History of Hospital Pharmacy

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Introduction to Hospital PharmacyOutline:I. Definition of Hospital PharmacyII. Evolution of Hospital PharmacyIII. Uniqueness of Hospital PharmacyIV. Goals of Hospital PharmacyV. Minimum Standards of Pharmacies in the Hospital

Definition: (Hassan, 1974)Department or service in a hospital in which under the direction of a professional competent, legally qualified pharmacist.

Evolution of Hospital Pharmacy56th centuryHospitals originated in India and Egypt to protect the society from contagious diseases, insanity and incurables

Temples of God serves as hospitals. Healing were associated with divine powers because they believed that illness is due to lack of purity.

Ex: Temple of Kos in Greece it is where Hippocrates (Father of Medicine practicedHistory

Temples of God in Greek and Roman CivilizationTemple of Aesculaptos 1134 (Greek God of Medicine)History 16th centuryMonasteries had infirmarian place where successful treatment to diseases were being offered 17th centuryPennsylvania Hospital ( the first hospital in Colonial America) was opened1752 - Jonathan Roberts was the first hospital pharmacist/apothecary

Medicine and Pharmacy are being practiced together. At that time drug preparation are often the responsibility of a medical apprentice

HistoryApothecarys shop was built. Apothecary became the resident in the hospital. His duties involved the administration of patients admissions, procurement and dispensing of medicines and the assumption of responsibility in the absence of medical staff and matron.Elaboratarian helps in the preparation of medicines; who did the unskilled work

18th centuryHospital pharmacist were rare because there were few hospitalsHospitals were places of dreaded impurity and exiled human wreckageHistoryHistory18th centuryIn early 1800s clean air and good food rather than medicines were treatments emphasized in hospitalsIn 1870s and 1880s responding to the influx of immigrants (mostly Roman Catholics) Catholic hospitals were built. Catholic hospitals charged patients small fee and they were willing to train nuns in the pharmacy.

HistoryEarly 1900sAdvent of hospital formularyHospital Formulary a list of drugs approved for use within the hospital or health system by the Pharmacy & Therapeutics Committee.1920 Prohibition (alcohol)1930s AHA created a Committee of Pharmacy to analyze problems and make recommendations.The aim of the committee was to develop minimum standards for hospital pharmacy department and prepare manual operations.1957 - 1960Major study conducted by the Audit of Pharmaceutical Services in Hospitals.The group published a book Mirror to Hospital Pharmacy (a publication documenting the state of pharmacy service in the hospitals in the late 1950s)History

Four major themes emerge from an examination changes over the period:Pharmacist must be in charge of drug product acquisition, distribution and controlPharmacist has a major role in patient safetyPharmacist has a major role in promoting rational drug therapyPharmacist has a mission to foster optimal patient outcomes from medication use. HistoryDrug Product Acquisition, Distribution and Control1949s Pharmacy was perceived as complementary service department, not as essential service.Nurses and Community pharmacists (not hospital pharmacist) were responsible for hospital drug Until..1950s2 types of services bulk compounding and sterile solution manufacturing were a major element of the hospital pharmacists identity Drug Product Acquisition, Distribution and ControlPatient Safety1957

2 ways of drug distribution:

1. ward stock2. individual prescription

Result: errors in prescribing and transcribingSolution: Unit dose Drug Distribution

William M. Heller & William W. Tester- conducted important studies on unit dose drug distribution

Unit Dose Drug DistributionThe RPh receives the physicians original order or direct copy.The RPh reviews the medication order before the first dose is dispensedSingle unit packagingMedication is dispensed in as ready to administer form Not more than 24 hours of dose is deliveredMedication profile is maintained

Ward stockThe RPh never sees the physicians original orderErrors made by the physician & errors in transcribing or nurses were often undetectedComparisonUntil..Automated systems and Distribution devices was developed

Electronic Medical RecordComputerized Prescriber Order SystemsUntil..Automated systems and Distribution devices was developed

Bar Code Medication AdministationSmart PumpsPromoting Rational Drug Use1936 U. S. Edward Spease ( Father of Hospital Pharmacy Standards) and Robert Porter developed the concept of..Pharmacy & Therapeutics CommitteeCommittee of medical staff (Dr, RN, RPh etc..) which oversights medication management.Establishes FormularyAssesses medication useMakes Recommendation on policies and procedure associated with medication management.Pharmacists serves as the secretary of the committee

A structure for evaluating, appraising and selecting drug products to be available for use in patient careFramework in which medication-use policies are established and implemented.

Formulary- A list of drugs approved for use within the hospitalFormulary SystemFostering Optimal Patient OutcomeTo help people make the best use of medicines

During 1950sPharmacists were less frequently asked for advice on medications (ADR, dosage forms..)

ASHP Hilton Head Conference in 1985Emerged the idea that hospital pharmacies should function as clinical departments with the mission to foster the appropriate use of medicine Fostering Optimal Patient OutcomeEvolution of Hospital Pharmacy in the Philippines281577 Hospital de San Juan de Dios and Hospital de San Lazaro were built by the Franciscans

1962 The Philippine Society of Hospital Pharmacist was organized. It promotes the interests of hospital pharmacists. Dr. Rosario Capistrano Tan-first president of PSHP Ms. Normita Leyesa (MMC)- the president of PSHP Uniqueness of Hospital Pharmacy Practice30Similarities of Community and Hospital PharmacyCheck prescriptions for proper dosageCompound prescribed pharmaceutical products by calculating, measuring and mixing the quantities of drugs and other ingredients required and filling appropriate containers with correct quantityDispense prescribed pharmaceuticals to customers or to other health care professionals and advise them on indications, contra-indications, adverse effects, drug interactions and dosage

Community pharmacists and hospital pharmacists perform some or all of the following duties:Maintain medication profiles of customers including registry of poisons and narcotic and controlled drugsEnsure proper preparation, packaging, distribution and storage of vaccines, serums, biologicals and other drugs and pharmaceuticalsOrder and maintain stock of pharmaceutical supplies

Community pharmacists and hospital pharmacists perform some or all of the following duties:Advise customers on selection and use of non-prescription medicationMay supervise and co-ordinate the activities of other pharmacists, pharmacy assistants, pharmacy technicians and other staff.

Source: Human Resource and Skill Development Canadahttp://www5.hrsdc.gc.ca/noc/english/noc/2011/Profile.aspx?val=3&val1=3131Community pharmacists and hospital pharmacists perform some or all of the following duties:Hospital Pharmacy differ from Community pharmacy in ways such asserves as a member of policy-making committees, including those concerned with drug selection, the use of antibiotics, and hospital infections (Drug and Therapeutics Committee) and thereby influences the preparation and composition of an essential-drug list or formulary;is in a better position to educate other health professionals about the rational use of drugs;more easily participates in studies to determine the beneficial or adverse effects of drugs, and is involved in the analysis of drugs in body fluids;

Hospital Pharmacy differ from Community pharmacy in ways such ashas more opportunity to interact closely with the prescriber and, therefore, to promote the rational prescribing and use of drugs;has a greater opportunity to interact with others, to specialize and to gain greater expertise;having access to medical records, is in a position to influence the selection of drugs and dosage regimens, to monitor patient compliance and therapeutic response to drugs, and to recognize and report adverse drug reactions;can more easily than the community pharmacist assess and monitor patterns of drug usage and thus recommend changes where necessary;

Hospital Pharmacy differ from Community pharmacy in ways such ascan control hospital manufacture and procurement of drugs to ensure the supply of high-quality products;takes part in the planning and implementation of clinical trials.

Source: Essential Medicines and Health Products Information PortalA World Health Organization resource, (http://apps.who.int/medicinedocs/en/d/Jh2995e/1.6.4.html#Jh2995e.1.6.4) Minimum Standards for Pharmacies in Hospital381936ASHP adopted the Minimum Standards of Pharmacies in Hospital it serves as a practice standards for hospital pharmacy practice

Practice StandardAuthoritative advisory documentIt offers minimum requirementsProvides optimal method for addressing an important issue or problemMinimum Standards for Pharmacies in HospitalMinimum Standards for Pharmacies in HospitalMinimum Standards for Pharmacies in Hospital