Chapter 9 Hospital Pharmacy Practice. HOSPITAL PHARMACY SERVICES Inpatient Drug Distribution...

Chapter 9

Hospital Pharmacy Practice

HOSPITAL PHARMACY SERVICES

• Inpatient Drug Distribution Systems: Hospital pharmacies carry out a number of unique activities such as unit dose drug distribution system, repackaging, floor stock, and an IV admixture/TPN service. Also, a unit dose drug distribution system saves money and reduces the chance of medication errors.

Functions of a Hospital

1. Diagnosis and testing

Multiple roles some we take for granted

Table 9.1

Edited by Dr. Ryan Lambert-Bellacov


2. Treatment and therapy

Table 9.1


3. Public processing (including admissions, record keeping, billing, and planning for post-release patient care)

Table 9.1

Functions of a Hospital 4. Public health education and promotion, done through a variety of programs, including smoking cessation programs, weight loss programs, support group programs, and screening of community members (including mammographies and testing of blood pressure and cholesterol) Table 9.1


5. Teaching (i.e., training health professionals)

Table 9.1


6. Research (i.e., carrying out programs that add to the sum of medical knowledge)

Table 9.1

Hospital Pharmacy Issues

• Only unopened unit doses can be returned to stock.

Safety Note!

Hospital Pharmacy Services

1. Maintaining drug treatment records

Lots of similar aspects!!!

Table 9.2

Services Similar to Community Pharmacy Services



2. Ordering and stocking medications and medical supplies

Table 9.2



3. Repackaging medications

Table 9.2




4. Dispensing medications

Table 9.2



5. Providing information about the proper use of medications

Table 9.2




6. Collecting and evaluating information about adverse drug reactions and interactions

Table 9.2




7. Preparing medications in various dose forms for dispensing

Table 9.2




8. Educating and counseling patients about their drug therapies

Table 9.2




9. Preventing, identifying, and resolving medication-related problems

Table 9.2




1. Preparing and maintaining a formulary

This is where the differences start to diverge.

Table 9.2

Services Provided by a Hospital Pharmacy



2. Conducting drug use evaluations

Especially state hospitals

Table 9.2



3. Following universal precautions

More diseases

Table 9.2



4. Preparing products using aseptic techniques

So sterile

Table 9.2




5. Ensuring that hazardous agents are handled and disposed of properly

Table 9.2




6. Filling medication orders (as opposed to prescriptions)

Table 9.2




7. Routinely preparing 24-hour supplies of patient medications in a form appropriate for a single administration to a patient (as opposed to a 30- or 90-day supply)

Table 9.2



8. Stocking nursing stations with medications and supplies

Table 9.2




9. Delivering medications to patients’ rooms

Table 9.2




10. Maintaining a drug information service, and providing drug information to the other healthcare professionals in the institution

Table 9.2



11. Educating and counseling inpatients and outpatients about their drug therapies

Table 9.2




12. Monitoring patient outcomes

Like ICU

Table 9.2



13. Preventing, identifying, and resolving medication-related problems

Table 9.2




14. Participating in clinical drug investigations and research

Table 9.2




15. Providing in-service drug-related education

Table 9.2




16. Reviewing or auditing prescription services for evaluation of service accuracy and quality

Table 9.2




17. Providing expert consultations in such areas as pediatric pharmacology, nutritional support, and pharmacokinetics

Table 9.2




• As in the community pharmacy, in the hospital pharmacy the technician works under the direct supervision of the pharmacist.

Safety Note!

Figure 9.1

Figure 9.2

Figure 9.3


• Clinical Services: Many hospitals offer clinical and consultative services such as nutrition support, pharmacokinetics, critical care, and other specialties.

• Drug Information Services: Most hospitals have a drug information service that is primarily responsible for making recommendations on a drug formulary. A hospital pharmacy may maintain a drug information center, containing reference works, including books, periodicals, microfilm, CDs, DVDs, and access to computerized or Internet databases.


• Outpatient Pharmacy Services: Many large hospitals operate an outpatient pharmacy to serve the medication needs of patients discharged from the hospital, as well as for those patients who are seen in the emergency room or other ambulatory clinics adjoining the hospital.

AUTOMATION IN THE HOSPITAL PHARMACY

Technology is used in the hospital pharmacy to increase accuracy and improve efficiency and quality of pharmacy services. Automated pharmacy services are replacing some of the routine, time-consuming filling procedures. For instance, large automated robots are now being used to perform some of the filling procedures with near 100% accuracy


• All computer systems must protect patient privacy.

Safety Note!


• Although automation reduces errors, technical errors must still be monitored.

Safety Note!


• Expiration dates must be included on all repackaged medications.

Safety Note!

INVENTORY MANAGEMENT

An important part of the technician’s position is the receipt, storage, and ordering of pharmaceuticals; discrepancies in the order from the wholesaler or pharmaceutical manufacturer should be resolved. Automation from the pharmacy wholesalers is making inventory management more accurate and less costly.

ORGANIZATION OF THE HOSPITAL

• Pharmacy Administration: The director of pharmacy is the pharmacist-in-charge, with overall responsibility for the hospital’s pharmacy services. Depending on the hospital size, additional assistant or associate directors may work under the director. In small rural hospitals, only one or two pharmacists may make up the pharmacy staff.


• Joint Commission on Accreditation of Healthcare Organizations: The JCAHO is an independent, non-profit group that sets the standards by which quality of healthcare is measured. The primary mission of JCAHO is to ensure quality care and patient safety in the hospitals that are accredited. They evaluate levels of safety and the quality of care in more than 15,000 healthcare organizations.


• Almost 50% of JCAHO standards relate directly to safety.

Safety Note!


• Pharmacy and Therapeutics Committee: The P&T committee is primarily responsible for making the final decision on drug formulary decisions.

• Infection Control Committee: The major role of the infection control committee (ICC) is the prevention of nosocomial infections in the hospital. Universal precautions are used to prevent infection when a hospital worker comes into contact with blood or other bodily fluids.


• Institutional Review Board: The IRB is responsible for protecting the patient in investigational studies undertaken in the hospital.

Universal Precaution Guidelines

1. Universal precautions apply to all persons within the hospital.

Table 9.3


2. Universal precautions apply to all contact or potential contact with blood, other bodily fluids, or body substances.

Table 9.3


3. Disposable latex gloves must be worn when contact with blood or other bodily fluids is anticipated or possible.

Table 9.3


4. Hands must be washed thoroughly after removing the latex gloves.

Table 9.3


5. Blood-soaked or contaminated materials, such as gloves, towels, or bandages, must be disposed of in a wastebasket lined with a plastic bag.

Table 9.3


6. Properly trained custodial personnel must be called if cleanup or removal of contaminated waste is necessary.

Table 9.3


7. Contaminated materials such as needles, syringes, swabs, and catheters must be placed into red plastic containers labeled for disposal of biohazardous materials. Proper institutional procedures generally involve incineration.

Table 9.3


8. A first-aid kit must be kept on hand in any area in which contact with blood or other bodily fluids is possible. The kit should contain, at minimum, the following items:• adhesive bandages for covering small wounds

Table 9.3


• alcohol

• antiseptic/disinfectant• bottle of bleach, which will be diluted at time of use to create a solution containing 1 part bleach to 10 parts water, for use in cleaning up blood spills• box of disposable latex gloves• disposable towels

Table 9.3


• medical tape

• plastic bag or container for contaminated waste disposal• sterile gauze for covering large wounds

Table 9.3Edited by Dr. Ryan Lambert-Bellacov

DiscussionCommunicating in the hospital setting often means working with a wide variety of other healthcare providers. Understanding what role they play in the patients’ healthcare is essential to effective communication. What duties do each of the following have?

a. primary care physician

b. anesthesiologist

c. registered nurse

d. practical nurse

e. nurse’s aide

f. housekeeping aide

g. social services aide or worker

h. respiratory therapist

i. phlebotomist

j. medical lab technician

k. pharmacist

l. pharmacy technician

Discussion

Write out a complete description, not using abbreviations, of the medication orders given in Figure 9.2 and Figure 9.3.


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Chapter 9 Hospital Pharmacy Practice. HOSPITAL PHARMACY SERVICES Inpatient Drug Distribution...

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