Institutional Pharmacy Chapter 16 Hospital Pharmacy In hospital

Institutional Pharmacy Chapter 16

Hospital Pharmacy • In hospital pharmacy technicians work as part of a team. • In hospitals, rooms are divided into groups called nursing units or patient care units. • Patents with similar problems are usually located together. • Read: Health care team page 317

Hospital Pharmacy Areas • Centralized Pharmacy systems – all pharmacy activities are conducted from one area within the hospital—called the inpatient pharmacy. • Decentralized Pharmacy systems – there are several satellite pharmacy areas located throughout the hospital, each serving a portion of the patient care areas.

Communication • There are several ways the pharmacy communicated with other areas of the hospital: – Fax – Telephone – Computer – In person – Pneumatic Tubes (shuttles items through a tube using compressed air) – Dumbwaiter (a small elevator to carry items between floors, but not people)

Computer Systems • Hospital computer systems can integrate and store patient information such as medical records, lab data and billing records. • Hospital computer systems differ from community pharmacy systems in some of the information they track-such as lab results and medical records.

Organization of Medication • Since hospitals cannot stock every medication available, most have a hospital formulary. • A formulary is a subset of medications the hospital keeps on its shelves from which a doctor can order.

Organization of Medication • Medication is usually organized alphabetically by generic name in hospital pharmacy. • In community pharmacy, medications are usually organized alphabetically by brand. • Read pages 322 & 323: hospital formulary, therapeutic interchanges, P&T committees, organization of medication

Unit Dose System • Medications are commonly provided to the nursing unit in medication cart containing 24 hours dosages for specific patients. (see illustrations page 325) • Medications in the cart are packaged in unit dose containers—holding a single dose of the medication.

Medication Orders & Order Processing • In hospitals, all drugs ordered for a patient are written on a medication order form or are electronically transmitted to the pharmacy. (see pages 326 -327) • Pharmacists must verify orders in the computer system and may check medications before they are sent to the floor. • In California, we now have “tech-check” where specifically trained techs can perform this last step provided the hospital has tech check protocols & training in place. (New this year)

Medication Orders & Order Processing • Standing Order – a standard medication that a patient is to receive at scheduled intervals. (eg: 1 tab q 8) • PRN Order – an order for medications to be administered only on an as needed basis. (eg: prn pain) • STAT Order – an order for medication to be administered immediately.

Inventory Control • A primary area of concern for inventory control is narcotics or controlled substances. – These require an exact record of the location & the exact count of every item. • Code Carts – a locked cart of emergency medication & equipment designed for emergency use only. ( see page 330) • Floor Stock – stock that is stored at the nursing station, does not require specific patient labeling.

General Hospital Issues • All departments within the hospital are required to maintain a policy & procedures manual by regulating agencies. • Joint Commission on Accreditation of Healthcare Organizations (JCAHO): – Surveys & accredits health care organizations – Organizations undergo survey every 3 years

Safety • During safety training, employees will learn universal precautions & how to handle hazardous spills. (Page 333) • Needles and other “sharps” should always be disposed in designated “sharps” containers.

Long Term Care • Long Term care facilities provide care for people unable to care for themselves. • Because of limited resources, most long term care facility contract out pharmacy services.

Long Term Care • Pharmacists provide dispensing serves and clinical services. • Distributive pharmacists – make sure the long term care patients receive the correct medication ordered. • Consultant pharmacists – develop & maintain an individual pharmacy plan for each patient.

Chapter 16 • Read all sections of Chapter 16 • Review Key Concepts • Take Self-Test