hospital pharmacy

1. HOSPITAL PHARMACY
By DEEPAK

2. contents
01
02
03
04
05
Hospital pharmacy: Definition, Objectives
and Functions
Organization & structure of Hospital pharmacy
Location & Layout, Infrastructure
Floor/space and equipment requirements,
finishing, facilities
Pharmacist & staff requirement, Responsibilities &
Functions of hospital pharmacist

4. Definition
Hospital pharmacy is the health care service, which comprises the art,
practice, and profession of choosing , preparing, storing, compounding,
and dispensing medicines and medical devices, advising healthcare
professionals and patients on their safe, effective and efficient use.
Hospital pharmacy is the profession that strives to continuously
maintain and improve the medication management and
pharmaceutical care of patients to the highest standards in a hospital
setting.
The hospital pharmacy is a department which consists competent and
legally qualified pharmacists which deals with procure/manufacture,
store, compound, check for quality, dispense, pack and distribute drugs
to in-patients and out-patients.

5. Objectivities
• To ensure the availability of right medication, at right time, in the right
dose at the minimum possible cost.
• To professionalize the functioning of pharmaceutical services in a hospital;.
• To act as a counselling department for medical staff, nurses and for patient.
• To act as a data bank on drug utilisation
• To participate in research projects
• To implement decisions of the pharmacy and therapeutics committee
• To coordinate and cooperate with other departments of a hospital
• To plan, organizer and implement pharmacy policy procedures in keeping
with established policies of the hospitals.

6. Functions of hospital pharmacy
Hospital pharmacy services offers both clinical service and operational functions.
Clinical services includes drug utilisation, providing patients with the proper medication and dosages at the
right time at a reasonable cost
• Proper storing of drugs
• Manufacturing and distribution of drugs
• Dispensing and sterilizing parenteral preparation, which are manufactured in hospital.
• Dispensing of drugs as per the prescriptions of the medical staff of the hospital.
• Filling and labelling of all drug containers from which medicines are to be administered.
• Management of stores which includes; purchase of drugs, proper storage conditions and
maintenance of records
• Establishment and maintenance of “Drug information Centre”.
• Providing cooperation in teaching and research programs.
• Discarding the expired drugs and containers worn and missing labels.
• Drug therapy selection and review screening for allergies, drug/drug interaction and
food/drug interactions are the clinical services offered.
• An educational program provided to patients and hospital staff, and pharmacy staff
development that includes continuing education, a pharmacy intervention workshop.

7. Compoundin
g area
Manufacturi
ng or
Production
Administrati
on and
Library
Education
and
training
Research
Sterilizati
on
Quality
control
The number of assistant chief
pharmacist in a hospital depends on
the volume of work, nature and
scope of operations, staff strength
and has to assist the chief in matters
relating to administration and
overseeing and controlling the
various functions of the pharmacy.
The staff pharmacist, technicians,
pharmacy workers and helpers are
responsible for compounding and
dispensing, manufacturing, drug
supply, central sterile supply and
library.

9. Head of
pharmacy
services
Dispensing
dept
(D.Pharm)
Warehouse
pharmacist
(B.Pharm)
Quality control
pharmacist
(M.Pharm)
Medical stores
pharmacist (B
or D.Pharm)
Manufacturing
dept.
(M.Pharm)
In
Patient
Out
Patient
Other manufacturing
services (B.Pharm)
Manufacturing of sterile
fluids (B.Pharm/M.Pharm)

10. Location
• Hospital pharmacy is mostly located in hospitals premises only so that
patients and staff can easily approach it.
• In multi stored building of a hospital, the pharmacy should be
preferably located on ground floor especially the dispensing unit.
• It should be laid in such way that there is a continuous flow of men
and materials
• The hospital pharmacy should be located on the first floor in the
centre and near to the out-patient department, this will increase the
efficiency and reduce the man-hours of work.

11. layout
Incoming
storage
Refrig
Storage for
Empty
boxes
Infusion
solution
Injectable
drugs
Narcotics
External
use
Materials
Materials
Oral
drugs
Oral
drugs
Materials
Working area
Desk
Outgoing storage
1 2 3 4
Schema 1

12. Incoming
storage
Refrig
Storage
for
Empty
boxes
Infusion
solutions
Injectable
drugs
Narcotics
External
use
Materials
Materials
Oral
drugs
Materials
Working area
Desk
Outgoing
storage
1
2
3 4
Materials
Oral
drugs
Schema 2

13. Infrastructure
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
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

14. Floor/space requirement
The floor area of hospital pharmacy in a hospital depends upon many factors
like,
Range of its operations
Number of divisions
Medicaments manufactured
Number of patients served through the out patient pharmacy
 Number of indoor patients
Strength of the staff of the pharmacy
• The area of the floor should not be less than 250 sq. m.
10 sq. m per bed for 100 Beds
6 sq. m per Bed for 200 Beds
5 sq. m per Bed for Larger hospitals
• The spacing of floor should be according to the norms prescribed by
Drug and Cosmetic act (under Schedule M)

15. • The floor should be Non skid, acid resistant with proper drainage.
• Floor should be smooth and easily washable.
• The walls should be smooth and preferable painted in light colour.
• Pharmacy should be provided with well illumination
• Appropriate temperature and humidity should be maintained.
• In manufacturing sections, drains should be provided, walls should be smooth,
painted in light colour.
• Wooden cabinets are laminated
• Fluorescent lamps are placed above prescription counter.
Area in sq. ft. for 50 Beds 100Beds 200 Beds
Compounding and dispensing laboratory 205 320 495
Parenteral solutions laboratory 185 200
Store room 125 200
Manufacturing laboratory 120
Office and library 105
circulation 60
Total 205 630 1,180

16.  Prescription case
 Storage cabinet with shelves and drawers
 Working table and counters
 Sink with drain board
 Cabinet for storing pestles and mortars
 Cabinet for keeping glass wares
 Narcotic vaults
 Refrigerator
 Oven
 Office desks
 File cabinet
 Space for journal and books
 Window for dispensing to out patient, nurses and issue of sterile items.
Equipment requirement

17. Finishing
Floor:
Floor should be smooth, tough and resistant to acid, base
A heavy linoleum is preferred.
Wall:
Walls to be smooth without crevices, washable, light colour.
Drug cabinet light coloured wood or steel.
Sterile solution room, water, smooth, non skid surface with drainage system
Arrangement of fixtures to be made in such way day light can be used.
Light:
Plenty of windows for day light
To make dust free venetian window blinds to be used
Florescent light on prescription and distribution are
Adequate electric sockets and exhaust for gases

18. Prescription area:
Prescription desk with cabinets and drawers
Sectional drawer cabinets with cupboards bases
Desk, office equipment, computer, telephone
Drug available list, information board
Preparation area:
Work table for manufacture of solutions
Empty, adjustable glass storage shelves
Sterilization facilities
The standard counter heights 36”×30”×74” with acid resistant tops
Acid proof sinks
Storage area:
Storage cabinet with proper levelling
Space for loading of woods packs
Space for pharmacy lab with testing equipments
Equipments for compounding, dispensing

19. Facilities require for pharmacy
Pharmaceutical and administrative facilities should be provided for efficient
running of pharmacy department.
a) Suitable equipments for compounding, dispensing and manufacturing of
pharmaceuticals
b) Supply of necessary book-keepings, stationary, furniture, material and
equipments for the proper administration of the department
c) An adequate library and filling facilities to make the information on drugs
readily available to both physician and pharmacist. A modern library should
be maintained in which following official books and journals should be
available:
 National formulary  International pharmaceutical abstract
 United states pharmacopoeia  Journal of pharmaceutical sciences
 America hospital formulary service  American journal of hospital pharmacy
 Journal of American pharmaceutical association  Journal of American medical association
The library should contain the text and reference books on the following subjects.
Pharmacy, chemistry, pharmacology, bacteriology, toxicology, therapeutics, staining techniques, sterilization and
disinfection techniques and medical dictionary.

20. Arrangement and storage of drugs
General drugs:
 Drug to be arranged alphabetically in cabinet.
 Arranged as per use i.e. antibiotics, anti hypertensive etc.
 Bin card showing stock position
 Short expiry to be placed in front and long expiry at the back.
 FIFO (first in first out) method to be followed.
 The drug to be used before date of expiry or transferred to other hospitals.
 Expiry drugs to be disposed up as per rule.
Narcotic drugs:
 There should be separate, special arrangement for narcotic drugs like
morphine, pethidine, barbiturates.
 Proper recording to be maintained
 Always to be kept under lock and key

21. Cold storage:
 Drugs such as antibiotics, vitamins, liver extracts should be stored in cold
room between 15˚ to 20˚ C.
 The room to be air conditioned with temperature control facility.
 Drugs like vaccines, sera, hormones etc to be stored at 2˚ to 8˚ C in deep
freezers or walk in cooler.
 Temperature monitoring through dial thermometer and temperature
charting.
Inflammable items:
 Separate enclosure to be made for inflammable like spirit, gases & chemicals
 Adequate ventilation and fire fighting arrangements
 Exhaust fans & sky scrappers for air to pass through
Storage of products requiring a cold chain:
 Products needing a cold chain should be stored in a refrigerator (between
2-8 ˚C) e.g. vaccines, immunoglobulins, serums, insulin, ergometrine,
oxytocin, dinoprostone, certain laboratory tests, etc.

22. Storage of drugs not requiring a cold chain:
drugs are arranged according to the classification adopted:
Oral drugs
Injectable drugs
Infusions
Drugs for external use and antiseptics
Disinfectants
Storage of controlled substances:
 Narcotics and other controlled substances should be placed under lock
and key.
Storing medical materials/supplies:
 Do not to use alphabetical ordering, but group articles by category:
Injections, dressings, sutures, reagents and laboratory material, etc.

23. Pharmacists & staff requirement
 A staff requirement in the hospital in the hospital pharmacy depends upon the
strength of patients available in the hospital wards or hospital premises.
Small set-up – Dispensing department
Big set-up – also Manufacturing, quality control & clinical pharmacy
departments
 The requirement of number of pharmacist in a hospital is calculated on the basis
of some workload norm like the number of prescription received and dispensed
on the number of beds available in the hospital and its occupancy rate.
 For a small hospital – minimum 3 pharmacists 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.

24. Bed strength Number of pharmacist
Up to 50 Beds 3
Up to 100 Beds 5
Up to 200 Beds 8
Up to 300 Beds 10
Up to 500 Beds 15
(Preferably M.Pharm. In
Pharmacology)
Director of Pharmacy
Dispensing department
Manufacturing
department
Sterile
section
Non-sterile
section
Clinical Pharmacy
department
Quality control
department

25. Responsibilities and functions of hospital pharmacist
Indoor pharmacist responsibilities
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

26. c) Direct patient areas:
1. Identification of drugs brought into the hospital
2. Obtaining patients medication history
3. Assist the physician in the selection of drugs
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

27. Outdoor pharmacist responsibilities:
a) Central dispensing area:
1. To ensure that all drugs are stored and dispensed correctly To check the
accuracy of the dosages prepared
2. Maintain proper records
3. Preparation of bills
4. 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
c) General responsibilities:
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