Introduction to Hospital Pharmacy

Outline:
I. Definition of Hospital Pharmacy
II. Evolution of Hospital Pharmacy
III. Uniqueness of Hospital Pharmacy
IV. Goals of Hospital Pharmacy
V. Minimum Standards of Pharmacies in the
Hospital


Definition: (Hassan, 1974)
Department or service in a hospital in which under the direction of
a professional competent, legally qualified pharmacist.


Hospital
Pharmacy
Pharmaceuticals are
manufactured
Medications are
supplied to the
nursing units and
other services
Prescriptions are filled for
ambulatory patients and
out patients
Special prescriptions
are filled for patients
in the hospital


Hospital
Pharmacy
Narcotics and other
prescribed drugs are
dispensed
Professional
supplies are often
stocked and
dispensed
Injectable
preparations are
prepared and
sterilized
Evolution of Hospital
Pharmacy
6
th
century
Hospitals originated in India and Egypt to protect the society
from contagious diseases, insanity and incurables

Temples of God serves as hospitals. Healing were associated
with divine powers because they believed that illness is due to
lack of purity.

Ex: Temple of Kos in Greece it is where Hippocrates (Father of
Medicine practiced
History
Temples of God in Greek and Roman Civilization
Temple of Aesculaptos 1134
(Greek God of Medicine)
History
16
th
century
Monasteries had infirmarian place where successful treatment to
diseases were being offered
17
th
century
Pennsylvania Hospital ( the first hospital in Colonial America) was opened
1752 - Jonathan Roberts was the first hospital pharmacist/apothecary

Medicine and Pharmacy are being practiced together. At that time drug
preparation are often the responsibility of a medical apprentice




History

Apothecarys shop was built.
Apothecary became the resident in the hospital. His duties
involved the administration of patients admissions,
procurement and dispensing of medicines and the assumption
of responsibility in the absence of medical staff and matron.
Elaboratarian helps in the preparation of medicines; who did
the unskilled work



18
th
century
Hospital pharmacist were rare because there were few hospitals
Hospitals were places of dreaded impurity and exiled human
wreckage
History
History
18
th
century
In early 1800s clean air and good food rather than medicines
were treatments emphasized in hospitals
In 1870s and 1880s responding to the influx of immigrants
(mostly Roman Catholics) Catholic hospitals were built.
Catholic hospitals charged patients small fee and they were
willing to train nuns in the pharmacy.
History
Early 1900s
Advent of hospital formulary
Hospital Formulary a list of drugs approved for use within the
hospital or health system by the Pharmacy & Therapeutics
Committee.
1920 Prohibition (alcohol)
1930s AHA created a Committee of Pharmacy to analyze
problems and make recommendations.
The aim of the committee was to develop minimum standards
for hospital pharmacy department and prepare manual
operations.
1957 - 1960
Major study conducted by the Audit of Pharmaceutical Services
in Hospitals.
The group published a book Mirror to Hospital Pharmacy (a
publication documenting the state of pharmacy service in the
hospitals in the late 1950s)
History
Four major themes emerge from an examination changes over
the period:
1. Pharmacist must be in charge of drug product acquisition,
distribution and control
2. Pharmacist has a major role in patient safety
3. Pharmacist has a major role in promoting rational drug
therapy
4. Pharmacist has a mission to foster optimal patient
outcomes from medication use.
History
Drug Product Acquisition,
Distribution and Control
1949s
Pharmacy was perceived as complementary service
department, not as essential service.
Nurses and Community pharmacists (not hospital pharmacist)
were responsible for hospital drug
Until..
1950s
2 types of services bulk compounding and sterile solution
manufacturing were a major element of the hospital
pharmacists identity
Drug Product Acquisition, Distribution and
Control
Patient Safety
1957

2 ways of drug distribution:

1. ward stock
2. individual prescription

Result: errors in prescribing and transcribing
Solution: Unit dose Drug Distribution

William M. Heller & William W. Tester
- conducted important studies on unit dose drug
distribution

Unit Dose Drug Distribution
1. The RPh receives the physicians
original order or direct copy.
2. The RPh reviews the medication
order before the first dose is
dispensed
3. Single unit packaging
4. Medication is dispensed in as
ready to administer form
5. Not more than 24 hours of dose
is delivered
6. Medication profile is maintained

Ward stock
The RPh never sees the
physicians original order
Errors made by the
physician & errors in
transcribing or nurses were
often undetected
Comparison
Until..
Automated systems and Distribution devices was developed

Electronic Medical Record Computerized Prescriber Order Systems
Until..
Automated systems and Distribution devices was developed

Bar Code Medication Administation
Smart Pumps
Promoting Rational Drug Use
1936 U. S. Edward Spease ( Father of Hospital Pharmacy
Standards) and Robert Porter developed the concept of..
Pharmacy & Therapeutics Committee
Committee of medical staff (Dr, RN, RPh etc..) which oversights
medication management.
Establishes Formulary
Assesses medication use
Makes Recommendation on policies and procedure associated
with medication management.
Pharmacists serves as the secretary of the committee

Formulary
System
American
Hospital
Association
Pharmacy &
Therapeutics
Committee
American
Society of
Hospital
Pharmacists
A structure for evaluating, appraising and selecting drug
products to be available for use in patient care
Framework in which medication-use policies are established
and implemented.

Formulary
- A list of drugs approved for use within the hospital
Formulary System
Fostering Optimal Patient
Outcome
To help people make the best use of medicines

During 1950s
Pharmacists were less frequently asked for advice on
medications (ADR, dosage forms..)

ASHP Hilton Head Conference in 1985
Emerged the idea that hospital pharmacies should function as
clinical departments with the mission to foster the appropriate
use of medicine
Fostering Optimal Patient Outcome
Evolution of Hospital
Pharmacy in the Philippines
1577 Hospital de San Juan de Dios and Hospital de San
Lazaro were built by the Franciscans

1962 The Philippine Society of Hospital Pharmacist was
organized. It promotes the interests of hospital pharmacists.
Dr. Rosario Capistrano Tan-first president of PSHP
Ms. Normita Leyesa (MMC)- the president of PSHP
Uniqueness of Hospital
Pharmacy Practice
Similarities of Community and Hospital Pharmacy
Check prescriptions for proper dosage
Compound prescribed pharmaceutical products by calculating,
measuring and mixing the quantities of drugs and other
ingredients required and filling appropriate containers with
correct quantity
Dispense prescribed pharmaceuticals to customers or to other
health care professionals and advise them on indications,
contra-indications, adverse effects, drug interactions and
dosage

Community pharmacists and hospital pharmacists
perform some or all of the following duties:
Maintain medication profiles of customers including registry of
poisons and narcotic and controlled drugs
Ensure proper preparation, packaging, distribution and
storage of vaccines, serums, biologicals and other drugs and
pharmaceuticals
Order and maintain stock of pharmaceutical supplies

Community pharmacists and hospital pharmacists
perform some or all of the following duties:
Advise customers on selection and use of non-prescription
medication
May supervise and co-ordinate the activities of other
pharmacists, pharmacy assistants, pharmacy technicians and
other staff.



Source: Human Resource and Skill Development Canada
http://www5.hrsdc.gc.ca/noc/english/noc/2011/Profile.aspx?val=3&val1=3131
Community pharmacists and hospital pharmacists
perform some or all of the following duties:
Hospital Pharmacy differ from Community pharmacy in ways such
as
serves as a member of policy-making committees, including
those concerned with drug selection, the use of antibiotics, and
hospital infections (Drug and Therapeutics Committee) and
thereby influences the preparation and composition of an
essential-drug list or formulary;
is in a better position to educate other health professionals
about the rational use of drugs;
more easily participates in studies to determine the beneficial or
adverse effects of drugs, and is involved in the analysis of drugs in
body fluids;

Hospital Pharmacy differ from Community pharmacy in ways such
as
has more opportunity to interact closely with the prescriber and,
therefore, to promote the rational prescribing and use of drugs;
has a greater opportunity to interact with others, to specialize
and to gain greater expertise;
having access to medical records, is in a position to influence the
selection of drugs and dosage regimens, to monitor patient
compliance and therapeutic response to drugs, and to recognize
and report adverse drug reactions;
can more easily than the community pharmacist assess and
monitor patterns of drug usage and thus recommend changes
where necessary;

Hospital Pharmacy differ from Community pharmacy in ways such
as
can control hospital manufacture and procurement of drugs to
ensure the supply of high-quality products;
takes part in the planning and implementation of clinical trials.






Source: Essential Medicines and Health Products Information Portal
A World Health Organization resource,
(http://apps.who.int/medicinedocs/en/d/Jh2995e/1.6.4.html#Jh2995e.1.6.4)
Minimum Standards for
Pharmacies in Hospital
1936
ASHP adopted the Minimum Standards of Pharmacies in
Hospital it serves as a practice standards for hospital
pharmacy practice

Practice Standard
Authoritative advisory document
It offers minimum requirements
Provides optimal method for addressing an important issue or
problem
Minimum Standards for Pharmacies in Hospital
Must be under the
direction of a
professionally
competent , legally
qualified pharmacist
Pharmacist has the
authority to develop
administrative policies
for the department
Professional policies
must be approved by
the P&TC
Minimum Standards for Pharmacies in Hospital
There must be an
ample number of
qualified number of
personnel in the
department
Adequate facilities
Expanded scope of
pharmacists
responsibilities
P&TC must establish a
formulary
Minimum Standards for Pharmacies in Hospital