August 14 Aleth Therese L.

Dacanay, RPh, MSc Phar 1

Aleth Therese L. Dacanay, RPh, MSc
Phar
UST Faculty of Pharmacy
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 2
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 3








August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 4
Historical Overview of the Evolution
of Pharmacy Practice
A. Early 20th century (1900-1960)
Traditional role (drug-oriented)
Apothecary, compounding, dispense
supply of pharmaceuticals
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 5
B. 1960-1985 - focus patient-
oriented
Unit dose
IV admixture services (TPN)
Drug information
Development and growth of Clinical
Pharmacy Practice and the role of
the pharmacist as therapeutic advisor.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 6
C. 1985-present
Re-professionalization a new
purpose of pharmacy
Definition and conceptualization of
Pharmaceutical Care
1989
improved patient care focus is totally
on patient
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 7
Pharmaceutical Care
responsible provision of drug therapy for the
purpose of achieving definite outcomes that
improve a patient quality of life.
Monitoring the regimens effect
Outcome:
1. cure of a disease
2. elimination or reduction of patient
symptomatology
3. arresting a disease process
4. preventing a disease or symptoms
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 8
THE HOSPITAL PHARMACY
The separation of pharmacy from
medicine took place in charitable
institutions operated under
governmental or ecclesiastic
authority.
The fact that business intervals
played no part in the delivery of care
to patients in these institutions led to
an eventual division of labor in order
to improve the quality of care.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 9
THE HOSPITAL PHARMACY
This division of labor in the physician-
apothecary function led to the
recognition of pharmacy as a
separate discipline from medicine.
Since the division occurred in
hospitals, the hospital pharmacist was
the first recognized practitioner of the
profession of pharmacy.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 10
The development of hospital
pharmacy in different countries was
vitally affected by educational
standards and by the caliber of its
practitioners.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 11
Thus hospital pharmacy as an
important professional specialty was
virtually neglected in America for
almost 169 years, from the time that
Jonathan Roberts became first
hospital pharmacist at the
Pennsylvania Hospital (Philadelphia)
in 1752, to approximately 1920.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 12
After naming:
Charles Rice (1841 1901) of
Bellevue hospital in New York City
Martin I Wilbert (1865 1916) of the
German Hospital in Philadelphia

it is difficult to recall other equally
prominent contemporary hospital
pharmacist of the same period.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 13
A National Professional Society
1. The American Journal of Hospital
Pharmacy one of the best
professional publication in
international pharmaceutical circles.
2. The International Pharmaceutical
Abstract
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 14
3. The American Hospital Formulary
Service is a comprehensive
unbiased source of information on
drugs provided on a supplemented
basis annually. It serves as the
basis for the pharmacist to extend
his role as pharmaceutical
consultant to the medical profession.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 15
4. Mirror to Hospital Pharmacy
provided the findings from an
exhaustive study of hospital
pharmacy in the US to find out
existing practices in hospital
pharmacy and to improve the quality
and expand the scope of its
pharmaceutical service.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 16
5. Institutes a continuing education
program served to help the hospital
pharmacy practitioner keep up with
current trends of professional
practice.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 17
STANDARDS OF PRACTICE
The movement to develop standards
of practice in the hospital was initiated
by the American College of Surgeons
during the early 1900s.
As a result of their initiative, the 1
st

Minimum Standard for Pharmacies in
Hospitals was presented to the 18
th

Hospital Standardization Conference
of the ACS in 1935.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 18
In 1942, when the ASHP was
organized, a standing Committee on
Minimum Standards was appointed
for the purpose of maintaining and
developing better Minimum
Standards.
In 1950, the original standard of the
ACS was revised by the ASHP.

August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 19
The Minimum Standard for
Pharmacies in Hospitals with Guide to
Application has been revised
periodically, resulting in the ASHP
Guidelines: Minimum Standard for
Pharmacies in Institutions.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 20
To assist hospital administrators and
hospital pharmacists to review their
pharmacy service in terms of
expected qualitative performance,
The JCAHCO has continued to revise
its standards for hospital pharmacy.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 21
Hospital Pharmacy
One of the most important department
among several departments of a
hospital.

August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 22
Hospital Pharmacy
Department or division of the Hospital
wherein the procurement, storage,
compounding, manufacturing,
packaging, controlling, assaying,
dispensing, distribution, and
monitoring, of medications to
hospitalized and ambulatory patients
are performed by legally qualified,
professionally competent
pharmacists.

August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 23
Hospital Pharmacy
The hospital pharmacy exerts a great
deal of influence on the professional
status of the hospital as well as the
economics of the total operational
cost of the institution.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 24
Hospital Pharmacy
Modern day hospital pharmacy also
provides:
Clinical pharmacy services
Drug monitoring
Drug delivery information system
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 25
Hospital Pharmacy: Functions &
Objectives

Pharmacy is recognized as an
essential hospital service in all the
major hospitals.

Managed by professionally qualified
pharmacists.

August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 26
Hospital Pharmacy

It has been realized that only
trained pharmaceutical personnel
are capable of purchasing, storing,
handling, pricing and dispensing of
medications.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 27
Hospital Pharmacy

It is the pharmacist who is an
expert to provide all information
regarding drugs to the health
professionals and also the public.
Therefore, he acts as a link
between the physician and the
patient
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 28
Hospital Pharmacy

A pharmacist is required to
perform various functions in
hospital pharmacy which are as
follows:
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 29
Hospital Pharmacy: Functions
1. Providing specifications for the
purchase of drugs, chemicals,
biologicals, etc.
2. Proper storing of drugs.
3. Manufacturing & distribution of
medicaments such as transfusion
fluids, parenteral products, tablets,
capsules, ointments and stock
mixtures.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 30
Hospital Pharmacy: Functions
4. Dispensing and sterilizing parenteral
preparations which are
manufactured in the hospital.
5. Dispensing of drugs as per the Rxs
of the medical staff of the hospital.
6. Filling and labelling of all drug
containers from which medicines are
to be administered.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 31
Hospital Pharmacy: Functions
7. Management of stores which includes
purchase of drugs, proper storage
conditions and maintenance of records.
8. Establishment and maintenance of Drug
Information Centre which will provide
information regarding medications to the
physician, nurses or any other competent
person who deals in drugs.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 32
Hospital Pharmacy: Functions
9. Patient counseling service while
supplying drugs especially from OP
department.
10. Maintaining liaison between medical
staff, nursing staff and patients.
11. Providing cooperation in teaching
and research programs of the
hospital.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 33
Hospital Pharmacy: Functions
12. Discarding the expired drugs and
containers with worn and missing
labels.
13. Providing drug monitoring services
by studying various effects of drugs
administered to the patients
especially the indoor patients from
Patient Charts maintained in the
wards, etc.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 34
Functions of Hospital Pharmacy
Dispensing
Manufacturing
Purchasing &
Inventory Control
Statistics and
reports
Teaching
Control
Research
OP
Alcohol
Narcotics
Med, Surgical & Lab supplies
Ward or Floor stock
IP
LV Parenterals
Bulk
SV
Parenterals
Surgical Irrigation Fluids
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 35
Hospital Pharmacy Organization
Within the organizational structure of
the hospital the director of pharmacy,
as a department head, reports to the
administrator of the hospital on the
proper operation and management of
pharmacy.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 36
Hospital Pharmacy Organization
The Director of Pharmacy:
formulates and implements
departmental administrative and
professional policies of the pharmacy
subject to the approval of the
administrator.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 37
Hospital Pharmacy Organization
The profession and clinical policies
relating to the hospital pharmacy
practice that have a direct relationship
to the medical staff are formulated
and developed through the Pharmacy
and Therapeutics Committee & are
subject to administrative approval.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 38
The Organizational Structure
The chart attempts to illustrate that
coordination and integration of all the
technical elements of practice must
be implemented effectively into a total
pharmaceutical services.
For example, there are technical and
professional elements of a clinical-
pharmacy service.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 39
On the other hand, there are clinical
components of professional, technical
and clinical implications to the
research and supportive components
to a pharmacy service.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 40
Therefore, one should look at the
organizational structure of a modern
hospital pharmacy in terms of the
overall elements compromising its
services rather than viewing it from a
clinical versus an operational
standpoint.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 41
This philosophical approach to the
organizational and operational
aspects of hospital pharmacy is
essential for effective use of all the
pharmaceutical sciences that underlie
the profession of pharmacy.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 42
A close examination of this
organizational chart shows the many
ramifications of the practice of
pharmacy in todays modern hospital.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 43
There follows a comprehensive job
description of the pharmacists
responsibilities in general hospital
pharmacy activities and in clinical
function and responsibilities.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 44
ADMINISTRATIVE STRUCTURE
OF THE HOSPITAL PHARMACY
A. Director of Pharmacy

Sometimes known as the Chief
Pharmacist or Pharmacy
Manager, the pharmacy director
has varied leadership
responsibilities
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 45
ADMINISTRATIVE STRUCTURE
OF THE HOSPITAL PHARMACY
A. Director of Pharmacy

1. Like all hospital department managers,
the pharmacy director oversees both
personnel and budgetary (fiscal)
matters.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 46
ADMINISTRATIVE STRUCTURE
OF THE HOSPITAL PHARMACY
A. Director of Pharmacy

2.The director also serves on various
hospital committees, typically acting as
secretary of the pharmacy and
therapeutics committee.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 47
ADMINISTRATIVE STRUCTURE
OF THE HOSPITAL PHARMACY
A. Director of Pharmacy

3. As a member of a hospital team, the
pharmacy director may be involved in
community out reach programs.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 48
ADMINISTRATIVE STRUCTURE
OF THE HOSPITAL PHARMACY
A. Director of Pharmacy

4. The pharmacy director sets quality
standards for the department,
evaluating policies and procedures and
implementing changes and innovations
as necessary.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 49
ADMINISTRATIVE STRUCTURE
OF THE HOSPITAL PHARMACY
A. Director of Pharmacy

5. The director is responsible for
developing management strategies to
assure cost effective pharmaceutical
services and for implementing total
quality management (TQM) concepts
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 50
ADMINISTRATIVE STRUCTURE
OF THE HOSPITAL PHARMACY
A. Director of Pharmacy

6. Compliance with accrediting and
regulating agencies (e.g., the joint
Commission on Accreditation of
Healthcare Organization, the
Department of Public Health, the Board
of Registration in Pharmacy).

August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 51
B. Associate or Assistant Director
of Pharmacy
Depending on department size,
the pharmacy have one or more
associate or assistant directors
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 52
B. Associate or Assistant Director
of Pharmacy
1. The associate or assistant director aids
the pharmacy director in the operation
of the pharmacy.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 53
B. Associate or Assistant Director
of Pharmacy
2. Specific tasks include overseeing day-
to-day pharmacy operations,
supervising the sterile products rooms,
and directing pharmacy purchasing.

August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 54
B. Associate or Assistant Director
of Pharmacy
3. When the pharmacy director is absent,
the associate or assistant director
assumes administrative responsibility.

August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 55
C. Staff pharmacists. The employees have
daily responsibility for the pharmacys
distributive and clinical duties.
1. Distributive duties include:
a. Physician order review and filling
b. Unit-dose chart checking
c. Extemporaneous compounding of
parenteral admixture, oral solution,
and topical preparations.
d. Specific assigned tasks, such as
purchasing, inventory control, and
narcotic distribution and control.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 56
2. Clinical duties of staff pharmacists
are varied.
a. Therapeutic assessment. In
addition to evaluating the
appropriateness of prescribed drugs
and dosages, staff pharmacist
monitor for drug-drug interactions and
adverse drug effects.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 57
2. Clinical duties of staff pharmacists
are varied.
b. Staff pharmacist also advise
physicians, participate in
physician rounds, and may
serve on the nutritional support
team.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 58
2. Clinical duties of staff pharmacists
are varied.
c. Other clinical duties of staff
pharmacist include
pharmacokinetic monitoring,
patient discharge counseling
and in service education.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 59
D. Clinical pharmacists. Because of
their specialized education and
training, these pharmacist are
responsible for providing clinical
activities for the hospital pharmacy.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 60
D. Clinical pharmacists.
1. Most clinical pharmacists have an
advanced degree, such as master of
science (MS) in clinical pharmacy or a
Doctor of Pharmacy degree
(PharmD). some also may have
completed a residency of fellowship in
clinical specialty.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 61
2. the clinical pharmacist play a
major role in monitoring and
evaluating drug therapy and
intervening when appropriate.
3. Depending of departmental
organization and hospital size, the
clinical pharmacist also may have
drug distribution duties.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 62
4. Some clinical pharmacists hold
appointments at colleges or
schools of pharmacy, serving as
preceptors to graduate and
undergraduate students.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 63
E. Hospital pharmacy residents. As
graduates of pharmacy programs,
these staff members have a special
interest in hospital practice.
1. Generally, pharmacy residencies
are 1-year or 2-year programs offered
by hospitals alone or in conjunction
with a college or school of pharmacy.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 64
2. Hospital pharmacy residents gain
intensive experience in the
distributive, clinical and administrative
aspects of institutional practice.

3. Many pharmacy residents go on to
graduate school, clinical fellowships,
or entry-level hospital pharmacy
management positions.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 65
4. The ASHP matches potential
pharmacy residents with ASHP
residency programs to facilitate
the selection process for both
residency candidates and
hospitals.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 66
F. Technicians and other support
personnel play an important part in
hospital pharmacy operation.
1. Technicians may be pharmacy
students fulfilling their internship
requirements, or they may be high
school graduates.

August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 67
F. Technicians and other support
personnel
2. Technicians work under the direct
supervision of a pharmacist. In fulfilling
their primary duty (i.e., helping to carry
out the pharmacists responsibilities)
technicians perform the following tasks:
a. Fill unit-dose cart
b. Fill floor stock pharmacy supplies
c. Extemporaneously compound and
prepare intravenous admixtures for
approval by a pharmacist.
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 68
PHARMACIST REQUIREMENT
Bed Strength
# of pharmacist
required
Up to 50 beds 3
Up to 100 beds 5
Up to 200 beds 8
Up to 300 beds 10
Up to 500 beds 15
August 14 Aleth Therese L. Dacanay, RPh, MSc Phar 69