pharm admin exam 2 - hospital pharmacy man.

Question 1

Background on hospital pharmacy management

Answer 1

Promising career option for pharmacists who enjoy the challenges of administrative work in an institutional setting

Hospital pharmacy managers oversee the operations of the pharmacy department that provides service 24/7 regardless of the hours of operation

Managers ensure that quality pharmaceutical services are provided according to accreditation, legal requirements and professional standards

Question 2

Role of the hospital pharmacy

Answer 2

To provide at all times an adequate supply of safe, effective and quality medications in appropriate dosage forms consistent with the needs of the patients

To rationalize drug utilization in collaboration with the medical staff

What makes this different than community pharmacy practice?

Question 3

Goals for the hospital pharmacy service and the manager

Answer 3

To provide the benefits of a qualified hospital pharmacist to patients and to the allied health professionals and institution

To assure a high quality of professional practice through establishment and maintenance of standards of professional ethics, education and attainment and promotion of economic welfare

To promote research in hospital pharmacy practice

Question 4

Goals for the hospital pharmacy service and the manager

Answer 4

To disseminate pharmaceutical knowledge by providing an exchange of information among hospital pharmacists and members of a multi-disciplinary team

How do these goals differ from those in community pharmacy?

Question 5

Responsibilities

Answer 5

Effective administration and management of a pharmaceutical service in a hospital

Development and provision of patient-oriented services

Maintenance of the hospital formulary through the pharmacy and therapeutics committee

Medication management

Budget management

Question 6

Tasks of a Pharmacy Manager

Answer 6

Daily
- Scheduling
- Operational/clinical situations
- Drug movement / inventory discrepancies
———-Drug shortages
- Occurrence reports
- Technology downtimes
- Hiring for open positions

Monthly
- Staff development
- Staff discipline
Union vs Non-union
- Strategic planning
- Budget review
——–Flexible budgets
——–Variance review
- Facility review

Question 7

Regulatory concerns of the pharmacy manager

Answer 7

The Joint Commission

Center for Medicaid & Medicare (CMS)

Board of Pharmacy

Drug enforcement agency (DEA)

Department of public health (DPH)

Office of the inspector general (compliance)

Health Resources and Services Adm (HRSA)

USP chapters
- 797, 800, 795

Human Resources (HR)
- Payroll, Discipline, FMLA

Question 8

Organization / Department Structure

Answer 8

Every business has an organizational chart
- Defines who reports to which “manager”
- Defines scope of responsibility
- Maps out structure for problem solving

Larger the organization – larger the chart
- Small community hospital with 3 FTE pharmacists the Director of pharmacy may enter orders
- Large academic hospital manager will most likely not enter any orders

Question 9

Who Does Pharmacy Report To?

Answer 9

Someone in the C-Suite
- Vice President of operations (VP, Operations)
- Chief Medical Officer (CMO)
- Chief Nursing Officer (CNO)

Other C-Suite members
- Chief Executive Officer (CEO), Chief Operations Officer (COO), Chief Financial Officer (CFO), Chief Informatics Officer (CIO)

Question 10

A pharmaceutical service

Answer 10

Encompasses everything that is within the control of the hospital pharmacy department
- Clinical services
- Drug distribution
- Drug information
- Investigational drug services
- Medication safety
- Drug disposal
- Formulary management

Question 11

Effective administration and management of a pharmaceutical service

Answer 11

Involves being totally familiar with the entire health care system and the specific functions of the hospital

Must consider the physical layout of the pharmacy department and the entire facility

Requires organization of the hospital pharmacy personnel

Requires an up to date manual of policies and procedures as well as continuous training and competency assessment

Question 12

Patient oriented services

Answer 12

Requires developing and maintaining a wide spectrum of clinical services geared towards your patient population

Some of these services are not geared towards drug dispensing activities (anticoagulation clinic, pain clinic, heart failure clinic, etc)

Fundamental to these services is the pharmacist’s knowledge of drugs, disease states, patient variables and the ability to interact routinely with other health care professionals and patients

Question 13

Development and provision of patient-oriented services

Answer 13

Academic training in toxicology, pathophysiology and therapeutics as well as clinical experience provide the background for a pharmacist to provide patient-oriented services
- Post-graduate education
- Professional experience
- Research interests

Question 14

Examples of patient-oriented services

Answer 14

Heart failure service

Antibiotic stewardship services

Surgical intensive care service

Cardiac intensive care service

Pediatric inpatient service

Solid organ transplant service

Oncology service

Medical intensive care service

Drug information service

Medication safety service

Question 15

Maintenance of the hospital formulary through the P & T committee

Answer 15

The P & T committee promotes the rational use of medications through the development of rational policies and procedures for
- Medication selection
- Procurement
- Distribution
- Pharmacy and staff education
- Response to medication shortages
- Therapeutic substitutions

Question 16

The managers role

Answer 16

To ensure that routine decisions about which medications to buy, how many and from what source are appropriately made

To focus on long-term planning and policies for improving safe and cost-effective use of medications

To ensure appropriate membership on the P & T committee including
- Medical staff
- Pharmacy
- Nursing
- Hospital administration
- Quality assurance staff

Question 17

Hospital formulary management

Answer 17

Ultimately the responsibility of the pharmacy manager, goals:

• To conserve resources by limiting the formulary
• To eliminate generic and therapeutic duplication and to minimize the number of strengths stocked of the same medication
• To select medications for the formulary based on diseases and conditions treated at the facility
• To specify formulary medication of choice for common therapeutic indications

Question 18

Hospital formulary management

Answer 18

To include second-line alternatives to medications of choice as needed while minimizing therapeutic duplication

To ensure that the hospital formulary corresponds with any national and regional standard treatment guidelines formally approved by the health system

To ensure best practices and evidence based practices are adhered to

Question 19

The P & T committee

Answer 19

Basic functions include:
Ensuring that the national essential medicines list and local formularies are used appropriately in the facility (Check the WHO website for the lists)

Disseminating national standard treatment guidelines and developing institution specific treatment guidelines for common diseases and medical conditions

Conducting medication use evaluations (MUE)
Conducting facility-based pharmacovigilance activities

Question 20

The P & T committee

Answer 20

Monitoring medication usage at the facility

Providing education to hospital staff

Monitoring medication errors and adverse drug reactions and implementing systems changes to minimize events

Development, approval and monitoring of all therapeutic substitution, restricted drug and non-formulary medication use policies

Question 21

Inpatient medication management

Answer 21

Drug distribution has historically been the primary function of the hospital pharmacy

Most hospitals utilize automated dispensing systems along with a system for distributing patient specific unit dose/unit of use medications

Challenges to medication management increase exponentially along with increases in the size of the institution

What are those challenges?

Question 22

Drug Shortages

Answer 22

Significant number of drug shortages that impact the hospital pharmacy

Causes include:
- Reduced profit on generic, intravenous drugs
- Consolidated generic manufacturers in industry
- Free market – No requirement to make drugs
FDA supported by FDAISA in July 2012
- 80% of raw ingredients for IV drugs from overseas

Question 23

Compounding of medicationsUSP 797 (sterile) USP 795 (non-sterile)

Answer 23

Includes sterile and non-sterile products

Non-sterile product compounding is most often for a dosage form or concentration that is not commercially available

Sterile product compounding occurs in the clean room and must meet all USP 797 standards. Compliance is a focus of The Joint Commission Survey. What do we know about USP 797?

Policies and procedures as well as all levels of accountability are the manager’s responsibility

Question 24

Budget management

Answer 24

One of the most critical responsibilities of the hospital pharmacy manager

Largest budget lines are the drug budget and costs of human resources

Budget management is most likely the main responsibility that the manager’s performance is evaluated on

Many other aspects of the operational management are delegated to supervisor’s, lead pharmacists, clinical specialists though the pharmacy director or manager is ultimately accountable

Question 25

Human resource issues

Answer 25

It is often difficult to attract and hire qualified pharmacists and technicians

The do more with less philosophy is prevalent in this practice area

No back-up when staffing issues occur

24/7 coverage including holidays and overnights

Continuous education as well as competency assessment documentation is required and necessary

Staffing includes multiple levels of educational and professional requirements

Question 26

Human resource challenges

Answer 26

Scheduling

Performance evaluations

Progressive discipline

Cross-discipline relationships

Per-diem staff

Communication within and outside of the department

Question 27

Controlled substance management

Answer 27

Controlled substances are stored in the pharmacy and in the patient care areas in the automated dispensing units including the inpatient, outpatient and procedure rooms

One missing dosage unit requires investigation and immediate notification to the DPH and the BOP

Discrepancy resolution occurs daily and is performed by pharmacy staff as well as nursing, anesthesiologists and physicians

Question 28

The most unique aspects of hospital pharmacy management

Answer 28

The manager may report to someone without any pharmacy background

The manager will most often interact with healthcare professionals outside of pharmacy

The manager will most likely spend more time focusing on satisfying outside customers than the pharmacy staff

The manager is responsible for systems that cross many disciplines

Regulatory bodies differ as well as accrediting bodies

Question 29

Rewards

Answer 29

What are the advantages of practicing in a hospital pharmacy environment?
- Multi-disciplinary practice

• Based on best practices and evidence based medicine
• Constant learning environment
• Level of professionalism
• Career ladder (staff pharmacist up to Director)

Question 30

How to become part of a pharmacy management team

Answer 30

Show off your leadership skills
- Volunteer for opportunities
- Demonstrate great teamwork with everyone
- Invest extra time

Look for additional training
- ASHP – pharmacy leadership academy
- Human resource programs

Committee work in pharmacy organization