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.