HOSPITAL AND CLINICAL
PHARMACY
PREPARED BY MR. ABHIJIT DAS
1.
DEFINE PTC. FUNCTIONS
OF PTC AND ROLE OF PTC IN DRUG SAFETY.
Pharmacy and Therapeutics
Committee (PTC):
The PTC is a group of
healthcare professionals in hospitals that helps decide which medicines should be used, how
they should be used, and ensures they are used
safely.
Functions:
Ø Choose
Medicines: Select and approve drugs for the hospital’s use.
Ø Set
Policies: Create and enforce rules for how medicines should be
used.
Ø Ensure
Safety: Monitor medication use to prevent errors and adverse
reactions.
Ø Control
Costs: Ensure drugs are used efficiently and affordably.
Ø Educate
Staff: Provide training on safe and effective medication
use.
Role:
Ø Advisory
Role: Guides the hospital on drug use and policies.
Ø Decision-Making:
Decides which drugs are included in the hospital's formulary.
Ø Safety:
Ensures medications are used safely by reviewing and monitoring practices.
Ø Collaboration:
Works with healthcare staff to improve patient care through better medication
management.
2.
DEFINE HOSPITAL,
DESCRIBE IT’S CLASSIFICATION AND FUNCTION.
Definition of Hospital:
A hospital is a
healthcare institution that provides medical, surgical, and nursing care to
patients who are sick or injured.
Classification of
Hospitals:
Ø Based
on Ownership:
· Public/Government:
Run by the government.
· Private:
Owned by private entities or organizations.
Ø Based
on Specialization:
· General:
Provides a wide range of medical services.
· Specialized:
Focuses on specific areas like cardiology, oncology, or pediatrics.
Ø Based
on Size:
· Small:
Fewer beds and services.
· Large:
More beds and comprehensive services.
Functions of a Hospital:
Ø Patient
Care: Provide diagnosis,
treatment, and rehabilitation
services.
Ø Education: Train healthcare professionals.
Ø Research:
Conduct medical and healthcare research.
Ø Public
Health: Promote health awareness and
disease prevention in the community.
3.
WRITE ABOUT THE
REQUIREMENTS AND RESPONSIBILITIES OF HOSPITAL PHARMACIST?
Requirements for a
Hospital Pharmacist:
Ø Educational
Qualification: A Diploma in Pharmacy (D.Pharm), although
a Bachelor’s or Master’s degree is preferred for advanced positions.
Ø Registration:
Registered with the State Pharmacy Council.
Ø Experience:
Relevant experience in clinical pharmacy is
preferred.
Responsibilities:
Ø Medication
Management: Ensure safe
and effective use of medications.
Ø Patient
Counseling: Provide information
and advice on medication use.
Ø Collaboration:
Work with doctors and nurses to optimize
patient care.
Ø Regulatory
Compliance: Follow legal
and hospital guidelines for drug use.
4.
DEFINE INPATIENT.
BRIEFLY DISCUSS ABOUT DRUG DISTRIBUTION FOR INPATIENT IN A HOSPITAL.
Inpatient
refers to a patient who is admitted to a
hospital or healthcare facility for at least one overnight stay for treatment,
surgery, or observation. These patients require close monitoring, ongoing
treatment, or intensive care that cannot be effectively provided in an
outpatient setting.
DRUG DISTRIBUTION FOR INPATIENTS IN A
HOSPITAL:
I.
INDIVIDUAL PRESCRIPTION ORDER METHOD:
- Medications
are prescribed by a doctor and then the pharmacy prepares and dispenses
these medications, which are then delivered to the patient’s ward or unit.
- Advantages:
Allows for individualized medication management based on specific patient
needs.
- Disadvantages:
Can be time-consuming and may lead to delays in medication administration.
II.
FLOOR STOCK METHOD:
- Medications
are stored on the nursing floor or ward in bulk or stock. Nurses have
access to these medications and can administer them as needed based on
doctor’s orders.
- Advantages:
Reduces delays in medication administration since nurses can access
medications directly.
- Disadvantages:
Higher risk of medication errors, potential for drug theft or misuse, and
difficulties in tracking inventory.
III.
UNIT DOSE DRUG DISTRIBUTION METHOD:
- Medications
are dispensed in single-dose packages, labeled for individual patients,
and delivered to the nursing units. Each dose is prepackaged and ready for
administration at the prescribed time.
- Advantages:
Enhances accuracy in drug administration, reduces medication errors, and
simplifies inventory management.
- Disadvantages:
Requires more complex preparation and packaging processes by the pharmacy.
IV.
DRUG BASKET METHOD:
- Medications
are placed in a basket or container for each patient and delivered to the
nursing unit. The basket contains all the medications needed for a
specific period, often for a shift or a day.
- Advantages:
Simplifies medication distribution and reduces time spent by nurses
retrieving individual doses.
- Disadvantages:
May lead to confusion if multiple patients have similar medications, and
it can be challenging to track and manage medication usage.
5.
DEFINE HOSPITAL
FORMULARY. PROCEDURE FOR DEVELOPMENT AND USE OF HOSPITAL FORMULARY.
Hospital Formulary
- Definition:
A list of approved medications for use in a hospital, chosen based on
effectiveness, safety, and cost.
Procedure for Development:
1.
Assessment:
·
Evaluate patient
needs and review drug data.
2.
Selection:
·
Choose medications based on effectiveness, safety, and cost.
·
Consult with experts
for input.
3.
Approval:
·
Present to the Pharmacy
and Therapeutics Committee for approval.
4.
Implementation:
·
Integrate the formulary
into hospital policies.
5.
Review:
·
update the
formulary regularly.
Uses of a Hospital Formulary:
- Promotes
Safety: Reduces medication errors.
- Controls
Costs: Manages medication expenses.
- Facilitates
Education: A reference for healthcare
training.
6.
DRUG INTERACTIONS
Drug Interactions
- Definition:
When one drug’s effects are changed by another drug, food, or substance.
- Types:
- Drug-drug:
Changes in absorption, distribution, metabolism, or excretion.
- Drug-Food:
Foods altering drug effects (e.g., grapefruit juice).
- Drug-Disease:
Health conditions affecting drug action.
- Clinical
Significance:
- Reduced
efficacy
- Increased
toxicity
- Unexpected
side effects
7.
PHARMACOVIGILANCE
Pharmacovigilance
- Definition:
The science and activities focused on detecting, assessing, understanding,
and preventing adverse effects of drugs.
- Aim:
To ensure safe and effective use of medicines by monitoring and minimizing
adverse drug reactions (ADRs).
- Importance:
- Enhances
patient safety
- Identifies
rare or serious ADRs early
- Improves
public confidence in drug safety
8.
POISONING AND GENERAL
PRANCIPLES OF ITS TREATMENT
Poisoning
- Definition:
Harmful effects on the body caused by ingestion, inhalation, or exposure
to toxic substances.
- General
Principles of Treatment:
- Stabilization:
Ensure airway, breathing, and circulation are stable.
- Decontamination:
Remove or reduce the poison (e.g., activated charcoal).
- Supportive
Care: Provide symptom management and vital support.
- Antidote
Administration: Use specific antidotes when
available and indicated.
- Elimination
Enhancement: Accelerate poison removal (e.g.,
dialysis in severe cases).
9.
MEDICATION ERRORS
Medication Errors
- Definition:
Mistakes in prescribing, dispensing, or administering medication that can
harm patients.
- Types:
- Prescribing
Errors: Incorrect drug, dose, or
instructions.
- Dispensing
Errors: Wrong medication or incorrect
labeling.
- Administration
Errors: Mistakes in timing, route, or dose
given.
- Causes:
- Miscommunication
- Inadequate
knowledge
- Similar
drug names or packaging
- LASA
Drugs (Look-Alike, Sound-Alike): Drugs with similar
names or appearance, increasing error risk (e.g., Celebrex vs. Celexa).
- Tallman
Lettering: Capitalizing parts of LASA drug
names to differentiate (e.g., hydrOXYzine vs. hydrALAzine).
10. APPLICATION OF COMPUTERS IN HOSPITAL PHARMACY
- Drug
Info & Prescriptions: Store drug details
and process prescriptions quickly and accurately.
- Inventory
Management: Track stock and automate orders to
avoid shortages.
- Patient
Records: Keep medication histories for
safer, personalized care.
- Safety
Alerts: Identify drug interactions and
allergies to protect patients.
- Billing:
Streamline billing and insurance processes, reducing errors.
11. VARIOUS SOFTWARES USED IN HOSPITAL PHARMACY
- Pharmacy
Management Systems: Manage prescriptions,
inventory, and patient records (e.g., Mediware, Rx30).
- Electronic
Health Records (EHR): Store and access patient
medical histories and medication profiles (e.g., Epic, Cerner).
- Clinical
Decision Support Systems (CDSS): Alert for drug
interactions, allergies, and dosing (e.g., Meditech, Wolters Kluwer).
- Inventory
Management Software: Track stock levels, expiry,
and automate reorders (e.g., Supplylogix, Omnicell).
- Billing
& Insurance Software: Handle billing,
insurance claims, and financial records (e.g., MediClick, McKesson).
12. VED ANALYSIS
- Definition:
A method to classify drugs and materials based on their importance in
treatment.
- Categories:
- V
(Vital): Essential for survival; must
always be in stock.
- E
(Essential): Important but can tolerate short
shortages.
- D
(Desirable): Not critical; stock can be
minimized.
- Purpose:
Helps prioritize inventory, ensuring availability of medicines.
13. FLOOR STOCK METHOD
- Definition:
A system where commonly used medications are stored
directly on the hospital floors for quick access by healthcare
staff.
- Process:
Medications are stocked in locked carts on
each unit, and authorized staff can access them
without needing to go to the pharmacy each time.
- Advantages:
- Reduces medication retrieval time.
- Improves
efficiency in emergency
situations.
- Disadvantages:
- Risk
of medication errors or misuse.
- Requires
careful inventory control to prevent theft or loss.
14. ORGANIZATIONAL STRUCTURE OF HOSPITAL PHARMACY.
- Chief
Pharmacist: Leads and
manages the pharmacy.
- Clinical
Pharmacists: Advise on patient
drug therapy.
- Dispensing
Pharmacists: Handle prescriptions
and dispensing.
- Pharmacy
Technicians: Assist with
medication prep and inventory.
- Support
Staff: Manage billing and
records.
15. INFECTION CONTROL COMMITTEE
- Objectives:
- Prevent and control infections in the
hospital.
- Develop
infection prevention policies.
- Composition:
- Doctors
(Infectious disease specialist, microbiologist)
- Nurses
- Pharmacist
- Housekeeping
and administrative staff
- Functions:
- Set
and review infection control policies.
- Conduct
infection surveillance and audits.
- Provide
staff training on infection
prevention.
- Monitor and report infection rates in
the hospital.
16. DISTRIBUTION OF NARCOTIC AND PSYCHOTIC SUBSTANCES.
- Regulated:
Controlled by strict laws.
- Authorized
Staff: Only licensed staff
handle them.
- Record-Keeping:
Every transaction is logged.
- Secure
Storage: Stored in locked,
secure areas.
- Audits:
Regular checks prevent misuse.
17. DISTRIBUTION OF DRUGS TO ICCU/ICU/EMERGENCY WARDS
- Immediate
Access: Essential
drugs are always available.
- Floor
Stock: Common medications are stored on-site.
- Emergency
Kits: Ready-to-use kits for
critical situations.
- Authorized
Staff: Only trained staff
handle distribution.
- Regular
checks: Stocks are checked and refilled frequently
18. AUTOMATED DRUG DISPENSING SYSTEM
- Definition:
A machine that stores and dispenses
medications electronically.
- Benefits:
- Quick
Access: Speeds up medication retrieval.
- Accuracy:
Reduces human error.
- Secure:
Only authorized staff can access.
- Inventory
Control: Tracks stock levels automatically.
Used in hospitals to improve efficiency and patient
safety.
19. HOME MEDICATION REVIEW
- Definition:
A process where a healthcare professional reviews a patient's medications at home.
- Purpose:
- Ensure
correct medication use.
- Identify
any potential drug interactions.
- Monitor
side effects.
- Benefits:
- Improves
patient safety.
- Enhances
communication between patients and
healthcare providers.
20. MEDICATION THERAPY MANAGEMENT
(SAME AS ‘HOME MEDICATION REVIEW’ AT HOSPITAL)
21. GOOD PHARMACY PRACTICE
Good Pharmacy Practice (GPP)
- Definition:
A set of guidelines to ensure that
pharmacy services are delivered safely,
effectively, and ethically to improve patient health.
- Aim:
- Ensure
patient safety in medication use.
- Promote
the proper use of medicines.
- Improve
healthcare outcomes through
professional pharmacy services.
22. RADIO PHARMACEUTICALS
- Definition:
Drugs that contain radioactive materials used for diagnosis or
treatment.
- Use:
- Diagnosis:
Used in imaging {e.g., PET scans (Positron Emission Tomography)}.
- Treatment:
Used to target and treat certain cancers.
- Safety:
Handled with care due to their radioactive nature.
23. NABH ACCREDITATION
NABH Accreditation
- Definition:
A certification by the National
Accreditation Board for Hospitals and Healthcare Providers (NABH) that ensures hospitals meet high-quality standards.
- Purpose:
- Improve
healthcare quality.
- Ensure
adherence to national and international
standards.
- Benefits:
- Enhances
hospital reputation.
- Ensures
better patient care and safety.
24. INVENTORY CONTROL TECHNIQUES
1.
Economic Order Quantity (EOQ):
·
Definition:
The ideal order quantity that minimizes total inventory costs (ordering + holding costs).
·
Formula: EOQ = √(2DS/H)
Ø D:
Demand for the product
Ø S:
Ordering cost per order
Ø H:
Holding cost per unit per year
2.
Reorder Quantity Level:
·
Definition:
The stock level at which a new order is placed to avoid stockouts.
3.
Inventory Turnover:
·
Definition:
Measures how often inventory is used in a given period. Higher turnover means
efficient inventory management.
NOTE:
- Example:
If a hospital pharmacy has a stock of 1000 items and sells 500 items in a
year, the inventory turnover rate would be 500/1000 = 0.5.
- Higher
Turnover: For example, selling 1000 items in
a year instead of 500 shows a higher turnover, meaning less unsold stock
is sitting on the shelves.