MIDTERM

FACILITIES AND SERVICES IN HOSPITALS

Professional Services

1. Anesthesia 9. Electroencephalography 17. Occupational Therapy

2. Blood Bank 10. Emergency Room 18. Operating Room
3. Central Supply Room 11. Inhalation 19. Outpatient Service
4. Clinical Laboratory 12. Medical Library 20. Pharmacy Service
5. Delivery Room 13. Medical Records 21. Physical Medicines
6. Dental Services 14. Medical-Social Services 22.Post-Operative Recovery Rm
7. Dietary Services 15. Nursery 23. Radioisotope Laboratory
8. Electrocardiography Lab 16. Nursing Service 24. Laboratory & X-Ray Therapy
 Business Management or Administrative

• 1. Accounting 8. Engineering and Maintenance

• 2. Admitting Section
• 3. Business Office
• 4. Cafeteria/ Canteen
• 5. Central Transportation
• 6. Credit and Collection
• 7. Data Processing
9. Housekeeping
10. Information Service
11. Personnel and payroll
12. Post-office
13. Purchase and supply
14. Telephone and switchboard
 Clinical Departments in Hospitals

• 1. Medicine Department 4. General Practice Department

• 2. Surgery Department 5. Physical Medicine
• 3. Obstetrics and Gynecology Dep’t. 6. Radiology
 Sub-Specialty under Surgery
• 1. Anesthesia 5. Oral Surgery 9. Plastic Surgery
• 2. General Surgery 6. Orthopedics 10. Proctology
• 3. Neurosurgery 7. Otolaryngology 11. Thorasic Surgery
• 4. Opthalmology 8. Pediatric Surgery 12. Urology
Supportive Services in the Hospital
• 1. Nursing Service 6. Blood Bank
• 2. Dietary 7. Medical-Social Service
• 3. Laboratory 8. Maintenance and Engineering
• 4. Record Section 9. Accounting and Billing
• 5. Central Sterile Service 10. Radiological Service
 Sub-Specialty Services under Medicine

• 1. Allergy 6. Gastroenterology 11. Preventive Medicine

• 2. Cardiology 7. Geriatrics 12. Psychiatry and Neurology
• 3. Tropical Diseases 8. Hematology 13. Pulmonary
• 4. Dermatology 9. Internal Medicine
• 5. Endocrinology 10. Pediatrics
  
NURSING SERVICE
• This service is a very important department
in the hospital that assists the attending
physician during rounds taking the order of
the physician. The nurses or students nurses
follows the order of the physicians as written
in the physician’s order sheet which is vital in
the care, prevention and treatment of disease
or disability.
• The nurses procure the drugs from the
pharmacy service. The food from dietary, the
hospital bills from the accounting, bed sheets
and other paraphernalia from the Central
Supply Room.
• The nurses administer the drug per Orem, IM
or SC injection and assist in the injection by
the doctor of IV drugs. They assist doctors in
the operating room (O.R.), delivery room
(D.R.), wards out-patient department (OPD),
intensive care unit (ICU).
• The nursing service is headed by a Director of
Nursing Service or a Chief Nurse assisted by
nurse supervisor.
 DIETARY SERVICE
• This is another important department in the hospital
as their department is responsible for the
procurement, planning and preparation of food for
the patients and hospital staff. The service may
employ dieticians or nutritionists supplemented by
technical personnel.

• They are responsible in the preparation of special

menu for special type of patients like diabetic, kidney
patients or ulcer patients. They are supposed to
prepare well balance diet.
  
MEDICAL RECORD SECTION
Hospitals are required to maintain a medical record of their
patients for the following reasons:

• Reference for future use in succeeding admissions.

• To serve as a document which may be needed by insurance

company, the courts of justice and business company.

• To protect the legal interest of hospital, patients and doctors

• To provide data for research purposes

• Some records can be computerized in big
hospitals to diminish the bulk records being
compiled.

• The records of a patient consists of Personal

Data, Past Illness, Present Illness, Family History,
Diagnosis, Laboratory Exam (Results), Pathology
Results, X-Ray Result, Autopsy Reports and
others.
 LABORATORY PATHOLOGY SERVICE
• This service includes Clinical Chemistry, Microbiology,
Clinical Microscopy, Hematology, Serology and
Pathology.

• Some hospitals may not have complete laboratory

facilities but they can do laboratory examination by
getting the specimen and sending to another hospital
or laboratory for proper examination and diagnosis.
This department is headed by Clinical Pathologist
assisted by Medical Technologist and Medical
Technology Interns.
 RADIOLOGICAL SERVICES
• This service is very important to the hospital as it
provides scientific, therapeutic and diagnostic facility
for the patient. Radiology is a branch in medicine that
deals with the diagnostic and therapeutic use of
roentgen rays and radium. X-rays are used to diagnose
TB, Ulcer, kidney stones, fractures and dislocations,
lung diseases, diseases of the bones like Cancer
patients,

• This service employs radiologists, radiotherapist, x-ray

technician, physicist, nurse, orderlies and clerk.
 CENTRAL SERVICE OR CENTRAL SUPPLY
SERVICE
• This service furnishes all supplies required by
the nursing department like toilet kits, linen
packs, needles, syringes and other medical
surgical supplies. This department concerned
with laundry, sterilizing and wrapping of
supplies.
  
BILLING AND ACCOUNTING SERVICE
• This section is responsible for the billing of
hospital patients. They prepare the statement
of account deducting or payment of
companies.
MAINTENANCE AND ENGINEERING SECTION

• This section takes care of the janitorial service

plumbing, electrical, carpentry and security
services.
• PHYSICAL PLANT
• This is one of the basic principle of hospital
which include the building in itself which need
proper maintenance in accordance with the
building code set by the government.
 Financial Management
• Financial Management in a hospital setting in 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.
  
Financial Management Considerations for the Hospital Pharmacy

1. Recognize the Pharmaceutical Service as the

major financial component of the hospital’s
operating costs.
2. Realize that pharmaceutical services are
unique from other hospital services.
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
6. Develop a long-range strategy to control drug
product costs.
7. Acknowledge that this is the “financial” era for
the health care industry and hospitals.
HOSPITAL PHARMACY
  
Organization
•  meets the minimum requirements prescribed
by Bureau of Food and Drugs, Bureau of Licensing
and Regulations, and Department of Health
•  directly administered and supervised by
licensed pharmacist.
• serves to establish the authority relationships
between positions and to assign special task’s that
achieve the pharmacy’s objectives.
 Personnel
•  professionally competent and legally
qualified pharmacist qualified
•  supportive personnel
 Relationship
•The Pharmacy Service shall expect the
following services from:
1.The Office of the Chief of Hospital
2.Administrative Services
3.Medical Social Work Service
4.Nursing Service
5.Medical Service
6.Dietary Service
7.Resident Commission on Audit (COA) Auditor
•Pharmaceutical Services expected by other hospital service
component:

1.Chief of Hospital
2.Administrative Service
3.Medical Service
4.Nursing Service
5.Medical Social Service
6.Dietary Service
7.Medical Records Service
8.Resident COA Auditor
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 to the
practice of pharmacy:
1.Bureau of Food and Drugs (BFAD)
2.Dangerous Drug Board (DDB)
3.Bureau of Licensing and Regulations (BLR)
4.Professional Regulation Commission (PRC)
5. Hospital Operations and Management
Service (HOMS)
 FUNCTIONS AND DUTIES OF HOSPITAL
PHARMACY PERSONNEL
•Functions of Chief Pharmacist
 
1.Make a report to the administrator. She can recommend appointments and
make suggestions for the improvement of facilities in the hospital
pharmacy.

2.Supervise her subordinates, from the assistant Chief Pharmacist, Staff

pharmacist, clerk, Secretary and Technicians.

3.Dispense medicines including narcotics.

4.Periodic checking of drugs stocked at nurse’s stations especially narcotics.

5.Maintain narcotics inventory and keep a record of narcotic drugs

dispensed.
6.Make a purchase order of drugs after proper
bidding.
7. Establish policies and procedures for all
transactions of the department.
8. Lecture to pharmacy interns (students)
9. Supervise answers to inquiries made by physicians
and nurses.
10. Pharmacy-Therapeutics Committee Coordinator
11. Edit Formulary and Newsletter
Duties of Assistant Chief Pharmacist or Staff
Pharmacist
1.Assist the Chief Pharmacist in dispensing of
medicines and making purchases when the
Chief Pharmacist is not around.
2.Assist in Inventory of Drugs in the Pharmacy.
3.Compounds drugs commonly used in the
hospital.
4.Supervise technicians and clerks.
5.Helps pharmacy in any functions that the
pharmacist will delegate.
  
Duties of Pharmacy Clerk
1.Assist the Pharmacist in dispensing.
2.Fill orders for nursing station.
3.Assist the pharmacist in stock control and
storage.
4.Responsible for order and cleanliness of
dispensing area.
 Duties of Secretary

1.Prepares all charges for drugs to individual

patients.
2.Fill prescription and maintain material cost
and billing records.
3.Billing and tabulation.
4.Prepares requisition forms, types letters.
5.Enter receipt or merchandise on the index
card file and invoices.
 Duties of Technicians
• Clean all bottles and other equipments.
• Clean the pharmacy area.
• Assist the pharmacist and clerk.
 Operations and Procedures

• The basic foundation of an effective drug

control system is its adherence to policies and
procedures. Procedures are established to
carry out policies, specify how control will be
achieved and outline 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 procedural 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 situation.
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
 Plant, Facilities and Equipment

• Plant, facilities, equipment and other materials of

the hospital pharmacy must comply with the
Bureau of Food and Drugs (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 for the professional and
administrative functions of the Pharmacy
Service to assure patient safety through the
proper storage, preparation (compounding,
packaging and labeling) 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 provided with suitable cabinets for
storing poison and/or dangerous drugs with
sectional type of cabinets and must have an
adequate supply of water.
  
Utensils, Apparatus and Other Equipment and Materials

1. Refrigerator for biological and other drug products requiring

refrigeration
2. Prescription balance and a set of weights
3. Glass volumetric measures and set of not less than 6 pcs. from
15 mL to 1000 mL capacity.
4. Mortar and pestle- a set not less than 3 in assorted sizes
5. Funnel, plain or ribbed- set of not less than 3 pcs. of different
capacities
6. Hot plate, double element, 3 heat control
7. Label moistener
8. Ring stand
9. Typewriter
10. Calculating Machine
• 11. Filing cabinet
• 12. Computer
• 13. Rough Balance with set of weights from 0.01
gram to 1000 grams
• 14. Analytical balance
• 15. Distilling apparatus
• 16. Mixer- 2 liter capacity.
• 17. Brewer’s cart for drug distribution
• 18. Tablet counter/ dispenser
• 19. Laminar flow- horizontal with Laminar down flow
unit
• 20. Tank glass
• 21. Utility cart
Reference Books and Pertinent Documents
•1. Reference books and documents
• a. PNDF Vol. I current edition
• b. CRI
• c. USP and NF latest edition
• d. RA 3720 as amended FDDC Act
• e. RA 6675 Generics Act of 1988
• f. RA 5921 as amended Pharmacy Law
• g. RA 4226 Hospital Licensure Act
• h. RA 6425 DDA as amended
• i. Rules and Regulations pertinent to the above stated laws
• j. RPS, latest edition
• k. Goodman and Gilman- Pharmacological Basis of Therapeutics
• l. Martindale’s Extra Pharmacopoeia
• m. Myler’s, Side Effects of Drugs
• 2. Basic books duly registered with BFAD/ DDB
• a. Dangerous Drug Book
• b. Exempt Preparation Book
• c. Poison Book
• d. Record book for selected non-prescription
drug subject to abuse as determined
• 3. Text on toxicity
• ex. Clinical toxicology of commercial products
• Handbook of Poisonings, Diagnosis and Treatment
• 4. Text of Clinical Pharmacy
• ex. Clinical Pharmacy Handbook for Patient
Counseling
• Clinical Pharmacy and Therapeutics
• 5. Medical Dictionary
• 6. Text on Diagnostic Laboratory Test
• ex. Clinical Laboratory Medicine
• Effects of Drugs on Clinical Laboratory Tests
• 7. Other secondary literature if available
 Location and Layout
• The pharmacy should be located in the ground
floor, easily accessible to all departments. If
the hospital is big enough, a branch of the
pharmacy may be established in or near the
out-patient block, keeping only such items
that are require there.
• In designing the pharmacy, the following
considerations should be kept in mind.
1. The pharmacy must be located, so that it is
• - accessible to the out-patient department
• - convenient for dispensing
• - accessible to the central delivery ward
2. Traffic within the department must be economical
and flexible
3. Its size is determined by its organization and
operational policies
4. Provisions for security of dangerous drugs and
narcotic drugs must be ensured
5. Provision for control of fire must be ensured
6. Finishes must be impervious to acid and alkali
and easy to clean
7. The corridors must allow easy turning of
wheeled vehicle
  
What is Pharmacy and Therapeutics Committee (PTC)
Pharmacy and Therapeutics Committee

• - plays an important role in the administration of

hospitals.

• - a policy framing and recommending body to the

medical staffs and for administration of hospitals
on all matters related to therapeutic use of drugs.
 Primary Purpose of the PTC
• 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.
• 2. Educational
The committee recommends or assist in the formulation
of programs designed to meet the needs of the
professional staff (physicians, pharmacists, nurses and
other health care practitioner) for complete and current
knowledge on matters related to drugs and drug use.
 General Organizational and Operational
Procedures
• The PTC shall be composed of at least three
physicians, a pharmacist, a nurse and administrator.
• A chairman coming from the representative
physicians shall be appointed. The pharmacist who
is usually designated the secretary, should be a
voting member of the committee.
• 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.
• Minutes of the meeting shall be prepared by
the secretary (pharmacist) and maintained in
the permanent records of the hospital.
• Recommendations of the committee shall be
presented to the medical staff or its
appropriate authority for adoption.
• Liaison with other hospital committees
concerned with drug use shall be maintained.
 Functions and Scope
• To serve as an advisory group to the medical staff,
pharmacy, and hospital administration in all matters
pertaining to the use pf drugs including investigational
drugs.
• 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.
• To assist Pharmaceutical Service in the development
of review policies, rules and regulations regarding the
use of drugs in the hospital.
• To review drug utilization in the hospital and promote
optimum standards for rational drug therapy.
• To collect and review ADR reports, DUR, Infection
Control reports, etc.
• To develop and disseminate pertinent educational
materials and programs on drugs to members of the
hospital staff concerned.
• To formulate policies pertinent to the above functions
which should be reviewed periodically to ensure that
the same are current.
 Typical Committee Agenda
• Minutes of the previous meeting
• Review of the specified section/s of the formulary for
updating and deletion of drugs
• Hospital non-formulary drugs and new drugs proposed
for inclusion with the approval of the DOH-NDC.
• Evaluation of an investigational drug protocol.
• Review of the reports of ADR/DUR committees for
appropriate plan and action.
• Drug safety in the hospital.
 Policies of the Committee
• Proposal for inclusion of a drug in the hospital formulary already listed in
the PNDF should be made using the Formulary Drug Request Form.

• Investigational Drugs or drugs for investigation purpose must be

approved by the appropriate agency for the specific use of its principal
investigator through the Chief of Hospital.

• The pre-signing of prescription blanks on drug orders, for any purpose, is

prohibited.

• To make it easier for both patients and prescribers, and for accounting
purposes, prescribing should follow a one item per prescription form
process.
• The Pharmaceutical Service shall dispense drugs in
accordance with the implementing rules of Generics
Act of 1988 and the formulary system to avoid
duplication of inventory an achieve cost containment.
• 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.
• Drugs and medicines dispense to in-patients.
• Reporting Medication Errors
 Other policies

– a. Up-to-date list of dangerous drugs

– b. Policies of Dangerous Drugs
• Development of Emergency Drug List
• Adverse Drug Reaction (ADR) reporting program
• Drug Utilization Review
• Infection Control
• Antidotes for Poisoning
• Disaster Plan for the Pharmacy Service