Hospital Pharmacy Overview

Hospital Pharmacy

• A specialized field focusing on the safe and effective use of medications within a hospital setting.
• It includes divisions providing patient care, education, and research support.

Administrative Services

• Managing pharmacy operations.
• Developing policies, and ensuring compliance with regulations.
• Handling budgeting and resource allocation.

Education and Training

• Offering continuous professional development for pharmacy staff.
• Providing training programs for healthcare professionals.
• Managing student internships and residency programs.

Pharmaceutical Research

• Involvement in clinical trials and drug studies to advance medical knowledge.
• Development of new therapeutic protocols.
• Collaboration with research institutions for shared advancements.

In-patient Services

• Managing medications for hospitalized patients.
• Providing pharmacokinetic consultations and monitoring.
• Collaborating with medical teams to optimize therapy.

Out-patient Services

• Managing medication therapy for discharged patients.
• Counseling patients and educating them on medication use.
• Conducting follow-up services to ensure adherence and safety.

Drug Information Services

• Providing healthcare providers with accurate drug-related information.
• Answering questions about medications and therapies.
• Creating educational materials for staff and patients.

Patient Care Pharmacist

• Healthcare professionals optimizing medication therapy and improving patient outcomes.
• Plays a key role in medication management, counseling, and ensuring safe drug use for patients.

Medication History

• Collecting comprehensive medication histories from patients.
• Assessing current and past medication use, including prescriptions, over-the-counter drugs, and supplements.
• Identifying potential drug interactions and allergies.

Drug Selection

• Evaluating appropriateness of prescribed medications based on patient-specific factors like age, weight, and renal function.
• Recommending alternative therapies when necessary to optimize treatment.
• Staying informed on new medications and treatment guidelines.

Patient Counseling

• Educating patients about their medications.
• Includes indications, side effects, and proper administration.
• Addressing patient concerns and questions.
• Promoting adherence through motivational interviewing techniques.

Monitoring

• Monitoring patient responses to therapy.
• Includes efficacy and adverse effects.
• Adjusting medication regimens based on clinical outcomes and lab results.
• Collaborating with healthcare providers for coordinated care.

Patient Care

• Offering comprehensive services from diagnosis to recovery.
• Provides inpatient and outpatient care by specialists.

Wellness/Public Health

• Focusing on disease prevention and health promotion.
• Implementing community health initiatives to reduce illness.

Education

• Providing training programs for healthcare professionals.
• Educating patients to improve understanding of their conditions and treatments.

Research

• Conducting studies to advance medical knowledge.
• Improving hospital practices and patient outcomes through evidence-based findings

Types of Hospital

• Hospitals can be categorized based on type of service, ownership, length of patient stay, and bed capacity.
• Classifications help identify appropriate healthcare facility for specific needs.

Type of Service

• General hospitals provide a wide range of services.
• Specialty hospitals focus on specific areas like cardiology.
• Teaching hospitals are affiliated with medical education and research.
• Rehabilitation hospitals specialize in recovery services.

Ownership

• Public hospitals are funded and operated by government entities.
• Private hospitals are owned by individuals or corporations.
• Non-profit hospitals operate without profit motives, reinvesting earnings.

Length of Stay

• Short-term hospitals commonly treat patients for a few days.
• Long-term care hospitals cater to patients needing extended stays for chronic conditions.

Bed Capacity

• Small hospitals have fewer than 100 beds.
• Medium hospitals have between 100 to 500 beds.
• Large hospitals have more than 500 beds, often providing comprehensive services.

Hospital Functions

• Organized systems providing comprehensive healthcare services.
• Includes patient care, public health initiatives, education, and research.
• Essential for diagnosing, treating, and preventing diseases, while also advancing medical knowledge.

Levels of Prevention

• Strategies focused on reducing disease incidence and impact within a community.
• Encompasses approaches addressing root causes to managing existing conditions to improve public health.

Primordial Prevention

• Focuses on mitigating social, economic, and cultural factors that contribute to risk.
• Example: policies for smoking cessation.

Primary Prevention

• Aims to prevent disease in healthy individuals or populations.
• Examples include general promotion and specific protective measures.

Secondary Prevention

• Involves early detection and prompt treatment of diseases.
• Example: Screening tests.

Tertiary Prevention

• Focuses on limiting disability and promoting rehabilitation after disease onset.
• Example: Early physiotherapy.

Hospital Pharmacy

• Specialized area within healthcare focusing on medications for hospitalized and ambulatory patients.
• Plays role in drug therapy management, ensuring safe and effective medication use by qualified pharmacists.
• Practice in hospital setting and involves organizationally related facilities or services.

Functions

• Provides patient care from diagnosis to convalescence.
• Supporting wellness and public health initiatives.
• Offering education for patients and healthcare professionals.

Organization

• Features structured hierarchy: Board of Directors, Medical Director, CEO, and various department heads.
• Includes attending, consulting, honorary, associate, courtesy, and resident medical staff.

Drug Management Cycle

• Includes procurement, storage, compounding, manufacturing, packaging, controlling, dispensing, etc.
• Drug distribution systems: floor stock, individual prescription order system (IPOS), combined systems, and unit-dose delivery system (UDDS).
• Medication errors must be minimized, requires restocking strategies.

Medical Staff Types

• Categories of healthcare professionals within a hospital.
• Understanding roles and responsibilities is essential for effective hospital organization and patient care.

Attending Medical Staff

• Active medical staff providing direct patient care.

Consulting Medical Staff

• Specialists recognized for their professional ability, often board-certified.

Honorary Medical Staff

• Former members or retirees honored for outstanding contributions.

Resident Medical Staff

• Full-time employees undergoing training while providing patient services.

Courtesy Medical Staff

• Physicians not formally part of the staff who attend to private patients under conditions.

Ownership

• Governmental: national hospitals funded by the government.
• City/municipal hospitals supported by local governments.
• Non-Governmental: non-profit oriented or profit-oriented.

Functional Capacity

• Levels of Service: Basic clinical services to advanced services and training.

Supporting Services

• Nursing, dietary, medical records, social services, blood bank, radiology, and pharmacy are essential.

Types of Hospitals

• General Hospitals: provide a wide range of services (e.g., Philippine General Hospital).
• Specialized Hospitals: focus on specific diseases (e.g., Fabella Memorial Hospital, San Lazaro Hospital, Philippine Orthopedic Center).
• Long-term Care Hospitals: cater to extended stays (>30 days).
• Short-term Care Hospitals: general hospitals with stays less than 30 days.

Healthcare Facility Classification

• Various types of healthcare institutions based on services, focus, and patient care levels.

Primary Care

• Includes infirmaries, birthing homes, medical out-patient clinics, and dental clinics.

Custodial Care

• Encompasses psychiatric care facilities, rehabilitation centers, sanitariums/leprosariums, and nursing homes.

Diagnostic/Therapeutic Facilities

• Offer services focused on diagnosis and treatment of diseases.

Specialized Out-patient Facilities

• Includes dialysis clinics and ambulatory clinics.

Long-term Health Care Facilities

• Deliver comprehensive care for in-patients beyond typical hospital settings.

Resident Treatment Facilities

• Provide safe living arrangements for residents needing continuous care.

Health Maintenance Organizations (HMOs)

• Offer comprehensive health services on pre-payment basis.

Hospital Organization

• Has a Board of Directors, Medical Director, CEO, COO, CFO, and Department Heads who manage operations.

Types of Medical Staff

• Open, Closed, Attending, Consulting, Honorary, Associate, Courtesy, Resident

Supporting Services

• Includes nursing, dietary, central supply, medical record, medical social service, blood bank, pathology, radiology, and anesthesia.

Classification by Ownership

• Governmental (national, federal, municipal) and Non-governmental (non-profit, profit-oriented).

Levels of Prevention

• Primordial, Primary, Secondary, Tertiary.

Types of Hospital Services

• General, Special, Chronic & rehabilitation, and Psychiatric.

Length of Stay

• Short-term (<30 days) vs. Long-term (>30 days).

Medication Errors

• Preventable events leading to inappropriate medication use or patient harm.
• Can result in extended hospital stays or malpractice litigation.

Types

• Include unordered/unauthorized drug errors, extra dose errors, omission errors, and wrong administration errors.

Sources

• Deviations from prescriber's orders and communication failures among healthcare professionals.
• Inadequate knowledge or training of staff and poorly designed medication management systems.

Prevention

• Implementing Drug Utilization Review (DUR) processes to check interactions.
• Includes standardizing protocols for prescribing and enhancing communication.

Types of Errors

• Harm can range from none to death.

Error Classification

• Adverse Drug Event (ADE): any adverse event linked to drug use.
• Adverse Drug Reaction (ADR): noxious and unintended effects at normal doses.
• Side Effect: unintended effect related to pharmacological properties.

Impact on Patients

• Varies from no harm to serious outcomes like permanent disability or death.
• Clinical significance of drug interactions classified into categories.

Incorrect Prescription Types

• Erroneous: Brand name precedes generic name; generic is in parentheses.
• Violative: Brand name only.
• Impossible: Illegible brand and generic names.

Adverse Drug Reactions

• Adverse drug reactions (ADRs) are noxious and unintended effects that occur at normal therapeutic doses of a medication.

Definitions

• Adverse Drug Reaction (ADR): An adverse event associated with drug use.
• Side Effect: Unintended effect related to the pharmacological properties of a drug.
• Precipitant Drug: The drug causing the interaction.
• Object Drug: The drug affected by the interaction.

Types of Reactions

• Established: Supported by well-proven studies.

Common Drug Incompatibilities

• Additive Effects: Combination of drugs leading to enhanced effects.
• Synergistic Effects: Drugs working together for greater effect.
• Antagonistic Effects: One drug counteracting another.
• Potentiation: One drug enhancing the effect of another.

Pregnancy Categories

• Classifies safety of medications during pregnancy based on available research.
• Helps healthcare providers assess risks/benefits when prescribing to pregnant individuals.

Safety in Pregnancy

• Category A: Human studies indicate no risk.
• Category B: No evidence of risk in human studies.
• Category C: Animal studies show adverse effects.
• Category D: Evidence of human harm exists.
• Category X: Studies demonstrate significant risk.

Drug Classification

• Established Interaction: Supported by well-proven studies.
• Probable Interaction: Very likely with no data available.
• Suspected Interaction: Might occur; some data may be present.
• Possible Interaction: Could occur; limited data available.
• Unlikely Interaction: Doubtful; insufficient evidence of altered clinical effect.

Definitions

• Precipitant Drug: The drug causing an interaction.
• Object Drug: The drug affected by the interaction.

Drug Management Cycle

• Encompasses processes involved in selection, procurement, distribution, and utilization of medications.
• Ensures essential drugs are available, safe, and effective while managing costs and inventory efficiently.

Selection

• Essential Drugs: Meet healthcare needs and have proven safety/efficacy.
• Criteria: Relevant to prevalent diseases with a favorable cost-benefit ratio.
• Evidence-based Medicine (EBM): integrates expertise with best external evidence.
• Pharmacoepidemiology: Studies drug utilization and effects in populations.

Procurement

• Inventory Management: routine ordering processes.
• Types of Stock: Cycle stock and Safety stock

Distribution

• Drug Distribution Systems: methods for dispensing drugs to patients.
• Floor Stock/Bulk Ward System: medications at nursing stations.
• Individual Prescription Order System (IPOS): allows pharmacist review.

Utilization Review

• Monitoring and Restocking: ensures adequate supply through methods like ABC analysis.
• Ven System: categorizes drugs into vital, essential, and non-essential.
• Clinical Trials: evaluates drug safety and efficacy through various phases before approval.

Conversion Values

• Essential for translating measurements between different units.
• Facilitate understanding and communication in various fields.

Metric Conversions

• Common conversion value: 1 m = 39.37 inches

Household Measures

• Common: 1 tumblerful = 240 mL

Temperature Conversions

• Fahrenheit to Celsius: ( 5F = 9C + 160 )
• Celsius to Fahrenheit: ( 9C = 5F - 160 )
• Celsius to Kelvin: ( K = C + 273.15)

Pediatrics

• Branch of medicine for health and medical care of infants, children, and adolescents.
• Covers age definitions for younger populations.

Age Definitions

• Neonate: 0-30 days
• Infant: 1 month to 1 year
• Toddler: 1 to 3 years

Developmental Stages

• Primordial Prevention: Prevents the development of risk factors.
• Primary Prevention: Aims to prevent disease from occurring.
• Secondary Prevention: Emphasizes early disease detection.
• Tertiary Prevention: Targets symptomatic patients.

Clinical Trials

• Research studies to evaluate the safety and effectiveness of new medical interventions.

Randomized Controlled Trials (RCTs)

• Gold standard for clinical trials Participants randomly allocated to receive intervention or placebo.

Cohort Studies

• Also known as prospective studies.

Case Control Studies

• Also known as retrospective studies.

Cross Sectional Studies

• Also known as prevalence studies.

Phases of Clinical Trials

• Phase I: Safety and dosage.
• Phase II: Efficacy and side effects.
• Phase III: Comparison with standard treatments.
• Phase IV: Post-marketing surveillance.

Clinical Significance

• Classify drug interaction likelihood like established, probable, possible, etc

Pharmacoeconomic Methodologies

• Evaluate the economic aspects of pharmaceutical products and treatments.

Cost of Illness

• Measure direct and indirect costs of disease.

Cost-Benefit Analysis

• Identifies and measures all costs against benefits derived.

Cost-Minimization Analysis

• Compares alternatives with equivalent outcomes.

Cost-Effectiveness Analysis

• Compares costs with therapeutic outcomes.

Cost-Utility Analysis

• Evaluates consequences in terms of quality-adjusted life years (QALY)

Drug Interactions

• Occur when the effects of one drug are altered by the presence of another substance.

Types of Interactions

• Additive: Combined effect equals the sum of individual effects.
• Synergistic: Combined effect is greater than of individual effects.
• Antagonistic: One drug reduces or counteracts the effect of another.
• Potentiation: One drug enhances the effect of another.

Mechanisms of Interaction

• Pharmacodynamic Interactions: Changes in drug effects due to interaction at the site of action.
• Pharmacokinetic Interactions: Alterations in absorption, distribution, metabolism, or excretion of drugs.

Clinical Implications

• Established: Well-proven studies.
• Probable: Very likely.
• Possible: Could occur.
• Unlikely: Doubtful.

Key Terms

• Precipitant Drug: Drug causing the interaction
• Object Drug: Drug that interacted

Pharmacy Ethics

• Encompasses moral principles that guide pharmacy practice for patient are and ethical conduct

Autonomy

• Respect for patients as individuals, honor in medical care

Beneficence

• Is ethical responsibilites to act in patients best interest, but informed decisions are crucial

Nonmaleficence

• The obligation to to no harm and respect autonomys so they may choose to proceed

Confidentiality

• Honor patents right to privacy of data and alignment to patients preferences