CHAPTER 1

Institutional Pharmacy Practice

Institutional Pharmacy Practice

Provision of distributional & clinical
services
Based in institutional setting
Hospital
Long-term care
Hospice
Correctional facilities

Integrated Health Systems

Individual institutions systems
Mission: positively impact health outcomes

Types of Hospital
Factors:
Location
Urban or small rural setting
Single building or campus complex

Size
Specialization

Types of Hospital
Community Hospital
Most common type
Assorted disease and injury
Provides emergency, In&Out patient,
Intensive care

Specialized Hospital
Particular disease
Specific organ
Specific population

Types of Hospital
Teaching Hospital
Serves patient need AND train future health care
professionals
Associated with medical schools

Ownership
For-profit Hospital corporation, private investors
Non-profit religious order, volunteer, community

Government Hospital
Federal, state, county or government

Types of Hospital in the Philippines

According to Ownership:
A. Government
B. Private

According to Functional Capacity

A. General Hospital
B. Specialty Hospital
Particular disease
Particular organ(s)
Particular Group of Patients

According to Trauma Capability

A. Trauma Capable Facility
B. Trauma Receiving Facility

Classification of Hospitals
Type of Service
General
Special
Rehabilitation and Chronic Disease
Psychiatric

Classification of Hospitals
Length of Stay
Short-term hospital
Less than 30 hospital days

Long-term hospital
30 or more hospital days

Classification of Hospitals
Ownership
Governmental
Federal
State
County
City
City-county

Non-governmental
Non profit
For profit
Individual
Partnership
Corporation

Classification of Hospitals
Bed Capacity
Very Small
Small
Medium
Large

below 100
100-500
501-1,000
above 1,000

New Classification of Hospital in the

Philippines
A.O. no. 2012-0012
DOH Bureau of Health Facilities and Services
New Classification of Hospitals and Other Facilities

Level I
Level II
Level III
Other Health care facilities

Primary care facility

Custodial care facility
Diagnostic/Therapeutic facility
Specialized Out-patient facility

Pharmacy Role in the Medication

Use Process
Prescribing

Transcribing

Dispensing

Administration

Usually done by ___________.

PRIVILEGING
Pharmacist can be sources of drug information
Pharmacist can develop protocols (formulary system)

Monitoring

Pharmacy Role in the Medication

Use Process
Prescribing

Transcribing

Dispensing

Administration

Manual or Electronic
More common type is _________ but _________

Monitoring

Pharmacy Role in the Medication

Use Process
Prescribing

Transcribing

Dispensing

Administration

Monitoring

Act of physically transferring the drug product

after review & approval of prescription.
Prone to:___________

Pharmacy Role in the Medication

Use Process
Prescribing

Transcribing

Dispensing

Administration

Monitoring

Usually done by ____________.

Very crucial step in drug use.
Pharmacist can prevent medication errors
thru:
Bar coding
Unit Dose Dispensing
Clearly labeling medications

Pharmacy Role in the Medication

Use Process
Prescribing

Transcribing

Dispensing

Administration

Monitoring

Review laboratory values

Monitor subjective and objective factors
Effective and Toxic effects

Practice Models
Drug-distribution-centered model
Pharmacist distribute drugs & process new
medication orders.
Pharmacist is __________ only to requests of
physicians and nurses.

Practice Models
Clinical-pharmacist-centered model
Two types:
Clinical
Distributive

Practice Models
Patient-centered integrated model
Both clinical and distributive

Key Models of Pharmacy

1

2
3
4
5
6
7
8

Must be interdisciplinary, team-based

Med preparation & distribution must be automated, centralized and done by trained
technicians
Direct patient care > Medication distribution

Health and Drug information will be an advantage

Must promote cost-effective therapy
Must provide pharmacotherapy plan for each patient

Continuous training for general and specialized practice

Must collaborate with community pharmacist

Key Individuals
Pharmacist Roles
Dispensing vs. Clinical
Clinical Pharmacist
Requires training and
residency program
May be a _________ or
__________.

Integrated pharmacist
Both dispensing and
clinical roles

Pharmacist in
Management
supervisor, director

Pharmacist in:
Informatics
Investigational drug
service
Research
Sterile compounding
Emergency care

Key Individuals
Pharmacy Technicians
Purchasing, stocking, preparation and compounding
of medication under the supervision of a
PHARMACIST.
Must have established training standards
Expansion in automated dispensing & information
technology
Assist Clinical Pharmacist in getting lab values, do
patient interview and medication reconciliation.

Automation and Technology

Since before 1990s
efficiency & accuracy of dispensing
Pharmacy automation
Unit-based cabinet (Pyxis, Omnicell)
Most common

Pharmacy robot (McKesson, Robot-Rx)

Automation and Technology

Medication-related technology
Bar-coded medicine administration
Nurse scans the patients wrist band & med bar
code

Smart pumps
programmable devices that allow the user to
predefine minimum and maximum rates of
administration

Computerized prescriber order entry

(CPOE)
Medication ordering information is able to transfer
between the prescriber and the pharmacy

Patient Care Areas

In-Patient
Critical care
higher acuity level; clinical status is constantly changing

General care

Out-patient
Similar to community phar W/O general
merchandise
Caters clinic, discharged and ER patients
Other types: Ambulatory care, home health
care service

Accreditation and Standards of

Practice
Accreditation

Practice standards

Voluntary process by which the

quality of care provided by a
hospital is assessed by an
outside accrediting body on a
routine basis
Done by

Practices that a profession

develops and imposes on
itself
Standards are called Best
practices
Initiated by:

Accrediting Body
Assess & improve quality
of patient care
Suggests improvement
Regulatory Body
Public protection
Impose fines and legal
action

ASHP
PSHP

Importance of Pharmacy
Leadership
Primary
Pharmacist

Pharmacy
Manager

Director of
Pharmacy