Hosp Rx History Development Defintion 11/6/14

HOSPITAL HOSPITAL PHARMACYPHARMACY

Mae Quenie A. Tiro, RPhMae Quenie A. Tiro, RPh

UNIT IUNIT I

HOSPITALHOSPITALComplex organization utilizing combination Complex organization utilizing combination

of intricate, specialized scientific of intricate, specialized scientific equipment, and functioning corps of equipment, and functioning corps of trained people educated to the problem of trained people educated to the problem of modern medical science.modern medical science.

Restoration and Maintenance of Good Restoration and Maintenance of Good HealthHealth

Functions of HospitalFunctions of Hospital

FUNCTIONS of HospitalsFUNCTIONS of Hospitals

1.1. PATIENT CAREPATIENT CARE

Diagnosis, preventive and treatment, rehab, Diagnosis, preventive and treatment, rehab, dental, personalized services.dental, personalized services.

2. EDUCATION- Patient and colleagues2. EDUCATION- Patient and colleagues

3. RESEARCH3. RESEARCH

-advancement of medical knowledge against -advancement of medical knowledge against diseasedisease

-improvement of hospital services -improvement of hospital services

4. ADMINISTRATION4. ADMINISTRATION

Hospital PharmacyHospital Pharmacy

Such practice traditionally involves:Such practice traditionally involves:

Supplying medicines for In patient and outpatientSupplying medicines for In patient and outpatient

Preparing of sterile medicationsPreparing of sterile medications

Narcotic and prescribed drugs are dispensed.Narcotic and prescribed drugs are dispensed.

Bulk compoundingBulk compounding

Pre-packingPre-packing

Drug formulationDrug formulation

Professional supplies are stocked and dispensed.Professional supplies are stocked and dispensed.


Maybe defined according to its form; Maybe defined according to its form; physical make-up, quantitative nature of physical make-up, quantitative nature of service.service.

Maybe also define according to its Maybe also define according to its purpose/ mission.purpose/ mission.


Teaching and ResearchTeaching and Research Drug therapy informationDrug therapy information Patient education programsPatient education programs Poison control center activitiesPoison control center activities Parenteral program participationParenteral program participation Communicating new product information Communicating new product information

to nursesto nurses RadiopharmaceuticalsRadiopharmaceuticals


““It serves as a focal point for the It serves as a focal point for the coordination and delivery of coordination and delivery of

patient care to its community”patient care to its community”

DEVELOPMENTAL HISTORYDEVELOPMENTAL HISTORY


Ancient man learned from instinct, from observation of Ancient man learned from instinct, from observation of birds and beasts. Cool water, a leaf, dirt, or mud was his birds and beasts. Cool water, a leaf, dirt, or mud was his

first soothing application.first soothing application.


Babylon, jewel of ancient Mesopotamia, often called the Babylon, jewel of ancient Mesopotamia, often called the cradle of civilization, provides the earliest known record cradle of civilization, provides the earliest known record

of practice of the art of the apothecary. of practice of the art of the apothecary.

Practitioners of healing of this era (about 2600 B.C.) were Practitioners of healing of this era (about 2600 B.C.) were priest, pharmacist and physician, all in one. priest, pharmacist and physician, all in one.


Chinese PharmacyChinese PharmacyShen Nung (about 2000 B.C.)Shen Nung (about 2000 B.C.)-an emperor who sought out and investigated the -an emperor who sought out and investigated the medicinal value of several hundred herbs.medicinal value of several hundred herbs.-written the first Pen T-Sao, or native herbal, recording -written the first Pen T-Sao, or native herbal, recording 365 drugs. 365 drugs.

-Examined many herbs, barks, and roots brought in from -Examined many herbs, barks, and roots brought in from the fields, swamps, and woods that are still recognized in the fields, swamps, and woods that are still recognized in Pharmacy today. Pharmacy today. -Medicinal plants include -Medicinal plants include podophyllum, rhubarb, ginseng, podophyllum, rhubarb, ginseng, stramonium, cinnamon bark, and, ma huang, or stramonium, cinnamon bark, and, ma huang, or Ephedra. Ephedra.

DEVELOPMENTAL HISTORYDEVELOPMENTAL HISTORYThough Egyptian medicine dates from about Though Egyptian medicine dates from about 2900 B.C., best known and most important 2900 B.C., best known and most important pharmaceutical record is the "Papyrus Ebers" pharmaceutical record is the "Papyrus Ebers" (1500 B.C.), a collection of 800 prescriptions, (1500 B.C.), a collection of 800 prescriptions, mentioning 700 drugs.mentioning 700 drugs.


Theophrastus (about 300 B.C.), among the Theophrastus (about 300 B.C.), among the greatest early Greek philosophers and greatest early Greek philosophers and natural scientists, is called the "father of natural scientists, is called the "father of botany." botany."

Mithridates VI, King of Pontus (about 100 Mithridates VI, King of Pontus (about 100 B.C.), found time to make not only the art B.C.), found time to make not only the art of poisoning, but also the art of preventing of poisoning, but also the art of preventing and counteracting poisoning, subjects of and counteracting poisoning, subjects of intensive study. intensive study.


Gertrude and George Gertrude and George Urdang Urdang

-first recognized representative of the pharmaceutical -first recognized representative of the pharmaceutical profession.profession.

-Adler Apotheke in -Adler Apotheke in Rosenberg/PrussiaRosenberg/Prussia. .

ApothecaryApothecary

ANCIENT PERIODANCIENT PERIOD

AMERICAN ERAAMERICAN ERA


17511751Colonial America's first hospital Colonial America's first hospital

(Pennsylvania) was established in (Pennsylvania) was established in PhiladelphiaPhiladelphia

17521752First Hospital Pharmacy began operationsFirst Hospital Pharmacy began operations Pennsylvania Hospital- first hospital in Pennsylvania Hospital- first hospital in

North AmericaNorth America Jonathan Roberts-Jonathan Roberts- hospital pharmacist hospital pharmacist


Pennsylvania HospitalPennsylvania HospitalBefore and NowBefore and Now

John MorganJohn Morgan importance to the development of importance to the development of

professional pharmacy in North America. professional pharmacy in North America. As physician, he advocated prescription As physician, he advocated prescription

writing and championed independent writing and championed independent practice of two professions. practice of two professions.


1565- Hospital Militar, cebu1565- Hospital Militar, cebu 1571- Hospital Militar, Manila1571- Hospital Militar, Manila 1577- Hospital de San Juan de Dios1577- Hospital de San Juan de Dios 1577- Hospital de San Lazaro1577- Hospital de San Lazaro 1588- Hospital de San Gabriel1588- Hospital de San Gabriel 1891- Chinese general Hospital1891- Chinese general Hospital 1911- Philippine general Hospital1911- Philippine general Hospital

DEVELOPMENTAL HISTORYDEVELOPMENTAL HISTORYin the Philippinesin the Philippines

1957- Government Hospital Association1957- Government Hospital Association

1960- Private Hospital Pharmacist 1960- Private Hospital Pharmacist AssociationAssociation

Philippine Society of Hospital Pharmacist Philippine Society of Hospital Pharmacist (PSHP)(PSHP)


ONE DOMINANT FACTOR: ONE DOMINANT FACTOR:

RELIGIOUS INFLUENCERELIGIOUS INFLUENCE Doctrines of Jesus Christ intensified the Doctrines of Jesus Christ intensified the

emotions and virtues of love, pity and emotions and virtues of love, pity and charity.charity.

DEVELOPMENT and EXPANSIONDEVELOPMENT and EXPANSION

ANOTHER FACTOR:ANOTHER FACTOR:

MILITARY INFLUENCEMILITARY INFLUENCEUrgent need for care of the wounded on the battlefield.Urgent need for care of the wounded on the battlefield.


OTHER FACTORS:OTHER FACTORS:1. FLEXNER REPORT on medical 1. FLEXNER REPORT on medical education caused revolutionary education caused revolutionary developments in medical education and developments in medical education and medical internship training.medical internship training.

2. ACTIVITIES OF FLORENCE OF 2. ACTIVITIES OF FLORENCE OF NIGHTINGALENIGHTINGALE

Quality of NURSING CARE/ nursing schoolQuality of NURSING CARE/ nursing school


Florence NightingaleFlorence Nightingale

3. THE PUBLIC INTEREST in 3. THE PUBLIC INTEREST in HOSPITALS-HOSPITALS-

- led to production of finances for further - led to production of finances for further development, expansion and development, expansion and improvement.improvement.


SIGNIFICANT GOVERNMENT SIGNIFICANT GOVERNMENT PROGRAMS:PROGRAMS:

-adoption of the HOSPITAL SURVEY AND -adoption of the HOSPITAL SURVEY AND CONSTRUCTION ACT (1946)CONSTRUCTION ACT (1946)

- Commonly known as HILL BURTON Commonly known as HILL BURTON PROGRAMPROGRAM

- Provide federal funds for hospital Provide federal funds for hospital constructionconstruction


NATIONAL PLANNING and NATIONAL PLANNING and RESOURCES DEVELOPMENT ACT RESOURCES DEVELOPMENT ACT (1975)(1975)

Created the development of HEALTH Created the development of HEALTH SYSTEMS AGENCIES (HAS)SYSTEMS AGENCIES (HAS)


Responsibilities of HASResponsibilities of HAS

1.1. Improving the health of residents of its Improving the health of residents of its health service areahealth service area

2.2. Increasing the accessibility, acceptability, Increasing the accessibility, acceptability, continuity and quality of services continuity and quality of services provided.provided.

3.3. Restraining increase in the cost of these Restraining increase in the cost of these services.services.


4. Preventing unnecessary duplication of 4. Preventing unnecessary duplication of health resources.health resources.


Beyond the 3 basic essentials of human Beyond the 3 basic essentials of human existence (food, clothing and shelter), the existence (food, clothing and shelter), the

hospital has become a necessary hospital has become a necessary instrument for the fourth basic element of instrument for the fourth basic element of

survival- survival- HEALTH.HEALTH.


GOALS of Hospital PharmacyGOALS of Hospital Pharmacy

Provide Provide benefit of a qualified hospitalbenefit of a qualified hospital pharmacist to patients and health care pharmacist to patients and health care institution, allied health profession and to institution, allied health profession and to pharmacy profession.pharmacy profession.

Assist a Assist a high quality of professional high quality of professional practicepractice thru establishment and thru establishment and maintenance of standards of professional maintenance of standards of professional ethics, education, attainment and ethics, education, attainment and economic welfare.economic welfare.

Promote Promote research in hospital pharmacyresearch in hospital pharmacy practices and in pharmaceutical sciences practices and in pharmaceutical sciences in general.in general.

To disseminate To disseminate pharmaceutical knowledgepharmaceutical knowledge by providing for interchange of information by providing for interchange of information among hospital pharmacist and with among hospital pharmacist and with members of the allied specialties and members of the allied specialties and profession.profession.


Expand and StrengthenExpand and Strengthen Institutional Pharmacists Institutional Pharmacists abilitiesabilities

Increase knowledge an understanding of Increase knowledge an understanding of contemporary institutional pharmacy practicecontemporary institutional pharmacy practice

Promote Promote compensation and benefitscompensation and benefits Ensure healthcare reimbursement and payment Ensure healthcare reimbursement and payment

system do not inhibit pharmaceutical servicessystem do not inhibit pharmaceutical services Assist In the development and advancement of Assist In the development and advancement of

pharmacy practice.pharmacy practice.


CLASSSIFICATION of HospitalsCLASSSIFICATION of Hospitals

1. TYPE OF SERVICE1. TYPE OF SERVICE General Hospital-General Hospital- provides care to provides care to

patients with any type of illnesspatients with any type of illness Special Hospital- those which restrict the Special Hospital- those which restrict the

care they provide to the special conditions care they provide to the special conditions such as cancer, psychiatric etcsuch as cancer, psychiatric etc

2. LENGTH OF STAY2. LENGTH OF STAY

-Short term hospital (less than 30 days)-Short term hospital (less than 30 days)

-Long term hospital (30 days or longer)-Long term hospital (30 days or longer)

3. OWNERSHIP3. OWNERSHIP

-Government hospitals-Government hospitals

a.a. Federal (armed forces, public health services)Federal (armed forces, public health services)

b.b. State State

c.c. CountyCounty


d. City ( Municipality)d. City ( Municipality)

e. City countye. City county

f. Districtf. District

-NON-GOVERNMENT HOSPITALS-NON-GOVERNMENT HOSPITALS

a.a. Non-profitNon-profit

b.b. For profitFor profit


4. BY BED CAPACITY4. BY BED CAPACITY

PatternPattern

Under 50 bedsUnder 50 beds 400-499 beds400-499 beds

50-90 beds50-90 beds 500 beds and over500 beds and over

100-199 beds100-199 beds

200-299 beds200-299 beds

300- 399 beds300- 399 beds


STUDENTSSTUDENTS

WE STOPPED HERE SO THERE MIGHT WE STOPPED HERE SO THERE MIGHT BE CHANGES DONE TO THE BE CHANGES DONE TO THE PRESENTATION RIGHT AFTER THIS PRESENTATION RIGHT AFTER THIS SLIDE. SO, BETTER TO COMPARE THE SLIDE. SO, BETTER TO COMPARE THE SLIDES ON THE NEXT UPLOAD.SLIDES ON THE NEXT UPLOAD.

Words to know:Words to know: ProcurementProcurement ManufacturingManufacturing StorageStorage CompoundingCompounding PackagingPackaging ControllingControlling AssayingAssaying DispensingDispensing Distribution and drug monitoringDistribution and drug monitoring

Minimum Standard for a Hospital Minimum Standard for a Hospital PharmacyPharmacy

Standard 1Standard 1ADMINISTRATIONADMINISTRATIONStandard 2Standard 2FACILITIESFACILITIESStandard 3Standard 3DRUG DISTRIBUTION and CONTROLDRUG DISTRIBUTION and CONTROLStandard 4Standard 4DRUG INFORMATIONDRUG INFORMATION

Standard 5Standard 5

ASSURING RATIONAL DRUG THERAPYASSURING RATIONAL DRUG THERAPY

Standard 6Standard 6

RESEARCHRESEARCH

Minimum Standard for a Hospital Minimum Standard for a Hospital PharmacyPharmacy

General Requirement Order no. 56 General Requirement Order no. 56 19891989

Standard petition formStandard petition form Proof of registration as an establishmentProof of registration as an establishment Valid certificate of registrationValid certificate of registration Certificate of attendance to a BFAS Certificate of attendance to a BFAS

sponsored seminar on Licensing of Drug sponsored seminar on Licensing of Drug OutletsOutlets

Affidavit of undertakingAffidavit of undertaking Tentative list of products to be sold using Tentative list of products to be sold using

GN with BNGN with BN

Authenticated photocopy of contract of Authenticated photocopy of contract of Lease of space to be occupied if rentingLease of space to be occupied if renting

General Requirement Order no. 56 General Requirement Order no. 56 19891989

Abilities required for Hospital Abilities required for Hospital PharmacistPharmacist

1.1. Thorough knowledge of drugs and their Thorough knowledge of drugs and their actions.actions.

2.2. Ability to develop and conduct a Ability to develop and conduct a pharmaceutical manufacturing program.pharmaceutical manufacturing program.

3.3. An intimate knowledge of control An intimate knowledge of control procedures.procedures.

4.4. Ability to conduct and participate in Ability to conduct and participate in research.research.

5. Ability to conduct teaching and in-service 5. Ability to conduct teaching and in-service training programstraining programs

6. Ability to administer and manage.6. Ability to administer and manage.

Abilities required for Hospital Abilities required for Hospital PharmacistPharmacist

GOVERNING BODYGOVERNING BODY

AdministratorAdministrator DirectorDirector SuperintendentSuperintendent Medical DirectorMedical Director Chief Administrative OfficerChief Administrative Officer

- Selection of personnel, control funds, - Selection of personnel, control funds, supervision of physical plantsupervision of physical plant

Standing CommitteesStanding Committees

EXECUTIVE COMMITTEEEXECUTIVE COMMITTEE HOSPITAL COMMITTEEHOSPITAL COMMITTEE FINANCE COMMITTEEFINANCE COMMITTEE

PUBLIC RELATIONS COMMITTEEPUBLIC RELATIONS COMMITTEE

Infection Control committeeInfection Control committee

Pharmacy and Therapeutics committeePharmacy and Therapeutics committee

DEPARTMENTS OF HOSPITALDEPARTMENTS OF HOSPITAL

A.A. Departments which the services involve Departments which the services involve primarily the professional care of the patient.primarily the professional care of the patient.

-Ambulatory care, Anaesthesia, Blood Bank, -Ambulatory care, Anaesthesia, Blood Bank, Central Sterile supply, Clinical laboratory, Central Sterile supply, Clinical laboratory, Dental Service, Dietary & Nutrition service, Dental Service, Dietary & Nutrition service, ECG, ER, Medical library, Medical records, ECG, ER, Medical library, Medical records, Medical social service, nuclear medicine, Medical social service, nuclear medicine, nursing service, OT, Pharmacy, Physical nursing service, OT, Pharmacy, Physical Medicine, Radiology and X-ray therapy. Medicine, Radiology and X-ray therapy. Respiratory therapyRespiratory therapy

B. Departments which deal with the business B. Departments which deal with the business management or administrative side of the management or administrative side of the HospitalHospital

-accounting, admitting, biomedical engineering, -accounting, admitting, biomedical engineering, business office, cafeteria and coffee shop, business office, cafeteria and coffee shop, central transportation, credit and collection, central transportation, credit and collection, computer services, engg and maintenance, computer services, engg and maintenance, housekeeping, information service, personnel housekeeping, information service, personnel and payroll, post office, purchase and store and payroll, post office, purchase and store room, telephone switchboard, volunteer serviceroom, telephone switchboard, volunteer service

DEPARTMENTS OF HOSPITALDEPARTMENTS OF HOSPITAL

MEDICAL STAFFMEDICAL STAFF

DutiesDuties

Providing professional care of the sicj and Providing professional care of the sicj and injured in the hospitalinjured in the hospital

Maintaining its own efficiencyMaintaining its own efficiency

Participating in the educational program of Participating in the educational program of the hospitalthe hospital

CategoriesCategories

Honorary staffHonorary staff

Composed of physicians who have been Composed of physicians who have been active in the hospital but who are retired active in the hospital but who are retired and those to whom it is desired to do and those to whom it is desired to do honor because of outstanding contributionhonor because of outstanding contribution

Consulting Medical staffConsulting Medical staff

Consist of specialists who are recognized as Consist of specialists who are recognized as such by right of passing specialty boards such by right of passing specialty boards or belonging to the rational organization of or belonging to the rational organization of their specialty, and who serve as their specialty, and who serve as consultants to other members of the consultants to other members of the medical staff. medical staff.


Active or attending Medical staffActive or attending Medical staff

The group primarily concerned with regular The group primarily concerned with regular patient care. It is the group most actively patient care. It is the group most actively involved in the hospital. involved in the hospital.


Associate Medical StaffAssociate Medical Staff

Composed of junior or less experienced Composed of junior or less experienced membersmembers


Courtesy medical staffCourtesy medical staff

Consists of physicians who desire the Consists of physicians who desire the privilege of attending.privilege of attending.


Resident Medical staffResident Medical staff

Composed of residents who are full time Composed of residents who are full time employees of the hospital. Provides employees of the hospital. Provides specific services, for which they receive specific services, for which they receive education and experiences.education and experiences.


Role of Pharmacy TechnicianRole of Pharmacy Technician

Receives written prescriptions or refillsReceives written prescriptions or refills Verify info on the prescriptionVerify info on the prescription Counting, weighing, measuring and mixing Counting, weighing, measuring and mixing

medicationmedication Preparing prescription labelsPreparing prescription labels Establishing and maintaining patient Establishing and maintaining patient

profilesprofiles Order and stockingOrder and stocking

Assisting drug studiesAssisting drug studies Taking order over the telephoneTaking order over the telephone Transferring prescriptionsTransferring prescriptions Tracking and reporting errorsTracking and reporting errors Tech check techTech check tech

Role of Pharmacy TechnicianRole of Pharmacy Technician

Organizational Structure of Organizational Structure of PharmacyPharmacy

1.1. Administrative Services DivisionAdministrative Services Division

2.2. Education and Training DivisionEducation and Training Division

3.3. Pharmaceutical Research DivisionPharmaceutical Research Division

4.4. In-patient Services DivisionIn-patient Services Division

5.5. Out-patient Services DivisionOut-patient Services Division

6.6. Drug Information Services DivisionDrug Information Services Division

7.7. Departmental Services DivisionDepartmental Services Division

8. Purchasing and Inventory Control Division8. Purchasing and Inventory Control Division

9. Central Supply Services Division9. Central Supply Services Division

10. Assay and Quality Control Division10. Assay and Quality Control Division

11. Manufacturing and Packaging Division11. Manufacturing and Packaging Division

12. Sterile Products Division12. Sterile Products Division

13. Radiopharmaceutical Services Division13. Radiopharmaceutical Services Division

14. Intravenous Admixture Division14. Intravenous Admixture Division

Organizational Structure of Organizational Structure of PharmacyPharmacy

Manpower requirements and Manpower requirements and ResponsibilitiesResponsibilities

Pharmacy Department

PHARMACY and THERAPEUTICS PHARMACY and THERAPEUTICS CommitteeCommittee

It is a policy-recommending body to the It is a policy-recommending body to the medical staff and the administration of medical staff and the administration of the hospital on matters related to the the hospital on matters related to the therapeutic use of drugs.therapeutic use of drugs.

1.1. ADVISORYADVISORY

2.2. EDUCATIONALEDUCATIONAL

PTC Organization and OperationPTC Organization and Operation

1.1. Composed of Physicians, pharmacist, Composed of Physicians, pharmacist, nurses and administratornurses and administrator

2.2. Chairman-physician, Secretary-Chairman-physician, Secretary-pharmacistpharmacist

3.3. Meetings- 6x a year or others 4xMeetings- 6x a year or others 4x

4.4. Invitation to meetingsInvitation to meetings

5.5. AgendaAgenda

6.6. Minutes of the meetingMinutes of the meeting

7. Recommendations7. Recommendations

8. Liaison w/ other hospital committee8. Liaison w/ other hospital committee

PTC Organization and OperationPTC Organization and Operation

Functions and Scope of PTCFunctions and Scope of PTC

1.1. Advise on the use of drugsAdvise on the use of drugs2.2. Drug FormularyDrug Formulary3.3. Ensures cost effective drug therapyEnsures cost effective drug therapy4.4. Educational programsEducational programs5.5. QA activities ( distribution, QA activities ( distribution,

administration, use of drugs)administration, use of drugs)6.6. ADRADR7.7. Drug use review programs and studiesDrug use review programs and studies

8. Effective drug distribution and control 8. Effective drug distribution and control procedureprocedure

9. Recommends drugs to be stocked in 9. Recommends drugs to be stocked in hospital patient care areashospital patient care areas

Functions and ScopeFunctions and Scope

HOSPITAL FORMULARYHOSPITAL FORMULARY

FormularyFormulary

- Continually revised compilation of - Continually revised compilation of pharmaceuticals that reflects the current pharmaceuticals that reflects the current clinical judgement of the medical staff.clinical judgement of the medical staff.

Formulary systemFormulary system

Is a method whereby the medical staff of an Is a method whereby the medical staff of an institution, working through the PTC, institution, working through the PTC, evaluates, appraises, and selects from evaluates, appraises, and selects from among the numerous available drug among the numerous available drug entities and drug products those that are entities and drug products those that are considered most useful in patient care considered most useful in patient care


Potential benefitsPotential benefits

1.1. TherapeuticTherapeutic

2.2. EconomicEconomic

3.3. EducationalEducational


Format of the FormularyFormat of the Formulary

1.1. Title PageTitle Page

2.2. Names of PTC membersNames of PTC members

3.3. Table of contentsTable of contents

4.4. Policies and ProceduresPolicies and Procedures

5.5. Drug productsDrug products

6.6. AppendixAppendix

Appearance of the FormularyAppearance of the Formulary

1.1. Different color of the paper Different color of the paper (recommended)(recommended)

2.2. Using and edge indexUsing and edge index

3.3. Pocket size (4 x & cm)Pocket size (4 x & cm)

4.4. Generic name in BOLDGeneric name in BOLD

FIVE RIGHTS FIVE RIGHTS for RATIONAL DRUG THERAPYfor RATIONAL DRUG THERAPY

Right PatientRight Patient Right DrugRight Drug Right StrengthRight Strength Right RouteRight Route Right TimeRight Time

Steps to be followed for DRUG Steps to be followed for DRUG INCLUSION in the HOSPITAL INCLUSION in the HOSPITAL

FORMULARY FORMULARY 1. Pharmaceutical representatives obtain

application form and list of requirements from the PTC Secretary

2. Completed requirements submitted to the PTC Secretary on or before the deadline set which is one (1) month before the next scheduled PTC meeting

3. All applications with complete documents endorsed to and reviewed by the PTC members

Drugs Approved

Drug Inclusion in the Hospital Formulary

Stock donations to precede regular stocking

Regular evaluation & review every 3 months during PTC meeting (history of drug adverse events/ reactions, sales movement)

PTC

Drugs Not Approved

Lack essential documents & other

considerations

Waiting List (Full 5 brand

listing)

Re-application (submission of letter of Re-application

with completed requirements)

Drug review on PTC Meeting

Drug Approved

Process of DRUG DELETION from the FORMULARY

Slow-moving Drugs Non-moving Drugs

List presented to the PTC during the regular Meeting

Involved companies are informed in writing regarding the status of their drugs. A grace period of 3 months

is given to allow for improvement in sales.

NO IMPROVEMENT

Formal deletion from the Formulary on the next PTC meeting

All stakeholders (drug companies/proponent physicians/ concerned medical staff) are informed through letters, postings at Pharmacy

Bulletin Board, information provided at Nurses’ Stations

•Only one brand shall be carried per generic of a dangerous drug at a time.Attending physicians are encouraged to utilize the formulary drugs.

•Non-formulary drugs are purchased upon request of the attending physicians when as the following have been made or approved:

•When referrals for available formulary drugs have been made to attending physicians who still opt to use the specific non-formulary drug of their choice.

•Non-formulary form is completely filled up and passed to the pharmacy. Indicating the concrete advantage the drug has over the available formulary drugs we have in the pharmacy.

Guidelines for Formulary and Non-Formulary

Drugs

••The Pharmacy will not cater herbal supplements and preparation of no The Pharmacy will not cater herbal supplements and preparation of no therapeutic claims.therapeutic claims.

••All procured Non-formulary drugs will automatically charged to the All procured Non-formulary drugs will automatically charged to the patient’s account and cannot be returned to the Pharmacy.patient’s account and cannot be returned to the Pharmacy.

All drugs must undergo Drug evaluation by the Pharmacy All drugs must undergo Drug evaluation by the Pharmacy

and Therapeutics committee before it can become a formulary drug.and Therapeutics committee before it can become a formulary drug.

••Formulary Drugs are the only drugs that can be stocked in the Formulary Drugs are the only drugs that can be stocked in the Pharmacy.Pharmacy.

••A maximum of A maximum of 5 brands 5 brands per generic entity excluding the innovatorper generic entity excluding the innovator

brand can be included in the Formulary Drug list.brand can be included in the Formulary Drug list.


Drugs

Drugs that are in the list are subject for deletion if deemed to be slow moving Drugs that are in the list are subject for deletion if deemed to be slow moving even after 3 months grace period given for the company to promote the even after 3 months grace period given for the company to promote the specific drug.specific drug.

••Deleted drugs are required to undergo similar process and pass all Deleted drugs are required to undergo similar process and pass all requirements again if the company wishes to re-apply for product inclusion.requirements again if the company wishes to re-apply for product inclusion.

••A different dose and preparation of an existing brand in the pharmacy need not A different dose and preparation of an existing brand in the pharmacy need not apply but required to submit Certificate of Analysis, Product registration and apply but required to submit Certificate of Analysis, Product registration and their stock donation.their stock donation.

••Endorsements from different medical departments will no longer be Endorsements from different medical departments will no longer be entertained if the maximum slot has been filled. If a drug is deleted in the entertained if the maximum slot has been filled. If a drug is deleted in the same category, the slot shall be open.same category, the slot shall be open.


Drugs

Facilities and EquipmentsFacilities and Equipments

Smaller hospitals- one room- one Smaller hospitals- one room- one pharmacistpharmacist

Sterile products- separate room or areaSterile products- separate room or area Hospitals with more than 200 bedsHospitals with more than 200 beds

---separate area for in patient and unit dose ---separate area for in patient and unit dose dispensingdispensing

--chief pharmacist (office)--chief pharmacist (office)

--compounding ,pre packaging, labelling--compounding ,pre packaging, labelling

---a storeroom, sterile products and IV ---a storeroom, sterile products and IV admixture roomadmixture room

--- drug info service room --- drug info service room

Hospitals of more than 500 or 1000 bedsHospitals of more than 500 or 1000 beds

--increase space requirements for --increase space requirements for pharmaceutical servicespharmaceutical services

Facilities and EquipmentsFacilities and Equipments

Other requirements for a Hospital Other requirements for a Hospital PharmacyPharmacy

BooksBooks Laboratory apparatusLaboratory apparatus Office suppliesOffice supplies Biological refrigeratorBiological refrigerator Laminar flow hoodLaminar flow hood Telephones/ shelvesTelephones/ shelves Internet serviceInternet service ComputerComputer

StaffingStaffing

100 beds- 1 pharmacist100 beds- 1 pharmacist 300 beds- director, assistant director, 7-12 300 beds- director, assistant director, 7-12

staff pharmacist, 5-15 non-pharmacist, staff pharmacist, 5-15 non-pharmacist, secretarysecretary

700 beds- director, assistant director (2 or 700 beds- director, assistant director (2 or more), supervisor pharmacist (2 or more), more), supervisor pharmacist (2 or more), 40-60 staff pharmacist 40-60 staff pharmacist

Competencies of PharmacistCompetencies of Pharmacist

Competencies for PharmacistsCompetencies for Pharmacists

Practice pharmacy in a professional and Practice pharmacy in a professional and cultural mannercultural manner

Contribute to the quality use of medicinesContribute to the quality use of medicines Provide primary health careProvide primary health care Apply management and organizational Apply management and organizational

skillsskills Research and provide information\Research and provide information\ Dispense MedicinesDispense Medicines

Prepare pharmaceutical productsPrepare pharmaceutical products

Competencies for PharmacistsCompetencies for Pharmacists

UNIT IIUNIT IIINPATIENT PHARMACYINPATIENT PHARMACY

Recommended PracticesRecommended Practices

1.1. RPh reviews M.D order before initial RPh reviews M.D order before initial administration.administration.

2.2. Ready to use medications to be Ready to use medications to be administered.administered.

3.3. Facilities & equipment accessible only to Facilities & equipment accessible only to medical practitioners.medical practitioners.

4.4. Facilities & equipment designed for Facilities & equipment designed for routine inspections.routine inspections.

5. Provisions are made to provide suitable 5. Provisions are made to provide suitable pharmaceutical services.pharmaceutical services.

6. Repacking from manufacturer’s original 6. Repacking from manufacturer’s original container should meet standards of good container should meet standards of good pharmacy practice.pharmacy practice.

7. Distinguishing accounting practices vs. 7. Distinguishing accounting practices vs. dispensing practice.dispensing practice.

Recommended PracticesRecommended Practices

Classification of In-patient Classification of In-patient dispensingdispensing

1.1. Individual Prescription Order systemIndividual Prescription Order system

2.2. Complete Floor Stock systemComplete Floor Stock system

3.3. Combination of 1 and 2.Combination of 1 and 2.

4.4. The unit dose drug distribution systemThe unit dose drug distribution system

ComparisonsComparisons Individual Individual RxRx

Complete Complete floor stock floor stock

systemsystem

CombinationCombination UDUD

AdvantagesAdvantages Reviewed Reviewed by RPhby RPh

InteractionInteraction

InventoryInventory

AvailabilityAvailabilityDrug Drug

ReturnsReturns

Rx personnelRx personnel

DisadvantagesDisadvantages Medication Medication errorserrors

PilferagesPilferages

Drug Drug inventoryinventory

UNIT DOSE DRUG UNIT DOSE DRUG DISTRIBUTION SYSTEMDISTRIBUTION SYSTEM

““Those medications which are ordered and Those medications which are ordered and packaged, handled, administered and packaged, handled, administered and

charged in multiples of single dose units charged in multiples of single dose units containing pre-determined amount of containing pre-determined amount of

drugs or supply sufficient for one regular drugs or supply sufficient for one regular dose application or use”dose application or use”

Advantages of UDAdvantages of UD

1.1. 24 h medicines24 h medicines2.2. More time of nurses for patient’s careMore time of nurses for patient’s care3.3. Check medication order/ prescriptionCheck medication order/ prescription4.4. Paper work decreasedPaper work decreased5.5. Eliminates credit ( decrease cost)Eliminates credit ( decrease cost)6.6. Iv preparation and drug reconstitution Iv preparation and drug reconstitution

procedures to the pharmacyprocedures to the pharmacy7.7. Profession utilizationProfession utilization

8. Prevents revenue losses8. Prevents revenue losses

9. Nursing units conserved9. Nursing units conserved

10. Eliminates pilferages and drug waste10. Eliminates pilferages and drug waste

11. Extends pharmacy coverage11. Extends pharmacy coverage

12. Communication of medication order12. Communication of medication order

ImprovedImproved

13. Drug consultants13. Drug consultants

Advantages of UDAdvantages of UD

EXEMPTED in UDEXEMPTED in UD

IV FluidsIV Fluids OintmentOintment gargle ( without definite dose or cc )gargle ( without definite dose or cc ) PRN MedicationsPRN Medications Dangerous DrugsDangerous Drugs TPN ( esp. large volume TPN )TPN ( esp. large volume TPN ) Once a week refrigerated drugOnce a week refrigerated drug

Procedures in UDDDSProcedures in UDDDS

Px entered into the systemPx entered into the system Medication order sent to pharmacistMedication order sent to pharmacist Pharmacist check drug orderPharmacist check drug order Dosing scheduleDosing schedule Dispensing medicinesDispensing medicines Medication cartsMedication carts Pharmacist check cartsPharmacist check carts Nurse administers the drug then logNurse administers the drug then log Cart is recheckedCart is rechecked

Unit Dose in Local SettingUnit Dose in Local Setting

1.1. Assignation of station of Unit Dose Assignation of station of Unit Dose PharmacistsPharmacists

2.2. Know the patients for UDKnow the patients for UD

3.3. Prepare Patient Profile sheets.Prepare Patient Profile sheets.

Discharged patients- disregard and fileDischarged patients- disregard and file

Transferred patients- endorse to other RPhTransferred patients- endorse to other RPh

4. Read medication orders from 10 am or to 4. Read medication orders from 10 am or to the last order written by the pharmacist.the last order written by the pharmacist.

5. Check medication area (specifically 5. Check medication area (specifically individual cubicle of patientsindividual cubicle of patients

6. Note down the number of meds in the 6. Note down the number of meds in the cubicle using the patient’s profilecubicle using the patient’s profile

7. Charge medicines in a 24h consumption.7. Charge medicines in a 24h consumption.8. Dispense the medicines and prepare for 8. Dispense the medicines and prepare for

individual packaging.individual packaging.9. Re-check your dispensed medicines 9. Re-check your dispensed medicines

ready for distributionready for distribution


10. Endorse the medicines to the nurses.10. Endorse the medicines to the nurses.

11. Check any discrepancies (billing or 11. Check any discrepancies (billing or lacking medicines)lacking medicines)


COMMON ABBREVIATIONCOMMON ABBREVIATION TabTab tablet tablet CapCap capsule capsule IVTTIVTT intravenous thru intravenous thru

tubing tubing IM IM intramuscular intramuscular SQSQ subcutaneous subcutaneous OD OD once daily once daily QO_ODQO_OD every other day every other day Bid Bid twice daily twice daily Tid Tid three times a day three times a day QidQid four times a day four times a day 5x a day5x a day five times a day five times a day Q4hrtcQ4hrtc every four hours every four hours

round round the clockthe clock

Q4hprnQ4hprn every four hours every four hours as as

neededneeded Q6hQ6h every six hours every six hours Q8hQ8h every eight hours every eight hours Q12h Q12h every twelve every twelve

hourshours

T/C T/C to consider to consider //t/c//t/c to consume to consume //d/c//d/c discontinue meds discontinue meds //DC//DC discharge discharge //shift//shift is use when a is use when a

previous order in IV and previous order in IV and changed into oralchanged into oral

//revise//revise is use if there’s a is use if there’s a change in meds change in meds with same with same therapeutictherapeutic

//complete//complete used used to indicate a to indicate a completed completed regimenregimen

//filled//filled used to indicate used to indicate if if the ordered med has the ordered med has been been fully fully dispenseddispensed

MGH MGH may go home may go home Arrow upArrow up increase increase Arrow downArrow down decrease decrease

SAMPLE UNIT DOSESAMPLE UNIT DOSE

Dispensing of controlled Dispensing of controlled substancessubstances

ADDICT

SS--11

Retail of DP/s containing Table I Controlled Retail of DP/s containing Table I Controlled Chemical/sChemical/s

500.00500.00

SS--33

Retail of DD/DDP/s & /or DP/s containing Retail of DD/DDP/s & /or DP/s containing Table I Controlled Chemical/sTable I Controlled Chemical/s

1,000.001,000.00

SS--44

Wholesale/Distribution of DD/DDP/s/Table Wholesale/Distribution of DD/DDP/s/Table 1 Controlled Chemical/s used in the 1 Controlled Chemical/s used in the manufacture of drug preparation/s/ &/or manufacture of drug preparation/s/ &/or their preparation/stheir preparation/s

3,000.003,000.00

SS--55

C Compounding/Manufacture of DD/ DDPs C Compounding/Manufacture of DD/ DDPs &/or D P/s containing Table I Controlled &/or D P/s containing Table I Controlled Chemical/sChemical/s

5,000.005,000.00

S-2S-2 License to prescribe DD/DDPs, &/or DP/s License to prescribe DD/DDPs, &/or DP/s containing Table I Controlled Chemical/scontaining Table I Controlled Chemical/s

IN-Patient PrescriptionIN-Patient Prescription

Annex for dangerous and regulatedAnnex for dangerous and regulated

Out-patient PrescriptionOut-patient Prescription

The official prescription form comes in 3 copies. This is called The official prescription form comes in 3 copies. This is called the DDB form 1-72.the DDB form 1-72.

Original (Yellow) – shall be retained by the Drugstore/ Original (Yellow) – shall be retained by the Drugstore/ Hospital Pharmacist for a period of Hospital Pharmacist for a period of 1 yr.1 yr. From the From the date of date of sole or delivery.sole or delivery.

Duplicate (Yellow) – shall be retained by the buyer or by Duplicate (Yellow) – shall be retained by the buyer or by the person to whom the drug is delivered until such the person to whom the drug is delivered until such drug is drug is consumed.consumed.Triplicate (Blue) – shall be retained by the person issuing Triplicate (Blue) – shall be retained by the person issuing the prescription.the prescription.

APOTHECARY

Factors considered in Factors considered in PREPACKINGPREPACKING

1.1. Demand for the productDemand for the product

2.2. Size units of the drugsSize units of the drugs

3.3. Special labellingSpecial labelling

4.4. Machine packaged or manual countMachine packaged or manual count

5.5. Stability of the drugStability of the drug

6.6. Cost of the pre-packaged drugCost of the pre-packaged drug

HYPERALIMENTATION

ExamplesExamples

KabivenKabiven NutriflexNutriflex VaminVamin AminoblendAminoblend IntralipidIntralipid AminosterilAminosteril NephrosterilNephrosteril

Sterile Medication Doses and IV Sterile Medication Doses and IV NutritionNutrition

1. Final Product- ASEPTIC TECHNIQUE 1. Final Product- ASEPTIC TECHNIQUE

2. Drug interactions avoided2. Drug interactions avoided

3.Final product- properly labelled, dispense 3.Final product- properly labelled, dispense and stored.and stored.

UNIT IIIUNIT III

PRIMARY HEALTH CAREPRIMARY HEALTH CARE

Responsible for assuring continuity of all Responsible for assuring continuity of all the care the patient that may subsequently the care the patient that may subsequently need.need.

1.1. The need of the hospital to supplement The need of the hospital to supplement its in-patient teaching program.its in-patient teaching program.

2.2. The demand of the community for The demand of the community for comprehensive diagnostic and treatment comprehensive diagnostic and treatment centers.centers.

3.3. The new philosophy of hospitals to play The new philosophy of hospitals to play an active role in the community health an active role in the community health programprogram

4.4. The need of hospital and physician to The need of hospital and physician to exercise greater control over pxs who exercise greater control over pxs who receives investigational drugs.receives investigational drugs.

5. The lack of a sufficient number of 5. The lack of a sufficient number of physicians in some areas thereby causing physicians in some areas thereby causing population to travel to medical centers for population to travel to medical centers for comprehensive care.comprehensive care.

6. Physicians are not available in some rural 6. Physicians are not available in some rural areas.areas.

MINIMUM STANDARD for MINIMUM STANDARD for AMBULATORY CARE AMBULATORY CARE

Pharmaceutical ServicesPharmaceutical Services

ASHPASHP

I- Leadership and Practice ManagementI- Leadership and Practice Management

II- Medication Therapy and Pharmaceutical II- Medication Therapy and Pharmaceutical carecare

III-Drug Distribution and controlIII-Drug Distribution and control

IV-Facilities, Equipment and other IV-Facilities, Equipment and other ResourcesResources

JCI Accreditation for Ambulatory careJCI Accreditation for Ambulatory care

I- International Patient Safety GoalsI- International Patient Safety Goals

II- Patient Access and AssessmentII- Patient Access and Assessment

III- Patient Care and Continuity of CareIII- Patient Care and Continuity of Care

IV-Patients Rights and ResponsibilitiesIV-Patients Rights and Responsibilities

V- Patient Record and FlowV- Patient Record and Flow

VI- Patient Service ContrastsVI- Patient Service Contrasts

VII-Patient and Family EducationVII-Patient and Family Education

VIII- Patient Anesthesia and SurgeryVIII- Patient Anesthesia and Surgery

JCI Accreditation for Ambulatory careJCI Accreditation for Ambulatory care

IX- Improvement in Quality and Patient IX- Improvement in Quality and Patient SafetySafety

X- Infection Control and Facility SafetyX- Infection Control and Facility Safety

XI- Human Resource ManagementXI- Human Resource Management

XII-Governance and LeadershipXII-Governance and Leadership

QUALIFIED QUALIFIED PHARMACISTPHARMACIST

Appropriateness of the choice of drug andAppropriateness of the choice of drug and its dosage, route of administration, and the its dosage, route of administration, and the

amount must be verified by the RPh.amount must be verified by the RPh.

All dispensed medications to patients All dispensed medications to patients will be completely and correctly will be completely and correctly

labelled and packaged.labelled and packaged.

PATIENTPATIENT

COUNSELINGCOUNSELING

LOCATION OF OUT-PATIENT LOCATION OF OUT-PATIENT DISPENSING AREADISPENSING AREA

NO RETURNSNO RETURNS

PRESCRIPTIONSPRESCRIPTIONS

Prescription call check to match the patient with the prescription

INVENTORY CONTROLINVENTORY CONTROL

Hosp Rx History Development Defintion 11/6/14

Health & Medicine

Transcript of Hosp Rx History Development Defintion 11/6/14