PARTMENT OF HEALTH nal Center for Health Facility Development FD) (20n ContlLirry 11560 ‘poy 240.45 Ps? [2012 /Hostl pharmacy manaoemerk maneiti Republic ofthe Philippines Department of Health OFFICE OF THE SECRETARY MESSAGE Sustaining health care services in the Philippines is an uphill but necessary process. The challenges ahead, such as the high cost of health care services that requires special technical expertise, may prove to be prohibitive. Hence, our road map needs to be paved with strategies, plans, structure, regulations, policies and legal mandates with which to carry out our ideal future state in hospital management and operations. For this reason, the National Center for Health Facility Development (NCHFD) produced a set of health/hospital facility manuals that serve as guide and standard reference for hospital management, service providers and support staff to inject quality in their day-to-day operations at various aspects of work and service delivery points in the hospital. While our initiatives are focused on addressing the disparities between public and the private hospital facility performance as well as rural-urban inequities, we need to ensure that the key dimensions of quality care are at the forefront of our core objectives. We envision our approaches to be sustained by (1) informed and empowered individuals, families and communities; (2) competent and responsive health practitioners; (3) effective and efficient health care organizations; and (4) supportive health systems. All these through a sector-wide approach to health care. Letusall constantly engage in more functional partnerships with our health care delivery networks, and in mutually fulfilling relationships with our hospital personnel in order to gain more meaningful achievements that will make our hospital system a real force to improve the health of the Filipino people. FRANGASCO T. Secretary of HealthRepublic of the Philippines Department of Health OFFICE OF THE SECRETARY MESSAGE To operate successfully in today’s globally competitive environment, a health facility must consistently deliver high quality, cost effective care to its clients. Improving health care quality and enhancing each patient's experience of care require attention not only on health system design but also on every process of patient care. The goals and objectives stated at each carefully crafted Hospital Manual are reflective of the fundamental principles in the delivery of a continuum of quality care that is expected to operate efficiently and effectively. Outstanding evidence-based medical care and management practices are born out of resource-rich as well as resource-challenged health systems. Most positive changes are achieved with the judicious and appropriate use of current capabilities of health facilities. In a low-resource environment, quality care can be achieved without compromising the life and safety of patients. Thus, we enjoin every health facility worker from the top management to the frontline and support services to seriously study, discuss among themselves and implement this set of hospital facility/hospital manuals in the best way appropriate to their setting, always keeping in mind human dignity--their own and their clients’--in executing more effective, efficient and responsive health care and management systems.vii REPUBLIC OF THE PHILIPPINES DEPARTMENT OF HEALTH NATIONAL CENTER FOR HEALTH FACILITY DEVELOPMENT Bldg, 4, San Lazaro Compound, Rizal Avenue, Sta. Cruz, Manila ‘Telephone No.: 743-8301 local1401-02: Telefax 742-8091 FOREWORD In line with the thrust of the Department of Health on Health Service Delivery and Good Governance under Fourmula One for Health (F1), the National Center for Health Facilities Development (NCHED) formulates policies and develops standards for the establishment, development, management and operations of health facilities in the country. The NCHFD assumes the technical leadership and coordinates the health facility development initiatives of government and its partners. Efforts to improve the health service delivery and determine the critical areas for continuing quality improvement that ensure patient-centered quality care have been our utmost priority. Health workers and Health Facility/Hospital Administrators have been continuously confronted with a wide range of issues, new trends and technologies in various health care settings. The development of more relevant and responsive policies and guidelines for patient-centered quality care attunes our health systems to this dynamic environment. The National Center for Health Facilities Development (NCHFD) proudly endorses a sct of Manuals for health facilities/hospitals. These Manuals are outputs of Technical Working Groups composed of experts in various fields of health facility management and quality patient care. The Manuals considered Philippine settings while maintaining consistency with international standards. Each of the following individual manuals is best used in conjunction with the other Manuals in the set: 1. Manual of Organization and Management of the Administrative and Finance Service for Hospitals Hospital Property and Supply Management Manual Hospital Nursing Service Administration Manual | Hospital Pharmacy Management Manual . Hospital Nutrition and Dietetics Service Management Manual Manual for Medical Social Workers Fifth edition AUEWNvil 7. Manual of Standards for Infection Control in Health Care Facilities 8. Quality Management Systems in Clinical Laboratories 9. Manual of Standards and Guidelines on the Management of Hospital Emergency Department 10. Revised Organization and Staffing Standards for Government Hospitals The standards and guidelines recommended in this set of Manuals will assist the Administrators and Clinical Practitioners achieve quality services through timely access, efficiency, effectiveness, safety and patient-centeredness in health facility/hospitals. ‘The above-mentioned Manuals will serve as standard reference materials for DOH health facilities/hospitals to aid administrators and clinical practitioners in the management and operations of the various services that directly and indirectly contribute to patient safety and quality patient care, These Manuals are also recommended for use in the health facilities/hospitals of the Local Government Units, the military, the PNP, the private sector and the academe. CRISELDA G- 'SAMIS, MD, FPSP, CESO III Director IVPREFACE Today’s hospital pharmacists are faced with more challenges than ever before, from regulatory changes, to financial pressures, from safety demands to a growing imbalance of supply versus labor costs. These challenges create an extremely difficult environment in which to manage a hospital pharmacy. For many people, the affordability of medicines is a major constraint. Most of the population does not have regular access to essential medicines and the hardest affected are patients at low and middle economic levels. Thus, access to medicines of assured quality and efficacy at affordable prices remain as the government’s nationwide concern. To address this issue, the Department of Health had established the “DOH Integrated Hospital Pharmacy Project.” Through this project, drugs and medicines and other pharmaceutical products were sold in DOH hospitals at low prices to in/out patients and the general public. Furthermore, one of the strategies of the government to lower the prices of pharmaceutical products is through the procurement of drugs and medicines in their generic names and other supplies for sale in DOH hospital pharmacies. It was established through “Expansion of the Gamot sa Presyong DOH” project. Implementation of this project was piloted in three (3) hospitals one each in Luzon (Jose R. Reyes Memorial Medical Center), Visayas (Western Visayas Medical Center), Mindanao (Davao Regional Hospital) through the issuance of Administrative Order No. 47 s. 1999, dated November 3, 1999 (Guidelines in the Implementation/Operation of the Expansion of Gamot sa Presyong DOH). In line with the aforementioned, Department Memorandum No. 85 s. 1999 dated Dec. 14, 1999,was issued in support to the administration’s thrust of reducing prices of drugs/medicines to make affordable to the Filipino people particularly the poor through the implementation of the project in all DOH hospitals. It was followed by the issuance of Administrative Order No. 49-A s. 2000 (Policy Guidelines in the Implementation/Operations of the DOH Botika in all DOH Hospitals), in which all DOH hospitals are mandated to provide continuous supply of quality, safe and efficacious drug products at affordable cost to all patients and clients, The project strengthens the operations of DOH hospital pharmacies.Apparently, the traditional role of hospital pharmacists in drug product preparation and dispensing broadened to a patient oriented approach. Clinical Pharmacy was adopted. This current pharmacy practice includes patient-oriented care with all the cognitive functions of counseling, provision of drug information and monitoring drug therapy, as well as technical aspects of pharmaceutical services including drugs supply management. In the role of managing drug therapy, the pharmacists provide vital contribution to patient care. Relative to this, pharmacists should have the knowledge and skills needed to take up their role and responsibilities and to function as a collaborative member of the health care team. In view of the foregoing, Chapters on Pharmocovigilance and Clinical Pharmacy including Drug Usage Evaluation (DUE), _ Patient Counseling/Education, Drug Information Service (DIS), Poison Control, and Hospital Infection Control are emphasized in this manual. In addition, the users of this manual specially the young and not so young pharmacists that may have forgotten the basic knowledge leaned during college days, are rewarded with information on abbreviations commonly seen in prescriptions, definition of terms and even apothecary and metric equivalents. This 3” edition of the Hospital Pharmacy Management Manual is structured to serve as guide and ready reference for government and private hospital pharmacists and administrators in their day- to- day operations to ensure delivery of optimal pharmaceutical care and quality services to all patients. and clients. _ Cheahesns title EX N. ELLSWORTH, RPh. Development Management Officer IV National Center for Health Facility Developmentxi ACKNOWLEDGEMENTS Firstly, thank God for without His guidance, blessings and gift of wisdom, the success of this endeavor would have been possible. Many individuals have contributed to the preparation of this manual by providing support, ideas, and details of methods or comments on various drafts. The members of the Technical Working Group (TWG) Ms. Faye Diana C, Chua (LCP), Ms. Michaela B. Punzalan (SLH), Ms. Imelda M.Viefia (PHC), Ms. Helen O. Santos (JFMH), Ms. Herculani P. Lepasana (IRRMC), Ms. Emelia P. Pausal (JRMMC), Ms. Cynthia Urgel (NKTI), Ms. Neonita D. Benafin (PCMC), Ms. Amelia M. Manuel (TMC), and Ms. Bheula F. Villanueva (QMMC) generously gave their time in providing insights, doing researches and otherwise helping in the completion of this manual. Special thanks is extended to Dr. Criselda G. Abesamis for her commitment to this project and for generously providing funds and support from the initial phase to the last activity that was undertaken for the modification of this manual. Also, thanks to DOH Undersecretaries Dr. Ethelyn P. Nieto, and Dr. Mario C. Villaverde for their support. Credit is also given to Ms. Amorcita M. Pallera and Ms. Catalina C. Sanchez, for spending their valuable time with the TWG and for their worthwhile advices; Ms. Violeta Alvarez, Chief Pharmacist -PGH and Ms. Ester A. Borja, Department Manager, Auxillary Service, PHC were particularly gracious in sharing their technical expertise and best practices on hospital operations. Similar pleasant obligation is due to Ms. Elizabeth G. Tresvalles Pharmacist -DJFMH for sharing her learned knowledge on Unit Dose Distribution System and for providing the copy of the “Code of Ethics” and to Mrs. Purita R. Tuazon for generously sharing her technical expertise on hospital operations. Sincere gratitude is extended for the untiring guidance of Dr. Melecio Dy, Chief-Support Division, Dr. Victoria Mandai OIC-Management and Systems Development Division, and to the NCHFD advisers and staff namely: Ms. Ma. Theresa Mendoza, Ms. Ma. Ella Guerrero, Ms. Ma. Catherina T.Benedictos, Ms. Madeliene Gabrielle Doromal, Ms. Juris Triunfante, Ms. Zenaida Villaluna, Ms. Myrna Reyes, Ms. Florinda Tuvillo, Ms. Lucita Piiion, Ms. Benedicta Ricohermoso, Mr. Victor Siasoco, Ms. Pheobe Cabab, Mr. Rene Obasa and to the Chief of the National Children’s Hospital, Dr. Robert Enriquez. Kindness and support of the Chief of Hospitals, Medical Center Chiefs and Executive Directors are very much appreciated. Thanks are due to Dr. Ma. Alicia M. Lim, (JRRMMC), Dr. Ruben C. Flores (DJFMH), Dr. Juanito A. Rubio (LCP), Dr. Julius A. Lecciones (PCMC), Dr. Angeles de Leon (OIC- QMMC), Dr. Ludgerio D. Torres (PHC), Dr. Arturo B, Cabanban (SLH), Dr Enrique T. Ona, (NKTI), and Dr. Victor J. dela Cruz (TMC) for allowing their pharmacists to attend meetings, and writeshops during the revision of this manual. The patience and support of Dr. Glorifino Juan (Ospital ng Palawan), Dr. Jose Marie Chan (NMMC), Dr. Gerardo Aquino (VSMMC) all throughout the writeshop done in their respective place are highly recognized and appreciated. And to everyone who have contributed to the successful preparation of this manual, THANK YOU VERY MUCH.xiii Committee on Revision of the Hospital Pharmacy Management Manual Chairperson: Chief,Technical Operations Division - NCHFD Vice-Chairperson: ( — vis nonin Development Management Officer IV (Pharmacy Adviser)- NCHFD Members: MS. CYNTHIA] URGEL MS. FAYE DIANA CHUA Chief Pharmacist - NKT OIC- Pharmacy Section, LCP ' =. (Gergen Ae. . MS. NEONITA BENAFIN MS. {MELDA VIENA Chief Pharmacist - PCMC Chief Pharmacist - PHC Orn MS. AMELIA MANUEL MS. EMEETA) PAUSAL Chief Pharmacist — TMC Chief Pharmaqist, JRRMMC Boo nt kh f MS. HELEN SANTOS, MS. MICHAE, PUNZALAN Chief Pharmacist — Dr.JFMH Chief Pharmacist - SLH ae MS. BEULAH VILLANUEVA Supervising Pharmacist - QMMCDEFINITION OF TERMS Active Ingredient is that portion of a drug that has therapeutic properties. Antineoplastic means acting to prevent, inhibit or half development of @ neoplasm (tumor). It is an agent with antineoplastic properties. Example: Oxalipatin (cloxatin) is an antineoplastic used in the treatment of metastatic of colon cancer. Area Under the Curve (AUC) refers to the amount or extent of drug absorption, Bin card 1 is a stock record form in which information on receipts, prices, issuances and balances of stocks is recorded It is maintained with each product in the storage area as a duplicate record. Bioavailability refers to the rate and extent of availability of an active ingredient from a dosage form as measured by the concentration /time curve in the systemic circulation or its excretion in the urine, Bioequivalence refers to two related drugs that show comparable bioavailability and similar times to achieve peak blood concentration, Biological products are viruses, sera, toxins, and analogous products used for the prevention or cure of human diseases. Clinical toxicology focuses on the effects of substances in patients caused by accidental poisoning or intentional overdoses of medications, drugs of abuse, household products or various other chemicals. Cold Chain Monitors are cards used to monitor the temperature of vaccines during distribution. Dangerous drugs refers to drugs included in the list of Schedules annexed to the 1961 Single Convention on Narcotic Drugs, as amended by the 1972 protocol, and in the Schedules annexed to the 1971 Single Convention on Psychotropic Substances as enumerated in the annexes which are an integral part of the Comprehensive Dangerous Drugs Act of 2002. Device is an instrument, apparatus, or contrivances including their components, parts, and accessories intended for the cure, mitigation, treatment, or prevention of disease in man or animals, or two (2) to affect the structure or any function of the body in man or animals. Dispensing is the act by a validly registered pharmacist of filling a prescription or doctor's order o the patient's chart Drug-Drug Interaction refers to the pharmacologic or clinical response to the administration of a drug combination different from that anticipated from the known effects of the two (2) agents ‘when given alone.avi Drug Outlets are drugstores, hospital pharmacy and other business establishment, which sells drugs or medicines, Drug Product or Medicine is a finished form that contains the active ingredient(s) generally, but not necessarily in association with inactive ingredients. Drugs are articles recognized in the current official United States Pharmacopoeia- National Drug Formulary (USP-NF), official Homeopathic Pharmacopoeia of the United States, Official Philippine National Drug Formulary, or any supplement to any of them, and (2) articles intended for use to diagnosis, cure, mitigation, treatment or prevention of disease in man or animals; and (3) articles (other than food) intended to affect the structure or function of the body of man or animals; and (4) articles intended for use as a component of any articles specified in clauses (1), (2), or (3) but do not include devices or their components, parts or accessories. First Expiry First Out (FEFO) is a method of inventory management in which products with the earliest expiry date are the first products issued, regardless of the order in which they are received. This method is more demanding than FIFO. First In First Out (FIFO) is a method of inventory management in which the first products received is the first products issued. Generic Dispensing is dispensing the patient’s/buyer’s choice from among generic equivalents, i.c. finished pharmaceutical products having the same active ingredient(s), same dosage form and same strength as the prescribed drug. Generic Prescribing means prescribing of drugs and medicines using their generic name(s) ‘or generic terminology Generic Substitution means the act of dispensing a different branded or unbranded drug Product for the drug product prescribed (ie. a pharmaceutical equivalent distributed by a different company) Inventory refers to the total stock kept on hand at any storage point to protect against uncertainty, permit bulk purchasing, minimize waiting time, increase transportation efficiency, and buffer against seasonal fluctuations. Inventory Control is a method of supply management that aims to provide sufficient stocks of drugs at the lowest costs possible. Menu Card is a list of drug products in generic names with brand names, ( if any), and corresponding selling prices, which is posted outside the dispensing area of the hospital pharmacy. It should be readily accessible to the patient/consumer. Medication Error refers to any preventable event that may cause or lead to inappropriate ‘medication use or patient’s harm, while the medication is in the control of the health care professional, patient, or consumer. Non-prescription or over the counter drug ate drugs that may be dispensed even without an order of a validly registered physician, dentist, or veterinarian in duly licensed drug outlets. Whenavii dispensing OTC drugs without a doctor's prescription, it is the duty of the pharmacist to provide the necessary information and direction for use of the drug product Overdose is an intentional toxic exposure either in the form of a suicide attempt or as an inadvertent exposure secondary to intentional drug abuse. Pallet is a transportable flat storage base with or without sides, designed to hold goods and to permit handling by mechanical aids such as pallet trucks and forklifts Peak Plasma Drug Concentration (Cmax) is the plasma drug concentration at Tmax that relates to the intensity of the pharmacological response Piggyback Infusions — are solutions or dilutions given through a secondary line. This is used to administer doses of IV medications such as potassium or antibiotics. The primary line would be the infusion directly connected to a solution administration set going to the venous access. The piggyback is going through another set which tubing will be connected to the injection port of the main line when piggyback unit is hung on an IV pole of at least 6 inches higher than the primary container Pharmaceutical care means the responsible provision of pharmaco-therapy for the purpose of achieving definite outcomes that improve or maintains a patient’s quality of life. It is a collaborative process that aims to prevent or identify and solve medicinal products and health related problems. This is a continuous quality improvement process for the use of medicinal products. Pharmaceutical equivalence refers to medicinal products that contain the same active ingredient(s) in the same dosage forms that meets the same or comparable standards, Pharmaceutical equivalence does not necessarily imply bioequivalence as differences in the excipients and/or the manufacturing process can lead to faster or slower dissolution and/or absorption. Pharmacodynamics is the response following administration of a drug is directly related to the concentration of the drug at the site of its action, which is a function of the dose, administered. Pharmacoeconomics refers to the scientific discipline that compares the value of one pharmaceutical drug or drug therapy to another. It is also defined as “the description and analysis of the costs of drug therapy to healthcare systems and society.” Pharmacokinetics is defined as the quantitative items dependent changes of both the plasma drug concentration and the total amount of drug in the body, following the drug’s administration by various routes, Pharmacy is the branch of pharmacology that deals with the preparation, dispensing, and proper use of drugs, Pharmacotherapeutics refers to the study of the uses of drugs in the treatment of disease.avi Poison is any drug, active principle or preparation of the same capable of destroying life or seriously endangering health when applied externally to the body or introduced internally in moderate dos Poisoning refers to accidental toxic exposure (e.g. the case of an elderly patient who misreads a drug label) or unintentional (c.g. the case of an inquisitive toddler or a child who gives drugs to another child when “playing doctor”) or unawareness of the toxic pressure (e.g. he or she is the victim of an intended homecide) Prescription means a written or electronic order and instruction of a validly registered physician, dentist or veterinarian for the use of a specific drug product for a specific patient or animal. For the purpose of these Rules and Regulations, the doctor's order on the patient’s chart for the use of specific drug(s) shall be considered a prescription, Prescription or Ethical Drugs are drugs that can only be dispensed upon a written order of a validly registered physician, dentist or veterinarian, Quality Assurance is an investigational function involves the auditing of quality control procedure and systems with suggestions for changes as needed. STAT Orders - are defined as emergency medications (needed only in life threatening situations) and writen by the prescribing physician. The physician calls a STAT order to the attention of the nurse so it can be taken off the chart immediately. Pharmacy can fill these orders in five (5) minutes or less if the order is called down and ready for pick up. $-3 license is a license issued by PDEA to the pharmacists who sell, procure, acquire, deal in or with specified (a) dangerous drugs preparations or (b) drug preparations, in parenteral or tablet or capsule form, containing Table I controlled chemicals as the only active medicinal ingredient or containing Table I controlled chemical and therapeutically insignificant quantities of another active medicinal ingredient, It covers activities granted to SI license holders. Stock card is a stock record form that provides basic information for inventory management by recording all transactions for an item including receipts, issues, orders received and stock losses. Therapeutic equivalence means two similar drugs have comparable efficacy and safety. Therapeutic Index is the ratio of the dose that produces toxicity to the dose that produces critically desired or effective response in a population of individuals. Time for Peak Plasma Drug Concentration (Tmax) relates to the rate constants for systemic rug absorption and elimination. Toxicology is the study of poisons, their actions, their detection, and the treatment of the conditions produced by them. Wholesaler means and includes every person who acts as merchant, broker, or agent, who sells or distributes for resale pharmaceuticals, propriety medicines or pharmaceutical specialties.xix LIST OF ABBREVIATIONS AA ADR ADE ALOBS AO APP. BAC BFAD BHES BnB BSA BUR CAA CBA cBO CEA cGMP CHD CHED MA MPS COA COE con CPR cat CRI csc CSR CUA DD DepEd DIS po DPO DOH DR DTI DUE DUR DV EO ER Administrative Aide ‘Adverse Drug Reaction ‘Adverse Drug Events/Experiences Allotment and Obligation Slip ‘Administrative Officer! Administrative Order Annual Procurement Plan Bids and Awards Committee Bureau of Food and Drugs Bureau of Health Facilities Service Botika ng Barangay Body Surface Area Budget Utilization Review Clean Air Act Cost Benefit Analysis Community-based Organization Cost Effectiveness Analysis current Good Manufacturing Practice Center for Health Development Commission on Higher Education Cost Minimization Analysis Chief, Medical Professional Service Commission on Audit Current Operating Expenses Chief of Hospital Certificate of Product Registration Continuous Quality Improvement Cross Reference Index Civil Service Commission Central Supply Room Cost Utility Analysis, Dangerous Drugs Department of Education Drug Information Service Department Order Department Personnel Order Department of Health Delivery Room/Delivery Receipt Department of Trade and Industry Drug Utilization Evaluation Drug Utilization Review Disbursement Voucher Executive Order Emergency Roomax FEFO FIFO GAA Gocc HEMS HEPA HHRDB HOMIS cc IcT Icu IHOMP IM IR Vv LFH LTO MIMS MMD. MOA MOOE MSW NCATS NCHFD NFC NF NGAS NGO NHIP NST OR ore PACOP PAPPI PCA PDAF PDEA PECs PES PHIC PITC PNDF PO. PPhA PPMP PR First Expiry-First Out First In-First Out General Appropriations Act Government Owned and Controlled Corporation Health Emergency Management Staff High Efficiency Particulate Air Health Human Resource Development Bureau Hospital Operations Management Information System Infection Control Committee Infection Control Team Intensive Care Unit Integrated Hospital Operations and Management Program Intramuscular Invoice Receipt Intravenous Laminar Flow Hood License to Operate Medical Index of Medical Specialties Materials Management Division Memorandum of Agreement Maintenance and other Operating Expenses Medical Social Worker National Committee on Affiliation and Training of Students National Center for Health Facilities Development National Formulary Committee National Formulary New Government Accounting System Non-Government Organizations National Health Insurance Program. Nutrition Support Team Operating Room Over-the-Counter Philippine Association of Colleges of Pharmacy Philippine Association of Pharmacists in Pharmaceutical Inductry Patient Controlled Analgesic Priority Development Assistance Fund Philippine Drug Enforcement Agency Precursor and Essential Chemicals Performance Evaluation System Philippine Health Insurance Corporation Philippine International Trading Corporation Philippine National Drug Formulary Purchase Order Philippine Pharmacists Association Project Procurement Management Plan Purchase RequestPRC PS PSHP PTAHC PTC PTR RA RCATS. RIS RR SAL sc SI SOP SPS TPN TT TWG UNICEF - USP WHO WMR ai Professional Regulation Commission Procurement Service Philippines Society of Hospital Pharmacists Philippine Traditional and Alternative Health Care Pharmacy and Therapeutics Committee Professional Tax Receipt Republic Act Regional Committee on Affiliation and Training of Students Requisition and Issue Slip Recovery Room Supplies Availability Inquiry ‘Subcutaneous Sales Invoice Standard Operating Procedures Stock Position Sheet Total Parenteral Nutrition Tetanus Toxoid Technical Working Group United Nations International Children Emergency Fund United States Pharmacopeia World Health Organization Waste Material ReportCommonly Used Abbreviations in Prescriptions Abbreviation Meaning Abbreviation Meaning aa of each NS Normal Saline ac before meals od right eye ad. right ear oint ointment as left ear os left eye am morning ou each eye amp ampoule pm aftemoon/evening au each ear po by mouth bid twice a day postop after surgery BP Blood Pressure pm when necessary/as needed BSA Body Surface Area q every cap capsule qd every day de discontinue medication gh every hour dil dilute gad every other day disp dispense gid four times a day div divide SL sublingual Dx diagnosis sol solution g gram ss One-half Gl gastrointestinal stat immediately gr grain supp suppository git adrop Susp suspension h an hour Sx symptom HCIZ hydrochlorothiazide yr syrup hs at bedtime tab tablet LU, international unit tbsp tablespoonfuul vp intravenous push tid three times a day K Potassium TMP-SMX Trimethoprim- lin liniment sulfamethoxazole lot. lotion M mix meg microgram mEq Milliequivalent mg ml milliliter MS Morphine Sulfate MIX Methotrexate MVE Multivitamin Na Sodium NPO nothing by mouthTABLE OF CONTENTS Message Foreword Preface Acknowledgement Committee on the Revision of the Hospital Pharmacy Management Manual Definition of Terms List of Abbreviations Commonly Used Abbreviations in Prescriptions List of Tables List of Figures List of Appendices PARTI - HosprrAL PHARMACY ADMINISTRATION 1 DEPARTMENT OF HEALTH Hospital PHARMACY SERVICE General Principle Institutional Goals of the Hospital Pharmacy Service Objectives 2 ORGANIZATION AND PERSONNEL Collaborative/Functional Relationships with Other Departments! Services Hospital Pharmacy Personnel Qualifications of the Pharmacy Staff Job Descriptions 3. FUNCTIONS AND POLICIES Policies 4) PHYSICAL PLANT FACILITIES, EQUIPMENT AND OTHER MATERIALS Pharmacy Location Requirements in Securing License to Operate Premises Utensils, Apparatus and Other Equipment Other Materials ‘Additional Requirements Optional References anit Page itt vii ix xi xiii wv xix aii ai xxx xt 33 33 33 34 35 36 31 37axiv Chapter TABLE OF CONTENTS (continued) FINANCIAL MANAGEMENT DOH Guidelines to Improve Hospital Resources Other Financial Resources Pricing Pharmacoeconomics Part IT - PHARMACY OPERATIONS AND PROCEDURES 6 PHARMACY AND THERAPEUTICS CoMMITTEE Functions of the Pharmacy and Therapeutics Committee Policies of the Committee Hospital Formulary System Objectives Hospital Formulary Factors to Consider in Preparing a Hospital Formulary Contents of a Hospital Formulary DRUG PROCUREMENT Drug Procurement Cycle Alternative Mode of Procurement for DOH-Botika Other Means of Acquiring Drug Products/Medicines Consignment System Drug Donations World Health Organization (WHO) Guidelines for Drug Donations Preparation of Purchase Request DRUG STORAGE, SECURITY AND ConTROL Methods of Proper Storage Security of Drugs and Medicines in the Pharmacy ‘Temperature Monitoring INVENTORY MANAGEMENT Purposes of Inventory Importance of Inventory Types of Inventory Page 39 41 42 42 4B 45 47 49 50 Sl 52 52 53 53 S7 58 59 60 60 62 63 66 69 70 72 wa 9 79 79 80Chapter 10 ul 12 ‘TABLE OF CONTENTS (continued) DIsPOsAL Disposal of Spoiled, Expired, Damaged Drugs Products/Medicines Healthcare Waste Management Responsibilities of the Pharmacist Categories of Pharmaceutical Wastes Disposal of Pharmaceutical Wastes Waste Management and Disposal of Cytotoxic Wastes DRUG DISTRIBUTION Dispensing Process In-Patient Drug Distribution Individual Prescription Order Floor Stock or Ward Stock System Combination of Individual Prescription Order and Floor Stock System Unit Dose Drug Distribution System Preparation of Patient’s Medication Profile Dosage Calculations Medicines for Emergency Treatment and Related Medical Supplies Out-Patient Drug Distribution Dispensing Practices for Out Patients, Guidelines in the Filling of Ordinary Prescription as per ‘Administrative No. 63 s 2000 Distribution of Vaccines Guidelines for the Acceptance of Returned Medicines DANGEROUS DRUGS AND THEIR CONTROL Persons Authorized to Engage in Professional Supply of Dangerous Drugs Prescription Requirements for Dangerous Drugs Prescribing and Filling an Order in Emergency Situation Emergency Situation Related to Filling of Emergency Order and Prescribing Dangerous Drugs Drug Preparation Containing Controlled Chemicals False and Misleading Entries in Registers and Records Duty to Notify Loss, Destruction or Discrepancies Safekeeping of Dangerous Drugs and Controlled Chemicals, Page 83 84 84 84 84 85 85 87 88 o1 91 92 92 92 96 98 102 106 106 108 ul 110 112 112 113 uN7 118, 118 119 119 1202owi Chapter 13 14 TABLE OF CONTENTS (continued) Duties Where There is Loss or Theft of Dangerous Drugs ot Controlled Chemical or Their Preparation Storage Area of Dangerous Drugs Prepara CLINICAL PHARMACY Features of a Clinical Pharmacy Service Advantages of the Clinical Pharmacy Service Clinical Pharmacists Competencies Procedures for Clinical Pharmacy Implementation Patient Drug Profile The Patient Medical Chart Drug Effects on Clinical Test Results Diagnostic Procedures Radiological Procedures Nuclear Medicine Procedures Cardiac Procedures Pulmonary Procedures Ophthalmology Procedures Laboratory Tests Drug Usage Evaluation (DUE) Patient Education/Counselling Pharmacist and Patient Roles Guidelines in Patient Counseling Reporting Drug Information Service Poison Control Role of the Pharmacist in Poison Control Properties of Common Drug Products Involved in Poisoning Infection Control Responsibilities of the Pharmacist Specific Infection Control Policies for the Pharmacy Service INTRAVENOUS ADMIXTURE SYSTEM Objectives Duties of the Pharmacist General Procedures for Intravenous (IV) Admixture IV Admixture Solutions/Preparations Required Set-up for IV Admixture Service Page 120 121 122 123 123 125 131 132 134 136 136 136 137 137 138 138 139 142 144 145 147 148 149 154 154 156 160 161 164 166 166 168 168 169 169Chapter 15 16 TABLE OF CONTENTS (continued) Labeling Requirements Intravenous Admixture Incompatibilities Total Parenteral Nutrition (TPN) Antineoplastic Medicines for Infusion Procedures for Safe Preparation of Cytotoxic Drug Products Techniques Used in the Preparation of Cytotoxic Drugs Potential Effects of Exposure to Cytotoxic Drugs Treatment of Cytotoxic Spills Spill Kit Contents of a Spill Kit Transport of Cytotoxic Drugs Pharmacovigilance Objectives Adverse Drug Reactions Six Recognizable Classification of ADR Role of Pharmacist in ADR Role of Pharmacy and Therapeutics Committee on ADR Monitoring Strategies to Prevent ADR Rational Drug Use Medication Errors Safe Medication Practices RECORDS AND REPORTS Records, Reports and Documents Maintained at the Hospital Pharmacy ‘Administrative Reports Required Regulatory Reports/Documents Part III - OTHER PHARMACY SERVICES 7 CONTINUOUS QUALITY IMPROVEMENT (CQD) FOR PHARMACY SERVICE Strategy of Plan Benefits of Continuous Quality Improvement (CQN) Program Measurement of Performance The Pharmacy Service Quality Improvement Program soil Page 171 171 174 181 182 183 185 186 186 186 189 190 190 191 191 194 194 194 197 200 203 208 208 210 211 219 219 220 220 221awit Chapter 18 19 References TABLE OF CONTENTS (continued) Patient-Centered Standards Medication Management and Use (MMU) Standards Pharmacy Service Effectiveness Standards Pharmacy Service Efficiency Standard The Clinical Pharmacy Practice Standards Monitoring Tool for the Assessment of the Hospital Pharmacy Drug Distribution System Standards DISASTER PREPAREDNESS Goals Disaster Codes Implementation of Disaster Codes RESEARCH AND TRAINING Research Human Resource Development Staff Development Continuing Education Hospital Pharmacy Internship Policy Statements General Requirements Specific Objectives Methodology Training Schedule Monitoring and Evaluation Rules and Regulations Requirements for Hospitals Requirements for Colleges/Students Page 225 225 225 226 226 227 231 239 240 241 243 245 245 246 246 247 248 248 249 249 250 250 250 251 251 252 253aovix List OF TABLES Table Page 2.1 Actual Plantilla Positions for Hospital Pharmacy of Selected 2B Hospitals 4.1 Standard Requirement for the Establishment of Hospital Pharmacy 34 4.2 Other Utensils, Apparatus, Equipment and Other Materials Needed 35 in the Hospital Pharmacy Service 13.1 Normal Laboratory Values 140 13.2. Properties of Common Drugs Involved in Poisoning 157 ‘ 13.3. Common Antidotes — Formulation and Dose 158 13.4 Drugs for Supportive Therapy — Formulation and Dose 160 14.1 Indications for TPN 177 14.2 Common IV Orders 179 14.3 Nutritional Requirements for Infants and Children for 180 Weight Categories 14.4 Total Parenteral Nutrition Therapy for Adult Patients 181Figure 241 22 23 24 Bel 61 13.1 14.1 14.2 15.1 LIST OF FIGURES Hospital Pharmacy Service Position Chart Organizational Chart of a 300-Bed Capacity Tertiary Teaching and Training Hospital Organizational Chart of the Pharmacy Division in a Corporate Hospital Organogram of a Tertiary Teaching and Training Hospital Pharmacy Functional Chart Organizational Chart of the Pharmacy and Therapeutics Committee Patient Care Team Flow of Intravenous Admixture Orders Procedures in Dealing with a Spill Kit Flowchart on ADR Report and Monitoring Page 10 27 48 133 169 189 197Appendix mommy = oe List OF APPENDICES Code of Ethics for Pharmacists Department of Health Administrative Order No. 2005-0010, “Guidelines for the Department of Health Retained Hospitals to Engage in Wholesale Procurement and Distribution of Essential Drugs” Department of Health Circular No. 2006-0069, “Application of the Expanded Senior Citizens Act of 2003 and Administrative Order No. 177, s. 2004 on Medicines and Health Related Services” List of Republic Acts Abbreviations of Some Medical Terms Stability and Compatibility Chart Drug-Food Interactions: General Drug Class Recommendations Apothecary and Metric Equivalents Spill Kit Sample Form - Confidential Report on Adverse Drug Experience ‘Sample Form - IV Antibiotic Schedule Sample Form - Medication Incident Reporting Form PNDF Forms Sample Form — Parenteral Nutrition Order Form wot Page 259 261 264 266 268 273 215 278 280 283 284 286 287 291PARTI HOSPITAL PHARMACY ADMINISTRATIONee ith Hospital Ph: 1 DEPARTMENT OF HEALTH HOSPITAL PHARMACY SERVICE GENERAL PRINCIPLE The hospital shall maintain a pharmacy service that is administered in accordance with ethical, professional practices and legal requirements. The hospital pharmacy a client friendly section, is responsible for providing optimal care to in/ out patients and the general public through the promotion of safe, accurate, rational, and cost-effective use of medicines. Moreover, the hospital pharmacists shall collaboratively work with the medical staff and hospital administration to assure quality patient care and to improve pharmacy operations and management. INSTITUTIONAL GOALS OF THE HOSPITAL PHARMACY SERVICE To provide quality pharmaceutical services to in /out patients, general public, and to the allied health professionals and institutions. To deliver total satisfaction by providing client-friendly pharmaceutical services, To provide quality patient care through assuring safe, accurate, rational and cost- effective use of medicines. To maintain standard professional ethics and education. To promote research on pharmaceuticals and hospital pharmacy practices. To disseminate pharmaceutical knowledge and share medication information among hospital pharmacists and members of allied specialties and professions To strengthen hospital pharmacy internship program through the development of a training module. To integrate new technological developments in improving pharmaceutical care and safety. Hospital Pharmacy Management Manual 3General Objective To properly utilize the Pharmacy Service to the maximum geared toward the actual dynamics of better patient care. Specific Objectives * To provide continuous supply of appropriate medicines to the patients in collaboration with the medical staff through the Pharmacy and Therapeutics Committee (PTC). © Torationalize the use and selection of medicines to be procured. © To render immediate and appropriate service to in and out patients, and the general public at all economic levels. «To manage pharmacy operations effectively and efficiently. To develop and provide patient-oriented services. «To strengthen counseling and information dissemination regarding medications. © To conduct and participate in pharmaceutical researches, educational programs and other hospital activities. © To implement automation systems and enforce new processes. ‘© To strengthen Continuous Quality Improvement (CQI) Program.2 ORGANIZATION AND PERSONNEL The Hospital Pharmacy is organized in accordance with the minimum requirements set by the Bureau of Food and Drugs (BFAD), and the One Stop Shop Licensure of the Bureau of Health Facilities Service (BHFS). A licensed pharmacist appropriately qualified by experience, education, and training shall effectively manage the hospital pharmacy under the general supervision of the Chief Administrative Officer or Deputy Director of the Administrative Services. It shall be staffed with adequate number of competent pharmacists and well-trained support personnel, in keeping with the service capability of the hospital. The need to ensure the availability of affordable, quality, safe, and efficacious drugs in the DOH hospitals for in/out patients and to the general public and in support to the government's thrust of reducing the prices of drugs and other pharmaceutical products, the DOH established the “Expansion of the Gamot sa Presyong DOH “ (the forerunner of which is Gamot sa Presyong DOH). Guidelines in the implementation /operations of the “Expansion of the Gamot Presyong DOH was issued through Administrative Order No. 47 s, 1999. The project was implemented to three (3) pilot DOH hospitals in Luzon, Visayas and Mindanao. To effectively implement the project, Pharmacist V and Pharmacist I positions were created. Per issuance of Administrative Order 49-A s, 2000 dated May 9, 2000 (Policy Guidelines in the Implementation/Operations of the DOH Botica in all DOH Retained Hospitals), all DOH hospitals were mandated to implement the DOH Botica. On July 14, 2009, DOH Memorandum Circular No, 2009-0033 was issued to provide all health officials, information and copy of the List of Re-allocated positions effective July 1, 2009 from the Department of Budget and Management. This is in line with Executive Order No. 811 entitled Adopting the First Tranche of Modified Salary Schedule of Civilian Personnel and Base pay schedule of Military and Uniformed personnel in Government and Modified Position Classification System.” In this list pharmacy group positions were revised as follows.Reallocated Positions for Hospital Pharmacists FROM. TO__ POSITIONS | SALARY GRADE |__ POSITIONS __| SALARY GRADE Pharmacist 1 10 Pharmacist I 1 Pharmacist IT 12 Pharmacist IT 15 Pharmacist III 14 Pharmacist IT 15 Pharmacist IV 18 Pharmacist IIT “18 Pharmacist V 20 Pharmacist IV 20 Pharmacist VI 2 Pharmacist V 2 ‘The success in the delivery of any pharmacy service offered will be based on expert ‘management and administrative procedures. As part of the function, the chief pharmacist ‘must be familiar with the health care system in general and the specific functions of the health institution in order to achieve the pharmacy’s goal in cooperation with all other departments and programs that ensures quality care for the patients.The Hospital Pharmacy section is structured to maximize teamwork, promote decision making, and to specify administrative line of authority, functional responsibilities, accountabilities, and designation of employees (see Figures 2.1, 2.2, and 2.3). Chief Pharmacist — lt Supervising Pharmacist — | Senior Pharmacist/s — | Pharmacist/s | Laboratory Aide/s ee Administrative Aide/s Figure 2.1 Hospital Pharmacy Position Chart @ Fioepital PRarmeney Mianeperrent Missal 7CHIEF OF HOSPITAL/MEDICAL CENTER CHIEF CHIEF ADMINISTRATIVE OFFICER PHARMACIST V Chiet Pharmacist PHARMACIST IV, Supervising. Pharmacist PHARMACIST IIL PHARMACIST HI PHARMACIST IIT Senior Pharmacist Senior Pharmacist ‘Senior Pharmacist PHARMACIST IL PHARMACIST IT PHARMACIST IL PHARMACIST 11 Staff Pharmacist ‘Staff Pharmacist ‘Staff Pharmacist Staff Pharmacist PHARMACIST | [ PHARMACIST | [ PHARMACISTY | [ PHARMACISTT | [ PHARMACIST I StattPharmacist | | Staff Pharmacist | [_StaffPharmacist_| [_StaffPharmacist_| [_Staff Pharmacist Figure 2.2 Organizational Chart of a 300 Bed Capacity Tertiary Teaching and Training Hospital NOTE: Provided with support personnel of one (1) Administrative Aide VI and three (3) Administrative Aide IV Adjusted based on the July 14, 2009 DOH Memorandum Circular No. 2009-0033 on “list of rex allocated positions” (effective July 01, 2009) from the Department of Budget and Managemen.fre EXECUTIVE DIRECTOR DEPUTY DIRECTOR FOR PROFESSONAL/ADMINISTRATIVE HEAD, ALLIED MEDICAL/ANCILLIARY/AUNILIARY SERVICES CHIEF, PHARMACY DIVISION "ASSISTANT CHIEF PHARMACIST Pharmacist V SUPERVISING PHARMACIST Pharmacist 1V SENIOR SENIOR SENIOR PHARMACIST PHARMACIST PHARMACIST ‘STAFF STAFF STAFF STAFF STAFF puarmactst| | PHARMACIST] | PHARMACIST] | PHARMACIST] | PHARMACIST Is Pharmacist | | pharmacist Pharmacist | | pharmacist | | Pharmacist I Figure 2.3 Organizational Chart of the Pharmacy Division in a Corporate Hospital NOTE: Provided with support personnel of Laboratory Aides, Administrative Aides and assigned cashier from pool (Cashier's Office) -Organizational Chart of the DOH Corporate Hospital Pharmacy personnel varies.Since the hospital pharmacy serves and interacts with other sections and departments, it is important to understand the relationship of the pharmacy within the hospital. Generally, the hospital pharmacy is directly under the supervision of the Chief, Administrative Officer and has direct accountability to the Chief of Hospital (see Figure 2.4). However, there are government hospitals in which the pharmacy section is under the supervision of the Chief of Clinies/Chief Medical and Professional Service. CHIEF OF HOSPITAL Medical Service Nursing Service Administrative Service ] | MedcaSoc rice Pesan ad | Honea etouee | Pharmacy I Propet nd Sore Medical Records eee r Eagonning wnt re Mee eau Fame 4 Serene ‘eouing Tae wd Landry T | Budget Hovrseping Biling Seeniy H Cashier Engineering Figure 24 Organogram of a Tertiary Teaching and Training HospitalCollaborative / Functional Relationships with Other Departments/Services The hospital pharmacy section contributes to the process improvement and operations of an institution through coordination and collaboration with the health system administrators, medical, nursing staff and from other departments/services. © The Chief of Hospital supports and approves all requirements necessary for the operation and management of the hospital pharmacy. © The Administrative Officer supervises the over all operations and regulatory compliance of the hospital pharmacy. © The Medical Officers and staff closely coordinate with the pharmacists through the Pharmacy and Therapeutics Committee (PTC) on the selection, rational drug use and other drug and pharmacy related matters. * Hospital Health Information ‘Medical Records Officer and Staff provides the pharmacists with drug information and database on Patient’s Medication Records whenever necessary. © The Head of the Nursing Service and staff participates in the regular pharmacy monitoring of medicines stored in the wards (proper storage, movement and utilization of medicines). They provide the pharmacists, data on medication errors, adverse drug experiences and other drug-related concerns. © The Chief Medical Technologist and staff (Laboratory Service) provide the pharmacists information on anti-microbial resistance and susceptibility necessary for drug procurement and dispensing © The Head and Staff of the Dietary Service provides referrals (on request) for total parenteral nutrition and information on any drug-food interactions. ‘© The Head and staff of the Medical Social Work Service (Medical Social Service) provides information on financial capability of the patients and availability of sources for the pharmaceutical requirements of the patients in the service wards. © The Chief Accountant and Staff (Accounting Section) Analyzes the financial reports submitted by the pharmacists that are used as basis for the hospital pharmacy budget estimate.+ Statement of accounts for drugs and medicines are prepared at the Billing Section based on the charge slips issued by the pharmacist to the patients. * The Cashier Section provides Official Receipts (ORs) to the patient/clients and presented to the pharmacist as confirmation of payment for the drug products being purchased. + The Budget Section provides Allocation and Obligation Slip (ALOBS) as an assurance of funds for the purchase of pharmacy supplies and requirements, + The Property and Supply Section facilitates procurement of supplies and ‘materials needed in the hospital pharmacy. HosprrAL PHARMACY PERSONNEL Pharmacists. must be licensed in accordance with the Professional Regulation Commission (PRC). Technicians and support personnel must have basic educational qualifications and training in order to properly assist the professional staff. All personnel are provided with regular continuing education and training to maintain proficiency and competence. To maintain a comprehensive pharmacy service in a hospital, there must be an adequate number of competent and qualified personnel that corresponds to the required hospital pharmacy-staffing pattern, Shortage of qualified pharmacists or trained dispensers, limit the performance of proper control measures in the delivery of pharmacy services. Small hospitals hire a pharmacist that would take eight (8) hours work and be on call to duty whenever needed. Likewise, in hospitals with only one pharmacist, the practice is to maintain floor stock medicines in the ward. The nurse on duty or staff trained in dispensing of commonly prescribed drug products is allowed to issue such medications in the absence of the pharmacist, He/she is required to record the drug products dispensed and are later validated by the pharmacist, Some teaching and training hospitals that provide extensive drug distribution and clinical services have more than twenty (20) staff pharmacists The hospital pharmacy personnel are divided into three major categories: © Management - includes the chief pharmacist and for deputy chief pharmacist, who is responsible for procurement, distribution, and control of all drug products used within the hospital, and in the management of personnel within the hospital pharmacy section. 1 Pharmacy Management Manat @ 12«Professional staff - These professionals are qualified pharmacists who procure, distribute, and control drug products/medicines and supervise support staff undertaking pharmacy activities, © Support staff - often includes a combination of trained pharmacy technician administrative aides. and Table 2.1 shows the hospital pharmacy plantilla positions of a corporate, general, medical, secondary and first level hospitals. ‘Table 2.1 Actual Plantilla Positions for the Pharmacy of Selected Hospitals before the issuance of DOH Memorandum Circular No. 2009-0033 ‘Corporate| Tertiary | Tertiary | Tertiary | Secondary | First level | Hospital | Teaching | Teaching and | Teaching | Level | special 300 bc. | and Training and | Custodial | hospital (PHC) | Training | Medical | Training | Care225 | 10h. Special | Center 450° | General he. arn) devel | Hospital he. Hospital 700 bc. | ORRRMMC) | 250 be EMH) (BRIT) _ (leveld) (level 4) (evel Division Chief 1 1 Pharmacist VI T T 1 Pharmacist V 7 7 Pharmacist IV z z i 7 Pharmacists Tl 3 3 6 z T Pharmacist 5 2 4 1 7 Pharmacist 2 2 Clerk 6 z 2 Siorekeeper Il 7 Taboratory Aide 3 7 Raminisative Aide 5 2 1 1 1 |Qualifications of the Pharmacy Staff Hospital Pharmacy personnel must possess the skills level to provide safe and appropriate care as specified in the scope of services in order to satisfy patients and/or clients needs, Chief Pharmacist BSS. Degree in Pharmacy Duly licensed by law to practice and operate a pharmacy MS in Pharmacy or its equivalent With a minimum of six (6) years work experience ~ ( three (3) years supervisory work and three (3)years as dispensing pharmacist) Have accomplished on the-job training Have attended continuing education seminars, conventions and trainings Computer literate With strong verbal and communication skills With strong problem solving skills Have demonstrated ability to build suecessfil teams and coalition in a complex organizational structure Physically, mentally, and morally fit to work. ing Pharmacist B.S. Degree in Pharmacy Duly licensed by law to practice and operate a pharmacy With a minimum of five (5) years work experience ~ (three (3) years supervisory work and two (2) years as dispensing pharmacist) With at least 18 units of post graduate studies Have accomplished on the job training Have attended continuing education seminars, conventions/trainings Computer literate With strong verbal and communication skills With strong problem solving skills Have demonstrated an ability to build successful teams and coalition in a complex organizational structure Physically, mentally and morally fit to workSenior Pharmacists * BS Degree in Pharmacy * Duly licensed by law to practice and operate a pharmacy © With at least three (3) years work experience (at least one (1) year on supervisory work and two (2) years as dispensing pharmacist) * Have accomplished on the job training * Haye attended continuing education seminars/conventions/trainings © Computer literate * Physically, mentally and morally fit to work Staff Pharmacist/s * BS. Degree in Pharmacy Duly licensed by law to practice pharmacy With at least one (1) year pharmacy practice Have accomplished on-the-job training Have attended continuing education seminars/conventions/training ‘Computer literate Physically, mentally and morally fit to work Laboratory Aide ‘* Completed at least 2" year college of any science course / or a pharmacy aide graduate © With at least two (2) years work experience in a pharmacy. Computer literate © Physically, mentally, and morally fit to work. istrative Aide I1-IV © Completed at least 2™ year college of any course * With at least one (1) year experience in the preparation of routine office correspondence, endorsements, reports and other related clerical works Have passed Career Service Eligibility examination (Sub-professional) Computer literate. Physically, mentally and morally fit to work. Administrative Aide (I) * Atleast high school graduate © With good moral character © Physically and mentally fit to workJOB DESCRIPTIONS Chief Pharmacist The chief pharmacist is responsible for the over all operation of the hospital pharmacy. ‘Administrative and management responsibilities of the chief pharmacist includes planning and integrating professional services, budgeting, inventory control, cost review, audit, maintenance of records and preparation of reports. Specifically, the Chief Pharmacist shall: Establish the goals and objectives of the hospital pharmacy in coordination with the staff, Assure compliance with all legal and regulatory requirements to effectively render hospital pharmacy services (BFAD, DDB/PDEA, and other regulatory agencies). Develop an organizational structure with clearly defined lines of authority and job responsibilities that enable the staff to work together toward common objectives. Instruct, train and supervise employees of the hospital pharmacy. ‘© Orient pharmacy interns on the Standard Operating Procedures (SOPs) of the Pharmacy, hospital organization, and policies. «Approve pharmacy staff schedule of duties Integrate pharmacy services with other hospital departments and with the medical staff to establish multidisciplinary approach on improving patient care. ‘* Prepare and submits Project Procurement Management Plan (PPMP) for medicines, supplies and equipment outlay. © Prepare the pharmacy service operational plan ‘© Seek innovative ways to reduce and contain costs while providing quality care. + Review and update list of pharmaceuticals to be procured. ‘Establish policies and procedures to improve pharmacy services. 16 Mospital Pharmacy Management Manual @EE] * Collate reactions/comments concerning prescribed medications and other pharmacy services rendered. * Report collected reactions/comments to the PTC and BAC * Approve pharmacy requisitions of supplies and medicines. * Provide information concerning medicines and drug therapy to all concemed health personnel in the hospital, * Participate actively as a voting member of the Pharmacy Therapeutics Committee (PTC). * Develop a system to assure continuous quality improvement of the pharmacy services. * Participate in hospital Infection Control program, * Assist in the evaluation of Adverse Drug Reaction (ADR) reports, Drug Utilization Evaluation (DUE) and on Infection Control. * Participate in research activities pharmaceutical and clinical researches. regarding behavioral, socio-economic * Inspect from time to time, the recorded data in the stock cards. * Prepare memoranda to the COH, Administrator and other departments of the hospital regarding pharmacy issues and concerns. * Review and submits financial, statistical, and other required reports. * Plan suitable educational and training programs for professional staff and pharmacy interns, * Conduct Continuous Quality Improvement (CQI) program review of the Pharmacy Service * Participate in the CQI program of the hospital multidisciplinary committee. Hospital Pharmacy Management ManualSn ee) «© Attend meetings/seminar-workshops related to medicines and hospital pharmacy operations. © Recommend pharmacy development to the Chief Administrative Officer or to the Chief of Hospital (COH). Check, evaluate, and approve performance ratings of the pharmacy staff. ‘* Maintain inventory control program. ‘* Monitor distribution of dangerous drugs. + Perform other related functions as instructed by the supervisor. Pharmacist V (prior to the CY 2009 re- allocation of positions for the pharmacy group) In charge of the DOH Botika: e Maintains and update stock cards of available medicines in the DOH Botika. ‘© Conducts inventory of stocks. «© Checks deliveries of supplies and medicines. «Checks and monitors recording of dangerous drugs. + Prepares requisitions of supplies and medicines needed. ‘* Monitors movement of drug/medicines regularly. ‘© Assumes the functions and responsibilities of the chief pharmacist in his/her absence, Supervising Pharmacist "Assists in the over-all supervision of the hospital pharmacy operations. ifically, the Supervising Pharmacist shall: «Assume the functions and responsibilities of the chief pharmacist in his/her absence. Is Hospital Pharmacy Management Manual @* Educate and train pharmacy interns and personnel on the different areas and services of the hospital pharmacy. * Assist in the planning of activities and in the preparation of policies and procedures on the operations of the hospital pharmacy. * Supervise clerical and record -keeping activities, ‘* Supervise compounding activities and preparation of prescriptions that are not commercially available. * Collate reports on Adverse Drug Reactions (ADRs), Infection Control and Drug Utilization Evaluation (DUE). © Supervise the receiving, checking, and proper storage of all drugs, biological products and medical supplies. * Review schedules and duties of the pharmacists and other personnel, * Participate in medical rounds and on the review of the patients’ medication history to promote rational drug therapy. + Supervise inventory taking on pharmaceuticals. * Prepare list of medicines to be procured and submits the same to the Chief Pharmacist. * Prepare list of medicines to be posted at the pharmacy -dispensing counter. ‘© Assist in the planning and preparation of research activities. ‘Assist in the preparation of educational pharmacy programs for professional staff and pharmacy interns. © Supervise/ assist pharmacists in the dispensing of pharmaceutical products. © Assist in the implementation of the CQI program of the hospital pharmacy. * Attend training/seminar-workshops and consultative meetings related to drugs, hospital pharmacy practices and services @ Hospital Pharmacy Management Manual 19