hospital pharmacy

7/17/2019 Hospital Pharmacy

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HOSPITAL PHARMACY

Prepared by:

Dr. Farman Ali Bozdar

Parm!D" M.A So#iolo$y"%MPil&

CO'T('TS

)'IT !I

In*rod+#*ion *o o,pi*al parma#y

-. Deni*ion o/ Ho,pi*al and Ho,pi*al Parma#y

!!!!!!!!!!!!!!!!!!!!!!!!!!! 0

1. 2oal, /or Ho,pi*al

Parma#y!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 3

4. Minim+m S*andard /or Ho,pi*al Parma#y

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 5

4!-Admini,*ra*ion !!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 3

4!1 Fa#ili*ie, !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

6

4!4 Dr+$ di,*rib+*ion and #on*rol

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 54!7 Dr+$ in/orma*ion

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 5



4!0 Ra*ional dr+$

*erapy!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 8

4!3 Re,ear# !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

8

7. Role o/ Parma#y Te#ni#ian in Parma#e+*i#al

Ser9i#e, !!!!!!!!!!!!!-1

0. Or$aniza*ional S*r+#*+re o/ Parma#y Depar*men*

!!!!!!!!!!!!!!!!!!!!!-4

3. Parma#y and Terape+*i#, Commi**ee

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!1

3!- Role or p+rpo,e, o/ #ommi**ee

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!1

3!1 Or$aniza*ion, and Opera*ion !!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!1-

3!4 F+n#*ion, and S#ope !!!! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!11

6. Te Ho,pi*al Form+lary

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!14

6!- Deni*ion o/ /orm+lary and /orm+lary ,y,*em !!!!!

!!!!!!!!!!! 14

6!1 Bene*, o/ *e /orm+lary ,y,*em!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!14

6!4 Forma* and appearan#e o/ /orm+lary

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!17



5. Te 9e ;ri$*,< /or #orre#* dr+$ admini,*ra*ion

!!!!!!!!!!!!!!!!!!!!!!!!13

8. )ni* re9ie=

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!15

)'IT >II

Inpa*ien* Parma#y

-. Ho,pi*al Dr+$ Di,*rib+*ion Sy,*em

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 4

-!- Indi9id+al pre,#rip*ion order ,y,*em!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 41

-!1 Comple*e ?oor ,*o#@ ,y,*em

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 44

-!4 Car$e ?oor ,*o#@ dr+$, and non!#ar$e ?oor ,*o#@

dr+$, !!! 47

-!7 Combina*ion o/ Indi9id+al pre,#rip*ion order ,y,*emand

Comple*e ?oor ,*o#@ ,y,*em !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

40

-!0 )ni* do,e ,y,*em

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 40

-!3 )ni* do,e di,pen,in$ pro#ed+re

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 46

1.Dr+$ Di,*rib+*ion and Con*rol %+ni* do,e ,e#*ion&

!!!!!!!!!!!!!!!!!!!!! 7



1!- (lemen*, o/ di,*rib+*ion

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 7

1!1 ri*in$ *e Order

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 71

1!4 Medi#a*ion Order See*, !!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 74

1!7 Spe#ial Order,

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 77

4.Di,pen,in$ o/ Con*rolled S+b,*an#e,

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 73

4!- Deni*ion o/ addi#*" admini,*er" #on*rol ,+b,*an#e,"

depre,,an* !and ,*im+lan* ,+b,*an#e," nar#o*i# dr+$,

!!!!!!!!!!!! 73

4!1 S#ed+le, /or Con*rolled S+b,*an#e,

!!!!!!!!!!!!!!!!!!!!!!!!!!!! 75

Ho,pi*al Parma#y

4

4!4 Pre,#rip*ion,

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 78

7. Re$+la*ion o/ Ho,pi*al Con*rolled S+b,*an#e,

!!!!!!!!!!!!!!!!!!!!!!!!!! 0

7!- Re$i,*ra*ion o/ do#*or, =o #an pre,#ribe

!!!!!!!!!!!!!!!!!!!!!!!! 0



7!1 Re,pon,ibili*y /or #on*rolled ,+b,*an#e,

!!!!!!!!!!!!!!!!!!!!!!!!!! 0-

7!4 Prepara*ion o/ order," *elepone and 9erbal order,

!!!!!!!!!!!! 0-

7!7 In/orma*ion on daily #on*rolled dr+$ admini,*ra*ion

,ee* ! !!!! 0-

7!0 Pre,#ribin$ #on*rolled dr+$ in o+* pa*ien* depar*men*

!!!!!!!!!!! 01

7!3 Di,pen,in$ #on*rolled dr+$, /or ome +,e

!!!!!!!!!!!!!!!!!!!!!!!! 01

7!6 Pro#ed+re in #a,e o/ =a,*e" de,*r+#*ion"

#on*amina*ion e*# !!!!! 04

0. Prepa#@in$

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 00

0!- Deni*ion and ad9an*a$e, o/ Prepa#@in$!!!!!!!!!!!!!!!!!!!!!!!!! 00

0!1 Fa#*or, #on,idered in prepa#@in$

!!!!!!!!!!!!!!!!!!!!!!!!!!03

3. S*erile medi#a*ion do,e, and I. n+*ri*ion

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 06

3!-Paren*eral Hyperalimen*a*ion!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 06

3!1 In*ra9eno+, addi*i9e pro$ram

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 05



3!4 Prepara*ion o/ I. addi*i9e

,ol+*ion,!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !! 08

3!7 Laminar ?o= ood,

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!3

6. (mer$en#y medi#a*ion

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 34

5. )ni* re9ie=

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 30

)'IT >III

O+* Pa*ien* Parma#y

-! Deni*ion o/ amb+la*ory!#are" primary #are" *er*iary

#are and

emer$en#y #are

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 36

1! Minim+m ,*andard /or amb+la*ory!#are parma#e+*i#al,er9i#e, !!!! 38

4! Lo#a*ion o/ o+*!pa*ien* di,pen,in$ area

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 6

7!Type, o/ pre,#rip*ion,

re#ei9ed!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 6-

0!Di,pen,in$ ro+*ine

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 61

3! In9en*ory Con*rol

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 66



6. )ni*

re9ie=!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!! 5

Re/eren#e ,!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 5-

Ho,pi*al Parma#y

7

)'IT !-

I'TROD)CTIO'

TO HOSPITAL PHARMACY

Ho,pi*al Parma#y

0

D(FI'ITIO' OF HOSPITAL A'D HOSPITAL PHARMACY

Ho,pi*al

Te o,pi*al i, a #omple or$aniza*ion +*ilizin$

#ombina*ion o/ in*ri#a*e"

,pe#ialized ,#ien*i# e+ipmen*" and /+n#*ionin$

*ro+$ a #orp, o/

*rained people ed+#a*ed *o *e problem o/ modern

medi#al ,#ien#e. Te,e

are all =elded *o$e*er in *e #ommon p+rpo,e o/

re,*ora*ion and

main*enan#e o/ $ood eal*



Ho,pi*al Parma#y

Te depar*men* or ,er9i#e in a o,pi*al =i# i, +nder

*e dire#*ion o/ a

pro/e,,ionally #ompe*en*" le$ally +alied parma#i,*"

and /rom =i#

all medi#a*ion, are ,+pplied *o *e n+r,in$ +ni*, and

o*er ,er9i#e," =ere

,pe#ial pre,#rip*ion, are lled /or pa*ien*, in *e

o,pi*al" =ere

pre,#rip*ion, are lled /or amb+la*ory pa*ien*, and

o+*!pa*ien*," =ere

parma#e+*i#al, are man+/a#*+red in b+l@" =ere

nar#o*i# and o*er

pre,#ribed dr+$, are di,pen,ed" =ere inEe#*able

prepara*ion, ,o+ld beprepared and ,*erilized" and =ere pro/e,,ional ,+pplie,

are o/*en ,*o#@ed

and di,pen,ed.

Te #omp+*eriza*ion o/ *e parma#y depar*men*

ma@e, i* po,,ible /or

*e ,*a *o par*i#ipa*e in pa*ien* ed+#a*ion

pro$ram," poi,on #on*rol

#en*er a#*i9i*ie," prepara*ion o/ pa*ien* dr+$ +,e

prole," paren*eral



n+*ri*ion pro$ram par*i#ipa*ion" #oopera*in$ in *e

*ea#in$ and re,ear#

pro$ram, o/ *e o,pi*al" #omm+ni#a*in$ ne= prod+#*

in/orma*ion *o

n+r,in$ ,er9i#e and o*er o,pi*al per,onnel and

di,pen,in$

radioparma#e+*i#al,

Ho,pi*al Parma#y

3

2OALS FOR HOSPITAL PHARMACY

G+,* a, any or$aniza*ion m+,* a9e lon$!ran$e $oal,

*o=ard =i#

i*, daily a#*i9i*ie, are dire#*ed" ,o m+,* a pro/e,,ion"

i*, member," and

*eir repre,en*a*i9e ,o#ie*ie,. For eample *e

Ameri#an So#ie*y o/

Ho,pi*al Parma#i,*," in i*, Con,*i*+*ion and Byla=,"

,e*, /or* *e

/ollo=in$ obEe#*i9e,:

-. To pro9ide *e bene*, o/ a +alied o,pi*alparma#i,* *o pa*ien*,

and eal* #are in,*i*+*ion," *o *e allied eal*

pro/e,,ion," and *o *e



pro/e,,ion o/ parma#y.

1. To a,,i,* in pro9idin$ an ade+a*e ,+pply o/ ,+#

+alied o,pi*al

parma#i,*,.

4. To a,,+re a i$ +ali*y o/ pro/e,,ional pra#*i#e

*ro+$ *e

e,*abli,men* and main*enan#e o/ ,*andard, o/

pro/e,,ional e*i#,"

ed+#a*ion" and a**ainmen*, and *ro+$ *epromo*ion o/ e#onomi#

=el/are.

7. To promo*e re,ear# in o,pi*al parma#y pra#*i#e,

and in *e

parma#e+*i#al ,#ien#e, in $eneral.

0. To di,,emina*e parma#e+*i#al @no=led$e by pro9idin$

/or

in*er#an$e o/ in/orma*ion amon$ o,pi*al parma#i,*,

and =i*

member, o/ allied ,pe#ial*ie, and pro/e,,ion,.

More broadly" *e So#ie*y, primary p+rpo,e i, *ead9an#emen* o/

ra*ional" pa*ien*!orien*ed dr+$ *erapy in o,pi*al,

and o*er or$anized



eal* #are ,e**in$,.

Ho,pi*al Parma#y

6 To *e pre#edin$ #an be added *e /ollo=in$ obEe#*i9e,:

-. To epand and ,*ren$*en in,*i*+*ional parma#i,*,

abili*ie, *o:

%a& (e#*i9ely mana$e an or$anized parma#e+*i#al

,er9i#e.

%b& De9elop and pro9ide #lini#al ,er9i#e,.

%#& Cond+#* and par*i#ipa*e in #lini#al and

parma#e+*i#al

re,ear#

%d& Cond+#* and par*i#ipa*e in ed+#a*ional pro$ram, /or

eal*pra#*i*ioner," ,*+den*," and *e p+bli#.

1. To in#rea,e *e @no=led$e and +nder,*andin$ o/

#on*emporary

in,*i*+*ional parma#y pra#*i#e by *e p+bli#"

$o9ernmen*"

parma#e+*i#al ind+,*ry" and o*er eal* #are

pro/e,,ional,.

4. To promo*e #ompen,a*ion and bene*,

#ommen,+ra*e =i*



parma#i,*, re,pon,ibili*ie, and #on*rib+*ion, *o pa*ien*

#are.

7. To elp pro9ide an ade+a*e ,+pply o/ +alied

,+ppor*i9e per,onnel

/or in,*i*+*ional parma#y ,er9i#e,.

0. To elp en,+re *a* eal* #are reimb+r,emen* and

paymen* ,y,*em,

do no* inibi* *e implemen*a*ion o/ inno9a*i9e

parma#e+*i#al

,er9i#e, or ad9er,ely re?e#* on in,*i*+*ional parma#y

pra#*i#e.

3. To a,,i,* in *e de9elopmen* and ad9an#emen* o/

*e parma#y

pro/e,,ion.

Te /ore$oin$ ,er9e, a, a #olle#*i9e ,*a*emen* o/ $oal, o/ *e So#ie*y and

i*, #on,*i*+en#y. Tran,/ormin$ *e,e $oal, in*o reali*ie,

=ill re+ire *e

dedi#a*ed eor*, o/ all in,*i*+*ional parma#i,*," bo* a,

indi9id+al, and

a, member, o/ *e So#ie*y.

Ho,pi*al Parma#y

5



MI'IM)M STA'DARD FOR HOSPITAL PHARMACY

Parma#e+*i#al ,er9i#e, in in,*i*+*ion, a9e n+mero+,

#omponen*,"

*e mo,* prominen* bein$

%-& Te pro#+remen*" di,*rib+*ion" and #on*rol o/ all

parma#e+*i#al, +,ed =i*in *e /a#ili*y.

%1& Te e9al+a*ion and di,,emina*ion o/

#ompreen,i9e

in/orma*ion abo+* dr+$, and *eir +,e *o *e

in,*i*+*ion, ,*a and

pa*ien*,.

%4& Te moni*orin$" e9al+a*ion" and a,,+ran#e o/ *e

+ali*y o/

dr+$ +,e. Te,e /+n#*ion, are #arried o+* in #oopera*ion =i*

o*er

in,*i*+*ional depar*men*, and pro$ram,.

Te primary /+n#*ion o/ *i, do#+men* i, *o ,er9e a, a

$+ide /or *e

de9elopmen* and pro9i,ion o/ parma#e+*i#al ,er9i#e,

in in,*i*+*ion,. I*

=ill al,o be +,e/+l in e9al+a*in$ *e ,#ope and +ali*y o/

*e,e ,er9i#e,. I*



doe, no*" o=e9er" pro9ide de*ailed in,*r+#*ion, /or

opera*in$ a

parma#yo*er So#ie*y p+bli#a*ion, ,er9e *i, /+n#*ion.

S*andard -: Admini,*ra*ion

Te parma#e+*i#al ,er9i#e ,all be dire#*ed by a

pro/e,,ionally

#ompe*en*" le$ally +alied parma#i,*. He or ,e m+,*

be on *e ,ame

le9el =i*in *e in,*i*+*ion, admini,*ra*i9e ,*r+#*+re a,dire#*or, o/ o*er

#lini#al ,er9i#e,. Te dire#*or o/ parma#e+*i#al

,er9i#e, i, re,pon,ible

/or:

%-& Se**in$ *e lon$! and ,or*!ran$e $oal, o/ *e

parma#y ba,ed on

de9elopmen*, and *rend, in eal* #are and

in,*i*+*ional parma#y

pra#*i#e and *e ,pe#i# need, o/ *e in,*i*+*ion.

%1& De9elopin$ a plan and ,#ed+le /or a#ie9in$ *e,e

$oal,.

Ho,pi*al Parma#y

8



%4& S+per9i,in$ *e implemen*a*ion o/ *e plan and

*e day!*o!day

a#*i9i*ie, a,,o#ia*ed =i* i*.

%7& De*erminin$ i/ *e $oal, and ,#ed+le are bein$ me*

and in,*i*+*in$

#orre#*i9e a#*ion, =ere ne#e,,ary.

Te dire#*or o/ parma#e+*i#al ,er9i#e," in #arryin$ o+*

*e,e *a,@,"

,all employ an ade+a*e n+mber o/ #omple*en* and+alied per,onnel

S*andard II: Fa#ili*ie,

Tere ,all be ade+a*e ,pa#e" e+ipmen*" and

,+pplie, /or *e

pro/e,,ional and admini,*ra*i9e /+n#*ion, o/ *e

parma#y.

Te parma#y ,all be lo#a*ed in an area %or area,&

*a* /a#ili*a*e %,&

*e pro9i,ion o/ ,er9i#e, *o pa*ien*,. I* m+,* be in*e$ra*ed

=i* *e

/a#ili*y, #omm+ni#a*ion and *ran,por*a*ion ,y,*em,.

Spa#e and e+ipmen*" in an amo+n* and *ype *o

pro9ide ,e#+re"

en9ironmen*ally #on*rolled ,*ora$e o/ dr+$," ,all be

a9ailable.



Tere ,all be de,i$na*ed ,pa#e and e+ipmen*

,+i*able /or *e

prepara*ion o/ ,*erile prod+#*, and o*er dr+$

#ompo+ndin$ and

pa#@a$in$ opera*ion,.

Te p arma#y ,o+ld a9e a pri9a*e area /or

parma#i,*!pa*ien*

#on,+l*a*ion,. Te dire#*or o/ parma#e+*i#al ,er9i#e,

,o+ld al,o

a9e a pri9a*e oJ#e or area.

C+rren* dr+$ in/orma*ion re,o+r#e, m+,* be a9ailable.

Te,e ,o+ld

in#l+de appropria*e parma#y and medi#al Eo+rnal, and

*e*, and

dr+$ li*era*+re ,ear# and re*rie9al re,o+r#e,.

Ho,pi*al Parma#y

-

S*andard III: Dr+$ Di,*rib+*ion and Con*rol

Te parma#y ,all be re,pon,ible /or *e

pro#+remen*"

di,*rib+*ion" and #on*rol o/ all dr+$, +,ed =i*in *e

in,*i*+*ion. Ti,



re,pon,ibili*y e*end, *o dr+$, and rela*ed ,er9i#e,

pro9ided *o

amb+la*ory pa*ien*,. Poli#ie, and pro#ed+re,

$o9ernin$ *e,e /+n#*ion,

,all be de9eloped by *e parma#i,* =i* inp+*

/rom o*er in9ol9ed

o,pi*al ,*a %e.$. n+r,e,& and #ommi**ee, %parma#y

and *erape+*i#,

#ommi**ee" pa*ien*!#are #ommi**ee" e*#.&. In doin$ ,o" i*

i, e,,en*ial *a*

*e parma#i,* ro+*inely be pre,en* in all pa*ien*!

#are area," e,*abli,

rappor* =i* *e per,onnel" and be#ome /amiliar =i*

and #on*rib+*e *o

medi#al and n+r,in$ pro#ed+re, rela*in$ *o dr+$,.S*andard I: Dr+$ In/orma*ion

Te parma#y i, re,pon,ible /or pro9idin$ *e in,*i*+*ion,

,*a and

pa*ien*, =i* a##+ra*e" #ompreen,i9e in/orma*ion abo+*

dr+$, and *eir

+,e and ,all ,er9e a, i*, #en*er /or dr+$ in/orma*ion.

Ho,pi*al Parma#y

--



S*andard : A,,+rin$ Ra*ional Dr+$ Terapy

An impor*an* a,pe#* o/ parma#e+*i#al ,er9i#e, i,

*a* o/

maimizin$ ra*ional dr+$ +,e. In *i, re$ard" *e

parma#i,*" in #on#er*

=i* *e medi#al ,*a" m+,* de9elop poli#ie, and

pro#ed+re, /or a,,+rin$

*e +ali*y o/ dr+$ *erapy.

S*andard I: Re,ear#

Te parma#i,* ,o+ld #ond+#*" par*i#ipa*e in" and

,+ppor* medi#al and

parma#e+*i#al re,ear# appropria*e *o *e $oal,"

obEe#*i9e," and

re,o+r#e, o/ *e parma#y and *e in,*i*+*ion.

Ho,pi*al Parma#y

-1

ROL( OF PHARMACY T(CH'ICIA'S I' TH(

PHARMAC()TICAL S(RIC(S

Te parma#i,* and parma#y *e#ni#ian are impor*an*

pro/e,,ional, on

*e eal*#are *eam. Te primary re,pon,ibili*y o/ *e

parma#i,* i, *o ,ee



*a* dr+$, are di,pen,ed properly and +,ed appropria*ely.

Te *e#ni#ian

a,,i,*, *e parma#i,* in *i, endea9or. I* a,

be#ome in#rea,in$ly

impor*an* /or parma#i,* *o /o#+, *eir eper*i,e and

E+d$men* on dire#*

pa*ien* #are and #o+n,elin$. A##ordin$ly"

re,pon,ibili*ie, rela*ed *o

di,pen,in$ a9e ,i/*ed *o *e parma#y *e#ni#ian.

A parma#y

*e#ni#ian i, dened a, an indi9id+al =or@in$ in a

parma#y =o" +nder

*e ,+per9i,ion o/ a li#en,ed parma#i,*" a,,i,*, in

a#*i9i*ie, no* re+irin$

*e pro/e,,ional E+d$men* o/ a parma#i,*. Te r+le, andre$+la*ion, *a*

,e* limi*, on *e role, and re,pon,ibili*ie, 9ary /rom

#o+n*ry *o #o+n*ry.

Te#ni#ian, are in9ol9ed in all /a#e, o/ dr+$ di,*rib+*ion. A

/e= o/ *eir

re,pon,ibili*ie, in#l+de:

re#ei9in$ =ri**en pre,#rip*ion, or re+e,*, /or

pre,#rip*ion rell,

/rom pa*ien*, or *eir #are$i9er,.



9eri/yin$ *a* *e in/orma*ion on *e pre,#rip*ion i,

#omple*e and

a##+ra*e.

#o+n*in$" =ei$in$" mea,+rin$" and miin$ *e

medi#a*ion

preparin$ pre,#rip*ion label, and ,ele#*in$ *e

#on*ainer

e,*abli,in$ and main*ainin$ pa*ien* pro/ile,

orderi

n$ and ,*o#@in$ pre,#rip*ion and o9er!*e!#o+n*er

medi#a*ion,

a,,i,*in$ =i* dr+$ ,*+die,

*a@in$ pre,#rip*ion, o9er *e *elepone

*ran,/errin$ pre,#rip*ion,

*ra#@in$ and repor*in$ error,

;*e# #e#@ *e#< in prepara*ion o/ medi#ine #ar*,

Ho,pi*al Parma#y

-4

OR2A'IKATIO'AL STR)CT)R( OF PHARMACY

D(PARTM('T

i* *e ,ele#*ion and #a*e$orizin$ o/ *e

employee," i* no=



be#ome, e,,en*ial *o de9elop a #ar* ,o=in$ *e ?o= o/

admini,*ra*i9e

a+*ori*y. Ob9io+,ly" in *e 9ery ,mall depar*men*,"

*i, i, +,+ally

$enerally +nder,*ood and no problem, ari,e. Ho=e9er" in

*e lar$e +ni*,

=i* a,,i,*an* #ie/ parma#i,*," ,+per9i,or," and lay

per,onnel" a+*ori*y

m+,* be dele$a*ed by *e #ie/ parma#i,*.

Sample di,*rib+*ion, are depi#*ed in Fi$+re, %-!-& and %-!

1&. Clearly *i,

#an and ,o+ld be *ailored *o mee* *e ,pe#i#

re+iremen*, o/ *e

depar*men* and o,pi*al. On#e prepared and

appro9ed" i* ,o+ld be#on,pi#+o+,ly po,*ed /or ea# o/ *e depar*men*al

employee, *o read and

adere *o.

In lar$e o,pi*al," depar*men*, o/ parma#y a9e a

more #omple

or$aniza*ion. 'o*e /or eample" *e Oio S*a*e

)ni9er,i*y Ho,pi*al,

Depar*men* o/ Parma#y or$aniza*ional #ar*. I* ,o+ld

,eem ob9io+, *o



*e ,*+den* *a* ea# o/ *e ,+bdi9i,ion, o/ *e

depar*men* are a,,i$ned

,pe#i# re,pon,ibili*ie,. Te /ollo=in$ are ,ome o/ *e

re,pon,ibili*ie, o/

ea# di9i,ion.

Ho,pi*al Parma#y

-7

O)TPATI('T

DISP('SI'2

S)P(RISOR

MA')FACT)RI'2

A'D CO'TROL

S)P(RISOR

I'PATI('T

DISP('SI'2

S)P(RISOR

M(SS('2(R

ASSISTA'T PHARMACIST I'!CHI(F

S(CR(TAR)

CL(R

PHARMACY



R(SID('TS

PHARMACIST I'!CHI(F

ASSOCIAT( DIR(CTORFi$ %-!-&. Depar*men*al or$aniza*ion

Ho,pi*al Parma#y

-0

ADMI'ISTRATI( S(RIC(S

DIISIO'

)'IT DOS( DISP('SI'2

A'D

ADMI'STRATIO'

(D)CATIO' TRA'I'2

DIISIO'

ASSOCIAT(

DIR(CTOR OF PHARMACY


PHARMMC()TICAL

R(S(ARCH DIISIO'S

R(S(ARCH

PHARMACIST

RADIOPHARMAC()TICAL



DIISIO'S

PHARMACIST

SP(CIALISTRADIOPHARMAC()TICAL

DIISIO'S

DR)2 I'FORMATIO'

S(RIC(S

ASSISTA'T


ASSAY N)ALITY

CO'TROL DIISIO'

DR)2 I'FORMATIO'

S(RIC(S

C('TRAL S)PPLY

DIISIO'

ASSISTA'T


I'!PATI('T S(RIC(S

DIISIO'

O)T!PATI('T S(RIC(S

DIISIO'



I'TRA('O)S

ADMIT)R( DIISIO'

ASSISTA'TDIR(CTOR OF PHARMACY

D(PARTM('TAL

S(RIC(S

P)RCHAS( A'D

I'('TORY CO'TROL

MA')FACT)RI'2 A'D

PACA2I'2

Fi$ %-!1&. Depar*men*al or$aniza*ion in a lar$e +ni9er,i*y

o,pi*al parma#y opera*ion

Ho,pi*al Parma#y

-3

Admini,*ra*i9e Ser9i#e, Di9i,ion

-. Plan and #oordina*e depar*men*al a#*i9i*ie,.

1. De9elop poli#ie,.

4. S#ed+le per,onnel and pro9ide ,+per9i,ion.7. Coordina*e admini,*ra*i9e need, o/ *e Parma#y and

Terape+*i#,

Commi**ee.



0. S+per9i,e depar*men*al oJ#e ,*a.

(d+#a*ion and Trainin$ Di9i,ion

-. Coordina*e pro$ram, o/ +nder$rad+a*e and$rad+a*e parma#y

,*+den*,.

1. Par*i#ipa*e in o,pi*al!=ide ed+#a*ional pro$ram,

in9ol9in$ n+r,e,"

do#*or, e*#.

4. Train ne=ly employed parma#y depar*men*

per,onnel.

Parma#e+*i#al Re,ear# Di9i,ion

-. De9elop ne= /orm+la*ion, o/ dr+$," e,pe#ially

do,a$e /orm, no*

#ommer#ially a9ailable" and o/ re,ear# dr+$,.1. Impro9e /orm+la*ion, o/ ei,*in$ prod+#*,.

4. Coopera*e =i* *e medi#al re,ear# ,*a o/

proEe#*, in9ol9in$

dr+$,.

In!Pa*ien* Ser9i#e, Di9i,ion

-. Pro9ide medi#a*ion, /or all in!pa*ien*, o/ *e o,pi*al

on a 17!o+r

per day ba,i,.



1. In,pe#*ion and #on*rol o/ dr+$, on all *rea*men* area,.

4. Coopera*e =i* medi#al dr+$ re,ear#.

Ho,pi*al Parma#y-6

O+*!Pa*ien* Ser9i#e, Di9i,ion

-. Compo+nd and di,pen,e o+*!pa*ien* pre,#rip*ion,.

1. In,pe#* and #on*rol all #lini# and emer$en#y

,er9i#e medi#a*ion

,*a*ion,.

4. Main*ain pre,#rip*ion re#ord,.

7. Pro9ide dr+$ #on,+l*a*ion ,er9i#e, *o ,*a and medi#al

,*+den*,.

Dr+$ In/orma*ion Ser9i#e, Di9i,ion

-. Pro9ide dr+$ in/orma*ion on dr+$, and dr+$

*erapy *o do#*or,"

n+r,e," medi#al and n+r,in$ ,*+den*, and *e o+,e ,*a.

1. Main*ain *e dr+$ in/orma*ion #en*er.

4. Prepare *e o,pi*al, parma#y ne=,le**er.

7. Main*ain li*era*+re le,.

Depar*men*al Ser9i#e, Di9i,ion

-. Con*rol and di,pen,e in*ra9eno+, ?+id,.



1. Con*rol and di,pen,e #on*rolled ,+b,*an#e,.

4. Coordina*e and #on*rol all dr+$ deli9ery and

di,*rib+*ion ,y,*em,.

P+r#a,in$ and In9en*ory Con*rol Di9i,ion

-. Main*ain dr+$ in9en*ory #on*rol.

1. P+r#a,e all dr+$,.

4. Re#ei9e" ,*ore and di,*rib+*e dr+$,.

7. In*er9ie= medi#al ,er9i#e repre,en*a*i9e,.

Ho,pi*al Parma#y

-5

Cen*ral S+pply Ser9i#e, Di9i,ion

-. De9elop and #oordina*e di,*rib+*ion o/ medi#al

,+pplie, and

irri$a*in$ ?+id,.

A,,ay and N+ali*y Con*rol Di9i,ion

-. Per/orm analy,e, on prod+#*, man+/a#*+rered and

p+r#a,ed.

1. De9elop and re9i,e a,,ay pro#ed+re,.

4. A,,i,* re,ear# di9i,ion in ,pe#ial /orm+la*ion,.

Man+/a#*+rin$ and Pa#@a$in$ Di9i,ion

-. Man+/a#*+re =ide 9arie*y o/ i*em, in #ommon +,e a*

*e o,pi*al.



1. Opera*e an o9erall dr+$ pa#@a$in$ and prepa#@a$in$

pro$ram.

4. )nder*a@e pro$ram in prod+#* de9elopmen*.

7. Main*ain a +ni* do,e pro$ram.

S*erile Prod+#*, Di9i,ion

-. Prod+#e ,mall 9ol+me paren*eral,.

1. Man+/a#*+re ,*erile op*almolo$i#" irri$a*in$ ,ol+*ion,

e*#.

4. Prepare a,ep*i# dil+*ion o/ lyopylizal and o*er

+n,*able ,*erile

inEe#*ion, /or admini,*ra*ion *o pa*ien*,.

Radioparma#e+*i#al Ser9i#e, di9i,ion

-. Cen*ralize *e pro#+remen*" ,*ora$e and di,pen,in$

o/ radioi,o*ope,+,ed in #lini#al pra#*i#e.

Ho,pi*al Parma#y

-8

In*ra9eno+, Admi*+re Di9i,ion

-. Cen*ralize *e prepara*ion o/ in*ra9eno+, ,ol+*ionadmi*+re.

1. Re9ie= ea# -.. admi*+re /or py,io!#emi#al

in#ompa*ibili*ie,.



Ho,pi*al Parma#y

1

PHARMACY A'D TH(RAP()TICS COMMITT(( Te m+l*ipli#i*y o/ dr+$, a9ailable and *e

#omplei*ie, ,+rro+ndin$

*eir ,a/e and ee#*i9e +,e ma@e i* ne#e,,ary /or

o,pi*al, *o a9e an

or$anized" ,o+nd pro$ram /or maimizin$ ra*ional

dr+$ +,e. Te

parma#y and *erape+*i#, #ommi**ee" or i*,

e+i9alen*" i, *e

or$aniza*ional @ey,*one o/ *e pro$ram.

Te parma#y and *erape+*i#, #ommi**ee i, an ad9i,ory

$ro+p o/ *e

medi#al ,*a and ,er9e, a, *e or$aniza*ional line o/

#omm+ni#a*ion

be*=een *e medi#al ,*a and parma#y depar*men*.

Ti, #ommi**ee i,

#ompo,ed o/ py,i#ian," parma#i,*," and o*er

eal* pro/e,,ional,

,ele#*ed =i* *e $+idan#e o/ *e medi#al ,*a. I* i,

a poli#yre#ommendin$ body *o *e medi#al ,*a and *e

admini,*ra*ion o/ *e



o,pi*al on ma**er, rela*ed *o *e *erape+*i# +,e o/

dr+$,.

Role or p+rpo,e, o/ #ommi**ee

Te primary p+rpo,e, o/ *e parma#y and *erape+*i#,

#ommi**ee are

a, ,pe#ied in *e /ollo=in$:

-. Ad9i,ory. Te #ommi**ee re#ommend, *e adop*ion

o/" or a,,i,*, in

*e /orm+la*ion o/" poli#ie, re$ardin$ e9al+a*ion",ele#*ion" and

*erape+*i# +,e o/ dr+$, in o,pi*al,

1. (d+#a*ional. Te #ommi**ee re#ommend, or a,,i,*, in

*e /orm+la*ion

o/ pro$ram, de,i$ned *o mee* *e need, o/ *e

pro/e,,ional ,*a

%py,i#ian," n+r,e," parma#i,*," and o*er eal*!#are

pra#*i*ioner,&

/or #omple*e #+rren* @no=led$e on ma**er, rela*ed *o

dr+$, and dr+$

+,e.

Ho,pi*al Parma#y

1-

Or$aniza*ion and Opera*ion



ile *e #ompo,i*ion and opera*ion o/ *e parma#y and

*erape+*i#,

#ommi**ee mi$* 9ary /rom o,pi*al *o o,pi*al" *e

/ollo=in$ $enerally

=ill apply:

-. Te parma#y and *erape+*i#, #ommi**ee ,o+ld be

#ompo,ed o/

a* lea,* *ree py,i#ian," a parma#i,*" a n+r,e" and

an

admini,*ra*or. Commi**ee member, are appoin*ed by a

$o9ernin$

+ni* or ele#*ed oJ#ial o/ *e or$anized medi#al ,*a.

1. A #airman /rom amon$ *e py,i#ian

repre,en*a*i9e, ,o+ld be

appoin*ed. A parma#i,* +,+ally i, de,i$na*ed a,,e#re*ary.

4. Te #ommi**ee ,o+ld mee* re$+larly" a* lea,* ,i

*ime, per year"

and more o/*en =en ne#e,,ary.

7. Te #ommi**ee ,o+ld in9i*e *o i*, mee*in$,

per,on, =i*in or

o+*,ide *e o,pi*al =o #an #on*rib+*e ,pe#ialized

or +ni+e

@no=led$e" ,@ill," and E+d$men*,.



0. An a$enda and ,+pplemen*ary ma*erial, %in#l+din$

min+*e, o/ *e

pre9io+, mee*in$& ,o+ld be prepared by *e

,e#re*ary and

,+bmi**ed *o *e #ommi**ee member, in,+J#ien* *ime

be/ore *e

mee*in$ /or *em *o properly re9ie= *e ma*erial.

3. Min+*e, o/ *e #ommi**ee mee*in$, ,o+ld be

prepared by *e

,e#re*ary and main*ained in *e permanen* re#ord, o/ *e

o,pi*al.

6. Re#ommenda*ion, o/ *e #ommi**ee ,all be

pre,en*ed *o *e

medi#al ,*a or i*, appropria*e #ommi**ee /or

adop*ion orre#ommenda*ion.

5. Liai,on =i* o*er o,pi*al #ommi**ee, #on#erned

=i* dr+$ +,e

%e.$." in/e#*ion #on*rol" medi#al a+di*& ,all be

main*ained.

Ho,pi*al Parma#y

11

F+n#*ion, and S#ope



Te ba,i# or$aniza*ion o/ *e o,pi*al and medi#al ,*a,

=ill de*ermine

*e /+n#*ion, and ,#ope o/ *e parma#y and

*erape+*i#, #ommi**ee.

Te /ollo=in$ li,* o/ #ommi**ee /+n#*ion, i, oered a, a

$+ide:

-. To ,er9i#e in an ad9i,ory #apa#i*y *o *e medi#al ,*a

and o,pi*al

admini,*ra*ion in all ma**er, per*ainin$ *o *e +,e o/

dr+$,

%in#l+din$ in9e,*i$a*ional dr+$,&.

1. To de9elop a /orm+lary o/ dr+$, a##ep*ed /or +,e in *e

o,pi*al

and pro9ide /or i*, #on,*an* re9i,ion. Te ,ele#*ion o/

i*em, *o bein#l+ded in *e /orm+lary =ill be ba,ed on obEe#*i9e

e9al+a*ion o/

*eir rela*i9e *erape+*i# meri*," ,a/e*y" and #o,*. Te

#ommi**ee

,o+ld minimize d+pli#a*ion o/ *e ,ame ba,i# dr+$

*ype dr+$

en*i*y" or dr+$ prod+#*.

4. To e,*abli, pro$ram, and pro#ed+re, *a* elp

en,+re #o,*ee#*i9e dr+$ *erapy.



7. To e,*abli, or plan ,+i*able ed+#a*ional" pro$ram,

/or *e

o,pi*al, pro/e,,ional ,*a on ma**er, rela*ed *o dr+$

+,e.

0. To par*i#ipa*e in +ali*y!a,,+ran#e a#*i9i*ie, rela*ed

*o *e

di,*rib+*ion" admini,*ra*ion" and +,e o/ medi#a*ion,.

3. To re9ie= ad9er,e dr+$ rea#*ion o##+rrin$ *e o,pi*al.

6. To ini*ia*e %or bo*& dr+$!+,e re9ie= pro$ram, and,*+die, and

re9ie= *e re,+l*, o/ ,+# a#*i9i*ie,.

5. To ad9i,e *e parma#y in *e implemen*a*ion o/

ee#*i9e dr+$

di,*rib+*ion and #on*rol pro#ed+re,.

8. To ma@e re#ommenda*ion, #on#ernin$ dr+$, *o be

,*o#@ed in

o,pi*al pa*ien*!#are area,.

Ho,pi*al Parma#y

14

TH( HOSPITAL FORM)LARY

Deni*ion o/ /orm+lary and /orm+lary ,y,*em

Te /orm+laryi, a #on*in+ally re9i,ed #ompila*ion o/

parma#e+*i#al,



%pl+, impor*an* an#illary in/orma*ion& *a* re?e#*, *e

#+rren* #lini#al

E+d$men* o/ *e medi#al ,*a.

Te /orm+lary ,y,*em i, a me*od =ereby *e

medi#al ,*a o/ an

in,*i*+*ion" =or@in$ *ro+$ *e parma#y and

*erape+*i#, #ommi**ee"

e9al+a*e," apprai,e," and ,ele#*, /rom amon$ *e

n+mero+, a9ailable dr+$

en*i*ie, and dr+$ prod+#*, *o,e *a* are #on,idered mo,*

+,e/+l in pa*ien*

#are. Only *o,e ,o ,ele#*ed are ro+*inely a9ailable /rom

*e parma#y.

Te /orm+lary ,y,*em i, *+, an impor*an* *ool /or

a,,+rin$ *e +ali*y o/dr+$ +,e and #on*rollin$ i*, #o,*.

Te /orm+lary ,y,*em pro9ide, /or *e pro#+rin$"

pre,#ribin$"

di,pen,in$" and admini,*erin$ o/ dr+$, +nder ei*er *eir

nonproprie*ary

or proprie*ary name, in in,*an#e, =ere dr+$, a9e bo*

name,

Bene*, o/ *e /orm+lary ,y,*em



Te po*en*ial bene*, o/ a /orm+lary ,y,*em are

*ree/old:

%l& Terape+*i#. %1& (#onomi#. %4& (d+#a*ional.

Te *erape+*i# a,pe#* o/ a /orm+lary ,y,*em

pro9ide, *e $rea*e,*

bene* *o *e pa*ien* and py,i#ian in *a* only *e

mo,* eJ#ien*

prod+#*, are li,*ed and a9ailable.

Te e#onomi# meri* al,o a, a do+ble bene* in *a**e /orm+lary

elimina*e, d+pli#a*ion *+, red+#in$ in9en*ory

d+pli#a*ion and *e

oppor*+ni*y /or 9ol+me p+r#a,in$ mean, lo=er #ar$e,

*o *e pa*ien*.

Te ed+#a*ional bene* i, al,o ,i$ni#an* /or *e re,iden*,*a" n+r,e,

and medi#al ,*+den*, be#a+,e many $ood /orm+larie,

#on*ain 9ario+,

pre,#ribin$ *ip, and addi*ional dr+$ in/orma*ion o/

ed+#a*ional 9al+e.

Ho,pi*al Parma#y

17

Forma* and appearan#e o/ *e /orm+lary



Te py,i#al appearan#e and ,*r+#*+re o/ *e /orm+lary i,

an impor*an*

in?+en#e on i*, +,e. Al*o+$ elabora*e and

epen,i9e ar*=or@ and

ma*erial, are +nne#e,,ary" *e /orm+lary ,o+ld be

9i,+ally plea,in$"

ea,ily readable" and pro/e,,ional in appearan#e.

Te need /or proper $rammar" p+n#*+a*ion" #orre#*

,pellin$" and

nea*ne,, i, ob9io+,. Tere i, no one ,in$le /orma*

or arran$emen*

=i# ail /orm+larie, m+,* /ollo=.

A *ypi#al /orm+lary m+,* a9e *e /ollo=in$ #ompo,i*ion:

-. Ti*le pa$e

1. 'ame, and *i*le, o/ *e member, o/ *e parma#y and

*erape+*i#,

#ommi**ee

4. Table o/ #on*en*,

7. In/orma*ion on o,pi*al poli#ie, and pro#ed+re,

#on#ernin$ dr+$,

7.- Te parma#y and *erape+*i#, #ommi**ee o/ YK

o,pi*al

7.1 ObEe#*i9e, and opera*ion o/ *e /orm+lary ,y,*em



7.4 Ho,pi*al re$+la*ion, and pro#ed+re, /or pre,#ribin$

and

di,pen,in$ dr+$,

7.7 Ho,pi*al parma#y ,er9i#e, and pro#ed+re,

7.0 Ho= *o +,e *e /orm+lary

0. Prod+#*, a##ep*ed /or +,e a* YK o,pi*al

0.- I*em, added and dele*ed ,in#e *e pre9io+, edi*ion

0.1 2eneri#!brand name #ro,, re/eren#e li,*

0.4 Parma#olo$i#alQ*erape+*i# inde =i* rela*i9e #o,*

#ode,.

0.7 De,#rip*ion, o/ /orm+lary dr+$ prod+#*, by

parma#olo$y

*erape+*i# #la,,

Ho,pi*al Parma#y

10

3. Appendi

3.- Cen*ral ,er9i#e e+ipmen* and ,+pply li,*

3.1 R+le, /or #al#+la*in$ pedia*ri# do,e,

3.4 'omo$ram /or e,*ima*in$ body ,+r/a#e area

3!7 S#ed+le o/ ,*andard dr+$ admini,*ra*ion *ime,

Se9eral *e#ni+e, #an be +,ed *o impro9e *e

appearan#e and ea,e o/



+,e o/ *e /orm+lary. Amon$ *e,e are:

-. ),in$ a dieren* #olor paper /or ea# ,e#*ion o/ *e

/orm+lary"

1. ),in$ an ed$e inde"

4. Ma@in$ *e /orm+lary po#@e* ,ize %approima*ely 7

6& and

7. Prin*in$ *e $eneri# name eadin$ o/ ea# dr+$ en*ry

in bold/a#e

*ype or +,in$ ,ome o*er me*od, /or ma@in$ i* ,*and o+*/rom *e re,*

o/ *e en*ry.

Ho,pi*al Parma#y

13

TH( FI( RI2HTS FOR CORR(CT DR)2 ADMI'ISTRATIO' Tere are 9e ;ri$*,< o/ medi#a*ion admini,*ra*ion

*a* oer +,e/+l

$+ideline, =en llin$ pre,#rip*ion, /or pa*ien*

medi#a*ion,. Te,e

#on#ep*, a9e been =idely +,ed *o a9oid medi#a*ion

error,. A dr+$

mi,ad9en*+re o##+r, =ene9er *e,e are no* /ollo=ed

#orre#*ly.



Fi$+re %-!4& ill+,*ra*e, *e #on#ep*," and *e 9e

ri$*, are

o9er9ie=ed belo=.

Ri$* Pa*ien*Al=ay, 9eri/y *e pa*ien* name be/ore

di,pen,in$

medi#ine,

Ri$* Dr+$ Al=ay, #e#@ *e medi#a*ion a$ain,*

*e ori$inal

pre,#rip*ion and *e pa*ien*, di,ea,e ,*a*e. Temedi#a*ion label

#on*ain, impor*an* in/orma*ion abo+* *e dr+$ *a*

=ill be

di,pen,ed *o *e pa*ien*.

Ri$* S*ren$* Ce#@ *e ori$inal pre,#rip*ion /or

*i,

in/orma*ion and pay a**en*ion *o *e a$e o/ *e pa*ien*.

Pedia*ri# or

elderly pa*ien* #an ea,ily $e* *e =ron$ do,e.

Ri$* Ro+*e Ce#@ *a* *e py,i#ian, order a$ree,

=i* *e

dr+$, ,pe#ied ro+*e o/ admini,*ra*ion. Many

medi#a*ion, #an be

$i9en by a 9arie*y o/ ro+*e, and *e ro+*e o/

admini,*ra*ion #an



ae#* *e medi#a*ion, ab,orp*ion.

Ri$* Time Ce#@ *e pre,#rip*ion *o de*ermine *e

appropria*e

*ime /or *e medi#a*ion *o be admini,*ra*ed. Some

medi#a*ion,

m+,* be *a@en on an emp*y ,*oma# %one o+r be/ore or

*=o o+r,

a/*er a meal& =ile o*er, ,o+ld be *a@en =i* /ood.

Some*ime," a

#er*ain *ime ,pan i, needed be*=een do,e, *o

main*ain a

*erape+*i#ally ee#*i9e blood le9el.

Ho,pi*al Parma#y

16

Fi$+re %-!4&. Te 9e ;ri$*,< /or #orre#* dr+$

admini,*ra*ion

Ho,pi*al Parma#y

15

)ni* re9ie=

-! Dene Parma#y Te#ni#ian

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!



!!!!!!!!!!!!!!!!!!!!!!!!1! Brie?y di,#+,," Role o/ Parma#y

Te#ni#ian in Parma#e+*i#al

Ser9i#e,

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!4! a* are *e main $oal,

/or o,pi*al parma#y

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!7! a* i, *e role o/

Terape+*i#, Commi**ee

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!0! a* Ho,pi*al Form+lary

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!3! (plain" *e Or$aniza*ional S*r+#*+re o/Parma#y Depar*men*

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!



!!!!!!!!!!!!!!!!!!!!!!!!6! a* are;Te Fi9e Ri$*, /or Corre#*

Dr+$ Admini,*ra*ion<

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!

Ho,pi*al Parma#y

18

)'IT ! II

I'!PATI('T PHARMACY

Ho,pi*al Parma#y

4

HOSPITAL DR)2 DISTRIB)TIO' SYST(M

Tradi*ional me*od, o/ di,*rib+*in$ dr+$, in o,pi*al, areno= +nder$oin$

ree9al+a*ion" and #on,iderable *o+$* and a#*i9i*y i,

bein$ dire#*ed

*o=ard *e de9elopmen* o/ ne= and impro9ed dr+$

di,*rib+*ion ,y,*em,.

Some o/ *e ne=er #on#ep*, and idea, in #onne#*ion =i*o,pi*al dr+$

di,*rib+*ion ,y,*em, are #en*ralized or de#en*ralized

%,in$le" or +ni*!do,e&



di,pendin$" a+*oma*ed %me#ani#al andQor ele#*roni#&

pro#e,,in$ o/

medi#a*ion order, and in9en*ory #on*rol" and

a+*oma*ed %me#ani#al

andQor ele#*roni#& ,*ora$e and deli9ery de9i#e,. Se9eral

in9e,*i$a*or, are

a* =or@ in ea# o/ *e,e area," and *e re,+l*, o/ *eir

,*+die, may $rea*ly

al*er #+rren* pra#*i#e, and pro#ed+re,.

Be#a+,e o/ *e pre,en* ,*a*e o/ +n#er*ain*y re$ardin$

*e proper

,#ope and op*im+m de,i$n o/ dr+$ di,*rib+*ion

,y,*em, /or *e modern

o,pi*al" and a, an aid *o parma#i,*," n+r,e,"

py,i#ian," andadmini,*ra*or, =o are /a#ed =i* ma@in$ de#i,ion,

#on#ernin$ dr+$

di,*rib+*ion ,y,*em, d+rin$ *i, period o/ #an$e" *e

/ollo=in$

$+ideline, /or e9al+a*in$ propo,ed #an$e, or ne= idea,

or e+ipmen*,

are pre,en*ed.

To+$ ,ome o/ *e pra#*i#e, re#ommended may no*

be



=ide,pread a* *e pre,en*" *e adop*ion o/ *e,e

pra#*i#e, i, belie9ed *o be

a de,irable and pra#*i#al $oal. Tere/ore" i* i, +r$ed

*a* *ey be $i9en

prime #on,idera*ion in *e de,i$n o/ ne= dr+$ di,*rib+*ion

,y,*em, and in

modi#a*ion, o/ ei,*in$ one, %par*i#+larly =ere

,+# #an$e, =o+ld

#ommi* a o,pi*al *o a #on,iderable nan#ial in9e,*men*

in a ,y,*em no*

in#l+din$" or no* ea,ily al*ered *o in#l+de" *e

re#ommended pra#*i#e,&.

-. Be/ore *e ini*ial do,e o/ medi#a*ion i, admini,*ered

*e parma#i,*

,o+ld re9ie= *e pre,#riber, ori$inal order or a dire#*#opy.

Ho,pi*al Parma#y

4-

1. Dr+$, di,pen,ed ,o+ld be a, ready /or

admini,*ra*ion *o *e

pa*ien* a, *e #+rren* ,*a*+, o/ parma#e+*i#al

*e#nolo$y =ill

permi*" and m+,* bear ade+a*e iden*i#a*ion

in#l+din$ %b+* no*



limi*ed *o& name or name, o/ dr+$" ,*ren$* or po*en#y"

ro+*e,%,&

o/ admini,*ra*ion" epira*ion da*e" #on*rol n+mber" and

,+# o*er

,pe#ial in,*r+#*ion, a, may be indi#a*ed.

4. Fa#ili*ie, and e+ipmen* +,ed *o ,*ore dr+$, ,o+ld be

,o de,i$ned

*a* *e dr+$, are a##e,,ible only *o medi#al

pra#*i*ioner,

a+*orized *o pre,#ribe" *o parma#i,*, a+*orized *o

di,pen,e" or *o

n+r,e, a+*orized *o admini,*er ,+# dr+$,.

7. Fa#ili*ie, and e+ipmen* +,ed *o ,*ore dr+$, ,o+ld be

de,i$ned *o

/a#ili*a*e ro+*ine in,pe#*ion o/ *e dr+$ prior *o *e*ime o/

admini,*ra*ion.

0. en +*ilizin$ a+*oma*ed %me#ani#al andQor

ele#*roni#& de9i#e,

a, parma#e+*i#al *ool," i* i, manda*ory *a* pro9i,ion be

made *o

pro9ide ,+i*able parma#e+*i#al ,er9i#e, in *e e9en* o/

/ail+re o/

*e de9i#e.



3. S+# me#ani#al or ele#*roni# dr+$ ,*ora$e and

di,pen,in$ de9i#e,"

a, re+ire or en#o+ra$e *e repa#@a$in$ o/ dr+$ do,a$e

/orm, /rom

*e man+/a#*+rer, ori$inal #on*ainer" ,o+ld permi* and

/a#ili*a*e

*e +,e o/ ne= pa#@a$e" =i# =ill a,,+re *e ,*abili*y o/

ea# dr+$

and mee* *e ,*andard, /or *e pa#@a$in$ and ,*orin$ o/

dr+$," in

addi*ion *o mee*in$ all o*er ,*andard, o/ $ood parma#y

pra#*i#e.

6. In #on,iderin$ a+*oma*ed %me#ani#al andQor

ele#*roni#& de9i#e, a,

parma#e+*i#al *ool," *e di,*in#*ion be*=een *ea##+ra#y re+ired

in a##o+n*in$ pra#*i#e, 9er,+, *a* re+ired in di,pen,in$

pra#*i#e,

,o+ld be #learly di,*in$+i,ed.

Ho,pi*al Parma#y

41

Tere are /o+r ,y,*em, in $eneral +,e /or di,pen,in$

dr+$, /or inpa*ien*,.

Tey may be #la,,ied a, /ollo=,:



%i& Indi9id+al Pre,#rip*ion Order Sy,*em.

%ii& Comple*e Floor S*o#@ Sy,*em.

%iii& Combina*ion o/ %i& and %ii&.%i9& Te +ni* do,e me*od.

Indi9id+al pre,#rip*ion order ,y,*em

A, a, been pre9io+,ly ,*a*ed" *i, ,y,*em i, $enerally

+,ed by *e ,mall

andQor pri9a*e o,pi*al be#a+,e o/ *e red+#ed manpo=er

re+iremen* and

*e de,irabili*y /or indi9id+alized ,er9i#e.

Ineren* in *i, ,y,*em i, *e po,,ible delay in

ob*ainin$ *e re+ired

medi#a*ion and *e in#rea,e in #o,* *o *e pa*ien*.

Ad9an*a$e, o/ *i, ,y,*em:

%i& All medi#a*ion order, are dire#*ly re9ie=ed by *e

parma#i,*.

%ii& Pro9ide, /or *e in*era#*ion o/ parma#i,*" do#*or"

n+r,e and

pa*ien*.

%iii& Pro9ide, #lo,er #on*rol o/ in9en*ory.

Ho,pi*al Parma#y

44



Comple*e ?oor ,*o#@ ,y,*em

)nder *i, ,y,*em" *e n+r,in$ ,*a*ion parma#y

#arrie, bo* ;#ar$e<

and ;non!#ar$e< pa*ien* medi#a*ion,. Rarely +,ed or

par*i#+larly

epen,i9e dr+$, are omi**ed /rom ?oor ,*o#@ b+* are

di,pen,ed +pon *e

re#eip* o/ a pre,#rip*ion or medi#a*ion order /or *e

indi9id+al pa*ien*.

Al*o+$ *i, ,y,*em i, +,ed mo,* o/*en in

$o9ernmen*al and o*er

o,pi*al, in =i# #ar$e, are no* made *o *e pa*ien*

or =en *e allin#l+,i9e ra*e i, +,ed /or #ar$in$" i*

doe, a9e appli#abili*y *o *e

$eneral o,pi*al. Ob9io+,ly" *ere are bo* ad9an*a$e,and di,ad9an*a$e,

*o *e #omple*e ?oor ,*o#@ ,y,*em.

Ad9an*a$e, o/ #omple*e ?oor ,*o#@ ,y,*em:

%i& Ready a9ailabili*y o/ *e re+ired dr+$,.

%ii& (limina*ion o/ dr+$ re*+rn,.

%iii& Red+#*ion in *e n+mber o/ dr+$ order *ran,#rip*ion,

/or *e

parma#y.



%i9& Red+#*ion in *e n+mber o/ parma#y per,onnel

re+ired.

Di,ad9an*a$e, o/ #omple*e ?oor ,*o#@ ,y,*em:

%i& Medi#a*ion error, may in#rea,e be#a+,e *e

re9ie= o/

medi#a*ion order, i, elimina*ed.

%ii& In#rea,ed dr+$ in9en*ory on *e pa9ilion,.

%iii& 2rea*er oppor*+ni*y /or pil/era$e.

%i9& In#rea,ed azard, a,,o#ia*ed =i* dr+$ de*eriora*ion.

%9& La#@ o/ proper ,*ora$e /a#ili*ie, on *e =ard may

re+ire

#api*al o+*lay *o pro9ide *em.

%9i& 2rea*er inroad, are made +pon *e n+r,e, *ime.

To be borne in mind by *e ,*+den* i, *e /a#* *a* in,ome o,pi*al, *e

#omple*e ?oor ,*o#@ ,y,*em i, ,+##e,,/+lly opera*ed

a, a de#en*ralized

parma#y +nder *e dire#*,+per9i,ion o/ a parma#i,*.

Ho,pi*al Parma#y

47

Ob9io+,ly" =en *i, o##+r," many o/ *e di,ad9an*a$e,

a,,o#ia*ed =i*



,+# a ,y,*em di,appear. In addi*ion" *e +,e o/ *e

de#en*ralized

parma#y #on#ep* pro9ide, /or a ome ba,e /or *e

#lini#ally orien*ed

parma#i,*.

In *e pa,*" ?oor ,*o#@ #on*ainer, =ere pre!labeled

m+l*iple do,e +ni*,.

Today" *e ?oor ,*o#@ i, in +ni*!o/!+,e pa#@a$in$ *ereby

a,,+rin$ be**er

pa#@a$in$" #on*rol and iden*i*y o/ *e medi#a*ion.

Car$e ?oor ,*o#@ dr+$, and non!#ar$e ?oor ,*o#@ dr+$,

(a# pa9ilion in *e o,pi*al" re$ardle,, o/ i*, ,ize or

,pe#ial*y

#are" a, a ,+pply o/ dr+$, ,*ored in *e medi#ine #abine*

e9en *o+$ *e

n+r,in$ +ni* i, ,er9i#ed by a +ni* do,e ,y,*em. Ho=e9er"

*e +,e o/ ?oor

,*o#@ medi#a*ion, ,o+ld be minimized. In addi*ion"

re,ear# a, ,o=n

*a* *e ,y,*em o/ dr+$ di,*rib+*ion a, an ee#* +pon

*e in#iden#e o/

ad9er,e dr+$ rea#*ion,. Te,e medi#a*ion, may be

#la,,ied +nder *=o



,epara*e eadin$," ea# o/ =i# ,er9e, a ,pe#i#

p+rpo,e. Dr+$, on *e

n+r,in$ ,*a*ion may be di9ided in*o ;#ar$e ?oor ,*o#@

dr+$,< and ;non#ar$e ?oor ,*o#@ dr+$,<.

Deni*ion,

Car$e ?oor ,*o#@ dr+$,may be dened a, *o,e

medi#a*ion, *a* are

,*o#@ed on *e n+r,in$ ,*a*ion.

Car$e ?oor ,*o#@ dr+$, repre,en* *a* $ro+p o/medi#a*ion, *a* are

pla#ed a* *e n+r,in$ ,*a*ion.

I* i, *e re,pon,ibili*y o/ *e o,pi*al parma#i,*"

=or@in$ in

#oopera*ion =i* *e n+r,in$ ,er9i#e" *o de9elop

=ay, and mean,

=ereby ade+a*e ,+pplie, o/ ea# are al=ay, on and

and" in appropria*e

,i*+a*ion *a* proper #ar$e, are made *o *e pa*ien*,

a##o+n*.

Ho,pi*al Parma#y

40

Combina*ion o/ Indi9id+al pre,#rip*ion order ,y,*em and

#omple*e



?oor ,*o#@ ,y,*em

Fallin$ in*o *i, #a*e$ory are *o,e o,pi*al, =i#

+,e *e indi9id+al

pre,#rip*ion or medi#a*ion order ,y,*em a, *eir

primary mean, o/

di,pen,in$" b+* al,o +*ilize a limi*ed ?oor ,*o#@. Ti,

#ombina*ion ,y,*em

i, probably *e mo,* #ommonly +,ed in o,pi*al, *oday

and i, modied *o

in#l+de *e +,e o/ +ni* do,e medi#a*ion,.

)ni* do,e ,y,*em

)ni*!do,e medi#a*ion, a9e been dened a,:

;To,e medi#a*ion, =i# are ordered" pa#@a$ed"

andled" admini,*ered

and #ar$ed in m+l*iple, o/ ,in$le do,e +ni*, #on*ainin$ a

prede*ermined

amo+n* o/ dr+$, or ,+pply ,+J#ien* /or one re$+lar do,e

appli#a*ion or

+,e.<

Ad9an*a$e, o/ +ni* do,e ,y,*em:

%-& Pa*ien*, re#ei9e impro9ed parma#e+*i#al ,er9i#e

17 o+r, a

day and are #ar$ed /or only *o,e do,e," =i# are



admini,*ered *o *em.

%1& All do,e, o/ medi#a*ion re+ired a* *e n+r,in$

,*a*ion are

prepared by *e parma#y *+, allo=in$ *e n+r,e

more *ime

/or dire#* pa*ien* #are.

%4& Allo= *e parma#i,*, *o in*erpre* or #e#@ a

#opy o/ *e

py,i#ian, ori$inal order *+, red+#in$ medi#a*ionerror,.

%7& (limina*ion e#e,,i9e d+pli#a*ion o/ order, and paper

=or@ a*

*e n+r,in$ ,*a*ion and parma#y.

%0& (limina*e, #redi*,.

%3& Tran,/er, in*ra9eno+, prepara*ion and dr+$

re#on,*i*+*ion

pro#ed+re, *o *e parma#y.

Ho,pi*al Parma#y

43

%6& Promo*e, more eJ#ien* +*iliza*ion o/ pro/e,,ional

and nonpro/e,,ional per,onnel.

%5& Red+#e, re9en+e lo,,e,.



%8& Con,er9e, ,pa#e in n+r,in$ +ni*, by elimina*in$

b+l@y ?oor

,*o#@.

%-& (limina*e, pil/era$e and dr+$ =a,*e.

%--& (*end, parma#y #o9era$e and #on*rol

*ro+$o+* *e

o,pi*al /rom *e *ime *e py,i#ian =ri*e, *e order *o

*e *ime

*e pa*ien* re#ei9e, *e +ni*!do,e.

%-1& Comm+ni#a*ion o/ medi#a*ion order, and deli9ery

,y,*em,

are impro9ed.

%-4& Te parma#i,*, #an $e* o+* o/ *e parma#y

and on*o *e

=ard, =ere *ey #an per/orm *eir in*ended /+n#*ion a,

dr+$

#on,+l*an*, and elp pro9ide *e *eam eor* *a* i,

needed /or

be**er pa*ien* #are.

Fi$ %1!-& A /+ll ran$e o/ +ni* do,e pa#@a$in$ e+ipmen*

Ho,pi*al Parma#y

46

)ni* do,e di,pen,in$ pro#ed+re



Te #ara#*eri,*i# /ea*+re, o/ #en*ralized +ni*!do,e

di,pendin$ are *a* all

in!pa*ien* dr+$, are di,pen,ed in +ni*!do,e, and all *e

dr+$, are ,*ored in

a #en*ral area parma#y and di,pen,ed a* *e *ime *e

do,e i, d+e *o be

$i9en *o *e pa*ien*. To opera*e *e ,y,*em

ee#*i9ely" ele#*roni# da*a

pro#e,,in$ e+ipmen* i, no* re+ired" o=e9er deli9ery"

,y,*em, ,+# a,

medi#a*ion #ar*, and d+mb=ai*er, are needed *o $e* *e

+ni*!do,e, *o *e

pa*ien*, al,o ,+#*ion *+be ,y,*em %#alled pne+ma*i#

*+be& or o*er mean,

are re+ired *o ,end a #opy o/ *e py,i#ian, ori$inalmedi#a*ion order *o

*e parma#y /or dire#* in*erpre*a*ion and llin$.

Te de#en*ralized +ni*!do,e ,y,*em" +nli@e *e

#en*ralized ,y,*em"

opera*e, *ro+$ ,mall ,a*elli*e parma#ie, lo#a*ed on

ea# ?oor o/ *e

o,pi*al. Te main parma#y in *i, ,y,*em be#ome,

a pro#+remen*"



,*ora$e" man+/a#*+rin$ and pa#@a$in$ #en*er ,er9in$ all

*e ,a*elli*e,.

Te deli9ery ,y,*em i, a##ompli,ed by *e +,e o/

medi#a*ion #ar*,.

Ti, *ype o/ ,y,*em #an be +,ed /or a o,pi*al =i*

,epara*e b+ildin$, or

old deli9ery ,y,*em,.

Fi$ %1!1& n+r,in$ #ar* /or +,e in +ni* do,e ,y,*em

Ho,pi*al Parma#y

45

Al*o+$ ea# o,pi*al in*rod+#e, 9aria*ion," *e

/ollo=in$ i, a ,*ep!by,*ep o+*line o/ *e pro#ed+re

en*ailed in a de#en*ralized +ni*!do,e ,y,*em:

-!)pon admi,,ion *o *e o,pi*al" *e pa*ien* i, en*ered

in*o *e ,y,*em.

Dia$no,i," aller$ie, and o*er per*inen* da*a are en*ered

on *o *e Pa*ien*

Prole #ard.

1!Dire#* #opie, o/ medi#a*ion order, are ,en* *o *e

parma#i,*.

4!Te medi#a*ion, ordered are en*ered on *o *e Pa*ien*

Prole #ard.

7!Parma#i,* #i#@, medi#a*ion order /or aller$ie,"

dr+$ >in*era#*ion,"



dr+$!labora*ory *e,* ee#*, and ra*ionale o/ *erapy.

0! Do,a$e ,#ed+led i, #oordina*ed =i* *e n+r,in$

,*a*ion.

3! Parma#y *e#ni#ian pi#@, medi#a*ion order,. Pla#in$

dr+$, in bin, o/

a! Tran,/er #ar* per do,a$e ,#ed+le $. %1!1& and %1!4&.

6! Medi#a*ion #ar* i, lled /or par*i#+lar do,a$e ,#ed+le

deli9ery.

5! Parma#i,* #e#@, #ar* prior *o relea,e.

8!Te n+r,e admini,*er, *e medi#a*ion and ma@e,

appropria*e en*ry on

er medi#a*ion re#ord.

-!)pon re*+rn, *o *e parma#y" *e #ar* i, re#e#@ed.

--!Tro+$o+* *e en*ire ,e+en#e" *e parma#i,* i,a9ailable /or

#on,+l*a*ion by *e do#*or, and n+r,e,. In addi*ion

e i, main*ainin$

,+r9eillan#e /or di,#on*in+ed order,.

Ho,pi*al Parma#y

48

Fi$ %1!4& '+r,in$ #ar* /or +,e in +ni* do,e ,y,*em

Ho,pi*al Parma#y



7

DR)2 DISTRIB)TIO' A'D CO'TROL

%)'IT DOS( S(CTIO'&Medi#a*ion di,*rib+*ion i, *e re,pon,ibili*y o/ *e

parma#y. Te

parma#i,*" =i* *e a,,i,*an#e o/ *e parma#y and

*erape+*i#,

#ommi**ee and *e depar*men* o/ n+r,in$" m+,*

de9elop #ompreen,i9e

poli#ie, and pro#ed+re, *a* pro9ider /or *e ,a/e

di,*rib+*ion o/ all

medi#a*ion, and rela*ed ,+pplie, *o inpa*ien*, and

o+*pa*ien*,.

For rea,on, o/ ,a/e*y and e#onomy" *e pre/erred

me*od *o di,*rib+*e

dr+$, in in,*i*+*ion, i, *e +ni* do,e ,y,*em. To+$ *e

+ni* do,e ,y,*em

may dier in /orm dependin$ on *e ,pe#i# need,"

re,o+r#e," and

#ara#*eri,*i#, o/ ea# in,*i*+*ion" /or elemen*, are

#ommon *o all.

(lemen*, o/ +ni* do,e di,*rib+*ion:

%-& Medi#a*ion, are #on*ained in" and admini,*ered

/rom" ,in$le +ni* or



+ni*!do,e pa#@a$e,

%1& Medi#a*ion, are di,pen,ed in ready!*o!admini,*er

/orm" *o *e e*en*

po,,ible

%4& For mo,* medi#a*ion," no* more *an a 17!o+r

,+pply o/ do,e, i,

pro9ided *o or a9ailable a* *e pa*ien* #are area a* any

*ime

%7& A pa*ien* medi#a*ion prole i, #on#+rren*lymain*ained in *e

parma#y /or ea# pa*ien*. Floor ,*o#@, o/ dr+$, are

minimized and

limi*ed *o dr+$, /or emer$en#y +,e and ro+*inely +,ed

;,a/e< i*em, ,+#

mo+*=a, and an*i,ep*i# ,ol+*ion,.

Ho,pi*al Parma#y

7-

Fi$ %1!7&. Daily #on*rolled dr+$, admini,*ra*ion /orm

Ho,pi*al Parma#y

71

ri*in$ *e Order:

Medi#a*ion, ,o+ld be $i9en %=i* #er*ain ,pe#ied

e#ep*ion,& only on



*e =ri**enorder o/ a +alied py,i#ian or o*er

a+*orized pre,#riber.

Allo=able e#ep*ion, *o *i, r+le %i.e." *eleponed or

9erbal order,&

,o+ld be p+* in =ri**en /orm immedia*ely and *e

pre,#riber ,o+ld

#o+n*er,i$n *e n+r,e, or parma#i,*, ,i$ned re#ord

o/ *e,e order,

=i*in 75 %pre/erably 17& o+r,. Only a parma#i,* or

re$i,*ered n+r,e

,o+ld a##ep* ,+# order,. Pro9i,ion ,o+ld be made *o

pla#e py,i#ian,

order in *e pa*ien*, #ar*" and a me*od /or ,endin$ *i,

in/orma*ion *o

*e parma#y ,o+ld be de9eloped.Pre,#riber, ,o+ld ,pe#i/y *e da*e and *ime

medi#a*ion order, are

=ri**en.

Medi#a*ion order, ,o+ld be =ri**en le$ibly in in@ and

,o+ld in#l+de:

Pa*ien*, name and lo#a*ion %+nle,, #learly indi#a*ed on

*e

order ,ee*&.

'ame %2eneri#& o/ medi#a*ion.



Do,a$e epre,,ed in *e me*ri# ,y,*em" e#ep* in

in,*an#e,

=ere do,a$e m+,* be epre,,ed o*er=i,e %i.e." +ni*,"

e*#&

Fre+en#y o/ admini,*ra*ion.

Ro+*e o/ admini,*ra*ion.

Si$na*+re o/ *e py,i#ian.

Da*e and o+r *e order =a, =ri**en.

Any abbre9ia*ion, +,ed in medi#a*ion order, ,o+ld

be a$reed *o and

Eoin*ly adop*ed by *e medi#al" n+r,in$" parma#y" and

medi#al re#ord,

,*a o/ *e in,*i*+*ion.

Any +e,*ion, ari,in$ /rom a medi#a*ion order"in#l+din$ *e

in*erpre*a*ion o/ an ille$ible order" ,o+ld be re/er *o

*e orderin$

Ho,pi*al Parma#y

74

py,i#ian. I* i, de,irable /or *e parma#i,* *o ma@e

%appropria*e& en*rie,

in *e pa*ien*, medi#al #ar* per*inen* *o *e pa*ien*,

dr+$ *erapy. Al,o"



a d+pli#a*e re#ord o/ *e en*ry #an be main*ained in *e

parma#y prole.

In #omp+*erized pa*ien* da*a ,y,*em," ea# pre,#riber

,o+ld be a,,i$ned

a +ni+e iden*ier *i, n+mber ,o+ld be in#l+ded

in all medi#a*ion

order,. )na+*orized per,onnel ,o+ld no* be able *o

$ain a,,e,, *o *e

,y,*em.

Medi#a*ion Order See*,:

Te parma#i,* %e#ep* in emer$en#y ,i*+a*ion,&

m+,* re#ei9e *e

py,i#ian, ori$inal order or a dire#* #opy o/ *e order

be/ore *e dr+$ i,

di,pen,ed. Ti, permi*, *e parma#i,* *o re,ol9e+e,*ion, or problem,

=i* dr+$ order be/ore *e dr+$ i, di,pen,ed and

admini,*ered. I* al,o

elimina*e, error," =i# may ari,e =en dr+$ order, are

*ran,#ribed on*o

ano*er /orm /or +,e by *e parma#y. Se9eral

me*od, by =i# *e

parma#y may re#ei9e py,i#ian, ori$inal order, or

dire#* #opie, are:



-. Sel/!#opyin$ order /orm,. Te py,i#ian, order

/orm i,

de,i$ned *o ma@e a dire#* #opy %#arbon or 'CR&" =i# i,

,en* *o

*e parma#y. Ti, me*od pro9ide, *e parma#i,*

=i* a

d+pli#a*e #opy o/ *e order and doe, no* re+ire ,pe#ial

e+ipmen*.

Tere are *=o ba,i# /orma*,:

a. Order, /or medi#a*ion, in#l+ded amon$ *rea*men*

order,.

),e o/ *i, /orm allo=, *e py,i#ian *o #on*in+e

=ri*in$ i,

order, on *e #ar* a, e a, been a##+,*omed in

*e pa,*"lea9in$ all o*er de*ail, *o o,pi*al per,onnel.

b. Medi#a*ion order, ,epara*ed /rom o*er *rea*men*

order, on

*e order /orm. Te ,epara*ion o/ dr+$ order, ma@e, i*

ea,ier /or

*e parma#i,* *o re9ie= *e order ,ee*.

Ho,pi*al Parma#y

77



1. (le#*rome#ani#al. Copyin$ ma#ine, or ,imilar

de9i#e, may be

+,ed *o prod+#e and ea#* #opy o/ *e py,i#ian, order.

Pro9i,ion

,o+ld be made *o *ran,mi* py,i#ian, order, *o *e

parma#y in

*e e9en* o/ me#ani#al /ail+re.

4. Comp+*erized. Comp+*er ,y,*em, in =i# *e

py,i#ian en*er,

order, in*o a #omp+*er" =i# *en ,*ore, and prin*, o+*

*e order

in *e parma#y or el,e=ere" are +,ed in ,ome

in,*i*+*ion,. Any

,+# ,y,*em ,o+ld pro9ide /or *e parma#i,*,

9eri#a*ion o/ anydr+$ order, en*ered in*o *e ,y,*em by anyone o*er

*an an

a+*orized pre,#riber.

Spe#ial Order,:

Spe#ial Order, %i.e." ;,*a*< and emer$en#y order,"

and *o,e /or

non/orm+lary dr+$," in9e,*i$a*ional dr+$," re,*ri#*ed!

+,e dr+$, or



#on*rolled ,+b,*an#e,& ,o+ld be pro#e,,ed a##ordin$ *o

,pe#i# =ri**en

pro#ed+re, mee*in$ all appli#able re$+la*ion, and

re+iremen*,.

Ho,pi*al Parma#y

70

Fi$. %1!0&. Mon*ly #on*rolled dr+$ in9en*ory /orm

Ho,pi*al Parma#y

73

DISP('SI'2 OF CO'TROL(D S)BSTA'C(S

Deni*ion,:

Addi#*:Any indi9id+al =o abi*+ally +,e, any nar#o*i#

dr+$ ,o a,

*o endan$er *e p+bli# moral," eal*" ,a/e*y or =el/are"or =o i, ,o /ar

addi#*ed *o *e +,e o/ nar#o*i# dr+$, a, *o a9e lo,*

*e po=er or ,el/#on*rol =i* re/eren#e *o i, addi#*ion.

Admini,*er:Te dire#* appli#a*ion o/ a #on*rolled

,+b,*an#e, *o *e

body o/ a pa*ien* or re,ear# ,+bEe#* by a pra#*i*ioner or

i, a$en* or by

*e pa*ien* or re,ear# ,+bEe#* a* *e dire#*ion and in *e

pre,en#e o/ *e



pra#*i*ioner.

Con*rolled S+b,*an#e,: A dr+$ or o*er ,+b,*an#e" or

immedia*e

pre#+r,or" in#l+ded in ,#ed+le I" II" III" I or o/ Par* B o/

*i, *i*le.

Te *erm do,e no* in#l+de, di,*illed ,piri*," =ine"

mal* be9era$e, or

*oba##o.

Depre,,an* Or S*im+lan* S+b,*an#e:

UAV a dr+$ =i# #on*ain any +an*i*y o/ %-& barbi*+ri#

a#id or any o/ *e

,al*, o/ barbi*+ri# a#id or %1& any deri9a*i9e o/ barbi*+ri#

a#id or

UBV a dr+$ =i# #on*ain, any +an*i*y o/ %-&

ampe*amine or any o/ i*,

op*i#al i,omer, %1& any ,al* o/ ampe*amine or any

,al* o/ an op*i#al

i,omer o/ ampe*amine or %4& any ,+b,*an#e =i#

*e A**orney

2eneral" a/*er in9e,*i$a*ion" a, /o+nd *o be" and by

re$+la*ion de,i$na*ed

a, abi*!/ormin$ be#a+,e o/ i*, ,*im+lan* ee#* on

*e #en*ral ner9o+,

,y,*em or



UCV Ly,er$i# a#id die*ylamide or

UDV any dr+$ =i# #on*ain, any +an*i*y o/ a

,+b,*an#e =i# *e

A**orney 2eneral" a/*er in9e,*i$a*ion" a, /o+nd *o

a9e" and by

re$+la*ion de,i$na*ed a, a9in$" a po*en*ial /or

ab+,e be#a+,e o/ i*,

depre,,an* or ,*im+lan* ee#* on *e #en*ral ner9o+,

,y,*em or i*,

all+#ino$eni# ee#*.

Ho,pi*al Parma#y

76

'ar#o*i# Dr+$:mean, any o/ *e /ollo=in$" =e*er

prod+#ed

dire#*ly or indire#*ly by e*ra#*ion /rom ,+b,*an#e, o/

9e$e*able ori$in" or

independen*ly by mean, o/ #emi#al ,yn*e,i," or by

a #ombina*ion o/

e*ra#*ion and #emi#al ,yn*e,i,.

UAV Opi+m" #o#a lea9e, and opia*e,.

UBV A #ompo+nd" man+/a#*+re" ,al*" deri9a*i9e" or

prepara*ion o/ opi+m"

#o#a lea9e, or opia*e,.



UCV A ,+b,*an#e %any #ompo+nd" man+/a#*+re" ,al*"

deri9a*i9e" or

prepara*ion *ereo/& =i# i, #emi#ally iden*i#al =i*

any ,+b,*an#e

re/erred *o in UAV or UBV abo9e. (#l+ded are de#o#ainized

#o#a lea9e, or

e*ra#*, o/ #o#a lea9e," =i# do no* #on*ain #o#aine or

e#$onine.

Ho,pi*al Parma#y

75

SCH(D)L(S FOR CO'TROLL(D S)BSTA'C(S

%-& SCH(D)L( I

UAV Te dr+$ or o*er ,+b,*an#e a, a i$ po*en*ial /or

ab+,e.

UBV Te dr+$ or o*er ,+b,*an#e a, no #+rren*ly

a##ep*ed medi#al +,e in

*rea*men* in *e %)ni*ed S*a*e,&.

UCV Tere i, a la#@ o/ a##ep*ed ,a/e*y /or +,e o/ *e

dr+$ or o*er

,+b,*an#e +nder medi#al ,+per9i,ion.

%1& SCH(D)L( II

UAV Te dr+$ or o*er ,+b,*an#e a, a i$ po*en*ial /or

ab+,e.



UBV Te dr+$ or o*er ,+b,*an#e a, re#+rren*ly a##ep*ed

medi#al +,e in

*rea*men* in *e %)ni*ed S*a*e,& or a #+rren*ly a##ep*ed

medi#al +,e =i*

,e9ere re,*ri#*ion,.

UCV Ab+,e o/ *e dr+$ or o*er ,+b,*an#e, may lead

*o ,e9ere

p,y#olo$i#al or py,i#al dependen#e.

%4& SCH(D)L( III

UAV Te dr+$ or o*er ,+b,*an#e a, a po*en*ial /or

ab+,e le,, *an *e

dr+$ or o*er ,+b,*an#e, in ,#ed+le, I and II.

UBV Te dr+$ or o*er ,+b,*an#e a, a #+rren*ly a##ep*ed

medi#al +,e in


UCV Ab+,e o/ *e dr+$ or o*er ,+b,*an#e, may lead *o

modera*e or lo=

py,i#al dependen#e or i$ p,y#olo$i#al dependen#e.

%7& SCH(D)L( I

UAV Te dr+$ or o*er ,+b,*an#e a, a lo= po*en*ial /or

ab+,e rela*i9e *o

*e dr+$ or o*er ,+b,*an#e, in ,#ed+le, III.




medi#al +,e in



limi*ed py,i#al

dependen#e or p,y#olo$i#al dependen#e rela*i9e *o

*e dr+$, or o*er

,+b,*an#e, in ,#ed+le III.

%0& SCH(D)L(

UAV Te dr+$ or o*er ,+b,*an#e a, a lo= po*en*ial /or

ab+,e rela*i9e *o

*e dr+$, or o*er ,+b,*an#e, in ,#ed+le, I.


medi#al +,e in



limi*ed py,i#al

dependen#e or p,y#olo$i#al dependen#e rela*i9e *o

*e dr+$, or o*er

,+b,*an#e, in ,#ed+le I.

Ho,pi*al Parma#y

78

PR(SCRIPTIO'S



In di,pen,in$ o/ #on*rolled ,+b,*an#e," *e /ollo=in$

re+iremen*, ,o+ld

be #on,idered =i* pre,#rip*ion,:

-. (#ep* =en di,pen,ed

1. Dr+$, may be di,pen,ed on *e oral pre,#rip*ion

in an emer$en#y

,i*+a*ion.

4. Pre,#rip*ion ,all be re*ained in #on/ormi*y =i* *e

re+iremen*, o/

*i, la=.

7. 'o pre,#rip*ion /or a #on*rolled ,+b,*an#e in

S#ed+le II may be

relled.

0. Con*rolled ,+b,*an#e, in S#ed+le III or I mayno* be di,pen,ed

=i*o+* a =ri**en or oral pre,#rip*ion in #on/ormi*y.

3. S+# pre,#rip*ion, may no* be lled or relled

more *an 3 mon*,

a/*er *e da*e *ereo/ or be relled more *an 0 *ime,

a/*er *e da*e o/ *e

pre,#rip*ion +nle,, rene=ed by *e pra#*i*ioner.

6. 'o #on*rolled ,+b,*an#e in S#ed+le *a* i, a

dr+$ may be



di,*rib+*ed or di,pen,ed o*er *an /or a medi#al

p+rpo,e.

Pre,#rip*ion, lled =i* #on*rolled ,+b,*an#e, in

S#ed+le II may be

=ri**en in in@ or indelible pen#il and m+,* be ,i$ned by

*e pra#*i*ioner

i,,+in$ *em. Pre,#rip*ion, /or nar#o*i# ,+b,*an#e, in

S#ed+le, III" I

and " m+,* be @ep* in a ,epara*e le.

Ho,pi*al Parma#y

0

R(2)LATIO'S OF HOSPITAL CO'TROLL(D S)BSTA'C(S

Deni*ion,:

-. ;Order<: Te dire#*ion /or *e dr+$" ,*ren$* and/re+en#y o/

admini,*ra*ion a, =ri**en on *e Do#*or, Order See*

o/ *e pa*ien*,

Medi#al Re#ord.

1. ;Pre,#rip*ion<:Te dire#*ion /or *e dr+$" ,*ren$*"

+an*i*y" and

/re+en#y o/ admini,*ra*ion a, =ri**en on a pre,#rip*ion

blan@ by a do#*or

/or di,pen,in$ by *e Parma#y.



4. ;Admini,*er<:Te =ord ;admini,*er< i, employed

=en a n+r,e or

o*er properly +alied indi9id+al $i9e, medi#a*ion *o a

pa*ien*" p+r,+an*

*o *e order o/ a +alied pra#*i*ioner.

7. ;Di,pen,e<:Te =ord ;di,pen,e< i, employed =en

a parma#i,*

$i9e, medi#a*ion *o a n+r,e or o*er properly

+alied indi9id+al in

a##ord =i* *e dire#*ion, o/ a properly =ri**en

pre,#rip*ion.

0. ;Do#*or<:Ti, *erm i, erein employed *o indi#a*e and

indi9id+al =o

a, +alied /or and a, re#ei9ed a n+mber /rom *e

Dr+$ (n/or#emen*A$en#y.

Re$i,*ra*ion o/ do#*or, =o #an pre,#ribe

Do#*or, %Pra#*i*ioner,&" in order *o pre,#ribe nar#o*i#,

/or or order

admini,*ered %di,pen,ed& *o *eir pa*ien*, in *e o,pi*al"

m+,* be li#en,ed

*o pra#*i#e +nder *e la=, o/ *e %,*a*e& and m+,* be d+ly

re$i,*ered =i*

*e D(A.



I'T(R'S and R(SID('TS

Re$i,*ra*ion re+iremen*, =ere =ai9ed *o allo= in*ern,

and re,iden*,

*o di,pen,e and pre,#ribe #on*rolled ,+b,*an#e, +nder

*e re$i,*ra*ion o/

*e o,pi*al by =i# *ey are employed.

Ho,pi*al Parma#y

0-

Re,pon,ibili*y /or #on*rolled ,+b,*an#e,

Te admini,*ra*i9e ead o/ *e o,pi*al i, re,pon,ible

/or *e proper

,a/e$+ardin$ and *e andlin$ o/ #on*rolled

,+b,*an#e, =i*in *e

o,pi*al. Re,pon,ibili*y /or *e p+r#a,e" ,*ora$e"a##o+n*abili*y and

proper di,pen,in$ o/ b+l@ #on*rolled ,+b,*an#e, =i*in

*e o,pi*al i,

dele$a*ed *o *e Parma#i,*!in!Cie/. Te Head '+r,e o/ a

n+r,in$ +ni* i,

re,pon,ible /or *e proper ,*ora$e and +,e o/ *e n+r,in$+ni*, #on*rolled

,+b,*an#e,.

Prepara*ion o/ order,



All #on*rolled ,+b,*an#e, order, and re#ord, m+,* be

*yped or =ri**en

in in@ or indelible pen#il and ,i$ned in in@ or indelible

pen#il.

Telepone order,

A do#*or may order a #on*rolled dr+$ by *elepone in

#a,e o/ ne#e,,i*y.

Te n+r,e =ill =ri*e *e order on *e do#*or, order ,ee*"

,*a*in$ *a* i* i,

a *elepone order and =ill ,i$n *e do#*or, name and er

o=n ini*ial,.

Te #on*rolled dr+$ may *en be admini,*ered a* on#e.

Te order m+,*

*en be ,i$ner by *e do#*or =i* ei*er i, ,i$na*+re or

i, ini*ial, =i*in17 o+r,.

erbal order,

A 9erbal order may be $i9en by a do#*or in an e*reme

emer$en#y =ere

*ime doe, no* permi* =ri*in$ *e order. Te n+r,e m+,*

=ri*e *e order on

*e do#*or, order ,ee*. Te do#*or m+,* ,i$n *e order

=i* ei*er i,

,i$na*+re or i, ini*ial, =i*in 17 o+r,.



In/orma*ion on daily #on*rolled dr+$ admini,*ra*ion ,ee*

Te /+ll in/orma*ion re+ired on *e Daily Con*rolled

Dr+$,

Admini,*ra*ion See* i, a, /ollo=,:

-. Da*e.

1. Amo+n* $i9en.

4. Pa*ien*, /+ll name

7. Pa*ien*, o,pi*al n+mber.

0. 'ame o/ do#*or orderin$.

3. Si$na*+re o/ n+r,e admini,*erin$.

Te /ollo=in$ in/orma*ion i, re+e,*ed /or a+di*in$

p+rpo,e, and i, no*

re+ired by Federal la=:

-. '+mber o/ *able*, or ml admini,*ered

1. Filin$ o+* in9en*ory #ol+mn %*o be re*ained /or

Parma#y&.

Ho,pi*al Parma#y

01

Pre,#ribin$ #on*rolled dr+$ in o+* pa*ien* depar*men*

Pre,#rip*ion, /or S#ed+le II and o*er #on*rolled

,+b,*an#e, dr+$,



may be di,pen,ed /rom Parma#y and m+,* in#l+de *e

/ollo=in$

in/orma*ion.

a. Pa*ien* , /+ll name

b. Pa*ien*, addre,, or o,pi*al n+mber

#. Da*e

d. 'ame and ,*ren$* o/ dr+$ pre,#ribed.

e. N+an*i*y o/ dr+$ *o be di,pen,ed

/. D(A n+mber and ,i$na*+re o/ py,i#ian

$. Fre+en#y and ro+*e o/ admini,*ra*ion

Te pre,#rip*ion m+,* be =ri**en in in@ or indelible pen#il

and ,all no*

bear #ro,, o+*, or era,+re,. Di,#ar$e pre,#rip*ion, /or

S#ed+le II dr+$,

m+,* be pi#@ed +p by a re$i,*ered n+r,e.

Di,pen,in$ #on*rolled dr+$, /or ome +,e

O##a,ionally pa*ien*, =o re+ire dr+$, /or +,e a*

ome are

di,#ar$ed /rom *e o,pi*al or relea,ed /rom Te(mer$en#y ard

d+rin$ o+r, =en *e Parma#y i, #lo,ed. ene9er

po,,ible" a



pre,#rip*ion ,i$ned by a member o/ *e ,*a =o

a, a Li#en,e *o

pra#*i#e medi#ine and a D(A n+mber ,o+ld be ob*ained.

A ,*a py,i#ian =o,e D(A n+mber i, i,,+ed *o an

o+*,ide oJ#e

,o+ld +,e i, o=n pre,#rip*ion blan@. I/ *i, i, no*

a9ailable" *en e

m+,* in,er* i, oJ#e addre,, on *e o,pi*al pre,#rip*ion

blan@. Ti, =ill

permi* *e pa*en* or i, rela*i9e *o p+r#a,e *e

dr+$, a* an o+*,ide

parma#y. I/ no py,i#ian i, a9ailable" or d+rin$

o+r, =en *e lo#al

parma#ie, are #lo,ed" *e /ollo=in$ pro#ed+re i,

allo=ed" b+* only a, an(M(R2('CY M(AS)R(:

Ho,pi*al Parma#y

04

Te a**endin$ do#*or =ill #al#+la*e *e ,malle,*

amo+n* o/ *e dr+$

ne#e,,ary *o *rea* *e pa*ien* +n*il *e Parma#y open,.

He =ill =ri*e a

pre,#rip*ion /or *i, amo+n* and *e n+r,e may di,pen,e

*e medi#a*ion



/rom er ,*o#@ ,+pply. Te pre,#rip*ion =ill be pre,en*ed

*o *e parma#y

*e /ollo=in$ mornin$ /or repla#emen* o/ ,*o#@.

Pro#ed+re in #a,e o/ =a,*e" de,*r+#*ion" #on*amina*ion

e*#

-. Ali+o* Par* o/ 'ar#o*i# Sol+*ion, ),ed /or Do,e:

Te n+r,e ,all +,e *e proper n+mber o/ *able*, or

ampo+le, /rom

n+r,in$ ,*o#@. Se ,all re#ord *e n+mber o/ *able*, orampo+le, +,ed

and *e do,e $i9en in *e proper #ol+mn, on Daily

Con*rolled Dr+$,

Admini,*ra*ion Form. Se ,all" in arri9in$ a* *e

proper ali+o* par*"

epel in*o *e ,in@ *a* por*ion o/ *e ,ol+*ion *a* i, no*+,ed.

1. Prepared Do,e re/+,ed by Pa*ien* or Can#elled by

Do#*or:

en a do,e a, been prepared /or a pa*ien* b+*

no* +,ed" d+e *o a

re/+,ed by *e pa*ien* or be#a+,e o/ #an#ella*ion by *e

do#*or" *e n+r,e

,all epel *e ,ol+*ion in*o *e ,in@ and re#ord =y

*e dr+$ =a, no*



admini,*ered. (ample,: Di,#arded" Re/+,ed by

pa*ien* or order

#an#elled by Dr. WWWWW. Te ead n+r,e o/ *e +ni* ,all

#o+n*er,i$n *e

,*a*emen*.

4. A##iden*al De,*r+#*ion and Con*amina*ion o/ Dr+$,:

en a ,ol+*ion" ampo+le" *able* e*#." i, a##iden*ally

de,*royed or

#on*amina*ed on a '+r,in$ )ni*" Te per,on re,pon,ible,all indi#a*e *e

lo,, on $+re %1!7&.

Ho,pi*al Parma#y

07

Fi$ %1!3&. Con*rolled S+b,*an#e Lo,, or FormHo,pi*al Parma#y

00

PR(PACI'2

Prepa#@a$in$ o/ dr+$, i, no* a ne= #on#ep* *o *e

pro/e,,ion o/

parma#y. I* a, been in pra#*i#e ,in#e *e apo*e#ary o/

old $re=

i, o=n erb, and dr+$, and ar9e,*ed and

pa#@a$ed *em /or



,ale. Many re*ail parma#ie, p+r#a,e 9ario+, o9er!

*e!#o+n*er

*able*, and ,yr+p, in b+l@ +an*i*ie, and prepa#@a$e *e

ma*erial

in ,maller!,ized #on*ainer,.

In *e o,pi*al parma#y" *e #on#ep* o/ prepa#@a$in$ i,

+*ilized

in bo* *e lar$e and *e ,mall o,pi*al /or i* i,"

o/*en*ime," *e

mean, o/ #opin$ =i* *e period, o/ pea@ demand

/or

parma#e+*i#al ,er9i#e. In *e ,mall o,pi*al" *e

parma#i,* may

prepa#@a$e only *o,e i*em, =i# e #on,ider, re+ire

*oo m+#*ime i/ lled only =en #alled /or. In ,ome o,pi*al

parma#ie,"

i*em," =i# /all in*o *i, #a*e$ory" are nar#o*i#,"

barbi*+ra*e, oily

prod+#*," ea9y ,yr+p, or ma$ma,.

Mo,* lar$e o,pi*al, a9e /o+nd i* e#onomi#al *o

prepa#@a$e all

=ard ,*o#@ i*em, a, =ell a, *e o/*en!pre,#ribed *able*,

#ap,+le,"



,yr+p," oin*men*, and #ream, +,ed bo* by *e in!

pa*ien*, a, =ell

a, *e o+*pa*ien* #lini#,. Be#a+,e o/ *e ,#ope o/ *+,

pa,e o/ a

lar$e o,pi*al parma#y opera*ion" i* o/*en re+ire, a

,epara*e

=or@ /or#e" ,pe#ial e+ipmen*" and de*ailed #on*rol

pro#ed+re, *o

en,+re a$ain,* *e po,,ibili*y o/ error,.

Ho,pi*al Parma#y

03

Fa#*or, #on,idered in prepa#@in$

a. Demand /or *e prod+#*.

I, i* a year ro+nd demand or i, i* a ,ea,onal demandI, *e demand one" =i# ori$ina*e, /rom *e #lini#, or

*e pa9ilion,

Can *i, prod+#* be p+r#a,ed in +an*i*ie, *o mee* *e

demand"

ye* a9e i* pa#@a$ed in ,mall +ni*, by *e man+/a#*+rer

a* a pri#e

lo=er *an *e o,pi*al #o,* *o prepa#@a$e *e ,ame

i*em in a

,imilar #on*ainer



b. a* ,ize +ni*, ,o+ldbe pa#@a$ed Ho= many o/ ea#

,ize

#. a* *ype o/ #on*ainer, and #lo,+re, m+,* be +,ed in

order *o

main*ain *erape+*i# in*e$ri*y

d. a* ,pe#ial labelin$ =ill be re+ired

e. Can *e i*em be ma#ine pa#@a$ed or m+,*

and#o+n*in$ be

re,or*ed *o

/.a* i, *e ,*abili*y o/ *e prod+#* I, i* da*ed

$.a* =ill *e +ni* #o,* o/ prepa#@a$in$ amo+n* *o

o

,o+ld pay i*

Ho,pi*al Parma#y06

ST(RIL( M(DICATIO' DOS(S A'D I. ')TRITIO'

Paren*eral Hyperalimen*a*ion

Paren*eral yperalimen*a*ion i, *e in*ra9eno+,

admini,*ra*ion o/

,+J#ien* n+*rien*, abo9e *e +,+al ba,al

re+iremen*, *o a#ie9e

*i,,+e ,yn*e,i," po,i*i9e ni*ro$en balan#e and anaboli,in.



Te prepara*ion o/ paren*eral yperalimen*a*ion

,ol+*ion, m+,* be

#on,idered a, an in*e$ral par* o/ *e parma#y

depar*men*, man+/a#*+rin$ pro$ram irre,pe#*i9e o/

i*, ,ize. Te pro#ed+re, employed are

no* +nd+ly #ompli#a*ed and do no* re+ire e*en,i9e

#api*al o+*lay /or

e+ipmen*.

Mo,* o,pi*al parma#i,*, prepare *e,e ,ol+*ion, by

+,in$ a *e#ni+e

de,#ribed a, *e =e* me*od *ro+$ *e

e*emporaneo+, #ompo+ndin$ *e#ni+e, o/ an

in*ra9eno+, admi*+re pro$ram.

- Ti, #on,i,*, o/ miin$ *e de*ro,e ,ol+*ion /rom

one ?a,@ =i* *e brin

ydroly,a*e ,ol+*ion in ano*er?a,@ +*ilizin$ a ,ol+*ion

*ran,/er ,e*. In

*e dry me*od *e parma#i,* add, *e

appropria*e amo+n* o/

anydro+, $l+#o,e *o *e brin ydroly,a*e ,ol+*ion.

Bo*

me*od, m+,* be #arried o+* +nder a laminar ?o= ood.



Be#a+,e o/ *e na*+re o/ *e,e prod+#*," *e parma#y

m+,* a9e

a9ailable appropria*e re/ri$era*ion e+ipmen* and *e

parma#i,*

m+,* be#ome /amiliar =i* membrane l*ra*ion pro#e,,e,

in 9ie=

o/ *e /a#* *a* *e ea* a,,o#ia*ed =i* *e normal

,*eriliza*ion

pro#e,, =ill #a+,e #arameliza*ion o/ *e de*ro,e

#on*ained in

ea# /orm+la.

Ho,pi*al Parma#y

05

In*ra9eno+, addi*i9e pro$ram

One =ri*er a, ,*a*ed *a* an in*ra9eno+, addi*i9e

pro$ram

and an in*ra9eno+, addi*i9e ,er9i#e may no* be *e

,ame. Te

dieren*ia*ion #i*ed i, *a* an I addi*i9e pro$ram

#on,i,*, o/

poli#ie, and pro#ed+re, /or bo* *e prepara*ion and

admini,*ra*ion o/ in*ra9eno+, ?+id, *o =i# dr+$,

are *o be



added +nder a,ep*i# #ondi*ion," on an aro+nd!*e!#lo#@

ba,i," and

#on*rolled a, *o lo#a*ion and per,on preparin$ *e

prod+#*. On *e

o*er and" *e I addi*i9e ,er9i#e +,+ally re/er,

only *o *e

prepara*ion o/ *e prod+#* by indi9id+al, =o may

no* ne#e,,arily be *e ,ame a, *o,e =o =ill admini,*er

*em and a,,+me

*e re,pon,ibili*y /or *e moni*orin$ o/ i*, #lini#al

ee#*,. Te

#on#l+,ionarri9eda* i, *a* an I addi*i9e ,er9i#e i, a par*

o/ an

I addi*i9e pro$ram.

Tro+$ *e implemen*a*ion o/ an I ,er9i#e" *eo,pi*al

parma#i,* mi$* be epe#*ed *o a#ie9e *e /ollo=in$

obEe#*i9e,:

A! Ta**e prepara*ion o/ *e nal prod+#* be

a##ompli,ed

+nder a,ep*i# #ondi*ion

B! Ta**e dr+$ in*era#*ion, be a9oided *ro+$ *e

E+di#io+,

#oi#e o/ addi*i9e and miin$ *e#ni+e,



C! Ta**e nal prod+#* i, appropria*ed labeled"

di,pen,ed and

,*ored.

In *e no* *oo di,*an* pa,*" *e prepara*ion o/

in*ra9eno+,

,ol+*ion, =i* *eir addi*i9e, =a, a *a,@ per/ormed on *e

n+r,in$

?oor by n+r,e, or in*ern, and re,iden*,. Te #on#ep*

*a* *e

prepara*ion o/ *e,e prod+#*, re+ire, *e ,@ill, o/ a

parma#i,*

a, rai,ed many o*er +e,*ion, no* *e lea,* o/

=i# i,

a9ailabili*y o/ *e prod+#* a* odd o+r, par*i#+larly i/ *e

,i*e o/prepara*ion i, mo9ed *o *e main parma#y. T+," a,

e9ol9ed

Ho,pi*al Parma#y

08

*e ,a*elli*e parma#y" ,*aed by a #lini#al

parma#i,* and

parma#y *e#ni#ian,. On nal analy,i," i*i, irrele9an*

=ere *e



addi*i9e, are added ,o lon$ a, deni*e poli#ie, are

/orm+la*ed

=i# ,pell o+* re,pon,ibili*ie,. In addi*ion" i* i,

impera*i9e *a*

*e parma#i,* be#ome, in9ol9ed in *e prepara*ion

o/ *e,e

prod+#*, in an en9ironmen* #ond+#i9e *o *e eJ#ien*

and ,a/e

prepara*ion o/ *em.

Prepara*ion o/ I. addi*i9e ,ol+*ion,

In *e prepara*ion o/ *e,e ,ol+*ion," *e parma#i,*

,o+ld

=or@ /rom *e py,i#ian, ori$inal order ,ee* or /rom

a dire#*

#opy. )pon re#eip* o/ *e order" a pre,,+re!,en,i*i9e labelm+,*

be prepared =i# pro9ide, *e /ollo=in$ in/orma*ion:

%a& Pa*ien* iden*i#a*ion

%b& Pa*ien* lo#a*ion

%#& Py,i#ian, name

%d& 'ame o/ dr+$, =i* +an*i*ie, added

%e& Da*e o/ #ompo+ndin$

%/& (pira*ion da*e



%$& Iden*i#a*ion o/*e parma#i,* preparin$ *e prod+#*.

I/ ne#e,,ary" any an#illary labelin$ ,o+ld al,o be

prepared a*

*i, *ime. en applyin$ *e label *o *e #on*ainer"

i* m+,* be

po,i*ioned in an +p,ide do=n order *o /a#ili*a*e

readin$ =en *e

#on*ainer i, +n$ /rom an in*ra9eno+, ,ol+*ion pole

on *e pa*ien*,

bed.

Prepara*ion o/ *e ,ol+*ion ,o+ld al=ay, *a@e pla#e

+nder a

laminar ?o= ood +,in$ ,*erile needle, and ,yrin$e, or

do+ble!ended

*ran,/er needle,. In ,ome in,*an#e," a Corn=all,yrin$e i, +,e/+l in

re#on,*i*+*ion pro#ed+re,.

Ho,pi*al Parma#y

3

On#e *e *ran,/er i, made" *e me*al di,# m+,* berepla#ed and a

ne= ,eal #rimped on *o *e #on*ainer. A, a ,a/e*y

de9i#e" a dieren*



#olored ,eal ,o+ld be +,ed in 9ie= o/ *e /a#* *a* i*

=arn, indi9id+al,

*a* dr+$, a9e been added.

Be/ore permi**in$ *e admi*+re *o lea9e i, #on*rol"

*e

parma#i,* m+,* #arry o+* a nal in,pe#*ion o/ *e

prod+#*. Te

in,pe#*ion ,o+ld in#l+de a re9ie= o/ *e label" #lari*y o/

*e ,ol+*ion"

and *e ma*ema*i#, in9ol9ed in *e prepara*ion.

Laminar ?o= ood,

Al*o+$ many o,pi*al, a9e abandoned *e

prepara*ion o/ lar$e

9ol+me" ,*erile in*ra9eno+, ?+id," a lar$e n+mber

a9e #ommen#ed

o*er pro$ram," ,+# a, *e in*ra9eno+, ,ol+*ion,

addi*i9e pro#ed+re"

=i# re+ire ,*erile *e#ni+e, *o be per/ormed in an

a*mo,pere o/

mi#ro!l*ered air.

In order *o #rea*e ,+# an a*mo,pere" 9ario+,

man+/a#*+rer, o/ ood,

a9e in#orpora*ed in*o *em *e laminar ?o= prin#iple.



Laminar air?o= i, dened a,:

Air?o= in =i# *e en*ire body o/ air =i*in a #onned

area mo9e,

=i* +ni/orm 9elo#i*y alon$ parallel ?o= line," =i* a

minim+m o/

eddie,.

By pro9idin$ a #on,*an* o+*=ard ?o= o/ mi#ro!l*ered

air o9er *e

en*ire /a#e o/ *e ood, =or@ area openin$" d+,*par*i#le, may be @ep*

/rom en*erin$*e =or@ area /rom *e ambien*

a*mo,pere.

Ho,pi*al Parma#y

3-

Fi$ %1!6& Horizon*al laminar air?o= +ni* $ %1!5& er*i#al

laminar air?o= +ni*

Ho,pi*al parma#i,*, =o plan *o #ommen#e

in*ra9eno+, ,ol+*ion,

addi*i9e pro$ram, or *o,e =o are #alled +pon *o

prod+#e

,pe#ial ,*erile re,ear# prod+#*, ,o+ld in9e,*i$a*e

*e

po,,ibili*ie," =i# ,+# an in,*alla*ion oer,.



Parma#y!Cen*ral S*erile S+pply Room, *a* ,*ill

prod+#e

paren*eral ?+id, ,o+ld in,*all laminar ?o= ood, in

order *o

en,+re ,a/e" ,*erile prod+#*,.

Ho,pi*al Parma#y

31

Fi$ %1!8& laminar air?o= +ni*

Ho,pi*al Parma#y

34

(mer$en#y medi#a*ion,

Be#a+,e in mo,* *r+e emer$en#ie, *ime i, o/ *e e,,en#e"

i* i, impera*i9e

*a* emer$en#y dr+$ or ;S*a* boe, #on*ainin$ dr+$,and ,+pplie, be

readily a9ailable /or +,e by *e bed,ide. Te

parma#y and *erape+*i#

#ommi**ee ,o+ld de9elop a li,* o/ ,+pplie, and dr+$,"

=i# o+$* *o be

in an emer$en#y bo and in,*r+#* *e parma#i,*

and n+r,in$ ,er9i#e

,+per9i,or, o/ *eir Eoin* re,pon,ibili*y *o a9e *e bo

ready /or +,e a* all



*ime,.

On#e *e #on*en* o/ *e bo a, been e,*abli,ed and *e

re,pon,ibili*y

/or i*, ,*o#@in$ a,,i$ned" *e +ni*, ,o+ld be prepared

and pla#ed on ea#

pa9ilion" in *e #lini#" in *e emer$en#y =ard and in

*e ,pe#ial

pro#ed+re, room o/ *e depar*men* o/ radiolo$y.

A/*er *e emer$en#y boe, a9e been pla#ed on *e=ard" i* i, manda*ory

*a* a pro$ram be de9eloped =ereby *ey are #e#@ed

daily ei*er by *e

o,pi*al parma#i,* or by *e n+r,in$ ,+per9i,or

re,pon,ible /or *e =ard.

Te /ollo=in$ li,* o/ #on*en*, i, pro9ided *o ,er9e a, a$+ide.

Ho,pi*al Parma#y

37

Ho,pi*al Parma#y

30

)ni* Re9ie=

-! a* are *e /o+r #la,,e, o/ dr+$ di,*rib+*ion ,y,*em,



a!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! b!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! d!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!1!Di,#+," ad9an*a$e, anddi,ad9an*a$e, o/ +ni* do,e ,y,*em.

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!4! a* are *e main

elemen*, o/ +ni* do,e di,*rib+*ion

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!7! a* i, *e dieren#e be*=een ).D.S

and C.F.S.S.

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!7! Dene *e /ollo=in$:

A! Addi#*:

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!B!Con*rolled S+b,*an#e,:

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!C! 'ar#o*i# Dr+$:

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!0! a* i,

laminar ?o= ood



D(FI'ITIO'S:

Amb+la*ory #are" primary #are" *er*iary #are" emer$en#y

#are

Amb+la*ory re/er, *o pa*ien*, no* o##+pyin$ bed, in

o,pi*al,

or o*er in pa*ien* ,e**in$," and *o #are $i9en in

py,i#ian, oJ#e,"

#lini#," eal* #en*er," and o*er pla#e, =ere

amb+la*ory pa*ien*,

+,+ally $o /or eal* #are. Today o,pi*al, brea@

do=n *eir

amb+la*ory pa*ien* load in*o *ree #a*e$orie,

emer$en#y" re/erral or

*er*iary #are and primary #are. Te *erm emer$en#y

#are i, ,el/eplana*ory and *er*iary #aremean, #are beyond *a* o/

primary #are.

S*a*ed ,imply" primary eal* #are i, =a* mo,* people

+,e mo,* o/ *e

*ime /or mo,* o/ *eir eal* problem,. Primary #are i,

maEori*y #are.

I* de,#ribe, a ran$e o/ ,er9i#e, ade+a*e /or mee*in$ *e

$rea* maEori*y



o/ daily per,onal eal* need,. Ti, maEori*y in#l+de,

*e need /or

pre9en*i9e eal* main*enan#e and /or *e e9al+a*ion

and mana$emen*

on a #on*in+in$ ba,i, o/ $eneral di,#om/or*" early

#omplain*,"

,ymp*om," problem," and #roni# in*ra#*able a,pe#*, o/

di,ea,e.

Mo,* primary #are i, +,ed by pa*ien*, =o are

amb+la*ory" and

mo,*" b+* no* all" amb+la*ory #are i, primary #are.

Primary #are doe,

no* in#l+de ,er9i#e *a* i, in*en,i9e" or 9ery ,pe#ialized"

or bo*. Te,e

#ara#*eri,*i#, de,#ribe o*er le9el, o/ #ompreen,i9eeal* #are.

In an or$aniza*ional ,en,e" primary eal* #are de,#ribe,

a lo#+,

=i# ,o+ld ,er9e *e pa*ien* a, an en*ry poin* in*o a

#ompreen,i9e

eal* #are ,y,*em. On#e en*ry i, madeand ini*ial #areneeded a* *e

*ime o/ en*ry $i9en*e primary #are lo#+, or

pro$ram ,o+ld be



re,pon,ible /or a,,+rin$ #on*in+i*y o/ all *e #are *e

pa*ien* may

,+b,e+en*ly need.

Ho,pi*al Parma#y

35

Te $ro=* o/ amb+la*ory #are #lini#, may be a**rib+*ed

*o

*e /ollo=in$:

A. Te need o/ *e o,pi*al *o ,+pplemen* i*, in!pa*ien*

*ea#in$

pro$ram.

B. Te demand by *e #omm+ni*y lay a, =ell a,

pro/e,,ional" /or

#ompreen,i9e dia$no,*i# and *rea*men* #en*er,.C. Te ne= pilo,opy o/ o,pi*al,*o *a@e a more a#*i9e

role in

*e #omm+ni*y eal* pro$ram,.

D. Te need o/ *e o,pi*al and py,i#ian *o eer#i,e

$rea*er

#on*rol o9er pa*ien*, re#ei9in$ in9e,*i$a*ional +,e dr+$,.

(. Te la#@ o/ a ,+J#ien* n+mber o/ py,i#ian, in ,ome

area,"



*ereby #a+,in$ *e pop+la*ion *o *ra9el *o *e medi#al

#en*er /or

#ompreen,i9e #are.

F. Te /a#* *a* *e emer$en#y ,er9i#e o/ a o,pi*al

i, al=ay,

a9ailable" =erea, a py,i#ian" in ,ome r+ral area,"

may no*

al=ay, be a9ailable.

Be#a+,e o/ *i, 9ol+me and *e pro,pe#* o/ $ro=in$lar$er

=i*in *e ne* 1 year," many #omm+ni*y parma#i,*,

a9e

been +i#@ *o #i*e *e e#onomi# ard,ip *i, *rend may

#rea*e in *e #omm+ni*y. Al*o+$ *i, i, an impor*an*

/a#*or

*o be #on,idered" i* =o+ld appear *a* *e #r+ o/ *e

problem i, *e la#@ o/ +nder,*andin$ by *e #omm+ni*y

pra#*i*ioner o/ *e p+rpo,e and ,#ope o/ a #omple*e or

#ompreen,i9e amb+la*ory ,er9i#e.

Ho,pi*al Parma#y

38

MI'IM)M STA'DARD FOR AMB)LATORY!CAR(



PHARMAC()TICAL S(RIC(S

Ser9i#e, *o amb+la*ory pa*ien*, are an impor*an*

par* o/ many

in,*i*+*ional parma#y pro$ram,. Te need /or ,+#

,er9i#e, probably

=ill in#rea,e ,+b,*an*ially in *e -85,.

Te So#ie*y a, iden*ied -1 a#*i9i*ie, in =i#

in,*i*+*ional

parma#i,*, =ill be in9ol9ed in *e amb+la*ory!#are,e**in$. Ho=e9er"

pro9idin$ all *e,e ,er9i#e, in all in,*i*+*ion, a* all *ime,

i, no* /ea,ible.

A* a minim+m" amb+la*ory pa*ien*, re+ire #er*ain

#ri*i#al

parma#e+*i#al ,er9i#e,. Te e,,en*ial elemen*, o/ anyamb+la*ory!#are

parma#e+*i#al ,er9i#e pro$ram are a, /ollo=,:

-. Te amb+la*ory!#are parma#y pro$ram m+,* be

dire#*ed by a

+alied parma#i,*.

1. Te appropria*ene,, o/ *e #oi#e o/ dr+$ and i*,

do,a$e" ro+*e o/

admini,*ra*ion" and amo+n* m+,* be 9eried by *e

parma#i,*. Ti,



=ill re+ire *e main*enan#e o/ medi#a*ion prole,

/or pa*ien*,

ro+*inely *rea*ed a* *e in,*i*+*ion *o pre9en* d+pli#a*e

dr+$ *erapie,

and *e +,e o/ #on*raindi#a*ed dr+$,.

4. All medi#a*ion, di,pen,ed *o pa*ien*, =ill be

#omple*ely and

#orre#*ly labeled and pa#@a$ed in a##ordan#e =i* all

appli#able

re$+la*ion, and a##ep*ed ,*andard, o/ pra#*i#e.

7. )pon di,pen,in$ a ne= %*o *e pa*ien*& medi#a*ion" *e

parma#i,*

=ill en,+re *a* *e pa*ien* or i, repre,en*a*i9e

re#ei9e, and

+nder,*and, all in/orma*ion re+ired /or proper +,e o/ *edr+$.

0. All dr+$, in amb+la*ory!#are ,er9i#e area, =ill be

properly

#on*rolled.

Ho,pi*al Parma#y

6

LOCATIO' OF O)T!PATI('T DISP('SI'2 AR(A



Tere i, no ,e* r+le a, *o *e be,* area *o lo#a*e an

o+*!pa*ien*

di,pen,in$ parma#y. Ti, i, e9iden#ed by *e /a#*

*a* in *oday,

pra#*i#e *ree e+ally ,+i*able pro9i,ion, are made /or

*i, area:

a. A ,epara*e o+*!pa*ien* parma#y i, a9ailable.

b. A #ombined in!pa*ien* and o+*!pa*ien* +ni* =i* ,er9i#e

pro9ided

/rom *e ,ame =indo=.

#. A #ombined in!pa*ien* and o+*!pa*ien* +ni* =i* ,er9i#e

pro9ided

/rom ,epara*e =indo=,.

A ,epara*e o+*!pa*ien* parma#y i, +,+ally e,*abli,ed

=ene9er

*e o+*!pa*ien* depar*men* and *e parma#y are

$eo$rapi#ally =idely

,epara*ed. Al*o+$ *i, arran$emen* a, *e

ad9an*a$e o/ bein$ a

,epara*e and di,*in#* +ni* =i* a ,pe#ialized /+n#*ion" i*

po,,e,,e, *e

di,ad9an*a$e, o/ re+irin$ a ,epara*e ,*a a, =ell a,

#on,+min$ a $rea*



deal o/ *ime" on *e par* o/ o*er parma#y

depar*men* per,onnel" in

*ran,por*in$ ,+pplie, and dr+$, *o *e area.

Te abo9e di,ad9an*a$e, are ob9io+,ly elimina*ed

=ene9er

bo* in! pa*ien* and o+*!pa*ien* /a#ili*ie, are #ombined.

An addi*ional

ad9an*a$e *o *i, arran$emen* i, *a* *e dire#*or o/

*e parma#y

,er9i#e i, able *o eer* a $rea*er de$ree o/ #on*rol and

,+per9i,ion.

Ho,pi*al Parma#y

6-

TYP(S OF PR(SCRIPTIO'S R(C(I(D

Dependin$ +pon *e lo#a*ion and @ind o/ o,pi*al"

*e

pre,#rip*ion, re#ei9ed in *e o+*!pa*ien* depar*men*

parma#y =ill

$enerally in#l+de *o,e o/ pri9a*e pa*ien*, %=ere

permi**ed by *e ,*a*e

board o/ re$i,*ra*ion in parma#y&" indi$en* pa*ien*,"

non!indi$en*

pa*ien*," employee," and pa*ien*, bein$ di,#ar$ed /rom

*e o,pi*al. I*



i, a @no=n /a#* *a* in any lar$e me*ropoli*an

*ea#in$ o,pi*al" *e

lar$e,* 9ol+me o/ pre,#rip*ion, #ome, /rom *e

indi$en* or par*ially

indi$en* $ro+p o/ pa*ien*,. I* i, al,o e,*abli,ed *a*

e9ery pa*ien* =o

9i,i*, *e #lini#, doe, no* a9e i, pre,#rip*ion lled

in *e o,pi*al.

Indeed" o,pi*al, =i* 0 or more bed, ll

approima*ely I

pre,#rip*ion per 4 o+*!pa*ien* 9i,i*," =erea, *e -

*o -88!bed

o,pi*al, a9era$e abo+* -.10 pre,#rip*ion, /or ea# 9i,i*.

Be#a+,e many o/ *e,e indi$en* pa*ien*, are ,+ppor*ed

by ,ome*ype o/ =el/are pro$ram" *eir pre,#rip*ion, re+ire

,pe#ial

iden*i#a*ion" and *e billin$ /or ,+# m+,* be in

a##ord =i* *e

re+iremen*, o/ *e par*i#+lar a$en#y.

Ho,pi*al Parma#y

61

DISP('SI'2 RO)TI'(



and nally *e prepared pre,#rip*ion i, =rapped and

di,pen,ed.

For in*ernal a+di* p+rpo,e," o,pi*al pre,#rip*ion, are

,epara*ed

in*o o+*!pa*ien* and in!pa*ien* di,#ar$e, and *ere/ore

may +*ilize *=o

dieren* #olored blan@,.

Fi$+re %4!1& repre,en*, one *ype o/ o,pi*al

pre,#rip*ion. I* i,

ra*er in$enio+, #ombina*ion o/ pre,#rip*ion #all

#e#@" pre,#rip*ion

and label in a ,in$le /orm =a, *a* o/ *e Piladelpia

2eneral Ho,pi*al

no= #lo,ed. Ti, /orm Fi$ %4!4& a, many ad9an*a$e,

in *a* i*#ombine, *ree /orm, in*o one i* ,a9e, *e

parma#i,*, *ime in

andin$ o+* a #all #e#@ and *ypin$ a label and nally" i*

i, probably

more e#onomi#al. I* =o+ld ,eem *a* i*, only

di,ad9an*a$e, are *a*

*e pre,#rip*ion on le doe, no* #arry *e dire#*ion, /or

+,e and *a* *e



dire#*ion, /or +,e =ri**en by *e py,i#ian on *e label

por*ion o/ *e

/orm" more o/*en *an no*" =ill be ille$ible *o *e pa*ien*.

Many o*er *ype, o/ pre,#rip*ion /orm, are in #+rren* +,e

in *e

Ho,pi*al Parma#y

64

o,pi*al, o/ *e na*ion. Some #on,i,* o/ m+l*iple pa$e,

a**a#ed *o a

pre!p+n#ed #ard ready /or +,e in a #omp+*er ,y,*em

o*er, #on,i,* o/

a pre,#rip*ion blan@ *e ba#@ o/ =i# i, aJed =i*

#oded ma$ne*i#

*ape *ereby renderin$ *e pre,#rip*ion ,+i*able /or

+,e in a+*oma*i#

billin$ and ele#*roni# da*a!re*rie9al ,y,*em,.

Ho,pi*al Parma#y

67

'ame

!!Parma#y Por*ion

Addre,,

P(T(R B('T BRI2HAM HOSPITAL



61-H=n*in$*on A9en+e

Bo,*on -0" Mo,,.

Fi$ %4!-& Pre,#rip*ion #all #e#@ +,ed in *e o+* pa*ien*di,pen,in$ parma#y a, a

mean, o/ ma*#in$ *e #orre#* pa*ien* and pre,#rip*ion

PR(SCRIPTIO' CH(C

'o. 06

PRIC(

P(T(R B('T BRI2HAM HOSPITAL

61-H=n*in$*on A9en+e

Bo,*on -0" Mo,,.

To a9oid error, plea,e pre,en* *i,

Ce#@ =en #allin$ /or yo+r

Pre,#rip*ion

!!Parma#y Por*ion

'o. 06

Ho,pi*al Parma#y

60 TH( CHILDR('S HOSPITAL.

M(DICAL C('T(R

4LO'2OODA(.. BOSTO' 1--0



T(L. 'O.: 647!3

AR(A COD(: 3-6

DAT(CLI'IC OR

DIISIO'

R(CORD 'O.

PTS

'AM(

PAR('T

ADDR(SS

A2( OF PATI('T

R

PL(AS( LAB(L

CO'T('TS

OR2('(RIC DR)2S (STABLISH(D )'D(R TH(

CHILDR('!S HOSP. M(D. CTR. FORM)LARY SYST(M

Fi$ %4!1&. A pre,#rip*ion blan@ de9eloped by Te

Cildren, Ho,pi*al Medi#al Cen*erin Bo,*on. 'o*e *e empa,i, on *e pa*ien*, a$e.

Ho,pi*al Parma#y

63



'o 161

R(TAI' THIS CH(C

'OTB TOPHYSICIA'

-. Pill in bo* ,e#*ion o/

pre,#rip*ion" in#l+din$

,i$na*+re.

1. ri*e dire#*ion, in

(n$li, in lo=er

,e#*ion a, *i, ,er9e,

a, label.

DAT(

Piladelpia 2eneral Ho,pi*al

Pre,#rip*ion 'o Da*e

Clini#

Pa*ien*

Addre,,

COD(

R

M.D

AMO)'T



M.S.S..

Amo+n*

'o 161Piladelpia2eneralHo,pi*al

Pre,#rip*ion 'o Da*e

Pa*ien*

DIR(CTIO'S

M.D

Form 63

Fi$ %4!4&. A pre,#rip*ion blan@ de9eloped by *e #ildren,

o,pi*al medi#al #en*er in

Bo,*on. 'o*e *e empa,i, on *e pa*ien*, a$e

Ho,pi*al Parma#y

66

I'('TORY CO'TROL

C('TRAL STORA2(S. PHARMACY STORA2(

Te di#o*omo+, ,*ora$e arran$emen* o/ ,+pplie, i,pre9alen* in

many o,pi*al," al*o+$ i* i, #ommon @no=led$e *a*

#en*ral ,*ora$e



i, ideal.

Te proponen*, o/ #en*ralized ,*ora$e /a#ili*ie, are

+i#@ *o demon,*ra*e *e red+#*ion in labor and re#ord

@eepin$" a, =ell a, *e *i$*

#on*rol aorded by #en*raliza*ion.

In #on*ra,*" i* ,o+ld be poin*ed o+* *a* *e

re,pon,ibili*y /or *e

,*ora$e o/ dr+$, ,o+ld be pla#ed =i* #ompe*en*

indi9id+al, =o a9e

been ed+#a*ed" *rained and li#en,ed *o andle

parma#e+*i#al,. Te,e

indi9id+al, are *e parma#i,*,.

In order *a* *e parma#i,* may properly ,+per9i,e

*e ,*ora$e o/

dr+$," *ey ,o+ld be ,*ored in an area dire#*ly +nder i,#on*rol. Ti,

allo=, im *e /reedom o/ ,*o#@ arran$emen*" in,*i*+*in$

o/ in9en*ory

#on*rol," *e adE+,*men* o/ in9en*ory ba,ed +pon i,

@no=led$e o/ *e

pre,#ribin$ *rend, o/ *e ,*a and *e prepara*ion o/

in9en*ory #o,*

repor*, *o mana$emen*.



Tere/ore" all mer#andi,e ordered by or /or *e

parma#y ,o+ld be

,ipped dire#*ly *o *e parma#y re#ei9in$ area.

So+ld *e mer#andi,e be re#ei9ed by *e o,pi*al po,*oJ#e or #en*ral ,*oreroom" i*

,o+ld immedia*ely be /or=arded *o *e parma#y in

*e +nopened

,*a*e.

Ho,pi*al Parma#y

65

)pon *e re#eip* o/ *e mer#andi,e in *e parma#y

re#ei9in$

area" *e depar*men* per,onnel *en pro#e,, i* in *e

ro+*ine manner"

namely" #e#@in$ *e re#ei9in$ ,lip =i* *e #opy o/ *ep+r#a,e order

and preparin$ a re#ei9in$ memorand+m.

Ho,pi*al Parma#y

68

STOR(ROOM ARRA'2(M('T

Tere i, no deni*e r+le ,pe#i/yin$ o= a parma#y

,*oreroom ,o+ld



be arran$ed. (a# indi9id+al may ,o arran$e *e area *o

mee* bo* i,

and *e in,*i*+*ion, need,.

In $eneral o,pi*al, andlin$ a 9arie*y o/ ,+pplie,"

*e ,*oreroom i,

di9ided in*o *e /ollo=in$ area,.

-. Al#ool and Li+or, 6.Biolo$i#al, and o*er #old room

in9en*ory

1. Cap,+le, and Table*, 5.Labora*ory In,*r+men*,

4. Cemi#al, 8.S+r$i#al In,*r+men*,

7. 2allon 2ood, -.R+bber 2ood,

0. 'ar#o*i# a+l* --.S+*+re,

3. Oin*men*, -1.Medi#al and S+r$i#al S+pplie,

Alpabe*i#al arran$emen* i, /ollo=ed" =ere po,,ible"

=i*in *e ,e#*ion. (a# ,el/" dra=er" or bin =i*in *e

,e#*ion i,

n+mbered *o /a#ili*a*e lo#a*ion o/ *e i*em d+rin$ *e

*a@in$ o/ a

py,i#al in9en*ory a, =ell a, *o lo#a*e *e i*em /or

ne=

per,onnel.

Ho,pi*al Parma#y



5

)ni* Re9ie=

-! Dene *e /ollo=in$: Amb+la*ory #are

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!Primary #are

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Ter*iary #are

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!(mer$en#y #are

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!1! Men*ion *e minim+m ,*andard /or

amb+la*ory! #are parma#e+*i#al

,er9i#e,

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!4! a* are *e me*od, o/

arran$emen* o/ dr+$, and in9en*ory #on*rol in



o+*! pa*ien* depar*men*

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!7! O+* pa*ien* parma#y i, +,ed in:

a! Daily #lini#,

b! Spe#iali,* #lini#

#! (mer$en#y ,er9i#e,

d! All o/ *i,

Ho,pi*al Parma#y

5-

Re/eren#e,:

-! illiam (. Ha,,an" GR. %-853& Ho,pi*al Parma#y Fi/*

(di*ion

Lea and Febi$er" Piladelpia

1!Don A. Ballin$*on" QMary M. La+$lin

%14&Parma#olo$y /or Te#ni#ian,

Se#ond (di*ion (MC Paradi$m

4!A.G. ineld Q R.M.(. Ri#ard," %-885& Parma#e+*i#al

Pra#*i#e



Se#ond edi*ion" C+r#ill Li9in$,*one > London

hospital pharmacy

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