TYPES OF HOSPITALS

1-General hospitals
Emergency rooms, x-ray
departments, surgical
suites and they care for
general medicine and
surgical pts.
2-Special hospitals
For special populations of pts
such as pediatric, geriatric, or
psychiatric pts.
3-Rehabilitation hospitals
Rehabilitating pts with
orthopedic (bone and joint) or
central nervous disorders.
The Medical Staff Structure

Organized by departments
such as; medicine,
pediatrics and radiology.
Committees important to
pharmacy are :

1- Pharmacy and Therapeutics

committee,

2- Patient Care Committee,

3-Ambulatory Care Committee.

•The P & T Committee
selects the drugs to be
used in the hospital and
approves appropriate
use of drugs within the
institution.
•Formulary Requests
From a member of the
medical staff who
must state the
reasons a drug is
being requested
 Outpatients or Inpatients Fear
Errors Associated With;
• (1) Receiving health care in
general (47%).
• (2) Going to a hospital for
care (47%).
• (3) Going to a physician's
office for care (40%).
• (4) Filling a Rx at a pharmacy
(34%) .
6% of the respondents
felt they had suffered an
injury or harm because
of a medical error
during a period of 12
months.
 The Covenant
Relationship Between The
Pt. & Ph.
"if you help me (pt.) make
the best use of my
medication, I will give
you (ph.) my respect,
trust, and cooperation".
Physicians, nurses, ph.,
dieticians, lab. &
radiology personnel
work together for ;
THE GOOD OF THE Pt.
Ph. were relied on to
make sure that:
The right drug was
given to the right
pt.& at the right
time.
To fulfill the first part, the correct
drug, the ph. needs to know that :
1-Pt is diagnosed correctly,
2-BEST drug for that pt has
been Rx.

WHICH REQUIRED
TO BE ON THE Pt. CARE UNIT
Most pts say "yes" when
asked if they talked with
a ph. during their
hospital stay &
remember ph's name.
How many pts in
hospitals do not
even know there
are pharmacists in
the hospital?
Viewed as a hospital
department or a clinical
department varies from
hospital to hospital
dependent on how the
pharmacy department
views itself
*Know where all drugs are
stored,

*There is enough drug,

*All drug products are fresh

and potent.
• Drugs must be stored in
correct temp. & light.

• Schedule II, III IV, V

controlled substances (high
addiction & abuse potential)
must be stored under lock &
key.
‘Are small quantities of drugs
provided by drug manufactures
to physicians for starting a
patient on a new drug to see how
it works before writing a
prescription.’
The policy of many hospitals is to
not use drug samples.
Used in clinical research trials
where some pts recieve the
investigational drug, whereas
other pts recieve a placebo.
The pharmacy keeps records
of which pt. gets what.
A well- defined process
to decide how drugs are
used in the hospital?
1-Policies and Procedures
Drug-use process include:

Prescribing , preparation ,
dispensing & administrating of
drugs.

These policies and procedures

should be regularly reviewed and
updated.
2-Documenting Medication Use
& Allergies
When admitted to the hospital pts
are asked:

1- What medications they take

regularly and

2- What allergies they have to

medication.
The Answers To These Questions Are:
1- Documented in the pt’s
record (paper or electronic
medical record) and
2- Sent to the pharmacy
electronically or by a copy of
the information.
3-Drug Preparation and Distribution
Three primary systems for
distributing drugs in hospitals:
1-Floor stock,

2-Unit-dose, and

3-Centralized IV additives.
Medication stored on the pt
care units in the form of floor
stock is not recommended,

If this is done,
Medication should be limited.

Floor stock offers more opportunity

for error as there is NO check
system to avoid mistakes.
Stock Drugs: narcotics, IV
solutions and emergency drugs.

Some pt care units:

Emergency Room (ER), Intensive
Care Units (ICUS), Operating
Room (OR), and Recovery Room
(RR) have more floor stock than
others.
Dispensed WITH no
further dosage
prep., calculation or
manipulation
 Two Medication
Drawers for each pt
• One drawer is in the pharmacy
being filled, the other is in the pt
care unit being used by the nurse
to give medication to that pt .

• Each drawer is usually divided

into two sections; one for
regularly scheduled medication,
the other for PRN medication.
The best procedure for checking a
pt’s unit-dose drawer

Check the contents of the drawer

against the nursing Kardex.

If the drawer is not correct, one

of three things happened:
(1) The drawer was filled wrong,

(2) Computer entry error made in

the pharmacy,

(3) Transcription error made

between physician’s order &
nursing Kardex.

Which error occurred ?

Answer can be found by checking the
physician’s order in the pt’s record
 The pharmacy places enough
medication for the pt. for ;

*The next shift (7A.M. to 3

P.M., 3 P.M. to 11 P.M., or 11
P.M. to 7 A.M.) or

*The next 24-hour period.

• The Pharmacy receives a copy
of the pt’s medication orders.

• Pharmacy technicians enter

the medication orders into the
pt’s profile (pharmacy
computer system).
If the hospital has a total
information system, the order
flow directly from the
physician’s electronic orders
into an electronic version of
the pt’s pharmacy profile in
the computer system.
The IV additives
are drugs added
to IV solutions
prepared in the
pharmacy using
aseptic technique.
• Ph. & pharmacy technicians are
trained to prep. IV admixtures,
& they should be recertified on
how to do this.

• Prep. just before they are need

& refrigerated between the
time they are prepared & the
time they are used.
Drugs are administered to
inpatients by registered
nurses (RNs) or in some
states by licensed practical
nurses (LPNs) who have taken
a course in medication
administration.
 Once the medication is
administered, the nurse must
“chart”, record, the medication
administered to the patient
By documenting
What was given, How much, &
When.
Important questions to ask
before administering
medication are:
Is this the correct pt?
(check the pt’s arm band ID).
Is this the correct medication?
Is the dose correct ?
Is this the correct dosage
form?
Is it the correct time to give
the medication?
Pharmacy’s Input into Rational
Therapeutics

Ph. practice PC in hospitals

are well accepted for their
expertise & help in
effecting rational and safe
drug therapy
 Drug Formulary
“Is a compilation of
pharmaceutical agents
recommended for prescriber
selection and pt.”

* Rational therap. begins with

having an effective drug
formulary.
Formularies may be used as:
1- A compulsory control over
drugs that may be prescribed.
OR
2- A voluntary guideline under
a quality assurance program
called a Drug Utilization
Review (DUR).
(1) Improve pt. health outcomes
by means of certifying drugs of
choice,

(2) Limiting purchases for drug

products (cost control), and

(3) Realizing administrative ends

such as ideal inventory control.
Pharmaceutical Care
For ph. to deliver ideal drug
therapy, they must be
involved in prescribing,
dispensing, administrating,
and monitoring the drugs
used in the hospital, which
is a big job.
1-Provide useful drug information
for specific populations of pts
with pain, cancer,& those
needing IV nutrition (TPN).

2-Useful during a cardiac arrest,

(pt’s heart stops) & is sometimes
called a code blue.

3-To draw up the drugs.

4-Make sure they are given in
the correct order and dosage,

5-Monitoring drugs that have

narrow therap. Index.

6- Ph. in some hospitals are

able to prescribe drugs to pts
under a written protocol.
At Good Samaritan Hospital, a
200-bed hospital in
washington, ph. have receive
prescribing authority from the
P & T Committee for
aminoglycoside antibiotics,
theophylline, & pain control in
ambulatory pts.
• Major differences between
clinical pharmacy & PC is the
focus of the physician whereas
the focus under PC is the pt.

• Most clinical pharmacy service

has been provided by ph. with a
Pharm D degree & residency
training (clinical specialists).
In PC all ph. including staff ph. &
those with a B.S. degree in
pharmacy can with some
training, provide direct pt care.
Under the PC model, the ph:
• Reviews the pt. therapy for
medication-related problems
• Perioritizes those problems,
• Develops solutions for each
problem.
• Watches the pt’s progress.
(1) Use of abbreviations,

(2) Not reading labels,

(3) Sound-alike drug names,

(4) Look alike names, and

(5) Illegible handwriting.

 The presence of a ph. on
rounds in a medical ICU could
substantially lower the rate of
Rx errors & can reduce
adverse drug events
(drug interactions, allergic drug
reactions).
 PHARMACY
•PHARMACY STAFF

•1-PHARMACISTS
* Sets the vision & direction for
the dept.,

*Responsible for the morale and

teamwork within the
department.

*Do the plan & work outside the

dept. with other departments
*Recommend raises& terminations

*Responsible for quality of work,

*See work gets done,

*Schedule employees,

*Hire personnel.
 A recent survey reported that
hospital ph. Spend:

*32% of their day supervising the

prep. & distrib. of drugs,

*23% on dispensing functions

*18% on clinical functions.

PHARMACY SUPPORTIVE PERSONNEL
Pharmacy Technicians
Pharmacy clerks : do routine
functions in the pharmacy
and do not prepare
medication.
Macon County General Hospital
Sumner Regional Medical Center
Photos courtesy of Bitacora Cubana
 But at least the healthcare is
free"
• Dr. Darsi Ferrer Ramírez, Director of
the Juan Bruno Zayas Health &
Human Rights Center in Havana, sent
these photos of Yamilet Fernandez
Donate, a 32 year old woman who
almost died after complaining last
November 27 of abdominal pain &
entering one of Havana's hospitals.
• At the time, Mrs. Fernandez was
six weeks pregnant & wasn't
suffering from any diagnosed
illness.
• She entered the Hospital
Nacional in Havana where she
was given intravenous analgesics
& was sent home when the pain
subsided.
• A few hours later, Yamilet's abdominal
pain got much worse & she was also
running a fever.

• She went to the Hijas de Galicia Maternity

Hospital.

• There she was told that her pain was not

related to her pregnancy & that she
should see the surgeon on duty at the
Miguel Enriques Hospital.
• In there, she was told that she was suffering
from Acute Gastritis & the doctors
recommended a gastric suction
(stomach pumping or gastric lavage) & after the
procedure she was told to go home that
everything was now OK.
• When Yamilet got much worse, her family
took her to the Julio Trigo Hospital.
• Once there, the doctors told her that what she
really had was an Urinary Infection & said
that the best thing was to send her back to the
Hospital Nacional.
• In the next couple of days Yamilet's
health got much worse. She was in
constant pain &running a high fever.

• She was vomiting, had muscular fatigue

& even fainted several times.

• After the family kept complaining, the

doctors decided to operate the poor
woman & they finally determined that
she had a perforated appendix,
peritonitis & an intestinal occlusion.
• After the operation she spent several days
in the intensive care unit & later had to
have another surgery due to several
complications that resulted from the first
one.
• Several days later the doctors told her
that they had to perform an abortion.

• At the end & because of the negligence of

her doctors, Yamilet lost her baby & also
portions of her intestine & colon.
• She also has very ugly scars on her
abdomen to remind her of the pain
& suffering that she had to endure
at the hands of these butchers
dressed as doctors.
• Castro has sent thousands of doctors
to Venezuela & many other
countries of South America &
Africa.
• And now who get sick have to
endure not only the lack of
medicines, but also the lack of
qualified medical practitioners.
• Of course, those 'doctors' don't
have to worry about a malpractice
lawsuit & the victims don't have
any right to complain about their
"free healthcare."
Omaha General Hospital
Middle-grade ph.(II) More responsibility is carried
(grade 1) than at C grade.

More senior-grade These more senior staff have

ph. (grades E/F) gained a reasonable level of
experience and have either
taken on a management or a
specialist role.

Top grades (grades Chief pharmacists would be

(F/G/H) graded at these levels or at a
similar level on a management
scale.