University Hospital Pharmacy Department Structure

• After selecting and categorizing employees, creating a chart that shows the flow of authority is essential.

Departmental Organization Structure

• Associate Director, Pharmacist in Chief, and Assistant Pharmacist in Chief are all positions within the structure.
• Secretary Clerk and Pharmacy Residents also have positions.
• Outpatient Dispensing Supervisor, Manufacturing and Control Supervisor, and Inpatient Dispensing Supervisor and Messenger all have positions.

Departmental Organization in a Large University Hospital Pharmacy Operation

• Director of Pharmacy, Associate Director of Pharmacy, Assistant Director of Pharmacy, Administrative Services Division, Unit Dose Dispensing and Administration, and Education & Training Division are all positions within this structure.
• Research Pharmacist, Pharmaceutical Research Divisions, Pharmacist Specialist, Radiopharmaceutical Divisions, Drug Information Services, Assay & Quality Control Division, Drug Information Services, Central Supply Division, In-Patient Services Division, Out-Patient Services Division, Intravenous Admixture Division, Departmental Services, Purchase and Inventory Control, and Manufacturing and Packaging positions also exist.

Administrative Services Division

• Plans and coordinates departmental activities.
• Develops policies.
• Schedules personnel and provides supervision.
• Coordinates administrative needs of the Pharmacy and Therapeutics Committee.
• Supervises departmental office staff.

Education and Training Division

• Coordinates programs of undergraduate and graduate pharmacy students.
• Participates in hospital-wide educational programs involving staff such as nurses and doctors.
• Trains newly employed pharmacy department personnel.

Pharmaceutical Research Division

• Develops new drug formulations, especially for dosage forms that are not commercially available, and for research drugs.
• Improves existing product formulations.
• It works together with the medical research staff on projects involving drugs.

In-Patient Services Division

• Provides medications for all hospital in-patients on a 24-hour per day basis.
• Conducts drug inspections and maintains control over drugs across all treatment areas.
• Cooperates with medical drug research.

Out-Patient Services Division

• Compounds and dispenses out-patient prescriptions.
• Inspects and controls all clinic and emergency service medication stations.
• Maintains prescription records.
• Offers drug consultation services to staff and medical students.

Drug Information Services Division

• Provides drug and drug treatment information to doctors, nurses, medical and nursing students, and house staff.
• Maintains the drug information center.
• Prepares the hospital's pharmacy newsletter.
• Maintains literature files.

Departmental Services Division

• Controls and dispenses intravenous fluids and controlled substances.
• Coordinates and controls all drug delivery and distribution systems.

Purchasing and Inventory Control Division

• Maintains drug inventory control.
• Purchases all drugs.
• Receives, stores, and distributes drugs.
• Interviews medical service representatives.

Central Supply Services Division

• Develops and coordinates the distribution of medical supplies and irrigating fluids.

Assay and Quality Control Division

• Conducts analyses on products manufactured and purchased.
• Develops and revises assay procedures.
• Assists the research division in special formulations.

Manufacturing and Packaging Division

• Manufactures a wide variety of items commonly used in the hospital.
• Operates an overall drug packaging and prepackaging program.
• Undertakes programs in product development.
• Maintains a unit dose program.

Sterile Products Division

• Produces small volume parenterals.
• Manufactures sterile ophthalmologic products and irrigating solutions.
• Aseptically dilutes lyophilized and other unstable sterile injections for patient administration.

Radiopharmaceutical Services Division

• Centralizes the procurement, storage, and dispensing of radioisotopes for clinical practice.

Intravenous Admixture Division

• Centralizes the preparation of intravenous solution admixtures.
• Reviews each IV admixture for physicochemical incompatibilities.

Pharmacy and Therapeutics Committee

• An advisory group of the medical staff, it serves as the organizational line of communication between the medical staff and the pharmacy department.
• Physicians, pharmacists, and other health professionals who are selected with the guidance of the medical staff comprise the committee.
• A policy recommending body to the medical staff and the hospital's administration on issues relating to the therapeutic use of drugs.

Role/Purposes of the Pharmacy and Therapeutics Committee

• Acts in an advisory capacity and recommends the adoption of, or assistance in the formulation of, policies on evaluation, selection, and therapeutic use of drugs in hospitals.
• The committee advises on or helps in the creation of programs to address the needs of the professional staff, including physicians, nurses, and pharmacists, and other healthcare professionals in regards to current knowledge of drugs and drug use.

Organization and Operation of the Pharmacy and Therapeutics Committee

• The committee should consist of at least three physicians, a pharmacist, a nurse, and an administrator.
• Members are appointed by a governing unit or elected official of the medical staff.
• A chairman from among the physician representatives should be appointed, while a pharmacist is typically designated as the secretary.
• The committee is expected to convene on a regular schedule, meeting a minimum of six times annually, and more frequently as needed.
• The committee has the prerogative to invite individuals from within or outside the hospital to its meetings, in order to gain specialized insights, skills, and judgments.
• The secretary should prepare an agenda and additional materials, including minutes from the previous meeting.
• The committee's recommendations are to be presented to the medical staff or its relevant committee for adoption or recommendation.
• Liaison with other hospital committees that deal with drug use, such as infection control and medical audit, must be maintained.

Functions and Scope of the Pharmacy and Therapeutics Committee

• Service in an advisory capacity to the medical staff and hospital administration in all matters pertaining to the use of drugs, including investigational drugs.
• Develop a drug formulary that is accepted for use inside of the hospital.
• Establish programs and procedures that ensure cost-effective drug therapy.
• To establish and plan suitable educational programs for the hospital's professional staff on issues related to drug use

Functions and Scope of the Pharmacy and Therapeutics Committee (continued)

• Participate in quality-assurance activities related to the distribution, administration, and use of medications.
• Review occurrences of adverse drug reactions within the hospital setting.
• Initiate or review drug-use programs and studies, including the assessment of their outcomes.
• Advise the pharmacy on the implementation of effective drug distribution and control procedures.
• Make recommendations concerning which drugs should be stocked in hospital patient-care areas.

The Hospital Formulary

• Is a system through which the medical staff, working through the pharmacy and therapeutics committee, evaluates, assesses, and selects the most useful available drug entities and drug products for patient care.

Benefits of the Formulary System

• Therapeutic
• Economic
• Educational

Format and Appearance of the Formulary

• Should be visually pleasing, easily readable, and professional in appearance.
• There is no single format or arrangement which all formularies must follow.

Typical Formulary Composition

• Title page
• Names and titles of the members of the pharmacy and therapeutics committee
• Table of contents
• Information on hospital policies and procedures concerning drugs
  • The pharmacy and therapeutics committee of XYZ hospital
  • Objectives and operation of the formulary system
  • Hospital regulations and procedures for prescribing and dispensing drugs
  • Hospital pharmacy services and procedures
• Products accepted for use at XYZ hospital
  • Items added and deleted since the previous edition
  • Generic-brand name cross reference list
  • Pharmacological/therapeutic index with relative cost codes.
  • Descriptions of formulary drug products by pharmacology therapeutic class
• Appendix
  • Central service equipment and supply list
  • Rules for calculating pediatric doses
  • Nomogram for estimating body surface area
  • Schedule of standard drug administration times

Techniques that improve the appearance and ease of use of the formulary

• Utilizing different color paper for each section
• Including an edge index.
• Making the formulary a pocket size, around 4" x 7"
• Printing the generic name heading of each drug entry in boldface, or using other methods to make it stand out.

The Five Rights for Correct Drug Administration

• Medication administration guidelines to avoid medication errors.
  • Right Patient: Always verify the patient's name before dispensing medicines.
  • Right Drug: Always check the medication against the original prescription and the patient’s disease state.
  • Right Strength: Check the original prescription for this information and pay attention to the age of the patient so pediatric/elderly patients get the wrong does.
  • Right Route: Check that the physician’s order agrees with the drug’s specified route of administration, influencing drug absorption.
  • Right Time: Check the prescription to determine the appropriate time for medication administration, influenced by food intake and the need for a therapeutic blood level.