Hospital Classifications, Services, and Pharmacy Roles

Posted on Feb 10, 2025 in Other university degrees and diplomas

Hospital Roles and Classifications

Weeks 1-3: Role of Hospital Care

  1. Patient Care: Diagnosis and treatment of illness/injury, preventative medicine, rehabilitation, convalescent care, and personalized services.
  2. Education: Education of all staff and patients, providing support (social, occupational, physical, psychological).
  3. Research: Advancement of medical knowledge, improvement of hospital services, animal research, clinical trials (not always related to medical personnel).
  4. Public Health.

Classification of Hospital Criteria

  1. Teaching Status: Affiliation with a faculty of medicine, acts as a referral center for seriously ill patients, and provides health instruction to other health disciplines.
  2. Type of Care:
    • General Treatment: Many illnesses, surgical patients, obstetrical (e.g., Toronto General, North York General).
    • Specialized: e.g., SickKids, Princess Margaret, St. John’s Rehab.
  3. Accreditation: The Canadian Council on Health Services Accreditation (CCHSA) promotes excellence in healthcare and the effective use of resources in health service organizations nationally and internationally to improve the delivery of health services.
  4. Ownership: Most hospitals became public when OHIP began – non-profit, available to all residents, owned by municipalities, operated by religious orders, or private.
  5. Length of Stay: Short (<30 days) or long.

Classifications of Hospitals

General, convalescent, for chronic patients, active treatment teaching psychiatric, active treatment hospitals for alcohol and drug addiction, regional rehabilitation.

Ontario Hospital Association (OHA)

Over 85 years of service, improved standards in healthcare, pioneered a results-oriented, patient-focused philosophy that remains prevalent.

Inpatient vs. Outpatient

  • Inpatient: Treated in the hospital, with different units/areas of care (ICU, ER, NICU, PACU, surgical, medical, pediatrics, geriatrics).
  • Outpatient: Comes to the hospital for treatment and then goes back home.

Hospital Departments

  • Administration: CEO, Vice President, Executive Assistant, Department Heads – run the hospital, oversee budget and finance, establish hospital policies and procedures, and often perform public relations.
  • Information Services: Admissions, billing and collections, medical records, computer information systems, health education, human resources.
  • Therapeutic Services: Treatment to patients
    1. Physical Therapy: Improve large muscle mobility.
    2. Occupational Therapy: Help patients regain fine motor skills.
    3. Speech/Language Pathology: Identify, evaluate, and treat communication disorders.
    4. Respiratory Therapy: Treat patients with heart and lung disease.
    5. Medical Psychology: Focus on the mental well-being of patients.
    6. Social Services: Connect patients with community resources.
    7. Pharmacy: Dispense medications.
    8. Dietary: Maintain nutritionally sound diets for patients.
    9. Sports Medicine: Rehabilitation for athletes.
    10. Nursing: Provide care to patients.
  • Diagnostic Services: Determine the root of illness/injury.
    • Medical Laboratory: Study body tissues.
    • Medical Imaging: Radiology, MRI, CT, Ultrasound.
    • Emergency Medicine: Emergency diagnoses and treatment.
  • Support Services: Support the entire hospital.
    1. Central Supply: Orders, receives, stocks, and distributes equipment and supplies.
    2. Biomedical Technology: Design, build, and repair medical equipment.
    3. Housekeeping/Maintenance: Maintain a safe and clean environment.

Pharmacy Roles and Policies

Pharmacy’s Role

Prescribing, transcribing, dispensing, administration, and monitoring. *July 22, 2014: The Safeguarding Health Care Integrity Act gave the Ontario College of Pharmacists (OCP) authority to license and inspect hospital pharmacies in Ontario. *OCP hospital assessment criteria checklist used by Hospital Practice Advisors (HPA).

Pharmacy Policies

If only a month and a year of expiration are given, the medication is to be used until the last day of the month. Labels are computer-generated. All reconstituted and mixed products have a beyond-use date (BUD). A minimum of two pharmacy staff are involved in the filling process of a prescription. No childproof packaging is used. There are no refills, no lock-and-leave, and minimal labeling and packing requirements.

Route of Dispensing Medication in Hospital

  1. Prescriber writes a medication order.
  2. The order is reviewed by a clinical pharmacist.
  3. The order is inputted into the pharmacy dispensing program.
  4. Medications are dispensed from the pharmacy or through a ward.
  5. Medications are sent to the nursing unit and administered to the patient.

Types of Medication Orders

  • Admitting Order: Issued by the MD upon hospital admission (ER): medications, dietary requests/restrictions, lab test results, drug allergies, suspected diagnosis.
  • Emergency (STAT): Given priority attention and processed by the pharmacy as soon as possible.
  • Daily and Continuation Order: New medication by the MD after every patient examination. Policy: The MD must review, approve, and rewrite all daily medications at least weekly.
  • Standing (Routine): The same set of medications and treatments applies for each patient who receives a similar treatment or surgery – the MD signs the order.
  • Discharge: Provide take-home instructions and medications.

Standard Medication Administration Times

Determined by the Pharmacy and Therapeutics Committee (P&T) with input from nursing and other groups. This ensures timely administration and prevents missed doses. Some medications require specific timing. STAT: within 30 minutes; NOW: within 2 hours. Patient-specific requirements must be documented in the MD’s order sheet. Drug interactions adjustments with reasons are noted by the MD in the order.

Government and Healthcare

Provincial Government

Management and delivery of health services; finances, plans, and evaluates healthcare provision.

Federal Government

Setting and administering standards, assisting in financing as it is constitutionally responsible.

Principles of the Canada Health Act

  1. Public Administration: The health insurance plan of a province must be administered and operated on a non-profit basis by a public authority accountable to the provincial government.
  2. Comprehensiveness: Medically necessary services should be insured (inpatient care, drugs, diagnostics, outpatient, chronic service fees – DAN).
  3. Universality: Available to all residents.
  4. Accessibility: Reasonable access to all patients, no barriers, discrimination, or additional charges.
  5. Portability: Residents are entitled to coverage when they relocate to another province or travel outside Canada.

Funding

Through taxes (provincial and federal), personal and corporate, sales tax, lottery proceeds. Federal funding to provinces: cash contributions and tax points.

Pharmacy Technician Roles

  • Narcotic Technician: Replenishes each nursing unit with enough narcotics for 24 hours, reviews daily narcotic sheets for accuracy and completeness, receives narcotic inventory, discards expired narcotics.
  • IV Technician: Prepares batches, clinical trials, study/special access IVs, and patient-specific IVs (TPN, antibiotics, narcotic infusions).
  • Inventory/Purchasing Technician: Generates, places, and receives orders; restocks shelves.
  • Dispensing Technician: Answers phones, prioritizes and dispenses new prescription medications to inpatients, dispenses refill medications, delivers all medications.
  • Order Entry Technician: Prioritizes and enters therapeutically checked medication orders, verifies orders, and notifies the pharmacist of any interactions or abnormal lab values.
  • MedRec Technician: Interviews patients, gathers the patient’s Best Possible Medication History (BPMH), contacts community pharmacies, communicates with other healthcare professionals, and acts as a liaison between the pharmacy and other MDs/nurses.

Committees

Pharmacy & Therapeutics Committee (P&T)

Functions at hospital, regional, or provincial levels. Manages drug-related policies. Composed of physicians, pharmacists, nurses, administrators, and public members. Formulary decisions are based on evidence, safety, cost, and overall impact on care. Meets once a month to review all changes, additions, or deletions to the formulary.

Medical Advisory Committee (MAC)

Mandated by the Public Hospitals Act to advise the board and CEO. Focuses on medical care, teaching, and research. Oversees medical staff appointments, reappointments, and privileges. Ensures quality supervision of medical practice or patient care (e.g., CAMH).

Drug Formulary

A continuously updated list of medications and related information, representing the clinical judgment of physicians, pharmacists, and other experts in the diagnosis and/or treatment of disease and promotion of health.