Hospital Pharmacy and Its Organization: Hospital pharmacy is the health care service, which comprises the art, practice, and profession of choosing, preparing, storing, compounding, and dispensing medicines and medical devices, advising healthcare professionals and patients on their safe, effective, and efficient use.
Hospital pharmacy is a specialized field of pharmacy which forms an integrated part of patient health care in a health facility. Hospital pharmacy is a profession that strives to continuously maintain and improve the medication management and pharmaceutical care of patients to the highest standards in a hospital setting.
Functions of Hospital Pharmacy
Hospital pharmacy performs several functions/roles, following are the major functions:
- Provide specifications for the purchase of drugs, chemicals, biological, etc.
- Proper storing of drugs.
- Manufacturing and distribution of medicaments such as; transfusion fluids, parenteral products, tablets, capsules, ointments, and stock mixtures.
- Dispensing and sterilizing parenteral preparations, which are manufactured in hospitals.
- Dispensing of drugs as per the prescriptions of the medical staff of the hospital.
- Filling and labeling of all drug containers from which medicines are to be administered.
- Management of stores which includes; purchase of drugs, proper storage conditions, and maintenance of records.
- Establishment and maintenance of “Drug Information Centre”.
- Providing co-operation in teaching and research programs.
- Discarding the expired drugs and containers worn and missing labels.
Hospital Pharmacy Organization Structure
The proper structure involves a two-step process:
- The pharmacy manager identifies a relatively standard organizational design that most closely fits the pharmacy’s needs. The design is molded to match with unique requirements of the pharmacy and hospital administrator.
- The size and nature of a pharmacy department’s management staff will depend on the number of personnel in the department and the scope of services delivered.
- Small pharmacies tend to have much simpler organizational structures, this is usually generally understood and no problems arise (for example: the pharmacy in primary health center).
- Large pharmacies with assistant chief pharmacists, supervisors, and unprofessional personnel have complex organizational structures. Therefore, the authority must be delegated by the chief pharmacist.
Location and Layout of Hospital Pharmacy
- Hospital pharmacy is mostly located in hospital premises only so that patients and staff can easily approach it.
- In the multi-stored building of a hospital, the pharmacy should be preferably located on the ground floor especially the dispensing unit.
- It should be laid in such a way that there is a continuous flow of men and materials.
Staff Required in Hospital Pharmacy
A staff requirement in the hospital pharmacy depends upon the strength of patients available in the hospital wards or hospital premises. Based on the strength, the following table shows the requirement of staff i.e. pharmacists in the hospital pharmacy department.
Table.1: Requirement of Hospital Pharmacist
|Bed Strength||Number of Pharmacists|
|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|
Role and Responsibilities of a Hospital Pharmacist
The hospital consists of various departments that depend upon specialized services and how large the hospital is. All the major departments within the hospital occupy specialists as per their needs. All the departments are leaded by experts and they are in turn headed by a higher authority/director. The hospital consists of various departments like outpatient department (OPD), inpatient department (IPD), manufacturing of sterile products, therapeutics committee, etc. Every department dealing with drugs and there play a role by a hospital pharmacist. Following should explain briefly the roles of hospital pharmacists:
Hospital and Therapeutic Committee: The pharmacist is an important member of the hospital and therapeutic committee. A pharmacist usually comes second in command, after a physician in the committee. Pharmacists work toward maximizing and maintaining rational drug use.
Dispensing to IPD/OPD: Before dispensing a drug, the pharmacist must make sure about the correct prescription of the drug and its validity with regards to diagnosis and treatment. Pharmacists should also check for any modification concerning the dose regimen. A pharmacist is responsible for the distribution of drugs within the ward and he is coordinating with nurses. A pharmacist also supervises a steady supply of drugs as per their needs. IPD/OPD pharmacist works together with inventory, drug distribution in-charge, and physicians.
Drug Distribution: Pharmacist has a major role in supervising regarding proper distribution of drugs across inventory, pharmacy, floor pharmacy, ward pharmacy, IPD, OPD, etc. to avoid ambiguities or any other failures. A pharmacist also supervises the purchase orders, manages logs of material transfer across departments, and maintains smooth functioning of drug distribution across the hospital.
Purchasing, Inventory Control, and Budget: Hospital pharmacist plays an important role in purchasing drug account. There are varieties of products with similar characteristics in such cases pharmacist has to choose the best few from a variety of products. The pharmacist has to take balancing and rational decisions considering the economy, health, and end-user service. A pharmacist has to play a role in budgeting pharmacy. The role also includes paperwork and clerical jobs.
Pharmacists are officially a part of the budgeting committee and they must skillfully plan an economic budget to deliver services at cheaper possible rates. To plan out a budget that strikes balance between all the aspects a vigorous experience and skills are required. To balance the quality and economy of drugs best brands/generics are generally chosen.
Controlled Substances, Procurement, and Distribution: Hospitals procure controlled substances in large volumes thus supervising this unit by the pharmacist has crucial. For the procurement of controlled substances, there is required complete legal paperwork and the pharmacist is authorized by law for procurement. Without the consent of a pharmacist, the hospital cannot procure the same. A pharmacist has also a responsibility to regulate the use of such substances on hospital premises because such substances are very likely to misuse.
Manufacturing Bulk and Sterile Product: Large hospitals manufacture their bulk drugs to save cost and allow a steady supply of commonly used drugs, for example: Paracetamol, Ranitidine, Saline solution, Dextrose solution, etc. In such a hospital, the manufacturing plant or unit is segregated into several departments like manufacturing, packaging, labeling, QA, etc. A pharmacist has to supervise the activities of manufacturing as well as have a responsibility to control them.
Hospital Formulary: Hospital Formulary is a brief and compilation of all information related to drugs and guidelines for regulation in hospitals. It is similar to pharmacopeia but intended towards incorporating better and cheaper, condition-specific drugs in the hospital pharmacy. It generally contains the drug information which is particularly preferred by hospital pharmacists for the patient. A pharmacist plays actively involved in the preparation, updating, reviewing, and following a hospital formulary.
Investigational Drug Use: Based on the technical expertise hospital pharmacist are work in phase 1 and phase 2 clinical trials. Drugs used in clinical trials are generally reviewed by hospital pharmacists and HTC before use.
Educational and Training Programs: The majority of hospitals provide training programs for healthcare practitioners. Such training programs run under diverse faculty of physicians, administrators, nurses, pharmacists, etc. In such a program pharmacist has played a role in training fresh or junior pharmacist. They provide theoretical and practical training to trainers.
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