Hospital Pharmacy Management and Clinical Practice
Classification and Organization of Hospitals
Hospitals are classified based on clinical specialization, ownership, bed strength, and level of care.
Clinical Basis
- Medicine: Internal medicine, pediatrics, dermatology, psychiatry, cardiology.
- Surgery: General surgery, orthopedics, neurosurgery, ophthalmology, ENT.
- Maternity & Gynecology: Specialized in obstetrics and women’s health.
- Specialty/Disease-Specific: Tuberculosis, oncology, and psychiatric care.
Non-Clinical Basis (Ownership and Control)
- Government/Public: Funded by central, state, or local authorities (e.g., Civil or Military Hospitals).
- Semi-Government/Autonomous: Operated by statutory bodies (e.g., AIIMS, Railway Hospitals).
- Private/Voluntary: Trust/Charitable (non-profit) or Corporate (for-profit).
Size (Bed Strength)
- Small: Up to 100 beds.
- Medium: 101 to 300 beds.
- Large: 301 to 1,000 beds.
- Very Large: Above 1,000 beds.
Hospital Pharmacy: Functions and Layout
A Hospital Pharmacy is a specialized department dedicated to the procurement, storage, compounding, packaging, quality testing, and distribution of medications, alongside clinical patient care.
Major Functions
- Procurement & Inventory: Planning and managing high-quality pharmaceutical stocks.
- Dispensing: Accurately filling prescriptions for IPD and OPD.
- Compounding & Manufacturing: Producing non-sterile solutions and sterile IV admixtures.
- Clinical Services: Providing drug information and monitoring adverse events.
Structural Requirements
- Location: Ground floor or basement with elevator access.
- Floors: Smooth, non-porous, seamless epoxy or terrazzo.
- Walls & Ceilings: Washable, moisture-resistant enamel paint.
- Lighting & HVAC: Minimum 100 foot-candles illumination; HEPA-filtered laminar airflow for sterile areas.
Responsibilities of Hospital Pharmacists
In-Patient (IPD) Pharmacist
- Dispensing: Verifying physician orders and maintaining narcotic records.
- Patient Care: Managing ward floor stock and emergency crash carts.
- Direct Care: Participating in ward rounds and providing patient counseling.
Adverse Drug Reactions (ADRs)
Definitions
- ADR: A noxious, unintended, and harmful response to a drug at normal doses.
- ADE: An untoward medical occurrence during treatment, not necessarily caused by the drug.
Classification
- Predictable: Excessive pharmacological action or secondary side effects (e.g., dry mouth from Atropine).
- Unpredictable: Allergic reactions or idiosyncratic responses (e.g., G6PD deficiency).
Drug Interactions
Interactions occur when the activity of a drug is modified by another substance.
- Beneficial: Synergistic effects (e.g., Amoxicillin + Clavulanic acid).
- Adverse: Decreased efficacy or increased toxicity (e.g., NSAIDs + Anticoagulants).
- Pharmacokinetic Interactions: Changes in ADME (Absorption, Distribution, Metabolism, Excretion).
Pharmacovigilance and ADR Detection
Pharmacovigilance is the science of detecting and preventing drug-related problems.
- Spontaneous Reporting: Voluntary reporting by healthcare professionals.
- Methods: Record linkage studies, case-control, and cohort studies.
- Challenges: Under-reporting, reporter bias, and lack of denominator data.
Drug Store Establishment
Licensing (Indian Context)
- Retail: Form 20 (general), Form 21 (biologicals), Form 20F (restricted).
- Wholesale: Form 20B (general), Form 21B (biologicals).
Operational Standards
- Personnel: Mandatory presence of a Registered Pharmacist.
- Space: Minimum 10 sq. meters for retail/wholesale; 15 sq. meters for combined.
- Storage: Adherence to FIFO/FEFO rules and temperature control.
In-Patient Drug Distribution
- Unit Dose Dispensing: Centralized (CUDD) or Decentralized (DUDD).
- Charge Floor Stock: High-cost items billed per use.
- Non-Charge Floor Stock: Routine, low-cost items supplied for general care.