PHARMACEUTICS - VI

UNIT – I
ORGANIZATION & STRUCTURE
FLOW CHART FOR IN-PATIENT
 ROLES & RESPONSIBILITIES OF
HOSPITAL PHARMACIST
A. Towards In-patient/ Indoor patients.
B. Towards Outdoor patients.
 Towards In-patient/ Indoor patients
A. Central Dispensing Area
 To ensure that all drugs are stored and dispensed correctly.
 To check the accuracy of the dosages prepared.
 To keep proper records and preparation of bills.
 To co-ordinate the over all pharmaceutical needs of the of the “patient care”.
 To ensure that the established policies and procedures laid down are followed.
 To maintain professional competence.
 To communicate with all pharmacy staff regarding new developments in the area.
 Assists in evaluation of employees of his section.
 To train newer personnel in his section (about policies and procedures).
 To coordinate with the available staff to make best possible use of the personnel
resources.
B. Patient Care Areas (Wards, OT etc. where drugs of special categories are used)
 To maintain a liaison with nursing staff.
 Periodical reviewing of drug administration in each patient.
 To provide instruction and assistance to the junior pharmacists dealing with patients
need.
 To coordinate overall pharmaceutical services on the running unit.
C. Direct Patient Care Areas
 Identification of drugs brought into hospital by the patient.
 Obtaining patients medication history and communicating all the information to the
attending physicians.
 To assist in the selection of drugs products and their identities.
 Assist physicians in selecting dosage pattern and schedules and signs the timing for
the drug administration
 To monitor patients total drug therapy for:
 Effectiveness
 Side effects
 Toxicities
 Allergic drug reactions
 Drug interactions
 Counselling patients on:
 Medications which are to be self administered in the hospital.
 Use of medicines after discharge.
 Participating in cardio-pulmonary emergencies by:
 Procurement and preparation of drugs needed.
 Charting all medications given.
 Performing cardio-pulmonary resuscitation.
D. General Responsibilities
 To provide service in training and education for:
 Pharmacists
 Pharmacy Students
 Nurses and nursing students
 Physician and medical students
 Towards Outdoor patients
A. Central Dispensing Area: Pharmacists ensure that:
 Proper techniques are used in extemporous compounding.
 Provide adequate record keeping and billing in respect of
 Patient's medication particulars
 Records of investigational drugs
 Records of outpatients bills for change of service and material
 Maintaining and preparing reports for the above
 Correctly maintaining prescription files
 Maintain cleanliness of out door pharmacy
B. Patient Care Area
 Periodically inspect the medication areas on the nursing unit and maintain
adequate supply of drugs and other articles.
  To identify drugs brought into clinic by the patient and record the patient’s
medication history
 Monitoring of drugs.
 Counsel patient on proper use of medication.

C. General Responsibilities
 To coordinate overall pharmaceutical needs of the outdoor service area and
exercise adequate control.
 To ensure that all drugs are handled properly such as storage of
investigational drugs.
 Participating in cardio-pulmonary emergencies as stated earlier.
 To provide service in training and education for pharmacists (mostly diploma
students sent for training at hospitals).
 PHARMACY AND THERAPEUTIC
COMMITTEE (PTC)
• The pharmacy and therapeutic committee is a policy framing and
recommending body to the medical staff and the administration of
hospital on matters related to therapeutic use of drugs.

• This committee is composed of physicians, pharmacists and other

health professionals selected with the inclusion of medical staff
 Objectives
• The PTC has 3 major roles to play in a hospital:
1. Advisory
2. Educational
3. Drug safety and adverse drug monitoring
 Advisory

• The committee recommends the adoption of policies or assists in the

formulation of broad professional policies regarding evaluation,
selection and therapeutic use of drugs in the hospital.
• The committee serves in an advisory capacity to medical staff and
hospital administration in all matters pertaining to the use of drugs,
including the investigational drugs.
• It makes recommendations concerning the drugs to be stocked in
hospital patient care areas.
• The committee advises the pharmacy in implementation of effective
drug distribution and control procedures.
 Educational

• The committee recommends or assists in the formulation of functions,

designed to meet the needs of professional staff like the physicians,
nurses, pharmacist and other health care practitioners, for the complete
current knowledge of the matter related to the drugs and their use.
• The committee evaluates the problems related to the distribution and
administration of medications, including medication incident.
• The committee develops and compiles a formulary of drugs and
prescriptions of formulations accepted for use in the hospital.
• The committee should minimize duplication of the same basic drug, drug
safety, and cost.
• It establishes or plans suitable educational schemes for the hospital’s
professional staff on the matters related to the use of drugs.
 Drug safety and adverse drug monitoring

• This function is assigned to or taken up by the PTC and it should be

continuous scheme of exerting vigilance (Pharmacovigilnace).

• Pharmacists contribute to the drug safety by preventing, identifying,

documenting, and reporting of ADRs
 Composition of PTC
• Composition vary from hospital to hospital.
• Main members are:
1. At least three physicians from the medical staff
2. A pharmacist
3. A representative of the nursing staff.
4. An hospital administrator with his or her designated as an ex-officio
member of the committee [one of the physicians may be appointed as the
chairman of PTC]
The pharmacist functions usually as the Secretary and therefore, he is
designated as the Secretary of the committee.
 Agenda of meetings of PTC
• A typical agenda may consists of the following categories in general
1. Minutes of the previous meeting.
2. Review of the contents of the Hospital Formulary for purpose of bringing it up to date, and deleting of
products not considered necessary for use
3. Information regarding new drugs which may have become commercially available.
4. Review of investigational drugs currently under processing in the hospital.
5. Review of side effects, adverse drug reactions, toxic effects, drug interactions of drugs reported by
various units of the hospital and brought to notice of the committee by DIC.
6. Review of Drug Safety in the hospital.
7. Reports of various sub-committees.
8. Report of medical audit.
9. Any other matter with the permission of chair.
10. Vote of thanks
The minutes of all meeting hold should be prepared by the secretary and a permanent records of these
minutes should maintained in the hospital
 Importance of PTC
1. Role of PTC in drug safety: Drug safety includes responsibility from dispensing of drugs
to drug administration and then to observe possible adverse effects. PTC can play a
major role in ensuring the drug-safety.
 Following guidelines may subserve the committee in ascertaining the adequate safety
factor of the hospital pharmacy:
 The hospital must employ a qualified and registered Pharmacist (with B. Pharm) as
Chief Pharmacist. Rest of the pharmacist may be diploma holders.
 Not permit non-pharmacist personnel to dispense drugs and allied materials.
 The hospital must employ a sufficient numbers of qualified personnel (to assist in
sharing workloads of pharmacists).
 The hospital must provide adequate safe, work space, and storage facilities for
pharmacy.
 The Pharmacy must contain necessary equipment to carry out modern practice of
pharmacy.
 The hospital must have an “automatic stop order” regulation for dangerous drugs eg.
Narcotics, hypnotics, anticoagulants etc.
• The hospital must have firm policy regarding the use of research drugs in the hospital and
its clinics.
• The hospital should have a drug formulary which periodically revised and kept up to date.
• The hospital must not permit any person other than registered pharmacist into the
pharmacy beyond the working hours.
• In the pharmacy “Poisonous” and No-poisonous” substances should be adequately
separated.
• In the pharmacy “external use drugs/ preparations” and “internal use drugs /
preparations” should be adequately separated.
• The hospital should maintain quality control measures and GMP during processing and in
final products.
• The hospital should provide adequate facility to the chief pharmacist to carry out
teaching and training of nursing and resident staff.
• All nursing drug statistics should be periodically inspected (and outdated are removed).
• Pharmacy must have adequate reference library.
2. Role of PTC in Adverse Drug Reaction Monitoring Program

 An ADR is defined as any unusual of unexpected harmful reaction including

acute poisonings by narcotics, barbiturates, and amphetamines as well as
industrial poisonings.

 Role of PTC is :
 To gain understanding of the problem.
 To formulate competent opinions.
 Develop and institute procedures to identify ADR.
3. Automatic Stop Orders for Dangerous Drugs
• Example of Stop Order: “All drugs orders for narcotics, sedatives,
hypnotic, anticoagulants and antibiotics shall be automatically
discontinued after 48 hrs unless the order indicates an exact number
of doses to be administered or attending physician, re-orders the
medication”
• All orders for narcotics, sedative and hypnotics must be re-written
every 24 hrs.
• All PRN (Pro Ne Rata) and Standing order for all medications except
narcotics, sedatives and hypnotics shall expire at 10 AM (or an hour
determined by PTC in consultation with medical staffs)
4. Role of PTC in developing “Emergency Drug Lists”
• PTC arranges “Emergency Kits” at the bed side (prepared boxes
containing emergency medicine).
• List of such drugs/ supplied should be compiled by PTC.
• Responsibility of stocking of such drugs are assigned accordingly, units
to be prepared and places specified in the clinic, emergency ward and
special procedure room of the Radiology department.
• Once Emergency Boxes are placed in wards, a system of daily
checking has to be developed (by hospital pharmacists/ nursing staff).
Supplies to be maintained in Drugs for emergency box- These may
emergency box be selected in consultation with the
• Syringes of various range physician
• Atropine sulphate 0.4 mg/ml
• Needles
• Digoxin 0.25 mg/ml
• Files for breaking the ampoule
• Heparin 10.0 units/ml
• Airway equipment
• Neostigmine methyl sulphate 0.25
• Tourniquets mg/ml
• Ryle’s tube • Mannitol injection 25%
• Saline for injection 0.9% 30 ml
• Water for injection 20 ml
Supplies for cabinet utility room Other emergency supplies
• Oxygen catheters • Burn sheets
• Razor with blades • Oxygen equipment
• Resuscitation tube • Dextran and tubing
• Package sterile gelatin sponges • Resuscitation carts
5. Role of PTC in drug product
defect reporting program
• The drugs purchased by hospital
may be defective in quality.
• PTC must get information about
the defective drug products and to
inform it first to the manufacturer
for appropriate action.
• If satisfactory answer is not
obtained from the manufacturer ,
it should be reported to the Food
and Drug Control Administration
6. Role of PTC in Drug Utilization Review
• Drug utilization includes prescribing, dispensing, administering and
ingesting of prescription of drugs.
• Hospital pharmacist should take medication history that should include
following information:
• Medication being taken at the time of admission, during admission, home
remedies (OTC drugs).
• Drug allergies and idiosyncrasy towards food products etc.
• Patent medication profile to be maintained for each patient. This will serve
the following purposes:
• To help improved drug prescribing practices.
• To detect and help prevent drug-interactions.
• To help to detect and prevent ADR in sensitive patients.
• To prevent drug induced diseases.
• To detect possible drug induced diseases