Clinical Pharmacy part 2 Dr J Domenech OBJECTIVES

Clinical Pharmacy (part 2) Dr. J. Domenech

OBJECTIVES – To define Hospital and know its system of organization. – To review the departments that make up the hospital pharmacy and know its scope of functions. – To define common terms used in Hospital Pharmacy – To identify, compare and review the different types of unit dose system.

OBJECTIVES – To define drug reporting and identify its know components. – To be able to understand comprehend how to go about drug reporting. – To do actual drug reporting by partner in a lecture type discussion.

Drug Reporting • • Penicillin -espana Macrolides -palconite Cephalosporins -amer Aminoglycosides -bugais Chloramphenicol -lo, tan Tetracyclines -alduheza Urinary anti-infectives- DEQUITO Anti-viral -arcenas

Drug Reporting • • Cimetidine -limpangog Anti-emetic -reginio Anti-helminthic Anti-inflammatory - arriola Antacid -santos Anti-diarrheal -noble Non-narcotic analgesic -recamadas

Drug Reporting • • • Anti-tussive -chan, gonzaga Diuretic -camargo Tranquilizers -capuras Sedatives -canales Anti-cholinergic agents -pernia Anti-convulsants -bondoc Local anesthetics -ramos Anti-coagulants -villoria Anti-hypertensive -caramonte

Patient chart – Full story of the patient while in Hospital – Authored by: MD, RN, RPh, allied health profession Ex. Patient’s personal data admitting history : HPI, PH, ROS Impressions admitting orders diet Laboratory exams/ results

Very Important to Clinical Pharmacists!! 1. Know the drugs prescribed for the px 2. Know its generic name 3. “ “ pharmacological classification 4. “ “ pharmacological action 5. “ “therapeutic indications. 6. “ “ pharmacokinetics- ADMET 7. Be interested in the response of the patient, his general condition, laboratory test results and relate to his progress.

Very Important to Clinical Pharmacists!! 8. Curiosity factor – BE ALWAYS CURIOUS and LOOK for REASONS why. Find out how, when and how much!!! 9. READ, READ on everything that you do not know or you have inadequate knowledge of.

Comprehensive Pharmacy Services - Strong drug distribution system in a hospital is very helpful in Clinical Pharmacy. 1. In-patient Dispensing a. UDDDS b. Individual order system c. Floor stock system 2. Out-patient Dispensing a. Patient counseling b. Drug information

Comprehensive Pharmacy Services 3. Iv admixture service a. Hyperalimentation b. TPN 4. Drug information a. solicited b. unsolicited, containing educational program

Comprehensive Pharmacy Services 5. Bulk compounding a. Quality Assurance b. GMP c. Formulation 6. CLINICAL Pharmacy Programs

CLINICAL PHARMACY PROGRAMS a. Pathophysiology of disease states b. Pharmacology c. Therapeutics d. Pharmacokinetics e. Bio pharmaceutics f. Drug interactions and ADR g. Formulary system

Hospital and its Organization

Hospital Complex organization utilizing combination of intricate, specialized scientific equipment, and functioning corps of trained people educated to the problem of modern medical science.

The character and extent of hospital services are adjusted continuously to keep abreast of changes and advances in medical science.

Governing Body and Management JCAH- Joint commission on accreditation of hospital 1. establish standards for the operation of hospitals and other health related facilities and services. 2. to conduct survey and accreditation programs that will encourage members of the health professions, hospitals and other health related facilities and services voluntarily:

a. To promote high quality care b. To apply certain basic principles of physical plant safety and maintenance, and of organization and administration of function c. To maintain the essential services in the facilities thru coordinated effort of the organized staff.

to cont. . JCAH 3. To recognize compliance with standards by issuance of certificates of accreditation. 4. To conduct programs of education and research 5. To assume such other responsibilities and to conduct other activities as are compatible with the operation of such standard-setting.

Board of Commissioners 1966 - “ to review, re-evaluate and rewrite the hospitalization standards and their supplemental interpretations to attain two objectives: 1. To raise and strengthen the standards from their present level of optimal achievable and maintain suitability to the state of the art.

Board of Commissioners 2. To simplify and clarify the language of standards and interpretations to remove all possible ambiguities and misunderstanding.

Departmental Organization in a Hospital Pharmacy Operation. Administrative Services Division Education and Training Division Pharmaceutical Research Division

Departmental Organization in a Hospital Pharmacy Operation. In-Patient Services Division Out-patient Services Division Drug Information Services Division

Administrative Services Division • Plans, coordinates departmental activities • Develop policies • Schedule personnel and provide supervision • Coordinate administrative needs of the PTC • Supervises departmental office staff

Education and Training Division • Coordinate programs of undergraduate and graduate pharmacy students • Participate in hospital-wide educational programs involving nurses, doctors, etc • Train newly employed pharmacy department personnel.

Pharmaceutical Research Division • Develop new formulations of drugs, especially dosage forms not commercially available, and of research drugs • Improve formulations of existing products • Cooperate with the medical research staff of projects involving drugs

In-Patient Services Division • Provide medications for all in-patience of the hospital on a 24 hr per day basis • Inspection and control of drugs on all treatment areas • Cooperate with the medical drug research

Out-patient Services Division • Compound and dispense out pxs prescription • Inspects and control all clinic and emergency service medication stations. • Maintain prescription records • Provide drug consultation services to staff and medical students.

Drug Information Services Division • Provide drug information on drugs and drug therapy to doctors, nurses, medical and nursing students and the house staff. • Maintain the drug information center • Prepare the hospital’s pharmacy newsletter. • Maintain literature files

DEFINTION OF TERMS

SINGLE UNIT PACKAGE • Is one which contains one discrete pharmaceutical form. Eg. One tablet one 5 m. L volume liquid

UNIT DOSE PACKAGE • Is one which contains the particular dose of drug ordered for the patient (single unit package is a unit dose if…)

UDDS/ UDDDS • Is a pharmacy-coordinated system of dispensing and controlling medications in health care institutions. • Medicines are contained in a single unit package. • Ready-to-administer form as possible • 24 hrs • Patient medication profile

CENTRALIZED UNIT DOSE SYSTEM • Is a unit dose system in which all doses are prepared at a central location. • The patient medication profiling, order prescribing and dose dispensing are all done in the central location.

DECENTRALIZED UNIT DOSE SYSTEM • Is a unit dose system in which doses are prepared in two or more satellite pharmacies located in or near the patient care areas of the hospital, • Pre-packing, inventory control and bulk compounding are done in a central location supporting the satellites.

FLOOR STOCK SYSTEM • Is a drug distribution system in which drug supplies are stocked on nursing units. • A nurse dispenses the drug doses for pxs form the bulk drug supply as a part of the drug administration process.

INDIVIDUAL PRESCRIPTION ORDER SYSTEM • Is a drug distribution system in which the medications are dispensed by a pharmacist on receipt of individual patient medication orders.

TRADITIONAL SYSTEM • Is a drug distribution system employing a combination of individual prescription order and floor stock system with floor stock items including selected controlled drug.

PLANNING OVERVIEW

In planning, 1. A minimum medication errors 2. Increased drug-use control 3. Minimal drug waste and pilferage 4. Economy of operation 5. Accurate and efficient billing

In planning, 6. Full utilization of the professional training and capabilities of all involved members of the health care team. 7. Enhanced quality of patient care