CHAPTER 1

Institutional Pharmacy Practice

Institutional Pharmacy Practice

• Provision of distributional & clinical

services

• Based in institutional setting

– Hospital

– Long-term care

– Hospice

– Correctional facilities

Integrated Health Systems

• Individual institutions “systems”

– Mission: positively impact health outcomes

Types of Hospital

• Factors:

– Location

• Urban or small rural setting

• Single building or campus complex

– Size

– Specialization

Types of Hospital

• Community Hospital

– Most common type

– Assorted disease and injury

– Provides emergency, In&Out patient,

Intensive care

• Specialized Hospital

– Particular disease

– Specific organ

– Specific population

Types of Hospital

• Teaching Hospital

– Serves patient need AND train future health care

professionals

– Associated with medical schools

• Ownership

– For-profit Hospital – corporation, private investors

– Non-profit – religious order, volunteer, community

• Government Hospital

– Federal, state, county or government

Types of Hospital in the Philippines

• According to Ownership: – A. Government

– B. Private

• According to Functional Capacity – A. General Hospital

– B. Specialty Hospital

• Particular disease

• Particular organ(s)

• Particular Group of Patients

• According to Trauma Capability – A. Trauma – Capable Facility

– B. Trauma – Receiving Facility

Classification of Hospitals

• Type of Service

– General

– Special

– Rehabilitation and Chronic Disease

– Psychiatric

Classification of Hospitals

• Length of Stay

– Short-term hospital

• Less than 30 hospital days

– Long-term hospital

• 30 or more hospital days

Classification of Hospitals

• Ownership

– Governmental

• Federal

• State

– County

– City

– City-county

– Non-governmental

• Non profit

• For profit

– Individual

– Partnership

– Corporation

Classification of Hospitals

• Bed Capacity

– Very Small below 100

– Small 100-500

– Medium 501-1,000

– Large above 1,000

New Classification of Hospital in the

Philippines

• A.O. no. 2012-0012

DOH Bureau of Health Facilities and Services

“New Classification of Hospitals and Other Facilities”

– Level I

– Level II

– Level III

– Other Health care facilities

• Primary care facility

• Custodial care facility

• Diagnostic/Therapeutic facility

• Specialized Out-patient facility

Pharmacy Role in the Medication

Use Process

Prescribing Transcribing Dispensing Administration Monitoring

• Usually done by ___________.

• “PRIVILEGING”

• Pharmacist can be sources of drug information

• Pharmacist can develop protocols (formulary system)

Pharmacy Role in the Medication

Use Process

Prescribing Transcribing Dispensing Administration Monitoring

• Manual or Electronic

• More common type is _________ but _________

Pharmacy Role in the Medication

Use Process

Prescribing Transcribing Dispensing Administration Monitoring

• Act of physically transferring the drug product

after review & approval of prescription.

• Prone to:___________

Pharmacy Role in the Medication

Use Process

Prescribing Transcribing Dispensing Administration Monitoring

• Usually done by ____________.

• Very crucial step in drug use.

• Pharmacist can prevent medication errors

thru:

• Bar coding

• Unit Dose Dispensing

• Clearly labeling medications

Pharmacy Role in the Medication

Use Process

Prescribing Transcribing Dispensing Administration Monitoring

• Review laboratory values

• Monitor subjective and objective factors

• Effective and Toxic effects

Practice Models

• Drug-distribution-centered model

– Pharmacist distribute drugs & process new

medication orders.

– Pharmacist is __________ only to requests of

physicians and nurses.

Practice Models

• Clinical-pharmacist-centered model

– Two types:

• Clinical

• Distributive

Practice Models

• Patient-centered integrated model

– Both clinical and distributive

Key Models of Pharmacy

1 • Must be interdisciplinary, team-based

2

• Med preparation & distribution must be automated, centralized and done by trained technicians

3 • Direct patient care > Medication distribution

4 • Health and Drug information will be an advantage

5 • Must promote cost-effective therapy

6 • Must provide pharmacotherapy plan for each patient

7 • Continuous training for general and specialized practice

8 • Must collaborate with community pharmacist

Key Individuals

• Pharmacist Roles – Dispensing vs. Clinical

• Clinical Pharmacist

– Requires training and

residency program

– May be a _________ or

__________.

– Integrated pharmacist

• Both dispensing and

clinical roles

– Pharmacist in

Management

• supervisor, director

– Pharmacist in:

• Informatics

• Investigational drug

service

• Research

• Sterile compounding

• Emergency care

Key Individuals

• Pharmacy Technicians

– Purchasing, stocking, preparation and compounding

of medication under the supervision of a

PHARMACIST.

– Must have established training standards

– Expansion in automated dispensing & information

technology

– Assist Clinical Pharmacist in getting lab values, do

patient interview and medication reconciliation.

Automation and Technology

• Since before 1990s

• ↑ efficiency & accuracy of dispensing

• Pharmacy automation – Unit-based cabinet (Pyxis, Omnicell)

• Most common

– Pharmacy robot (McKesson, Robot-Rx)

Automation and Technology

• Medication-related technology

– Bar-coded medicine administration

• Nurse scans the patient’s wrist band & med bar

code

– Smart pumps

• programmable devices that allow the user to

predefine minimum and maximum rates of

administration

– Computerized prescriber order entry

(CPOE) • Medication ordering information is able to transfer

between the prescriber and the pharmacy

Patient Care Areas

• In-Patient

– Critical care • higher acuity level; clinical status is constantly changing

– General care

• Out-patient

– Similar to community phar W/O general

merchandise

– Caters clinic, discharged and ER patients

– Other types: Ambulatory care, home health

care service

Accreditation and Standards of

Practice Accreditation • Voluntary process by which the

quality of care provided by a

hospital is assessed by an

outside accrediting body on a

routine basis

• Done by

– Accrediting Body

• Assess & improve quality

of patient care

• Suggests improvement

– Regulatory Body

• Public protection

• Impose fines and legal

action

Practice standards • Practices that a profession

develops and imposes on

itself

• Standards are called “Best

practices”

• Initiated by:

– ASHP

– PSHP

Importance of Pharmacy

Leadership

Primary Pharmacist

Pharmacy Manager

Director of Pharmacy