Hospital Pharmacy

Hospital Pharmacy

Introduction

·       Hospital pharmacy is a specialized branch of pharmacy practice that integrates clinical services with supply chain management of medicines within a hospital.

·       Unlike retail pharmacy, hospital pharmacy focuses not only on dispensing medications but also on ensuring rational drug use, safety, and therapeutic effectiveness for inpatients and outpatients.

·       It is an essential component of hospital administration that bridges medicine, nursing, and administration for patient-centered care.

·       The organization of a hospital pharmacy depends on the size of the hospital, type of services offered (primary, secondary, tertiary care), and government regulations.

·       The main objectives are:

·        Ensuring the availability of quality medicines.

·        Promoting rational use of drugs.

·        Implementing cost-effective and evidence-based treatment through formulary systems.

·        Coordinating with physicians, nurses, administrators, and drug manufacturers.

·        Safeguarding against medication errors and adverse drug reactions.

Pharmacy and Therapeutic Committee (PTC)

·       The Pharmacy and Therapeutic Committee (PTC) is the principal body responsible for drug policy-making in a hospital.

·       It is a multidisciplinary committee, usually under the medical board or clinical governance unit.

Composition

• Chairperson – Senior physician/medical superintendent.
• Secretary – Chief hospital pharmacist.
• Members – Physicians from different specialties, nurses, administrators, clinical pharmacologists.

Functions

• Drug Selection: Review and approve drugs to be included in the hospital formulary.
• Therapeutic Guidelines: Develop evidence-based treatment protocols.
• Drug Utilization Review (DUR): Monitor drug use patterns, irrational prescriptions, and polypharmacy.
• Adverse Drug Reaction (ADR) Monitoring: Establish pharmacovigilance systems.
• Cost Control: Recommend cost-effective alternatives (generic substitution, therapeutic equivalence).
• Policy Making: Frame policies on procurement, storage, and distribution of drugs.
• Education: Organize training sessions for doctors, nurses, and pharmacists.

Importance

• Promotes rational and evidence-based prescribing.
• Reduces duplication of similar drugs.
• Improves patient safety by monitoring ADRs.
• Ensures budgetary control in drug expenditure.

Hospital Formulary

·       A hospital formulary is an official list of drugs approved by the PTC for use in the hospital.

·       It is considered a dynamic document, regularly updated to reflect current therapeutic practices.

Objectives

• Standardize drug therapy.
• Promote rational prescribing.
• Control hospital expenditure on drugs.
• Avoid irrational use of branded and non-essential drugs.

Content

• Drug Information: Generic names, dosage forms, strengths, indications, contraindications.
• Therapeutic Guidelines: Protocols for management of common diseases.
• Alternatives: Cost-effective substitutes and therapeutic equivalents.
• Restricted/Controlled Drugs: Narcotics, psychotropics, and antibiotics with usage protocols.

Advantages

• Ensures safe and effective therapy.
• Minimizes confusion among prescribers.
• Provides a reference manual for prescribers and pharmacists.
• Reduces procurement and inventory burden.

Pharmacy Communications and Procedural Manual

·       Hospital pharmacy requires well-defined communication channels and documented procedures to ensure consistency in operations.

Pharmacy Communications

• Internal Communication: Between pharmacists, physicians, nurses, and administrative staff for prescriptions, drug availability, ADR reporting, and stock status.
• External Communication: With suppliers, regulatory authorities, and pharmaceutical companies.
• Modes: Circulars, bulletins, memos, email systems, drug alerts, notice boards, and hospital intranet.
• Pharmacy Bulletin/Newsletter: Regular updates on new drugs, formulary changes, drug recalls, ADR reports.

Procedural Manual

A Pharmacy Procedural Manual is a comprehensive document outlining Standard Operating Procedures (SOPs).

Contents include:

1. Drug Procurement Procedures – tendering, supplier selection.
2. Storage Guidelines – temperature, humidity, segregation of controlled drugs.
3. Dispensing Procedures – for inpatients, outpatients, and emergency.
4. Drug Distribution System – unit dose, ward stock, floor stock.
5. ADR Monitoring Protocols.
6. Documentation Requirements – stock registers, narcotic registers, expiry monitoring.
7. Disaster/Shortage Management Plans.

Benefits

• Standardizes pharmacy operations.
• Minimizes errors and discrepancies.
• Serves as a training tool for new staff.
• Facilitates compliance with legal and accreditation standards.

Relationship of Hospital Pharmacist with Medical Representatives

·       Hospital pharmacists frequently interact with medical representatives (MRs) of pharmaceutical companies.

·       The relationship must be professional, ethical, and transparent to avoid conflict of interest.

Role of Medical Representatives

• Provide information about new drugs, formulations, and clinical data.
• Distribute promotional literature and samples.
• Act as a liaison between pharmaceutical companies and hospitals.

Responsibilities of Hospital Pharmacist in Relation to MRs

• Evaluation: Critically assess claims of MRs, focusing on scientific validity rather than promotional hype.
• Formulary Decisions: Use information provided for formulary updates, only after PTC approval.
• Ethical Boundaries: Avoid being influenced by gifts, incentives, or biased information.
• Regulatory Compliance: Ensure drugs comply with hospital policies, national drug laws, and WHO Essential Medicines List.
• Information Sharing: Provide unbiased information to physicians and nurses after careful verification.

Challenges

• Risk of irrational drug promotion.
• Potential conflict of interest.
• Pressure from companies to include branded drugs in formulary.

Good Practices

• Hospital policies should regulate MR visits.
• All new drug requests should be routed through the PTC.
• MRs should be allowed to meet pharmacists/doctors only at designated times.

Video Description

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