CHAPTER 1

Institutional Pharmacy Practice

 Institutional Pharmacy Practice
• Provision of distributional & clinical
services
• Based in institutional setting
– Hospital
– Long-term care
– Hospice
– Correctional facilities
 Integrated Health Systems
• Individual institutions  “systems”
– Mission: positively impact health outcomes
 Types of Hospital
• Factors:
– Location
• Urban or small rural setting
• Single building or campus complex
– Size
– Specialization
 Types of Hospital
• Community Hospital
– Most common type
– Assorted disease and injury
– Provides emergency, In&Out patient,
Intensive care
• Specialized Hospital
– Particular disease
– Specific organ
– Specific population
 Types of Hospital
• Teaching Hospital
– Serves patient need AND train future health care
professionals
– Associated with medical schools
• Ownership
– For-profit Hospital – corporation, private investors
– Non-profit – religious order, volunteer, community
• Government Hospital
– Federal, state, county or government
Types of Hospital in the Philippines
• According to Ownership:
– A. Government
– B. Private
• According to Functional Capacity
– A. General Hospital
– B. Specialty Hospital
• Particular disease
• Particular organ(s)
• Particular Group of Patients

• According to Trauma Capability

– A. Trauma – Capable Facility
– B. Trauma – Receiving Facility
 Classification of Hospitals
• Type of Service
– General
– Special
– Rehabilitation and Chronic Disease
– Psychiatric
 Classification of Hospitals
• Length of Stay
– Short-term hospital
• Less than 30 hospital days
– Long-term hospital
• 30 or more hospital days
 Classification of Hospitals
• Ownership

– Governmental – Non-governmental
• Federal • Non profit
• State • For profit
– County – Individual
– City – Partnership
– City-county – Corporation
 Classification of Hospitals
• Bed Capacity
– Very Small below 100
– Small 100-500
– Medium 501-1,000
– Large above 1,000
 New Classification of Hospital in the
Philippines
• A.O. no. 2012-0012
DOH Bureau of Health Facilities and Services
“New Classification of Hospitals and Other Facilities”

– Level I
– Level II
– Level III
– Other Health care facilities
• Primary care facility
• Custodial care facility
• Diagnostic/Therapeutic facility
• Specialized Out-patient facility
 Pharmacy Role in the Medication
Use Process

Prescribing Transcribing Dispensing Administration Monitoring

• Usually done by ___________.

• “PRIVILEGING”
• Pharmacist can be sources of drug information
• Pharmacist can develop protocols (formulary system)
 Pharmacy Role in the Medication
Use Process

Prescribing Transcribing Dispensing Administration Monitoring

• Manual or Electronic
• More common type is _________ but _________
 Pharmacy Role in the Medication
Use Process

Prescribing Transcribing Dispensing Administration Monitoring

• Act of physically transferring the drug product

after review & approval of prescription.
• Prone to:___________
 Pharmacy Role in the Medication
Use Process

Prescribing Transcribing Dispensing Administration Monitoring

• Usually done by ____________.

• Very crucial step in drug use.
• Pharmacist can prevent medication errors
thru:
• Bar coding
• Unit Dose Dispensing
• Clearly labeling medications
 Pharmacy Role in the Medication
Use Process

Prescribing Transcribing Dispensing Administration Monitoring

• Review laboratory values

• Monitor subjective and objective factors
• Effective and Toxic effects
 Practice Models
• Drug-distribution-centered model
– Pharmacist distribute drugs & process new
medication orders.
– Pharmacist is __________ only to requests of
physicians and nurses.
 Practice Models
• Clinical-pharmacist-centered model
– Two types:
• Clinical
• Distributive
 Practice Models
• Patient-centered integrated model
– Both clinical and distributive
 Key Models of Pharmacy
• Must be interdisciplinary, team-based
1

• Med preparation & distribution must be automated, centralized and done by trained
2 technicians

• Direct patient care > Medication distribution

3

• Health and Drug information will be an advantage

4

• Must promote cost-effective therapy

5

• Must provide pharmacotherapy plan for each patient

6

• Continuous training for general and specialized practice

7

• Must collaborate with community pharmacist

8
 Key Individuals
• Pharmacist Roles
– Dispensing vs. Clinical – Pharmacist in
• Clinical Pharmacist
Management
– Requires training and • supervisor, director
residency program – Pharmacist in:
– May be a _________ or • Informatics
__________.
• Investigational drug
– Integrated pharmacist service
• Both dispensing and • Research
clinical roles
• Sterile compounding
• Emergency care
 Key Individuals
• Pharmacy Technicians
– Purchasing, stocking, preparation and compounding
of medication under the supervision of a
PHARMACIST.
– Must have established training standards
– Expansion in automated dispensing & information
technology
– Assist Clinical Pharmacist in getting lab values, do
patient interview and medication reconciliation.
 Automation and Technology
• Since before 1990s
• ↑ efficiency & accuracy of dispensing
• Pharmacy automation
– Unit-based cabinet (Pyxis, Omnicell)
• Most common
– Pharmacy robot (McKesson, Robot-Rx)
 Automation and Technology
• Medication-related technology
– Bar-coded medicine administration
• Nurse scans the patient’s wrist band & med bar
code
– Smart pumps
• programmable devices that allow the user to
predefine minimum and maximum rates of
administration
– Computerized prescriber order entry
(CPOE)
• Medication ordering information is able to transfer
between the prescriber and the pharmacy
 Patient Care Areas
• In-Patient
– Critical care
• higher acuity level; clinical status is constantly changing
– General care
• Out-patient
– Similar to community phar W/O general
merchandise
– Caters clinic, discharged and ER patients
– Other types: Ambulatory care, home health
care service
 Accreditation and Standards of
Practice
Accreditation Practice standards
• Voluntary process by which the • Practices that a profession
quality of care provided by a develops and imposes on
hospital is assessed by an itself
outside accrediting body on a • Standards are called “Best
routine basis practices”
• Done by • Initiated by:
– Accrediting Body – ASHP
• Assess & improve quality – PSHP
of patient care
• Suggests improvement
– Regulatory Body
• Public protection
• Impose fines and legal
action
Importance of Pharmacy
Leadership

Primary
Pharmacist

Pharmacy
Manager

Director of
Pharmacy