Our Mission

The primary mission statement of RHUH is to provide quality community based medical services. Our goal is to be the leaders in the health care sector. We care for our patients, our community and our staff. We provide a friendly, prompt, and cost-effective service in a caring manner for all and incomes from every region in ebanon. We value our community, our employees and most important our patient. We support the environment. We deliver the highest standards and quality of service in a cost-effective manner. We teach in an environment of healthcare for further medical education at all levels, and in multidisciplinary sciences. !ollaborating "ith institutions of higher learning "e assist residents in receiving the highest quality medical care and develop nursing education programs. We discover through a continuous research programs. We play a leadership role, in addressing and responding to regional and local health and related needs. Our leadership role comes from the policies and the vision of its #irector, and the advisory board.

Our Vision
$atients are our first and most important priority. %mployees are our most valuable resource. We are committed to provide the highest quality, most cost-effective services. We distinguish ourselves through our leadership in the health care sector. We are committed to values that RHUH focuses on patient & centered care, e'cellence, innovation, diversity, ethical values and integrity.

 Our name is a community of people living this vision.

Our Values
$atient-!entered !are( )n all its endeavors, RHUH is guided by the needs of the patient, creating a partnership that is effective and personal across the continuum of care. !ontinuous earning( RHUH actively supports outstanding programs of education and research designed to encourage the acquisition of *no"ledge and s*ills that are of value to the national health care program and the society.

+ociety( RHUH actively develops partnerships that "ill improve the health care of the society and, as a ste"ard of public trust, it ensures informed and dignified care for all patients regardless of their ability to pay. Organi-ational %thics( RHUH is guided by ethical values that emphasi-e honesty, fairness, dignity, and respect for the individual. +uperior $erformance( RHUH strives for superior performance in all "hat it does, to preserve the hospital.s clinical, organi-ational and financial strength. Relationships( RHUH develops and strengthen collaborative relationships "ith all of its customers, including patients, their families, employees, volunteers, medical staff and business partners. Human Resources( RHUH supports the professional and personal gro"th of employees in their pursuit of the hospital.s mission. !ommunication( RHUH strives to acquire and understand information, and share it clearly and effectively.

Hospital Management Repot

The need for a governmental hospital in Beirut was an issue over 30 years ago. On February 2, 1 ! the "ebanese government released a de#ision to build a governmental hospital of $00 beds on a publi# owned property in Bir %assan & Beirut. The de#ision was based on te#hni#al studies made by the minister of %ealth and the 'inister of (ubli# )or*s and Transportation. +onstru#tion did not start until 1 during 2000. $ due to #ivil war and its #onse,uen#es and it was finali-ed

.in#e /%0% is a publi# institution its #onstru#tion was finan#ed by the "ebanese government through 'inistry of Finan#e. .imilar to all publi# #onstru#tions /%0% #onstru#tion was handed to the +oun#il of 1evelopment and /e#onstru#tion 2 +1/& The #onstru#tion and supplies of the hospital were finan#ed by a low interest loan from the .audi 1evelopment Fund and 3slami# development Ban*. The four au4iliary buildings5 #onstru#tion was finan#ed by a grant from 6ing Fahd of .audi 7rabia. 7ll medi#al and non&medi#al e,uipments were pur#hased through 3slami# 1evelopment Ban* by a low interest loan. The hospital is an independent publi# institution where it has its own board of dire#tors and is under the supervision of the 'inistry of (ubli# %ealth whi#h supervises the hospital5s fun#tion through its representative in the board. /%)RUT 0O1%R2%3T4 U3)1%R+)T5 HO+$)T4 , also "idely *no"n as RHUH, is a hospital in RHUH +treet, behind O0%RO, /ir-Hassan, /eirut, ebanon, telephone 6789 9

:;<<<<, 6789 9 :;9<<<, 67899:;=<<<. RHUH is a university hospital. )t is a training center for medicine students and as post graduate establishment for speciali-ation in the various medical branches, as "ell as its partnerships "ith related faculties of the ebanese University, ebanese )nternational University, and "ith other local and international faculties of medicine, pharmacy, and health organi-ations. /esides being a research center. RHUH and +pace is >:,<<< m?, 7<,<<< m?of "hich is the building space. The building consists of @ floors, A< apartments, > villas, ;<< students and nurses dorms, and nursing university. RHUH contain A>> beds, 9A< of them are occupied right no" and the others "ill be available in the near future. The future A>> bed are classified as follo"( 2edicine +urgery $ediatrics O/-053 3ursery )!3 )!U !!U !+U /urn Units #ialysis Unit !hild $sychiatry Rehabilitation for drug addiction Oncology $rison Total /eds 9=: 9=: 8> 8> 9: 98 99 7 > 8 => ;> 9A 99 9= A>>

9- The general director is the head of the RHUH and he is responsible for all the departments in the hospital, such as the )nformation Technology, Binance C administration, 2edical, )nternal 4udit, 2aterial and C $urchasing, and nursing department. The finance and 4dministration department is responsible for the logistics, Human Resources, and Binance, "hereas the 2aterial and purchasing is responsible for the /iomedical, %ngineering C 2aintenance and the Pharmacy departments. The pharmacy is directly lin*ed to the 2aterial C 2anagement and indirectly to the 2aterial C $urchasing and 2anagement D0eneral #irectorE through the 2aterial C 2anagement.

Management
)nformation Technology

2edical

)nternal audit

3ursing

2aterial and purchasing Binance and administration ogistics Human resources /iomedical Binance %ng C maintenance 2aterial management

PHARMACY

=- Hospital accreditation standards are statement of accruements and recommendation that the hospital should meet. These rules are implanted by the Over +eas $roFect !orporation of 1ictoria DO$!1E and under the super vision of the ministry of public health of ebanon D2O$HE and the health sector rehabilitation proFect DH+R$E. The proFect is financed by the World /an*. !H%!G TH% 34T)O34 HO+$T4 +UR1%5 $40% D E. %stablishment of a hospital accreditation system in ebanon "ill pave the "ay for the provision of good quality of health care. 4s the accreditation system matures more and more in ebanon the standards "ill further develop and quality assurance and quality improvement "ill lead on to the more precise measurement of health outcomes. Huality assurance principles and hospital accreditation address quality of care deficiencies and harmful andIor "asteful practices, and can stimulate debate bet"een public and private providers, policy ma*ers and consumers on "hat practices conform to the latest reliable evidence. This promotes a "ider dissemination of *no"ledge. )ncreased *no"ledge and a"areness by the public ensures that hospitals achieve greater throughputs because of the public.s faith that the hospital is able to meet the "ide range of quality standards. Hospital management has often remar*ed during visits of the O$!1 +urvey Team that unless a hospital provided Jthe full optionsJ- that is a complete range of the latest sophisticated medical technology, then it "as not considered to be a good hospital. +cant attention is paid to "hether the si-e and comple'ity of the hospital "arrants a complete range of equipment, or indeed "hether the hospital can provide the qualified staff necessary to operate such equipment safely. The image of "hat constitutes a good hospital is generally supported by the current Hospital !lassification system and it this image that is required to be changed through the implementation of quality assuranceIimprovement to support the mar*eting of ebanon.s hospital services to other countries. 4 public education campaign is therefore a concomitant e'ercise to be carried out in parallel "ith the development of the quality approach.

The hospitals are classified in 4, /, !, and # categories. Hospitals classified as 4 and / are considered the most satisfactory hospitals and those "ho are classified ! and # they are not satisfactory and need improvements to meet the hospital accreditation standards. )ncase the hospital does not meet the standards Dclassified as ! or #E then the ministry of health "ill decrease the budget given to it. 4n e'ample of the results for the ebanese hospitals done in =<<A(

Committees
;- The RHUH contains many medical comities including infectious disease committee, pharmacy C therapeutics committee, nutrition committee, research committee and disaster committee. The hospitals pharmacy play role in most of these committees. Bor e'ample, in the pharmacy and therapeutic committee the pharmacists study and evaluate all ne" drugs found in the mar*et and they reevaluate the old drugs already e'ist in the hospital and compare them "ith other drugs follo"ing the cost-effectiveness concept. 4lso, in infectious disease committee they are responsible for antibiotic resistance, rules of antibiotic usage, and monitoring the restricted antibiotics in order to minimi-e nosocomial infections and antibiotic resistance problems. /esides it updates the research committee "ith the most resent ne"s about drugs and drug discovery. 2oreover, it supplies the nutrition committee "ith the drugfood interaction list to provide the patients "ith the best therapeutical outcomes and it provides them "ith the total peripheral nutrition guidelines. )n addition it is a member in the disaster committee "hich id responsible for safety guidelines in case of emergency inside the hospital. >- )ncase of medical error such as drug interaction, and "rong dose, the error should be reported to the quality department in the pharmacy. The report should be field by the person "ho discovered the error and the error "ill be immediately corrected using all available methods such as internet or the pharmacy library Dboo*s, micromedics, 1)#4 KE, or they call the order of pharmacy of ebanon and as* the dug information center. 4ll reports are classified in the pharmacy department and every si' months a conclusion report "ill be done to detect problems of most frequent errors and to detect if the same employee is doing the same error. 4ction "ill be ta*en after the conclusion report is done. A- The inventory control is done every month in RHUH hospital pharmacy. They print out the inventory in a hard copy and then they chec* it on the shelves. #rugs in tablet or capsule dosage forms are counted per tablet "hile intravenous drugs are counted per ampoule. The inventory control involve all the drugs in the hospital, in the satellite pharmacy on the floors, the store in the surgery room, intensive care unite store, dialysis room and emergency room. 8- The RHUH depends on high technology systems to get the best quality. )n fact all the hospital "or* is computeri-ed including the hospital pharmacy. The compute soft"are used in the pharmacy is #2+, their is no bare code system. @- The special loc* to computer system in special ).#. and pass"ord can detect all employees and trainees move in all the hospital including the pharmacy. 2oreover the monthly inventory control "ill detect any lost drug in the pharmacy and all the hospital parts mentioned above that contain drug store.

:- There is a special team involved in the drug information. This team "ill get his information from boo*s, internet, scientific office, and some times they contact the drug information center "hich is related to the LOrder of $harmacist in ebanonM. 7- The human resource department serves RHUH and its community by providing leadership in personnel policy management, compensation and employee development. )t ensure uniform and consistent understanding and application of personnel policies and operating procedures, assign authority and responsibility for the administration of the personnel policies and operating procedures, provide evidence of compliance "ith the ebanese a" that pertain to employment, provide a structure for continuous training to staff. The human resource department did not provide us "ith detailed describing recruiting and hiring the members of the hospital pharmacy due to restricted privacy policy rules follo"ed in the pharmacy. 9<- +ome employees are paid monthly and others are paid hourly. Those "ho "or* hourly have a ma'imum of >> hour per a "ee*. The employees that are paid "ee*ly benefit from the 3++B. The paper that they should fill out is attached at the end. 99- The employee la" for full timers is offered fourteen days vacation in a year, forty days maternity, and they can ta*e a sic* leave "hen they are not able to "or* due to sic*ness. Their are no unpaid vacations. The human resource is responsible for firing employee, this decision is ta*en after giving the employee three "arnings. 9=- The RHUH Pharmacy epartment is devoted to the concept of high quality, cost effective, timely delivery of drug therapy and achievement of optimal patient outcomes. )t provides therapeutic drug monitoring, therapeutic interventions, pharmaco*inetic consults, drug information and medication distribution to the patients served throughout the institution. The $harmacy #epartment is committed to, meet international criteria of practice , see* continually performance improvement , be an integral part of the patient care team , contribute to an optimal therapeutic outcomes, foster an educational environment. The pharmacy department is responsible also for dispensing drugs to inpatients and insured outpatients, preparation of !ytoto'ic drugs and )1 4dmi'ture, dissemination of information on drugs to doctors, nurses and other users, training of pharmacy students DHospital $harmacy and !linical pharmacy programsE, cooperating in education continuing program, preparation of T$3 DTotal $arenteral 3utritionE. The main pharmacy is located in the basement 9D/9E. )t consists of 7 areas( dispensing area, purchasing office, storage and compounding area, chief pharmacist office, speciali-ed area for cytoto'ic drug preparation, pharmacistsN offices, bathroom, library, and studentsN room. The chemotherapy preparation unit is located in basement ;D/;E. $harmacy is open from:(<< a.m. till @(<< p.m. 2onday till Briday and from :(<< a.m. till >(<< +aturday and +unday. !hemotherapy preparations are accepted from :(<<a.m. till ;(;< p.m. from 2onday till Briday. 4 pharmacist on call is available for after hour The chief pharmacist is the head of the pharmacy. HeIshe is responsible for all actions done in the pharmacy including purchasing, dispensing, management, e'piry date of the drug in the

pharmacy, in the floor sto*e, and chemotherapy. HeIshe has his o"n secretary, and hisIher personal assistant "ill be available in the near future. The purchasing team, scientific team, drug information specialist, clinical pharmacist, accreditation team, acting supervisor, oncology team, secretary and the assistant to head of pharmacy department are directly related to the head of the pharmacy. The pharmacist and assistant pharmacist are lin*ed to the acting supervisor. 4lso the oncology pharmacist and assistant oncology pharmacist are lin*ed to the oncology team. The senior technicians and technicians are lin*ed to the pharmacist and assistant pharmacist.

4ssistant to head pharmacist

Head of pharmacy

+ecretary

$urchasing team

+cientific team #)+ & clinical pharmacist accreditation team

4cting supervisor oncology team

4cting supervisor oncology team

Oncology pharmacist C assistant oncology pharmacists

$harmacists C assistant pharmacists

+uperior technicians

Technicians

The role of the !hief pharmacist is to plan, organi-e, and supervise all activities of the pharmacy, follo" up of all pharmacy related policies in the country and their impact on the hospital, implement pharmacy information system in corporation "ith 2)+ department, control pharmacy request, control delivery, control stoc*s and prepare purchasing request and contact agents, control periodical and annual inventory, control e'piry dates, control through audits,

usage of antibiotics mainly the restricted ones, disseminate of information to physicians, nurses and others, update hospital pharmacy, prepare of annual budget, assure specific antidotes and urgent drugs, responsible of training programs for hospital pharmacy students, meet medical Rep, agents, control good maintenance of equipments, buy and control usage of narcotics, psychotropic and reporting annual consumption to the 2OH, control usage of drugs "ithin budget, control invoices "ith receipts, and approve them, prepare bids for generics and e'pensive drugs in cooperation "ith purchasing department, fill any vacancy in case of shortage. 4lso heIshe is secretary of $T!, and a member in disaster, nutrition and infectious disease committee. The role of Oncology pharmacist is to fulfill all responsibilities of oncology division, inform the chief pharmacist about stoc* and problems related to the division, give help in the dispensing area in case of free time The role of $harmacist is to assist !$ and being responsible in her absence, control pharmacy request, control delivery, control stoc*, reception, and storage, contact #r in case of any problem related to drug usage, disseminate of information, control out patient dispensing, control stoc* in nursing office and emergency carriages, control labeling system, deliver controlled drugs and preparing monthly inventory, help in training of pharmacy students, fulfill any Fob in case of shortage. The #hief pharma#ist, on#ology pharma#ist, and pharma#ist are on #all duty. The role of the Technician is to prepare drugs for in patients, place drugs on the shelf, and fulfill any Fob in case of shortage. The acting supervisor pharmacist "ill be selected by the chief pharmacist Dhead of the pharmacy departmentE. HeIshe is illegible to perform all the duties Dmanagement and administrative "or*E of the chief pharmacist during specific circumstances "here the chief pharmacist "ill not be available i.e. incase of sic*ness or vacation. )ncase the assistant to head of pharmacy department is present heIshe "ill be responsible of all managerial "or* in case of absence of the head of pharmacy. The pharmacy members are being paid either monthly or per hour depending on the type of contract they signed because originally by la" the pharmacy is allo"ed to recruit only > pharmacist in addition to the head pharmacist those are paid on a monthly basis and the rest are paid on an hourly basis. $harmacist must fulfill a total of >> hrsI "ee*. $harmacists benefit from insurance from both the order of pharmacy and the 3+BB, technicians benefit only from 3++B. Bor the pharmacists :<O is covered by the 3++B, insurance company covers the remaining =< O.

Tas!s performed at the hospital

9- The manual for the pharmacy contain the pharmacy policy and procedure, Fob description of employee, performance appraisal, purchasing, budgeting, prepare and dispensing of medication, chemotherapy policy and procedure Dpreparation of chemotherapy, "aste of !ytoto'ic "aste, personal protective equipment &$$%- mas*, gloves, go"nKE, quality improvement plane for the pharmacy department, adverse drug reactions, drug-drug interactions, drug food interactions, and clinical information sheet Dantibiotics stability, special protocols dopamine, dobutamineE. )t describes each phase of activity in the pharmacy. =- The drugs are delivered to the pharmacy in closed bo'es. 4ll intravenous drugs are stored in the pharmacy store, "hereas the all oral syrups, suspensions, capsules, tablets, and caplets dosage form drugs are *ept on special shelves and dra"ers in the pharmacy. #rugs that have to be *ept a"ay from light are *ept in special closet in the drug store. 3arcotics and sedative drugs are *ept in controlled closet in the pharmacy, and the *eys are *ept "ith the pharmacist responsible for storing and delivering controlled drugs. ;- 3arcotics and psychotic drugs are very dangerous drugs and they have a special "ay of delivery. 3arcotic and psychotropic drugs are under restriction use. Those drugs must be dispensed for periods that do not e'ceed @ days. The prescription is "ritten and signed by the attending physician after he "rote it on the medication order form. The pharmacist and the nurse in charge are in collaboration responsible of the application of the system. The controlled substances shall be stored in a loc*ed safe in the pharmacy under responsibility of the chief pharmacist and distributed against "ritten requests from the hospital pharmacist. The ordered controlled substances shall be recorded in the "ard in a loc*ed safe under the supervision of the nurse in charge. The hospital pharmacy shall order controlled substances through a "ritten request. !ontrolled substances shall be transported in a secure manner by the nurse in charge. The pharmacist responsible for controlled substances shall receive, chec*, record and store the medicine. The nurse shall chec* the physician order of controlled substances for completeness before administration. The controlled substance shall be issued by the pharmacist to the nursing unit upon the nursing request after verifying the physician order for completeness. $harmacist shall record monthly consumption of controlled substances after chec*ing the nursing stoc* in the units. )n case of accidental brea*age of controlled substances, ampoule or unused opened ampoule, the accident should be reported and the report form shall be sent by the person involved to the pharmacy "ith the bro*en pieced of the ampoule. !hief pharmacist shall sign the controlled substances incident report form. The nurse shall record the amount of "astage of the drug in the controlled substances register boo* "ith self and "itness signature, the pharmacist shall chec* the records. )n case of "astage of controlled substance, the ampoule shall not be thro"n by the nurse, the empty ampoule shall be retained by the nurse in the bo' provided to the pharmacy. 4ll controlled drugs documents shall be stored by the pharmacy department. 4ny e'pired controlled substance in the nurse stations shall be sent by the responsible nurse "ith proper documents for proper disposal.

>- %'pired date drugs are usually returned by the supplier up to five bo'es and three bo'es from the refrigerated drugs according to the pharmacy lo". The supplied must be notified tree months before the e'piry date. A- +atellite pharmacy is a delocali-ed pharmacy on hospital floors that branches out of a central or main pharmacy. )t is the nurse reservation present at each floor and contains drug "hich are mostly used in the floor and vital to patient life. %ach floor has also an emergency crash card that is set by the !$R committee and it is the same in all the floors. Role of these medication is to help the nurse for rapid administration of the drug incase the pharmacy is closed or in emergency cases. 8- Medical representati"es usually visit the pharmacy on specific days announced by the chief pharmacist Dusually t"o days in the "ee*sE. They update and refresh the pharmacist *no"ledge and tell them "hat is ne" in the mar*et of medicine. They are responsible for developing and managing relationships "ith *ey decision-ma*ers, and play an influential role interfacing "ith numerous internal and e'ternal *ey sta*eholders. @-#o$ inter"ie%s(We didnNt have any chance to observe a Fob intervie" or performance evaluation.

#o$ descriptions&
:-The pharmacist "ill print out the medical orders and chec* for drug interaction, "rong doses, and correct medication prior dispensing. !harging drugs of each patient is also done by t the pharmacists. Then the technician prepares the drugs "hich are controlled by the pharmacist in the final stage. 4ll drugs are delivered in closed bags "ith a lable "here the patient name and floor are "ritten. The technician "ill deliver the drugs from the pharmacy to the nurses on the floors. The nurses "ill receive the drugs, open the closed containers, prepare )1 drugs and put then in a special ----that contain many small dra"ers and "ill dispense the drug to the patients depending on room number, bed number and his name respectively 7- Hospital pharmacist "ill choose the drug that they "ant, the chief pharmacist "ill as* the purchasing team to sent a request to the material and purchase department to sign it, then the material and purchase department "ill sent it to the general director after the approval of the general director it "ill be fa'ed to all the suppliers that have these drugs. 4fter the replay of the suppliers the pharmacist "ill choose the best one depending on the quality and price. The supplier "ill deliver the drugs to the receiving committee in the pharmacy.

'- Restricted drugs 4ll medication orders that may contain restricted antibiotics "ill be stopped after one day by the pharmacist if the infectious disease specialist did not fill the special form for restricted antibiotics "here he "rote the indication, suspected strain, and antibiogram susceptibility.

Oncologist can prescribe restricted antibiotic approved in febrile neutropenia "ithout )# consultation. (rand name
Ta-ocin >.Ag $ri-ma >.Ag Bortum 9g 3egacef 9g Bortum =g 2a'ipime 9g 4-actam 9g Tienam A<<mg Tygacil A<mg 4mi*in 9<<mg 4mi*in A<<mg $ierami A<<mg 0entamicin 1ancolon <.Ag Targocid =<<mg Targoplanin =<<mg Pyvo' #aptomycin +ynercid Bungi-one A<mg #iflucan Blucand 1B%3# !ancidas 4belcet 4mbisome 2ycamin Povira' =A<mg +upraviran =A<mg !ymeven A<<mg

)eneric name
$iperacillinI Ta-obactam $iperacillinI Ta-obactam !efta-idime !efta-idime !efta-idime !efepime 4-treonam )mipenamIcilastatin Tigecyclin 4mi*acin 4mi*acin 4mi*acin 0entamicin 1ancomycin Teicoplanin Teicoplanin ine-olid #aptomycin +ynercid 4mphotericin / Blucona-ole =<<mg Blucona-ole =<<mg 1oricona-ole !apsofungin ipid comple' amphotericin / iposomal amphotericin / 2ycafungin 4cyclovir 4cyclovir 0ancylovir

*- rugs Protected from light (rand name

!oversyl Burosemide >< Rifadin ;<<mg $ropranolol 4po pento'yfylline $lendil Amg $lavi' Rabe-ol 3ifedicor =<mg 3imotop 2icardis ><, :< mg escol Q oratin 0libomet !orvasal !ortancyl !alcium !restor 9<mg !o-ar A<mg,9<<mg !ardular #iovan %ltro'in 9<<mg 4-omycin =A<mg 4moclan 9g 4ltia-em Begenore 0e #igi'in

)eneric name
$erindopril Burosemide Rifampin $ropranolol 4po pento'yfylline Belodipine !lopidogrel Rabepra-ole 3ifedipine 3imodipine Telmisartan Bluvastatin oratidine 0libenclamide 2olsidonin $rednisone !alcium Rosuvastatin asartan #o'a-ocin mesylate 1alsatan Thyro'in 4-ythromycin 4mo'icillinIclavunate #iltia-em Benofibrate #igo'in

+- rugs that must $e refrigerated& (rand name

4ctrapid H2 4mbisone

0eneric name
,nsulin -iposomal amohoteriin

!olorcsi phnylehrine 9<O #e'ametha-one %potin ><<< )U %smeron A< m Bungisone A< mg 0lucogen Human albumin =<O )nsulatard H2 2i'tard ;< 3imbe' 3ovomi' ;< 3ovmi rapid O'ytocin 9< nits $avuln > mg $rostin =A< mcg $rostin A<< mcg 1R +u'amethonium = g Tracrim =A mg %ngeri'-/ DFuniorE %ngeri' / Hepatitis / immunoglobulin Resogamma $ Ag for 9<<ml Tetava' telegram 1enimmum R !alcium folinate ;< mg 2abthera 2iacalcic 2inirin 3eupogen One alpha +andostatin 1treptase

Phenylephrine e.amithasone /rythropoietin 000U Rocironium Amphotericin ( )lucogen Al$umin ,nsulin ,nsulin Cistracurium ,nsulin ,nsulin O.ytocin Pancuronni $romidium Car$oprost tromethan Alprostadil 1.amethonium Atracurium Hepatitis ( Hepatitis ( Ptitis ( immunoglo$ulin ,mmunoglo$ulin ) Tetanus immunoglo$ulin ,mmunoglo$ulin ) Calcium folinate +0 mg Ritu.ima$ '002 300 mg 1almocalcitonon '00 ,U esmopression 4 mcg5ml 6ilgrastim +0 75/ Alphacalcidiol * mg5ml Octreotid 08' mg5ml 1trepto!inase *30 0002 '000 000 V,

-ist of drugs that should $e monitored (rand names 5 )eneric name

ipitor Iatorvastatin asi'I furosemide !orticosteroid %uthyro' , %ltro'inIlevothyro'in 1ancomycin, 0entamicin, 4mi*acin #epa*eneI valproic acid Tegretol Icarbama-epine

Monitoring parameters
BT s G6,3a6,!a?6 #onNt stop abruptly ifR9< days Thyroid test !r 2onitor levels

%panutin Iphenytoin #igo'in 4lbumin oveno' Ieno'aparin 4mbisome , fungisomeIamphotericin / ipantylI fenofibrate 3eupogenI filgrastine

2onitor levels 2onitor levels 2onitor platelets +r!r, *6, 2g6 BT 43!

Third party payers and reim$ursement

This hospital is a governmental hospital and most of the patients pay only ten percent from the RHUH price list. D!hec* page E and the other ninety percent are paid by the ministry of public health of ebanon. 4lso insurance and third party payer are allo"ed in this hospital. 4ll drugs that are not ta*en by the patients are immediately returned to the pharmacy and canceled from the patient bills. 4ll drugs are covered by the hospital e'cept this list of e'clusions(

(rand name
4calasta inF A mg 4T0- fresenius inF Aml 4valo' inF ><<mg !affeine inF =AO-9ml !olimycin inF 9 million U) #esferal inF A<<mg %ngeri' / adult Bolic acid tab920 Bolic acid tab Amg 2ycamine inF A<mg +etron inF >20I=ml Tracutil Dtrace elementsE 1alcyte tab >A<2g 1asopressin inF 1fend tab =<<2g Qylocaine Felly=O lidocaine Pithroma' inF A<<20

)eneric name
Polidronic acid Rabbit anti-lymph )g 2o'iflo'acin !affeine !olistin methane sulphone #esfero'amine %ngeri' / adult Bolic acid Bolic acid 2ycafungin Ondansetron Tracutil 1algancyclovir 1asopressin inF 1oricona-ole Qylocaine Felly=O lidocaine 4-ithromycin

Automatic stop medication2 drug restrictions '- Policy& 9. 2edications prescribed to in-patients are dispensed from the main pharmacy for a limited period of time( specified by the $harmacy and Therapeutic !ommittee.

=. 4n automatic stop order "ill be applicable on these drugs after a predetermined time interval unless re"ritten by the prescribers. Oral medications9PO:;;;;;;;;;;;;;;;;;;;;; 88'4 days ,ntra"enous drugs;;;;;;;;;;;;;;;;;;;;;;88888<days Heparin KKKKKKKKKKKKKKKKKKKKKKKKKKK..9 day 4ntibiotics restrictedKKKKKKKKKKKKKKKKKKKKKK..@ days 4-ithromycin D-ithroma'EKKKKKKKKKKKKKKKKKKKK..; days )ntravenous quinolonesKKKKKKKKKKKKKKKKKKKKK...; days )ntravenous proton pump inhibitorsKKKKKKKKKKKKKKKKK; days 3+4)#+Dstanding orderEKKKKKKKKKKKKKKKKKKKK.A days !ontrolled substancesD$R3 orders and standind ordersEKKKKKKKK9 day 4nticoagulant normalKKKKKKKKKKKKKKKKKKKKK...On daily basis for first "ee* until )3R is normali-ed O'yto'ics KKKKKKKKKKKKKKKKKKKKKKKKKK.9 day 4lbumin KKKKKKKKKKKKKKKKKKKKKKKKKKK= days 4nalgesic and antiemeticD$R3 disordersEKKKKKKKKKKKKKK.9 day S Therapeutic subcutaneous heparin is e'cluded from the policy and may be ordered up to seven day supply. Heparin infusions require evaluation of a$TT daily for continuance. S 4lbumin level should be chec*ed daily before dispensing e'cept in case of burns. ;- )t is the responsibility of the nurse to notify the physician prior to the e'piration of the medical orders. >- )t is the responsibility of the pharmacist to dispense only the quantities of drug needed daily to complete the physician s orders for these drugs "ithin the above time frames.

*- Responsi$ilities(
S 3ursing department S 2edical department S 2ain pharmacy

+- Procedure(
S Orders should be entered to the system according to the duration set for each class of medications. Ho"ever , all the pre-e'isting orders shall be canceled "hen the patient is transferred bet"een nursing units. 3e" orders shall be "ritten by the medical team receiving the patient on the ne" 3ursing unit after the evaluation of the patient s condition. 8ote that, pharma#ists review medi#al orders and perform patient monitoring on daily basis in order to intervene whenever there is a wrong dose, drug&drug or drug&disease intera#tion, dose&ad9ustment a##ording to the renal and hepati# fun#tion, side effe#t monitoring, monitoring serum levels: therefore, whenever pharma#ists intervene, they fill the ;pharma#ist intervention from <in order to *eep a re#ord of the intervention and to be able to follow it.