Hospital Pharmacy Operations

• Hospitals and other institutions like drug dependency treatment and long-term care facilities can be operated by the government or privately.
• Hospital pharmacists have different activities than community pharmacists.

Hospital or Institutional Pharmacist Role

• There is increased opportunity to closely interact with prescribers, to encourage the rational prescribing and use of drugs.
• The pharmacist has greater opportunity to interact with others, to specialize and gain expertise in larger hospitals.
• Pharmacists have access to medical records.
• A pharmacist can influence drug selection and dosage, monitor patient compliance and therapeutic response and report adverse drug reactions.
• They can more easily assess and monitor patterns of drug usage than community pharmacists, and recommend changes where necessary.
• As a member of policy-making committees, they are concerned with drug selection, the use of antibiotics, and hospital infections via the Drug and Therapeutics Committee.
• This influences the preparation and composition of an essential-drug list or formulary.
• Pharmacists are in a better position to educate other health professionals about the rational use of drugs.
• Pharmacists easily participate in studies to determine the beneficial or adverse effects of drugs.
• They control hospital manufacture and procurement of drugs to ensure the supply of high-quality products.
• Pharmacists take part in the planning and implementation of clinical trials.

Outpatient Services role

• Supplying the right drug at the right dose to the right patient.
• Important factors: Drug, Dose, Polypharmacy and Interaction
• Providing substitute drugs
• Patient counseling

Outpatient Services (Cont)

• Important to maintain Communication with patient & other staff
• Supervision of staff
• Sistem mendispens ubat secara temujanji (SMART)
• Ubat melalui pos 1 Malaysia (UMP1Malaysia)

Inpatient Services role

• Ward pharmacy/satellite pharmacy.
• Discharge counseling
• Unit dose
• Unit of use
• Monitoring of drug usage of dangerous drugs.

Manufacturing in hospitals

• Primarily not built for manufacturing.
• Requires Compliance with GMP.
• Consideration of Contamination is a factor.
• Often preparing "Extemporaneous" products - preparations on demand
• Limited quantities in preparation

Clinical Pharmacy Services

• Pharmacists will do "rounds" together with doctors or separately.
• Requires good knowledge of medicines and patient's condition is needed.
• Skill and confidence is needed.
• Medication reviews are performed.
• Important to Identify drug-related illnesses
• Services provided in ICU, paediatrics, geriatrics, nephrology, surgical wards

Total Parenteral Nutrition

• TPN is for patients who cannot eat.
• Requires careful preparation of mixtures.
• Indicated for Patients that are very ill
• Food is a good media for microbial growth
• Intravenous solutions include fats, amino acids, sugar, electrolytes, trace elements
• Special aseptic technique for preparation
• Requires good knowledge of calorific value of foods and miscibility

IV admixture and cytotoxic drug reconstitution (CDR)

• Process for very toxic drugs.
• Protects the person administering the drug.
• Prevents contamination of the mixture.
• It is a very useful service.
• Requires special facilities.

Therapeutic Drug Monitoring Services

• Determines the levels of drug in the blood.
• Useful for drugs with a narrow therapeutic index.
• Requires specialised equipment.
• Tests are done by pharmacy department or the pathology laboratory.
• An analysis of data is done by the pharmacist.
• Blood concentrations are used to demonstrate MEC (Minimum Effective Concentration).
• Identify the Cmax (maximum concentration)
• Identify the Cmin (minimum concetration

Drug Information Services

• Important to answer questions about drugs.
• Preparing reports and drug bulletins
• Preparing the hospital formulary

Medication Therapy Adherence Clinic (MTAC)

• Services to improve compliance.
• Work to get better outcomes
• Identify problems patients have with their medications.
• In line with the concept of pharmaceutical care.
• Focus on MTAC for diabetes, warfarin, asthma, etc.

Hospital Administration

• Preparing the budget for medicines
• Purchasing for the hospital
• Supervision of staff
• Involved in the Hospital drugs & therapeutics committee
• Dealing with complaints from management, the public, and the press.

Explore the various operational modes of hospitals and related facilities. Distinguish between hospital and community pharmacists and discuss governmental vs. private pharmacy approaches. Consider the impact of pharmaceutical technology.