21/11/2016

Hospital Pharmacy
 Practice of pharmacy in a
hospital setting including its
Pharmacist Licensure Examination organizationally-related

HOSPITAL PHARMACY facilities and services

LECTURER: CHARLES MANDY G. AYRAN, RPH,

MS HOSPITAL PHARMACY (ON-GOING)

Roles of Hospital Pharmacy Topics

Department Introduction Management and
Control
Procurement Controlling
Hospital and Its
Organization Drug Distribution
Storage Assaying System
Hospital Pharmacy
Department
Compounding Dispensing
Medication Error
Pharmacy and
Manufacturing Distribution Therapeutics Committee

Special
Packaging Monitoring Hospital Formulary Preparations

Health Care Institutions

Long-term Health Facility

Resident Treatment Facility

INTRODUCTION
Health Maintenance Organization

TYPES OF HEALTHCARE INSTITUTIONS, FUNCTIONS OF HOSPITALS, Clinic

MINIMUM STANDARDS AND REQUIREMENTS FOR HOSPITALS

Hospital

1
 21/11/2016

Long-term Health Facility Resident Treatment Facility

 A facility for inpatient care other than a  A facility providing safe, hygienic living
hospital arrangements for residents
 With an organized medical staff,  Regular and emergency health
medical staff equivalent, or medical services are available when needed
director
 With appropriate supportive services
 With continuous ________________
service
 Provides preventive, ________________,
social, spiritual, and ________________
inpatient care to individuals requiring
long-term health care

Health Maintenance Organization Clinic

 A public or private organization that provides and/or manages
comprehensive health services to individuals enrolled in the
health plan
 Facility or area where ______________
patients are seen by appointment,
treated by a group of physicians
practicing together, and where the
patient is not confined as in a
hospital

Hospital Functions of the Hospital

Organized structure which pools together:

Patient Care • Diagnosis and treatment
• Other forms?
Health Professions

Diagnostic and Therapeutic Facilities

Education • Education of medical and allied health professions
• Education of?

Equipment and Supplies Research • Advancement of medical knowledge

• To improve?

Physical Facilities Wellness • Reduction of incidence of illness

• Improvement of?

2
 21/11/2016

Requirements for Hospital Minimum Standards for

Registration Hospital Pharmacies (ASHP)
Compounding, Packaging, and Labelling
Practice Management
Personnel
Medication Delivery
Policy Development
Facilities and Equipment Monitoring

Therapy Optimization
Evaluation

Services
Procurement and Inventory Research

Self-assessment Quiz A:
Identify:
1. A public or private organization that provides and/or manages
comprehensive health services to individuals enrolled in the
health plan
2. A facility providing safe, hygienic living arrangements for

Test Yourself! 3.
residents
Meaning of ASHP
TYPES OF HEALTHCARE INSTITUTIONS, FUNCTIONS OF HOSPITALS, 4. Type of patient care primarily for older adults with a chronic
MINIMUM STANDARDS AND REQUIREMENTS FOR HOSPITALS
illness who require more time to recover before returning home
5. Number of inpatient beds for general hospitals to be accepted
for registration

Self-assessment Quiz B:
Identify the function of hospital related to:
1. Devising new diagnostic procedures
2. Close-working relationships between hospitals and
public-health departments of communicable
HOSPITAL and its
3.
disease
On-the-job training programs
ORGANIZATION
CLASSIFICATION OF HOSPITALS AND OTHER HEALTH FACILITIES,
4. Emergency care SUPPORTING SERVICES, HOSPITAL ORGANIZATION

5. Residencies

3
 21/11/2016

Classification of Hospitals Scope of Services

Scope of Services •Provides services for all kinds
General of illnesses, diseases, injuries
or deformities
Ownership
•Specializes in a particular
Functional Capacity ? disease or condition or in
one type of patient

Ownership Functional Capacity

General Hospital •Levels 1, 2, or 3

? • Created by law
Specialty Hospital
•Trauma-capable Facility?
Trauma Capability •Trauma-receiving Facility?

• Owned, established and operated with funds •Short-term?

? through donation, principal, investment or

other means by any individual, corporation,
association or organization
Length of Stay •Long-term?

Bed Capacity

General Hospitals
Level 1 Level 2 Level 3
Classification of Other
Level 1 plus: Level 2 plus:
Health Facilities
Consulting specialists in:
Teaching/training with
Category A •Primary Care Facility
Medicine
Departmentalized clinical accredited residency

Category B
OB-GYNE
Pediatrics
services training program in the 4
major clinical services
•Custodial Care Facility
Surgery
Emergency and out-patient
Category C
Physical medicine and
services, isolation facilities,
surgical/maternity facilities, dental
Respiratory unit, General ICU,
HRPU, NICU
rehabilitation unit, ambulatory •Diagnostic/Therapeutic Facility
surgical unit, dialysis clinic
clinic

Ancillary services?
More advanced ancillary services More advanced ancillary services
than Level 1 than Level 2
Category D •Specialized Out-patient Facility

4
 21/11/2016

A: __________________ B: __________________
 First-contact healthcare facility that offers basic services  Provides long-term care
including emergency service and provision for normal  Examples:
deliveries
 Custodial Psychiatric Care Facility
 May be:
 Substance/Drug Abuse Treatment
• Dental clinic and Rehabilitation Center
Without beds • Medical out-patient clinic
• Medical facility for overseas workers and seafarers  Sanitarium
 Leprosarium
With in-patient • Infirmary  Nursing Homes
beds • Birthing home

C: __________________ D: __________________
 Performs highly specialized procedures on
 Examines the human body or an out-patient basis
specimens from the human  Examples:
body for the diagnosis,
 Dialysis Clinic
sometimes treatment of diseases
 Ambulatory Surgical Unit
 Examples:
 In-vitro Fertilization Center
 Laboratory Facility  Stem Cell Facility
 Radiologic Facility  Oncology Chemotherapeutic
 Nuclear Medicine Facility Center/Clinic
 Radiation Oncology Facility
 Physical Medicine and Rehabilitation
Center/Clinic

Supporting Services Supporting Services

? • Provision of nursing care ? • Generally under the supervision of a licensed physician who
has basic interest on hematology

Pathology • Cytological and gross anatomical analysis

? • Procurement, planning, and preparation of • Clinical laboratories

food for patient and staff
? • Dx and Tx application of radiant energy

? • Supplies sterile linen, OR packs, & other

medical supplies
Anesthesia • Anesthesia care

? • Provide data for use in research education

• Serve as basis for review and evaluation ? • Very important liaison between the hospital and patient and
his community

5
 21/11/2016

Hospital Organization Medical Staff

BOD • Overall mission and goals of hospital

Hospital Director • Implementation of board directives Open •One in which certain physicians are
allowed to use the private room facilities,

Staff
provided that they comply with all rules
CEO • Day-to-day operations and regulations of the institution

CFO • Revenues and expenses

Director of Nursing • Nursing department handling direct px care

•One in which all professional services,
Department Heads • All aspects of a particular hospital service ? private and charity are provided and
controlled by the attending physician
Medical Staff • Medical care provided to patients

Medical Staff
Attending • Takes care of patient and who has direct involvement with the
staff organizational and administrative duties

Associate • Being considered for advancement to the active medical staff

Consulting • Medical practitioners of recognized professional ability

Honorary • Former staff members, retired or emeritus, and of other

practitioners whom the medical staff chooses to honor
Test Yourself!
CLASSIFICATION OF HOSPITALS AND OTHER HEALTH FACILITIES,
Courtesy • Given privileges to admit an occasional patient to the hospital SUPPORTING SERVICES, HOSPITAL ORGANIZATION

Resident • Receiving specialized clinical training, usually after completing

an internship

Self-assessment Quiz A: Self-assessment Quiz B:

Identify: Identify the type of hospital based on scope of service:
1. First-contact healthcare facility that offers basic services
including emergency service and provision for normal deliveries
1. Ospital ng Maynila
2. Type of hospital in which the average length of stay is < 30 days 2. Dr. Jose Fabella Memorial Hospital
(acute illness, emergency needs) 3. Research Institute for Tropical Medicine
3. Supporting service which provide data for use in research
education 4. St. Luke’s Medical Center
4. Four (4) major clinical service that all hospitals must offer 5. San Lazaro Hospital
5. Medical staff most actively involved in patient care

6
 21/11/2016

Administrative Services
1. Plan & coordinate departmental
activities

HOSPITAL PHARMACY 2.
3.
Develop policies
Schedule personnel & provide

DEPARTMENT 4.
supervision
Coordinate administrative needs of the
DIVISIONS OF THE HOSPITAL PHARMACY DEPARTMENT Pharmacy & Therapeutics Committee
5. Supervise departmental office staff

Education and Training Pharmaceutical Research

1. Coordinate programs of 1. Develop new formulations of drugs
undergraduate & graduate especially dosage forms not
pharmacy students commercially available & of research
2. Participate in hospital wide drugs
educational programs involving 2. Improve formulations of existing
nurses, doctors, etc. products
3. Train newly employed pharmacy 3. Cooperate w/ the medical research
department personnel staff on projects involving drugs

In-patient Services Out-patient Services

1. Provide medications for all in-patients 1. Compound & dispense out-
of the hospital on a 24-hour per day patient prescriptions
basis 2. Inspect & control all clinic &
2. Inspection & control of drugs on all emergency service medication
treatment areas stations
3. Cooperate w/ medical drug research 3. Maintain prescription records
4. Provide drug consultation
services to staff & medical
students

7
 21/11/2016

Drug Information Services Purchasing and Inventory Control

1. Provide drug information on 1. Maintain drug inventory control
drugs & drug therapy to doctors, 2. Purchase all drugs
nurses, medical & nursing
students & the house staff 3. Receive, store & distribute drugs

2. Maintain the drug information 4. Interview medical service

center representatives

3. Prepare the hospital’s pharmacy

newsletter
4. Maintain literature files

Central Supply Services Assay and Quality Control

1. Develop & coordinate 1. Perform analyses on
distribution of medical products manufactured &
supplies & irrigating fluids purchased
2. Develop & revise assay
procedures
3. Assist research division in
special formulations

Manufacturing and Packaging Departmental Services

1. Manufacture wide variety of 1. Control & dispense IV fluids
items in common use at the 2. Control & dispense controlled
hospital substances
2. Operate an overall drug 3. Coordinate & control all drug
packaging & prepackaging delivery & distribution systems
program
3. Undertake program in product
development
4. Maintain a unit dose program

8
 21/11/2016

Sterile Products IV Admixture

1. Produce small volume 1. Centralize the
parenterals preparation of IV
2. Manufacture sterile solution admixture
ophthalmologics, irrigating 2. Review each IV
solutions, etc. admixture for physico-
3. Prepare aseptic dilution of chemical
lyophilized & other unstable incompatibilities
sterile injections for
administration to patients

Radiopharmaceutical Summary
Services Administrative Services Central Supply Services

Education and Training Assay and Quality Control

1. Centralize the procurement,
storage & dispensing of Pharmaceutical Research Manufacturing and Packaging
radioisotopes used in clinical
practice In-patient Services Departmental Services

Out-patient Services Sterile Products

Drug Information Services IV Admixture

Purchasing and Inventory Control Radiopharmaceutical Services

Self-assessment Quiz A:
Identify the division responsible for:
1. Improving formulations of existing products
2. Controlling & dispensing controlled substances
3. Interviewing medical service representatives

Test Yourself! 4.
5.
Developing policies
Inspect & control all clinic & emergency service medication
DIVISIONS OF THE HOSPITAL PHARMACY DEPARTMENT
stations

9
 21/11/2016

Drug Management Cycle

PHARMACY AND 1. Selection
Selection

THERAPEUTICS 2. Procurement
3. Distribution
COMMITTEE (PTC) Use
Management Procurement
Support
4. Use
DRUG MANAGEMENT CYCLE, OBJECTIVES OF PTC, FUNCTIONS OF PTC,
COMPOSITION OF PTC

Distribution

Pharmacy and Therapeutics Functions of PTC

Committee (PTC) Evaluative and advisory capacity
Quality assurance
 Objective: To achieve optimal patient care and safety through to medical staff
rational drug therapy
Formulary of drugs Monitor and evaluate ADRs

 Primary Purposes:
Programs to ensure safe and Drug use evaluation program
effective drug therapy and studies

? • Formulation of policies regarding evaluation, selection, and

therapeutic use of drugs and related devices
Programs to ensure cost-
effective drug therapy
Advise pharmacy department

?
• Recommends or assists in the formulation of programs designed
to meet the needs of the professional staff for complete current
knowledge on matters related to drugs and drug use Educational programs Disseminate information

Sources of Information Composition of PTC

 Martindale: The Extra Pharmacopeia
Voting
• Physicians
 American Medical Association Drug Evaluation Annual • Pharmacists
• Nurses
British National Formulary
members
• Administrators
 • Quality Assurance Coordinators

 Medical Letter on Drugs and Therapeutics • Others, as appropriate

 Drug and Therapeutics Bulletin

 WHO Model List of Essential Drugs
Officers • Chairperson?
• Secretary?

10
 21/11/2016

Self-assessment Quiz A:
Identify:
1. Four (4) steps in the drug management cycle
2. Two (2) primary purposes of PTC
3. Chairperson of PTC

Test Yourself! 4.
5.
Secretary of PTC
Meaning of DUR
DRUG MANAGEMENT CYCLE, OBJECTIVES OF PTC, FUNCTIONS OF PTC,
COMPOSITION OF PTC

Definitions

Formulary
• A method whereby the medical staff of an
institution, working through the PTC, evaluates,
appraises, and selects from among the numerous
System available drug entities and drug products those
that are considered useful in patient care

HOSPITAL FORMULARY
PARTS OF FORMULARY, ESSENTIAL LIST OF DRUGS, MEDICAL SUPPLIES,
• A continually revised compilation of
AND EQUIPMENT, CRITERIA FOR SELECTION
Formulary pharmaceuticals that reflects the current clinical
judgment of the medical staff

Philippine National Drug Parts of a Formulary

Formulary (PNDF)
Information on Hospital Policies and Procedures
• Needed by ________ of the population
Core List • Drugs included must be accessible and readily available
Drug Product Listing

• May also refer to drugs for rare disorders Special Information

Complementary • Drugs included in the list are only prescribed to patients with
List • Developed resistance
• Hypersensitivity or tolerance

11
 21/11/2016

Part I. Information on Hospital Policies Part II. Drug Product Listing

and Procedures Concerning Drugs
 Categories of drugs  “__________ of the formulary” Generic name

 Brief description of the PTC  The entries may be arranged in

any of the ff. ways: Common synonyms/brands
 Hospital regulations regarding prescribing,
 Alphabetically by generic
dispensing, and administration of drugs name Dosage form, strength,
packaging, size
 Pharmacy operating procedures  Alphabetically within
 Information on using the formulary therapeutic class
Formulation (API)
 Combination of the two
systems
Additional information

Part III. Special Information Essential Drugs

 This varies from hospital to hospital and may include:  Those that are deemed to satisfy the health care
 List of hospital-approved abbreviations needs of the majority of the population
 Rules of calculating pediatric dosages  Should be available in the appropriate dosage forms
and strengths at all times
 Dosing guides for patients with renal impairment
 Essential Drugs List?
 Lists of dialyzable poisons, etc.

Advantages of EDL Criteria for Selecting Drugs in the

Formulary
Efficacy and Safety
Improved Supply
Quality

Rational
Relative Benefits
Prescribing
Cost Benefit
Lower Cost
Pharmacologic Advantages and Availability

Better Patient Use Rational Formulation

12
 21/11/2016

Essential Medical Supplies National List of Medical

and Equipment
•Comprise mainly disposable
? items or items with relatively
short life spans
•Encompasses both capital
? equipment and recurrent
equipment
Supplies and Equipment
 Defines priority items and help ensure that the most

essential items are available where needed
Promotes cost-effective use of scarce financial
resources
 Reduces the number of items through standardization
 Serves as the basis for training staff and technicians

Criteria for Selecting Equipment Criteria for Selecting Supplies

Type of Supplies Advantages Disadvantages
Local availability • No sterilizer and • Usually more
running costs expensive
• No labor costs • Bulky
Disposables
Well-established • Safer • Wastage problem
• Less risk of disease • Unsafe if reused
transmission

Local training ? ?
Reusables

Self-assessment Quiz A:
Identify:
1. A continually revised compilation of pharmaceuticals that
reflects the current clinical judgment of the medical staff
2. Heart of the formulary

Test Yourself! 3. List of drugs considered optimal treatment choices to satisfy

the health care needs of a given population
PARTS OF FORMULARY, ESSENTIAL LIST OF DRUGS, MEDICAL SUPPLIES, 4. Type of supplies in which no sterilizer and running cost is
AND EQUIPMENT, CRITERIA FOR SELECTION needed
5. Give the meaning of PNDF

13
 21/11/2016

Definitions
•Process of acquiring supplies from private & public
? suppliers or through purchases from manufacturers,
distributors, or agencies

MANAGEMENT AND Inventory

Management
•Routine order processing
•“___________ of the drug supply system”

CONTROL Lead Time •Time interval needed to complete the procurement

cycle
METHODS AND MODELS OF PROCUREMENT, IDEAL INVENTORY CONTROL
METHOD, STOCK RECORDS, INVENTORY CLASSIFICATION TECHNIQUES

•Procedure by which competing bids are entered for a

Tendering particular contract

Methods of Procurement Models of Procurement

Open Tender
•Formal procedure by which quotations are invited from
any manufacturer or manufacturer’s representative on a
local or worldwide basis
Annual • Drug requirements are determined and orders

Purchasing are placed once a year

Restricted/ Selective •Interested suppliers must be approved in advance, often

Tender through a formal prequalification process
• Stock levels are reviewed periodically at set

Competitive
? times during the year and orders are placed as
necessary
•Buyers may bargain with suppliers to achieve specific
Negotiation/ Local price or service arrangements
Shopping
• Stock levels are reviewed continually, and orders
Direct Procurement
•Simplest, but usually most expensive, either at the
quoted price or at a negotiated price
? are placed whenever stock levels fall below
designated or calculated reorder points

Ideal Inventory Control Stock Records

Model
 Core records in the IM Vertical File Cards
system
 Primary source of Kardex System
information/data
 Can either be manual Bin Cards
or computerized
Ledger System

14
 21/11/2016

Stock Records Inventory Classification Techniques

ABC Analysis • Value in terms of annual consumption
Vertical File Cards
VEN Classification • Degree of disease managed
Kardex System
HML Classification • Value in terms of unit price
Bin Cards SDE Classification • Availability

Ledger System FSN Classification • Pattern of usage/movement

ABC Analysis VEN Classification

•10 to 20% of items; 75 to 80%
A Vital
• Potentially life-saving, have significant
withdrawal side effects, or are crucial to
of expenditures providing basic health needs

•10 to 20% of items; 15 to 20%

B Essential
• Effective against less severe but nevertheless
significant forms of illness but are not absolutely
of expenditures vital to providing basic health care

•60 to 80% of items; 5 to 10%

C ?
• Used for minor or self-limited illnesses, are of
questionable efficacy or have a comparatively
of expenditures high cost for a marginal therapeutic advantage

Other Classifications
HML SDE FSN
High Scarce Fast-moving

? Difficult ?
Test Yourself!
METHODS AND MODELS OF PROCUREMENT, IDEAL INVENTORY CONTROL
METHOD, STOCK RECORDS, INVENTORY CLASSIFICATION TECHNIQUES

? ? ?

15
 21/11/2016

Self-assessment Quiz A: Self-assessment Quiz B:

Identify: Identify the meaning of the following in the context of
1. Heart of the drug supply system inventory classification techniques:
2. Heart of the inventory management system 1. V in VEN
3. Time interval needed to complete the procurement cycle 2. N in FSN
4. Simplest but usually the most expensive method of 3. M in HML
procurement 4. S in SDE
5. Represents 10 to 20% of items; 75 to 80% of expenditures in 5. E in VEN
ABC Analysis

Drug Distribution Systems

Floor-Stock • Used most often in governmental & other hospitals
in which charges are not made to the patient or
System when all inclusive rate is used for charging

DRUG DISTRIBUTION Individual

SYSTEM Prescription Order
System
• Generally used by the small &/or private hospital

TYPES AND THEIR ADVANTAGES AND DISADVANTAGES

Unit Dose • Standard of practice in most hospitals today

• Tablets and capsules are labeled and dispensed
Dispensing as a single dose for each patient

Floor-Stock System Floor-Stock System

Charge • Stocked on the nursing station at all
times & are charged to patient’s
Floor Stock account after they have been
Drugs administered to him
• Placed at the nursing station for the
use of all patients on the pavilion &
?
for which there may be no direct
charge to the patient’s account
Advantages
1. Ready availability of the required drugs
2. Elimination of drug returns
3. Reduction in number of drug order
transcriptions for the pharmacy
4. Reduction in the number of pharmacy
personnel needed
Disadvantages
1. Possible increase in medication errors
due to elimination of order review
2. Increased drug inventory on the pavilion
3. Greater opportunity for pilferage
4. Increased hazards associated with drug
deterioration
5. Possible lack of proper storage facilities
on the ward
6. Greater inroads are made upon the
nurses time

16
 21/11/2016

Individual Prescription Order System Unit Dose Dispensing System

Advantages
1. Reduced manpower requirements
2. Individualized service
3. All medications directly reviewed by the 2. Increase in cost to the patient
pharmacist
4. Provides interaction of pharmacist,
doctor, nurse, and patient
5. Provides closer control of inventory
Disadvantages Advantages
1. Possible delay in obtaining required 1. Improved pharmaceutical service 24 hours a
day and patients are charged only those
medication
doses which are administered to them
2. Nurses have more time for direct patient care
because all doses are prepared in the
pharmacy
3. Reduced medication error - allows checking
or interpreting of the doctor’s original order
4. Eliminates excessive duplication of orders and
paper works at the nursing station and
pharmacy
5. Eliminates credit
6. IV preparation and reconstitution done at the
pharmacy
Advantages
7. More efficient utilization of professional
and non- professional personnel
8. Reduced revenue loss
9. Conserves space in nursing units by
eliminating bulky floor stocks
10. Eliminates pilferage and drug waste
11. Extend pharmacy control and coverage
throughout the hospital
12. Improved communication of medication
orders and delivery systems
13. Ward work as drug consultants and help
provide the team effort needed for better
patient care

Forms of UDDDS
•All the drugs are stored in a central area pharmacy &
Centralized dispensed at the time the dose is due to be given to the
patient

•Operates from two or more dispensing locations

? commonly called pharmacy satellites

Combination of I •Some distribution activities are performed in the patient

Test Yourself!
and II care areas while the rest are performed centrally
TYPES AND THEIR ADVANTAGES AND DISADVANTAGES

•Some unit dose systems are only partially complete due

Partial to special circumstances of certain hospitals.

Self-assessment Quiz A:
Identify:
1. Standard of practice in most hospitals today
2. Used most often in governmental & other hospitals in which
charges are not made to the patient or when all inclusive rate is
used for charging
3. Floor stock placed at the nursing station for the use of all patients
on the pavilion
MEDICATION ERROR
TYPES AND CATEGORIES OF MEDICATION ERROR, TYPES OF
4. Form of UDDDS that operates from two or more dispensing ADMINISTRATION ERROR
locations commonly called pharmacy satellites
5. Disadvantage is possible delay in obtaining required medication

17
 21/11/2016

Medication Error
 Any preventable event that Prescribing Error
may lead to inappropriate
medication use or cause
harm to the patient while Monitoring Error
the medication is in the
control of a health care Dispensing Error
professional or the patient
(NCCMERP) Administration Error

Compliance Error

Prescribing Error

Prescribing Error Prescribing Error

18
 21/11/2016

Dispensing Error Dispensing Error

Types of Administration Error Types of Human Error

Omission Error Wrong Dosage Form Error Slips •Actions not carried out as intended or
planned

Wrong Time Error Wrong Drug Preparation Error

Lapses •Missed actions or omissions
Wrong Administration Technique
Unauthorized Drug Error
Error

Administration of Discontinued
Mistakes •Brought about by a faulty
plan/intention
Deteriorated Drug Error
Medicine

Improper Dose Error Uncharted Dose Violations •Deliberate illegal actions

Self-assessment Quiz A:
Identify the medication error categories:
1. An error occurred that resulted in the need for increased
patient monitoring, but no patient harm.
2. An error occurred that reaches the patient, but did not
cause harm.
Test Yourself! 3. An error occurred that resulted in permanent patient harm.
TYPES AND CATEGORIES OF MEDICATION ERROR, TYPES OF 4. An error occurred that resulted in a near-death event.
ADMINISTRATION ERROR
5. An error occurred but the medication did not reach the
patient.

19
 21/11/2016

Self-assessment Quiz B:
Identify the type of administration error:
1. Ciprofloxacin 500mg tablet BID (to d/c by 01/11/11) was ordered. But it
was given up to 01/14/11.
2. Simvastatin 40mg tablet OD was ordered by the doctor but it was not
administered.
3.
4.
Acetylcysteine sachet was administered but 200mg IV was ordered.
Correct route but at the wrong site
SPECIAL PREPARATIONS
COMMON TERMS, PARENTERAL AND ENTERAL NUTRITION, COMPONENTS,
5. Isosorbide dinitrate 10mg tablet TID was ordered to be given at COMPOUNDING, AND ADMINISTRATION OF PARENTERALS
specified time of 7AM-11AM-4PM. But it was transcribed on the
therapeutic sheet as 8AM-1PM-6PM. It was administered as
transcribed.

Definitions Definitions
• Dosage forms which are injected directly
Parenterals into body tissue through the skin and
mucous membranes
Parenteral •Feeding of a patient by the
intravenous infusion of fluids
Nutrition and basic nutrients
Large-volume • Single dose injections having a volume of
100 mL or more and containing no added
Parenterals substances
•Method of providing nutrition
• Packaged in containers having the ? support via tubes inserted into
? capacity of 25 to 50 mL. the stomach or small intestine

Definitions Parenteral Nutrition Access

Central •Often called Total Parenteral
Parenteral Nutrition (TPN)
Nutrition •Delivered into a central vein

•Delivered into a smaller or

? peripheral vein
•When to use?

20
 21/11/2016

Intravenous Solutions Components of IV Admixtures

•Fluid replacement, electrolyte Carbohydrate • Dextrose
• 3.4 kcal/g
imbalance, restoration & supplementary
IV Fluids nutrition, as vehicles for administration of
other drug substances
Protein • Crystalline amino acid
• 4.0 kcal/g

Lipids • Safflower and/or soybean oil

IV
• 10kcal/g
•When one or more sterile products are
Admixtures added to an IV fluid for administration
Others
• Electrolytes
• Trace Elements
• Vitamins

Compounding of Parenterals Compounding of Parenterals

 Prepared with aseptic technique or environment provided by
laminar flow hood, in which the air is filtered through HEPA
(High Efficiency Particulate Air) filter
 HEPA filters remove 99.97% of all particles larger than 0.3 um
 The flow of air may be in either a horizontal or vertical pattern
 The best way to determine the proper functioning of a HEPA
filter is to use the dioctylphthalate (DOP) test

Materials Materials
 Needle  Needle
 Syringe  Syringe
 Micropore filter  Micropore filter
 Infusion set  Infusion set
 TPN bag  TPN bag
 TPN bottle  TPN bottle
 Vials  Vials
 Ampules  Ampules

21
 21/11/2016

Types of IV Administration Intermittent IV Administration

• Drug is added to a large-volume
Continuous parenteral solution and then slowly
IV Infusion and continuously dripped into a
vein

• Drug is added to an intermediate

Intermittent volume and given in an
IV Infusion immediate period of time, at
spaced interval

Self-assessment Quiz A:
Identify:
1. Packaged in containers having the capacity of 25 to 50 mL.
2. Often called Total Parenteral Nutrition (TPN)
3. Lipids can provide how much kcal/g?

Test Yourself! 4.
5.
Type of hood for TPN compounding
Method of intermittent IV infusion in which there is the use of
COMMON TERMS, PARENTERAL AND ENTERAL NUTRITION, COMPONENTS,
COMPOUNDING, AND ADMINISTRATION OF PARENTERALS
a second container with an already hanging IV fluid

End of Hospital Pharmacy

Test Yourself!
SYNTHESIS

Review

22
 21/11/2016

Self-assessment Quiz A: Self-assessment Quiz B:

Identify: Identify the type of hospital based on scope of service:
1. A public or private organization that provides and/or manages
comprehensive health services to individuals enrolled in the
1. Ospital ng Maynila
health plan 2. Dr. Jose Fabella Memorial Hospital
2. A facility providing safe, hygienic living arrangements for 3. Research Institute for Tropical Medicine
residents
3. Meaning of ASHP 4. St. Luke’s Medical Center
4. Type of patient care primarily for older adults with a chronic 5. San Lazaro Hospital
illness who require more time to recover before returning home
5. Number of inpatient beds for general hospitals to be accepted
for registration

Self-assessment Quiz C: Self-assessment Quiz D:

Identify: Identify:
1. A public or private organization that provides and/or manages 1. Four (4) steps in the drug management cycle
comprehensive health services to individuals enrolled in the
health plan 2. Two (2) primary purposes of PTC
2. A facility providing safe, hygienic living arrangements for 3. Chairperson of PTC
residents 4. Secretary of PTC
3. Meaning of ASHP 5. Meaning of DUR
4. Type of patient care primarily for older adults with a chronic
illness who require more time to recover before returning home
5. Number of inpatient beds for general hospitals to be accepted
for registration

Self-assessment Quiz E: Self-assessment Quiz F:

Identify: Identify:
1. A continually revised compilation of pharmaceuticals that 1. Heart of the drug supply system
reflects the current clinical judgment of the medical staff 2. Heart of the inventory management system
2. Heart of the formulary 3. Time interval needed to complete the procurement cycle
3. List of drugs considered optimal treatment choices to satisfy 4. Simplest but usually the most expensive method of
the health care needs of a given population procurement
4. Type of supplies in which no sterilizer and running cost is 5. Represents 10 to 20% of items; 75 to 80% of expenditures in
needed ABC Analysis
5. Give the meaning of PNDF

23
 21/11/2016

Self-assessment Quiz G: Self-assessment Quiz H:

Identify: Identify the medication error categories:
1. Standard of practice in most hospitals today 1. An error occurred that resulted in the need for increased
2. Used most often in governmental & other hospitals in which patient monitoring, but no patient harm.
charges are not made to the patient or when all inclusive rate is 2. An error occurred that reaches the patient, but did not
used for charging cause harm.
3. Floor stock placed at the nursing station for the use of all patients 3. An error occurred that resulted in permanent patient harm.
on the pavilion
4. An error occurred that resulted in a near-death event.
4. Form of UDDDS that operates from two or more dispensing
locations commonly called pharmacy satellites 5. An error occurred but the medication did not reach the
patient.
5. Disadvantage is possible delay in obtaining required medication

Self-assessment Quiz I: Self-assessment Quiz J:

Identify the type of administration error: Identify:
1. Ciprofloxacin 500mg tablet BID (to d/c by 01/11/11) was ordered. But it 1. Packaged in containers having the capacity of 25 to 50 mL.
was given up to 01/14/11.
2. Often called Total Parenteral Nutrition (TPN)
2. Simvastatin 40mg tablet OD was ordered by the doctor but it was not
administered. 3. Lipids can provide how much kcal/g?
3. Acetylcysteine sachet was administered but 200mg IV was ordered. 4. Type of hood for TPN compounding
4. Correct route but at the wrong site 5. Method of intermittent IV infusion in which there is the use of
5. Isosorbide dinitrate 10mg tablet TID was ordered to be given at a second container with an already hanging IV fluid
specified time of 7AM-11AM-4PM. But it was transcribed on the
therapeutic sheet as 8AM-1PM-6PM. It was administered as
transcribed.

End of Hospital Pharmacy

Review Synthesis

24