Hospital Pharmacy

Question 1

what does the trust chief executive do?

Answer 1

overall responsibility for medicines supply according to controls assurance standard or medicines management

Question 2

what does the chief pharmacist/clinical director do?

Answer 2

responsible for ensuring there are systems in place for all aspects of safe and secure handling of medicines in the trust

Question 3

Name the different documents in the development of hospital pharmacy (6)

Answer 3

Nuffield report 1986
pharmacy in the future 2000
spoonful of sugar 2001
Francis report 2013
RPS standards for hospital pharmacy 2014
carter report 2015

Question 4

Nuffield report 1986

Answer 4

clinical pharmacy should be practiced in all hospitals, there should be 24 hour provision of hospital pharmacy services

Question 5

pharmacy in the future 2000

Answer 5

one step dispensing (dispensing for discharge)
self administration
pharmacists on wards

Question 6

spoonful of sugar 2001

Answer 6

automation of medicines supply, electronic prescriptions, original pack dispensing and one stop dispensing

Question 7

Francis report 2013

Answer 7

patient centred (number one priority), improving openness, high standards, leadership

Question 8

RPS standards for hospital pharmacy 2014

Answer 8

(a) improving patient experience - putting them first, integrated transfer of care (i.e communication between hospital & community)
(b) safe and effective use of medicines - safe use and supply, medicines expertise
(c) delivering service - governance and financial management, workforce

Question 9

Carter report 2015

Answer 9

optimising the use of medicines to= improve medicines safety, reduce medicines waste.
- Pharmacists in A&E
roll out summary care records

Question 10

Briefly outline the role of the pharmacist in the medical assessment unit (5marks)

Answer 10

When a patient is first admitted to hospital, the MAU assesses patients, diagnose and decide upon initial treatments. The pharmacist plays a key role in this.
They carry out medicines reconciliation - a thorough drug history of the patient pooling various sources
They assess the patients own drugs they have brought in, check medicines are in date, if not, order more. If they are running low they will order more medicines and label them ready for discharge (one step dispensing).
They also remove any unnecessary medicines and resolve any problems regarding their medicine records, contact prescribers if necessary. This ensures all medicines are error free, determines appropriateness of treatments and everything is ready for when the patient is discharged.

Question 11

what is the dispensing process in hospital?

Answer 11

Pharmacist or tech transcribes order and sends to dispensary
item is labelled and dispensed by either tech, robot, assistant
checked for accuracy by ACT or pharmacist
transported to wards via portar in a sealed bag

Question 12

do hospitals need prescriptions?

Answer 12

NO - not when the sale and supply is made part of its normal business, with a patient specific direction and is to be given to the patient by an appropriate HCP.

Question 13

are patient information leaflets legally required in hospital inpatients?

Answer 13

No - but generally given anyway, should be kept in pharmacy to provide on request.
They MUST be given for outpatients and TTOs

Question 14

What is included in medicines for outpatients?

Answer 14

warning cards if on high risk meds- warfarin, methotrexate, steroids, or unlicensed meds
- Any info for the community pharmacist

Question 15

Describe the dispensary area

Answer 15

stored medicines A-Z and in categories e.g inhalers, liquids, tablets.
Each step in the dispensing process has its own zone - dispensing, screening, checking

Question 16

Describe the pharmacy stores

Answer 16

Responsible for the control of stock - cost, quality, continuous supply of medicines.
- Generic substitutes
purchasing contracts, the trust formulary

The wards have stock list of commonly used drugs and they are topped up regularly by the technicians by the stores.

Question 17

What are technical services In hospital pharmacy?

Answer 17

This is where items are made to order e.g chemotherapy (which does not have a long life once its made), intravenous nutrition/feeds, creams, ointments, eye drops.
Special facilities to avoid contamination
Example: pharmacist will screen chemo Rx.
The technician will write a worksheet, another technician will check it. The assistant will then set up the ingredients and equipment needed. The technician will prepare the chemotherapy. The pharmacist will then do a final check and release the product, and nurse will administer to patient.

Question 18

what is the on call pharmacist?

Answer 18

24 hour pharmacy as in the Nuffield report

- Urgent items only

Question 19

what happens when a patient is ready to be discharged?

Answer 19

TTOs medicines is supplied using PODS and extra dispensed items.
It is supplied to patient in a green bag, the technician will counsel the patient if they have any new medicines, and communication with community if so.