New Applications of Hospital Pharmacy

Ass.Prof.Dr.H.Cem Özyurt Fall. 2018 EMU

Phar 473

Outline of Phar 473 : Defination Mission and functions Organization Staff Dispensing and quotation Manufacturing IV additives Radiopharmacy Consulting Training Warehouse management Surgical materials and medicinal supplies Pharmacoviligance International rules of WHO

Post graduation bussines areas : -Pharmacy (pharmacist or co-pharmacist ) -Goverment -Ministry of Health -Official Association (FDA,EMEA,TİTCK) -Social Security Service (Office work)

- Hospital - - Hospital pharmacist - - Oncology Pharmacist - - Clinical Pharmacist

Oncology pharmacy specialist –Oncology Pharmacist A licensed pharmacist with special training in how to design, give, monitor, and change chemotherapy for cancer patients. Also called BCOP and board certified oncology pharmacy specialist. Oncology pharmacists play an important role in the delivery of care for individuals living with cancer. As an integral part of the cancer care team, oncology pharmacists represent a broad range of expertise and levels of practice, skills, and responsibilities.

Clinical pharmacists Clinical Pharmacist work directly with physicians, other health professionals, and patients to ensure that the medications prescribed for patients contribute to the best possible health outcomes. Clinical pharmacists practice in health care settings where they have frequent and regular interactions with physicians and other health professionals, contributing to better coordination of care.

Industry -R&D -QQ -QA -Production -Regulatory Affair - Sales & Marketing -Product Manager -Training -Salesman -Production Planning - Pharmacovilligance

Hospital pharmacy and pharmacist video

Definitions: HOSPITAL: Hospital is an institution for the care, cure and treatment of the sick and wounded, for the study of the diseases, and for the training of the doctors and nurses. Definition according to WHO: The hospital is a complex organization utilizing combination of intricate, specialized scientific equipment, and functioning through a corps of trained people educated to the problem of modern medical science.

Hospital type: 1. Government or Public Hospital: These are run by Central or State Governments. These are funded by the government. They can be general or specialized hospitals.

2. Non–Government Hospitals (private): They are supported by client’s fees, donations, or endowments (relating to funds or property donated to institutions or individuals). Non-government hospitals are further classified as either proprietary or non–profit organization (social aid : red cross , Red Crescent ...etc ).

Hospital pharmacy : The department or service in a hospital which is under the direction of a professionally competent, legally qualified pharmacist, and from which all medications are supplied to the nursing units and other services, where special prescriptions are filled for patients in the hospital, where prescriptions are filled for ambulatory patients and out-patients, where pharmaceuticals are manufactured in bulk, where narcotic and other prescribed drugs are dispensed, where injectable preparations should be prepared and sterilized, and where professional supplies are often stocked and dispensed.

Definitions:

The missions of the hospital pharmacist (1)

It is the profession that strives to continuously maintain and improve the medication management and pharmaceutical care of patients to the highest standards in a hospital setting. To be part of the medication management in hospitals, which encompasses the entire way in which medicines are selected, procured, delivered, prescribed, administered and reviewed to optimize the contribution that medicines make to producing informed and desired outcomes

To enhance the safety and quality of all medicine related processes affecting patients of the hospital To ensure the 7 “rights” are respected: right patient, right dose, right route, right time, right drug with the right information and documentation.

The missions of the hospital pharmacist(2)

• To ensure the availability of right medication, at right time, in the right dose at the minimum possible cost.

• To professionalize the functioning of pharmaceutical services in a hospital.

• To act as a counseling department for medical staff, nurses and for patient.

• To act as a data bank on drug utilization. • To participate in research projects.

Objectives of Hospital Pharmacy

• To implement decisions of the pharmacy and therapeutics committee.

• To co-ordinate and co-operate with other departments of a hospital.

• To plan, organize and implement pharmacy policy procedures in keeping with established policies of the hospitals.

Objectives of Hospital Pharmacy (Continue)

• Provide specifications for the purchase of drugs, chemicals, biological etc.

• Proper storing of drugs. • Manufacturing and distribution of

medicaments such as transfusion fluids, parenteral products, tablets, capsules, ointments, and stock mixtures.

• Dispensing and sterilizing parenteral preparations which are manufactured in hospital.

• Dispensing of drugs as per the prescriptions of the medical staff of the hospital.

Functions of Hospital Pharmacy

• Filling and labelling of all drug containers from which medicines are to be administered.

• Management of stores which includes purchase of drugs, proper storage conditions, and maintenance of records.

• Establishment and maintenance of “Drug Information Centre”.

• Providing co-operation in teaching and research programmes.

• Discarding the expired drugs and containers worn and missing labels.

Functions of Hospital Pharmacy (Continue)

Organization of hospital pharmacy Head of pharmacy services

(M.Pharm)

Dispensing Dept (D.Pharm)

Werehouse Pharmacist (B.Pharm)

Quality Control

Pharmacist (M.Pharm

Medical Stores Pharmacist (B or D Pharm

Manufacturing Dept.

(M.Pharm)

Manufacturing of steril fluids

(B.Pharm/M.Pharm

Other Manufacturing

Services (B.Pharm)

inpatient

outpateint

Ideally Organization of Hospital Pharmacy • DIRECTOR OF PHARMACY • ASSOCIATE DIRECTOR OF PHARMACY • ASSISTANT DIRECTOR OF PHARMACY: Dealing with

1. ASSAY & QUALITY CONTROL DIVISION 2. DRUG INFORMATION SERVICES 3. CENTRAL SUPPLY DIVISION 4. IN-PATIENT SERVICES DIVISION 5. OUT-PATIENT SERVICES DIVISION 6. INTRAVENOUS ADMIXTURE DIVISION 7. PURCHASE AND INVENTORY CONTROL 8. MANUFACTURING AND PACKAGING 9. RESEARCH PHARMACIST: Dealing with PHARMMCEUTICAL RESEARCH

DIVISIONS 10. PHARMACIST SPECIALIST: Dealing with RADIOPHARMACEUTICAL

DIVISIONS Above all are commonly dealing with; ADMINISTRATIVE SERVICES DIVISION UNIT DOSE DISPENSING AND ADMINSTRATION EDUCATION & TRANING DIVISION

Duties & Responsibilities of Hospital Pharmacy

1.To provide the benefits of a qualified hospital pharmacist to patients and health care institutions, to the allied health professions (dental hygienists, diagnostic medical sonographers, dietitians, medical technologists, radiographers, respiratory therapists etc), and to the profession of pharmacy. 2. To assist in providing an adequate supply of such qualified hospital pharmacists.

3. To assure a high quality of professional practice through the establishment and maintenance of standards of professional ethics, education. 4. To promote research in hospital pharmacy practices and in the pharmaceutical sciences in general. 5. To disseminate (To spread) pharmaceutical knowledge by providing for interchange of information among hospital pharmacists and with members of allied specialties and professions.

Duties & Responsibilities of Hospital Pharmacy (Continue)

DEPARTMENT/DIVISION WISE DUTIES OF HOSPITAL PHARMACIST

Administrative Services Division 1. Plan and coordinate departmental activities. 2. Develop policies regarding health professionals. 3. Schedule personnel and provide supervision. 4. Coordinate administrative needs of the Pharmacy and Therapeutics Committee. 5. Supervise departmental office staff. Education and Training Division 1. Coordinate programs of undergraduate and graduate pharmacy students. 2. Participate in hospital-wide educational programs involving nurses, doctors etc. 3. Train newly employed pharmacy department personnel.

Pharmaceutical Research Division 1. Develop new formulations of drugs, especially dosage forms not commercially available, and of research drugs. 2. Improve formulations of existing products. 3. Cooperate with the medical research staff of projects involving drugs. In-Patient Services Division 1. Provide medications for all in-patients of the hospital on a 24-hour per day basis. 2. Inspection and control of drugs on all treatment areas. 3. Cooperate with medical drug research. 4. Maintain prescription records.

Out-Patient Services Division 1. Compound and dispense out-patient prescriptions. 2. Inspect and control all clinical and emergency services 3. Maintain prescription records. 4. Provide drug consultation services to staff and medical students. Drug Information Services Division 1. Provide drug information on drugs and drug therapy to doctors, nurses, medical and nursing students. 2. Maintain the drug information center. 3. Maintain literature files.

Departmental Services Division 1. Control and dispense intravenous fluids. 2. Control and dispense controlled substances. 3. Coordinate and control all drug delivery and distribution systems. Purchasing and Inventory Control Division 1. Maintain drug inventory control. 2. Purchase all drugs. 3. Receive, store and distribute drugs. 4. Interview medical service representatives.

Central Supply Services Division Develop and coordinate distribution of medical supplies and irrigating fluids. Assay and Quality Control Division 1. Perform analyses on products manufactured and purchased. 2. Develop and revise assay procedures. 3. Assist research division in special formulations.

Manufacturing and Packaging Division 1. Manufacture wide variety of items in common use at the hospital. 2. Operate an overall drug packaging and prepackaging program. 3. Undertake program in product development. 4. Maintain a unit dose program. Sterile Products Division 1. Produce small volume parenterals. 2. Manufacture sterile ophthalmologic, irrigating solutions etc. 3. Prepare aseptic dilution of lyophilize and other "unstable" sterile injections for administration to patients.

Radiopharmaceutical Services division 1. Centralize the procurement, storage and dispensing of

radioisotopes used in clinical practice Intravenous Admixture Division 1. Centralize the preparation of intravenous solution

admixture. 2. Review each I.V. admixture for physio-chemical and

therapeutic incompatibilities.

ASEPTIC AREA WAREHOUSE

Typical layout of hospital pharmacy

FACILITIES REQUIRED IN SMALL HOSPITAL

In smaller hospitals, with one pharmacist only, one room is required for pharmacy, having a combination of dispensing, manufacturing, administrative and all other sections of complete pharmaceutical service.

For sterile products there should be a separate room or area.

A separate area is required for :-

Inpatient services and unit dose dispensing

Outpatient service

An office for the chief pharmacist

A compounding room

Prepacking and labelling room

A store room

Sterile products room

A separate area for drug information services and space assigned on various nursing units for unit dose drug administration.

In large hospitals, (with 200 or more beds)

departmentalization of pharmacy activities is required.

THE DRUGS THAT HAVE HIGH RISK • They must be protected in special locker • They always to be kept under lock (as narcotic drugs)

LIST OF HIGH RISK MEDICATION

Propofol Inj Kinz Inj Nalbin Inj Succinyl Inj Intatan Inj Bupiron Inj Neostigmin Inj Tramadol Inj Isoflourene Inj Atropin Inj Avil Inj Decadron Inj Tracium Inj Dobutamine Inj Dopamin Inj Sosegon Inj Heprin Inj Valium Inj Syntocinon Inj Norpin Inj Morphine Inj Bupicain Inj Dormicum Inj Serenace Inj Calcium Gluconate Inj KCL Inj Streptokinas Inj 25% Dextrose Water Inj Ketamin Inj Digoxin Inj Lignocaine Inj Thiopental Inj Adrenaline Inj Ephedrine Inj

Design parameters: FLOOR SPACE REQUIREMENTS

25 sq. meter is the minimum required area for any sized hospital. 1 sq. meter per bed in 100 beded hospital. (100 sq.M) 0,65 sq. meter per bed in 200 beded hospital.(130 sq M) Floors of pharmacy should be smooth, easily washable and acid resistant. In manufacturing sections, drains should be provided, walls should be smooth, painted in light colour. Wooden cabinets are laminated. Fluorescent lamps are placed above priscription counter.

For converting to square meter use 0,0929

Personnel requirement in hospital pharmacy: No standard rules regarding the requirement of personnel for

inpatient pharmacy.

Number of pharmacists required for a hospital are calculated on the basis of workload, and the number of bed available.

For a small hospital minimum 3 pharmacist are required. As the number of bed increases, the number of pharmacist also increases.

Pharmacist should possess adequate pharmacy qualification and experience.

If manufacturing drugs is involved in pharmacy, adequate number of technicians, assistants, peons etc. required.

Bed strength Number of pharmacist required

Upto 50 beds Upto 100 beds Upto 200 beds Upto 300 beds Upto 500 beds

3 5 8 10 15

Pharmacist requirement according to bed strength

DEFINITION Supply of drugs in the hospitals and other clinics for the treatment of indoor and outdoor patients by indent system.

Drug Distribution System

The Flow of Order

*Doctor visits patient;writes medication order (or prescription) *Order written on doctor’s order sheet, placed in patient’s record *Doctor,nurse or unit clerk input admitting information in patient’s record *Many hospitals have gone to electronic charts and ordering.

Technology is used in the hospital pharmacy to increase accuracy and improve efficiency and quality of pharmacy services. Automated pharmacy services are replacing some of the routine, time-consuming filling procedures. For instance, large automated robots are now being used to perform some of the filling procedures with near 100% accuracy

Automation in The Hospital Pharmacy

Movie about automation or robotic system

Indoor Patient Service

Types

Individual prescription order system

Complete floor stock system –

charge floor system and

non charge floor stock system

Combination of individual drug order and floor stock system

Unit dose dispensing system

Charge non-floor stock system

1. INDIVIDUAL PRESCRIPTION ORDER SYSTEM

Used by small and private hospitals because of reduced man power requirements.

Physician writes the prescription for individual patient who obtains the drugs prescribed by paying own charges.

Advantages:

Medn. orders are directly reviewed by the pharmacist.

Provides interaction with pharmacist and other medical staff and patients.

Provides clear control of inventory.

Often used in the government hospitals

The drugs are given to the patients through nursing stations and the pharmacy supplies from the drug store of the hospitals.

Drugs on nursing station or ward may be divided into

a) Charge floor stock drugs

b) Non charge floor stock drugs

2.THE COMPLETE FLOOR STOCK SYSTEM

Charge floor stock drugs:

Medicines (stocked in nursing stations) are charged to the patient’s account after they have been administered.

Selection of “charge” stock drugs: Decision as to which drug shall be placed should rest with the PTC (Pharmacy and Therapeutic Comittee). The list of drugs may vary from hospital to hospital.

In the same hospital the list of drugs may change from time to time as per the recommendations of the PTC.

e.g. mannitol injections, dextrose 50%, 25%

PTC –Pharmacy and Therapeutics Comittee : -is an advisory group of the medical staff and serves as the organizational line of communication between the medical staff and the pharmacy department. The comittee assists in the formulation of broadprofessional policies regarding the evalution, selection, procurement, distribution, use, safety procedures and other matters releating to drugs use in the hospital

Non charge floor stock drugs: Used by patients in unit ward and for which there may be no direct charge to the patient’s account . Cost of this group of drugs, is calculated as, per day cost of room or ward . Selection of non charge stock drugs: Consideration is given to the cost of preparation, the quantity used, and the effect on hospital budget and reimbursement from third party payers (Employees’ state insurance scheme).It varies from hospital to hospital. Ampoules: digoxin, adrenaline Tablets: aspirin, paracetamol

A typical medication order sheet, which includes the full name of the patient, the date and time the order was written, the name and dose of drug, the route of administration, and the time or frequency of dosing, is shown in below.Typically, these instructions are written by the physician in ink; however, these orders may be transmitted electronically, typed or written by the physician, or given orally to nursing or pharmacy.

An medication order sample :

Maintaining drug treatment records

Ordering and stocking medications and medical supplies

Repackaging medications

Dispensing medications

Providing information about the proper use of medications

Collecting and evaluating information about adverse drug reactions and interactions Preparing medications in various dose forms for dispensing

Services DivisionPatient -Out.4 • Dispense out-patient prescriptions • Maintain prescription records. • Provide drug consultation services to

staff and medical students.

A general account is opened for each patient who comes into the hospital ,during the registration. Medicine and medical material’s cost which used in the period of the treatment is collected when the patient is discharged from the hospital. This cost is paid either by the patient or by the social security institution.

Billing :

Off-office departments of Hospital Pharmacy : Manufacturing-general -IV additives -Sterile products Radiopharmaceutical service Quality control Laboratory Warehouse management -Medicines -Chemicals -Surgical and medicinal materials

General Manufacturing

COMPOUNDED DOSAGE FORMS:

Oral Solids (Capsules, Tablets) Oral Liquids (Solutions, Susp, Emulsions) Topicals (Creams, Ointments, Gels) Suppositories, Inserts Injectables

Origine of compounded formulas:

* Pharmacopeia : e.g. USP Chapter 1161>Pharmacy Compounding Practices <795 Pharmacy Compounding Monographs of accepted bulk drug substances are being developed <1206> Sterile Preparations-Pharmacy Practices has been recommended as guidelines for sterile preparations compounding.

* Semi official Pharmacist society e.g. Pharmacist chamber, Doctor’s chamber * Prescribed formulas

* PTC Comitee Recipe’s

Important headlines about manufacturing: • In general manufacturing in Hospital Pharmacy: Liquid formulations Eye Drops Creams Ointments Capsules

Solutions can be formulated for different

routes of administration

Orally: Syrups, drops

In mouth and throat: Mouth washes, gargles,

throat sprays.

In body cavities: Douches, enemas, ear drops,

nasal sprays.

On body Surfaces: Collodions, lotions.

• Aseptic manufacturing in Hospital Pharmacy The majority of aseptically prepared items are IV Additives,total parenteral nutrition and oncologic IV drugs (Rarely ophtalmic drops). 40% of hospital inpatients receive IV preparations (and it is continue raising!)

Hospitalised patients need intravenous (IV) fluid and electrolytes for one or more of the following reason:

1-Fluid resuscitation IV fluids may need to be given urgently to restore circulation to vital organs following loss of intravascular volume due to bleeding, plasma loss, or excessive external fluid and electrolyte loss, usually from the gastrointestinal (GI) tract, or severe internal losses (e.g. from fluid redistribution in sepsis).

IV Therapy

2-Routine maintenance IV fluids are sometimes needed for patients who simply cannot meet their normal fluid or electrolyte needs by oral or enteral routes but who are otherwise well in terms of fluid and electrolyte balance and handling i.e. they are essentially euvolaemic (till reacing normal blood volume), with no significant deficits, ongoing abnormal losses or redistribution issues. However, even when prescribing IV fluids for more complex cases, there is still a need to meet the patient’s routine maintenance requirements, adjusting the maintenance prescription to account for the more complex fluid or electrolyte problems. Estimates of routine maintenance requirements are therefore essential for all patients on continuing IV fluid therapy.

3-Replacement In some patients, IV fluids to treat losses from intravascular and or other fluid compartments, are not needed urgently for resuscitation, but are still required to correct existing water and/or electrolyte deficits or ongoing external losses. These losses are usually from the GI or urinary tract, although high insensible losses occur with fever and burns patients can lose high volumes of what is effectively plasma Sometimes, these deficits have developed slowly with associated compensatory adaptations of tissue electrolyte and fluid distribution that must be taken into account in subsequent replacement regimens (e.g. cautious, slow replacement to reduce risks of pontine demyelinosis).

4-Redistribution In addition to external fluid and electrolyte losses, some hospital patients have marked internal fluid distribution changes or abnormal fluid handling. This type of problem is seen particularly in those who are septic, otherwise critically ill, post-major surgery or those with major cardiac , liver or renal co-morbidity. Many of these patients develop oedema from sodium and water excess and some sequester fluids in the GI trac or thoracic/peritoneal cavities. Deciding on the optimal amount, composition and rate of administration of IV fluids to address these often complex needs is inherently difficult yet assessment, prescribing and monitoring of IV fluids in general admission and ward areas of hospitals, is often left to junior doctors and hard-pressed nurses who may lack required training and competence.

Evidence suggests that mismanagement of fluids is common, particularly in general ward areas with the potential for adverse outcomes including excess morbidity and mortality, prolonged hospital stays and increased costs.

ISMP Safe Practice Guidelines for Adult IV Push Medications

(Prepared by the Institute for Safe Medication Practices (ISMP))

IV Additives:

Must beware of both stability and compatibility of drugs administer by the IV route

IV addiction • Begin any IV preparation by washing your hands thoroughly using a germicidal agent such as chlorhexidine gluconate or povidone-iodine • All jewelry should be removed from the hands and

wrists before scrubbing and while making a sterile product

• Wear gloves during procedures • Laminar airflow hoods are normally kept running • Eating, drinking, talking, or coughing is prohibited

in the laminar airflow hood • Working in the laminar flow hood should be free

from interruptions

*Work in the center of the work area within the laminar airflow hood at least six inches inside the edge of the hood *Make sure nothing obstructs the flow of air from the high-efficiency particulate air (HEPA) filter over the preparation area *Nothing should pass behind a sterile object and the HEPA filter in a horizontal airflow hood or above a sterile object in a vertical airflow hood

Process • First pharmacist will determine iv dosage,

diluents, volume of diluent, and rate of administration are correct

• Next the label will be checked against the original order.

• The final solution with additives will then be checked against the label to ensure that the proper dose has been prepared

• “Read the label three times”

Compatibility A pharmacist education should prepare him/her to deal with problems of physical, chemical, and therapeutic incompatibilities and to design suitable alternatives when these problem arise

Incompatibility: Physical: visible change e.g. Precipitation,adsorbtion to packaging. Solubility changing,light decomposing Chemical: may or not visible change, deterioration or inactivation of an active ingredient Therapeutic: drug-drug or drug-disease interaction that lead to potentiating of drug effect, drug toxicity, deterioration

Discussing of all incompatibility

Contamination: Medication errors in intravenous drug preparation and administration Discussing of possible reasons

Discussing of total incompatibility Two weeks minimum

Labels for IV admixtures should bear the following information:

patient’s name and identification number

room number

fluid and amount

drug name and strength (if appropriate)

infusion period

flow rate (e.g., 100 mL/hr or infuse over 30 min)

expiration date and time

additional information as required by the institution or by state or federal guidelines

In chemotherapy, generally cytotoxic drugs are used. By working within controlled envoriment of the aseptic suite. The pharmacy operators are also protectted whilst preparing medication.

Oncologic preparation:

• During the aseptic manufacturing filter sterilization

mostly uses under Laminar Air Flow Cabinet (LAF)

• Cleaning and disinfection of all places and working area is necessary.

• The manufacture of medicinals are a complex operation and must conform to GMP requirements of the releated country. • All manufacturing must controlled by the QQ Department using compendial (Microbial and chemical) testing. • API’s and Excipients, labels, packing components, in-process samples and finished product are tested according to GMP rules and compendial expectations.

Necessary Standard Operation Procedure (SOP) Which releated to testing and formulary and additionally envorimental monitoring, cleaning works should developped before.

Radiopharmaceutical’s A radiopharmaceutical is a radioactive compound used for

the diagnosis and therapeutic treatment of human diseases.

In nuclear medicine nearly 95% of the radiopharmaceuticals are used for diagnostic purposes, while the rest are used for therapeutic treatment.

Radiopharmaceuticals usually have minimal pharmacologic effect, because in most cases they are used in tracer quantities.

Therapeutic radiopharmaceuticals can cause tissue damage by radiation.

Because they are administered to humans, they should be sterile and pyrogen free, and should undergo all quality control measures required of a conventional drug.

A radiopharmaceutical may be a radioactive element such as 133Xe, or a labeled compound such as 131I-iodinated proteins and 99mTc-labeled compounds.

A radiopharmaceutical has two components: a radionuclide and a pharmaceutical.

The usefulness of a radiopharmaceutical is

dictated by the characteristics of these two components.

In designing a radiopharmaceutical, a pharmaceutical is first chosen on the basis of its preferential localization in a given organ or its participation in the physiologic function of the organ.

Dosis calculation : All cytostatic drug dose have to calculate according to patient’s surface area. The equation :

BSA (Body Surface Area =m2) = ℎ 𝑐𝑚 𝑥 𝑊(𝑘𝑔)

3600

Quality Controls in Hospital Pharmacy Manufacturing

Definition :

Q.C.is the part of GMP concerned with

sampling, specifications, testing, with the

organization, documentation and release

procedures which ensure that the necessary

and relevant test are actually carried out and

that materials are neither released for use, nor

products released for sale or supply, until

their quality has been satisfactory.

Steps of an QC operation : 1) Choosing the control subject 2) Choosing an unit of measure 3) Setting a standard value 4) Providing device 5) Conducting actual management 6) Interpreting the mean between the actual and standard 7) Taking decision and acting on difference

Establish, validate, and implement all the Q.C. procedure, maintain sufficient standards and reagents. Evaluate, maintain, and store reference and working standards for substances. Ensure the correct labeling of containers of materials and products. Ensure that the stability of API and product is monitored . Participate in the investigation of complaints related to quality of product. Participate in environmental monitoring.

Role of Q.C.

Warehouse and purchasing

• To ensure an adequate storage space and continuous supply of pharmaceutical, medical and surgical inventories to improve customer service.

• To ensure the facility design, construct and build comply with the requirements of TPS, GSP and other relevant guidelines from MOH and other authorities.

• To obtain measurable financial performance and customer satisfaction on logistic, procurement and supply processes.

OBJECTIVES :

General Operational Policies a) HPS is the main store for pharmaceutical, medical

and surgical supply. b) The HPS shall be headed by a Senior Pharmacist

who also supervise other pharmacists in the HPS. c) The Senior Pharmacist shall ensure the security of

the HPS. d) The Senior Pharmacist shall be supported by

administrative staff and general workers. e) The number of supporting staff shall be

proportionate to the workload and budget managed by the HPS.

f ) The HPS shall manage the procurement, storage and supply of all items according to TPS and GSP. g) The HPS shall keep Psychotropic Substances / Dangerous Drug under lock and key and controlled in accordance with the Dangerous Drug Act 1952 and Poison Act 1952. h) The HPS shall ensure the supply is able to meet the

pharmacotherapy and medical needs of the patients.

i) Adequate space shall be made available so that First-in-First-Out (FIFO) can be implemented efficiently. j) Mechanical handling equipment and system shall be made available.

j) Mechanical handling equipment and system shall be made available.

k) Computerised system for the management of HPS shall be made available for procurement, storage, supply and payment so as to meet the requirements of TPS.This is in addition to e-Procurement, Integrated Hospital Inventory System (IHIS), Teleprimary Care (TPC) and other existing systems.

l) Comprehensive records of all transactions shall be electronically documented, maintained and hard copies shall be generated at regular intervals.

m) The HPS shall manage all the product recalls according to stated processes and procedures.

n) All disposals of items and documents shall be carried out in accordance with standard procedures and regulations.

o) The design of the building shall be rodent and vermin-proof.

p) Good housekeeping such as cleaning, sanitation and inspection shall be carried out as scheduled.

General Development & Maintenance Policies a) Location b) Security against theft c) Fire security d) Safety from weather hazard e) Storage Area There shall be sufficient physically separated areas with appropriate storage conditions for orderly segregation of products namely biological, refrigerated, inflammable and corrosive liquid and solids, medical gases, cytotoxic drugs, Dangerous Drugs and Psychotropic Substances.

Controlled storage environment: Where controlled storage environment is required, it conditions shall be continuously monitored using appropriate equipment at predetermined intervals. Maximum and minimum temperature of the day shall be monitored and recorded.

Medical supplies What are medical supplies? They are designed to aid in the diagnosis, monitoring or treatment of medical conditions. A hospital that keeps key pieces of medical equipment on-hand at all times is a hospital that is ready for any case that might pass through their doors. The nature of medical treatment requires that in order to provide complete care, you must be in possession of complete equipment.

Surgical Gloves Examination Gloves Glove Powder Syringes & Hypodermic Needles Cotton wool Gauze bandage Elastic Bandage Gypsium bandage Plasters Applicator sticks Bedpan Gloves Diaper for adult and baby Disinfectants

Clinical Thermometer Cannula(Branule) Elastic Bandage Plaster Scalp Vein Set Gauze Infusion Set Sutures Sterile Gas Compressor Sterile Syringe Catheters ( For both women and men)

Essential Medical Supplies Found In A Hospital Pharmacy

Consulting about medicines

Training : - To nurse - Health care Staff - Patient

Pharmacovigilance (PV) is defined as the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem.

Pharmacovilligance

WHO established its Programme for International Drug Monitoring in response to the thalidomide disaster detected in 1961. Together with the WHO Collaborating Centre for International Drug Monitoring,

The European Medicines Agency (EMA) coordinates the European Union (EU) pharmacovigilance system and operates services and processes to support pharmacovigilance in the EU.

WHO promotes PV at the country level. At the end of 2010, 134 countries were part of the WHO PV Programme. The aims of PV are to enhance patient care and patient safety in relation to the use of medicines; and to support public health programmes by providing reliable, balanced information for the effective assessment of the risk-benefit profile of medicines.

Official guidelines :

References: 1 Remington The Science and Practice of Pharmacy, 21.th Ed. David Btroy(Ed.) Lippincott Williams & Wilkins USA ISBN 0-7817-4673-6 2 Hospital Pharmacy, Wasfi Abbas (Ed) Department Pharmacy- Riyadh-KSA 3 California Correctional Health Care Services Chapter 20 Vol 9 Pharmacy Service 4 Hospital Pharmacy Procurement and Supply, Special Booklet 5 Hospital Pharmacy 2.nd Ed. Martin Stephens (Ed.) Pharmaceutical Press, 22011 GB ISBN 978 0 85369 900 2