Hospital pharmacy-Organisation and management a) Organizational structure-Staff, Infrastructure & work load statistics b) Management of materials and finance c) Roles & responsibilities of hospital pharmacist

1. DOCTOR OF PHARMACY
IV YEAR
HOSPITAL PHARMACY
14T00408
CHAPTER-2
Hospital pharmacy-Organization and
management
Dr.V.Chanukya Pharm D

2. Student Learning Outcomes
Upon completion of the chapter, the student will be able to:
•Know various drug distribution methods
•Know the professional practice management skills
in hospital pharmacies provide unbiased drug
information to the doctors
•Know the manufacturing practices of various
formulations in hospital set up appreciate the
practice based research methods
•Appreciate the stores management and inventory
control.

3. Contents
• Hospital pharmacy-Organisation and management
I. Organizational structure-Staff, Infrastructure & work load statistics
II. Management of materials and finance
III. Roles & responsibilities of hospital pharmacist

4. Definition: Hospital pharmacy
• The practice of pharmacy within the hospital under the supervision of
a professional pharmacist is known as hospital pharmacy.
• The department or service in a hospital which is under the direction of
a professionally competent, legally qualified pharmacist, and carry out
functions like
– Supply of all medications to the nursing units and other services, where special
prescriptions are filled for patients in the hospital,
– Dispensing of prescriptions for ambulatory patients and out-patients
– Manufacture of pharmaceuticals in bulk
– Dispensing of narcotic and other controlled prescribed drugs,
– Extemporaneous injectable preparations should be prepared and sterilized
– Stocking and dispensing of professional supplies

5. Organizational structure of pharmacy
department
• With the selection and categorizing of the employees, it now becomes
essential to develop a chart showing the flow of administrative
authority.
• Obviously, in the very small departments, this is usually generally
understood and no problems arise.
• However, in the large units with assistant chief pharmacists,
supervisors, and lay personnel, authority must be delegated by the
chief pharmacist.
• Clearly this can and should be tailored to meet the specific
requirements of the department and hospital.
• Once prepared and approved, it should be conspicuously posted for
each of the departmental employees to read and adhere to.

6. Medium Hospital pharmacy
Departmental organization sample

7. • In large hospitals, departments of pharmacy have a more complex
organization.
• Note for example, tertiary care Hospital's Department of Pharmacy
organizational chart.
• It should seem obvious to the student that each of the subdivisions of
the department are assigned specific responsibilities.
• The following are some of the responsibilities of each division.

8. Tertiary care Hospital pharmacy
Departmental organization sample

9. 1. Administrative Services Division
• Plan and coordinate departmental activities.
• Develop policies.
• Schedule personnel and provide supervision.
• Coordinate administrative needs of the Pharmacy and Therapeutics
Committee.
• Supervise departmental office staff.
2. Education and Training Division
• Coordinate programs of undergraduate and graduate pharmacy
students.
• Participate in hospital-wide educational programs involving nurses,
doctors etc.
• Train newly employed pharmacy department personnel.

10. 3. Pharmaceutical Research Division
• Develop new formulations of drugs, especially dosage forms not
commercially available, and of research drugs.
• Improve formulations of existing products.
• Cooperate with the medical research staff of projects involving drugs.
4. In-Patient Services Division
• Provide medications for all in-patients of the hospital on a 24-hour per
day basis.
• Inspection and control of drugs on all treatment areas.
• Cooperate with medical drug research.

11. 5. Out-Patient Services Division
• Compound and dispense out-patient prescriptions.
• Inspect and control all clinic and emergency service medication
stations.
• Maintain prescription records.
• Provide drug consultation services to staff and medical students.
6. Drug Information Services Division
• Provide drug information on drugs and drug therapy to doctors,
nurses, medical and nursing students and the house staff.
• Maintain the drug information center.
• Prepare the hospital's pharmacy newsletter.
• Maintain literature files.

12. 7. Departmental Services Division
• 1. Control and dispense intravenous fluids.
• 2. Control and dispense controlled substances.
• 3. Coordinate and control all drug delivery and distribution systems.
8. Purchasing and Inventory Control Division
• Maintain drug inventory control.
• Purchase all drugs.
• Receive, store and distribute drugs.
• Interview medical service representatives.

13. 9. Central Supply Services Division
• Develop and coordinate distribution of medical supplies and irrigating
fluids.
10. Assay and Quality Control Division
• Perform analyses on products manufacturered and purchased.
• Develop and revise assay procedures.
• Assist research division in special formulations.
11. Radiopharmaceutical Services division
• Centralize the procurement, storage and dispensing of radioisotopes
used in clinical practice

14. 12. Manufacturing and Packaging Division
• Manufacture wide variety of items in common use at the hospital.
• Operate an overall drug packaging and prepackaging program.
• Undertake program in product development.
• Maintain a unit dose program.
13. Sterile Products Division
• Produce small volume parenterals.
• Manufacture sterile ophthalmologic, irrigating solutions etc.
• Prepare aseptic dilution of lyophylizal and other "unstable" sterile
injections for administration to patients.

15. 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.

16. 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.

17. Functions of hospital pharmacy:
• Forecast of demand
• Selection of reliable suppliers
• Prescribing specifications of the required medicament
• Manufacturing of sterile or non-sterile preparations
• Maintenance of manufacturing records
• Quality control of purchased or manufactured products
• Distribution of medicaments in the wards
• Dispensing of medicaments to out-patients
• Drug information source in hospitals
• Centre for drug utilization studies
• Implement recommendations of the pharmacy and therapeutic
committee
• Patient counseling and maintaining liaison between medical,
nursing and the patient.

18. ASHP Guidelines: Minimum Standard
for Pharmacies in Hospitals
• The following minimum standard guidelines are intended to serve
as a basic guide for the provision of pharmacy services in hospitals
by American Society of Health-System Pharmacy (ASHP).
• These guidelines outline a minimum level of services that most
hospital pharmacy departments should consistently provide.
• Certain elements of these guidelines may be applicable to other
health care settings or may be useful in evaluating the scope and
quality of pharmacy services.

19. Staff and work load statistics
• Areas of responsibility within the scope of pharmacy services shall be
clearly defined to each staff.
• The responsibilities and related competencies of professional and
supportive personnel shall be clearly defined in written position
descriptions.
• These position descriptions shall be reviewed and revised as required
by the hospital’s policies.
• Position descriptions should reflect more general aspects of
performance (e.g., communication, motivation, teamwork) in addition
to specific responsibilities and competencies

20. Director of Pharmacy.
• The pharmacy shall be managed by a professionally competent,
legally qualified pharmacist.
• The director of pharmacy should be thoroughly knowledgeable about
and have experience in hospital pharmacy practice and management.
• An advanced management degree (e.g., M.B.A., M.H.A., or M.S.) or
an administrative specialty residency is desirable..

21. The director of pharmacy shall be responsible for
• Establishing the mission, vision, goals, and scope of services of the
pharmacy based on the needs of the patients served, the needs of the
hospital (and any health system of which the hospital may be a
component), and developments and trends in health care and hospital
pharmacy practice.
• Developing, implementing, evaluating, and updating plans and
activities to fulfill the mission, vision, goals, and scope of services of
the pharmacy

22. • Actively working with or as a part of hospital or health-system
leadership to develop and implement policies and procedures that
provide safe and effective medication use for the patients served by
the institution.
• Mobilizing and managing the resources, both human and financial,
necessary for the optimal provision of pharmacy services.
• Ensuring that patient care services provided by pharmacists and other
pharmacy personnel are delivered in adherence to applicable state and
federal laws and regulations, hospital privileging requirements, and
national practice standards.

23. Pharmacists.
• The pharmacy shall employ an adequate number of competent, legally
qualified pharmacists to meet the specific medication-use needs of the
hospital’s patients.
• Pharmacists hired on a temporary or contract basis shall meet the
same requirements as those employed by the hospital.
Support Personnel.
• Sufficient support personnel (e.g., pharmacy technicians and clerical
or secretarial personnel) shall be employed to facilitate pharmacy
services.
• Support positions shall have a written job description that includes a
statement of the competencies required for that position.
• Support staff shall be properly trained and supervised, and
professional development programs for them are desirable.

24. • Pharmacy technicians should have completed an ASHP accredited
pharmacy technician training program, should be certified by the
Pharmacy Technician Certification Board, and shall meet the
requirements of applicable laws and regulations.
• Pharmacy technicians working in advanced roles should have
additional training and demonstrate competencies specific to the tasks
to be performed.
Education and Training.
• All personnel shall possess the education and training required to
fulfill their responsibilities and shall participate in relevant
continuing-education programs and activities as necessary to maintain
or enhance their competence.

25. Recruitment, Selection, and Retention of Personnel.
• Personnel should be recruited and selected by the pharmacy director
on the basis of job-related qualifications and prior performance.
• An employee retention plan is desirable.
Work Schedules and Assignments.
• The director of pharmacy shall ensure that work schedules,
procedures, and assignments optimize the use of personnel and
resources.
• There shall be a written departmental staffing plan that addresses how
patients’ needs will be met during periods of staff shortages and
fluctuation in workload and/or patient acuity.
• Remote medication order processing may be employed to help address
staff shortages or workload fluctuations

26. • CHIEF PHARMACIST
Provide the overall supervision of the activities of the Pharmacy Service
of comparatively large general or special hospitals and perform other
related functions.
Specifically, the Chief Pharmacist shall:
1. Establish and implement policies and procedures of the pharmacy in
accordance with the policies of the hospital and of the DOH;
2. Instruct, train and supervise all employees of the Pharmacy Service;
3. Review and approve schedule of duties of the pharmacy staff
4. Provide information concerning drugs and drug therapy to
physicians, nurses and other health personnel of the hospital;
5. Participate actively as member and secretary of the hospital’s
Pharmacy and Therapeutics Committee (PTC);
6. Assist in the evaluation of reports on ADR, and Infection Control
Programs;

27. 8. Plan and prepare research activities on behavioral and socio-
economic,pharmaceutical operational and clinical researches;
9. Supervise checking of deliveries to bulk storeroom of the pharmacy
for safekeeping and proper storage.
10. Prepare reports and memoranda to the COH, Administrator and other
departments of the hospital on pharmacy matters;
11. Plan suitable educational and training programs for professional staff
and pharmacy interns in accordance with the requirements of the
DOH
12. Attend meetings/seminars related to drugs and hospital pharmacy
practices;
13. Recommend pharmacy development or improvements to the COH;
14. Check and evaluate overall performance of the pharmacy.

28. SUPERVISING PHARMACIST
• Supervise activities of the Pharmacy Service of smaller general or
special hospitals and/or supervise the activities of employees in the
Pharmacy Service of a comparatively large general or special
hospital, and perform other related functions.
Specifically, the Supervising Pharmacist shall:
1. Assume the duties and functions of the chief pharmacist in his/her
absence;
2. Supervise record-keeping activities

29. 3. Supervise the receiving, checking and proper storage of all drugs
biological and medical supplies;
4. Check the prepared schedule of duties of pharmacists and other
personnel;
5. Assist in the planning and preparation of research activities;
6. Assist in the preparation of suitable educational pharmacy programs
for professional staff
7. Supervise dispensing of drugs to in and out-patients;
8. Attend meetings related to drugs and hospital pharmacy practices;
9. Assist in the evaluation of the overall performance of the pharmacy
staff and review performance appraisal forms of pharmacy personnel;
and
10. Listing of all regulate and narcotic drugs on their appropriate books

30. SENIOR PHARMACIST
Under general supervision, the Senior Pharmacist shall supervise the
activities of a small group of employees of the Pharmacy Service of a
general hospital or special hospital and perform other related
functions.
• Specifically, the Senior Pharmacist shall:
1. Assume the functions and responsibilities of the supervising
pharmacist in his/her absence;
2. Assist the supervising pharmacist in the supervision of
Pharmaceutical Service activities or perform other duties relating to
the preparation, care, distribution, disposition and inspection of drugs
and supplies

31. 3. Assist the supervising pharmacist in planning, organizing and
implementing pharmacy policies and procedures in accordance with
established policies of the hospital and the DOH;
4. Guide subordinates in work prioritization and specific tasks to be
performed and reviewed;
5. Supervise the maintenance of the Drug Information Center with
updates, journals and literature files, etc.;
6. Supervise the bottling and labelling of stocks from bulk compounded
stocks;
7. Inspect and monitor drugs in all treatment areas;
8. Participate in all research activities;
9. Discuss performance report with subordinate employees
10. Participate in the QAP of the Pharmacy Service

32. • PHARMACIST
• Under general supervision, the pharmacist fills and dispenses drugs
and medical supplies to in-patients and Out-out-patients ordered or
prescribed by a licensed physician, dentist or veterinarian.
The Pharmacist shall:
1. Fill prescriptions and dispense drugs;
2. Compound preparations not available commercially;
3. Label all drug containers issued to various services;
4. Check the manufacture and expiration dates and labels of drugs

33. 5. Participate in medical rounds when deemed necessary for
medication history of patients in promoting rational drug therapy;
6. Notify physicians of any therapeutic incompatibilities, potential
drug interactions and duplicate prescriptions;
7. Make certain that the right patient takes the right drug and right
dosage at the right time;
8. Participate in research activities;
9. Attend scientific seminar-workshops/consultative meetings and
continuing education on drug-related matters and hospital
pharmacy practices;
10. Participate in the QAP of the Pharmaceutical Service;
11. Prepare performance appraisal report;.

34. CLERK
Under general supervision, the clerk shall:
1. Do all the typing/filing/safekeeping of documents, receiving and
releasing papers pertinent to the operation of the Pharmacy Service;
2. Prepare adjustment sheets as the basis for the statistical report on
the monthly consumption and balances of stocks in the pharmacy;
3. Participate in the QAP of the Pharmacy Service
4. Attend staff development programs and seminar/workshops
relevant to his/her work;

35. STOREKEEPER
Under general supervision, the storekeeper shall:
1. Receive/check/post drugs on ledger cards for safekeeping and proper
storage in the bulk storage area and record releases for pharmacy
stocks in the active storage area;
2. Transfer/withdraw drug items from bulk storeroom to active
storeroom of pharmacy for distribution assisted by the utility worker;
3. Conduct regular and weekly follow-up of physical inventory of
drugs;
4. Attend seminar/workshops, and other staff development programs
relevant to the work;
5. Participate in the QAP of the Pharmacy Service

36. UTILITY WORKER
Under general supervision, the utility worker shall:
1. Maintain housekeeping and sanitation of the pharmacy as well as its
bulk and active storage areas;
2. Maintain facilities of the pharmacy;
3. Attend to the administrative needs in the operation of the Pharmacy
Service;
4. Assist the storekeeper in the transfer or withdrawal of drug items from
the bulk storage area to the active storage area of the pharmacy for
eventual distribution;
5. Participate in the QAP of the Pharmacy Service;

37. Personnel requirement in hospital pharmacy
• No standard rules regarding the requirement of personnel for
inpatient pharmacy.
• Number of pharmacists required for a hospital are calculated on the
basis of workload, and the number of bed available.
• For a small hospital minimum 3 pharmacist are required. As the
number of bed increases, the number of pharmacist also increases.
• Pharmacist should possess adequate pharmacy qualification and
experience.
• If manufacturing drugs is involved in pharmacy, adequate number of
technicians, assistants, peons etc. required.

38. Pharmacist requirement on the basis of
bed strength
Bed strength No of pharmacist required
Upto 50 beds
Upto 100 beds
Upto 200 beds
Upto 300 beds
Upto 500 beds
3
5
8
10
15

39. Infrastructure / Facilities
Pharmacy
• Adequate space, equipment, and supplies shall be available for all
professional and administrative functions relating to pharmacy
services.
• These resources shall meet all applicable laws and regulations; shall
be located in areas that facilitate the provision of services to patients,
nurses, prescribers, and other health care providers; and shall be
integrated with the hospital’s communication and delivery or
transportation systems.

40. Medication Storage and Preparation Areas.
• There shall be suitable facilities to enable the receipt, storage, and
preparation of medications under proper conditions of sanitation,
temperature, light, moisture, ventilation, segregation, and security to
ensure medication integrity and personnel safety throughout the
hospital.
Compounding Areas.
• There shall be suitable facilities to enable the compounding,
preparation, and labeling of sterile and nonsterile products,
including hazardous drug products, in accordance with established
quality-assurance procedures.
• The work environment should promote orderliness and efficiency
and minimize the potential for medication errors and contamination
of products

41. Patient Assessment and Consultation Area.
• In outpatient settings, a private area for pharmacist–patient
consultations shall be available to confidentially enhance patients’
knowledge of and adherence to prescribed medication regimens.
Office and Meeting Space.
• Adequate office and meeting areas shall be available for
administrative, educational, and training activities.
Automated Systems.
• There shall be policies and procedures for the evaluation, selection,
use, calibration, monitoring, and maintenance of all automated
pharmacy systems.
• Automated mechanical systems and software can promote safe,
accurate, and efficient medication ordering and preparation, drug
distribution, and clinical monitoring

42. • Information Technology.
• A comprehensive pharmacy computer system shall be employed and
should be integrated to the fullest extent possible with other hospital
information systems and software, including computerized
providerorder- entry, medication administration, electronic health
record, and patient billing systems.
• Pharmacists should be involved in the development and maintenance
of order sets, templates, and dose ranges used in computerized
provider-order-entry and clinical decision-support systems.
• Pharmacy computer systems should be integrated with the hospital’s
clinical, financial, and administrative information systems.
• All computer systems shall include adequate safeguards to maintain
the confidentiality and security of patient records, and a backup
system should be available to continue essential computerized
functions.

43. Drug Information.
• Adequate space, current resources, and information-handling and
communication technology shall be available to facilitate the
provision of drug information.
• The department of pharmacy shall select its drug information
resources, and pharmacists shall play a leadership role in the selection
of drug information resources used by other health care providers in
the hospital.
• Up-to-date, objective drug information shall be available, including
current print or electronic periodicals, newsletters, best-practices
guidelines, and recent editions of reference books in appropriate
pharmaceutical and biomedical subject areas

44. Infrastructure- Managment
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 pharmacist.
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

45. Equipment's required in hospital pharmacy
• Prescription case
• Drug stock cabinets with proper shelves and drawers.
• Sectional drawer cabinets with cupboards bases.
• Work tables and counters for routine dispensing.
• Sink with drain board.
• Cabinet to store mortar and pestles.
• Cabinet for glass utensils, flasks, funnels and beakers.
• Refrigerator of suitable capacity.
• Narcotics safe with individually locked drawers.
• Office desk with telephone connection and file cabinet.
• Dispensing window for nurses and outpatients.

46. Location of hospital pharmacy
• Located in hospital premises so that patients and staff can easily
approach it.
• In multistoried building of a hospital, the pharmacy should be
preferably located on ground floor especially the dispensing unit.
• It should be laid in such a way that there is a continuous flow of men
and materials.

47. Layout of hospital pharmacy
PASSAGE
ASEPTIC AREA
RAW
MATERIAL
STORES
FINISHED
PRODUCTS
MANUFACTURING SECTION
ADMINISTRATIVE
SECTION
OPEN SPACE
DISPENSING

48. Floor space requirements
• 250 sq. feet is the minimum required area for any sized hospital.
• 10 sq. feet per bed in 100 beded hospital.
• 6 sq. feet per bed in 200 beded hospital.
• Floors of pharmacy should be smooth, easily washable and acid
resistant.
• In manufacturing sections, drains should be provided, walls should be
smooth, painted in light colour.
• Wooden cabinets are laminated.
• Fluorescent lamps are placed above priscription counter.
• Counter for Bunsen burner are also required.

49. Requirements On The Basis Of Bed Strength
(Area in sq. feet)
Store room
100 B – 450
300 B – 1000
700 B - 2400
dispensary
100 B – 350
300 B – 500
700 B - 800
office
100 B – 110
300 B – 150
700 B - 200
Manufacturing of
compressed tablets
And capsules
1 2 3 4
5 6
•For tablets
700 B - 900
•For capsules
700 B - 200
Parenterals
300 B – 600
700 B - 600
Manufacturing under aseptic
condition for eye drops, eye
lotions & other preparations for
external use
300 B – 250
700 B - 250000

50. Flow charts for materials and men
General flow chart for outpatients
Rx written by doctor
Rx received by pharmacist
Filling of prescription
selection
labelling
pricing
Dispensed to patient
Receipt of payment Prescription filed
Free Cash Charge
Statistics and reports
Regular
prescription file
Narcotic prescription
file

51. General flow chart for in-patients
Pharmacy
Prescription
Copied by
nurse
Inpatient
Medication
orders
Rx received by
pharmacist
Filling of order
Dispensing order
charge
Returns to credit
Credit issue
selecting
labeling
pricing
Rx written
By doctor
Inpatient discharge
medications
Rx received by
pharmacist
Filling of prescription
Dispensing
prescription
Statistics and control
selection
labeling
pricing
free cash credit

52. FLOW OF MATERIALS
Requisition or an indent
For supply of medicines and other items
Maintain inventory for received items
Distributes the medicine to out-patients and in-patients

53. MARCH -2019 14T00408 /Chapter-2 /S53
EDUCATION FOR PEACE & PROGRESS
COPY RIGHTS RESERVED
Santhiram College of Pharmacy, Nandyal
Flow charts for materials
Medical stores
Pharmacy
Quality
control
Inpatient
department
Outpatient
department
issues
issues
Parenteral
manufacturing
receipt
Manufacturing
of other dosage
forms
receipt

54. Finances -Management
• Primary source- charges received from the patient.
• Charges received by the patients are either fully paid by himself or
from third party.
• Research work grants from government and private sectors.
• Invested endowment funds
• Other types of investment
• Gifts, contributions towards general functional expenses

55. • Financial management focuses on making wise decisions about
obtaining and using financial resources.
• These resources include both funds that the owners of an
organization have invested in it and funds that the organization has
borrowed.
• Pharmacist managers face many such decisions: how much inventory
to carry, which sources of supply to use, how to set prices, which
third-party prescription plans to participate in, which drugs to include
on a formulary, whether a new disease management service will be
profitable, whether the hospital should open a pharmacist-managed
hypertension clinic.
• Being familiar with the tools and techniques of financial
management will help pharmacists make better decisions when faced
with such questions.

56. Goals of financial management
• The principal goal of financial management is to increase the value of
the organization.
• A major part of achieving this goal is making efficient use of financial
resources.
• Pharmacies, for example, carry inventories of prescription and
nonprescription drugs.
• They must invest cash, a scarce financial resource, to buy inventories.
• Pharmacies make the most efficient use of cash that is invested in
inventories when they carry the smallest amount of inventory
necessary to meet consumer demand.
• Carrying larger inventories is inefficient because it takes cash away
from other, more productive uses.
• Making the most efficient use of financial resources is more important
than ever before in pharmacy practice.

57. • Pharmacies of all types face substantial competition and economic
challenges.
• The community pharmacy market has become increasingly
competitive.
• Ambulatory consumers can obtain their prescription medicines from a
number of outlets including pharmacies in supermarkets and mass
merchandising stores (such as K-Mart and Wal-Mart), mail-order
pharmacies, ambulatory care clinics, and physicians’ offices, as well
as traditional chain and independent community pharmacies.
• All of these face financial pressures from the reimbursement policies
of government, managed-care, and other third-party prescription
programs intent on controlling prescription drug costs.
• These policies have dramatically decreased the prices and gross
margins that pharmacies receive for prescriptions.
• In the new competitive environment, pharmacies must use financial
resources efficiently if they are to survive and grow.

58. • Hospital pharmacies face similar financial pressures.
• Insurance companies, managed-care organizations, and federal and
state governments have instituted a number of programs to control the
increases in hospital costs.
• The federal Prospective Pricing System, for example, mandates that
hospitals be paid no more than a fixed and predetermined amount for
each inpatient with a given diagnosis.
• If the hospital spends more than this amount to treat the patient, it
must pay for the excess.
• The federal government has also implemented prospective pricing
programs for ambulatory care services provided in hospitals and for
long-term care facilities (nursing homes).

59. Accounting and financial management
• A proper understanding of the tools and techniques of financial
management requires a basic working knowledge of accounting.
• Accounting is a specialized language used to communicate financial
information.
• This information is communicated via financial statements.
• Accounting data, and the financial statements developed from them,
are maintained because they aid decision making. Financial statements
facilitate decision making in three areas.
• First, financial statements provide information to decision makers.
• With this information, decision makers can better assess the financial
implications of various decisions they must make. For example,
bankers are decision makers. Before making loans, they will carefully
evaluate the financial statements submitted by applicants to decide
whether they can repay the loans

60. • Second, financial statements aid decision makers by reporting the
results of past decisions.
• The prudence of a banker’s past lending decisions will be reflected in
his or her current financial statements.
• Likewise, a manager who makes poor service and pricing decisions
will notice, on financial statements, a decrease in profits.
• Finally, financial statements keep track of a range of financial items
such as cash, debts, and assets.
• Decision makers need this information to efficiently and effectively
manage their organizations.

61. • Financial statements provide decision makers with the following types
of information:
1. Present financial status of the business. The balance sheet, or
statement of financial position, indicates what a business owns and
what it owes at one point in time.
2. Past profit performance of the business. The income statement, also
called the profit and loss statement, indicates whether the business
made a profit or suffered a loss over some period of time.
3. Where the business is getting its cash and how it is spending it. This
is found on the statement of changes in financial position or the cash
flow statement.
4. How the owners’ investment in the business has changed over some
period of time. This information is found in the statement of capital
or the statement of retained earnings.

62. Limitations of financial management
• Financial management is a tool that managers can use to better assess
the financial implications of decisions they face.
• Its use should be limited to deciding among potential courses of action
that will help the pharmacy to reach its goals.
• In most cases, it should not be used to decide what those goals are, nor
should most decisions be based solely on financial criteria.
• On the other hand, given that a pharmacy has limited financial
resources, the decision as to which particular clinical and educational
services to offer would benefit from a financial analysis.
• Financial statements do not contain all the information, or in many
cases even the most important information, about the factors that
affect the finances of a pharmacy.

63. MARCH -2019 14T00408 /Chapter-2 /S63
EDUCATION FOR PEACE & PROGRESS
COPY RIGHTS RESERVED
Santhiram College of Pharmacy, Nandyal
ROLES AND RESPONSIBILITIES OF HOSPITALPHARMACIST
INDOOR PHARMACISTS
a) Central dispensing area:
1.To ensure that all drugs are stored and dispensed correctly.
2.To check the accuracy of the dosages prepared.
3.Maintain proper records
4.Preparation of bills
5.Co-ordinate over all pharmaceutical needs of the patient
6.Framed policies and procedures are followed
7.Maintain professional competence
8.communicate with all pharmacy staffs
b) Patient care areas
1.Maintain liaison with nurses
2.Reviewing of drug administration
3.Provide instruction and assistance to the junior pharmacist

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c)Direct patient areas:
1.Identification of drugs brought into the hospital
2.Obtaining patients medication history
3.Assist in the selection of drug products
4.Monitor patients total drug therapy
5.Counseling patients
6.Participating in cardio-pulmonary emergencies
d)General responsibilities:
1.Ensure that all drugs are handled properly
2.Participate in cardio-pulmonary emergencies
3.Provide education and training for pharmacists

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Outdoor pharmacist responsibilites:
a)Central dispensing area:
1.To ensure that all drugs are stored and dispensed correctly.
2.To check the accuracy of the dosages prepared.
3.Maintain proper records
4.Preparation of bills
5.Keeps the pharmacy neat and tidy manner
b)Patient care areas
1.Inspect periodically the medication areas
2.Identify the drugs brought into the hospital
3.Monitoring of drugs
4.Counsel the patients

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c)General responsibilites:
1.Ensure that all drugs are handled properly
2.Participate in cardio-pulmonary emergencies
3.Provide education and training for pharmacists
4.Co-ordinate overall pharmaceutical need of the
outdoor services

67. Referances
1. Hospital pharmacy by William .E. Hassan
2. b. A text book of Hospital Pharmacyby S.H.Merchant & Dr. J.S.
Qadry. Revised by R.K.Goyal & R.K. Parikh
3. ASHP Guidelines: Minimum Standard for Pharmacies in Hospitals