Evolution of Hospital Pharmacy Practice

M A
ACCY
Y
PHHAAR
R M
P I T
T A
ALL P
S
OS PI
HO
H
Aleth Therese L. Dacanay, RPh, MSc Phar

UST Faculty of Pharmacy
Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 1

Good
Mornin
g
Historical Overview of the Evolution
of Pharmacy Practice
A. Early 20th century – (1900-1960)
Traditional role (drug-oriented)
Apothecary, compounding, dispense
supply of pharmaceuticals

B. 1960-1985 - focus → patient-
oriented
Unit dose
IV admixture services (TPN)
Drug information
Development and growth of “Clinical
Pharmacy Practice” and the role of
the pharmacist as therapeutic
advisor.

C. 1985-present
Re-professionalization – a new
purpose of pharmacy
Definition and conceptualization of
Pharmaceutical Care
→1989
improved patient care → focus is totally
on patient

Pharmaceutical Care
responsible provision of drug therapy for the
purpose of achieving definite outcomes that
improve a patient quality of life.
Monitoring the regimen’s effect
Outcome:
1. cure of a disease
2. elimination or reduction of patient
symptomatology
3. arresting a disease process
4. preventing a disease or symptoms

THE HOSPITAL PHARMACY
The separation of pharmacy from
medicine took place in charitable
institutions operated under
governmental or ecclesiastic
authority.
The fact that business intervals
played no part in the delivery of care
to patients in these institutions led to
an eventual division of labor in order
to improve the quality of care.
THE HOSPITAL PHARMACY
This division of labor in the physician-
apothecary function led to the
recognition of pharmacy as a
separate discipline from medicine.
Since the division occurred in
hospitals, the hospital pharmacist was
the first recognized practitioner of the
profession of pharmacy.

The development of hospital
pharmacy in different countries was
vitally affected by educational
standards and by the caliber of its
practitioners.

Thus hospital pharmacy as an
important professional specialty was
virtually neglected in America for
almost 169 years, from the time that
Jonathan Roberts became first
hospital pharmacist at the
Pennsylvania Hospital (Philadelphia)
in 1752, to approximately 1920.

After naming:
Charles Rice (1841 – 1901) of
Bellevue hospital in New York City
Martin I Wilbert (1865 – 1916) of the
German Hospital in Philadelphia
it is difficult to recall other equally

prominent contemporary hospital
pharmacist of the same period.

A National Professional Society
1. The American Journal of Hospital

Pharmacy – one of the best
professional publication in
international pharmaceutical circles.
2. The International Pharmaceutical
Abstract

3. The American Hospital Formulary
Service – is a comprehensive
unbiased source of information on
drugs provided on a supplemented
basis annually. It serves as the
basis for the pharmacist to extend
his role as pharmaceutical
consultant to the medical profession.

4. Mirror to Hospital Pharmacy –
provided the findings from an
exhaustive study of hospital
pharmacy in the US to find out
existing practices in hospital
pharmacy and to improve the quality
and expand the scope of its
pharmaceutical service.

5. Institutes – a continuing education
program served to help the hospital
pharmacy practitioner keep up with
current trends of professional
practice.

STANDARDS OF PRACTICE
The movement to develop standards
of practice in the hospital was initiated
by the American College of Surgeons
during the early 1900s.
As a result of their initiative, the 1st
Minimum Standard for Pharmacies in
Hospitals was presented to the 18th
Hospital Standardization Conference
of the ACS in 1935.
In 1942, when the ASHP was
organized, a standing Committee on
Minimum Standards was appointed
for the purpose of maintaining and
developing better Minimum
Standards.
In 1950, the original standard of the
ACS was revised by the ASHP.

The Minimum Standard for
Pharmacies in Hospitals with Guide to
Application has been revised
periodically, resulting in the ASHP
Guidelines: Minimum Standard for
Pharmacies in Institutions.

To assist hospital administrators and
hospital pharmacists to review their
pharmacy service in terms of
expected qualitative performance,
The JCAHCO has continued to revise
its standards for hospital pharmacy.

Hospital Pharmacy
One of the most important department

among several departments of a
hospital.

Hospital Pharmacy
Department or division of the Hospital
wherein the procurement, storage,
compounding, manufacturing,
packaging, controlling, assaying,
dispensing, distribution, and
monitoring, of medications to
hospitalized and ambulatory patients
are performed by legally qualified,
professionally competent
pharmacists.
Hospital Pharmacy
The hospital pharmacy exerts a great

deal of influence on the professional
status of the hospital as well as the
economics of the total operational
cost of the institution.

Hospital Pharmacy
Modern day hospital pharmacy also

provides:
Clinical pharmacy services
Drug monitoring
Drug delivery information system

Hospital Pharmacy: Functions &
Objectives
Pharmacy is recognized as an
essential hospital service in all the
major hospitals.
Managed by professionally qualified

pharmacists.

Hospital Pharmacy
It has been realized that only

trained pharmaceutical personnel
are capable of purchasing, storing,
handling, pricing and dispensing of
medications.

Hospital Pharmacy
It is the pharmacist who is an

expert to provide all information
regarding drugs to the health
professionals and also the public.
Therefore, he acts as a link
between the physician and the
patient

Hospital Pharmacy
A pharmacist is required to
perform various functions in
hospital pharmacy which are as
follows:

Hospital Pharmacy: Functions
1. Providing specifications for the
purchase of drugs, chemicals,
biologicals, etc.
2. Proper storing of drugs.
3. Manufacturing & distribution of
medicaments such as transfusion
fluids, parenteral products, tablets,
capsules, ointments and stock
mixtures.
4. Dispensing and sterilizing parenteral

preparations which are
manufactured in the hospital.
5. Dispensing of drugs as per the Rxs
of the medical staff of the hospital.
6. Filling and labelling of all drug
containers from which medicines are
to be administered.
7. Management of stores which includes
purchase of drugs, proper storage
conditions and maintenance of records.
8. Establishment and maintenance of “Drug
Information Centre” which will provide
information regarding medications to the
physician, nurses or any other competent
person who deals in drugs.

9. Patient counseling service while

supplying drugs especially from OP
department.
10. Maintaining liaison between medical
staff, nursing staff and patients.
11. Providing cooperation in teaching
and research programs of the
hospital.
12. Discarding the expired drugs and
containers with worn and missing
labels.
13. Providing drug monitoring services
by studying various effects of drugs’
administered to the patients
especially the indoor patients from
‘Patient Charts’ maintained in the
wards, etc.
Functions of Hospital Pharmacy
Dispensing Manufacturing
Purchasing & Statistics and

Inventory Control reports
Teaching Research Control
OP Bulk
IP
LV Parenterals
Med, Surgical & Lab supplies
Ward or Floor stock
SV
Alcohol Parenterals
Surgical Irrigation Fluids
Narcotics

Hospital Pharmacy Organization
Within the organizational structure of
the hospital the director of pharmacy,
as a department head, reports to the
administrator of the hospital on the
proper operation and management of
pharmacy.

The Director of Pharmacy:

formulates and implements
departmental administrative and
professional policies of the pharmacy
subject to the approval of the
administrator.

The profession and clinical policies
relating to the hospital pharmacy
practice that have a direct relationship
to the medical staff are formulated
and developed through the Pharmacy
and Therapeutics Committee & are
subject to administrative approval.

The Organizational Structure
The chart attempts to illustrate that
coordination and integration of all the
technical elements of practice must
be implemented effectively into a total
pharmaceutical services.
For example, there are technical and
professional elements of a clinical-
pharmacy service.

On the other hand, there are clinical
components of professional, technical
and clinical implications to the
research and supportive components
to a pharmacy service.

Therefore, one should look at the
organizational structure of a modern
hospital pharmacy in terms of the
overall elements compromising its
services rather than viewing it from a
clinical versus an operational
standpoint.

This philosophical approach to the
organizational and operational
aspects of hospital pharmacy is
essential for effective use of all the
pharmaceutical sciences that underlie
the profession of pharmacy.

A close examination of this
organizational chart shows the many
ramifications of the practice of
pharmacy in today’s modern hospital.

There follows a comprehensive job
description of the pharmacist’s
responsibilities in general hospital
pharmacy activities and in clinical
function and responsibilities.

ADMINISTRATIVE STRUCTURE
OF THE HOSPITAL PHARMACY
A. Director of Pharmacy
Sometimes known as the Chief

Pharmacist or Pharmacy Manager,
the pharmacy director has varied
leadership responsibilities

1. Like all hospital department managers,

the pharmacy director oversees both
personnel and budgetary (fiscal)
matters.

2.The director also serves on various

hospital committees, typically acting as
secretary of the pharmacy and
therapeutics committee.

3. As a member of a hospital team, the

pharmacy director may be involved in
community out reach programs.

4. The pharmacy director sets quality

standards for the department,
evaluating policies and procedures and
implementing changes and innovations
as necessary.

5. The director is responsible for

developing management strategies to
assure cost effective pharmaceutical
services and for implementing total
quality management (TQM) concepts

6. Compliance with accrediting and

regulating agencies (e.g., the joint
Commission on Accreditation of
Healthcare Organization, the
Department of Public Health, the Board
of Registration in Pharmacy).

B. Associate or Assistant Director
of Pharmacy
Depending on
Depending on department
department size,
size, the
the
pharmacy have
pharmacy have one
one or
or more
more
associate or
associate or assistant
assistant directors
directors

of Pharmacy
1. The associate or assistant director aids
the pharmacy director in the operation
of the pharmacy.

of Pharmacy
2. Specific tasks include overseeing day-

to-day pharmacy operations,
supervising the sterile products rooms,
and directing pharmacy purchasing.

of Pharmacy
3. When the pharmacy director is absent,

the associate or assistant director
assumes administrative responsibility.

C. Staff pharmacists.
The employees have daily responsibilit
y for the pharmacy’s distributive and cli
nical duties.
1. Distributive duties include:
a. Physician order review and filling
b. Unit-dose chart checking
c. Extemporaneous compounding of
parenteral admixture, oral solution,
and topical preparations.
d. Specific assigned tasks, such as
purchasing, inventory control, and
narcotic distribution and control.
2. Clinical duties of staff pharmacists
are varied.
a. Therapeutic assessment. In
addition to evaluating the
appropriateness of prescribed drugs
and dosages, staff pharmacist
monitor for drug-drug interactions and
adverse drug effects.

are varied.
b. Staff pharmacist also advise
physicians, participate in
physician rounds, and may
serve on the nutritional support
team.

are varied.
c. Other clinical duties of staff
pharmacist include
pharmacokinetic monitoring,
patient discharge counseling
and in service education.

D. Clinical pharmacists. Because of
their specialized education and
training, these pharmacist are
responsible for providing clinical
activities for the hospital pharmacy.

D. Clinical pharmacists.
1. Most clinical pharmacists have an
advanced degree, such as master of
science (MS) in clinical pharmacy or a
Doctor of Pharmacy degree
(PharmD). some also may have
completed a residency of fellowship in
clinical specialty.

2. the clinical pharmacist play a
major role in monitoring and
evaluating drug therapy and
intervening when appropriate.
3. Depending of departmental
organization and hospital size, the
clinical pharmacist also may have
drug distribution duties.

4. Some clinical pharmacists hold
appointments at colleges or
schools of pharmacy, serving as
preceptors to graduate and
undergraduate students.

E. Hospital pharmacy residents. As
graduates of pharmacy programs,
these staff members have a special
interest in hospital practice.
1. Generally, pharmacy residencies
are 1-year or 2-year programs offered
by hospitals alone or in conjunction
with a college or school of pharmacy.

2. Hospital pharmacy residents gain
intensive experience in the
distributive, clinical and administrative
aspects of institutional practice.
3. Many pharmacy residents go on to

graduate school, clinical fellowships,
or entry-level hospital pharmacy
management positions.

4. The ASHP matches potential
pharmacy residents with ASHP
residency programs to facilitate
the selection process for both
residency candidates and
hospitals.

F. Technicians and other support
personnel play an important part in
hospital pharmacy operation.
1. Technicians may be pharmacy
students fulfilling their internship
requirements, or they may be high
school graduates.

F. Technicians and other support
personnel
2. Technicians work under the direct
supervision of a pharmacist. In fulfilling
their primary duty (i.e., helping to carry
out the pharmacist’s responsibilities)
technicians perform the following tasks:
a. Fill unit-dose cart
b. Fill floor stock pharmacy supplies
c. Extemporaneously compound and
prepare intravenous admixtures for
approval by a pharmacist.

PHARMACIST REQUIREMENT
Bed Strength # of pharmacist

required
Up to 50 beds 3
Up to 100 beds 5
Up to 200 beds 8
Up to 300 beds 10
Up to 500 beds 15


Evolution of Hospital Pharmacy Practice

Transféré par

Informations du document

Titre original

Copyright

Formats disponibles

Partager ce document

Partager ou intégrer le document

Options de partage

Avez-vous trouvé ce document utile ?

Ce contenu est-il inapproprié ?

Droits d'auteur :

Formats disponibles

Evolution of Hospital Pharmacy Practice

Transféré par

Droits d'auteur :

Formats disponibles

M A

Aleth Therese L. Dacanay, RPh, MSc Phar

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 1

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 4

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 5

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 6

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 7

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 9

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 10

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 11

it is difficult to recall other equally

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 12

1. The American Journal of Hospital

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 13

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 14

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 15

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 16

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 18

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 19

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 20

One of the most important department

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 21

The hospital pharmacy exerts a great

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 23

Modern day hospital pharmacy also

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 24

Managed by professionally qualified

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 25

It has been realized that only

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 26

It is the pharmacist who is an

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 27

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 28

4. Dispensing and sterilizing parenteral

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 31

9. Patient counseling service while

Purchasing & Statistics and

Teaching Research Control

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 34

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 35

The Director of Pharmacy:

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 36

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 37

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 38

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 39

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 40

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 41

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 42

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 43

Sometimes known as the Chief

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 44

1. Like all hospital department managers,

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 45

2.The director also serves on various

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 46

3. As a member of a hospital team, the

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 47

4. The pharmacy director sets quality

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 48

5. The director is responsible for

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 49

6. Compliance with accrediting and

Dec 8, 2021 Aleth Therese L. Dacanay, RPh, MSc Phar 50