hospital pharmacy procedure

Pharmacy is the department where drugs are sold.

INTRODUCTION

Hospital pharmacy may be defined as department of hospital wherein procurement, storage, compounding, packaging, dispensing, distribution & monitoring of medication are performed by graduate Pharmacist.

INTRODUCTION

Function of Pharmacy:

To ensure the availability of the right medication, at the right time, in the right dose, at the minimum possible cost to the patients.

To provide information concerning medications to physicians and nurses.

To serve as a counseling department To dispense all narcotic drugs and its

monitoringInventory controlSo on

Department of Pharmacy

Background Information• Number of Pharmacist = 7• Number of Dispenser = 15• Pharmacy aide = 7• Technician = 1• Data entry operator = 1

Qualifications

• Most of the Pharmacists are post- graduates.• Dispensers are diploma holders.• Pharmacy aides holding mid level diploma certificate.

Pharmacist

Dispenser Data entry operator

Technician

Pharmacy Aide

Pharmacist

Dispenser

Pharmacy Aide

Chief Pharmacist

IPD Pharmacy

OPD Pharmacy

Senior pharmacist

Medication procedure of IPD

From the cabin/ward-

• In-house Doctors writes the prescriptions.• The nurses transcribe the prescription electronically onto the IHIS.

At the Pharmacy Department

• Data entry operators electronically transcribes and translates the nurses electronic requisition for the medicine onto a printed medication order sheet.



• Dispensers physically procure medicine from the shelves to the dispensing table according to the printed medication order.• Then medicines are kept in a small medication carts along with the printed medication order sheet.



• Pharmacists cross-check the medication.• After confirming proper dispensing pharmacy aide bag all the medications into a bag (patient wise) and attaches the medication order along with it.• Labeling can also done if necessary.



• Pharmacy Aides carry the bags and carry it to individual floors.• Submits the medications patient wise to the nurses responsible in the floors and sub- floors.



At the cabin/ward-

• The nurses received medicine from pharmacy aide and check the quantity as per requirement.• The final round of nurses mentioned above administer the medication to the patients.

Check Before making indent for patient in

IHISPatient ID Number.Patient BED Number.Patient Name.Dose and Dosage form written in prescription.Reserve medicine in patient cabinet.Last indent receive paper.

Should be very careful about….

Reading of prescription Receiving of medicine. Double indenting. Return medicine. Return of fridge items. DDA box handover. Route of administration Storage and expiry of medicine.

Should know about the medicine you are receiving for your patients…

What is the prescribed dosage?

How it should be taken?

Purpose of medicine.

what are common side effects of the medicine ?

DRUG STORAGE

Proper storage of medication is always an important consideration during periods of extreme heat or cold. Drugs can undergo physical, chemical & microbial changes on storage.

Recommended storage conditions:Store below -50C (freeze)Store between (2 to 8)0C (refrigerate, do not

freeze)Store below 250C (air conditioning)Store below 300C (room temperature)

DRUG STORAGE

Drug Storage Room Standards:

A lockable room Adequate lighting A temperature of below 250C, with air conditioning

units that operate 24 hrs per day & are connected to an emergency power supply.

A vaccine refrigerator for storage of vaccines & anti-venom.

A nominated refrigerator for cold storage of pharmaceutical products that requires refrigeration.

Adequate shelving for appropriate storage of the different categories of drugs.

DRUG CATEGORIES

All drugs are grouped in the following categories:

Refrigerated ( Heat sensitive products)Oral ( solid & liquid )Injectable (IV & IM)TopicalInfusionInhalationCosmeticLocal Purchase

Criteria of storage1. Always read the storage directions on each

medication label. 2. Keep medications in their original container. 3. Never combine different medications into one

bottle.4. Never store multiple medications in a plastic bag

Store medications in a cool, dry place 5. Avoid storing medications in areas of high

humidity.6. If a medication is required to be stored in the

refrigerator, be careful not to store it in the freezer.

DRUG STABILITY

Drug stability means the ability of the pharmaceutical dosage form to maintain the physical, chemical, therapeutic & microbial properties during the time of storage & usage by the patient.

Expiry Dates

Expiry date means that drug can not be used after this date due to the chance of chemical degradation, harmful to patient or low potency.

DRUG STABILITY

If the expiry date is expressed as month/year only (e.g., 3/2013), this shall be interpreted to mean that the drug may be safely used through the last day of that month, i.e., 3/31/2013.

If the expiration date is expressed as month/day/year (e.g., 15/3/2013), this shall be interpreted to mean that the drug may be safely used through that day only.

DRUG STABILITY

Chemical stability of the active ingredient

As the rate of decomposition usually doubles for every 100C rise in temperature, it is important to comply with the storage conditions specified on the container.

DRUG STABILITY

Once opened, the shelf-life of some products, e.g. eye drops, will be determined not by decomposition of the active drug but by the risk of microbial contamination.

Stability after opening drug container

The stability of products is variable. A product which is stable in its container may become unstable once the container is opened.

DRUG STABILITY

The expiry date will be shorter in case of-

Eye drops: can be used for one month after opening the droppers.

Antibiotic syrups & suspensions: generally can be used for one week by storage in room temperature & for two weeks by storage in refrigerator.

DRUG STABILITY

Ampoules: must be used immediately but the vials (multi-dose) are stable for 24 h in the presence of preservatives.

Nebulizer solution: can be used for one month after opening.

Insulin: once punctured, it must be used within 28 days.

Syrup/Suspension (except antibiotics): can be used for one month after opening.

Tablets & capsules: remain stable in the package but after removal expiry date will be changed.

DRUG STABILITY

Factors affecting drug stability:Temperature: high temperature accelerate

oxidation, reduction & hydrolysis reaction which leads to drug degradation.

PH: acidic & alkaline pH influence the rate of decomposition of most drugs. Many drugs are stable between pH 4 - 8.

Moisture: water catalyses chemical reactions as oxidation, hydrolysis & reduction reaction. Water promotes microbial growth.

Light: affects drug stability through its energy or thermal effect which leads to oxidation.

Medication error

Objectives of evaluation of dispensing errors

• To determine the dispensing errors.• To determine associated factors with them. • To suggest preventive actions.• To evaluate role of pharmacists.

Medication error

Causes of errors in Hospital• The most frequent cause of mistake was misreading the prescription due to poor handwriting.• The typing or computer error because of misreading.• Lack of knowledge about the brand name or generic name of the drugs/medicines during typing by nurses.• Disagree to consult with doctors if nurses do not understand the prescription.

Medication error

Causes of errors in Hospital• The errors to do with similar drug names or similar packaging (Frusin Inj., Zydol Inj.,Kolosal IV infusion, Koloride IV Infusion, Hydralazine, Hydroxyzine)• Interruptions are the biggest cause (telephone interruption, busy counter business, query from member of staff, etc).• Lack of concentration during dispensing, Gossip during dispensing due to presence of more personnel, Multi-task.

Medication error

Causes of errors in Hospital• New or unusual staffs are also significant.• Failure to check, Poor communication, Job dissatisfaction, No breaks, Failure to follow standard operating procedures, Lighting etc.• The final point is the time of day problem. This might be first thing in the morning for some people or last thing at night for others.

Medication error

Factors of errors in Hospital

• Inexperience employee• Lack of training• Poor Communication (Nurse, pharmacist & physicians)• Poor Handwriting• Lack of knowledge (Generic & Brand)• Lack of training on IHIS software• Gossip• Dissatisfaction

Medication error

Factors of errors in Hospital

• Too many customers • Lack of concentration • Staff shortage • Similar drug names • No time to counsel • Misinterpreted prescription • Haphazard arrangement of drugs

Medication Safety Tips to avoid serious medication errors in hospital

1. Create IHIS prescription by using patient ID not by name or bed.

2. After putting patient ID check the name and bed number.3. Write the medicine if you can read the prescription

easily.4. Don’t gage if you have any confusion in handwriting.5. Consult with your doctor if any confusion.6. Check the dose of drug as OD, TD, BD or stat.7. Check what the dosage form doctor advice like Injection

(IV/IM), tablet, capsule, cream, ointment, syrup, suspension, etc.

Medication Safety Tips to avoid serious medication errors in hospital

8. Receive medicine as per requirements and then store as per storage condition.

9. Check Patient details (Name, ID, and BED)10.Put the receiving Signature & time just below

your signature.11.Recheck before administration.12.Return the medicines if not need.13.Write the brand name in the return voucher.14.If need to maintain cool chain please use Ice box.15.Reserve all the documents for further inquiry.

Timing of Drugs - Before or After Food

Taking Drugs Before FoodFor quick action/fast absorptionFor acid sensitive drugs

Some drugs need to be absorbed quickly to have an effect, such as nitrates in angina, drugs to help sleep (hypnotics), drugs to reduce agitation (sedatives) & drugs to reduce vomiting . As food can slow the absorption of these drugs, they need to be taken on an empty stomach.


The acid in the stomach breaks down some drugs, so delayed emptying will mean that more of the drug is broken down, and less of the drug is available, so it will be less effective.

Some Medications which should be taken on an EMPTY stomach:

Alendronate, Bisacodyl, Captopril, Sucralfate, Azithromycin, Co-trimoxazole, Omeprazole, Lansoprazole, Levothyroxine, loratadine, Rifampin, Methotrexate Mycophenolate, Tetracycline ……….etc.


Taking Drugs With or After FoodFor drugs causing stomach upsetFor less soluble drugs

The acid in the stomach changes some drugs, making them more soluble and so more easily absorbed. This means that the drug will be more effective.


NSAIDs can cause stomach upsets by increasing gastric secretion. Taking these drugs with food can reduce the irritation to the stomach lining.


Some drugs have to be taken during or after meals to be effective – for example,

Orlistat is designed to block the absorption of some of the fat in food as a treatment for obesity.

Over the Counter (OTC) medications

OTC medications are those medicines that do not require a prescription from a physician and are readily available to the public. This does not mean that they do not need to be taken carefully.

The most commonly used OTC medicines are : Pain Relievers Antihistamines Decongestants Cough medicines


Pain RelieversNSAIDS (non-steroidal anti-inflammatory

drugs) such as paracetamol, aspirin, ibuprofen,ketoprofen etc.

NSAIDS work by blocking the synthesis prostaglandins, which are involved in injury or infection and thus reduce pain, fever and inflammation.


NSAIDS can cause stomach upset and occasional gastrointestinal bleeding.

AntihistaminesHistamines are chemicals in our bodies that

produce itching and allergy responses. Antihistamines block these. Some common antihistamines are diphenhydramine HCl , chlorpheniramine etc.


Antihistamines can cause drowsiness. Be careful driving or doing any dangerous work. But, the Non-sedating antihistamines do not cause drowsiness and are now OTC. Some common antihistamines are loratadine, desloratadine, cetrizine & fexofenadine.

DecongestantsThese medicines work by shrinking/constricting

blood vessels in the nose and decrease congestion. The only over the counter decongestant is pseudoephedrine.


Cough Medicines

Cough medicines are two types: antitussives (anti cough) and expectorants (mucous reducer)

Dextromethorphan is the antitussive in most cough medicines.

Guaifensin is the expectorant that is mostly used. Cough Medicines can cause agitation and

confusion for some users.

Medication Safety Tips to avoid serious medication errors in house

Never take medication intended for someone elseNever keep medications that are expiredNever combine multiple medications in the same bottleNever take medication that is not clearly markedDon't expect immediate resultsDon't stop taking your medication just because you feel

better especially, antibiotics.Keep all medication away from childrenTo know clearly about existing drug-drug interactions.

Conclusion

Pharmacists should ensure that “right”patient is receiving the “right” drug in a “right”Dose at the right timePharmacists and other health careprofessionals involved in the medication useprocess must work together to develop a systemsapproach to medication.

hospital pharmacy procedure

Health & Medicine