmacy

The primary function of the institution(hospital) is

to provide patient services, diagnostic, and
therapeutic, for a particular or general medical
conditions. AHA
 OVERVIEW
60% are 22 % are Hospital
Bureau of Labor Statistics (BLS) : 2002 Community Pharmacists
Pharmacists
Pharmacist in 2012 is predicted to
increase yearly;
Reasons:
* increase elderly population
* increase new medications in the market
* increased number of physicians
* increase prescription volume
* increase utilization of health care facilities
* decreased supply of pharmacists
ORGANIZATIONAL CHART GOVERNING BOARD
Provides direction for the organization, provides appropriation of resources

CEO
Makes recommendation to the board, select
competent personnel, control hospital funds &
supervise the physical plant

ADMINISTRATOR
Appoints department leaders
MEDICAL
STAFF
DEPARTMENT HEADS
Operates the department
effectively and properly
 R20th p1921

ORGANIZATIONAL CHART HOSPITAL ADMINISTRATOR

DEPARTMENT OF PHARMACY DIRECTOR

EXECUTIVE & ADMINISTRATIVE OPERATIONS

PROFESSIONAL EDUCATIONAL RESEARCH &

& CLINICAL & TECHNICAL SUPPORT
SERVICES SERVICES SERVICES
*Nuclear Pharmacy *Drug Info and Poison *pharmaceutical and
*UDDDS control research
*Ambulatory & Home *Education & training *Assay and quality control
care *Professional staff dev *Drug kinetic &
*IV admixture unit *Residency training bioavailability
*Sterile product unit *Technician selection and *Manu and packaging
*Drug administration unit training •Purchasing and inventory
*Clinical Pharmacy * Computerized operation •Investigational drug stud
 Minimum requirements for pharmacies in
hospitals:
Overview

1900s ACS initiated for practice in hospital

Result: “First Minimum Standard for
Pharmacies in Hospitals”
18th Hospital Standardization Conference of the American
College of Surgeons
1942- ASHP was organized standing Committee on Minimum
Standards
- develop and maintain better minimum standards
1950-revision of the original standard of the ACS by ASHP
*organized, directed by a professionally competent,
legally, qualified pharmacist
*pharmacist- develop administrative policies for the
department
*development of department’s professional policies –
under PTC approval
**ample number of qualified personnel
*adequate facilities
*expanded scope of pharmacist’s responsibilities:
>drug information service
>nurse and physician teaching
>file periodic progress report
*PTC must establish a formulary
1. Receiving patients
2. Ensuring the presence of the required
information
3. Dispensing of Prescription
4. Patient’s Counseling
5. Patient’s Education
6. Patient’s Care

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 1. Compounds extemporaneous
products, cytotoxic drugs,
Injectable antibiotic
injectable antibiotics, nutritional
Extemporaneous products
infusions etc.
2. Participate in Pharmacy and
Therapeutic Committee and
Cytotoxic drugs Nutritional infusions
Hospital Formulary
3. Contributing in research and
development especially in clinical
trials

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 4. Ensures medicinal products
are proper storage to
guarantee potency.
Proper Storage Proper Storage of vaccines

5. Teaching in pharmacy
department and hospital.

Proper Storage

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6. Pharmacovigilance by documenting,
reporting and managing adverse drug
reactions.

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