Hair Loss Treatment

Losing your hair makes uncomfortable feeling, producing low self-esteem and self-discrimination. People who are in this state of ailment are very desperate to find solution to resolve it.

Origin of Hair Loss

Hair is usually composed of protein and keratin that grows beneath the hair follicle. The living portion of the hair is in the follicle, and the visible hair is called hair shaft, which does not have any biochemical activity and considered dead. The base of the root is the bulb, which produces cells to make hair shaft. The hair is oiled by the sebaceous gland found in the hair follicle, and the arrector pili muscles are responsible for the goose-bumps of the the hair. Nutrients must reach the hair follicle to initiate healthy hair growth.

The possible cause of hair loss can be associated with the following:

1. Genes – usually if your father or mother has lesser hair; and they tend to lose their hair, there is a big probability that you will also lose your hair.
2. Hormone – usually an increased in androgen level in your body causes hair loss. Men have the bigger possibility to have it than women, because the hormone is found more in their body than women.
3. Excessive exposure to sunlight and UV rays – can trigger the hair follicle to stop produce healthier hair and damage them.
4. Oils, waxes and gels – these can irritate your scalp if too much or daily use is done, and may affect the production of the hair to grow. Natural oil produced by sebaceous gland is needed for hair to stay healthy and smooth, yet, when excessive oil is placed this can destroy your hair. Remember that oils including the waxes and gels are producing heat that can be potentially destroy your hair.
5. Drugs, chemicals and diagnostic procedures – undergoing such treatment can affect your hair. Some drugs such as chemotherapeutic agents, antibiotics and other drug chemicals can cause hair thinning. Also undergoing diagnostic procedures such as X-ray or exposure to radiation can be the reasons.
6. Diseases and illnesses – fungal infections, bacterial infections, burns, cancer and thyroid problem can be associated to thinning of hair. Abnormal supply of nutrients to the hair follicle can be a problem, such as anemia and malnutrition can be the culprit.
7. Stress and fatigue – there is a direct effect of stress and fatigue over hair loss. Because when someone is under stressful situation, the body function does not work properly and may cause of hair loss.

Hair Loss Treatment

There are organic and synthetic ways of prophylaxis for hair loss. Mostly used are the synthetic drugs that are proven effective and used commercially as active ingredient of hair thickening and regrowth treatment. Also procedural and surgical treatments may be the option.

1. Minoxidil – used before as an anti-hypertensive drug. While under this therapy, the patients have visibly thickened their hair as a side effect, hence, in the later research study it is proven to be effective in treatment of alopecia (hair loss). Minoxidil when taken orally will cause excessive hair growth all over the body, so it is advice to use the topical counter-part of the drug that can be obtain in sprays, lotions, solutions or creams. The exact part of hair loss only must be applied to prevent unwanted growth on the other parts of the body. Minoxidil has a very powerful thickening action towards hair, so be careful when using it. Do not excessively or misapplied the drug in the your body.
2. Finasteride – it is a first line treatment for benign prostatic hyperplasia (BPH), but it is now proven to slow down the thinning of hair. Finasteride helps to prevent the formation of dihydrotestosterone that affects the growth of the hair in the hair follicle. It is prohibited in pregnant women to use. Side effects in men can be composed of low sex drive and sexual dysfunction.
3. Use of herbal jojoba oil, gogo extract and flesh of aloe vera – it has shown that these herbs help to prevent hair loss and actually promote regrowth of hair when thinning. Just use them everyday as shampoo or when washing the hair. These herbs can be found in the shampoos, conditioners and other variant of hair cosmetic products that intended to relive and energize hair production.
4. Vitamins and Minerals – Such as vitamins A, B, C, D and E are needed for production of glowing and healthier hair. They are important in maintenance of scalp and boost the immune system to fight against fungal or bacterial infection that may cause disease in the hair follicle or skin pores. Minerals such as iron, zinc, calcium, selenium and alike can help to substantiate hair follicle for healthy growth.
5. Hair transplant – invasive surgical procedure where new live and healthy hairs are transplanted in one's scalp that will be the new hair. This procedure is quite expensive and may be the last sort if the other treatments are failed.
6. Use of comb stimulator – stimulates the hair follicle and improves blood circulation in the scalp, especially the supply of oxygen and nutrients in the hair.
7. Balanced diet, exercise and destressing – One way of keeping the growth of the hair is by supplementing the body with healthy and nutritious food. Everybody knows that the food we eat are the major source of energy and cell regeneration in our body. Destressing yourself by exercise, unwinding, and being physically fit and under meditation can be factors in helping your body to recover from major stresses, thus, boosting your immune system and high chance of cell regeneration.

Dos and Don'ts To Effectively Prevent Hair Loss

1. Take care of your hair. Wash it everyday and use shampoo with mild cleansing action to prevent damage and destruction of hair at all. Use hair conditioner at least once or twice a week.
2. Do not expose hair excessively under the sun or heat. This may affect the hair strand and make your hair look dry and frizzy. Use cap or cover them.
3. Do not over use gels, oils and waxes. They can affect the hair, especially when use them everyday. Do not leave you hair unwashed before going to sleep.
4. Comb you hair for a while but not too lengthy. Longer combing can cause hair breakage or plucking, because of the stress applied. Use combs with wide tooth or brush, but avoid narrow-tooth combs.
5. Use shampoo that helps to prevent hair loss and promotes hair growth as much as possible. Read labels of the shampoo before obtaining. Buy shampoos with rich herbal ingredients over synthetic ones.
6. Do not over tie hair and avoid harsh hair dyes, hair treatments and other hairstyling to prevent damaging the hair that eventually lead to hair loss. Be sure to go to hair experts that know the solution to your hair problems.
7. Observing the number of hair fall everyday, and if gets worst see your dermatologist as soon as possible. Better advice and treatment can she give to you.
8. Good lifestyle, balanced diet and supplement your body with multivitamins and minerals to have healthier you.

The following treatments and pieces of advice are only for informational purposes only. If you plan to undergo hair treatment consult you doctor first before entering an extensive therapy. The doctor can give you the better answer to you problem and lead you to right treatment for hair loss.

Pharmacists' Salary Will Be Soon Increased?

The Philippine Pharmacists Association (PPhA) is advocating the revamp of wages of pharmacists in the Philippines. PPhA has been proposing and advocating to the law makers to make the salary, incentives and benefits of pharmacists to be increased and unified to help the profession and the industry from insufficient manpower, and immediate come-and-go of pharmacists from one establishment to another.

The major problems the pharmaceutical industry are facing this contemporary time are lacking of pharmacists and having faster post and resignation of pharmacists from one company to another. The reasons why these problems occur can be associated with the low enrollees to the Pharmacy Degree, and also the opportunities and wages from one company to another may differ, which may be enticing for pharmacists to grab the other companies offer, which can give them better career growth and better income. However, this may lead for some establishments to be left behind without pharmacist or “NO PHARMACIST.” Some problems still facing by the industry is the rampant hiring of “ghost pharmacists”, diverted career and unsatisfactory salary.

Thus, at least to resolve these issues of pharmaceutical profession, the PPhA has proposing a good fortune for pharmacists, and advocating a better compensation that are acceptable and ought to be. They overt and appeal to law makers to pass a law that will alleviate the convenience for pharmacists, especially the compensation part that they can receive when they hired to a certain company. The organization is intending to increase the basic salary of pharmacists with 30% benefits and exclusively rental fee for their license that should have been done long ago. The salary may depend still to the experience and highest educational attainment of pharmacist, but a general salary base must be set. Benefits included must be SSS premiums, PhilHealth, Pag-ibig, GSIS (government employs), food allowance, travel allowance and etc. Also if this law will be applied the rental fee for using pharmacist's license will be included in the compensation, which the pharmacists can be enjoyed.

The compensation revamps have been fully pursuing by the PPhA to attract and instigate high school graduating students to choose and enroll in Pharmacy Degree. Such scenario of more students who are taking pharmacy course can extrapolated the future deployment of sufficient or overwhelming volume of manpower of pharmacists, therefore, all establishments will be occupied and no reason not to hire pharmacist anymore. Also to eliminate the come-and-go of pharmacists that causing the establishments to have no pharmacists.

These compensation changes might be included in the amendment of Pharmacy Law. As the organization is really pursuing to rectify the existing law for the betterment of privileges and rights of pharmacists. Let us pray and hope that this might be soon passed and enacted. For your information only.

Pharmacy And Therapeutics Committee

The Pharmacy and Therapeutics Committee is an advisory group of the medical staff which serves as the organizational line of communication between the medical staff and pharmacy department. It is a policy recommending body to the medical staff and the administration of the hospital on matters related to drug use. This committee is composed of physicians, pharmacists and other health professionals elected with the guidance of the medical staff.

The Purpose of Pharmacy and Therapeutics Committee

A. Advisory

The committee recommends the adoption of, or assists in the formulation of, broad professional policies regarding evaluation, selection and therapeutic use of drugs in hospitals.

B. Educational

The committee recommends or assists in the formulation of programs assigned to meet the needs of the professional staff (physicians, nurses, pharmacists and other health care practitioners) for complete current knowledge on matters related to drugs and drug use.

Organization and Operation of PTC

A. The PTC should be composed of at least three physicians, a pharmacist and representatives of the nursing staff. Committee members are appointed by a governing unit or elected officials of the organized medical staff. The hospital administrator or his/her representative should be an ex – officio member of the committee.

B. A chairman from among the three physician representatives should be appointed. A pharmacist usually is designated as secretary.

C. The committee should meet regularly at least six times per year, and when necessary.

D. The committee should invite to its meeting persons within or outside the hospital who can contribute specialized or unique knowledge, skills and judgments.

E. An agenda and supplementary materials (including minutes of the previous meeting ) should be prepared by the secretary and submitted to the committee members in sufficient time before the meeting for them to properly review the material.

F. Minutes of the committee meetings should be prepared by the secretary and maintained in the permanent records of the hospital.

G. Recommendations of the committee shall be presented to the medical staff or its appropriate committee for adoption or recommendation.

H. Liaison with other hospital committee concerned with drug use (e.g. infection control, medical audit) shall be maintained.

Functions and Scope of PTC

A. To serve in an evaluative, educational, and advisory capacity to the medical staff and organiztional administration in all matters pertaining to the use of drugs.

B. To develop a formulary of drugs accepted for use in the organization and provide for its constant revision.

C. To establish programs and procedures that help ensure safe and effective drug therapy.

D. To establish programs and procedures that help ensure cost – effective drug therapy.

E. To establish or plan suitable educational programs for the organization's professional staff on matters related to drug use.

F. To participate in quality assurance activities related to distribution, administration, and use of medications.

G. To monitor and evaluate ADRs in the health – care setting and to make appropriate recommendations to prevent their occurrence

H. To initiate or direct (or both) drug use evaluation program and studies, review the results of such activities, and make appropriate recommendations to optimize drug use.

I. To advise the pharmacy department in the implementation of effective drug distribution and control procedures.

J. To disseminate information on its actions and approved recommendations to all organizational health – care staff.

Policies of the Committee

A. Proposal for a new drug for the hospital formulary shall be submitted on a Formulary Request Form. Such request may be submitted by any member of the medical staff. The Committee will evaluate the request and notify the proposer as to acceptance or rejection. The proposer shall have the opportunity to appeal the decision of the Committee.

B. Drugs evaluated and approved by the Committee will be assigned to one of the four categories:

1. Formulary Drug
   - An FDA approved drug which is recommended as being essential for good patient care with a well established usage. Once accepted as a Formulary Drug, it may be prescribed by all members of the attending and house staff.
   
   
2. Drug Approved on a Conditional Trial Period
   - A drug approved by the FDA for general use but which the Committee will evaluate for a 6 to 12 months period before final consideration. During that period, the drug may be prescribed by all members of the attending and house staff.
3. Specialized Formulary Drug
   
   
   - An FDA approved drug which is recommended for use in specialized patient care. The drug may be placed in this category by the proposer or the Committee and either may designate those persons authorized to prescribed the Specialized Formulary Drug.
   
   
4. Investigational Drugs
   - A drug which has been approved by the FDA for a special use by its principal investigator and designated associates. Such drugs are not commercially available. A protocol of the study must be submitted to the pharmacy if it is to be used in the hospital.

• The drugs is not necessarily a new chemical substance but may be:
  • A. An old or approved drug proposed for a new use
  • B. A new combination of 2 or more old drugs.
  • C. A combination of old drugs in new proportions
  • D. A new dosage form or method of administration.

C. Non – Formulary Drugs are drugs which do not qualify for the four categories listed and will not be stocked in the pharmacy. If prescribed the Pharmacy will obtain and dispense a limited quantity of the drug.

D. The pre-signing of prescription blanks or drug orders for any purpose is prohibited.

E. Formulary system dictates that all drugs will be dispensed on the basis of generic names. Authority for the routine selection of the drug brands is delegated to the Pharmacy Department utilizing a fair and equitable bid process, when necessary.

F. Drug Recall may emanate from manufacturers, regulatory agencies, or the Pharmacy Department, and may be of a general nature or a specific recall for one or more lot numbers. Once the recall notice is received, the drugs will be removed and replaced; and this information will be sent to staff and pertinent hospital departments.

G. In – Patient Prescribing

1. Routine Drug Orders – A physician's medication order written on in-patient order form is deemed a legal prescription. A legible copy of the medication order must be forwarded to the Pharmacy. Orders written by medical students must be counter-signed by a member of the medical staff. Quantities of drugs to be dispensed need not be specified since the pharmacist will determine the optimum amounts in keeping with greatest economy to the patients and efficiency in handling and storage by the nursing and pharmacy staff.
2. IV Orders – Orders for intravenous medications must be written in the same manner as routine drugs and must include then following additional information:

• The exact quantity of the drug/s which must be added.
• The exact volume and name of the infusate solution.
• Specific directions for administration such as IV drip, IV bolus, IV push, etc.
• Specific times to hang infusate solution and drip rate.
• Specific directions for continuing or discontinuing any IV medications.

3. Total Parenteral Nutrition (TPN)

• TPN has been designed to serve as a nutritional infusion providing essential amino acids, carbohydrates, and electrolytes for patients incapable of ingesting, digesting, or absorbing food substances given by mouth. Since a standard hyperalimentation solution always be prepared extemporaneously, the pharmacy department shall be responsible for the preparation of these solutions.
• Ordering
  • The TPN mixture may only be prescribed by an authorized House Staff physician in conjunction with a Dietician through consultation.
  • The written order must be sent to the Pharmacy for verification including the basic solution and all additives.
  • Following the original order, subsequent orders must be confirmed every morning and recorded on a card designated for that specific patient.
  • A 24 hour supply is to be ordered by the physician each morning.
  • Only electrolytes and vitamins may be added to hyperalimentation solution

4. Self-Medication – Only nitroglycerin and antacids may be left at the patient's bedside for self administration if so ordered by the physician. The quantity of nitroglycerin is limited to 10 tablets which must be counted by the nurse at the conclusion of each shift and charted in the patient's medical record. Antacids must be recorded and replenished in the same manner.
   
   
5. Automatic Stop Orders – Applies to instances when the physician did not specify the exact number of doses or duration of therapy (open ended drug order). The automatic stop order policy serves as a protection against indiscriminate and indefinite open ended drug orders that can be harmful to the patient and at the same time ensures continuous therapy if so desired by the physician.

• Automatic Stop Orders requirements for medications are:
  • A) 24 hours for controlled drugs
  • B) 7 days for all other drugs
• PRN and standing orders for all medications except Controlled drugs expire at 10:00AM of the following Tuesday. All orders shall be renewed between the hours of 4:00PM Monday and 10:00AM Tuesday. Orders which are written on Monday become effective at 10:00AM Tuesday.

6. A new medication order must be written by the physician if a change is wanted in route of administration or in dosage.
   
   
7. Discharge Prescriptions – a separate prescription is required for each medication which the patient is to take home. Discharge prescriptions must be received in the Pharmacy prior to discharge, so that they may be processed and returned to the nursing station. Delays may result in the patient having to wait which is not consistent may result good patient care.
   
   
8. Emergency (STAT) Orders – Bonafide emergency orders should be rare and in most cases obtained from the nursing station emergency drug supplies. When necessary, these orders should be transmitted in writing on the Pharmacy copy of the in-patient order form. This procedure prevents unnecessary delay and confusion which results from hurried verbal transmission orders. If it is necessary to phone the pharmacy for emergency drugs, calls should be placed either by the physician or the nurse in order to avoid delay and error.
   
   
9. Emergency Kit or Stat Boxes – contains drugs and supplies which is readily available in case of emergencies. The medications and related accessories are standardized and approved by the medical staff through the Pharmacy and Therapeutics Committee.

The Hospital Formulary

The formulary and formularies have existed in the United States since the days of the American Revolution; they existed in European hospitals for centuries prior to this. The need for hospital formularies becomes increasingly great because of: (1) the increasing number of new drugs being marketed, (2) the increasing influence of biased advertising and unscientific “scientific” drug literature, (3) the increasing complexity of untoward effects of the newer more potent drugs, (4) the highly competitive marketing practices of the pharmaceutical industry; and (5) the public's interest in seeing that the health professions are continuously providing the best possible care at the lowest possible cost. In the interest of better patient care, the institution should have a program of objective evaluation, selection, and use of medicinal agents in the facility. This program is the basics of appropriate, economical drug therapy. The formulary concept is a method for providing such a program and has been utilized as such for many years.

Definition of Formulary and Formulary System

Formulary System is a method whereby the medical staff of an institution, working through the PTC evaluates, appraises and selects from among the numerous available drug entities and drug products those that are considered most useful in patient care. Only those so selected are routinely available from the pharmacy. The formulary system is thus an important tool for assuring the quality of drug use and controlling its costs.

Formulary is a continually revised compilation of pharmaceuticals (plus important auxillary information) that reflects the current clinical judgment of the medical staff.

Formulary Content and Organization

The primary objective of the formulary are to provide the hospital staff with:

1. Information on what drug products have been approved by the pharmacy and therapeutics committee.
2. Basic therapeutic information about each approved item.
3. Information on hospital policies and procedures governing the use of drugs.
4. Special information about drugs such as drug dosing rules monograms, hospital approved abbreviations, etc.

In accordance with these objectives, the formulary should consist of three main parts:

PART I – Information on hospital policies and procedures concerning drugs

PART II – Drug products listings

PART III – Special Information

PART I: Information of Hospital Policies and Procedures Concerning Drugs

The material to be included in this section may vary from hospital to hospital. Generally, the following items may be included: (1) Categories of drugs, (2) Brief description of the PTC, (3) Hospital regulation governing the prescribing, dispensing and administration of drugs, (4) Pharmacy operating procedures, and (5) information on using the formulary.

PART II: Drug Product Listing:

This section is the heart of the formulary and consists one or more descriptive entries for each formulary item plus one or more indexes to facilitate the use of the formulary. Formulary item entries are entries that can be arranged in several ways: (1) alphabetically generic name with entries for synonyms and brand names containing only a “see generic name” notation, (2) alphabetically within the therapeutic class, (3) a combination of the two systems whereby the bulk of the drug are contained (alphabetically) in a “general” section which is supplemented by several “special” sections such as ophthalmic / otic drugs, dermatologicals and diagnostic agents.

PART III: Special Information

Example of items found in the special information section of hospital formularies are: list of hospital-approved abbreviations, poison antidote charts, etc.

Selection of Guiding Principles for Admission or Deletion of Drugs

Criteria:

1. Drugs must be of proven clinical value based upon experience.
2. The drugs must be recognized by USP/NF or their supplement.
3. The manufacturers of these drugs must be of proven integrity and dependability as well as having the regulation of initiating and supporting research activities of merits.
4. No preparation of secret composition will be considered or admitted to the formulary.
5. No product of multiple composition shall be admitted if the same therapeutic value can be obtained through the use of a single drug entity.

The Hospital

Hospital is a place wherein sick people and injured people are being attended to and cared for.

Institution is a significant and persistent element (as a practice, a relationship, an organization) in the life of a culture that centers on a fundamental human need, activity or value, occupies an enduring and cardinal position within a society, and is usually maintained and stabilized through social and regulatory agencies.

History and Development of Hospital

Hospital had their origin in Indian and Egyptian culture during the sixth century. Evolution of the hospital is related to the sociological development of the individual's expansion of interest beyond himself and his family to the welfare of the community. Although early hospitals were really places to remove people from society to protect society, is, the insane, the incurables, and the contagious, other hospitals were developed through religious and divine motives. The temples of the gods in early Greek and Roman civilization were used as hospitals where healing was associated with divine powers, while continued illness or death was associated with lack of purity. Greek temples were forerunners of the modern hospital in the sense that they provided refuge and treatment for the sick and also provided for the teaching of young medical students. Such temples as the Temple of Aesculapius (Greek god of Medicine) existed in 1134 B.C., which the temple at Kos, Greece was where Hippocrates (born about 460 BC) practiced.

One of the dominant factor in the development and expansion of hospitals was the religious influence. Prior to the Christian Era, hospitals were temples dedicated to the god of medicine in which care of the sick was accompanied by magical, mystical, and religious ceremonies. The doctrines of Jesus Christ intensified the emotions and virtues of love, pity, and charity. These strong motivating forces toward one's fellow man fave impetus to the expansion of hospitals.

Another major factor in the development and expansion of hospitals devolves from a military influence. Much of the impetus toward medical and surgical progress over the centuries has come from the urgent need for care of the wounded on the battlefield. This was true during the Roman Empire; it was also true in the United States before, during, and after the Civil War. The Civil War, however, focused attention on the inadequacy of hospital construction and also on the lack of nursing care. Lincoln requested Catholic Sisters to care for wounded army personnel, because hospital care was so poor. The work done in the army set a pattern for improvement in patient care and combined the military and religious influence on hospital development.

Other factors which have influenced the development and expansion of hospitals were:

1. The Flexner report on medical education (1910), which caused revolutionary developments in medical education per se and in medical internship training which helped the development of minimum standards for patient care in hospital surroundings.
2. The activities of Florence Nightingale during and after the Crimean War, which served as the basis for revolutionizing the quality of nursing care in hospitals and for the development of schools of nursing; and
3. The public interest in hospitals through greater dependence and improved confidence in hospital care. With support provided the finances for further development, expansion, and improvement in hospital facilities. This public interest extended its influence into private hospitalization insurance and into government participation in health care through social security and other health-related agencies.

One of the most significant governmental programs which has affected the development and expansion of hospital facilities in the US was the adoption (in 1946) by the congress of the Hospital Survey and Construction Act. Commonly known as the Hill-Burton Program, this act was passed to provide federal funds for hospital construction on a matching basis with local communities. From 1946 to 1973 hundreds of new hospitals have been built which hundreds of other hospitals have undertaken major expansion programs of existing facilities through the availability of government finances through the Hill-Burton Act.

Since that time a number of legislative amendments have been adopted by the Congress which made funds available for construction and improvement of various health-care facilities, including, medical and nursing schools, out-patient facilities, extended-care facilities, and specialized diagnostic and therapeutic facilities in hospitals. In addition, the Social Security Amendments of 1965 (Medicare) will have long range impact on the development and expansion of hospitals, because funds are made available to pay for services of medically indigent patients lacking means to pay hospitals for services rendered.

The National Planning and Resources Development Act was implemented in 1975 creating the development of Health Systems Agencies (HSAs). These agencies have the responsibility of effective health planning and development of health services, manpower, and facilities in local areas. Each has is responsible for:

1. Improving the health of residents of its health service area;
2. Increasing the accessibility, acceptability, continuity, and quality of services provided;
3. Restraining increases the cost of these services;
4. Preventing unnecessary duplication of health resources.

In 1983, Congress enacted significant changes in the methods by which hospitals are reimbursed for medicare patients in an effort to hold down the escalating hospital costs. A Prospective Payment System was developed to reimburse hospitals at a specific rate based upon the diagnosis of the patient diagnosis related group (DRG). The system of payment may affect other private reimbursement system.

The first hospital on the American continent was built by the Spaniards (led by Cortez) in 1524 – The Hospital of the Immaculate Conception in Mexico City. In 1663 its name was changed to The Hospital of Jesus of Nazareth, and it still exists today. In the American Colonies a hospital was built in 1663 on Manhattan Island for sick soldiers. The first incorporated hospital in the United States was the Pennsylvania Hospital, established in 1751 through the efforts of Dr. Thomas Bond to provide physicians in Philadelphia with a population of 300,000 had no hospital. Since 1873 the population of the United States has more than doubled but the number of hospitals has increased 44 times – from only 149 to approximately 7000.

Beyond the three basic essentials of human existence the hospital has become a necessary instrument for providing a fourth basic element of survival – health. The hospital serves as a major instrument through which the health professions are able to provide health to the people of the community. It is because of the increasing complexity of health care – diagnostic, preventive, and therapeutic – that the necessary trained personnel, facilities and equipment are consolidated into what is known as the hospital in order to provide the quality of care the public expects, demands and deserves.

Definition of Hospital in terms of form:

Hospital is best exemplified by the “registration of hospitals program.” In order to be registered under this program an institution must meet certain requirements which constitute the definition of a hospital. The American Hospital Association (AHA) has specific definitions for “General” and “Special” hospitals in order for these institutions to qualify for the association's registration program.

Requirements for Accepting General Hospitals for Registration:

1. The institution shall maintain at least six in-patient beds, which shall be continuously available for the care of the patients and who stay on the average in excess of 24 hours per admission.
2. The institution shall be constructed, equipped and maintained to ensure the health and safety of patients and to provide uncrowded, sanity facilities for the treatment of patients.
3. There shall be an identifiable governing authority legally and morally responsible for the conduct of the hospital.
4. There shall be a chief executive to whom the governing authority delegates the continuous responsibility for the operation of the hospital in accordance with established policy.
5. The shall be an organized medical staff of physicians that may include, but shall not be limited to dentists. The medical stall shall be accountable to the governing authority for maintaining proper standards of medical care, and it shall be governed by laws adopted by said staff and approved by the governing authority.
6. Each patient shall be admitted on the authority of a staff member shall be directly responsible for the patient's diagnosis and treatment. Any graduate of a foreign medical school who is permitted to assume responsibilities for patient care shall possess a valid license to practice medicine, or shall be certified by the Educational Council for Foreign Medical Graduates, or shall have qualified for and have successfully completed an academic year of supervised clinical training under the direction of a medical school approved by the liaison Committee on Medical Education.
7. Registered nurse supervision and other nursing services are continuous.
8. A current and complete medical record shall be maintained by the institution for each patient and shall be available for reference.
9. Pharmacy service shall be maintained in the institution and shall be supervised by a registered pharmacist.
10. The institution shall provide patients with food service that meets the nutritional and therapeutic requirements; special diets shall also be available.
11. The institution shall maintain diagnostic X-ray service, with facilities and staff for a variety of procedures.
12. The institution shall maintain clinical laboratory service with facilities and staff for a variety of procedures. Anatomical pathology services shall be regularly and conveniently available.
13. The institution shall maintain operating room service with facilities and staff.

Requirements for Accepting Special Hospitals for Registration:

1. The institution shall maintain at least six in-patient beds, which can be continuously availability for the care of the patients and who stay on the average in excess of 24 hours per admission.
2. The institution shall be constructed, equipped and maintained to ensure the health and safety of patients and to provide uncrowded, sanity facilities for the treatment of patients.
3. There shall be an identifiable governing authority legally and morally responsible for the conduct of the hospital.
4. There shall be a chief executive to whom the governing authority delegates the continuous responsibility for the operation of the hospital in accordance with established policy.
5. The shall be an organized medical staff of physicians that may include, but shall not be limited to dentists. The medical stall shall be accountable to the governing authority for maintaining proper standards of medical care, and it shall be governed by laws adopted by said staff and approved by the governing authority.
6. Each patient shall be admitted on the authority of a staff member shall be directly responsible for the patient's diagnosis and treatment. Any graduate of a foreign medical school who is permitted to assume responsibilities for patient care shall possess a valid license to practice medicine, or shall be certified by the Educational Council for Foreign Medical Graduates, or shall have qualified for and have successfully completed an academic year of supervised clinical training under the direction of a medical school approved by the liaison Committee on Medical Education.
7. Registered nurse supervision and other nursing services are continuous.
8. A current and complete medical record shall be maintained by the institution for each patient and shall be available for reference.
9. Pharmacy service shall be maintained in the institution and shall be supervised by a registered pharmacist.
10. The institution shall provide patients with food service that meets the nutritional and therapeutic requirements; special diets shall also be available.
11. Such diagnostic and treatment services as may be determined by the Board of Approval to be appropriate for the specified medical conditions for which medical services are provided shall be maintained in the institution, with suitable facilities and staff. If such conditions do not normally require diagnostic X-ray service, Laboratory service, or operating room service, and if any such services are therefore not maintained in the institution, there shall be written arrangements to make them available to patients requiring then.
12. When the institution provides pregnancy termination services, clinical laboratory services shall include the capability to provide tissue diagnosis.

Definition of Hospital in terms of broad purpose or mission:

The contemporary hospital is a community institution which is an instrument of society. It serves as the focal point for the coordination and delivery of patient care to its community. A hospital may be viewed as an organized structure which pools together all the health professions, the diagnostic and therapeutic facilities, equipment and supplies, and the physical facilities into a coordinated system for delivering health care to the public.

Classification of Hospital

Hospital may be classified in different ways by:

1. Type of Service:

• A. General Hospital – provides care to patients with any type of illness: medical, surgical, pediatric, psychiatric, etc.
• B. Special Hospital – are those which restrict the care they provide to special conditions, such as cancer, psychiatric, or pediatric cases.

2. Length of Stay:

• A. Short – Term Hospital – is one which the average length of stay the patient is less than 30 days. E.g. The patients with acute disease conditions and emergency cases, usually general hospitals are short-term, since acutely ill patients usually recover in less than 30 days.
• B. Long – Term Hospital – is one in which the average length of stay of the patient is 30 days or longer. E.g. Psychiatric or mental retardation conditions.

3. According to Ownership:

• A. Governmental Hospitals – Federal (Armed Forces Veterans Administration and Public Health Services), State, County, City / Municipality, City – County, Hospital District
• B. Non-governmental Hospitals – Non – profit ( Church related or operated) and other non – profit institutions. For profit ( individual, partnership and corporation)

4. Hospitals are generally classified by bed capacity in according to the following pattern:

• Under 50 beds
• 50 – 90 beds
• 100 – 199 beds
• 200 – 299 beds
• 300 – 399 beds
• 400 – 499 beds
• 500 beds and over

5. According to Level

• A. Primary Level Hospital
• B. Secondary Level Hospital
• C. Tertiary Level Hospital

Definition of Different Hospitals

1. Federal Hospitals – are owned and operated by various branches of federal government.
2. State Hospitals – are owned by the states and controlled by a board of control or division of the state government, or a similar organization responsible to state government.
3. County Hospitals – are owned by the county and are financed and controlled similarly to state hospitals, only on a county level. They are usually general hospital caring for the indigents.
4. City Hospitals – are owned, financed, and controlled by the city government. They are usually general hospital caring for the indigents.
5. The Proprietary or Private Hospital Organized for Profit – is usually a corporation composed of physicians, although, other businessman may be involved in the corporate profit-making structure.
6. Non – Profit, Non-governmental Grouping of Hospitals – some are church hospitals supported financially by fees from paying patients or by contributions from the several religious orders or churches.
7. Community Hospitals or Private Non – Profit Hospitals – are owned and operated by members of the community, but with no relationship to the local government.

Four Fundamental Functions of Hospitals

A. Patient Care – the modern hospital is charged with maintaining and restoring health to the community which serves. Two basic types of accommodation based on the patient's ability to pay:

• 1. The full pay or private patient 

• 2. The partially or totally medical indigent (charity) patient.

B. Teaching Education – important function of the modern hospital whether it is or it is not affiliated with a university. Two major forms:

• 1. Education of medical and allied health professional
• 2. Education of the patients

C. Research – hospitals carry out research as a vital function for two major purpose:

• 1. The advancement of medical knowledge against diseases
• 2. The improvement of hospital services

D. Public Health – prime objective is to assist the community in reducing the incidence of sickness and to increase the general health of the population.

Organization and Administration of Hospital

Governing Body – it is where the administrator, director, medical director or whatever the individual be titled must report.

Duties of the Governing Board performed through the CEO (Chief Executive Officer):

1. Responsible for the selection of competent personnel including the medical staff.
2. The control of hospital funds
3. The supervision of the physical plan

Internal organization of the Governing Board:

1. A president or chairman
2. Vice chairman
3. Secretary – CEO
4. Treasurer
5. Lawyer

Departments Classification

1. Services involve primarily the professional care of the patient:

• Example: Pharmacy, Blood Bank, Central Sterile Supply, Clinical Laboratory, Dental Service, Dietary and Nutritional Service, etc.

2. Services which involve primarily the business management or administration side of the hospital:

• Example: Accounting, Admitting, Business Office, Credit and Collection Computer Services, Engineering and Maintenance, etc.

The Medical Staff

The medical staff of a hospital falls in a different category organizationally than the departments. Physicians are independent agents taking care of their patients, and they utilize the hospital, its departments, facilities, and services to care for these patients. The governing board of the hospital and the community, which it represents exercise effective control over the medical staff, although the governing board neither originates nor implements medical policy, it is responsible for it, and while the board members are not competent to pass judgment on the professional care of the patients they are, as representatives of the ownership of the hospital, liable for dereliction pf duties established by law. Thus the board delegates a portion of its duties and responsibilities to its appointed medical staff to originate medical policy honestly and carry out his policy in good faith. To do this requires that the medical staff be organized to govern itself and appraise its own work, and yet be responsible to the governing board for the details of its work.

Duties of the Medical Staff

1. Providing professional care of the sick and injured in the hospital.
2. Maintaining its own efficiency.
3. Self – government
4. Participating in the educational program of the hospital.
5. Auditing its own professional work.
6. Advisory and assisting the administrator and governing board regarding medical policies.

Two Main Types of Hospital Staff

1. An Open Staff – one in which certain physicians other than those on the attending or active medical staff are allowed to utilize the private room facilities, provided they comply with the rules and regulations of the institution. These physicians are termed members of the “courtesy” medical staff; the hospital is termed an open staff hospital.
   
   
2. A Closed Staff – one in which all professional services, private and charity are provided and controlled by the attending or active medical staff; the hospital is termed as closed staff hospital. The closed staff, though it has minor drawbacks, is the more desirable for the average hospital and especially for the teaching hospital, because it allows careful selection of a group of specialists with excellent reputation.

Medical Staff Categories

1. An Honorary Staff – is composed of physicians who have been active in the hospital but who are retired, and of those to whom it is desired to do honor because of outstanding contribution.
2. The Consulting Medical Staff – consists of specialists who are recognized as such by right of passing specialty boards or belonging to the rational organization of their specialty, and who serve as consultants to other members of the medical staff.
3. The Active or Attending Medical Staff – is the group primarily concerned with regular patient care. It is the group most actively involved in the hospital. In internal staff government it is the authoritative body.
4. The Associate Medical Staff – is composed of junior or less experienced members of the staff.
5. The Courtesy Medical Staff – consists of those physicians who desire the privilege of attending private patients but who do not desire active staff membership.
6. The Resident Medical Staff – is composed of residents, who are full time employees of the hospital. These persons provide specific services, for which they receive education and experiences.

Hospital Pharmacy

Hospital Pharmacy is the practice of pharmacy in a hospital setting including its organizationally related facilities or services. It is a department or division of the hospital wherein the procurement, storage, compounding, manufacturing, packaging, controlling, assaying, dispensing, distribution, and monitoring of medications to hospitalized and ambulatory patients are performed by legally, professionally competent pharmacists.

Hospital Pharmacy is responsible for the safe and appropriate usage of drugs in patients, which includes among other things, the rational selection, monitoring, dosing and control of the patients overall drug therapy program. This approach to pharmacy practice has been referred to as “Clinical Pharmacy.”

Uniqueness of Hospital Pharmacy from Private or Community Pharmacy

A. Internal forces affecting the practice of pharmacy in the hospital setting

1. A major factor is the organizational structure of a hospital/institution.

• Administrator – implements the policies and philosophies of the governing board.
• Department Heads – coordinate their services and activities with other department heads.
• Business and Accounting Department – handles the financial affairs.
• Building Services Department – provides the essential maintenance, housekeeping, and security functions.
• Personnel Department – implements personnel policies.
• Clinical Laboratory Department – performs a multitude of patient laboratory tests and services.

2. There is a physician – pharmacist – nurse – patient relationship in the hospital.

B. External forces which affect the practice of pharmacy in the hospital setting

1. Accreditation Agencies – exerts their influence on professional standards of practice as they affect patient care.
2. Licensing Agencies – exert their legal influences on hospital operations.
3. Federal Government – imposes standards and regulations on hospitals, such as the “conditions of Participation for Hospital” under medicare.
4. Third-Party (Hospitalization Insurance) Agencies – exerts their influence on the methods by which hospitals may be reimbursed for services rendered to patients.
5. Social Agencies and Governmental Welfare Agencies – influence the services provided to medically indigent and totally indigent patients.
6. The Government Board and Public Opinion – exert their influences over the policies, objectives and philosophies of hospital operation and services.

C. Fundamental Functions of Hospitals

1. Patient Care – the modern hospital is charged with maintaining and restoring health to the community which serves. Two basic types of accommodation based on the patient's ability to pay:

• 1. The full pay or private patient
• 2. The partially or totally medical indigent (charity) patient.

2. Teaching Education – important function of the modern hospital whether it is or it is not affiliated with a university. Two major forms:

• 1. Education of medical and allied health professional
• 2. Education of the patients

2. Research – hospitals carry out research as a vital function for two major purpose:

• 1. The advancement of medical knowledge against diseases
• 2. The improvement of hospital services

4. Public Health – prime objective is to assist the community in reducing the incidence of sickness and to increase the general health of the population.

Recent Significant Developments in Hospital Pharmacy

1. There is a special education and training at the graduate level.
2. It has its own vigorous professional society
3. It has been developing a useful body of specialized knowledge through its documented literature.
4. It has developed a strong corps of well-qualified career hospital practitioners who have adopted a sound philosophy of professional service and have developed a high standards of practice.

The Hospital Pharmacy

The separation of pharmacy form medicine took place in charitable institutions operated under governmental or ecclesiastic authority. The fact that business interests played no part in the delivery of care to patients in these institutions led to an eventual division of labor in the physician – apothecary function led to the recognition of pharmacy as a separate discipline from medicine. Since the division occurred in hospitals, the hospital pharmacist was the first recognized practitioner of the profession of pharmacy.

The development of hospital pharmacy in different countries was vitally affected by educational standards and by the caliber of its practitioners. Thus, hospital pharmacy as an important professional specialty was virtually neglected in America for almost 168 years, form the time that Jonathan Roberts became the first hospital pharmacist as the Pennsylvania Hospital (Philadelphia) in 1752, to approximately 1920. After naming Charles Rice (1841 – 1901) of Bellevue Hospital in New York City, and Martin I Wilbert (1865 – 1916) of the German Hospital in Philadelphia, it is difficult to recall other equally prominent contemporary hospital pharmacist of the same period.

A National Professional Society

Significant Contributions of the American Society of Hospital Pharmacist Toward The Improvement of Hospital Pharmacy:

1. The American Journal of Hospital Pharmacy – one of the best professional publication in international pharmaceutical circles.
2. The international Pharmaceutical Abstract
3. The American Hospital Formulary Service – is a comprehensive unbiased source of information on drugs provided on a supplemented basis annually. It serves as the basis for the pharmacist to extend his role as pharmaceutical consultant to the medical profession.
4. Mirror to Hospital Pharmacy – provided the findings from an exhaustive study of hospital pharmacy in the US to improve the quality and expand the scope of its pharmaceutical service.
5. Institutes – a continuing education program served to help the hospital pharmacy practitioner to keep up with current trends of professional practice.

Organization of Hospital Pharmacy:

Within the organizational structure of the hospital the director of pharmacy, as department head, reports to the administrator of the hospital on the proper operation and management of the pharmacy. The director of pharmacy formulates and implements departmental administrative and professional policies of the pharmacy subject to the approval of the administrator. The professional and clinical policies relating to hospital pharmacy practice that have a direct relationship to the medical staff are formulated and developed through the pharmacy and therapeutic committee and are subjected to administrative approval.

Hospital Pharmacist Responsibilities

A. In – patient Pharmacist's Responsibilities

1. Central Dispensing Area

• Ensures that established policies and procedures are followed.
• Checks for accuracy of doses prepared.
• Provides for proper drug control
• Ensures that good techniques are used in compounding IV admixtures and extemporaneous preparations.
• Provides for proper record keeping and billing
• Maintains professional competence particularly in knowledge of drug stability and incompatibilities.
• Keeps the central dispensing area neat and orderly.
• Provides drug information as necessary to the pharmacy, medical, and nursing staff
• Coordinates the overall pharmaceutical needs of the patient care area with the central dispensing area.

2. Patient Care Area

• Supervision of drug administration technicians
• Direct Patient Care
  • 1. Identifies drugs brought into the hospital by patients
  • 2. Obtains patient medication histories and communicate all pertinent information to the physician.
  • 3. Assists in drug product and entity selection.
  • 4. Assists the physician in selecting dosage regimens and schedules, then assigns drug administration times for these schedules.
  • 5. Monitors patient's total drug therapy for:
    • Effectiveness/ineffectiveness
    • Side effects
    • Toxicities
    • Allergic drug reactions
    • Drug interactions
  • 6. Counsels patients on:
    • Medication to be self administered in the hospitalization
    • Discharge medications
  • 7. Participates in Cardiopulmonary emergencies by:
    • Procurement and preparation of needed drugs
    • Charting all medications given
    • Performing cardiopulmonary resuscitation, if necessary

B. General Responsibilities

1. Provides in – service education to:

• Pharmacists, pharmacy interns, residents and students.
• Nurses and nursing students
• Physician and medical students

2. Provides drug information to physicians, nurses and other health care personnel

Hospital Pharmacy Staffing

The staffing pattern in hospital pharmacy varies, depending on the scope and quality of service being offered.

As the size of the hospital increases so does the personnel in the pharmacy. For example in a 300 – bed progressive hospital, the pharmacy may be staffed with a chief pharmacist, an assistant chief pharmacist, from 5 – 10 staff pharmacists, 4 – 8 non – pharmacists and a full – time department secretary.

In a very large hospital with several hundred of beds, one may mind the staffing pattern to consist of pharmacy director, an associate director, two or more assistant directors, one or more supervisor pharmacists, as many as 40 – 50 or more staff pharmacists, 10 – 16 pharmacy residents, and about as many non – pharmacist helpers, technicians and secretarial personnel as professional personnel.