pharm admin exam 2 - hospital pharmacy man. Flashcards
Background on hospital pharmacy management
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
Role of the hospital pharmacy
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?
Goals for the hospital pharmacy service and the manager
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
Goals for the hospital pharmacy service and the manager
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?
Responsibilities
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
Tasks of a Pharmacy Manager
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
Regulatory concerns of the pharmacy manager
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
Organization / Department Structure
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
Who Does Pharmacy Report To?
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)
A pharmaceutical service
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
Effective administration and management of a pharmaceutical service
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
Patient oriented services
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
Development and provision of patient-oriented services
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
Examples of patient-oriented services
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
Maintenance of the hospital formulary through the P & T committee
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
The managers role
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
Hospital formulary management
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
Hospital formulary management
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
The P & T committee
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
The P & T committee
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
Inpatient medication management
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?
Drug Shortages
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
Compounding of medicationsUSP 797 (sterile) USP 795 (non-sterile)
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
Budget management
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
Human resource issues
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
Human resource challenges
Scheduling
Performance evaluations
Progressive discipline
Cross-discipline relationships
Per-diem staff
Communication within and outside of the department
Controlled substance management
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
The most unique aspects of hospital pharmacy management
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
Rewards
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)
How to become part of a pharmacy management team
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
