HISTORY

Changes over the last 50 years:1. In-charge of drug product acquisition, distribution, and control Major elements of hospital pharmacists' professional identityBulk compounding and sterile solution manufacturing - unsuitability of many commercially available dosage forms for hospital use; close relationship between phycisians and pharmacists

2. Major role in patient safety Getting involved in the medication-use process - greater accuracy in dispensing and administration; improving prescribing and monitoring; improve drug product distributionMedication Use Process: Prescribing (Physicians) - influence prescribing of other health professionals Transcribing (Nurse/Ward Clerk) - prescriber's written order is copied and entered into pharmacy records; must understand potential breakdowns Dispensing (Pharmacists) - physically transferring drug product following review and approval of prescription to area responsible for administering medication to the patient Administration (Nurse) - clearly label medications, using barcoding systems, and unit dose packaging, reducing time and effort involved in accessing drugs, and using technology Monitoring (Physician/Nurse/Pharmacist) - reviewing laboratory values that are correlated with the expected medication-therapy outcomesDrug Distribution Systems: Floor Stock Systems - every floor = stock; fast supply for emergencies Patient Prescription Systems - physician writes prescription for limited number of drugs; transcribed by nurse or ward Unit Dose Drug Distribution System - receives original/direct copy > reviewing of medication order before first dose is dispensed > single unit packaging > ready to administer form as possible > not more than 24-hour supply of doses is delivered/available at patient care area > patient medication is concurrently maintained per patientAdvantages: Greater nursing efficiency, better use of pharmacists' talents, cost savings, improve patient safety Centralized - one supplier; more effecient for preparation and distribution of medication Decentralized - come in contact regularly with physicians, nurses, and patients

3. Major role in promoting rational drug therapy Pharmacy and Therapeutics (P&T) Committee - medical staff of hospital/health system with oversight for medication management; formulary, assesses medication use, makes recommendations on policies; medical staff, administration, pharmacy, nursing, and other parties interested in medication use process; pharmacist=secretary of committee; promulgated by Edward Spease and Robert Porter AHA and ASHP - developed guidance on P&T committee and on the operation of a hospital formulary systemsFormulary System - selection of drug products most useful in patient care; framework on how medication-use policies are established and implementedFormulary - approved drug list4. Foster optimal patient outcomes from medication use Right drug, right patient, right time Achieving optimal outcomes from medication use "The mission of pharmacists is to help people make the best use of medicines." Answer drug information questions related to dosage, dosage forms, and pharmacology Asked for advice on ADR and clinical comparisons of products Hilton Head Conference - directions for clinical practice in pharmacy: Clinical pharmacy should not be thought of as something separate from pharmacy practice at a whole Hospital pharmacies should function as clinical department