1. Hospital pharmacy el 2189 lab 1

2. Flow Chart of Pharmaceuticals/Drugs and Patient
There are three steps followed by the patients in the hospital.
Step I: It is registration step where the patient is registered and get the card after paying the nominal fees of entrance.
Step II: In this general physiological parameters, e.g. weight and height, are recorded and guided to respective clinical department on the basis of symptoms reported by the patient.

3. Step III:
- In this majority of patients come to the pharmacy for medicine and rest of patients are admitted or returned after giving advice.

4. The following chart illustrate the flow of out-patient:
Registration
General Check Up
Old Patient New Patient
Various Clinical Departments
Admitted
In – Patient
Patient Not Requiring Medicines Out
Pharmacy
Out
Cash Counter

5. Flow Chart for Pharmaceuticals/Drugs
Pharmacist has both receiving and distribution functions.
Pharmacist receives the drugs from main medical store or sometimes directly from manufacturing units and then distributes to the in-patients and out-patient.
Generally quality control tests are performed before entry in pharmacy.

6. A illustration of flow of pharmaceuticals/drugs is shown below:
Manufacturing unit
Main medical store
Quality control
Pharmacy
Issues
In- patient department
Out- patient department
Flow Chart for Pharmaceuticals drugs

7. Storage Temperature

8. Refrigerated storage (2-8◦C):
Normal storage area:
Contains the largest portion of the pharmacy inventory (المخزون).
E.g.  liquids, tablets, capsules, injections
Maintained at 250C.
For substance not thermolable.
Refrigerated storage (2-8◦C):
A separate freezing compartment should be available for biologicals and other drugs which must be stored at temperature below freezing ex. Insulin.

9. Freezer -20 to -10 0C Refrigerator 2- 8 0C Cold place less than 8 0C
The complete list of storage temperature terms and the definitions for the thermolabile products are as follows:
Freezer
-20 to -10 0C
Refrigerator
2- 8 0C
Cold place
less than 8 0C
Cool place
8-15 0C
Room temp C
Excessive heat
less than 40 0C

10. Pneumatic tube systems:
These are modern engineering technology used for transporting nearly every item from the pharmacy to its hospital destination.

12. Pneumatic tubes

13. Another type of Pneumatic tubes

14. Medication
carts

15. Selection of 'Charge' Floor Stock Drugs:
The decision to which drugs should be placed under the category of 'charge' drugs depends on pharmacy and therapeutics committee (PTC).
Selection of Non-charge Floor Stock Drugs
A list of non-charge floor stock drugs is prepared on the basis of following criteria:
(i) The cost of preparation.
(ii) the frequency of use.
(iii) the quantity used.
(iv) the hospital budget.

16. list of pharmaceuticals and related preparations which are considered to be non-charge floor stock drugs, is shown below:

17. Labeling of Floor Stock Drugs
It is quite interesting that stock drugs in the ward are not labeled with the direction for use.
This is so because number of patients may be receiving the same type of medication but under different therapeutic regimen.
If one set of direction is affixed to the container, it may cause confusion and error may result.
Therefore, stock medications bear a label which shows the ward number, name and strength of the preparation as well as any other related information.

18. The unit dose dispensing concept may be introduced into the hospital in either of two ways:
Centralized unit dose drug distribution system (CUDD).
Decentralized unit dose drug distribution system (DUDD).

19. Centralized Unit Dose Dispensing:
In this system, all in-patient drugs are dispensed in unit doses and all the drugs are stored in main pharmacy and dispensed at the time, the dose is due to be given to the patient.
Drugs are transferred from the pharmacy to the indoor patient by medication carts and dumbwaiters.
Suction tube system (called pneumatic tubes) or other means are required to send a copy of the physician's original medication order to the pharmacy for direct interpretation and filling.

20. Decentralized Unit Dose Dispensing:
Small pharmacy often called Satellite pharmacy is set up on each floor of the hospital.
The main pharmacy procures, stores, manufactures and packages of the drug.
It supplies the drugs to the satellite pharmacies upon the receipt of medication order.
This type of system can be used for a hospital with separate building.

21. General outline of procedure followed in decentralized unit dose system is mentioned here:
(i) Admission to the hospital the patient is entered into the system. Diagnosis, allergies and other data are entered on patient profile card.
(ii) Medication order copy is sent to the hospital pharmacist.
(iii) Medication order is entered on the patient profile card.
(iv) Pharmacist checks the medication order for allergies, drug-interaction and rationale of therapy.
(v) Dosage scheduled in coordination with the nursing station.
(vi) Pharmacy technician picks medication orders, placing drugs in bins of a transfer cart per dosage schedule.
(vii) Medication cart is filled for particular dosage schedule delivery.
(viii) Pharmacist checks cart prior to release.
(ix) The nurse administers the medication and makes appropriate entry on her medication record.
(x) Upon return to the pharmacy the cart is rechecked.

22. Labeling and dispensing in-patient prescription
In-patient prescription labels should bear the following:
Patient name/medical number.
Nonproprietary and/or proprietary name of drug actually dispensed.
Strength of medication dispensed.
Date of issue.
Name or initial of dispensing pharmacist.

23. Location of Central Sterile Supply Department
Central sterile supply room should be centrally located.
It should be situated near to area from which it receives most of the supplies and also from the departments which are its largest consumers.
If central sterile supply department is controlled by the pharmacy department, then these two units should be physically combined or at least adjacent to one another for better supervision by pharmacy personnel.
It consists of a series of working stations in 'dirty areas' which are separated from "clean area" by autoclaving and sterilizing equipment.

24. Central sterile department has a layout as shown in Figure 4:

25. Laminar Air Flow:
Laminar air flow is defined as air flow in which the entire air within a confined area moves with uniform velocity along parallel flow lines, with a minimum of eddies.
Generally big size hospitals manufacture intravenous fluid themselves, so they must have laminar air flow in central sterile supply department.
It provides the microfiltered air over working area and keep away dirt particles from entering in the working area.

27. Prescription Writing
All the prescription must be neatly written. Every prescription must have following information:
Name and address of the patients
The date of prescription.
The drugs which they prescribe, should be written in terminology used in the formulary.
The strength of medication prescribed.
The total amount to be dispensed.

28. The "Signa" containing instructions to the patient should be clear and should be in simple terms.
When repetition of the medication or drug is desired, the number of times the drug is to be repeatedly taken by patient should be clearly written.
The prescriptions for narcotics must name, in addition to all the above information and the patients age. It is also necessary that all prescription are signed by the prescribing physicians.

29. Out patient prescription label
It should bear the following information: 1- patient full name 2- prescription identification no. 3- specific direction for use 4- date of issue 5- name of initial of dispenser 6- name of prescribing physician 7- keep out of reach of children 8- name, address, telephone no. of hospital

30. (Medical History) Patient Profile Card