Lecture 1-Introduction to Hospital Pharmacy 2024

Introduction to Hospital
Pharmacy
10 October 2024
D r Ta h a n i A l w i d y a n
A s s i s t a n t P r o fe s s o r I n C l i n i c a l P h a r m a c y a n d T h e r a p e u t i c s .
Department of Clinical Pharmacy and Pharmacy Practice
Faculty of Pharmaceutical Sciences
The Hashemite University
10/24/2024 HOSPITAL PHARMACY 1

Outline
1. Introduction and Background
2. Classification of Hospitals
3. Hospital Pharmacy Overview
4. Core Functions of a Hospital Pharmacist
5. Organizational Structure
6. Technology and Automation in Hospital Pharmacy
7. Drug Information and Poison Control Centers
8. Education, Research, and Continuing Professional Development (CPD)
9. Sustainability and Ethics in Hospital Pharmacy

Introduction and Background
Hospital definition:
An institution for the care, cure, and treatment of the sick and wounded, study of diseases, and
training of healthcare professionals.
Primary Functions:
1. Patient Care: Observational, diagnostic, therapeutic, rehabilitative, and preventive care for
patients.
2. Public Health: Hospitals promote public health activities, reducing the incidence of disease, injury,
and epidemics in the community.

Classification of Hospitals
A. According to the ownership (Jordan):

1. Government or Public Hospitals.
2. Military Hospitals.
3. Non–Government Hospitals (private).
4. University hospitals.
B. According to the size (U.S.A):

1. Small hospitals (< 100 beds).
2. Medium hospitals (100 to 499 beds).
3. Large hospitals: (≥ 500 beds).

C. According to the specialty (UK):
1. General Medical & Surgical Hospitals.
2. Psychiatric Hospitals.
3. Hospices & Palliative Care Centers.

D. Hospitals are classified into primary, secondary and tertiary based on bed capacity.
1. Primary hospitals (less than 100 beds):
▪ providing preventive care, minimal health care and rehabilitation services.
▪ they are a basic level of contact between individuals and families with the healthcare system.
▪ they include general practitioners, family physicians and physiotherapist.
▪ the basic services provided by them are immunization, maternal and child health services,
curative care services and prevention of diseases.
▪ the staff includes a medical officer, a staff nurse and paramedical support staff.

2. Secondary hospitals (>100 beds but less than 500 beds):

▪ preferred with a medium size city, country or district.
▪ they are responsible for providing complete health services and medical education and also
conduct research on regional basis.
▪ these hospitals include cardiologists, urologists, dermatologists and other such specialists.
▪ the services are provided by medical specialists.
▪ the services include acute care, short period stay in hospital emergency department for brief
but serious illness.
▪ there may be providers who remain in contact but do not work in hospitals such as
psychiatrists, physiotherapists, respiratory therapists etc.

3. Tertiary hospitals (more than 500 beds):
▪ these are comprehensive or general hospitals of the city at national or regional level.
▪ they are responsible for providing specialist health services and play a vital role with regard to
medical education and scientific research and they also serve as a medical hub providing care to
multiple regions.
▪ the Patients are admitted into these centres on a referral from primary or secondary health
professionals.
▪ they offer personnel facility as well as facilities for advanced medical investigation and
treatment.
▪ they provide advanced diagnostic support services, specialized intensive care and special
services such as neurosurgery, cancer management, cardiac surgery etc that cannot be provided
by primary and secondary health centres.

Hospital Pharmacy Overview
Hospital Pharmacy Division:
• It is a critical component of healthcare institutions, responsible for the safe and effective
management of medications.
•It serves as the hub for medication procurement, distribution, and clinical services, ensuring that
patients receive optimal drug therapy in collaboration with healthcare teams.
Functions: to ensures safe, cost-effective, and evidence-based medication management within
healthcare institutions e.g. in drug procurement, drug distribution and clinical services.
Pharmacists also play a role in developing hospital policies related to drug use and safety.

Core Functions of a Hospital Pharmacist
Scope of Services
1) Product Services:
▪ Procurement: Hospital pharmacists ensure the acquisition of high-quality medications, adhering to
formulary standards and regulatory requirements.
▪ Preparation: Includes compounding and sterile preparations (e.g., IV admixtures, chemotherapy),
ensuring the accuracy, safety, and proper storage of medications.
▪ Dispensing: Safe and efficient medication dispensing to both inpatients and outpatients, including
verifying prescriptions and packaging medications correctly.
2) Clinical Services:
▪ Therapeutic Drug Monitoring (TDM): Monitoring drug levels (e.g., antibiotics, anticoagulants) to ensure
efficacy and minimize toxicity.
▪ Medication Therapy Management (MTM): Optimizing therapeutic outcomes through reviewing,
adjusting, and monitoring patients' drug regimens.
▪ Patient Counseling: Providing education on medication use, potential side effects, and adherence,
particularly during discharge or transition of care.

Pharmaceutical Services Division in
Hospital Pharmacy
3) Teaching & Research:
1. Education: Training pharmacy students, interns, and residents in clinical and operational aspects of
hospital pharmacy.
2. Residency Programs: Offering postgraduate training in specialized fields (e.g., critical care, oncology)
to develop clinical expertise.
3. Research: Hospital pharmacists engage in clinical research, contribute to evidence-based practice,
and participate in the development of new therapeutic protocols.
4) Interdisciplinary Collaboration
a. Role of Pharmacists in Healthcare Teams
b. Role of Pharmacists as Public Health Initiatives
5) Sustainability and Ethics in Hospital Pharmacy

Interdisciplinary Collaboration
1) Role of Pharmacists in Healthcare Teams
▪ Hospital pharmacists work closely with other healthcare professionals, including physicians, nurses, dietitians,
and therapists, to provide comprehensive patient care.
▪ This collaboration ensures that medication use is safe, effective, and personalized to individual patient needs.
Key Areas of Involvement:
1. Medication Reconciliation: Pharmacists ensure accurate medication histories at transitions of care (admission,
transfer, discharge) to prevent medication errors.
2. Chronic Disease Management: Pharmacists help manage conditions such as diabetes, hypertension, and heart
failure by optimizing medication therapy, adjusting doses, and monitoring patient progress.
3. Multidisciplinary Rounds: Pharmacists participate in patient care rounds in high-risk areas like the ICU,
oncology, and surgery wards, where they offer therapeutic recommendations, monitor drug therapy, and address
potential drug interactions or adverse effects.
Pharmacists' expertise in pharmacotherapy ensures that treatments are appropriate for the patient’s clinical
status, reducing complications and improving outcomes. Their inclusion in teams enables quick, informed
decisions regarding drug therapy, making them crucial in achieving patient-centered care.

Interdisciplinary Collaboration
2) Role of Pharmacists as Public Health Initiatives
▪ Hospital pharmacists play a significant role in advancing public health efforts by overseeing various
programs that enhance medication safety, prevent disease, and optimize the use of medications
within the hospital and the community.
Key Contributions:
1. Vaccination Programs: Pharmacists manage vaccine storage, administration, and patient education
regarding immunizations. They help organize mass vaccination drives, especially during public health
emergencies (e.g., COVID-19).
2. Rational Drug Use: Hospital pharmacists ensure the judicious use of medications by implementing
policies that minimize misuse, overuse, or underuse of drugs. This includes promoting the
appropriate prescribing and dispensing of medications.
3. Antimicrobial Stewardship: A critical area where pharmacists help reduce the spread of
antimicrobial resistance. They develop protocols to ensure the appropriate use of antibiotics, monitor
patient antibiotic use, and educate healthcare providers on proper antimicrobial prescribing
practices.

Sustainability and Ethics in Hospital
Pharmacy
Sustainability in Hospital Pharmacy
Hospital pharmacists are playing an increasingly important role in sustainability efforts, focusing
on the following areas:
1. Pharmaceutical Waste Reduction: Pharmacists help reduce medication waste by ensuring
precise dosing, proper storage, and managing drug expiration dates.
2. Managing Drug Shortages: Hospital pharmacists work to manage limited drug supplies
through effective stock control and prioritizing essential medications.
3. Green Pharmacy Practices: Promoting eco-friendly disposal of medications, minimizing the
environmental impact of pharmaceutical manufacturing, and reducing the carbon footprint
of drug transportation.

Pharmacy
Ethical Challenges in Hospital Pharmacy
Hospital pharmacists frequently face ethical challenges due to limited resources, high costs of
therapies, and complex clinical decisions. Some key areas include:
1. Drug Shortages: Ethical decisions must be made about how to allocate scarce medications,
balancing the needs of different patient populations.
2. Access to Costly Therapies: Hospital pharmacists must navigate the tension between
providing the best possible care and managing high-cost treatments, often working with
budget constraints.
3. End-of-Life Care: Ethical dilemmas arise in balancing aggressive treatments with quality of
life in end-of-life scenarios, often requiring input from pharmacists on medication use in
palliative care settings.

Pharmacy
Role in Ethical Decision-Making
Hospital pharmacists are increasingly involved in institutional ethics committees, where they provide
valuable input on medication use, particularly in cases of limited resources, high-cost therapies, and
patient care decisions. This involvement ensures that medication use is consistent with ethical
principles, patient safety is prioritized, and there is equitable resource allocation across all patients.
Their contribution is vital in:
✓ Resource Allocation: Ensuring fair distribution of medications, especially during shortages.
✓ Policy Development: Establishing guidelines for ethical medication management.
✓ Patient Advocacy: Acting as advocates for patient rights in decisions about drug therapy and access
to medications.
This integration of pharmacists into ethical decision-making processes helps hospitals maintain a
balance between cost-effectiveness, resource availability, and delivering high-quality, compassionate
care.

Organizational Structure
1) Director of Pharmaceutical Services:
1. Oversees all pharmaceutical services, ensuring compliance with legal standards, managing staff, and
setting strategic goals for the department.
2. Responsible for policy development, operational efficiency, and clinical outcomes within the
hospital pharmacy.
2) Pharmacy Managers:
1. Supervise day-to-day operations, manage drug procurement and inventory, and ensure adherence
to policies and protocols.
2. Work closely with other healthcare departments to align pharmacy services with hospital goals.
3) Supervisors:
1. Oversee specific sections or shifts within the pharmacy, ensuring that all tasks are completed
accurately and efficiently.
2. Responsible for training staff and monitoring performance.

Organizational Structure
4) Pharmacists:
1. General Pharmacists: Handle dispensing, drug preparation, and general pharmacy operations.
2. Clinical Pharmacists: Work directly with healthcare teams to optimize drug therapy, perform TDM,
and manage patient care.
3. Specialist Pharmacists: Focus on specific therapeutic areas like oncology, critical care, or infectious
diseases, providing expertise in complex medication management.
4. Pharmacy Residents: Postgraduate pharmacists undergoing specialized training in clinical and
operational aspects of hospital pharmacy.
5) Pharmacy Technicians:
1. Provide essential technical support, including preparing medications, compounding sterile products,
and managing inventory.
2. Assist pharmacists by handling administrative tasks, allowing pharmacists to focus on clinical duties.

Technology and Automation in Hospital
Pharmacy
▪ Technology and automation have significantly transformed hospital pharmacy operations, improving
efficiency, safety, and patient care.
▪ Key advances include:
1. Automated Dispensing Cabinets (ADCs)
✓ Function: ADCs are secure, computerized medication storage and dispensing units. These cabinets
provide controlled access to medications and help track drug use.
✓ Benefits:
• Improved Drug Distribution: Medications are dispensed at the point of care, reducing the time required
to deliver them from central pharmacies.
• Accuracy: ADCs reduce the risk of human error in drug dispensing by providing real-time data on inventory
and dispensing transactions.
• Efficiency: Streamlines medication management and reduces manual work for pharmacists and nurses.
• Security: Enhanced control over medications, particularly high-risk and controlled substances, minimizing
misuse and theft.

Pharmacy
2. Computerized Physician Order Entry (CPOE)
✓ Function: CPOE systems allow healthcare providers to enter medication orders electronically, directly into
a patient’s medical record.
✓ Benefits:
▪ Reduces Medication Errors: CPOE minimizes errors related to poor handwriting, transcription
mistakes, and ambiguous abbreviations.
▪ Clinical Decision Support: Many CPOE systems come with integrated decision support, providing
real-time alerts for potential drug interactions, allergies, and dosing errors.
▪ Efficiency: Improves the speed of medication order processing by eliminating the need for
handwritten or verbal orders.
▪ Improved Communication: Ensures clear and direct communication between physicians,
pharmacists, and nurses, reducing delays and misunderstandings.

Pharmacy
3. Bar-Code Medication Administration (BCMA)
•Function: BCMA technology involves scanning barcodes on patient wristbands and medication
packaging to verify the “seven rights" of medication administration: right patient, right drug,
right dose, right route, and right time, right administration, and right documentation.
•Benefits:
• Enhanced Safety: BCMA prevents medication administration errors by ensuring that the correct
medication is given to the correct patient.
• Real-Time Verification: Provides instant validation that the medication and patient match,
improving accuracy in high-risk environments like intensive care units.
• Tracking and Documentation: Automatically updates patient records after each medication
administration, streamlining documentation and reducing the risk of errors in manual charting.

Pharmacy
4. Artificial Intelligence (AI) and Data Analytics
✓ Function: AI tools and data analytics platforms are used to analyze large datasets from
electronic health records (EHRs), clinical trials, and patient outcomes to support clinical
decision-making and personalized medicine.
✓ Benefits:
• Clinical Decision Support: AI-powered tools assist pharmacists in evaluating complex drug therapies,
predicting adverse reactions, and optimizing drug dosing based on real-time patient data.
• Pharmacovigilance: AI can detect patterns in adverse drug reactions (ADRs) by processing large
volumes of data, improving drug safety monitoring.
• Personalized Medicine: AI helps tailor drug therapies to individual patient genetics, lifestyle, and
medical history, leading to more effective treatments.
• Efficiency: AI-driven automation speeds up tasks such as medication reconciliation, drug inventory
management, and identifying trends in medication usage.

Pharmacy
In summary :
▪ Technology and automation in hospital pharmacy have enhanced patient safety, improved
workflow efficiency, and allowed pharmacists to play a greater role in clinical decision-making.
▪ These tools not only reduce errors but also enable hospital pharmacists to deliver more
personalized and data-driven care.
▪ Each technological advancement, from ADCs and CPOE systems to AI and BCMA, contributes to
the overall goal of optimizing medication management and improving patient outcomes.

Drug Information and Poison Control
Centers
Drug Information Center:
▪ Provides timely, evidence-based information to healthcare providers on drug selection, dosing,
interactions, and adverse events.
▪ Critical role in promoting the safe and effective use of medications.
Poison Control Center:

▪ Offers immediate treatment advice for cases of poisoning or exposure to hazardous
substances.
▪ Reduces unnecessary emergency room visits by managing poison cases via phone
consultations.

Education, Research, and Continuing
Professional Development (CPD)
Education
▪ Hospitals offer in-service training, residency programs, and clinical rotations for pharmacists,
nurses, physicians, and other healthcare professionals.
Research
▪ Hospital pharmacists are involved in clinical trials, pharmacoeconomic research, and quality
improvement initiatives.
▪ Research helps improve hospital services, develops new therapies, and addresses emerging
health threats.
Continuing Professional Development

▪ Pharmacists engage in lifelong learning to stay updated on advancements in pharmacotherapy,
technology, and best practices in patient care.

(CPD) for Pharmacists
▪ Continuing Professional Development (CPD) refers to the ongoing process by which pharmacists maintain and enhance
their professional knowledge, skills, and abilities throughout their careers.
▪ CPD is essential in ensuring that pharmacists stay up to date with the latest advancements in pharmacotherapy,
technology, and evolving healthcare practices.
Importance of CPD
1. Adapting to New Therapies and Practices: With rapid advancements in drug therapies, new diseases, and treatment
protocols, CPD helps pharmacists keep their knowledge current, ensuring the safe and effective use of medications.
2. Integration of New Technologies: The healthcare industry constantly evolves with new technologies, such as
automated dispensing systems, telepharmacy, and electronic health records (EHR). CPD ensures that pharmacists
are proficient in these technologies.
3. Improving Patient Outcomes: Lifelong learning enhances pharmacists' ability to provide patient-centered care,
improving therapeutic outcomes and reducing medication errors.
4. Compliance with Regulations: Regulatory bodies often require pharmacists to complete a certain amount of CPD
hours to maintain their license. This ensures that all practicing pharmacists meet contemporary standards of care.

CPD Activities
Pharmacists engage in various learning activities as part of CPD:
1. Formal Education: Advanced degrees, certifications (e.g., Board Certified Pharmacotherapy
Specialist), and specialized training in areas like oncology or geriatrics.
2. Workshops and Conferences: Participation in professional workshops, seminars, and pharmacy
conferences for real-time updates on innovations and clinical guidelines.
3. Online Courses and Webinars: Digital learning platforms offer flexibility for pharmacists to learn at
their own pace. Topics include the latest clinical guidelines, regulatory changes, and case studies.
4. Research and Publication: Contributing to or reviewing scholarly articles, participating in clinical
research, and publishing findings.
5. Peer Learning: Discussions with colleagues, case reviews, and participation in pharmacy
associations.
6. Self-directed Learning: Reading journals, pharmacotherapy texts, and staying updated on regulatory
updates through newsletters and reports.

Areas of CPD Focus
1. Pharmacotherapy: Learning about new drugs, therapies, and evidence-based treatment
guidelines.
2. Clinical Skills: Enhancing skills in therapeutic drug monitoring, pharmacokinetics, and
disease management.
3. Technology Integration: Staying up to date with new tools like artificial intelligence in
pharmacy, robotic dispensing systems, and electronic health records.
4. Regulatory Compliance: Keeping current with changes in pharmaceutical laws, accreditation
standards, and healthcare policies.

Benefits of CPD
1. Improved Competency: Pharmacists who engage in CPD are better prepared to offer safe,
effective, and cutting-edge pharmaceutical care.
2. Career Advancement: CPD can help pharmacists specialize in fields such as oncology,
pediatrics, or infectious disease, opening doors to career advancement.
3. Quality of Care: Continuous learning allows pharmacists to enhance the quality of care they
provide to patients, which leads to better health outcomes.
4. Professional Satisfaction: Lifelong learning fosters professional growth and job satisfaction
by keeping pharmacists engaged in their profession.

Examples of CPD in Hospital Pharmacy
1. Antimicrobial Stewardship Certification: Pharmacists trained in this area can help hospitals
manage the use of antibiotics, reducing resistance and improving patient care.
2. Critical Care Pharmacy: Specialized training in critical care allows pharmacists to play a
crucial role in ICUs, managing high-risk medications and ensuring patient safety.
3. Oncology Pharmacy: Specializing in oncology requires ongoing education to keep up with
advancements in cancer therapies, chemotherapy protocols, and immunotherapies.
4. Pharmacogenomics: CPD can help pharmacists stay informed on personalized medicine
approaches, using genetic data to optimize drug therapy.

Questions & Discussion
✓ How can hospital pharmacists further improve patient safety in high-risk settings?
✓ What role do you see technology playing in the future of hospital pharmacy?

Thank you
Dr Tahani Alwidyan
[email protected]
[email protected]
http://staff.hu.edu.jo/tahanialwidyan

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Introduction to Hospital

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A. According to the ownership (Jordan):

B. According to the size (U.S.A):

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2. Secondary hospitals (>100 beds but less than 500 beds):

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5) Sustainability and Ethics in Hospital Pharmacy

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▪ Critical role in promoting the safe and effective use of medications.

Poison Control Center:

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Continuing Professional Development

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