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Pharmacy Practice

Pharmacy PracticeBy Dr. ABDRHMAN GAMILAssociate Professor of PharmaceuticsAl-Neelain University - Khartoum

Institutional PharmacyHospital Pharmacy

Definition Practice of pharmacy in a hospital setting including it organizational related facilities or services.It is that department or division of the hospital wherein the procurement, storage, compounding, manufacturing, packaging, controlling, assaying, dispensing, distribution and monitoring of medicines through the drug therapy management for hospitalized and ambulatory patients are performed by a legally qualified, professionally competent pharmacist.It includes responsibility for the safe and appropriate use of drugs. Rational selection, monitoring, dosing and overall control of the therapy program

Uniqueness of hospital pharmacy

Functions of hospital pharmacy

Functions of hospital pharmacy

Functions of hospital pharmacy

Routine contacts of hospital pharmacistPhysician specialists ( PTC), clinical round, all matters related to drug therapy)Nursing professionals.Microbiologists.Biochemists.Physicists and radiologistClinical pharmacologistMedical sociologistMedical dieteticsEngineering Administrative staff

Group practice There is a need for a number of hospital pharmacists of variety of clinical pharmacy specialists to assist in the rational selection and use of drug therapy. This will strengthen the professional role of the hospital pharmacist and give them entry to the group of professionals who make up the health care team.

Organizational StructureThe head department reports to the hospital administrator.Formulates and implements administrative and professional polices of the pharmacy subject to the approval of the administrator.Professional and clinical policies which have direct relationship to the medical staff, are formulated and developed through the pharmacy and therapeutics committee and are subject to administrative approval.Comprehensive job description and responsibilities in pharmacy activities and in clinical functions

Hospital AdministratorDepartment of Pharmacy DirectorExecutive and administrative operationsProfessional and clinical services Research and support servicesEducational and technical servicesNuclear pharmacy divisionUnit dose dispensing divisionAmbulatory &home careI.V admixture divisionSterile products divisionDrug administration divisionClinical pharmacy divisionResearch divisionAssay & QC divisionKinetic & bioavailability labManufacturing & packaging Purchasing&inventory controlDept services divisionInvestigation divisionDrug information divisionEducation& training divisionProfessional developmentResidency training programComputerized operations

Determine the level and scope of pharmacy services. Planning and monitoring the budget.Developing the policy and procedures manual.Pharmacist Responsibilities Director GENERAL

Pharmacist Responsibilities Central Pharmacist Ensures that established policies and procedures are followed.Check for accuracy of doses prepared, IV or unit dose.Proper drug control, investigational drugs, laws are followed.Good techniques are used in compounding Proper record keeping and billingPatient medication records.Extemporaneous compounding records.IV admixture records.Investigational drug records.Monthly workload reports.Maintain professional competence; drug stability & incompatibilities and drug information.Ensures that personnel are well trained on policies and procedures.Coordinate and evaluate the personnel activities.Keep the dispensing area neat, clean and orderly organized.Coordinate with the patient-care area.

Dispensing Area

1. Supervision of drug administration: Review and interprets each unit-dose and IV admixture medication order to ensure that it is entered accurately into the system.Review each patients drug administration form ( missed doses, review drug charges)Confirm that administered doses are noted correctly in patient chart.( sign)Ensures that records for controlled drugs are correctly kept.Ensures that proper drug administration techniques are used.Acts as liaison between the pharmacist and nursing and medical staff.Communicate with nurses and physicians concerning medication problems.Periodically inspects the medication area on the nursing units to ensure that adequate levels of floor stock are maintained.Ensures that drugs are procured from the dispensing area as required.Coordinate all pharmacy services on the nursing units level. Ensures that the area is neat, orderly and appropriate security levels are maintained. Pharmacist Responsibilities Central Pharmacist Patient - care Area

2. Direct Patient care:Identify drugs brought by the patient.Obtain patient medication histories.Assist in drug-product selectionAssist physician in selecting dosage regimens and schedules, then assigns administration times.Monitors patient total therapy ( effectiveness, side effects, toxicity, allergic reactions, drug interaction, therapeutic outcome)Patient counseling.Participate in cardiopulmonary emergencies.3. General responsibilities:Education to personnel staff, students, medical and nursing students.Provides drug information to the health care personnel.Pharmacist Responsibilities Central Pharmacist Patient - care Area

Pharmacist Responsibilities Ambulatory Pharmacist Dispensing AreaEnsures that established policies and procedures are followed.Checks for the accuracy of supportive personnel.Ensures that proper techniques are used in compounding.Adequate record keeping ( patient medication records, investigational drug records, outpatient billing, reports and prescription files)Maintain professional COMPETENCE.Training for the new personnel.Coordinate the activities of the area.Keep the area neat, clean and orderly organized.

Pharmacist Responsibilities Ambulatory Pharmacist Patient care AreaInspect the medication area at the nursing unit to ensure an adequate supply of stock and proper storage.Identifies drugs brought by the patient into the clinic.Obtain patient medication records and provided to the physician.Assist in drug-product and entity selection.Assist the physician in dosage regimen and schedules.Monitors patient total therapy ( effectiveness, side effects, toxicity, allergic reactions, drug interaction, therapeutic outcome)Patient counselingPrepare medications for intravenous administration.Provides medications for patient home care.

Pharmacist Responsibilities Ambulatory Pharmacist General ResponsibilitiesProvide drug information to staff , nursing and medical staff.

Coordinate activities and needs within the area,

Provide adequate control and proper handling following the laws.

Maintain professional competence.

Participate in cardiopulmonary emergencies.

Provides education on service to staff, nursing and medical students.

Pharmacy staffDirector of the pharmacy.7 12 pharmacists to each 300 beds hospital.5- 15 technicians, helpers, clerical staff.Full-time secretary.Administrative aids:Functional organization charts.Operation manualJob description.Policy and procedures manual

Facilities The space varies according to the hospital size. Example; hospital of 200 beds requires:Office for chief pharmacist.Separate area for inpatient and unit-dose dispensing.Outpatient services.Compounding area.Sterile admixture area.Store room.Departmental computer.Space for drug information service.Controlled medicines.Clinical pharmacy services.

Pharmacy & Therapeutics CommitteeThe American society of health system pharmacists state that the multiplicity of drugs available and the complexities surrounding their safe and effective use make it necessary for hospital to have organized, sound program for maximizing rational use of drug. The pharmacy and therapeutic committee, or equivalent, is the organizational keystone for this program Health system pharmacists.

10/8/201622Pharmacy and Therapeutic Committee:-Objectives:-1- Developing and implementing professional policies on drug selection, procurement, evaluation, safe use and drug information.2- Assisting in the formulation of educational programs designed to meet the needs of the staff for drug related practices.The formulary and therapeutic committee is the authoritative body who formulates the drug list circulating in that facility, and regulates the intervention concerning drug. The P&TC should have a regulatory power and activity.The committee should be launched by the first post in the organization. His first deputy, normally, is the chairman of the committee. The committee should be permanent and the order should point to the members and functions and activities regulating its work.

10/8/201623 Members: -Chairman usually a physician representing the headquarter.Secretary pharmacist; senior or drug information centre or pharmacologist.Head of main clinical department.Hospital pharmacist.Authoritative physician and specialist.Invited specialists to participate in certain issues, also nurses when needed with no voting privileges.-Decisions should be made by vote.-Members should not have any business relationship with pharmaceutical distributors or manufactures.- Members should not be more than ten.- One at least should attend continuing course in clinical pharmacology.

Pharmacy & Therapeutic CommitteeSubcommitteesSubcommittee on Antineoplastic Agents.Subcommittee on Anti-infective Agents.Subcommittee on GIT Agents.Subcommittee on Cardiovascular Agents. Subcommittee on CNS Agents.Subcommittee on Endocrinology Agents.etc.

10/8/201625Functions of Formulary & Therapeutic Committee: -1- Developing criteria for evaluation of drugs to be included in the drug hospital list, preparing and maintaining the formulary list.2


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