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Hospital PharmacyPart-3

Shiekha AlAujan Msc.

Purchasing & Inventory Control

+Managing the Purchesing & Inventory Control SystemThe Hospital Formulary System is the cornerstone of

purchasing inventory control maintained by P&T committee the products on the formulary dictate what the hospital

pharmacy should purchase & keep in inventory

+Managing the Purchesing & Inventory Control SystemManaging the Purchasing & Inventory Control

System: Some pharmacies employ a FEW specialized

individuals responsible for managing the purchasing & inventory process, others use MANY individuals.

Limiting the number of individuals to few specialized: Permits greater expertise & efficiency. Other staff uninformed and unengaged. So, with high turnover rate, it would be a problem.

Best, Cross training individuals in Purchasing & Inventory Control

+Managing the Purchesing & Inventory Control SystemNow, computers & internet technology are used to

manage purchasing & receiving of pharmaceuticals from a drug wholesaler. Bar codes Hand-held computer devices

Benefits of Using Computer Technology: Up to-the-minute product availability information. Comprehensive reporting capabilities. Accuracy Tighter inventory control & efficiency Complying with various pharmaceutical purchasing contracts

by keeping track of terms & reminding about deadlines, & contract pricing deals.

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Manufacturer OR Wholesaler?!

+Purchasing & Inventory Control

Manufacturer or Wholesaler ?!

**The disadvantages of direct purchasing from a manufacturer outweigh the advantages. Therefore, most pharmacies primarily purchase through a drug wholesaler.

Some drugs , however, i.e. those that require unique control or storage conditions can be purchased only directly from the manufacturer. 

+Purchasing & Inventory ControlAdvantages of Direct Purchasing from Manufacturer:

1. Not having to pay handling fees to a third party wholesaler.

2. The ability to order on an infrequent basis (once a month).

3. Less demanding system for monitoring inventory. 

+Purchasing & Inventory Control

Disadvantages of Purchasing from manufacturers:1. Need to order larger quantities to take advantage of manufacturer

discounts.

2. need for more capacity to store additional inventory.

3. More cash tied up in inventory.

4. More complicated drug return & crediting.

5. The need to spend more time to prepare & pay purchase orders to many different companies.

6. The manufacturer may be distant to the pharmacy, creating problems with long product delivery.

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Receiving medications from the suppliers is one of the most important parts of the pharmacy operation

A poorly organized receiving system put patients at risk and elevate health care costs

Example .. Misplaced or out-of-stock product:

harm the patient lower the efficiency of the department

Receiving & Storing Pharmaceuticals

+Receiving & Storing Pharmaceuticals

The Receiving Process:By Receiving personnel, to verify the shipment is complete &

intact before putting items into circulation or inventory.

Check for missing or damaged items Some pharmacy follow the policy that requires the

person who receives pharmaceuticals be different from the person ordering them Important for controlled substances

+The Receiving Process

1- Checking of damaged shipment or incorrect box counts Receiving personnel play a critical role in protecting the

pharmacy from financial responsibility for damaged products in the shipment, products not ordered ,and products not received.

Products with a cold storage requirement should be processed first

Performed in the presence of delivery person Any damage, should be documented when signing the

order

+The Receiving Process

2- Checking the delivered products against the receiving copy Done after the delivery person has left Ensures that the products ordered have been received The name, brand, dosage form, size of the package,

concentration strength, and quantity of the product must match the purchase order

Expiration date should be checked, minimum of 6 months is acceptable

+The Storing Process

store properly at temperature & humidity levels recommended by manufacturers.

Depending on size & type of the pharmacy operation, the product may be placed in bulk, central storage area or into the active dispensing areas of pharmacy.

Expired products in stock should be removed. Products near expiry should be highlighted & placed in the front of the

shelf (stock rotation).

+The Storing Process

Stock Rotation: The process of placing newly acquired products behind currently

stocked medications on the shelf. Help in using the products before they expire First-in, first-out

+The Storing Process

All stocks should be stored at temperature and humidity levels recommended by the manufacturers and defined by the United States Pharmacopoeia (USP)

Freezer -25 to -10°C Cold (refrigerated) 2 to 8°CCool 8 to 15°CRoom temperature The temperature of working

areaControlled room temperature 20 to 25°CWarm 30 to 40°CExcessive heat Above 40°C

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+ Inventory Control

Pharmacy Inventory: The stock of drugs & components which will be used to

fill prescriptions. A business wants sufficient inventory to meet customer

need, but does not want inventory which has already been paid for, sitting on the shelf unused (potential for out-of-date).

**A key goal of inventory management is to maximize inventory turns (products should be used & not remain on the shelf)

+ Inventory Control

** The higher the # of inventory turns, the more profitable the business.

At the hospital pharmacy, the inventory is restricted by the formulary system which is constructed by the P&T committee.

+ Inventory Control

The reasons for restricting the # of drugs stocked by the pharmacy are:

1. To save money

2. To assure the patients receive the most effective drugs

+ Inventory Control

** Managing the inventory requires a team effort in a pharmacy; all employees who order, receive, check, stock, dispense, sell, or restock products must make accurate entries to the inventory system.

+ Inventory Control

**Using computer technology to maintain a continuous status of the inventory: An initial inventory of products is loaded into the

computer & as each item is sold or dispensed, the computer automatically subtracts amount of the item sold from the present inventory. 

**Perpetual Inventory: For prescription drugs **Point of Sale Inventory: All items prescriptions &

otherwise 

+Borrowing Pharmaceuticals

Borrowing of medications between pharmacies Restricted to emergency situations Limited to authorized staff A Borrow form is used to provide a detailed directions

on the process. A secure procedure is required

+Drug Recalls

A manufacturer or FDA occasionally recall pharmaceuticals from pharmacies.

Reasons for recalling that harm the public health include: Mislabeling Microbial contamination Presence of forign substances Content uniformity failure Subpotency pH failure Dissolution failure Deviation in good manufacturing process Stability data does not support expiration date

Hospital Pharmacy

Source of Drugs

• Wholesaler

• Other Pharmacy• Drug Company

Purchase

Borrow

Expired

Recall

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I.V. Admixtures

+ I.V. Admixtures- Intravenous: within the vein.

- Additive: The drug that added to an IV solution.

- IV admixture: The completed preparation. Improper compounding May be associated with critical problems. So appropriately qualified pharmacists & technicians are

responsible to prepare IV admixtures Establishing a centralized pharmacy IV admixtures service is

essential to ensure: 1. Sterility by applying aseptic technique 2. Stability 3. Accurate pharmaceutical calculations 4. Avoid incompatibility

+ I.V. Admixtures

Advantages of IV Admixture Service:1. Centralizes the responsibility of the

preparation, dispensing, & controlling of parenteral admixtures.

2. Eliminates the need for nurses or physicians to prepare & dispense IV preparations providing them additional time for their professional responsibilities.

3. Increases the safety of parenteral medications.

+ I.V. Admixtures**All IV fluids sent from Pharmacy should be labeled under

standard format produced automatically by computer. The label contains the following information:

1. Patient’s name & location 7. Scheduled hang time

2. Patient’s medical record # 8. Any special storage conditions

3. Patient date of birth 9. Date prepared

4. Active ingredient(s) & quantity of each

10. Expiration date & time

5. IV solution (diluent) 11. Initials of pharmacist

6. Run rate or frequency

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 Quality Control

+  Quality Control

 or Quality Assurance (QA) program A program that defines medication errors & learn

from them how to prevent recurrence of the error. Aim: to establishes an acceptable level of performance

& identify when standard of performance is not met.

** prevent medication error by: Analyzing individually & collectively data collected in response to medication error to assess the cause & any contributing factors.

+  Quality Control

Quality Control includes all activities that contribute to:

Defining, assessing, designing, monitoring & Improving the quality of health care

Principles to guide QA in Health Care:

1. Focus on the patient

2. Focus on the system & processes

3. Focus on measurement

4. Focus on treatment

 

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Pharmacy Satellites

+Pharmacy Satellites

**The satellites needed for:1.Operating Room2.Oncology for Chemotherapy3.Pediatrics4.The Emergency Room

 

+Pharmacy Satellites

Functions:1. First-dose distribution (orals & IVs)2. Routine drug distribution (cart filling)3.Compounding parenteral agents4.Drug therapy monitoring5.Order review, editing, & computer entry6.Provision of DI to professionals7.Cardiopulmonary resuscitation team participation8.Distribution of controlled substances9.Consultation with physicians & nurses

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Education/ Training / Research

+ Education/Training/Research

1.Offering Continuous Education CE Programs to pharmacists, physicians, nurses.

2.Training pharmacy students (internship)3.Providing residency programs4.Hospital pharmacists may participate in

research conducted in the hospital5.Publishing newsletters accessible to staff &

public

+ Education/Training/Research

**Importance of Research in Hospital Pharmacy:

1. Promotion

2. Better service for patients

3. Better opportunities for pharmacist career

4. Gain knowledge

5. Prosper for the country

+ Education/Training/Research

**Elements of Research in Hospital Pharmacy:

1.Abstract

2.Introduction

3.Methodology

4.Results

5.Discussion

6.Conclusion