Hospital and clinical pharmacy refers to the provision of pharmaceutical care within hospitals and other clinical settings, where pharmacists play an essential role in ensuring safe and effective medication therapy for patients. These pharmacy professionals work closely with healthcare teams to optimize medication use, manage drug-related problems, and improve patient outcomes. The field of hospital and clinical pharmacy encompasses a wide range of activities, including medication review, therapeutic consultations, medication reconciliation, adverse drug reaction monitoring, and patient education. Pharmacists in these settings collaborate with physicians, nurses, and other healthcare professionals to deliver comprehensive and patient-centered care.
In this article, we will explore the significance of hospital and clinical pharmacy, the roles and responsibilities of hospital pharmacists, the clinical pharmacy services they provide, the importance of collaboration with other healthcare professionals, and the integration of technology to ensure medication safety.Hospital and Clinical Pharmacy is a subject that focuses on the application of pharmacy principles and practices in a hospital or clinical setting. It involves the study of various aspects related to the safe and effective use of medications in patient care.
Upon successful completion of this course, the students will be able to:
- Explain about the basic concepts of hospital pharmacy administration.
- Manage the supply chain and distribution of medicines within the hospital settings.
- Assist the other healthcare providers in monitoring drug therapy and address drug related problems.
- Interpret common lab investigation reports for optimizing drug therapy.
Topics which students will learn in the Hospital and Clinical Pharmacy subject are:
- Definition, scope, and national and international scenario: Hospital pharmacy involves the provision of pharmaceutical care within a hospital setting. It includes various functions such as drug procurement, storage, distribution, and clinical services.
- Organizational structure: The organizational structure of a hospital pharmacy may vary, but it typically includes departments such as inpatient pharmacy, outpatient pharmacy, clinical pharmacy, and drug information services.
- Professional responsibilities: Hospital pharmacists are responsible for ensuring the safe and effective use of medications in the hospital. They collaborate with healthcare teams to provide medication therapy management, monitor patient outcomes, and contribute to patient safety initiatives.
- Good Pharmacy Practice (GPP) in hospital: GPP principles ensure the highest standards of pharmaceutical care, including medication management, quality assurance, and patient counseling.
- Hospital Pharmacy Standards: These standards, such as the FIP Basel Statements and AHSP (Accredited Hospital Pharmacy Standards), provide guidelines for the organization and delivery of pharmacy services in hospitals.
- Introduction to NAQS guidelines and NABH Accreditation: NAQS (National Accreditation for Quality and Safety in Healthcare Services) and NABH (National Accreditation Board for Hospitals & Healthcare Providers) are accreditation programs that focus on quality improvement and patient safety in healthcare facilities.
Different Committees in the Hospital:
- Pharmacy and Therapeutics Committee: This committee is responsible for reviewing and approving the formulary, establishing drug use policies, and monitoring medication-related issues.
- Hospital Formulary: It is a list of medications approved for use within the hospital. The formulary development process involves evaluating the safety, efficacy, and cost-effectiveness of medications.
- Infection Control Committee: This committee works to prevent and control hospital-acquired infections. Pharmacists play a role in ensuring appropriate antimicrobial use and preventing antimicrobial resistance.
Supply Chain and Inventory Control:
- Preparation of drug lists: Hospitals create specific drug lists, such as high-risk drugs, emergency drugs, and restricted antibiotics, to ensure their appropriate use and availability.
- Procedures for drug purchases: This includes drug selection, procurement methods like short-term and long-term contracts, tendering processes, and quotations.
- Inventory control techniques: Pharmacists use various techniques like Economic Order Quantity (EOQ), Reorder Quantity Level, and Inventory Turnover to optimize inventory management.
- Inventory Management of Central Drug Store: Proper storage conditions, distribution, cold chain maintenance, and adherence to First-Expiry-First-Out (FEFO) and First-In-First-Out (FIFO) methods are essential. Disposal of expired drugs and controlled substances is handled according to regulations.
- Documentation: Accurate documentation of drug purchases and inventory management activities is crucial for record-keeping and regulatory compliance.
- Different methods of drug distribution: Individual prescription order method, Floor Stock Method, Unit Dose Drug Distribution Method, and Drug Basket Method are used based on patient care units and medication needs.
- Distribution of drugs to specialized wards: Pharmacists play a role in ensuring timely and accurate medication delivery to critical care units like ICCU/ICU/NICU and emergency departments.
- Automated drug dispensing systems and devices: These technologies automate the medication dispensing process, enhance accuracy, and improve workflow efficiency.
- Distribution of narcotic and psychotropic substances: Special handling, storage, and documentation procedures are followed to ensure compliance with legal and regulatory requirements.
Compounding in Hospitals:
- Bulk compounding: Hospital pharmacies may engage in bulk compounding to prepare customized medications in large quantities, such as intravenous solutions or oral suspensions.
- IV admixture services and incompatibilities: Pharmacists prepare sterile intravenous admixtures, ensuring proper compounding techniques and considering drug compatibility and stability.
- Total parenteral nutrition: Hospital pharmacists are involved in the preparation and monitoring of total parenteral nutrition solutions used in patients who cannot obtain adequate nutrition orally.
Storage, dispensing, and disposal of radiopharmaceuticals: Radiopharmaceuticals, used in nuclear medicine procedures, require special handling, storage, and disposal procedures to ensure radiation safety and regulatory compliance.
Application of Computers in Hospital Pharmacy Practice:
- Use of electronic health records: Pharmacists utilize electronic health records to access patient information, track medication therapy, and communicate with healthcare teams.
- Software used in hospital pharmacy: Hospital pharmacies employ software systems for tasks such as medication inventory management, drug utilization review, and medication reconciliation.
- Definition, scope, and development: Clinical pharmacy focuses on the direct patient care aspects of pharmacy practice. Clinical pharmacists work closely with healthcare teams to optimize medication therapy and improve patient outcomes.
- Daily activities of clinical pharmacists: Clinical pharmacists participate in various activities such as ward rounds, treatment chart review, adverse drug reaction monitoring, drug information services, medication history taking, patient counseling, and interdisciplinary collaboration.
- Pharmaceutical care: Pharmaceutical care is a patient-centered practice that involves identifying and resolving drug-related problems, providing medication therapy management, and ensuring medication safety and effectiveness.
- Medication Therapy Management and Home Medication Review: These services involve comprehensive medication reviews, patient education, and monitoring to optimize medication therapy and improve patient adherence.
Clinical Laboratory Tests:
Significance and interpretation of test results: Pharmacists have knowledge of various clinical laboratory tests and their interpretation to assess disease states. This includes tests related to hematology, liver function, renal function, thyroid function, cardiac disorders, fluid and electrolyte balance, and pulmonary function.
- Types of poisoning: Pharmacists are familiar with various types of poisoning, their clinical manifestations, and the appropriate antidotes for treatment.
- Drugs and Poison Information Centre: These specialized centers provide information resources, advice, and toxicology consultations to healthcare professionals and the public regarding poisoning incidents.
Hospital and clinical pharmacy are integral components of the healthcare system, contributing to optimal patient care, medication safety, and improved treatment outcomes. Clinical pharmacists, through their specialized knowledge and collaborative practice, play a crucial role in ensuring the appropriate use of medications within the hospital setting. With technological advancements and evolving healthcare trends, the future of hospital and clinical pharmacy holds immense potential for further enhancing patient care and safety.