HOSPITAL PHARMACY

Ms. Rajguru Apeksha

Ph.D Scholar (Pharmaceutics)
M. Pharmacy (Pharmaceutics)
 Introduction
 Scope of hospital pharmacy
 Functions of hospital pharmacy
 Objectives of hospital pharmacy
 Roles and responsibilities of hospital pharmacist inddor pharmacist
 Organizational structure
 Professional responsibilities
 Qualification and experience requirement
 Good pharmacy practice requirement
 Hospital pharmacy standards
 Introduction to NABH accreditation and role of pharmacist
 NABH accreditation process

2
 A hospital is a health care institution providing patient
treatment with specialized and trained medical staff,
pharmacist and nursing staff and medical equipment to cure
the patient

3
 INTRODUCTION
Hospital pharmacy
 A practice which will be performed under the hospital with
special supervision and guidance of registered pharmacist which
is known as hospital pharmacist.
 Hospital pharmacy is a department in which the drug are
procured ,stored , compounded checked for quality ,dispensed ,
manufactured packed and distributed to in patients and out
patients by competent and legally qualified pharmacists .
 It is an important department which caters the need of
physicians ,nurses, technicians and other staff members of
hospital.

4
 SCOPE OF HOSPITAL PHARMACY

 Develop a formulatory of drugs accepted for use in the hospital

and provide for its constant revision
 Establish programs and procedure that help ensure cost effective drug
therapy.
 The selection of items based on objective evaluation of their
relative therapeutic merits, safety, and cost. The committee should
minimize duplication of the same basic drug type, drug entity, or
product.
 To establish or plan suitable educational, programs for the hospital
professionals staff on mattrs relaed to drug use.
 Participate in quality assurance activities related to distribution,
administration and use of medicaments.
5
 To review ADR occurring in hospital
 FUNCTION OF HOSPITAL PHARMACY
 Dispensing of drugs, chemicals and pharmaceutical preparations.
 Preparation and sterilization of injectable drug when manufactured
in the hospital .
 The filling and labeling of drug containers issued to other
department from which medication is to be administered.
 Necessary inspection of all pharmaceuticals supplies in other
department.
 Maintenance of an approved stock of antidotes and other emergency
drugs.
 Dispensing of all narcotic drug and alcohols and the maintenance of
perpetual inventory control.
 Collection and circulation of information regarding the drug to
physician interns and nurses. 6
 Maintenance of the facilities of the department.
7
 OBJECTIVES
 Professionalize the pharmaceutical services in hospital
 To ensure the availability of the right medication at reasonable
cost.
 To develop the administrative or management skills and other
aspects essential to the hospital pharmacist in his role as a
departmental head.
 To attract a greater number of qualified pharmacists in hospital
practice.
 To utilize the resources of hospital to help in improvement of the
department and profession as a whole.
 To co-ordinate and Co-operate with other departments of a
hospital.
 To counsel the patient, medical staff, nurses and other on use of 8
drug, side effect, toxicity, adverse effect, drug interaction.
 ORGANIZATIONAL STRUCTURE

Associate director

Pharmacist in chief

Assistant pharmacist in chief

Secretary clerk Pharmacy residents

Outpatient Manufacturing and Inpatient dispensing

dispensing supervisor control supervisor supervisor messenger
9
Administrative services division
 Plan and coordinate departmental activities.

 Develop policies.

 Schedule personnel and provide supervision

 Coordinate administrative needs of the Pharmacy and Therapeutics

Committee.
 Supervise departmental office staff.

Education and Training Division

Coordinate programs of undergraduate and graduate pharmacy students.
nurses, doctors etc.
Participate in hospital-wide educational programs involving nurses,
doctors.
Train newly employed pharmacy department personnel.
Pharmaceutical Research Division
Develop new formulations of drugs, especially dosage forms not 10
commercially available.
Improve formulations of existing products.
PROFESSIONAL RESPONSIBILITIES

11
PROFESSIONAL RESPONSIBILITIES
 Medicine Management
 A key role in a hospital pharmacist's job is determining which form of
medication be suits each patient
 Each decision must be made in a timely and efficient manner and
requires significance input from doctors, nurses and other healthcare
professionals
 Hospital pharmacists will often monitor the effects of the medications
they prescribe counsel their patients on the effects of the drugs
 Another aspect of this role is to recommend administration routes and
dosages, all which are dependent on an individual's needs
 A source of information a hospital pharmacist is often a great source of
advice for patients.
 They can also be called upon to recommend safe combinations of
medicines or solutions to specific patient problems.
 Hospital pharmacists can offer information on potential side effects and
check that medicines are compatible with existing medication.

12
 They will often also monitor the effects of treatments to ensure that they
are proving effective, safe and appropriate to the user.
 Monitoring drug charts as hospital pharmacists are required to work
closely with other members of staff, such as physicians, nurses and
dieticians, information must be passed on in a way that is clear to
understand.
 Hospital pharmacists must monitor these charts and ensure that the
correct medication is being provided to each patient.
 Such information may include which form of medication a patient
requires, with options including tablets, injections, ointments or inhalers.
 How the medication should be administered must also be communicated.
 Discharging patients is another important role. It is the duty of a hospital
pharmacist to keep track of which patients are being discharged
summary.
 This requires the pharmacist to inspect the patient's drug chart to ensure
that the medication prescribed matches that contained in the discharge
summary.
 Keep up to date as with any healthcare job, hospital pharmacist are
expected to remain up to date with all aspects of medicine.

13
QUALIFICATION AND EXPERIENCE REQUIREMENT
 Head of hospital pharmacy acts as a co ordinator for pharmacy and non-
pharmacy staff– Post graduate in pharmacy (pharmaceutics/
pharmacology or hospital pharmacy)
 Director superintendent of pharmaceutical services / Chief pharmacist
(M.Pharm)- drug distribution pharmacist
 Quality control 2 pharmacist B. Pharm/ D. pharm (Dispensing / medical
store)

Abilities Required
 Technical ability
 Ability to develop manufacturing section
 Administrative ability
 Ability to control inventory
 Ability to conduct and participate in research
 Ability to conduct teaching programmes

14
Job specifications
 Compound and dispense medications as prescribed by doctors and
dentists, calculating, weighing, measuring, and mixing ingredients
 Review prescriptions from doctors to ensure accuracy, to ascertain
the needed ingredients, and to evaluate their suitability for the
patient
 Provide information and advice about drugs, their side effects,
correct dosage, and proper storage
 Keep records such as pharmacy files, patient profiles, charge system
files, inventories, registries of poisons, narcotics or controlled drugs
 Plan, implement, or maintain procedures for mixing, packaging, or
labeling pharmaceuticals, according to policy and legal requirements,
to ensure quality, security and proper disposal
 Assess the identity, strength, or purity of medications
 Work with other health care professionals to plan, monitor, review,
or evaluate the quality or effectiveness of drugs
 Order and purchase pharmaceutical supplies, medical supplies, or
15
drugs, maintaining stock and storing and handling it properly
16
GOOD PHARMACY PRACTISE (GPP) REQUIREMENT
 GPP requires that a pharmacist's first concern must be the welfare
of the patients in all settings.
 GPP requires that the core of the pharmacy activity is the supply of
medication and other health care products, of assured quality,
appropriate information and advice for the patient, and
monitoring the effects of their use.
 GPP requires that an integral part of the pharmacist's contribution is
the promotion of rational and economic prescribing and appropriate
medicine use.
 GPP requires that the objective of each element of pharmacy
service is relevant to the individual, is clearly defined and is
effectively communicated to all those involved.

17
Requirement in practice
There are four main elements
 Activities associated with promotion of good health, avoidance of ill
health and the achievement of health objectives.
 Activities associated with the supply and use of medicines and items
for the administration of medicines or otherwise related to treatment.
These activities may be undertaken in the pharmacy or in an
institution or home care setting.
 Activities associated with self care, including advice about and, where
appropriate, the supply of a medicine or other treatment for the
symptoms of ailments that can properly be self treated.
 Activities associated with influencing prescribing and medicine use.
 Good Pharmacy Practice also encompasses: establishment of
arrangements with other health professional communities for health
promotion activities at a population level, including the minimization
of the abuse and misuse of medicines professional assessment of
promotional materials for medicines and other products associated
with health dissemination of evaluated information about medicines
and aspects of health care involvement in all stages of clinical trials.
18
MAIN ELEMENTS OF GOOD PHARMACY PRACTICE (GPP)
Health promotion and ill health prevention
 Facilities for confidential conversation

 Provision of general advice on health matters

 Involvement of personnel in briefings for specific campaigns to ensure
coordination of effort and consistency of advice.
 Quality assurance of equipment used and advice given in diagnostic testing

Supply and the use of prescribed medicines and other health care products
 Reception of the prescription and confirmation of the integrity of the
communication
 National standards are needed for Facilities, Procedure & Personnel.

Assessment of the prescription by the pharmacist

 Therapeutic aspects (Pharmaceutical and Pharmacological)
 Appropriateness for the individual

 Social, legal, economic aspects.

19
Assembly of the prescribed items: National standards are needed
for:
 Sources of supply of medicines and other items; manufacture of
medicines
 Storage

 Condition at time of supply to the patient

 Personnel involved

 Equipment required

 Facilities and workplace required

 Preparation and quality assurance of extemporaneous

preparations.

20
HOSPITAL PHARMACY STANDARDS ( FIP BASAL STANDARDS,
AHSP)
 FIP - International Pharmaceutical Federation
 The overarching goal of hospital pharmacists is to optimize patient
outcomes through collaborative, inter-professional, responsible use of
medicines and medical devices.
 The overarching goal of hospital pharmacists is to optimize patient
outcomes through collaborative, inter-professional, responsible use of
medicines and medical devices.
 The responsible use of medicines means:
 That a medicine is only used when necessary and that the choice of
medicine is appropriate based on what is proven by scientific and/or
clinical evidence to be most effective and least likely to cause harm.
This choice also considers patient preferences and makes the best use
of limited healthcare resources.
21
 There is timely access to and the availability of quality medicine that is
properly administered and monitored for effectiveness and safety.
A multidisciplinary collaborative approach is used that includes patients
and those in addition to health professionals assisting in their care.
At a global level, evidence-based hospital pharmacy practice standards
should be developed. These should assist national efforts to define
standards for the extent and scope of hospital pharmacy services and
should include corresponding human resource and training
requirements.
Hospital pharmacists should engage health authorities and hospital
administrators to ensure appropriate resources for, and design of, the
hospital medicines-use process.
Health authorities should ensure that each hospital is serviced by a
pharmacy that is supervised by pharmacists who have completed
advanced training in hospital pharmacy.
The Chief Pharmacist/Director of Pharmacy should be the accountable
professional coordinating the responsible use of medicines1 in the
hospital.
Hospital pharmacists should serve as a resource regarding all aspects o22f
medicines use and be accessible as a point of contact for patients and
health care providers.
All prescriptions should be reviewed, interpreted, and validated by a
hospital pharmacist prior to the medicine being dispensed and
administered.
Hospital pharmacists should monitor patients taking medicines to
assure patient safety, appropriate medicine use, and optimal outcomes
for inpatients and outpatients. When resource limitations do not
permit pharmacist monitoring of all patients taking medicines,
patientselection criteria should be established to guide pharmacist
monitoring.
Hospital pharmacists should be allowed to access and document in the
full patient record.
Hospital pharmacists should ensure that patients or care givers are
educated and provided written information on the appropriate use of
medicines.

23
Hospital pharmacists should provide orientation, drug information and
education to nurses, physicians, and other hospital staff regarding best
practices for medicines use (a best practice is a method or technique
that has consistently shown results superior to those achieved with
other means, and that is used as a benchmark).
Undergraduate pharmacy curricula should include hospital-relevant
content, and postgraduate training programs and specializations in
hospital pharmacy should be developed.
Hospital pharmacists should actively engage in research into new
methods and systems to improve the use of medicines and of human
resource needs in hospital pharmacy.
Hospital pharmacists should take responsibility for the management and
disposal of waste related to the medicine use process, and advise on
disposal of human waste from patients receiving medicines.
Hospital pharmacists should take responsibility for all aspects of
selection, implementation and maintenance of technologies that
support the medicine use process, including distribution devices, 24
administration devices and other equipment.
 The “seven rights” (right patient, medicine, dose, route, information,
documentation and time) should be fulfilled in all medicine-related
activities in the hospital.
 Theme 1 – Procurement

Hospital pharmacists should be involved in the complex process of

procurement of medicines and health products, promoting equity and
access. They should ensure transparent procurement processes are in
place in line with best practice and national legislation, are free from
conflict of interest, and are based on the principles of safety, quality and
efficacy.
Procurement practices must be supported by strong quality assurance
principles, regularly reviewed and adapted to fit different settings and
emerging needs in the most appropriate and cost effective way.

25
 Theme 2 - Influences on Prescribing
Hospitals should utilize a medicine formulary system (local, regional,
and/or national) linked to standard treatment guidelines, protocols,
and treatment pathways based on the best available evidence.
Hospital pharmacists should be key members of pharmacy and
therapeutics committees to oversee all medicines management policies
and procedures, including those related to off-label use and
investigational medicines.
Hospital pharmacists should have a key role in educating prescribers at
all levels of training on the access to and evidence for responsible use
of medicines, including the required monitoring parameters and
subsequent prescribing adjustments.

26
 Theme 3 - Preparation and Delivery
Hospital pharmacists should assume responsibility for storage,
preparation, dispensing, and distribution of all medicines,
including investigational medicines.
Hospital pharmacists should assume responsibility for the
appropriate labeling and control of medicines stored throughout
the facility.
Hospital pharmacists should be involved in determining which
medicines are included in ward stock and standardizing the
storage and handling of ward medicines.

27
 Theme 4 – Administration
Hospital pharmacists should ensure that the information resources
needed for safe medicines preparation and administration are
accessible at the point of care.
Hospital pharmacists should ensure that clinically relevant allergies,
drug interactions, contraindications, past adverse events and other
relevant medication history details are accurately recorded in a
standard location in patient records and evaluated prior to medicine
use.
Hospital pharmacists should ensure that medicines are packaged and
labeled to ensure identification and to maintain integrity until
immediately prior to administration to the individual patient.
Medication labels should be clear and have sufficient information to
ensure safe administration, including at least 2 patient identifiers, the
name of the medicine, prescribed route, dose in mass and, where
appropriate, volume and rate of administration.

28
 Theme 5 - Monitoring of Medicines Use
An easily accessible reporting system for defective medicines should be
established and maintained.
Reports of defective or substandard medicines should be reviewed
internally and sent in a timely manner to regional or national
pharmacovigilance or regulatory reporting programs, and the
manufacturer.
An easily accessible reporting system for adverse drug reactions should
be established and maintained.
Reports of reactions should be reviewed internally and sent in a timely
manner to regional or national pharmacovigilance or regulatory reporting
programs. These data should be regularly reviewed to improve the
quality and safety of medicines use practices.
An easily accessible, non-punitive reporting system for medication errors,
including near misses, should be established and maintained.
Reports of medication errors should be reviewed internally and sent to
regional or national medication error reporting or regulatory programs.
These data should be regularly reviewed to improve the quality and
safety of medicines use practices.
29
 Theme 6 - Human Resources, Training and Development
At a national level, competency frameworks are defined, established and
regularly assessed.
At a national level, hospital pharmacists should engage health authorities to
bring together stakeholders to collaboratively develop evidence-based hospital
pharmacy human resource plans, to support responsible use of medicines
including those in rural and remote areas.
Hospital pharmacists should work with key stakeholders to ensure that
workforce education, training, competency, size, and capacity are appropriate
to the scope of services, coverage, and responsibilities of all cadres providing
pharmacy services.

30
NATIONAL ACCREDITATION BOARD FOR
HOSPITALS & HEALTHCARE PROVIDERS (NABH)
31
INTRODUCTION TO NABH ACCREDITATION AND ROLE
OF PHARMACIST

 Definition of Accreditation
Accreditation is a public recognition by a national healthcare
accreditation body, of the achievement of accreditation standards by a
healthcare organization, demonstrated through an independent
external peer assessment of that organization's level of performance in
relation the standards.

National Accreditation Board for Hospitals & Healthcare Providers

(NABH) is a constituent board of Quality Council of India (QCI), set up
to establish and operate accreditation program for healthcare
organization.

32
 The board is structured to cater to much desired needs of the
consumers and to set benchmark for progress of health industry.
 The board is supported by all stakeholders including industry,
consumers government has fully functional autonomy in its
operation.
 Objective.

To enhance health system and promoting continuous quality

improvement and patient safety
 Benefits of Accreditation

Aimed at establishing common framework for healthcare recognition to

demonstrate and practice compliance to patient safety protocol.
International Society for Quality in healthcare (ISQua) HAS ACCREDITED
“Standards for hospitals”, 2 nd edition, Nov.2007 developed by National
Accreditation Board fo Hospitals and healthcare providers (NABH, India)
under its International Acceditation programme for a cycle of 4 years
The approval of ISQua authenticates that NABH standards are in 33
consonance with he global benchmarks st by ISQua.
 NABH ACCREDITATION PROCEDURE
Application for accreditation
 The HCO (Health care organization) shall apply to NABH in the
prescribed application form.
 The application shall be accompanied with the prescribed application
fee as detailed in the application form.
 Signed copy of ‘Terms and conditions for maintaining NABH
Accreditation’, available free on web site
 Filled in self assessment toolkit, free on web site

 Quality/ clinic manual and other relevent document i.e. different

policies and procedures of the clinic
 The clinic should carry out evaluation of its services, documents etc
against this checklist and and rate itself as fully met, partially met or
not.
 In continuous improvement the self assessment checklist is valuable 34
tool.
 The external assessment is also carried out along same lines. This
provides an objective method of standardized evaluation.
 NABH accreditation is only considered for clinics entire activities and
not for part of it.
 NABH Secretariat receives the application form and after scrutiny of
application for its completeness in all respects, an acknowledgement
letter for the application shall be issued to the clinic with unique
reference number
 Clinic / HCO quote this reference number in all future correpondence

35
 Patients
High quality care, rights
of patient

Clinic staff
Clinic Continous learning,
good working,
Improvement,
quality care, Benefits leadership,
professional
community
development of
confidence
clinicians, para
medical staff

Paying and regulatory

bodies
Reliable and certified
info on facilities, 36
infrastructure
37