Hospital Pharmacy Overview

Introduction

• Hospitals and other facilities (e.g., drug dependency treatment, drug information centers, long-term care) can be government- or privately-operated.
• Key activities differ between hospital and community pharmacists.

The Hospital Pharmacist

• Has more interaction with prescribers to promote rational drug use.
• In larger pharmacies, pharmacists typically specialize and collaborate more with peers.
• Hospital pharmacists often have access to medical records.
• They can influence drug selection and dosages, monitor patient compliance, and report adverse events.

The Hospital Pharmacist (Continued)

• Can monitor drug usage patterns more readily compared to community pharmacists.
• This translates into improved recommendations for changes as needed.
• Members of key committees, e.g., drug selection, antibiotic use, and hospital infections (Drug and Therapeutics Committee).
• Influences preparation and composition of the essential drug list or formulary.

The Hospital Pharmacist (Continued)

• Better positioned to educate other health professionals about rational drug use.
• Easily participates in studies to assess beneficial or adverse drug effects.
• Controls hospital manufacturing and procurement to ensure high-quality products.
• Contributes to planning and implementation of clinical trials.

Outpatient Services

• Supply of precise drugs at the correct dose to the right patient.
• Clarification of drug information (drug, dose, polypharmacy, interactions).
• Substitution options.
• Patient counseling.

Outpatient Services (Continued)

• Maintain communication with patients and staff.
• Provide staff supervision.
• Implement appointment-based dispensing systems (SMART).
• Participate in national initiatives, e.g., Ubat Melalui Pos 1 Malaysia.

Inpatient Services

• Ward pharmacy/satellite pharmacy services.
• Discharge counseling concerning discharge prescriptions.
• Services like unit dose and unit of use systems.
• Monitoring of high-risk drug usage.

Manufacturing in Hospitals

• Hospitals are not built for manufacturing drugs.
• Adherence to Good Manufacturing Practices (GMP).
• Risk of contamination.
• "Extemporaneous" compounding (mixing drugs).
• Limited quantities manufactured.

Clinical Pharmacy Services

• Pharmacists do rounds with doctors (sometimes separately).
• Require strong knowledge of medicine and patient's condition.
• Proficiency in medication reviews.
• Identify drug-related illnesses across various patient populations (e.g., ICU, paediatrics, geriatrics, nephrology, surgical wards).

Total Parenteral Nutrition

• Serves patients unable to consume food.
• Prepares nutrient mixtures carefully.
• Patients often require intravenous solutions of fats, amino acids, sugars, electrolytes, and vitamins.
• Strict aseptic techniques required.
• Good understanding of the nutritional value of ingredients.

IV admixture and cytotoxic drug reconstitution

• Handles very toxic drugs.
• Provides protection for personnel administering drugs.
• Prevents contamination.
• Special facilities are necessary for these tasks.

Therapeutic Drug Monitoring Services

• Measures drug levels in the blood.
• Useful for narrow therapeutic index drugs.
• Requires specialized equipment, typically in the pharmacy or lab.
• Data analysis by pharmacists.

Blood Concentration

• Blood concentration measurements determine the Minimum Effective Concentration (MEC).
• Measures peak (Cmax) and trough (Cmin) concentrations.
• Demonstrates effectiveness of the drug.

Blood Concentrations

• Evaluating the concentration of two different drugs to understand optimal efficacy and safety parameters.
• Identifying Minimum Effective Concentrations (MEC) and Minimum Toxic Concentrations (MTC).
• Understanding pharmacokinetic patterns of the medications.

Drug Information Services

• Answers drug-related questions.
• Creates reports and drug bulletins.
• Develops hospital formularies.

Medication Therapy Adherence Clinic (MTAC)

• Improves medication adherence.
• Enhances positive treatment outcomes.
• Identifies patient-specific medication challenges.
• Aligns with pharmaceutical care principles.
• Addresses specific medication needs, e.g., diabetes, warfarin, asthma.

Hospital Administration

• Develops medicine budgets.
• Manages hospital purchasing of drugs.
• Supervises staff.
• Manages the hospital drugs & therapeutics committee.
• Handles patient and public complaints.