Hospital Pharmacy: Essential Practices and Standards

Posted on Jan 19, 2025 in Other university degrees and diplomas

Hospital Pharmacy: Definition and Scope

Hospital pharmacy is a specialized field of pharmacy that is integrated into the care of a medical center. These include centers such as a hospital, outpatient clinic, drug dependency facility, poison control center, drug information center, or residential care facility.

Scope of Hospital Pharmacy

  • To ensure the availability of the right medication at the right time in the right dose at the minimum possible cost.
  • To professionalize the functioning of pharmaceutical services in a hospital.
  • To act as a data bank on drug utilization.
  • To participate in research projects.
  • To coordinate and cooperate with other departments of the hospital.

Hospital Classification and Organizational Structure

Hospitals can be classified on various bases:

1. Clinical Basis

On the basis of therapy provided by the hospital:

  • Maternity Hospitals
  • Surgical Hospitals
  • Medicinal Hospitals

2. On Basis of Ownership

  • Government Hospitals
    • Public health services (AIIMS, PGI)
    • Military Hospitals
  • Non-government Hospitals
    • Private Hospitals
    • Charitable Hospitals

3. On the Basis of System of Medicine

  • Allopathic Hospitals
  • Ayurvedic Hospitals
  • Homeopathic Hospitals
  • Unani Hospitals
  • Rehabilitation Centers

4. On Basis of Medical Staff

  • Closed Staff
  • Open Staff

5. On Basis of Number of Beds

  • Small Hospitals (beds up to 100)
  • Medium Hospitals (beds 101 to 499)
  • Large Hospitals (beds above 500)

6. On Basis of Teaching Activities

  • Teaching Hospitals
  • Non-teaching Hospitals

7. As per WHO

  • Regional Hospitals
  • District Hospitals
  • Rural Hospitals

8. On Basis of Cost

  • Elite Hospitals
  • Low-budget Hospitals

9. On Basis of Level of Healthcare

  • Primary
  • Secondary
  • Tertiary

Pharmacy and Therapeutics Committee

Composition

  1. The Medical Superintendent – Chairman
  2. Chief of Pharmacy Services – Secretary
  3. One representative each from:
    • Department of Internal Medicine
    • Department of Surgery
    • Department of Clinical Pharmacology
    • Department of Microbiology
    • Department of Nursing
    • Department of Nutrition

Function

  • Maintain the Drug Formularies to promote safety, effectiveness, and affordability according to the Formulary Principles.
  • Oversight consists of the Commercial Drug Formularies, the Medicare Formulary, and the State Programs Formulary (Minnesota Health Care Programs).
  • Maintain pharmacy-related medical policies that promote the safety, effectiveness, and affordability of medications used in clinic settings.
  • Maintain Formulary Principles that guide the management of the Drug Formularies.
  • Review new drugs, drug classes, new clinical indications, therapeutic advantages, new chemical entities, and new safety information.
  • Review the Drug Formularies and therapeutic classes at least annually.
  • Analyze scientific, clinical, and economic information.

Hospital Formulary

  • The hospital formulary is a continuously revised compilation of pharmaceutical dosage agents and their forms, etc., which reflects the current clinical judgment of the medical staff.
  • The hospital formulary system is a method whereby the medical staff of a hospital, with the help of the pharmacy and therapeutic committee, selects and evaluates medical agents and their dosage forms which are considered to be most useful in patient care.
  • It provides information for:
    • Procuring
    • Prescribing
    • Dispensing
    • Administration of drugs under brand names where the drug has both names.

NQAS and NABH

NQAS (National Quality Assurance Standards) Guidelines

The NQAS program was initiated by the Ministry of Health and Family Welfare with the goal of highlighting top-performing facilities and enhancing the public hospitals’ reliability in the community.

Organizational Structure

1) The State Quality Assurance Committee (SQAC) is a state-level organization responsible for policy decisions, providing guidance, and also for QA initiatives, including their successes and failures. At the state level, the committee’s main responsibility is to regulate, guide, and monitor the districts’ QA initiatives.

2) District Quality Assurance Committee (DQAC) is a district-level organization having District Quality Assurance Unit (DQAU) as a functional body that performs various duties according to the unit’s TORs.

Some Areas Where They Focus

  • Service Provision
  • Patient Rights
  • Infection Control
  • Quality Management
  • Hand Washing Facilities
  • Postpartum care (hormonal level and uterus size return to a non-pregnant state after 6 weeks of childbirth)
  • Oxytocin administration within 60 seconds of childbirth
  • Availability of curtains, etc.

NABH (National Accreditation Board for Hospitals & Healthcare Providers) Accreditation

National Accreditation Board for Hospitals and Healthcare Providers (NABH) is a constituent board of the Quality Council of India (QCI) that has been established to create and operate the Hospital Accreditation Program for healthcare organizations.

Aim

To operate accreditation and allied programs along with stakeholders, focusing on patient safety and quality of healthcare, based upon national/international standards, through the process of self and external evaluation.

Benefits of Accreditation

  • High-quality medical care and patient safety are the results of accreditation. The patients receive services from licensed medical personnel.
  • Patients’ rights are valued and protected.
  • It is possible to assess patient satisfaction.

High-Risk Drugs

High-risk drugs are medicines that can cause significant harm to the patient; they may cause serious side effects, especially when administered incorrectly or when a dose is calculated incorrectly.

High-Risk Drugs List

  1. Adrenergic agonists IV (Epinephrine, Norepinephrine)
  2. Adrenergic antagonists IV (Propranolol, Prazosin, Atenolol)
  3. Anesthetic agents (general) inhaled and IV, (Ketamine, Propofol)
  4. Antiarrhythmic agents (Lidocaine, Procainamide)
  5. Antithrombotic agents (anticoagulants): Heparin, Argatroban
  6. Hypoglycemic Agents (Metformin)
  7. Sedative agents (Alprazolam, Diazepam)
  8. Narcotic drugs: Codeine, Morphine
  9. Neuromuscular blocking agents: Succinylcholine
  10. Insulin IV and subcutaneous

Emergency Drugs and Schedule H1 Drugs

Emergency drugs are essential to meet the immediate therapeutic needs of patients and which are not available from any other approved source in the required time to prevent risk or harm to patients.

List of Emergency Drugs

  1. Life-saving drugs. Example: Atropine, Adrenaline
  2. Painkillers (analgesics). Example: Paracetamol
  3. Cardiac drugs. Example: Dopamine
  4. Respiratory drugs. Example: Dexamethasone
  5. Gastrointestinal drug. Example: Drotaverine
  6. Central nervous system drugs. Example: Phenytoin, Magnesium Sulphate
  7. Obstetrics. Example: Drotaverine
  8. Allergy. Example: Dexamethasone
  9. Antibiotics. Example: Monocef

Schedule H1 drugs comprise of sensitive antibiotics, habit-forming medications, and drugs with severe side effects if used without supervision and prescription of a registered medical practitioner.

  • List of schedule H1 drugs: Ethambutol hydrochloride, Ethionamide, Isoniazid, Levofloxacin, Moxifloxacin, Pyrazinamide, Rifabutin, Rifampicin.

Cold Chain and Cold Storage Devices

Maintaining Cold Chain

It means to provide 2-8°C temperature to any product like vaccines, during manufacturing, storing, transporting, and distribution, to maintain their potency.

Devices Used for Cold Storage

  1. Refrigerator
  2. Thermometer which indicates the temperature level.
  3. Cold boxes for storage and transportation.
  4. Ice packs

IRLs (Ice-Lined Refrigerators)

Ice-lined refrigerator is a type of refrigerator which has an extra function where cold ice water or ice packs are filled. They maintain the inside temperature at a safe level in case of electricity failure.

Walk-In Cold Rooms (WIC)

A walk-in cold room is a cold storage condition on a large scale and it provides a constant and comfortable temperature throughout the space.

FEFO and FIFO Methods

FIFO: First In, First Out

It is a method in which the product that came first in the warehouse is taken out first, to avoid expiration.

FEFO: First Expire, First Out

In this method, the products whose expiry is closest are out first, to avoid expiration.

Advantages

  • Obsolete stock reduction
  • Spending cuts for warehouse logistics
  • Customer satisfaction rate increase
  • Reducing the inflation impact on business

Disadvantages

  • An accurate product tracking system is required
  • Warehouse space has to be well-organized
  • Difficult to scale up a business
  • Higher taxes

Procedure for Drug Purchase

1) Purchase Request Form / Purchase Requisition

a) The pharmacist prepares the drug list to buy and fills out a purchase request form.

b) This form provides information regarding required drugs, their quality, and quantity.

c) This form will be sent to administration for approval. After approval, it will be sent to the purchasing officer.

2) Quotation Invitation

The purchasing officer sends this form to different suppliers and asks for their quotations.

3) Purchase Form

The purchasing officer checks all the quotations, selects suppliers based on price, quality, etc., and places the purchase orders.

4) Receipt of Goods

When the ordered products are delivered to the purchasing department, their quality, quantity, and prices are checked. If any products miss the desired quality, quantity, or price, they should be returned to the supplier.

5) Payment

After satisfactory completion of all these processes, the purchasing officer pays the amount to the suppliers.