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HOSPITAL
 An organized structure which pools
together all the health professionals, the
diagnostic and therapeutic facilities,
equipment and supplies and the physical
facilities into a coordinated system for
delivering health care to the public

HOSPITAL PHARMACY
BREX REVIEW FOR EXCELLENCE, INC

CLINIC REQUIREMENTS OF A HOSPITAL

 A facility or area where ambulatory
patients are seen for special study and
treatment by a group of physicians
practicing together, and where the patient
is not confined in a hospital
 Outpatient vs inpatient
 At least 6 inpt beds for operating for 24 hrs
 Ensuring health and safety of patients
 Governing authority
 CEO/Director
 Organized medical staff
 Pts are admitted on the authority of a member of
a medical staff
 Current/complete medical records
 Pharmacy service
 Patient service

CLASSIFICATION OF HOSPITALS CLASSIFICATION OF HOSPITALS

 Based on the type of service  Ownership
 General  Government

 Special  Non-government (non-profit oriented, profit

oriented)

 Based on length of stay

 Short-term - <30 days
 Long-term - ≥30 days

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CLASSIFICATION OF HOSPITALS CLASSIFICATION OF HOSPITALS

 Based on bed capacity  Based on Service Capabilities (DOH)
 Under 50 beds  Level 1 Primary
 50-99  Level 2 Secondary
 100-199  Level 3 Tertiary

 200-299  Level 4 Quaternary

 300-399

 400-499

 ≥500

…based on service capabilities …based on service capabilities

Functions of a Hospital SUPPORTING SERVICES

 Patient Care  Nursing services
 Education  Dietary services
 Research  Central supply services

 Public health/ wellness of the community  Medical record service

 Blood bank

 Pathology

 Radiology

 Anesthesia

 Medical social services

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Medical Staff: Main Medical Staff: Specific Types

 Open Staff  Honorary staff
 Physicians who are allowed to use the private  Active staff
room facilities
 Associate Staff
 Members of the courtesy medical staff
 Courtesy staff
 Closed staff
 Consulting staff
 All professional services are controlled by
attending or active medical staff  Resident staff

HOSPITAL PHARMACY CLINICAL PHARMACY

 The practice of pharmacy in a hospital
setting including its organizationally
related facilities or services
 Procurement, storage, compounding,
manufacturing, packaging, controlling,
assaying, dispensing, distribution and
monitoring of medications through drug-
therapy management
 A practice in which the pharmacist utilizes
his professional judgment in the
application of pharmaceutical sciences to
foster the safe and appropriate use of
drugs, in or by patients, while working with
members of the health care team
 A patient-oriented pharmacy practice

FUNCTIONS DIVISIONS
 Purchasing and inventory control  Administrative services
 Drug distribution (filling, labeling,  Basically, supervises the department
dispensing)  Develop policies
 Production services  Education and training
 Information services  Coordinate programs of undergraduate and
graduate pharmacy students
 Education services
 Participate in hospital wide educational
 Clinical services programs involving nurses, doctors, etc.
 Train newly employed pharmacy department
personnel

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DIVISIONS DIVISIONS
 Pharmaceutical research  Out-patient services
 Develop new formulations of drugs especially  Compound and dispense out-patient
dosage forms not commercially available and prescriptions
of research drugs  Provide drug consultation services to staff and
 Improve formulations of existing products medical students
 In-patient services  Drug information services
 Provide medications for all in-patients of the  Provide drug information to doctors, nurses,
hospital on a 24-hour per day basis medical and nursing students and house staff
 Prepare the hospital’s pharmacy newsletter

DIVISIONS DIVISIONS
 Department services  Central supply services
 Control and dispense IV fluid  Assay and quality control
 Control and dispense controlled substances  Perform analysis on products manufactured
 Coordinate and control all drug delivery and and purchased
distribution systems  Assist research division in special
 Purchasing and inventory control formulations
 Maintain drug inventory control  Manufacturing and packaging
 Purchase all drugs  Sterile products
 Interview medical service representatives  Produce small volume parenterals

DIVISIONS DIVISIONS
 Aseptic filling area  Glass
 Class 100 environment (no more than 100  Type 1
particles 0.5 micrometer or larger/cubic foot  Type 2
 LAF with HEPA filter – 0.3 micrometer  Type 3
 Test for integrity of the HEPA filter:  Type 4: general purpose glass (for
Dioctyl pthalate test nonparenterals)
 Test for integrity of the membrane filter:
bubble point test

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DIVISIONS
 Single dose
 Multiple dose
 Small volume preparations – up to 100 mL
 Large volume preparations – >100 mL
PHARMACY AND THERAPEUTICS
COMMITTEE
 Objective: to achieve optimal patient care
and safety through rational drug therapy
 Organization
 Atleast 3 physicians (chairman)
 Pharmacist (secretary)
 Nursing staff representative
 Administrators
 Quality assurance coordinators
FORMULARY
 A continually revised compilation of
pharmaceuticals that reflects the current
clinical judgment of the medical staff
4/24/2015
DIVISIONS
 Radiopharmaceutical services
 Centralize the procurement, storage and
dispensing of radioisotopes use in clinical
practice.
 IV admixture
FORMULARY SYSTEM
 A method whereby the medical staff of an
institution, working through the PTC,
evaluates, appraises, and selects from
among the numerous available drug
entities and drug products those that are
considered useful in patient care
PARTS OF THE FORMULARY
 Information on hospital policies and procedures
concerning drugs
 Drug product listing
 Alphabetically arranged by generic name
 Alphabetically within therapeutic class
 Generic name
 Common synonyms and brand names
 Dosage forms, strengths, packagings and sizes
stocked by the formulary
 Formulation
 Additional information: special cautions, pediatric
doses
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HOSPITAL FORMULARY HOSPITAL FORMULARY

 Objectives  Special information
To provide the hospital staff with  List of hospital-approved abbreviations
 Information on drugs approved for use in the  Rules of calculating pediatric doses
hospital  Dosing guides for patients with renal

 Basic therapeutic information impairment

 Information on hospital policies and  List of dialyzable poisons
procedures concerning drugs
 Special information about drugs
(abbreviations, calculation of dosages)

DRUG DISTRIBUTION SYSTEMS DRUG DISTRIBUTION SYSTEM

 COMPLETE FLOORSTOCK  ADVANTAGES
 Used in small hospitals  Ready availability of drugs
 Charged floorstock drugs  Reduction in number of drug order
 Medicationsstocked in nursing station at all transcriptions for the pharmacy
times and are charged to patients  Reduction in the number of pharmacy
personnel needed
 Non-charged floorstock drugs
 Medications in nursing station for use of all
patients but with no direct charge on the
patient

DRUG DISTRIBUTION SYSTEM DRUG DISTRIBUTION SYSTEM

 DISADVANTAGES
 Possible increase in medication errors due to
elimination order review
 Increased hazards associated with drug
deterioration due to possible lack of proper
storage facilities in the ward
 Individual prescription order system
 Used in small hospitals where a pharmacist is
not on the premise all the time
 Advantages:
 Reduced manpower requirements
 Allmedications directly reviewed by the
pharmacist
 Disadvantages
 Possible delay in obtaining required
medication

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DRUG DISTRIBUTION SYSTEM PRESCRIPTION

 UNIT DOSE DISPENSING
 Allin-patient drugs are dispensed in unit
doses and sorted in central area pharmacy
and dispensed at the time the dose is given to
the patient
 Centralized
 Written order and instruction of validly
registered physician, dentist, veterinarian
for use of specific drug products for specific
drugs

 Decentralized

PRESCRIPTION INCORRECT PRESCRIPTIONS

 Parts of a prescription  ERRONEOUS PRESCRIPTION
 Patient information
 Superscription  The brand name precedes the generic name
 Inscription  The generic name is the one in parenthesis
 Subscription
 The brand name is not in parenthesis
 Signa
 Date  VIOLATIVE PRESCRIPTION
 Signature
 The generic name is not written
 Prescriber information
 License number  The generic name is not legible and a brand
 Number of refills name that is legible is written
 The brand name is indicated and instructions
added (“no substitution”)

DRUGS FOR THE EMERGENCY

INCORRECT PRESCRIPTIONS
BOX
 IMPOSSIBLE PRESCRIPTION  Aminophylline
 Only the generic name is written but is not  Amphetamine
legible
 Amyl nitrite inhalation
 The generic name does not correspond to the
 Atropine sulfate
brand name
 Both the generic name and the brand name  Caffeine sodium benzoate

are not legible  Calcium gluconate

 Chloroprophenpyrimadine

 Digoxin

 Diphenylhydantoin sodium

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DRUGS FOR THE EMERGENCY DRUGS FOR THE EMERGENCY

BOX BOX
 Epinephrine HCl  Norepinephrine injection
 Heparin  Pentobarbital
 Hydrocortisone
 Pentylenetetrazol injection
 Phenobarbital
 Isoproterenol
 Phenylephrine
 Magnesium sulfate injection
 Phytonadione injection
 Metaraminol bitartrate
 Picrotoxin injection
 Mannitol injection  Procaine
 Nalorphine HCl  Protamine sulfate
 Neostigmine methylsulfate  Saline for injection, water for injection

TOTAL PARENTERAL TOTAL PARENTERAL

NUTRITION
 Hyperalimentation
 Indications
 When enteral route cannot be used because
of dysfunction or disease states (acute
pancreatitis, inflammatory bowel disease,
complete bowel obstruction)
NUTRITION
 Routes of administration
 Central venous route
 Hypertonic formulations
 Dextrose concentrations of 25%
 Osmolarity >2000 mOsm/L
 Rapid dilution by high flow rates
 Peripheral venous route
 Dextrose concentration 10% or less
 Osmolarity 900-1000 mOsm/L

TOTAL PARENTERAL
STORAGE TEMPERATURES
NUTRITION
 STORAGE AND PACKAGING TERM CONDITION
COLD PLACE Not exceeding 8⁰C
 Storeat 2-6C
FREEZER Between -25⁰C – (-10⁰C)
 Notallowed to be stored at room temperature
REFRIGERATOR Between 2⁰C – 8⁰C
for more than 12-24 hours
COOL Between 8⁰C – 15⁰C
ROOM TEMPERATURE The temperature prevailing in
the working area
CONTROLLED ROOM 20⁰C – 25⁰C
TEMPERATURE Between 15⁰C – 30⁰C
WARM Any temperature between 30⁰C
and 40⁰C
EXCESSIVE HEAT Above 40⁰C