Our Mission

The primary mission statement of RHUH is to provide quality community based medical services. Our goal is to be the leaders in the health care sector.

We care for our patients, our community and our staff.

We provide a friendly, prompt, and cost-effective service in a caring manner for all and incomes from every region in Lebanon.

We value our community, our employees and most important our patient.

We support the environment.

We deliver the highest standards and quality of service in a cost-effective manner.

We teach in an environment of healthcare for further medical education at all levels, and in multidisciplinary sciences. Collaborating with institutions of higher learning we assist residents in receiving the highest quality medical care and develop nursing education programs.

We discover through a continuous research programs.

We play a leadership role, in addressing and responding to regional and local health and related needs. Our leadership role comes from the policies and the vision of its Director, and the advisory board.

Our Vision

Patients are our first and most important priority. Employees are our most valuable resource.

We are committed to provide the highest quality, most cost-effective services.

We distinguish ourselves through our leadership in the health care sector.

We are committed to values that RHUH focuses on patient – centered care, excellence, innovation, diversity, ethical values and integrity.

Our name is a community of people living this vision.

Our Values

Patient-Centered Care: In all its endeavors, RHUH is guided by the needs of the patient, creating a partnership that is effective and personal across the continuum of care.

Continuous Learning: RHUH actively supports outstanding programs of education and research designed to encourage the acquisition of knowledge and skills that are of value to the national health care program and the society.

Society: RHUH actively develops partnerships that will improve the health care of the society and, as a steward of public trust; it ensures informed and dignified care for all patients regardless of their ability to pay.

Organizational Ethics: RHUH is guided by ethical values that emphasize honesty, fairness, dignity, and respect for the individual.

Superior Performance: RHUH strives for superior performance in all what it does; to preserve the hospital's clinical, organizational and financial strength.

Relationships: RHUH develops and strengthen collaborative relationships with all of its customers, including patients, their families, employees, volunteers, medical staff and business partners.

Human Resources: RHUH supports the professional and personal growth of employees in their pursuit of the hospital's mission.

Communication: RHUH strives to acquire and understand information, and share it clearly and effectively.

Hospital Management Repot

The need for a governmental hospital in Beirut was an issue over 30 years ago. On February 2, 1979 the Lebanese government released a decision to build a governmental hospital of 500 beds on a public owned property in Bir Hassan - Beirut. The decision was based on technical studies made by the minister of Health and the Minister of Public Works and Transportation.

Construction did not start until 1995 due to civil war and its consequences and it was finalized during 2000.

Since RHUH is a public institution its construction was financed by the Lebanese government through Ministry of Finance. Similar to all public constructions RHUH construction was handed to the Council of Development and Reconstruction – CDR- The construction and supplies of the hospital were financed by a low interest loan from the Saudi Development Fund and Islamic development Bank.

The four auxiliary buildings’ construction was financed by a grant from King Fahd of Saudi Arabia.

All medical and non-medical equipments were purchased through Islamic Development Bank by a low interest loan.

The hospital is an independent public institution where it has its own board of directors and is under the supervision of the Ministry of Public Health which supervises the hospital’s function through its representative in the board.

BEIRUT GOVERMENTAL UNIVERSITY HOSPITAL, also widely known as RHUH, is a hospital in RHUH Street, behind OGERO, Bir-Hassan, Beirut, Lebanon; telephone +961 1 830000, +961 1 831000, +9611832000. RHUH is a university hospital. It is a training center for medicine students and as post graduate establishment for specialization in the various medical branches, as well as its partnerships with related faculties of the Lebanese University,

Lebanese International University, and with other local and international faculties of medicine, pharmacy, and health organizations. Besides being a research center.

RHUH Land Space is 48,000 m², 90,000 m²of which is the building space. The building consists of 7 floors, 50 apartments, 4 villas, 300 students and nurses dorms, and nursing university. RHUH contain 544 beds; 150 of them are occupied right now and the others will be available in the near future. The future 544 bed are classified as follow:

Medicine 128Surgery 128

Pediatrics 64OB-GYN 64Nursery 18

ICN 16ICU 11CCU 9CSU 4

Burn Units 6Dialysis Unit 24

Child Psychiatry 34Rehabilitation for drug

addiction15

Oncology 11Prison 12

Total Beds 544

1- The general director is the head of the RHUH and he is responsible for all the departments in the hospital, such as the Information Technology, Finance & administration, Medical, Internal Audit, Material and & Purchasing, and nursing department. The finance and Administration department is responsible for the logistics, Human Resources, and Finance; whereas the Material and purchasing is responsible for the Biomedical, Engineering & Maintenance and the Pharmacy departments. The pharmacy is directly linked to the Material & Management and indirectly to the Material & Purchasing and Management (General Director) through the Material & Management.

2- Hospital accreditation standards are statement of accruements and recommendation that the hospital should meet. These rules are implanted by the Over Seas Project Corporation of Victoria (OPCV) and under the super vision of the ministry of public health of Lebanon (MOPH) and the health sector rehabilitation project (HSRP). The project is financed by the World Bank. CHECK THE NATIONAL HOSPTAL SURVEY PAGE ( ).

Establishment of a hospital accreditation system in Lebanon will pave the way for the provision of good quality of health care. As the accreditation system matures more and more in Lebanon the standards will further develop and quality assurance and quality improvement will lead on to the more precise measurement of health outcomes.

Quality assurance principles and hospital accreditation address quality of care deficiencies and harmful and/or wasteful practices, and can stimulate debate between public and private providers, policy makers and consumers on what practices conform to the latest reliable evidence. This promotes a wider dissemination of knowledge. Increased knowledge and awareness by the public ensures that hospitals achieve greater throughputs because of the public's faith that the hospital is able to meet the wide range of quality standards.

Hospital management has often remarked during visits of the OPCV Survey Team that unless a hospital provided "the full options"- that is a complete range of the latest sophisticated medical technology; then it was not considered to be a good hospital. Scant attention is paid to whether the size and complexity of the hospital warrants a complete range of equipment, or indeed whether the hospital can provide the qualified staff necessary to operate such equipment safely. The image of what constitutes a good hospital is generally supported by the current Hospital Classification system and it this image that is required to be changed through the implementation of quality assurance/improvement to support the marketing of Lebanon's hospital services to other countries. A public education campaign is therefore a concomitant exercise to be carried out in parallel with the development of the quality approach.

Management

Internal audit

Finance and administration

NursingInformation Technology

Logistics FinanceHuman resources

Medical

Material and purchasing

Eng & maintenance

Biomedical Material management

PHARMACY

The hospitals are classified in A, B, C, and D categories. Hospitals classified as A and B are considered the most satisfactory hospitals and those who are classified C and D they are not satisfactory and need improvements to meet the hospital accreditation standards. Incase the hospital does not meet the standards (classified as C or D) then the ministry of health will decrease the budget given to it. An example of the results for the Lebanese hospitals done in 2005:

Committees

3- The RHUH contains many medical comities including infectious disease committee, pharmacy & therapeutics committee, nutrition committee, research committee and disaster committee. The hospitals pharmacy play role in most of these committees. For example, in the pharmacy and therapeutic committee the pharmacists study and evaluate all new drugs found in the market and they reevaluate the old drugs already exist in the hospital and compare them with other drugs following the cost-effectiveness concept. Also, in infectious disease committee they are responsible for antibiotic resistance, rules of antibiotic usage, and monitoring the restricted antibiotics in order to minimize nosocomial infections and antibiotic resistance problems. Besides it updates the research committee with the most resent news about drugs and drug discovery. Moreover, it supplies the nutrition committee with the drug-food interaction list to provide the patients with the best therapeutical outcomes and it provides them with the total peripheral nutrition guidelines. In addition it is a member in the disaster committee which id responsible for safety guidelines in case of emergency inside the hospital.

4- Incase of medical error such as drug interaction, and wrong dose; the error should be reported to the quality department in the pharmacy. The report should be field by the person who discovered the error and the error will be immediately corrected using all available methods such as internet or the pharmacy library (books, micromedics, VIDAL…), or they call the order of pharmacy of Lebanon and ask the dug information center. All reports are classified in the pharmacy department and every six months a conclusion report will be done to detect problems of most frequent errors and to detect if the same employee is doing the same error. Action will be taken after the conclusion report is done.

5- The inventory control is done every month in RHUH hospital pharmacy. They print out the inventory in a hard copy and then they check it on the shelves. Drugs in tablet or capsule dosage forms are counted per tablet while intravenous drugs are counted per ampoule. The inventory control involve all the drugs in the hospital, in the satellite pharmacy on the floors, the store in the surgery room, intensive care unite store, dialysis room and emergency room.

6- The RHUH depends on high technology systems to get the best quality. In fact all the hospital work is computerized including the hospital pharmacy. The compute software used in the pharmacy is DMS, their is no bare code system.

7- The special lock to computer system in special I.D. and password can detect all employees and trainees move in all the hospital including the pharmacy. Moreover the monthly inventory

control will detect any lost drug in the pharmacy and all the hospital parts mentioned above that contain drug store.

8- There is a special team involved in the drug information. This team will get his information from books, internet, scientific office, and some times they contact the drug information center which is related to the “Order of Pharmacist in Lebanon”.

9- The human resource department serves RHUH and its community by providing leadership in personnel policy management, compensation and employee development. It ensure uniform and consistent understanding and application of personnel policies and operating procedures, assign authority and responsibility for the administration of the personnel policies and operating procedures, provide evidence of compliance with the Lebanese Law that pertain to employment, provide a structure for continuous training to staff.The human resource department did not provide us with detailed describing recruiting and hiring the members of the hospital pharmacy due to restricted privacy policy rules followed in the pharmacy.

10- Some employees are paid monthly and others are paid hourly. Those who work hourly have a maximum of 44 hour per a week. The employees that are paid weekly benefit from the NSSF. The paper that they should fill out is attached at the end.

11- The employee law for full timers is offered fourteen days vacation in a year, forty days maternity, and they can take a sick leave when they are not able to work due to sickness. Their are no unpaid vacations. The human resource is responsible for firing employee; this decision is taken after giving the employee three warnings.

12- The RHUH Pharmacy Department is devoted to the concept of high quality, cost effective, timely delivery of drug therapy and achievement of optimal patient outcomes. It provides therapeutic drug monitoring, therapeutic interventions, pharmacokinetic consults, drug information and medication distribution to the patients served throughout the institution.The Pharmacy Department is committed to, meet international criteria of practice , seek continually performance improvement , be an integral part of the patient care team , contribute to an optimal therapeutic outcomes, foster an educational environment. The pharmacy department is responsible also for dispensing drugs to inpatients and insured outpatients, preparation of Cytotoxic drugs and IV Admixture, dissemination of information on drugs to doctors, nurses and other users, training of pharmacy students (Hospital Pharmacy and Clinical pharmacy programs), cooperating in education continuing program, preparation of TPN (Total Parenteral Nutrition). The main pharmacy is located in the basement 1(B1). It consists of 9 areas: dispensing area, purchasing office, storage and compounding area, chief pharmacist office, specialized area for cytotoxic drug preparation, pharmacists’ offices, bathroom, library, and students’ room. The chemotherapy preparation unit is located in basement 3(B3). Pharmacy is open from8:00 a.m. till 7:00 p.m. Monday till Friday and from 8:00 a.m. till 4:00 Saturday and Sunday. Chemotherapy preparations are accepted from 8:00a.m. till 3:30 p.m. from Monday till Friday. A pharmacist on call is available for after hour

The chief pharmacist is the head of the pharmacy. He/she is responsible for all actions done in the pharmacy including purchasing, dispensing, management, expiry date of the drug in the pharmacy, in the floor stoke, and chemotherapy. He/she has his own secretary; and his/her personal assistant will be available in the near future. The purchasing team, scientific team, drug information specialist, clinical pharmacist, accreditation team, acting supervisor, oncology team, secretary and the assistant to head of pharmacy department are directly related to the head of the pharmacy. The pharmacist and assistant pharmacist are linked to the acting supervisor. Also the oncology pharmacist and assistant oncology pharmacist are linked to the oncology team. The senior technicians and technicians are linked to the pharmacist and assistant pharmacist.

The role of the Chief pharmacist is to plan, organize, and supervise all activities of the pharmacy, follow up of all pharmacy related policies in the country and their impact on the hospital, implement pharmacy information system in corporation with MIS department, control

Head of pharmacyAssistant to head pharmacist

Scientific team DIS – clinical

pharmacist accreditation team

Acting supervisor oncology team Purchasing team

Secretary

Acting supervisor oncology team

Oncology pharmacist & assistant oncology

pharmacists

Pharmacists & assistant

pharmacists

Superior technicians

Technicians

pharmacy request, control delivery, control stocks and prepare purchasing request and contact agents, control periodical and annual inventory, control expiry dates, control through audits, usage of antibiotics mainly the restricted ones, disseminate of information to physicians, nurses and others, update hospital pharmacy, prepare of annual budget, assure specific antidotes and urgent drugs, responsible of training programs for hospital pharmacy students, meet medical Rep, agents, control good maintenance of equipments, buy and control usage of narcotics, psychotropic and reporting annual consumption to the MOH, control usage of drugs within budget, control invoices with receipts, and approve them, prepare bids for generics and expensive drugs in cooperation with purchasing department, fill any vacancy in case of shortage.Also he/she is secretary of PTC; and a member in disaster, nutrition and infectious disease committee.

The role of Oncology pharmacist is to fulfill all responsibilities of oncology division, inform the chief pharmacist about stock and problems related to the division, give help in the dispensing area in case of free time

The role of Pharmacist is to assist CP and being responsible in her absence, control pharmacy request, control delivery, control stock, reception, and storage, contact Dr in case of any problem related to drug usage, disseminate of information, control out patient dispensing, control stock in nursing office and emergency carriages, control labeling system, deliver controlled drugs and preparing monthly inventory, help in training of pharmacy students, fulfill any job in case of shortage.

The chief pharmacist, oncology pharmacist, and pharmacist are on call duty.

The role of the Technician is to prepare drugs for in patients, place drugs on the shelf, and fulfill any job in case of shortage.

The acting supervisor pharmacist will be selected by the chief pharmacist (head of the pharmacy department). He/she is illegible to perform all the duties (management and administrative work) of the chief pharmacist during specific circumstances where the chief pharmacist will not be available i.e. incase of sickness or vacation.Incase the assistant to head of pharmacy department is present he/she will be responsible of all managerial work in case of absence of the head of pharmacy.

The pharmacy members are being paid either monthly or per hour depending on the type of contract they signed because originally by law the pharmacy is allowed to recruit only 4 pharmacist in addition to the head pharmacist those are paid on a monthly basis and the rest are paid on an hourly basis. Pharmacist must fulfill a total of 44 hrs/ week. Pharmacists benefit from insurance from both the order of pharmacy and the NSFF, technicians benefit only from NSSF. For the pharmacists 80% is covered by the NSSF; insurance company covers the remaining 20 %.

Tasks performed at the hospital

1- The manual for the pharmacy contain the pharmacy policy and procedure, job description of employee, performance appraisal, purchasing, budgeting, prepare and dispensing of medication, chemotherapy policy and procedure (preparation of chemotherapy, waste of Cytotoxic waste, personal protective equipment –PPE- mask, gloves, gown…), quality improvement plane for the pharmacy department, adverse drug reactions, drug-drug interactions, drug food interactions, and clinical information sheet (antibiotics stability, special protocols dopamine, dobutamine). It describes each phase of activity in the pharmacy.

2- The drugs are delivered to the pharmacy in closed boxes. All intravenous drugs are stored in the pharmacy store, whereas the all oral syrups, suspensions, capsules, tablets, and caplets dosage form drugs are kept on special shelves and drawers in the pharmacy. Drugs that have to be kept away from light are kept in special closet in the drug store. Narcotics and sedative drugs are kept in controlled closet in the pharmacy, and the keys are kept with the pharmacist responsible for storing and delivering controlled drugs.

3- Narcotics and psychotic drugs are very dangerous drugs and they have a special way of delivery. Narcotic and psychotropic drugs are under restriction use. Those drugs must be dispensed for periods that do not exceed 7 days. The prescription is written and signed by the attending physician after he wrote it on the medication order form. The pharmacist and the nurse in charge are in collaboration responsible of the application of the system.

The controlled substances shall be stored in a locked safe in the pharmacy under responsibility of the chief pharmacist and distributed against written requests from the hospital pharmacist. The ordered controlled substances shall be recorded in the ward in a locked safe under the supervision of the nurse in charge. The hospital pharmacy shall order controlled substances through a written request. Controlled substances shall be transported in a secure manner by the nurse in charge. The pharmacist responsible for controlled substances shall receive, check, record and store the medicine. The nurse shall check the physician order of controlled substances for completeness before administration. The controlled substance shall be issued by the pharmacist to the nursing unit upon the nursing request after verifying the physician order for completeness. Pharmacist shall record monthly consumption of controlled substances after checking the nursing stock in the units. In case of accidental breakage of controlled substances, ampoule or unused opened ampoule, the accident should be reported and the report form shall be sent by the person involved to the pharmacy with the broken pieced of the ampoule. Chief pharmacist shall sign the controlled substances incident report form. The nurse shall record the amount of wastage of the drug in the controlled substances register book with self and witness signature; the pharmacist shall check the records. In case of wastage of controlled substance, the ampoule shall not be thrown by the nurse; the empty ampoule shall be retained by the nurse in the box provided to the pharmacy. All controlled drugs documents shall be stored by the pharmacy department. Any expired controlled substance in the nurse stations shall be sent by the responsible nurse with proper documents for proper disposal.

4- Expired date drugs are usually returned by the supplier up to five boxes and three boxes from the refrigerated drugs according to the pharmacy low. The supplied must be notified tree months before the expiry date.

5- Satellite pharmacy is a delocalized pharmacy on hospital floors that branches out of a central or main pharmacy. It is the nurse reservation present at each floor and contains drug which are mostly used in the floor and vital to patient life. Each floor has also an emergency crash card that is set by the CPR committee and it is the same in all the floors. Role of these medication is to help the nurse for rapid administration of the drug incase the pharmacy is closed or in emergency cases.

6- Medical representatives usually visit the pharmacy on specific days announced by the chief pharmacist (usually two days in the weeks). They update and refresh the pharmacist knowledge and tell them what is new in the market of medicine. They are responsible for developing and managing relationships with key decision-makers, and play an influential role interfacing with numerous internal and external key stakeholders. 7-Job interviews:We didn’t have any chance to observe a job interview or performance evaluation.

Job descriptions:8-The pharmacist will print out the medical orders and check for drug interaction, wrong doses, and correct medication prior dispensing. Charging drugs of each patient is also done by tthe pharmacists. Then the technician prepares the drugs which are controlled by the pharmacist in the final stage. All drugs are delivered in closed bags with a lable where the patient name and floor are written. The technician will deliver the drugs from the pharmacy to the nurses on the floors. The nurses will receive the drugs, open the closed containers, prepare IV drugs and put then in a special ----that contain many small drawers and will dispense the drug to the patients depending on room number, bed number and his name respectively

9- Hospital pharmacist will choose the drug that they want, the chief pharmacist will ask the purchasing team to sent a request to the material and purchase department to sign it; then the material and purchase department will sent it to the general director after the approval of the general director it will be faxed to all the suppliers that have these drugs. After the replay of the suppliers the pharmacist will choose the best one depending on the quality and price. The supplier will deliver the drugs to the receiving committee in the pharmacy.

1- Restricted drugsAll medication orders that may contain restricted antibiotics will be stopped after one day by the pharmacist if the infectious disease

specialist did not fill the special form for restricted antibiotics where he wrote the indication, suspected strain, and antibiogram susceptibility. Oncologist can prescribe restricted antibiotic approved in febrile neutropenia without ID consultation.

Brand name Generic nameTazocin 4.5g Piperacillin/ Tazobactam Prizma 4.5g Piperacillin/ Tazobactam Fortum 1g Ceftazidime Negacef 1g Ceftazidime Fortum 2g Ceftazidime Maxipime 1g Cefepime Azactam 1g Aztreonam Tienam 500mg Imipenam/cilastatin Tygacil 50mg Tigecyclin Amikin 100mg Amikacin Amikin 500mg Amikacin Pierami 500mg Amikacin Gentamicin Gentamicin Vancolon 0.5g Vancomycin Targocid 200mg Teicoplanin Targoplanin 200mg Teicoplanin Zyvox Linezolid Daptomycin Daptomycin Synercid Synercid Fungizone 50mg Amphotericin BDiflucan Fluconazole 200mgFlucand Fluconazole 200mgVFEND Voriconazole Cancidas Capsofungin Abelcet Lipid complex amphotericin BAmbisome Liposomal amphotericin BMycamin Mycafungin Zovirax 250mg Acyclovir Supraviran 250mg Acyclovir Cymeven 500mg Gancylovir

2-Drugs Protected from light

Brand name Generic nameCoversyl Perindopril Furosemide 40 Furosemide Rifadin 300mg Rifampin Propranolol Propranolol Apo pentoxyfylline Apo pentoxyfyllinePlendil 5mg Felodipine Plavix Clopidogrel Rabezol Rabeprazole Nifedicor 20mg Nifedipine Nimotop Nimodipine Micardis 40, 80 mg Telmisartan Lescol XL Fluvastatin Loratin Loratidine Glibomet Glibenclamide Corvasal Molsidonin Cortancyl Prednisone Calcium CalciumCrestor 10mg Rosuvastatin Cozar 50mg,100mg Lasartan Cardular Doxazocin mesylateDiovan Valsatan Eltroxin 100mg Thyroxin Azomycin 250mg Azythromycin Amoclan 1g Amoxicillin/clavunateAltiazem Diltiazem Fegenore Ge Fenofibrate Digixin Digoxin

3-Drugs that must be refrigerated:

Brand name Generic name

Actrapid HM InsulinAmbisone Liposomal amohoteriinColorcsi phnylehrine 10% PhenylephrineDexamethazone DexamithasoneEpotin 4000 IU Erythropoietin 000UEsmeron 50 m RocironiumFungisone 50 mg Amphotericin BGlucogen GlucogenHuman albumin 20% AlbuminInsulatard HM InsulinMixtard 30 InsulinNimbex CistracuriumNovomix 30 InsulinNovmi rapid InsulinOxytocin 10 nits OxytocinPavuln 4 mg Pancuronni bromidiumProstin 250 mcg Carboprost tromethanProstin 500 mcg VR AlprostadilSuxamethonium 2 g SxamethoniumTracrim 25 mg AtracuriumEngerix-B (junior) Hepatitis BEngerix B Hepatitis BHepatitis B immunoglobulin Ptitis B immunoglobulinResogamma P 5g for 100ml Immunoglobulin GTetavax telegram Tetanus immunoglobulinVenimmum R Immunoglobulin GCalcium folinate 30 mg Calcium folinate 30 mgMabthera Rituximab 100, 500 mgMiacalcic Salmocalcitonon 100 IUMinirin Desmopression 4 mcg/mlNeupogen Filgrastim 30 µ/EOne alpha Alphacalcidiol 2 mg/mlSandostatin Octreotid 0.1 mg/mlStreptase Streptokinase 250 000, 1000 000

VI

List of drugs that should be monitored

Brand names / Generic name Monitoring parametersLipitor /atorvastatin LFT sLasix/ furosemide K+,Na+,Ca²+Corticosteroid Don’t stop abruptly if>10 daysEuthyrox , Eltroxin/levothyroxin Thyroid testVancomycin, Gentamicin, Amikacin Cr

Depakene/ valproic acid Tegretol /carbamazepineEpanutin /phenytoin

Monitor levels

Digoxin Monitor levelsAlbumin Monitor levelsLovenox /enoxaparin Monitor plateletsAmbisome , fungisome/amphotericin B SrCr, k+, Mg+Lipantyl/ fenofibrate LFTNeupogen/ filgrastine ANC

Third party payers and reimbursement This hospital is a governmental hospital and most of the patients pay only ten percent from the RHUH price list. (Check page ) and the other ninety percent are paid by the ministry of public health of Lebanon. Also insurance and third party payer are allowed in this hospital. All drugs that are not taken by the patients are immediately returned to the pharmacy and canceled from the patient bills.

All drugs are covered by the hospital except this list of exclusions:Brand name Generic nameAcalasta inj 5 mg Zolidronic acidATG- fresenius inj 5ml Rabbit anti-lymph IgAvalox inj 400mg MoxifloxacinCaffeine inj 25%-1ml CaffeineColimycin inj 1 million UI Colistin methane sulphoneDesferal inj 500mg Desferoxamine Engerix B adult Engerix B adultFolic acid tab1MG Folic acidFolic acid tab 5mg Folic acid Mycamine inj 50mg Mycafungin Setron inj 4MG/2ml Ondansetron Tracutil (trace elements) TracutilValcyte tab 450Mg Valgancyclovir Vasopressin inj Vasopressin injVfend tab 200Mg Voriconazole Xylocaine jelly2% lidocaine Xylocaine jelly2% lidocaineZithromax inj 500MG Azithromycin

Automatic stop medication, drug restrictions

1- Policy:

1. Medications prescribed to in-patients are dispensed from the main pharmacy for a limited period of time: specified by the Pharmacy and Therapeutic Committee.

2. An automatic stop order will be applicable on these drugs after a predetermined time interval unless rewritten by the prescribers.

Oral medications(PO)……………………………………………………… ..14 daysIntravenous drugs………………………………………………………….....7daysHeparin ………………………………………………………………………..1 dayAntibiotics restricted…………………………………………………………..7 daysAzithromycin (zithromax)……………………………………………………..3 daysIntravenous quinolones………………………………………………………...3 days Intravenous proton pump inhibitors……………………………………………3 daysNSAIDS(standing order)…………………………………………………….5 daysControlled substances(PRN orders and standind orders)……………………1 dayAnticoagulant normal………………………………………………………...On daily basis for first week until INR is normalizedOxytoxics …………………………………………………………………….1 dayAlbumin ………………………………………………………………………2 daysAnalgesic and antiemetic(PRN disorders)…………………………………….1 day

* Therapeutic subcutaneous heparin is excluded from the policy and may be ordered up to seven day supply. Heparin infusions require evaluation of aPTT daily for continuance. * Albumin level should be checked daily before dispensing except in case of burns.

3- It is the responsibility of the nurse to notify the physician prior to the expiration of the medical orders.

4- It is the responsibility of the pharmacist to dispense only the quantities of drug needed daily to complete the physician s orders for these drugs within the above time frames.

2- Responsibilities:* Nursing department* Medical department* Main pharmacy

3- Procedure: * Orders should be entered to the system according to the duration set for each class of medications. However , all the pre-existing orders shall be canceled when the patient is transferred between nursing units. New orders shall be written by the medical team receiving the patient on the new Nursing unit after the evaluation of the patient s condition.

Note that, pharmacists review medical orders and perform patient monitoring on daily basis in order to intervene whenever there is a wrong dose, drug-drug or drug-disease interaction,

dose-adjustment according to the renal and hepatic function, side effect monitoring, monitoring serum levels… therefore, whenever pharmacists intervene, they fill the “pharmacist intervention from ”in order to keep a record of the intervention and to be able to follow it.