1. Institutional Pharmacy
Chapter 16

2. Hospital Pharmacy
In hospital pharmacy technicians work as part of a team.
In hospitals, rooms are divided into groups called nursing units or patient care units.
Patents with similar problems are usually located together.
Read: Health care team page 317

3. Hospital Pharmacy Areas
Centralized Pharmacy systems – all pharmacy activities are conducted from one area within the hospital—called the inpatient pharmacy.
Decentralized Pharmacy systems – there are several satellite pharmacy areas located throughout the hospital, each serving a portion of the patient care areas.

4. Communication
There are several ways the pharmacy communicated with other areas of the hospital:
Fax
Telephone
Computer
In person
Pneumatic Tubes (shuttles items through a tube using compressed air)
Dumbwaiter (a small elevator to carry items between floors, but not people)

5. Computer Systems
Hospital computer systems can integrate and store patient information such as medical records, lab data and billing records.
Hospital computer systems differ from community pharmacy systems in some of the information they track-such as lab results and medical records.

6. Organization of Medication
Since hospitals cannot stock every medication available, most have a hospital formulary.
A formulary is a subset of medications the hospital keeps on its shelves from which a doctor can order.

7. Organization of Medication
Medication is usually organized alphabetically by generic name in hospital pharmacy.
In community pharmacy, medications are usually organized alphabetically by brand.
Read pages 322 & 323: hospital formulary, therapeutic interchanges, P&T committees, organization of medication

8. Unit Dose System
Medications are commonly provided to the nursing unit in medication cart containing 24 hours dosages for specific patients. (see illustrations page 325)
Medications in the cart are packaged in unit dose containers—holding a single dose of the medication.

9. Medication Orders & Order Processing
In hospitals, all drugs ordered for a patient are written on a medication order form or are electronically transmitted to the pharmacy. (see pages )
Pharmacists must verify orders in the computer system and may check medications before they are sent to the floor.
In California, we now have “tech-check” where specifically trained techs can perform this last step provided the hospital has tech check protocols & training in place. (New this year)

10. Medication Orders & Order Processing
Standing Order – a standard medication that a patient is to receive at scheduled intervals. (eg: 1 tab q8)
PRN Order – an order for medications to be administered only on an as needed basis. (eg: prn pain)
STAT Order – an order for medication to be administered immediately.

11. Inventory Control
A primary area of concern for inventory control is narcotics or controlled substances.
These require an exact record of the location & the exact count of every item.
Code Carts – a locked cart of emergency medication & equipment designed for emergency use only. ( see page 330)
Floor Stock – stock that is stored at the nursing station, does not require specific patient labeling.

12. General Hospital Issues
All departments within the hospital are required to maintain a policy & procedures manual by regulating agencies.
Joint Commission on Accreditation of Healthcare Organizations (JCAHO):
Surveys & accredits health care organizations
Organizations undergo survey every 3 years

13. Safety
During safety training, employees will learn universal precautions & how to handle hazardous spills. (Page 333)
Needles and other “sharps” should always be disposed in designated “sharps” containers.

14. Long Term Care
Long Term care facilities provide care for people unable to care for themselves.
Because of limited resources, most long term care facility contract out pharmacy services.

15. Long Term Care
Pharmacists provide dispensing serves and clinical services.
Distributive pharmacists – make sure the long term care patients receive the correct medication ordered.
Consultant pharmacists – develop & maintain an individual pharmacy plan for each patient.

16. Chapter 16 Read all sections of Chapter 16 Review Key Concepts
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