Hospital Pharmacy Flashcards
Institution where the injured or ill may receive medical, surgical, or psychiatric,
nursing care, food, and lodging
Hospital
Institution providing patient services, diagnosis, and treatment
Hospital
Hospital is Organized structure of:
Healthcare professional
Diagnostic and treatment facilities equipment and supplies
Physical facilities
MaMaSoRy napanak jay
Mobility
Medical procedures
Setting
Recovery
Clinic is a Facility where _____________________ are seen for special study and treatment by
a group of physicians practicing together
Ambulatory patient
Facility where ambulatory patient are seen for special study and treatment by
a group of physicians practicing together
Clinic
Differentiate hospital and clinic in terms of
Size
Larger
Smaller
Differentiate hospital and clinic in terms of range of services
More
Less
Differentiate hospital and clinic in terms of
Patient
Inpatient/ outpatient
Out patient
Differentiate hospital and clinic in terms of
Emergency services
24/7
Limited
Differentiate hospital and clinic in terms of
Procedures
Complex surgery
Less complex
What are the Function of a hospital
PaWER
patient care
Wellness/ public health
Education/ training
Research/ Innovation
Diagnosis, treatment, preventive medicine,
dental care, personalized care, rehabilitation,
convalescent care
Patient care
Promotion of overall health, prevention of
illnesses, screening and detecting programs
Wellness/ Public health
For medical and allied health professionals and
patients
Education/ Training
For advancement of medical knowledge and
improvement of hospital services
Research/ innovation
what are the requirements of a hospital
Governing authority
CEO
Current / complete medical records
Organized medical staff
Pharmacy services
PATIENT SERVICE
Patients
Minimum of 6 patient bedS
Health and safety
acts as a liaison officer; in-charge of day-to-day operations
CEO
Most important requirements of a hospital
Patient services
Sources of income
In patient/ outpatient
HOSPITAL PHARMACY
GOVERNMENT
Third party
Insurance
Donation
Fund and investment
Primary source of income
Inpatient outpatient
Secondary source of income
Hospital Pharmacy
For subsidized source of income
Government
HEALTH MAINTENANCE ORGANIZATIONS source of income
Third party
What are the classification of a hospital
BOLT
Bed capacity
Ownership
Length of stay
Type of services
Bed capacity
A < 50
B 50-99
C 100-199
D 200-299
E 300-399
F 400-499
Bed capacity
< 50
A
Bed capacity
50-99
B
Bed capacity 100-199
C
BED CAPACITY
200-299
D
Bed capacity 300-399
E
Bed capacity 400-499
F
Bed capacity is small
Small < 100
Bed capacity is medium
Medium 500-1000
BED capacity is
Large
Large > 1000
Tyoe of ownership
Government (public)
Private
Ownership:
Government what are their types
National
Federal
Municipal/ city
supported by the national government (e.g., Philippine
General Hospital)
National
operated by branches of the federal government (e.g.,
Veterans Memorial Medical Center
Federal
Example of federal hospital
Veterans Memorial Medical Center
supported by the national government to help the local
populations (e.g., Ospital ng Maynila)
City/ Municipal
Private hospital is classified by two what are those
Non- profited oriented
Profit oriented
Examples of nonprofited orient private hospital
Church-oriented
* Fraternal order
* Community
* Company
Example of profit oriented private hospital
Individual
* Partnership – NLT 3
* Corporation – NLT 15
Length of stay is either
Short term
Long term
Length of stay is LT 30 days
Short term in General Hospital
Length of stay is LT 30 days in special hospital
Long term
Types of services
General Hospital
Special Hospital
rehabilitation/ chronic disease
Psychiatric hospital
All kinds of illnesses, diseases, injuries, or
deformities
General Hospital
Specified disease or condition, or in one type of
patient
Special Hospital
- Restorative and adjustive services
- For handicapped / disabled patients
- Place of refuge and recovery
Rehabilitation hospital/ chronic disease
For mental illnesses
Psychiatric hospital
Categories of general hospital
Clinical services
Ancillary service
Either primary (level 1)
Secondary L2
Tertiary L3
Consulting services in:
* General medicine
* Pediatrics
* Surgery
* Nonsurgical gynecology
* Dental clinic
* Isolation facilities
* Emergency and outpatient
services
* Maternity facilities
LEVEL 1 PRIMARY
CLINICAL SERVICES
- Pharmacy
- Secondary clinical lab
- Blood station
- 1st-level x-ray
Ancillary service, Primary service (L1)
Level 2 clinical services
* Teaching / training
program
* Physical medicine and
rehabilitation unit
* Ambulatory surgical clinic
* Dialysis clinic
Clinical services, tertiary L3
Pharmacy
* Tertiary clinical lab
* Blood station
* 2nd-level x-ray with
contrast and mobile
unit
Ancillary service
,Secondary l2
Level 1 clinical services
* Departmentalized
clinical services
* Units:
* Respiratory unit
* General ICU
* Neonatal ICU
* High-risk
pregnancy unit
CLINICAL SERVICES, Secondary
L2
Pharmacy
* Tertiary clinical lab with
histopathology
* Blood bank
* 3rd-level x-ray with
interventional radiology
Ancillary service,
L3 TERTIARY
Type of services in special hospital
Fabella Memorial Hospital
* San Lazaro Hospital
* Research Institute and Topical Medicine
* Quezon Institute
* Tala Hospital
Fabella Memorial Hospital
OB Gyne
Quezon Institute
TB
Communicable and infectious diseasse hospital
San Lazaro Hospital
* Research Institute and Topical Medicine
Tala Hospital
Formerly leprosarium
Ambulatory patients seen by appointment
Clinic
Treatment by a group of physician practicing together
operational diagnosis facility
Clinic
Convalescent / long-term care
Long term Healthcare facility
Provides medical, comprehensive, preventive,
rehabilitative, social, spiritual, and emotional in-patient
care to individuals
Long term Healthcare facility
Facility providing safe, hygienic and living arrangements
for residents
Residential Treatment facility
Special type if health care facility
Clinic
Long term Healthcare facility
Residential Treatment facility
Ambulatory surgery center
Birthing homes
Health Maintenance Organization
Classification of health care facility
Primacy care ( Category A)
Custodial care ( Category B)
Diagnostic Facility ( Category C)
Specialized out patient (Category D)
Offers basic services including
emergency services and provision
for normal deliveries
Primacy care ( Category A)
First contact healthcare facilitie
Primacy care ( Category A)
Provides long-term care
Custodial care ( Category B)
Examines the human body or
specimens from the human body for
the diagnosis or sometimes
treatment of disease
Diagnostic Facility ( Category C)
Performs highly specialized
procedures on an out-patient basis
Specialized out patient ( Category D)
Facility where patients are admitted for minor surgical
procedures and discharged afterwards
Ambulatory surgery center
Maternity services on:
* Pre and postnatal care
* Normal, spontaneous vaginal delivery
* Care of newborn babies
Birthing homes
Public or private organization which provides
comprehensive health services to individuals enrolled with
such organization on a per capita pre-payment basis
Health Maintenance Organization
pioneer HMO in the Philippines
Health maintenance incorporation
Supporting services in the hospitals
Ancillary service
Ancillary services are
Medical record services
Medical social service
Dietary service
Central supply serviec
Blood bank
Basis for planning and continuity of patient care
* Provide data for use in research education of the care
rendered to the patient
Medical record services
Liaison between the hospital, patient, and community
Medical social service
Procurement, planning, and preparation of food for the
patient and hospital staff
Dietary service
Sterile linen, operating room packs and other medical
surgical supplies
Central supply serviec
Under the supervision of a licensed physician who has a basic interest in hematology
Blood bank
Anesthetic care
Anesthesia
Diagnostic and therapeutic application of radiant energy
Radiology
Cytological and gross anatomical analysis
* Clinical laboratories
Pathology
Composed of physicians only
MEDICAL STAFF
nurses, pharmacists, etc.
Allied medical staff
Certain MDs (other than the
attending/active) are allowed to
use the facilities
Open medical staff
Not a regular staff of the
hospital
Open medical staff
Exclusive and affiliated with the
hospital
Clinical medical staff
All services provided and
controlled by the
attending/active
Clinical medical staff
Regular staff of the hospital
Clinical medical staff
2 types of medical staff
Open medical staff
Clinical medical staff
Medical staff: Groups / groups of medical staff
Honorary
Consulting
Attending/ active
Associate medical staff
Courtesy medical staff
Resident medical staff
Retired or emeritus practitioners
Honorary
Given to a former member whom medical staff choose to
honor (honored due to outstanding contribution)
Honorary
pass a specialty board exam and a member of a
specialty organization / society
Specialist
Under
Consulting
Medical practitioners of recognized professional ability
Consulting
Gives advice to the active staff, but not member of the
staff
Consulting
Most active
Attending/ active
Involved in regular patient care (patient rounds)
Attending/ active
Direct involvement with the staff organizational and and administrative duties
Attending/ active
Associate medical staff is also known as
Junior staff
Being considered for advancement to the active
medical staff
Associate medical staff
Junior staff is also knwon as
Associate medical staff
Not a member but allowed to attend to a private
patient
Courtesy medical staff
Not compensated by the hospital
Courtesy medical staff
Usually applies to private hospitals only
Courtesy medical staff
Full-time
Resident medical staff
Offer patient care in exchange for training
Resident medical staff
Like internship
Resident medical staff
Practice of pharmacy in a hospital setting including its organizationally related
facilities or services
Hospital pharmacy
Department / division of the hospital where the procurement, storage,
compounding, dispensing, and distribution of medications are performed by legally
qualified and professionally competent pharmacists and their assistants
Hospital pharmacy
First American hospital pharmacist
Jonathan Roberts
Influenced changes in the
development of professional pharmacy
in North America
John Morgan
Revision of the USP and instrumental
in the creation of the national
formulary
Charles Rice
First president of the Philippine
Society of Hospital Pharmacists
(PSHP), 1962
Dr. Rosario Capistrano Tan
Current president of the PSHP
Christina Liza R. Sta. Maria
Plan, coordinate, and supervise departmental activities
Administrative services
division
Develop policies
Administrative services
division
Make schedule of staff
Administrative services
division
Coordinate administrative needs of the P&TC
Administrative services
division
Coordinate activities of undergraduate / graduate programs of pharmacy students
Education / training
division
Hospital-wide education program
Education / training
division
Train newly employed personnel
Education / training
division
Develop new formulations and improve existing ones
Pharmaceutical research
division
Conduct clinical trials
Pharmaceutical research
division
Cooperate in research
Pharmaceutical research
division
Perform drug analyses
* Develop and revise assay procedures
* Assist in research
Assay / quality control
division
Perform drug analyses
Assay / quality control
division
Develop and revise assay procedures
Assay / quality control
division
Assist in research
Assay / quality control
division
Compound and dispense out-patient prescriptions
Inspect / control of drugs
* Maintain prescription records
* Provide drug consultation / patient counselling
Out-patient services
division
Compound and dispense out-patient prescriptions
Out-patient services
division
Inspect / control of drugs
Out-patient services
division
Maintain prescription records
Out-patient services
division
Provide drug consultation / patient counselling
Out-patient services
division
Maintain and provide drug information and drug therapy
to hospital staff
Drug information service
Create hospital pharmacy newsletter
Drug information service
Maintain and provide drug information and drug therapy
to hospital staff
* Create hospital pharmacy newsletter
Drug information service
Procurement, storage, and dispensing of radioisotopes
Radiopharmaceutical
division
Involves proper handling and control
Radiopharmaceutical
division
Maintain drug inventory
Purchasing and
inventory control
division
Purchase, receive, store, and distribute drugs
Purchasing and
inventory control
division
Interview medical representatives
Purchasing and
inventory control
division
Purchasing and
inventory control
division
Compute for _______
* Ratio – ___
* Preferred result – ___
Satisfactory rate – ____
Compute for TURN OVER RATE
* Ratio – ANNUAL PURCHASE/ ANNUAL INVENTORY
* Preferred result – HIGH TURN OVER RATE
Satisfactory rate – EVERY 3 MONTHS
Manufacture commonly used items in the hospital
Manufacturing and
packaging division
Drug packaging
Manufacturing and
packaging division
Unit dose program
Manufacturing and
packaging division
Produce small volume parenteral
Sterile products division
Manufacture sterile, ophthalmic, irrigating solutions
Sterile products division
Perform aseptic dilution
Sterile products division
Review each IV admixture for incompatibilities
IV admixture division
Work with IV therapy nurses
IV admixture division
Centralize the preparation of IV admixture
IV admixture division
Control and dispense IV fluids and regulated drugs
Departmental /
dispensing services
division
Coordinate and control all drug delivery distribution
system
Departmental /
dispensing services
division
Types of IV administration
IV injection
IV infusion/ drip
IV injection/ is aka __ when administered
quickly
Aka IV push/ Bolus
For relatively small volume of solution from a syringe
IV injection/ IV push/ Bolus
For larger volume of a solution
IV infusion/ drip
Drip into the vein
IV infusion/ drip
IV infusion/ drip types
Continuous
* Intermittent
* Piggyback
Beyond use dates (BUD)
Aqueous solutions
14 days
Beyond use dates (BUD)
Refrigerated oral preparation
14 days
Beyond use dates (BUD)
Non-refrigerated oral preparation
7 days
Beyond use dates (BUD)
TPN
24 hrs
Beyond use dates (BUD)
TPN and example
Vitamins ; 14 hrs
Medication order review
¡ Supervision of medication administration
¡ Medication / therapy monitoring
Patient care area
HOSPITAL PHARMACIST RESPONSIBILITIES
Patient care area
Dispensing area
Additional: maintenance of the emergency cart
PHARMACY AND THERAPEUTICS COMMITTEE is also knwon as
Drug and Therapeutics Committee (DTC)
PHARMACY AND THERAPEUTICS COMMITTEE is Composed of:
At least three physicians – PTC chairperso
Pharmacist - PTC secretary
Representative of the nursing staff
Hospital administrator
Quality assurance coordinator
PHARMACY AND THERAPEUTICS COMMITTEE
Meeting schedule:
At least 6 times a year
For large hospitals: 10-12 times a year
Main function of PHARMACY AND THERAPEUTICS COMMITTEE
Advisory and educational
What are the functions of PHARMACY AND THERAPEUTICS COMMITTEE
¡ Manage the formulary system
¡ Evaluate the clinical use of the drug
Supervise the use of investigational drugs
¡ Develop policies for managing drug use and drug administration
¡ Develop and recommend to the medical staff and the administration on matters related
to therapeutic use of the drug and drug administration
Selection upto using the drug
Drug management cycle
Drug management cycle
Selection
Procurement
Distribution
Use
Identifying and choosing the most appropriate
pharmaceutical products to meet the healthcare needs of
patients within a specific healthcare setting
Selection
Acquisition of selected pharmaceutical products through
purchasing or sourcing channels
Procurement
Transportation, storage, and management of pharmaceutical
products from the point of procurement to the point of use
Distribution
Administration and monitoring of pharmaceutical products to patients according to prescribed treatment regimens
Use
Continually revised compilation of pharmaceuticals that reflects current clinical judgment of
medical staff
FORMULARY
Main formulary:
PNDF
Philippine National Drug Formulary
PNDF Is also knwon as
Essential drug list
__ – list of drugs deemed to satisfy the needs of the majority of the population
Essential drug list/ PNDF
The government’s response to the problem of inadequate provision of good quality essential drugs to
people
PNDF
PNDF is divided into 2
Core/ main list
Complimentary list
For most healthcare needs
Core/ main list
Available at all times, in adequate
amounts, and in appropriate dosage
forms and cost
Core/ main list
Alternative drugs
Complimentary list
Treating rare disorders or in
exceptional circumstances
Complimentary list
For hypersensitivity reactions,
resistance, patient tolerance
Complimentary list
Types of formulaRy
Open
Closed
Restricted
Negative
All drugs in the market can be included
Open formulary
Exclusive list of drugs (e.g., PNDF)
Closed formulary
Limits certain classes of drugs
Restricted formulary
List of drugs which cannot be
prescribed
Negative formulary
Management of routine ordering processes
INVENTORY MANAGEMENT
INVENTORY MANAGEMENT is also known as
heart of drug supply system
Types of inventory
Cycle stock
Safety stock
Most active
* Drugs first prescribed and dispensed to
patients
Cycle Stock
Safety Stock is aka
Buffer stock
Protect against the fluctuations in
demand or supply
* Prevent stockouts
Safety Stock
Types of cost
Acquisition Cost
Procurement Cost
Opportunity Cost
Carrying Cost
Customer
Dissatisfaction
Mark-ups, discounts, and cost inherent in
the product itself
Acquisition Cost
Cost of shipping, receiving, stocking, and
bookkeeping
Procurement Cost
Cost of something in terms of something
else that could be purchased and sold
instead
Opportunity Cost
Cost of holding inventor
Carrying Cost
Hardest to determine, but easily
observable
Customer
Dissatisfaction
Customer
Dissatisfaction Common cause is
Stock out
Means of Inventory Control and Monitoring
Visual Inspection
Periodic Inspection
ABC Method
Pareto Method
Most commonly employed Means of Inventory Control and Monitoring
Visual Inspec7on
It is the number of
items remaining on a shelf
Visual Inspec7on
Rou8nely inspect designated inventory
levels
Periodic Inspec7on
Based on priority (A- highest;
C –lowest)
ABC Method
Pareto Method aka
Aka 80/20 method
Means of Restocking
ABC Analysis
VEN System
Categorizes items by volume and value
of consumptions
ABC Analysis
VEN system stands for
Vital
Essential
Non-essential
VEN SYSTEM
Based on health impact
* Vital – __
* Essential – __
* Non-essential – _
Based on health impact
* Vital – life-saving
* Essential – less severe illnesses
* Non-essential – minor / self-
limiting diseases
Methods used to forecast and manage the demand for
inventory items within a supply chain or inventory management
system
Demand Systems
Demand system is either
Dependent
Independent
Differentiate dependent demand system and independent demand system
Based on the demand for the
final product or the production
schedule
For raw materials
Based on customer orders,
sales, trends, seasonality
For finished products
Approaches for managing the flow of goods through the supply
chain
Logistics System
Logistic system is either
Push
Pull
Differentiate push and pull logistics system
- Based on forecasts and
management decisions - Pushed” by supplier → manufacturer → distributors
/ Based on customer demands
/ “Pulled” by customers from the
distributors ← manufacturer ←
supplier
Distribution 3 types
- Floor stock / bulk ward
- Individual prescription patient system
- Unit-dose drug delivery system (UDDS) – gold standard
Use
Types
Drug Use Evaluation
Drug Utilization Review (DUR
Designed to foster appropriate
drug taking behaviors, ra8onal
decision making in the use of
drugs
Drug Use evaluation
Drug Use evaluation question to answer
“How do I use the drug?”
Review of medication profile to
ensure appropriateness of
prescription and medication
order
Drug Utilization review
Drug Utilization review question to answer
“Is the medicine right for me?
Types of Drug Utilization review
Prospective
Concurrent
Retrospective
Before prescribing and dispensing
* Check interac8ons, contraindica8ons,
etc.
Prospective
During treatment
* Real time adjustment takes place
Concurrent
Aker medica8on is taken
* Assess pajerns, trends, and outcomes
Retrospective
Predetermined list
of medications
available at patient
care area
Floor stock/ bulk ward
- No charge - for
universal patient
use (e.g., alcohol
Floor stock /
Bulk ward
Floor stock /
Bulk ward advantage
Readily available - for
emergency situations
* Less drug returns to the
pharmacy
* Reduced number of
pharmacy personnel
* Shorter turn-around time
between prescription and
drug administration
* Reduction in prescription
and transactions
Floor stock /
Bulk ward disadvantage
Prone to theft and
pilferage
* Increased incidence of
medication errors
* Increased drug
inventory
* Added burden to
nurses
* Lack of proper storage
facilities = drug
deterioration / degradation
Patient medication
compounded and
dispensed in the
pharmacy
Individual
prescription
patient system
For small hospitals
only
Individual
prescription
patient system
Individual
prescription
patient system advantage
Individualized service
* Directly reviewed by the
pharmacist = less
medication errors
* Monitored drug inventory
* Provides interaction of
RPh, MD, nurses, and
patients
Individual
prescription
patient system advantage
Time-consuming and
laborious
* Possible delay in the in
obtaining required
medication
* Increase in drug returns
* Increase in the cost of
patient information
Safest and most
accepted method of distribution
Unit-dose drug
delivery system
(UDDS)
Standard of practice
of most hospitals
* RPh prepares each
dose for
administration
(good for 24 hours)
in the pharmacy
Unit-dose drug
delivery system
(UDDS)
IV preparation and
reconstitution done
in the pharmac
Unit-dose drug
delivery system
(UDDS)
Unit-dose drug
delivery system
(UDDS) Advantage
Eliminate duplication of
orders
* Eliminate pilferage and drug
waste
* Improved communication of
medication orders and
delivery systems
* Cheaper for patients
* Nurse has more time for
direct patient care
* Decrease medication errors
* Eliminate excessive
paperwork
Unit-dose drug
delivery system
(UDDS) Types
Centralized
Decentralized
Combination
Partial
stocks in main / central
pharmacy
Centralized
stocks
in satellite pharmacies in
nurse stations
Decentralized
UDDS in
government hospital
Combination
due to
special circumstances of
hospitals
Partial
Authorized, structured, on-going system
for monitoring drug use through
comparison with specific standards and
initiation on appropriate actions when
results are inconsistent with the standards
Drug use evaluation
Authorized, structured, continuing
program which analyzes and interprets
patterns of drug use in a given healthcare
delivery system against a predetermined
standard
Drug Utilization review
