RESPONSIBILITIES OF HOSPITAL PHARMACIST
1) RESPONSIBILITIES OF PHARMACIST TOWARDS IN-PATIENTS:
A. Responsibility in Central dispensing area:
i. To ensure that all drugs are stored and dispensed correctly.
ii. To check the accuracy of the dosages prepared
iii. Maintain proper records
iv. Preparation of bills
v. Co-ordinate over all pharmaceutical needs of the patient
vi. ensure that the proper techniques are used for compounding of the preparations and all
the laws and regulations are followed.
vii. communicate with all pharmacy staffs
viii. keep good knowledge about the drugs and gives information to the staff of hospital and to
patients.
B. Responsibility in the Patient care areas (nursing ward):
i. He gives instructions to nurses regarding administration of the drug.
ii. He advises doctors regarding treatment of the patient if necessary.
iii. He keeps supervision on the drugs, stored in nursing ward.
iv. He ensures that adequate stock of drug is kept in the nursing ward.
v. He helps in the training of new technicians.
vi. He reviews all the prescription to check the accuracy of dose.
vii. He inspects, drug administration chart of each patient and ensure that all drugs are given
to the patient according to the chart.
viii. He rearranges any missing dose of the drug.
ix. He fills forms of drug interaction and adverse-reactions and submits them to authority.
x. He ensures that rational drug therapy is provided to the patients.
C. Direct responsibility of pharmacist towards the patient:
1. He prepares history of patient and communicates to physician.
2. He identifies drugs, brought in the hospital by the patient.
3. He participates in the emergency problems of heart and respiratory system.
4. He assists the physician in selection of drug; its dose and time of administration.
5. Counseling patients
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6. Monitor patients total drug therapy
D. General responsibility:
He provides education and information of drug to all health professionals.
2) RESPONSIBILITIES OF PHARMACIST TOWARDS OUT-PATIENTS:
1. To ensure that all drugs are stored and dispensed correctly.
2. To check the accuracy of the dosages prepared.
3. Maintain proper records
4. He provides drug information to all the patients.
5. He co-ordinates all activities to maximise benefit for the patient.
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IN-PATIENT PHARMACY SERVICES
In patient pharmacy services include:
A- Drug distribution system.
B- Dose adjustment.
C- Intravenous admixture.
D- Drug therapy monitoring.
A- Drug distribution system:
There are 3 different systems for dispensing drugs to inpatients.
1- Complete Floor or ward stock system:
Drugs are stocked in nursing station and nurses are responsible for drug distribution to the
patients (both charges floor stock drug and non-charge floor stock drugs).
Definition of charge floor stock drugs-
“Those medications which are stocked on the pharmacy of nursing station at all times and are
charged to the patients account after they have been administered to him”.
Definition of Non charge floor stock drugs-
“Those medications which are stocked on the pharmacy of nursing station for the use of all
patients on the nursing station and for which there may be no direct charge to the patients
account. In fact the cost of this group of drugs is usually included in the per day cost of the
hospital room”.
Advantages:
a- Ready availability of the required drugs.
b- Elimination of drug return to pharmacy or store.
c- Reduction of drug order for the pharmacy.
d- It reduces manpower in pharmacy.
Disadvantages:
a- Medication errors increase because prescription is not reviewed by pharmacist.
b- Increased drug inventory in the ward.
c- Financial loss due to greater chance for pilferage.
d- It increases chances of drug deterioration.
e- Lack of proper storage facilities on the ward.
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The floor stock system is successfully operated in some hospitals as a decentralized pharmacy
(Satellite pharmacy) under the direct supervision of pharmacists.
Satellite pharmacies-
These are subpharmacies, which receive their supplies (drugs etc) from the main pharmacy. They
are situated on the nursing floor. The pharmacist is available for taking drug history of patient,
observing the patient for drug reaction and toxicity and dispensing unit dosage and I.V. products
with additives.
In this system pharmacist is available to physician, nurse and patient for consultation on clinical
matters.
Selection of charge floor stock drugs-
- The decision of which drugs are to be placed on the wards, nursing station is of P.T.C.
committee.
- The hospital pharmacist provides the required drugs to the wards and nursing stations.
- The drugs are selected on the basis of need.
- The lists of the drugs are consistently revised according to the needs.
- Each drug is chargeable to the patient accounts.
- The patients financial condition should not have effect on clinical needs.
Anti histaminic, antibiotics, anticoagulants, antihypertensives, anti-nauseant, cardiovascular
drugs, diuretics, tranquilizers, anti-spasmodics and miscellaneous are kept as charge stock drugs.
These drugs are used as soon as patient is admitted for relief.
Selection of non-charge floor stock drugs-
The list varies from hospital to hospital. Drugs are selected on the following criteria.
1) Cost of the drug.
2) Frequency of use.
3) Quantity of use.
4) Effect on the hospital budget.
e.g. Mouth wash, Benzoid tincture, Calamine lotion, deodorising spray, ether alcohol mixture,
glycerine, hand lotion, Iodine tincture, Zinc Oxide ointment, etc.
2- Individual prescription order system:
In this system, all medications are dispensed by the pharmacist on individual prescription orders.
These medications are labeled with individual patient’s name and sometimes the instructions for
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dosage. The prescriptions are sent to the pharmacy, where prepared by the pharmacist and the
prescription may be kept in the pharmacy or sent for price. This system is traditionally used only
in the small and/or private hospitals.
Advantages:
a- All medications orders (prescriptions) are directly reviewed by pharmacists so there are less
chances of errors in treatment.
b- It provides interaction between the pharmacists, doctor, patient and nurse.
c- Facilitate charging of private patients.
d- Provides closer control of inventory.
e- Names of medicine appearing on the patient’s handling avoid confusion of nursing staff.
Disadvantages:
a- Consumption of excessive nursing in the preparation of doses and in conducting the medicine-
related activities.
b- Increase potential for drug loss due to waste and deterioration.
c- A large numbers of containers are on the ward under this system may cause increase potential
medication errors unless they are placed in a trolley with drawers labeled for individual patients.
d- Serious medication errors may arise if the dosage instructions are not on the label of the
dispensing medication.
e- Since the nurse may administer the medications to the patient without any reference
(prescription sheet) may leading to dose medication error.
3- Combined stock and individual prescription order system:
In this system, medications are supplied as ward stocks or individually dispensed items.
4- Unit dose distribution system:
Unit-dose medications have been defined as:
“Those medications which are ordered, packaged, handled, administered and charged in
multiples of single dose units containing a predetermined amount of drugs or supply sufficient
for one regular dose application or use.”
Pharmacists prepare every dose of medicine ready for administration.
Methods of dispensing of unit dosages-
There are two methods of dispensing of unit dosage.
1. Central unit dose distribution system (CUDD).
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2. Decentralised unit dose distribution system (DUDD).
1. CUDD-
All inpatients are dispensed in unit doses. All the drugs are stored in the pharmacy. They are
dispensed at the time when the dose is to be administered to patient. The delivery of drug is
made by carts to patient.
2. DUDD-
Satellite pharmacies which are located on each floor of Hospital receives unit dosage form main
pharmacy. Unit dosages are stored in satellite pharmacy. The main pharmacy manufacturer and
packs the unit doses and delivers to satellite pharmacy in carts.
Advantages:
a- Patients are charged for only those doses, which are administered to them.
b- Saves the time of nurses.
c- Allow the pharmacists to interpret or check a copy of the physician’s original order thus
reducing medication errors.
d- Transfers intravenous preparation and drug reconstitution procedures to the pharmacy.
e- More utilisation of professional and non-professional personnel.
f- No wastage and pilferage of drugs.
g- Extends pharmacy coverage and control throughout the hospital from the time the physician
writes the order to the time the patient receives the unit-dose.
h- The pharmacists can get out of the pharmacy and onto the wards where they can perform their
intended function as drug consultants and help provide the team effort that is needed for better
patient care.
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DISPENSING DURING OFF HOURS
The major criticism of small hospital was the lack of pharmaceutical service on 24 hours. Two
major reasons for that are:
1. Shortage of trained personnel.
2. Prohibitive costs.
Means of the hospitals to provide 24-hour a day pharmacy coverage:
A- Use of the Nursing Supervisor:
- It permits the evening and night nursing supervisor to enter the pharmacy and provide limited
type of services. It is the most widely used.
- Disadvantage: 1. Dangerous. 2. An illegal practice (in some areas).
- Nursing personnel serving in this category should be: Specifically prohibited from
compounding a mixture and Restricted to dispensing from the selection of pre-labeled and pre-
packaged items.
B- Emergency Boxes and Night Drug Cabinets:
-Emergency Boxes
They are necessary to expedite treatment in situations where time is of the essence.
So, the emergency box must be:
i. Large enough
ii. Sufficiently compact (to facilitate handling items)
iii. Kept in a ready accessible place (known to all ward personnel).
iv. Ready for use at all times.
- In order to accomplish this goal; the pharmacy should’ve reserve boxes prepared so that the
units may be handled on an exchange basis reduce the period of time without a ready to use
emergency box.
- If the hospital policy charge for the supplies used from emergency box the nurse should prepare
a charge bill and submit it to the pharmacy with the used box.
- “Emergency cart” or “resuscitation cart”; Mobile units have on them the same basic supplies
contained in emergency box plus:
i. Facilities for the administration of oxygen
ii. The application of suction
iii. A cardiac pacemaker.
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- Emergency box must be checked on regular basis by hospital pharmacist, In order to: Remove
outdated and deteriorated medications.
- This system requires placing an inventory and product control card in the box.
- The objectives of the card;
1. Serves as an inventory of the emergency box.
2. Shows when the unit was last checked
3. Provides the nursing personnel with adequate directions for replenishing any item which may
have been used.
The night drug supply cabinet:
- This is an adjunct to the charge floor stock medications already on the pavilion. Range from
simple cabinets with drawers to large elaborate installations which include narcotic vaults and
refrigerate compartments.
- The large cabinets are usually constructed in the wall of the pharmacy →→ serviced from
within the pharmacy →→ yet is accessible from the corridor side to authorized nursing
personnel.
- It should be stocked with: Pre-packaged, Labeled containers of the drugs• Many hospitals also
store certain medical and surgical supplies.
- The nursing supervisor leave identified charge bill Listing: – the item removed – To whom it
was administered. The next morning the pharmacy personnel restock the unit and forward the
charged bill to accounting office.
C- Use of Physicians:
-This requires the physician to enter the pharmacy and obtain any special medication not
provided through: The floor stocks, Night cabinets or Emergency box.
- Advantage: The physician may be influenced to use available drug which will accomplish the
same purpose.
- Drawbacks: A physician might waste a great time searching for a product. More burden for the
busy physician.
D- Pharmacist on call:
In order to encourage this type of coverage, many administrators have developed:
- Bonus
- Extra pay plans
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- A rotational plan of on-calls will not burden single individual.
E- Purchased Service:
- Contracting with local community pharmacy for: Night, Holiday (vacation). This is relief for
the staff pharmacist.
- Advantages: Safe and legal, protect the drug needs of the hospital and patient, safeguard the
health needs of the area on a round-the-clock basis.
- Where there is more than one pharmacy in the community, care should be taken to avoid any
claims of favoritism or politics.
- This may be accomplished by:
1- Develop a set of specifications and requirement concerning the desired service.
2- Request the local community pharmacies to submit their bids.
3- Only the retail pharmacies with adequate staff, inventory, and delivery service can qualify to
bid.
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