Chapter

2: Overview of History of Hospital o Catholic hospitals – charged a small

Pharmacy in the United States fee ; willing to train nuns in pharmacy
• Reforms in nursing, devlpt. of germ theories &
Key Terms & Definitions rise of scientific med & surgery
• Mirror to Hospital Pharmacy – a publication • 1890s – adoption of aseptic surgery
documenting the state hospital pharmacy
services Early 1900s
• ASHP ( American Society of Health-System • traditional role of compounding
Pharmacists ) Hilton Head conference – for • advent of the hospital formulary concept
pharma leaders & educators persuaded the hospital leaders the value of
o 1965 in Hilton Head, South Caroline ; prof. pharmaceutical services
hospitals pharmacies should function • 1920s – Prohibition: inventory control &
as clinical departments manufacture alcohol-containing preps.
• Practice Standard – authoritative advisory • 1930s – American Hospital Assoc. ( AHA)
document o created a Committee of Pharmacy to
o offers advice on min. requirements or analyze problems & make recomm.
optimal method for an issue / problem o Develop minimum standards for hospi
• Pharmacy and therapeutic committee phar & prepare manual of pharmacy
( P&T) - committee of medical staff of a health operations
system
o Establishes a formulary, assesses med. A 50-Year Perspective
Use & makes recommendations • Audit of Pharmaceutical Services in Hospitals
o Physician ( head ) ; RPh ( secretary ) o Book: Mirror to Hospital Pharmacy
• Full time equivalent – method of • 4 themes of changes
standardizing the nos. of full & part-time o Hospitals recognized that RPh must be
employees in charge of drug product acquisition,
o 40 hour week = 1 FTE distribution, control
• Formulary System – structure whereby the o HP have assumed a major role in
med. Staff evaluates, appraises, and selects patient safety
from among the drug products are most o HP assumed a major role in promoting
useful in patient care rational drug therapy
o Framework in w/c med-use policies o HP saw their mission as fostering
are established optimal pt. outcomes
• Formulary – list of drugs approved for use
Drug Product Acquisition, Distribution, & Control
Hospital Pharmacy’s Nascence • American College of Surgeons ( ACS ) - 1949
• Pennsylvania Hospital ( 1752 ) hospital standards
o First hospital in Colonial America o Pharmacy – perceived as a
o Jonathan Roberts – appointed as its complementary service dept. not an
apothecary essential service
o Medicine & pharmacy commonly • Middle of 20th Century
practiced together o Nurses & community RPh were
• Bellevue Hospital ( 1800 ) responsible for hospital phar
o Bulk medicine area • 1950s
o Charles Rice – eminent chief o Bulk compounding
pharmacist o Sterile solution manufacturing

1800s Patient Safety
• Drug therapy consisted of strong cathartics, • 1957 – drug products distributed to inpatients
emetics, & diaphoretics using floor stock or pt. prescription systems
• Clean air & good food rather than meds. • improved drug distribution systems
• Organized pharmacy service was NOT seen as • evolved unit dose drug distribution:
necessary in hospitals o RPh receives physician’s original
• During Civil War: order
o Hospitals sought out RPh for their o RPh reviews order before dispensing
experience in extemporaneous o Meds in single-unit packaging
manufacturing o Meds dispensed in ready to administer
• Influx of immigrants ( Roman Catholics ) form
 o Not more than 24 hr supply is o Expanded clinical research & drug
dispensed product development
o Patient medication profile o Greater complexity & cost of drug
therapy
Promoting Rational Drug Use o Growing interest in improving the
• P&T committee quality of health care services
o Formal mechanism for the phar. • Internal factors
Department & the med. Staff to o Visionary leadership
communicate on drug-use issues o Professional associations
o Promulgated in 1936 o Pharmacy education
o Edward Spease – dean of School of o Postgraduate residency education
Pharmacy at Western Reserve o Practice standards
University )
o Robert Porter – chief RPh at univ’s Visionary Leadership
hospitals • University teaching hospitals
• Use of PIN ( patient identification nos. ) o Inspiring vision about the devlpt of
• American Hospital Assoc. ( AHA) & ASHP ( hospi phar & its role in elevating the
American society of hospital pharmacists ) – status of pharmacy
developed guidance on P&T committee • Arthur Purdum ; Edward Spease ; Harvey AK ;
• Formulary System – med staff working Donald E. Francke
through P&T committee, evaluates, appraises, • Mirror to Hospital Pharmacy
& selects among the drug products available
those that are considered most useful Professional Associations
o Framework in w/c a hospitals’ • ASHP ( American society of health-system
medication-use policies are pharmacists )
established o Had the profound effect on the
• Formulary – approved drug list advancement of hospi phar
• In most hospitals today § Serve as a vehicle for the nurturing,
o RPh track & assess adverse drug expression, & actualization of the
events ( ADEs ) ; conduct professional ideals of HRPh
retrospective drug-use evaluations ; § Creations of resources to assist
monitor patients on high-risk practitioners in fostering the devlpt
therapies of hospi phar practice
• American Pharmaceutical Association (APhA
Fostering Optimal Patient Outcomes o Oldest national pharmacist
• Right drug, right patient, right time organization
• “ The mission of RPh is to help people make • AHFS ( American Hospital Formulary Service
the best use of medicines. “ Drug Information
• transformation of hospi phar department from • American Journal of Health-System Pharmacy
a product orientation to a clinical orientation • ASHP Objectives:
• ASHP Hilton Head conference o Establish min. standards of
o Assess the progress of hospi phar pharmaceutical service in hospitals
departments in implementing clinical o Ensure an adequate supply of
pharmacy qualified HRPh by providing
o Pharmacokinetic monitoring standardized hospi phar training
o American Journal of Hospital Pharmacy o Arrange for interchange of info.
( AJHP ) o Aid the medical profession in the
economic & rational use of medicines
Recap of Major Themes • ASHP Core Strengths
• Hospital pharmacy has been transformed from o Practice standards & professional
a marginal, optional activity into a vital policy
profession contributing to well-being of o Advocacy ( govt affairs )
patients o Residency & technician training
accreditation
Explaining the Transformation o Drug information
• Indirect / External factors o Practitioner education
o Shift of national resources into health o Publications & communications
care

Pharmacy Education • ASHP practice standards:
• 3 important points on role of phar. Ed. in o Requirement for phar practice sites
transforming hospital pharmacy: that conduct accredited residency
o HP has benefited by gaining programs
practitioners who are better educated o Tools for pharmacy directors who
& prepared to meet the demands in seeks administrative approval for
hospital practice practice changes
o Hospital leaders have put pressure on o Guidance…
pharmacy educators to upgrade the § to practitioners who voluntarily
pharmacy curriculum comply w/ national standards
o Faculty members from schools of § to the Joint Commission ( major
pharmacy established practice sites in hospital-accreditation
hospitals organization ) in developing
standards for pharmacy
Postgraduate Residency Education and Training § to regulatory bodies & courts of
• Imperatives for hospital pharmacy residency law
training: § to curriculum committees of
o Hospitals were expanding, creating a schools
growing need for RPh who had been
educated & trained in hospi phar
o Pharmacy education was out of touch
w/ the needs in hospi phar
o Internship training required by state
boards was not adequate prep for a
career in hospi phar
o Hospi phar required specialized
training in manufacturing, sterile
solns, & phar. department adminis.
1907 2 years ( Graduate in Pharmacy )
1925 3 years ( “ “ “ / Pharmaceutical
Chemist )
1932 4 years ( B.S. Pharmacy )
1960 5 years ( B.S. Pharmacy )
2004 6 years ( Pharm.D. )
• Height of mentorship in professionalism in
American Pharmacy

Practice Standards
• Authoritative advisory document
• Issued by an expert body that offers advice on
minimum requirements or optimal method for
addressing an issue / problem
• Minimum Standard for Pharmacies in Hospitals
( by American College of Surgeons
• Revision by ASHP in 1940s specified the ff:
o Organized pharmacy department
under a legally qualified RPh
o RPh’s authority to develop
administrative policies
o Ample nos. of qualified personnel in
the department
o Adequate facilities
o Expanded scope of RPh’s
responsibilities
§ Maintain drug info service
§ Nurse & physician teaching
§ File periodic progress report