Hospital Pharmacy

1. Hospital Pharmacy PayamParchamazad, PharmD Staff Pharmacist Capital Regional Medical Center Tallahassee, Fl

2. Ownership • Government Owned • VA Hospitals • Hospital affiliated with state universities • Non-Profit • Privately Owned • Responsible for own funding • May be for profit or non-profit

3. Care Provided • Acutely Ill • Chronically Ill with acute illness • Primary • Basic Care • Secondary • Involves a specialist • Tertiary • Requires specialized skill, technology or support services

4. Teaching Affiliation • Teaching Hospital • Shands • Teaching affiliated Hospitals • TMH • Non-Teaching Hospitals • CRMC

5. Pharmacy Organization • Functional Divisions • Administrative • Clinical • Distributive • Physical Locations • Centralized • Decentralized • Combination

6. Director of Pharmacy Assistant Directors Clinical Coordinator Medication Safety Officer Administrative

7. Director of Pharmacy • Responsible for the entire pharmacy department. • Responsible for • Policies & Procedures • Ensuring compliance with Joint Commission Standards. • Pharmacy Budget • Serves on various committees

8. Assistant Directors • May be over inpatient services or outpatient services. • Responsible for • Staff • Maintaining the appropriate pharmacy license for the establishment.

9. Clinical Coordinator • Supervises clinical pharmacists • Developing and maintaining clinical programs • Annual employee assessments • Participates in P&T

10. Medication Safety Officer • Oversees all aspects of medication safety. • Coordinates medication safety interventions. • Responsible for educating all health care professionals about medication safety. • Medication Safety Issues • Look-a-like • Sound-a-like • Illegible handwriting • Unapproved abbreviations

11. Clinical • Clinical pharmacists • Generally work in decentralized units • May round with physicians • Work with physicians, nurses, and other health care professionals to manage patient drug therapy. • May have to perform order entry.

12. Distributive • Deliver the medications to the patient care units. • Pharmacy technicians & Pharmacists • Medications may be delivered through a tube system or they may be sent in bulk to the patient care units.

13. Classification According to Location • Centralized • Staff Pharmacist • Pharmacy Technicians • Distribute medications from a central location • Decentralized • Clinical Pharmacist • Clinical Services • Order Entry • Pharmacy Technicians (sometimes) • Reside on nursing units or wards, may serve more than one unit. • Often times may be a combination of both.

14. List of medications approved by an expert panel of healthcare practitioners, predominantly physicians and pharmacists. • Each medication on the formulary is kept in-stock in the pharmacy. • The Formulary Book is a list of all the pharmaceuticals stocked in the pharmacy. • Continuously updated and revised • Physicians may order medications that are non-formulary if it is necessary. Formulary Systems

15. Evaluate pharmaceutical products and make the decision whether or not to include them on the formulary. • Products are evaluated based on efficacy, safety, ease of use and cost. • Provide educational materials and programs about drug products added to the formulary to all healthcare practitioners. Pharmacy & Therapeutics Committee

16. Develop and monitor quality issues in regard to correct drug use for the organization. • Monitor adverse drug reactions • Develop generic substitution policies and procedures. • Interact with quality assurance or medical utilization committees in the development of treatment guidelines for drug therapy. • Subcommittees may be formed to address specific issues. Pharmacy & Therapeutics Committee

17. Automated Medication Dispensing Devices

18. Drug storage devices or cabinets that electronically dispense medications in a controlled fashion. • Can be stocked by centralized or decentralized pharmacies. What are they???

19. Allow for medications to be obtained for inpatients at the point of use. • Free pharmacists from labor-intensive distributive functions and help pharmacists provide pharmaceutical care. • Improve the accuracy and timeliness of distributive functions. • Assist with inventory control. Advantages

20. Units are kept on the patient care units • Computer interfaces with pharmacy computers. • Physician orders are entered into the pharmacy computer. This information is then sent electronically to the Medstation where it is displayed on the patient profile. • Nurses are given personal passwords or Bio ID. • Nurse selects a medication and the drawer containing the medication opens. • Pharmacy technicians restock the units. Pyxis Medstation

21. Must have procedures for ensuring that all the staff members involved receive adequate education and training. • Should ensure that there are adequate resources for providing effective education and training on a continual basis are present. • Must evaluate staff to ensure competency in the use of automated machines. Education and Training

22. Refill errors • Medication shift from one drawer to another • Reduction of medication errors Potential for Harm??

23. Questions • Dr. PayamParchamazad • parchamp@gmail. com • Capital Regional Medical Center • 850 325 5070

24. THANK YOU FOR YOUR ATTENTION