Hospital Pharmacy Practice PDF

perform a specific scope of patient care services within that MODULE 1: Introduction to Hospital Pharmacy Practice setting....

perform a specific scope of patient care services within that MODULE 1: Introduction to Hospital Pharmacy Practice setting. A more common role for pharmacists actually beyond prescribing is their duty to influence the prescribing of Institutional Pharmacy Practice other health professionals. The provision of distributional and clinical pharmacy Pharmacists indirectly influence prescribing by acting as services at a broad range of institutional settings: hospitals, information resources about medications, providing long-term care, hospice, correctional facilities, etc. feedback about the quality of prescribing, and developing These institutions that pharmacists serve are formally or prescribing protocols through the formulary. informally linked together into integrated health systems. Transcribing At one time, institutional pharmacy practice referred almost It is the process by which a prescriber’s written order is exclusively to service in hospital pharmacies. copied and either manually or electronically entered into pharmacy records. Integrated Health Systems Pharmacists must understand potential breakdowns in the Integrate all care under the umbrella of a central transcribing process to help find ways to minimize errors. organization. Dispensing Often includes inpatient/acute care, primary/outpatient Act of physically transferring the drug product following care, long term care, and home care review and approval of the prescription to the area responsible for administering the medication to the patient. Health Systems Also an area where medication errors can occur, including Are a collection of organizations and institutions whose but not limited to wrong drug, wrong dose, or wrong mission is to positively impact health outcomes. dosage form errors. Although they are made up of independent entities, they Administration are systems because the entities are interdependent and Medication administration to the patient in hospitals is unified. typically managed by nurses. Last step before patients are given their medications and Pharmacy’s Roles in the Medication Use Process errors at this point cannot be corrected. Prescribing Nurses usually served as the final check in the Often viewed as something that only physicians are medication-use process authorized to do Pharmacists help improve safety of medication Privileging – a formalized process in hospitals by which an administration by clearly labeling medications, using oversight body of a healthcare organization or other barcoding systems and unit dose packaging, reducing the appropriate provider body, having reviewed an individual time and effort involved in accessing drugs, and using health care provider’s credentials and performance and technology that reduces administrations errors (e.g. smart found them satisfactory, authorizes that individual to pumps) Monitoring problems. Monitoring the patient’s response is a critical phase where Distributive Pharmacists spend most of their time in drug pharmacists play a vital role. distribution, reviewing orders and verifying the accuracy of This includes reviewing laboratory values that are correlated medication preparation by technicians. with the expected medication-therapy outcomes, as well as Since little or no collaboration occurs between the two, the other objective and subjective factors that indicate whether latter are selectively accountable for the medication-use the therapy is effective, or may be having a toxic effect. process. Patient-Centered Integrated Model Practice Models All pharmacists in the department accept responsibility for The operational structure that defines how and where all elements of the medication-use process and therefore pharmacists practice, including the type of drug spend their time on both clinical and distributive functions. distribution system used, the layout and design of the Many distribution tasks are delegated to well-trained departments, how pharmacists spend their time, practice pharmacy technicians, so the pharmacists’ roles in drug functions, and practice priorities distribution are often limited. It is probably the most important factor determining the Pharmacists are able to expand their clinical roles to more role and effectiveness of the pharmacy department. active engagement as part of an interdisciplinary team. It sets the stage and defines the roles. Pharmacists exhibit a high degree of ownership of and accountability for the entire medication-use process. Three Major Types of Pharmacy Practice Models Drug-Distribution-Centered Model Key Individuals Pharmacists primarily distribute drugs and process new Pharmacists – responsible for the preparation of medications, medication orders. either directly or through supervising the preparatory work of They have a reactive role where they respond to requests of pharmacy technicians. physicians and nurses but rarely initiates major changes in Dispensing Pharmacists – most traditional role; play an therapy important role in verifying that medications are prepared The pharmacist is not actively involved with the health care correctly and are dispensed accurately. teams or in the development of therapeutic plans for the Clinical Pharmacists – are likely to serve on patient. Therefore, they are not accountable for the health interdisciplinary patient-care teams, and interact directly outcomes of patients and exert little leadership in with patients. They usually have clinical pharmacy training influencing the medication-use process. and often have completed a pharmacy residency. Clinical-Pharmacist-Centered Model - Generalists – provide clinical pharmacy Clinical Pharmacists are chiefly involved in clinical services to a wide range of patients activities associated with medical teams. In this model, they - Specialists – have a defined expertise in accept little or no responsibility for the medication-use or one or more areas (critical care, oncology, delivery systems. Their primary responsibility is to assist etc.) physicians and other health professionals in avoiding and Integrated practice – the pharmacist has both dispensing and solving clinical clinical roles. This is the most prevalent role in institutional practice. Element of Care Pharmacists in management usually serve as the It is the pharmacists’ mission to help people make the best supervisor for pharmacy activities or as the director for the use of medications and so they are also concerned with the pharmacy department. outcome of pharmacy services. Other pharmacist roles are evolving. This includes those These elements are critical to safe, effective, and who are responsible for informatics, investigational drug cost-conscious medication use in a hospital. Although the services, research, sterile compounding, and emergency scope of pharmacy services may vary, these elements are care. linked to successful outcomes that failure to provide any of Pharmacy Technicians – integral in the purchasing, stocking, these services may compromise the quality of patient care. preparation, and compounding of medication which are all under 1. Practice Management the direct supervision of the pharmacist 2. Medication-Use Policy Development 3. Optimizing Medication Therapy Hospital Pharmacy Practice 4. Drug Product Procurement and Inventory Management Hospital pharmacy services are about providing 5. Preparing, Packaging, and Labeling Medication high-quality patient care by bringing expertise on 6. Medication Delivery medicines to the healthcare team. It is about ensuring safe 7. Monitoring Medication Use and effective use of medicines, and ensuring that resources 8. Evaluating the Effectiveness of the Medication-Use System are widely used – cost-effective use of medicines. 9. Research On top of a pharmacist’s basic responsibility, it includes talking to patients about their drug regimen, checking their DOH Hospital Pharmacy Management Manual understanding of how to use their medicines and involving General Principle: The pharmacy is an essential service of a hospital, them in the decision-making process regarding their responsible for the provision of pharmaceutical care to patients. Medicine. UHC: “provide every Filipino the highest quality of healthcare, It is vital that services are patient-focused, not efficient, equitably distributed. Fairly finances and appropriately pharmacocentric. used by an informed and empowered public. Client-friendly pharmacy in accordance with its ethical and professional practice. Minimum Standards of Practice Hospital Pharmacists + other Healthcare Providers = Better Health Outcome of all Patients ASHP Guidelines: Minimum Standard for Pharmacies in Ensure the quality pharmaceutical care is provided through Hospitals, 2012 application standards and methods of which the patients are Purpose: Intended to serve as a basic guide for the provision of the prime beneficiary. pharmacy services in hospitals by outlining minimum level services that most hospital pharmacy departments should consistently Goals provide. Optimal therapeutic and medication safety for all patients Application of new methods and techniques on pharmaceutical care in relation to patient safety.  Elevate pharmacy stature by enhancing its services through twenty-four hour use or longer by patients in the treatment the use of automation technology and capacity building of of diseases. the management and the workforce. All hospitals shall provide basic hospital functions such as, Practice but not limited to, acute medical and surgical services, Vital Role anesthesia services, emergency and outpatient services, - Provision of safe, effective and quality nursing service, dental service, with common diagnostic pharmaceutical products and support units such as pathology, radiology and - Pharmaceutical care pharmacy. - Drug information They should also have non-medical support such as, but - Patient medication counseling not limited to, administrative and finance section, medical - Health promotion records section, information management, dietary services, Sec. 4 of R.A. 10918 facility management and maintenance, waste The traditional role of pharmacist in drug product preparation and management and security services. dispensing broadened to patient care approach. Medical Center A hospital staffed and equipped to care for many patients Ideally, the hospital pharmacy shall have the following services: and for a large number of kinds of diseases and dysfunction Dispensing using modern technology. Clinical Pharmacy Drug Information Service Classification of Hospitals Compounding A. According to Ownership Training 1. Government – created by law. It may be under the national Research government, DOH, LGU, DND, PNP, DOJ, SUCs, and others. Administrative 2. Private – owned, established and operated with funds through donation, principal, investment or other means by any individual, corporation, association or organization. It may be a single proprietorship, partnership, corporation, cooperative, foundation, MODULE 2: Hospital and its Organization (DOH A.O. 2012-0012) religious, NGO, and others. B. According to Scope of Services Hospital 1. General – provides services of all kinds of illnesses, diseases, A place devoted primarily to the maintenance and injuries or deformities. It shall provide medical and surgical care to operation of health facilities for the diagnosis, treatment the sick and injured, maternity, newborn and child care. and care of individuals suffering from illness, disease, injury It shall be equipped with the service capabilities needed to support or deformity or in need of obstetrical or other surgical, medical specialists and other licensed physicians rendering services medical and nursing care. in, but not limited to, the following: It shall also be construed as an institution, building or place Clinical Services: Fam Med, Pedia, IM, ObGyne, Surgery where there are installed beds, cribs or bassinets for Emergency Services Outpatient Services  Ancillary and Support Services such as clinical laboratory, 7. A separate dental section/clinic; imaging facility, and pharmacy 8. Provision for blood station; 2. Specialty – specializes in a particular disease or condition or in 9. A DOH licensed secondary clinical laboratory with the one type of patient. It may be devoted to the treatment of any of services of a consulting pathologist; the following: 10. A DOH licensed level 1 imaging facility with the services of a Treatment of a particular type of illness or for a particular consulting radiologist; condition requiring a range of treatment. 11. A DOH licensed pharmacy. Treatment of patients suffering from diseases of a particular organ or group of organs. b) Level 2 Treatment of patients belonging to a particular group such A Level 2 hospital shall have as minimum, all of Level l capacity, as children, women, elderly and others. including, but not limited to, the following: C. According to Functional Capacity 1. An organized staff of qualified and. competent personnel General Hospital with Chief of Hospital/Medical Director and appropriate a) Level 1 board certified Clinical Department Heads; A Level I hospital shall have as minimum the services stipulated 2. Departmentalized and equipped with the service under Rule V. B. 1. b. 1. of this Order, including, but not capabilities needed to support board certified/eligible limited to, the following: medical specialists and other licensed physicians rendering 1. A staff of qualified medical, allied medical and services in the specialties of Medicine, Pediatrics, Obstetrics administrative personnel headed by a physician duly and Gynecology, Surgery; their subspecialties and ancillary licensed by PRC; services; 2. Bed space for its authorized bed capacity in accordance 3. Provision for general ICU for critically ill patients. with DOH Guidelines in the Planning and Design of 4. Provision for NICU (Neonatal Intensive Care Unit) Hospitals; 5. Provision for HRPU (High Risk Pregnancy Unit) 3. An operating room with standard equipment and provision 6. Provision for respiratory therapy services; for sterilization of equipment and supplies in accordance 7. A DOH licensed tertiary clinical laboratory; with: 8. A DOH licensed level 2 imaging facility with mobile x-ray a. DOH Reference Plan in the Planning and Design of an inside the institution and with capability for contrast Operating Room/Theater (Annex A); examinations. b. DOH Guidelines on Cleaning, Disinfection and Sterilization of Reusable Medical Devices in Hospital c) Level 3 Facilities in the Philippines (Annex B); A Level 3 hospital shall have as minimum, all of Level 2 capacity, 4. A post-operative recovery room; including, but not limited to, the following: 5. Maternity facilities, consisting of ward(s), room(s),a delivery 1. Teaching and/or training hospital with accredited residency room, exclusively for maternity patients and newborns; training program for physicians in the four (4) major 6. Isolation facilities with proper procedures for the care and specialties namely: Medicine, Pediatrics, Obstetrics and control of infectious and communicable diseases as well as Gynecology, and Surgery; for the prevention of cross infections; 2. Provision for physical medicine and rehabilitation unit;  3. Provision for ambulatory surgical clinic; 4. Provision for dialysis facility; 5. Provision for blood bank; 6. A DOH licensed tertiary clinical laboratory with standard equipment/reagents/supplies necessary for the performance of histopathology examinations; 7. A DOH licensed level 3 imaging facility with interventional radiology. Table 2. New Classification of General Hospitals Chief of Hospital – supports and approves all requirements necessary for the operation and managements Administrative Service – Administrative Officer – supervises the overall operations and regulatory compliance. Medical Service – Doctors; Clinical Departments – closely coordinate with the pharmacists through the PTC on the selection, rational drug use, and other drug and pharmacy related matters. Nursing Service – Nurses; Nursing units – participate in the regular pharmacy monitoring of medicines stored in the wards (proper storage, movement and utilization of medicines). Provide data on medication errors, adverse drug experiences and other drug-related concerns. Medical Social Service – help patients in acquiring financial aid. Each clinical department shall meet the membership Provide information on the financial capability of the patients and requirements of the concerned specialty/subspecialty availability of sources for the pharmaceutical requirements of the society recognized by the Philippine Medical Association. patients in the service wards. ➔ Department of Internal Medicine Medical Records – Hospital Health Information – collects and ➔ Department of Anesthesiology safekeeps patients’ medical records. Provide drug information and ➔ Department of Obstetrics and Gynecology database on Patient’s Medication Records whenever necessary. ➔ Department of Pediatrics Dietary – provide referrals (on request) for total parenteral nutrition and information on any drug-food interactions. Finance – analyze the financial reports submitted by the MODULE 3: Hospital Pharmacy Department pharmacists that are used as basis for the hospital pharmacy budget estimate. Property and Supply – facilitate the procurement of supplies and Organization materials needed. The Hospital Pharmacy is organized in accordance with the Laboratory – provide the pharmacists information on anti-microbial minimum requirements set by the FDA, and the One-Stop Shop resistance and susceptibility necessary for drug procurement and Licensure of the Health Facilities and Services Regulatory Bureau dispensing. (HFSRB), Philippine Drug Enforcement Agency (PDEA), and Other Hospital Units: Professional Regulation Commission (PRC). Dental Clinic Emergency Department One-Stop Shop (OSS) - a strategy employed by the DOH to Intensive Care Unit (ICU) – where patients requiring close harmonize the licensure of hospitals and other health facilities monitoring, continuous attention and including, but not limited to, their ancillary and support intensive/critical care are kept. services. NICU, PICU, SICU The Hospital Pharmacy has been structures in a way that it can Physical Medicine and Rehabilitation Unit – involves the manifest and specify administrative line of authority, functional diagnosis, evaluation, and management of persons with responsibilities, accountabilities, and designation of employees. physical and/or cognitive impairment and disability Respiratory Therapy Unit (Cardio-Pulmo Unit) – has the necessary Level 1: equipment needed for the provision of respiratory care. Pharmacist II Radiology Pharmacist I Administrative Aide IV Department Level 2: Administrative units in a hospital with a clearly articulated Pharmacist III mission that includes education, research and clinical Pharmacist I service in the field of medicine. Administrative Aide II Level 3: Pharmacist V  Pharmacist IV Pharmacist II Administrative Aide II Competency Standard No.1 For Government-owned and Controlled Corporation (Specialty - Provides quality medicines and other health products appropriate Hospitals): to the needs of the client/patient Pharmacist VI - head of the Ancillary Services Dept. Competency Standard No. 2 Pharmacy Support Personnel: - Compounds products in a manner that ensures product, quality, Pharmacy Aide safety, and efficacy Pharmacy Assistant Competency Standard No.3 Pharmacy Technician. - Counsels client/patient on the safe and judicious use of medicines and other health products Personnel Competency Standard No. 4 - Pharmacists must be licensed in accordance with PRC. - Engages actively in client/patient safety and health promotion - Support personnel must have basic educational qualifications and activities training. Competency Standard No. 5 - All personnel are provided with regular continuing education and - Ensures business sustainability through efficient processes and training to maintain proficiency, competence, and for compliance systems with licensing requirements. Qualifications Three Major Categories Chief Pharmacist 1. Management- Chief Pharmacist and/or Supervising Pharmacist/s Supervising Pharmacists Responsible for the procurement, distribution, and control Clinical Pharmacists of all drug products used within the hospital; in the Staff Pharmacists management of pharmacy personnel; and in the Pharmacy Assistant maintenance and proper implementation of established Administrative Assistant standards in the operations. 2. Professional/Technical Staff - Senior and Staff Pharmacists Procure, distribute, and control drug products; provide Job Description clinical pharmacy service; and supervise support staff 3. Support Staff Provide assistance to the pharmacist Chief Pharmacist - responsible for the overall operation of the hospital pharmacy. Supervising Pharmacist - assists the Chief Pharmacist in the Competencies management and administrative of the pharmacy. Dispensing Supervisor 2015 Philippine Practice Standards for Pharmacists PhilPSP) Clinical Supervisor Practice Area4: Dispensing Service Other regulatory bodies Considered as the main function of the Pharmacy Where technical abilities of the pharmacists are utilized. Requirements in Securing LTO Requires expertise in the pharmacology, pathophysiology, DOH A.O. No. 2018-0015 - Revised Guidelines in the therapeutics, patient care and basic communication skill. Implementation of the One-Stop-Shop Licensing System The knowledge in medicines and their actions is the fundamental FDA Circular 2014-025 contribution to health care by a dispensing pharmacist. A.O. No. 2021-0017 A.O. 2014-0034 Clinical Service Other pertinent existing rules and regulations This service includes: Drug product information - collection, organization, Pharmacy Location, Practices,& Premises retrieval, interpretation and evaluation of the applicable The pharmacy should be located within a suitable area of the literature in an appropriates fashion. hospital, which is accessible and visible to in and out patients, Collection of the pharmacy patient data base business offices, frontline services and to the general public. Patient education/counseling Drug Utilization Review (DUR) A work flow chart must be posted in a conspicuous area within the Adverse Drug Reaction (ADR) detection, reporting and vicinity. monitoring May not be directly associated with the dispensing of The pharmacy must be compliant to the following FDA and medicines, but has become part of the overall pharmacy international regulatory standards activity and requirements such as Also requires comprehensive knowledge on medicines, GMP diseases, patient and drug product variables, and the ability GDP to interact with other health care professionals. GSP GCP Clinical Pharmacist - direct interaction with patients, and work Cold-chain management collaboratively with health care team Staff Pharmacist - undertake all other pharmacy activities Other Requirements Pharmacy Assistant/ Administrative Assistant - assist to expedite Required by the FDA acquisition of administrative needs/ requirements and facilitate -Records/e-file (e.g. distribution records, Patient Medication Profile, provision of pharmaceutical services. Senior Citizen and Person with Disability records) Operational Requirements -Standard Operating Procedures of: Statutory and Regulatory requirements of the: Pharmacovigilance Health Facility Services and Regulatory Bureau (HFSRB) Procurement of stocks FDA Dispensing of pharmaceutical products PDEA Distribution of stocks to different stations/areas  of the hospital administration and to the Policy Planning and Advocacy Division (PPAD). Report shall also be Functions of the PTC submitted to the Food and Drug Administration (formerly Implements Hospitals Formulary System. the Bureau of Food and Drugs or BFAD) every 20th day of Standardizes prescribing policies and treatment guidelines January and December. (per DOH AO 107 s. 2000) Formulates broad professional policies regarding drug product evaluation, selection, purchase, use, and safe Factors to Consider in the Review & Evaluation of the Drug practices. Product List Recommends adoption of policies regarding the Updated list of drugs in the hospital formulary based in the evaluation, selection, deletion, and therapeutic use of drug current edition of the PNF products. Based on Clinical Practice Guidelines Serves as an advisory group to the medical staff, Availability of the drug in the market pharmacists, and hospital administrators in all matters Cost effectiveness of the drug pertaining to the use of drug products including those under investigation. Selection of Drug Products Develops and constantly updates the hospital formulary - Basic and extremely important function based on the latest edition of the PNF and on evaluated - Sound drug product selection is vital as it is the cornerstone of a and selected drug products to be used by the hospital. progressive pharmaceutical policy. Evaluates and approves/rejects proposals of the medical staff for inclusion or deletion of drug products in the Crucial Step because hospital formulary Drug selection process ensures access to rational drug use Requests authority to procure drug products not included Essential, affordable and cost effective drug products are in the current edition of the PNF highly prioritized Collects and reviews ADR/ADE reports for submission in Availability of safe, effective and quality drug products at all compliance to DOH AO No. 2011-0009 National Policy and time is ensured Program on Pharmacovigilance Promote systematic selection of drug products based in Monitors medication errors and adverse drug reactions that clinical practice guidelines may unpredictably incur to patients during drug therapy Organizes and recommends periodic training programs for Drug Product Selection Process capability building of physicians, nurses, pharmacists and Each clinical department prepares list of drug products other para-medical professionals in their respective field of based on their clinical practice guidelines. expertise List of drug products are submitted to the Pharmacy Develops and disseminates educational materials and Section. programs relative to drug products to all concerned At the pharmacy, submitted list of drug products are hospital staff. consolidated. Drug products included in the list are verified Reports committee composition every two (2) years and if: submits semi-annual accomplishments report to the chief  Extemporaneous compounding /Non-sterile compounding ensuring that affordable, safe, quality, and efficacious drug products Storage of stocks including temperature monitoring and retention are available for the patients. of monitoring records (per DOH Administrative Order No. 2013-0027) Role of Pharmacists in the Selection of Drug Products Cold chain management Aids the Pharmacy and Therapeutics Committee (PTC) in Handling complaints, product recall, and returned products ensuring optimal medication management Destruction/disposal of pharmaceutical products (expired, Coordinates with other health care providers with regard to damaged, unusable stocks) the selection of drug products to be included in the list. Disposal of used empty vials Ensures that all drug products listed in the PPMP are Sanitation program indicating the frequency of cleaning and the included in the latest Philippine National Formulary (PNF) methods to be used Usually designated as the secretary of the PTC, but may Programme projects/ programs (e.g. Donated products, Anti-TB, also act as Chair/Vice-Chair etc.) Documents and reports to all concerned hospitals Hospital Formulary committees adverse drug reactions, adverse events (e.g. Maximum Drug Retail Price/ Government Medicated access prices medication errors) concerning prescribed medications Temperature and relative humidity monitoring record Provide pharmaceutical expertise in the evaluation of drugs Certificate of calibration of equipment (e.g. Thermometer, for possible inclusion in the hospital formulary. thermohygrometer, etc.) Information, Education and communication materials (properly Pharmacy and Therapeutics Committee (PTC) displayed) - A special committee created to ensure the safe and effective use Risk Management Plan (per FDA Circular No. 2018-0013) of medications in the hospital. Relevant Reference Materials -A committee made up of representatives of the medical staff, Republic Acts administration, pharmacy, nursing, and other parties interested in WHO Good Dispensing Practice and Good Storage Practice Guide the medication use process with oversight for medication Philippine National Formulary, latest edition management. The pharmacist often serves as the secretary of the United States Pharmacopeia/ National Formulary (US-NF), latest committee. edition - It is created in accordance with the DOH A.O. No. 51 Standard Practice Guidelines Pharmacovigilance-related references MODULE 4: The Pharmacy and Therapeutics Committee and Hospital Formulary R.A. 11223 (Universal Health Care Act) - Pharmacists play an important role in the implementation and success of the UHC by  a. Included in Philippine National Formulary- Executive dosage forms those that are considered most useful in Order (EO) No. 49 series of 1993, directs the mandatory use patient care. of the Philippine National Drug Formulary (PNDF) Volume I as the basis for procurement of drug products by the The system provides the pharmacists time to work with: government. The PNDF, now called Philippine National Medical Staff- selection, evaluation of new drug products and Formulary (PNF), shall continuously serve as the national critical use of therapeutic agents, and in the promotion of rational reference for quality and rational selection of medicines drug therapy that are vital in achieving the best health outcomes. Nursing Staff- avoid practices and procedures which may lead to The Pharmacist further evaluates, reviews and medication errors reconciles the consolidated list, based on the Both medical and nursing staff- implementation of policies historical consumption of each drug product. concerning the use of drug products in the hospital. The Pharmacist shall present the reconciled list (including the allotted budget, mode of Objectives procurement and schedule/milestone of activities) - It serves to educate physicians on the relative merits of of drugs and medicines to the PTC for deliberation available medicines to provide rational therapeutics and and recommendation. promote quality patient care. The recommended list shall be forwarded to the - It serves as a teaching aid to the interns and other medical Chief of Medical Professional Staff for review and staff by providing essential information, approval. - It prevents unnecessary duplication, wastage and confusion Once approved, the list shall become the final on prescribed medications, thus promoting savings to both Project Procurement Management Plan (PPMP) for the hospital and patient. the following calendar year. - It promotes safe, intelligent, and effective therapy in a The Final PPMP shall then be included in the hospital. Annual Procurement Plan of the hospital for the following calendar year - Cornerstone of drug management in the hospital, and is the principal concern of the PTC. - A continually revised compilation of pharmaceuticals, which reflects the current clinical judgement of the medical staff and the Hospital Formulary relevant policies on medication. - It is tailored to fit the needs of the hospital and reflects Hospital Formulary System departmental consensus on the first choice treatment from the - Process in which the list of drug products of formulary of national list. the hospital is developed. - It should be handy, complete, concise and easy to use. - It is the method where the medical staff of a hospital working with the PTC evaluates, appraises, and selects from Contents of a Hospital Formulary among the numerous available medicinal agents and - Entries may be arranged: Alphabetically, by generic name  Alphabetically, within therapeutic class Therapeutic equivalents A combination of the two systems where most are listed Drug products with different chemical structure but are of the alphabetically in a general section which is then same pharmacologic and/or therapeutic class and are expected to supplemented by several special sections. have similar therapeutic effects and adverse effects. Drug listing indices- by generic name or therapeutic/pharmacologic index Therapeutics interchange Appendices Authorized exchange of therapeutic alternatives in Pharmacologic/ Therapeutic Index accordance with previously established and approved written guidelines. -Special information which are not readily available in other sources Establishment of therapeutic equivalents extends beyond List of hospital-approved abbreviations the chemical entity. It must include the dosage strength, Table of sodium content of antacids dose frequency, and route of administration for the List of the contents of the E-cart interchange. Dosage guides for patients with impaired renal function Metric conversion scales and tables Therapeutic Interchange Equivalence by Therapeutic Class H2 Examples of request for deletion/inclusion and prescription blockers forms Provisions of the Generics Act Table of drug interactions Poison antidote charts Formularies can be categorized by their access to medications: Open Formulary - Generally large and has no limitation to access to a medication Closed Formulary -limited list of medications; it may limit drugs to specific physicians, patient care areas, or disease states via formulary restrictions. New Product Evaluation - Pharmacists have the opportunity to assume a leadership Formulary Restriction role in the selection of agents to the formulary. The The act of limiting the use of specific formulary medications to evaluation of an agent should consider the indications for specific physicians based on areas of expertise, patient disease use, pharmacokinetics, safety, and cost. state, or hospital location. - Development of a standard format for new drug It does not necessarily translate to optimal medication evaluations is useful in facilitating PTC discussions. management. Therefore, the key is to carefully consider the Standard elements include: potential impact of formulary restrictions prior to implementation Generic Name and to monitor the actual impact after implementation. Trade Name Therapeutic or Pharmacological Class  Pharmacology - The formulary restriction policy should specifically define Pharmacokinetics how items are selected for formulary restriction, rationale Indications for Use for selecting approved prescribers, and a method for Clinical Studies managing the process. Adverse Effects/ Warnings Drug - A formulary policy should describe the method for drug Interactions addition and deletion as well as nonformulary drug use. Dosage Range PTC Dosage Form and Cost -The Policy should address the committee membership, Summary operation, and responsibilities. Recommendation Medication Prescribing, Dispensing, and Administration References - Organizational policies on the prescribing, dispensing, and administration of pharmaceuticals are required and Outcome Assessment necessary to ensure safe medication use. Such policies Drug Use Evaluation (DUE) - A systematic process used to should address all aspects of the medication use process. assess the appropriateness of drug therapy by engaging in the evaluation of data on drug use in a given health care The published formulary should provide information on the environment against predetermined criteria and standards. medications approved for use, basic therapeutic information about Medication Use Evaluation (MUE) -Encompasses the goals each item, information on medication use policies and procedures, and objectives of the DUE, with an emphasis on improving and special information about medications such as dosing patient outcomes. guidelines among others. DUE Criteria Diagnosis-related DUE criteria- identify indications for MODULE 5: Pharmacy Management and Control which select drug/s may be appropriate for a given disease state. Prescriber-related DUE criteria- identify the specific Hospitals are extremely complex organizations that depend physicians whom the PTC has determined may use certain on experienced, well-trained managers and clinicians with drugs. good management skills for the development and delivery Drug-specific DUE criteria- focus - Focus on specific aspects of high-quality, efficient and patient-centered services. of a select drug such as the dose or dosing frequency. Leadership and management are two distinct but related activities. They are often confused because they both seek Medication Use Policies to bring about change in organizations by influencing Formulary Management behavior. - Formulary policies should include information on who may The distinction between the two may be irrelevant but it use a special agent, how a drug is added or deleted from can highlight different strategies employed in influencing the formulary, how a drug is stocked, and which drugs are individuals. Organizations need individuals who are both stocked and who gets to decide, good leaders and managers. What is Leadership? leadership and team work. The chief pharmacist does not only - It is the process through which an individual attempts to required to lead the pharmacy service but also to act as an intentionally influence another individual or group in order advocate for and representative of the service within the to achieve a goal. organization as whole - It is more concerned with findings direction and purpose in the pace of critical challenges. What is Management? Financial Management It is about organizing to achieve desired purposes efficiently, effectively and creatively. Scope of Managing Finances A.O No. 2018-0014- Strategic Framework and Implementing Guidelines for FOURmula One Plus for Health (F1Plus) FOURmula OnePlan (F1)- financing reforms for healthcare institutions created by DOH to be able to secure better and sustained investment in health. - Involves strategic action plans that seek to provide equity and improve health outcomes. Chief Pharmacist Strategic financial planning in the areas of the product Leaders focus on getting people to commit to a common goal, procurement,storage,retrieval,preparation,drug distribution and while Managers concentration on getting people to take action prescriptions toward that goal. Budget Preparation,monitoring and explanation of variances A good manager will require leadership skills, but leadership must Human resource analysis through performance indicators be displayed by staff at all levels if they are to navigate local Application of basic accounting principles for the preparation of circumstances and deliver the best care possible for patients. reports/understanding financial statements. Pharmacy manager make a critical contribution to patient care by applying a wide variety of skills, expertise and experience to the Source of Funds delivery and development of clinical and support services that are - General appropriation Act. compatible with the overall aims of the hospital. - Revolving fund for medicines Chief Pharmacist – where overall managerial responsibility for the - Trust fund pharmacy service will rest, who, in turn, is accountable to a senior - Petty cash fund manager (executive director) and to the board of directors for all - Cash advance aspects of medicine development. Pricing - Maximum retail price on Drugs and Medicine (MRP/MDRP) Effective manager of pharmacy services demands high levels of