Chapter 22: Introduction to Hospital Pharmacy

DEFINITION:

The practice of pharmacy within the hospital under the supervision of a professional pharmacist is known
as hospital pharmacy.

FUNCTIONS OF HOSPITAL PHARMACY:

1. Forecast of demand
2. Selection of reliable suppliers
3. Prescribing specifications of the required medicament
4. Manufacturing of sterile or non-sterile preparations
5. Maintenance of manufacturing records
6. Quality control of purchased or manufactured products
7. Distribution of medicaments in the wards
8. Dispensing of medicaments to out-patients
9. Drug information source in hospitals
10. Centre for drug utilization studies
11. Implement recommendations of the pharmacy and therapeutic committee
12. Patient counseling
13. Maintaining liaison between medical, nursing and the patient.

OBJECTIVES OF HOSPITAL PHARMACY

1. To professionalize the functioning of the pharmaceutical services in hospitals.
2. To ensure availability of the required medication at an affordable cost at the required time.
3. To plan, organize and implement the policies of the pharmacy.
4. To perform functions of management of material, purchase, storage of essential items.
5. To maintain strict inventory of all items received and issued.
6. To counsel the patient, medical staff, nurses and others involved in patient care on the use of
drugs, possible side effects, toxicity, adverse effects, drug interactions etc.
7. To serve as a source of information on drug utilization.
8. To manufacture drugs, large/ small volume parenterals which are critical for use in patients.
9. To participate in and implement the decisions of the pharmacy and therapeutics committee.
10. To organize and participate in research programmes, educational programmes,
11. To provide training to various members of the patient team on various aspects of drug action,
administration and usage.
12. To engage in public health activities to improve the well-being of the population.
13. To interact, cooperate and coordinate with various other departments of the hospital.

HISTORY & DEVELOPMENT OF HOSPITAL PHARMACY IN INDIA

 During the colonial period and later also for a long time, compounding and dispensing
remained in the hands of ill-prepared legion of compounders. There could not come up a
required level of pharmacy practice as such.
 The state of pharmaceutical service in the hospitals was pathetic. In most of the Government
controlled hospitals there prevailed deplorable conditions.
 The depiction which appeared in an editorial in a premier pharmacy journal (1952) aptly
portrayed the sad state of pharmacy in hospitals. This is what was actually observed on a visit
to a better known hospital, ‘Patients bring their own bottles which are never washed in the
dispensary, the bottles filled with the medicines are never labeled and the instructions are
shouted through a narrow hole through which at the same time the medicines are also thrust
out to a group of people standing outside.
 The patients are expected to recognize their bottles as soon as they emerge from that hole
and, in spite of all the noise and other diversions inside as well as outside the dispensary,
they catch whatever they can of instructions shouted.
 Development of hospital pharmacy in India The pharmacy profession was introduced in India
in the year 1932 and completed 75 years in the year 2007. Development of pharmacy
profession in India: Drug Enquiry Committee 1931: The Government of India appointed the
drugs enquiry committee (1930-31) under the chairmanship of Dr. R.N. Chopra. First
Pharmacy College in India in 1932: With the inspiration of Late Mahamana Pandit Madan
Mohan Malviya and with the untiring zeal and enthusiasm of Late Professor M.L.Schroff, the
Pharmacy Department was established as early as 1932.
 The full 4 year course in pharmacy was started in the year 1937 in B.H.U. Drug Act 1940:
The Govt. of India took nine years to process the drugs act 1940 after submitting the report of
Drugs Enquiry Committee in 1931.
 The Drugs rules were framed in the year 1945 to formulate as per provision of the act.
Hospital Pharmacy: Hospital pharmacy is a department or service in a hospital that provides
pharmaceutical services or pharmaceutical care.
 The objective of the hospital pharmacy services is to provide safe and effective medication
for all patients attending hospitals and clinics.
 Development of hospital pharmacy in India: In the year1959, the model scheme for a
Hospital Pharmacy was approved by the PCI envisioned a hospital with 500 beds or more to
have in addition to the ordinary Hospital Pharmacy.
 Formation of Indian Hospital Pharmacist Association in 1963: During the 15th IPC at Pilani
in 1963 Dr. B.D.Miglani who is known as the Father of Hospital Pharmacy started the Indian
Hospital Pharmacist Association in the country with the founder member of Sh. S.L.Nasa and
Sh. Davender K Jain, Ex-Secretary, Pharmacy Council of India.
 IHPA is the National Professional Body of Hospital Pharmacists engaged in Practice of
Pharmacy. The mission of IHPA is to promote & develop the practice of pharmacy, upgrade
the knowledge and skills of hospital pharmacists.
 There are various committees setup by the govt. to develop hospital pharmacy in India which
includes Mysore Expert Committee -1967, Haathi Committee, National Human Right
Commission (1991), etc.
 Drugs information centers are to facilitate more information about the use of drugs and its
contents for the pharmacists; Software has been developed in which the data of more than
80,000 drugs has been displayed. This can give drug information to the doctors, nurses &
other para medical staff. Some of the Drugs information Centre available in India is Delhi
Institute of Pharmaceutical Sciences and Research, Delhi, L.B.S. College of Pharmacy,
Jaipur, Rajasthan, J.S.S. College of Pharmacy, Mysore, Ooty.
INFRASTRUCTURE / LAYOUT

1. Located in the ground floor or in the first floor.

2. Sufficient space for seating of patients.
3. Waiting room for out-patients. It should contain educative posters on health , hygiene and
offer literature for reading.
4. Suitable space – routine manufacturing of bulk preparations (stock solutions, bulk powders
and ointments etc.
5. Office of the chief
6. Packaging and labeling area
7. Cold storage area
8. Research wing
9. Pharmacy store room
10. Library
11. Radio isotope storage and dispensing area
MANPOWER REQUIREMENTS FOR HOSPITAL PHARMACY

1. General administration of pharmaceutical care (GAPC) had started implementation five

strategic general goals since in 2012.

2. Human resources development and implementation were the 2nd strategic goal among
them. In 2004, the GAPG applied hospital pharmacy staff standard. It was 0, 04 hospital
pharmacists per each bed for each hospital with total 176 working hours per month; 40
hours/week with additional 16 hours divided over the weekends.

3. This qualification of hospital pharmacy staff consisted of a pharmacist and clinical

pharmacists as showed in Table 1.

4. After ten years in 2014, GAPC had revised these strategies based on the increases of
population in Kingdom of india within 2007-2013, the number of hospitals and beds
increased 244 to268 hospitals, and 33,277 to 38,970 beds.

5. Also, the Non governmental number of beds increased 10,822 to 11,397 beds without
increased number of hospitals, and private hospitals with number of beds increased 125
to 136 hospitals, and 11,833 to 14,310 beds in 2009-2013 respectively.

6. The total number of hospitals rose from 408 to 445, and total number beds increased
55,932 to 64,77. Moreover, the number of disease quantities and quality increased, and
the number of hospital admissions, number of ambulatory care visits, in addition to
expanding of pharmacy practice services and several type of clinical pharmacy specialties
for adult and pediatric patients.
SCOPE OF HOSPITAL PHARMACY

Hospitals and other institutions and facilities, such as outpatient clinics, drug-dependency
treatment facilities, poison control centres, drug information centres, and long-term care
facilities, may be operated by the government or privately. While many of the pharmacist’s
activities in such facilities may be similar to those performed by community pharmacists, they
differ in a number of ways. Additionally, the hospital or institutional pharmacist:

• Has more opportunity to interact closely with the prescriber and, therefore, to promote the
rational prescribing and use of drugs;

• In larger hospital and institutional pharmacies, is usually one of several pharmacists, and thus
has a greater opportunity to interact with others, to specialize and to gain greater expertise;

• Having access to medical records, is in a position to influence the selection of drugs and dosage
regimens, to monitor patient compliance and therapeutic response to drugs, and to recognize and
report adverse drug reactions;

• Can more easily than the community pharmacist assess and monitor patterns of drug usage and
thus recommend changes where necessary;

• Serves as a member of policy-making committees, including those concerned with drug

selection, the use of antibiotics, and hospital infections (Drug and Therapeutics Committee) and
thereby influences the preparation and composition of an essential-drug list or formulary;

• Is in a better position to educate other health professionals about the rational use of drugs;

• More easily participates in studies to determine the beneficial or adverse effects of drugs, and is
involved in the analysis of drugs in body fluids;

• Can control hospital manufacture and procurement of drugs to ensure the supply of high-
quality products;

• Takes part in the planning and implementation of clinical trials.