Hospital Pharmacy- LECTURE 8

Hospital pharmacy Hospital pharmacy is the department responsible for provide (giving) all pharmaceutical services in hospital specially:

1. Out- patient pharmacy services. Out patient services: This services is to provide pharmaceutical services to ambulatory patients mainly: a. daily clinic b. specialist clinic & emergency services

f In- patient drug distribution & control - Keep sufficient stock of drugs , properly stored , ready to supply to hospitalized patient (in –patient) according to their order sheets. It should be noticed that : -sufficient stock of drugs involve, proper follow up of current stock quantities so that stock of the drug will not be less than a minimum quantity. - i.e , the minimum quantity will be enough to cover patients needs until new supply of drug comes to the pharmacy , -proper storage ( proper storage of drug should be followed as shown on drug package)e.g -store in cool place . - store away from direct sun light -store below 25 c or 30c . - keep refrigerated. 1

-Distribution of drugs to wards then to in-patient , must be according to one of the following system: -

a- Unit dose system "U.D.S" b- Complete floor stock system 'C.F.S.S"

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- Dispensed drugs should be: a- properly packaged e.g "plastic container or sealable bags"

b. Clearly labeled e.g ." patients name ,drug name , drug potency, type of dosage form , dose & frequency , date & word name". Other duties of in- patient pharmacy A. supply of disinfectant , chemical and pesticides to all departments. B. Supply of surgical equipment & disposable surgical equipment together with anesthetic & and anesthesia equipment to operation theater & emergency clinic also supplying medical equipment of stethoscope , sphygmomanometer. C. Supplying laboratory chemical & blood bank requirement. D. Supply of drug & equipment to intensive care unit (I.C.U) e.g 1. Analgesic e.g (morphine , pethedine………. etc). 2. Antihypertensive e.g ( propranolol , digoxin ). 3. Bronchodilator e.g (salbutamol , aminophyline ). 4. Corticosteroid (paranteral ) 5. Antitoxin & antidotes. 6. Adrenaline paranteral

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3 .Preparation , manufacturing & prepacking of the drug. Manufacturing wide variety of items in common use at hospital e.g - gentian violet -iodine solution. - nasal drug -ear drops. - sulphur ointment.

-All shoud be prepare under hygiene condition in proper container & labeled with: a-Name of drug. b-Manufacturing date. c-Expiry date d-Bach no. e-Formula labeled f-Direction of use

4. Unit dose system. 5 .Drug information services Consultant , specialist . GP , technician , nurses or patients may need detailed information or to clarify information about: a- Drug side effect. b-Indication & contraindication. c-Maximum dose or minimum dose ( paracetamol & aspirine "both the maximum 4g/day) d -Dose to patient with liver or kidney damage. 3

e-Drug combination. f- Dose to ( pregnant ,lactating women ,elderly ,premature babies g-Restriction of drug during pregnancy & lactating e.g tetracyclinei-Antidote to toxic drug or suicidal administration of drug or over dose. k-Incompatibilities of drug. l- long term effect of drug to chronic patients.

6 .Supplying emergency packs to paramedics. e.g.There are boxes which contain drug & tools necessary for paramedics: I -. Ampulance. II - helicopter ambulance. They includes: a- I.v solutin e.g (normal saline drip ,glucose drip) b-Adrenaline "I. M". c-Morphine . paranteral d-Anesthetic e.g local or i.v e.g thiopental na e-Oxygen cylinder & masks. f-Nebulizer for "asthma emergencies" g-Antihistamine injection. h-Cardiovascular drug i-Sedative cns stimulant J-Antidote ,bandage ,first aid…………..etc.

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7. Participating ( taking part) in hospital committee 8. I.V additives departments. 9. Clinical pharmacy services. 10. Administration & Organization of pharmacy department. This involve organization of the pharmacy department such as : 1. Distribution of duties and shift work. 2. Recording prescription and keeping both: a- Prescription b- The record. 3. Recording narcotic & control drugs prescription , then keeping the following: a- copy of narcotic and control drug prescription. b- keeping of the narcotic & control drug record. c - empty container of the drug all in safe cabin. 4.keeping statistic of drug dispenced through the year. 5.Checking the maintenance of refrigerators & air conditioner in the pharmacy. 6.keeping contact with other department & taken part in committees. 7.keeping adequate supply & storing them properly.

)Note: Role of pharmacy department include 1-10 as above.)

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Pharmacy Site , Area The pharmacy site should be located in an area which is convenient for providing service to many department of the hospital, it should be: A. Easily accessible to all department. B. It should not be in the crowded area. C .Should provide free movement of medication carts in and out of the pharmacy. The inpatient pharmacy department serves as storage , manufacturing ,dispensing of medicines to the discharge patients and to in patients. Now a days there is new concept of satellite pharmacy or sub pharmacy to be near to the patient. The pharmacy is formed of the following components: A. Compounding and dispensing area This area is the nearest to the patient or it could be called as dispensing window where the delivery of medication to the patients is done. In early pharmacy times the compounding of drugs was also done in this area but in modern times the compounding is not done , the dosage form is readily available , this area has to be kept neat and clean all time. B. Active storage room This is the area where the medication are stored which are needed on daily bases and are fast running. This area is freely accessible to the pharmacy technician working on dispensing . In this area the stock has to be checked on daily bases as the stock is kept to a limited.

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C. Manufacturing room In this area the manufacturing of some medications used in the hospital is done such as ointments, some of the material are repacked in this area such as castor oil

. This area is also called as the lab which is under

the pharmacist and he is responsible for all the preparation being carried out here. D. Nonsterile Mixing and filling area This is also a part of the lab which is separated from the sterile area, in this area the preparation which does not require much sterilization or aseptic area are packed here, this area has to be separate from the oral liquids. E. Prepacking area This is the area used to pre packing either for unit single dose or separating to small volume. F. I.V admixture room This is very sterile area and also aseptic on where the reconstitution of the injection is done , the person has to be very active conscious and knowledgeable to work in this area as most of the important medication are diluted here so the knowledge of the diluents and mixing technique and keeping himself sterile is important. G. Labeling and inspection room after the dilution is done the labeling is also very important and it is done by the pharmacist who is in charge after the preparation are kept in the prepared area before going to the storage area .It is adjacent to the

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filling area to facilitate the transfer of unlabeled drugs to the labeling area. H. Quarantine storage new products manufactured in the pharmacy are subjected quarantine until appropriate chemical and bacterial testing is done.

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------------------------------------------------Pharmacy Equipments And Instruments Adequate pharmaceutical and administrative facilities shall be provided for the pharmacy department , including; 1. The necessary equipment for the compounding ,dispensing and manufacturing of pharmaceutical and parental preparations. 2. Book keeping supplies and related materials for proper administration of the department. 3. An adequate library and filing equipment to make information concerning drugs readily available to both pharmacist and the physicians. 4.Special locked storage space to meet the legal requirement for storage of narcotics ,alcohol and other prescribed drugs. 5.A refrigerator for the storage of thermo bile products. 6. Adequate floor space for all pharmacy operations and storage of the products in a satisfactory location with proper lighting and ventilation .

The equipment are segregated into tow groups fixed and movable: Fixed: it is defined as those equipment which requires installation and become attached to the building . example cabinets ,counters ,sinks , etc. Movable; it is defined as that equipment which is capable of being moved and is not intended to be permanently affixed to the building .example carts ,desk balance ,mixer etc.

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Role of pharmacy technician in pharmaceutical services Duties in the central hospital 1). Preparation of prescription under pharmacist supervision: Involves:a. The ability to read prescriptions b. Identifying different dosage form & different strength of drugs. c. Compounding f drug in the pharmacy. d. Writing the correct directions for use on each drug. e. The ability to identifying drug incompatibility and contraindication. 2) I.V admixture or IV additives: Involves: The ability to follow procedure of I.V additives, mixed under sterile condition to prepare: a .Total paranteral nutrition (TPN). b.Cytotoxic &and cancer treating. c. Antibiotic & antiviral drug. It is mainly prepare specific drugs and strength (potency) to patient which need special treatment i.e weaker or much stronger drug, or prepare nutrition or vitamins, salt etc. All these preparation are not available as ready products (items) on pharmacy shelves. 3) Preparation of medication for in- patient according to the unit dose system(U.D.S).

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It is process followed in modern hospital to supply drugs daily to each patient individually( one by one) giving only 24 hours drugs supply.

4)Prepacking of medication: Prepare packages which contain a standard of doses ( tablet, capsule, ampoules etc.)in (bottles or plastic bags ) & writing standard direction for use on them . Prepacking of medication is done during hours of no rush (i.e not crowded and few patients) in preparation (to get ready) for the rush hours( when highest number of patients come to the pharmacy).

5)Arrangement of medication in the pharmacy: Medication can be arranged in the pharmacy according to: A) Alphabet sequence (usually using the generic name but trade name can be used.) B) According to dosage form (tablet, capsule ,ointment, cream, paranteral ,syrup …..etc) C. According to use: This means that drug will be grouped (put together) as the action they used for e,g 1.Antipyretic & analgecic. 2. Antibiotic ,anti fungal & antiviral. 3.Antihypertensive drug. 4. Anti diabetic drug.

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This is done both in out patient & in oupatient pharmacy. Also we must but drug with short expiry date in front of the shelves& new drug behind them.

6) Estimation of drug requirement of the pharmacy: Pharmacy technicians should make statistics for dispensed drug in records & plot (draw) curve showing: A .In which months drug are dispensed more (i.e seasonal patterns of dispensation of drug). B. Quantities for each season & quantities during ordinary seasons. C. Special drugs which are necessary for indemic diseases e.g Malaria etc.

7) Control of expiry date for all medication : - Clear notes must be ( display) on each drug on the shelves " also in fridge " showing the expiry date of each batch. - it is good practice to put drug with short expiry date in front of shelves " to dispensed them first" & put drugs with longer expiry date in the back of the shelves " to dispensed them after finished short expiry date". Best practice to remind the pharmacy technician is to use labels with different colours. A. Red labels ( when the expiry date closer to six month) B. blue labels ( on drug of long expiry date).

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-Daily or weekly checks on expiry date in the pharmacy is best practice , because drug must be returned to drug store, before six month or at least pharmacy department must write to the stores a list of: A. Name of items near expiry. B. Quantities of each item.

8) Registration & storage of prescription : - Daily registration of all prescription , then storing them. - Specially care must be followed with prescription of: . A. Narcotic B. Controlled drugs which must also be registered in special register and must be kept with register in special safe because they may be committees which will check on your stocks of drugs and narcotic any time. Therefore all your registers (books) & stocks must be accurate & up to date.

9) Helping the pharmacist in-charge to distribute work shift & duties in the pharmacy. Most hospital pharmacies work (24 hours ) , but staff work in 8 hours in rotation . This means that (3 shift) will take duty in a hours. But they rotate their shift . So that some of them will work night shift one weak but morning or afternoon shift next weak and so on ,also there must be stand by staff in case one of them ill or in leave.

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Out- patient medication system Prescription polices: Is agreement on a system to be followed and understood by: 1. Doctors, specialist and consultants. 2. Pharmacy department staff. They agree on: A. Quantity of medication dispensed. B. Quality and type of drugs prescribed by specialist and consultants.

A. Quantity of medication dispensed: fixed quantities of dispensed drugs are agreed between pharmacy department and doctors , according to:-

The essential ( necessary ) need of patients : this varies : 1) Acute cases : Where is the smallest quantity of drugs , will usually be recommended , e.g 10-20 tabs of paracetamol are enough as analgesic after tooth extraction , but the antibiotic must always be a

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complete course ( in order to avoid development of resistance strain of bacteria).

2) Chronic cases: These are long term patients , suffering from hypertension, heart disease , diabetes etc, where large quantities of drugs are needed to treat ( help) them as long as they suffer from these disease. But the treatment is given every month or every 2-3 month with special ( repeat) or refill prescription

3. Quantities supplied by drug store: The quantity of each drug order by the pharmacy from drug store , May not be supplied as orderd by the pharmacy. Many factors control that: A. Availability of that items (drug) i.e may be not available ( out of stock) or the quantity available in the store is small. B. Financial limitation – specially if the item is not an essential therapeutic drug e.g effervescent vitamin tablets etc. C. Time of change of new supplier or drug company i.e the same generic name but different trade name ,where the new supply is not ready or being tested for quality in the laboratory. B. Quality and type f drug prescribed by specialists and consultants only: To organized and limit highly specialized and expensive drugs it is always agreed to make a list of these drugs and a list of consultants who are allowed to prescribe them.

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Refill system This is a system for chronic patient who keeps taking the same medication for long time or as longer as he or she is a live e,g diabetes patients , asthmatic , hypertensive , sickle cell anemia patients etc. They usually get (take ) their supply of long –term drugs ,dispensed by the out –patient pharmacy . the pharmacy must use the computer to keep records of these patients. If there was no computer , the pharmacist should keep a ( card system) i.e cards with special file or box for these chronic patients and their refills. In either cases computer or card system , there must be the essential information listed e,g 1) Patients name 2) Age 3) Sex 4.) Diagnosis. 5) Drug to be refilled and how frequent (every 1,2,or 3 month) 16

6) Date to be refilled (last date dispensed) 7.) Doctors name and telephone number.

Prescription of narcotic and controlled drug These prescription should dealt with very carefully , starting with: 1.Reading them & checking every (item ,date ,doctor signature .etc. 2.Despensing them ( make sure of the patient name). 3.Recording them ( in special record for them ) 4.Keeping them ( storing them) Narcotic drug prescription are usually 1-4 copies, each of them in a different colored ,but always red colors is used to mark these prescription , in out –patient pharmacy , but on special sheets (also 34) copies of different colors for in- patients in the UDS Checking each item in the prescription is important to avoid any mistakes or old prescription or not an authorized doctors has prescribed it…..etc. Narcotic drug & control drug prescription should be recorded as soon as the items (drug) prepared into the special record book. This record should be kept in the special safe(strong and locked with a key that only the pharmacist keeps), with the narcotic and controlled drugs. 17

It must be remembered to include a copy of the narcotic or controlled drugs ,prescription with the record in that safe for 3 years or more. Inspectors from: 1.The hospital itself 2.The ministry of Health 3 .The ministry of interior Can come any time and check every thing in the safe. It must be learnt very well and practiced that even broken ampouls , bottles or not completely use ampouls or does must be reported , in case of accidents with narcotic a committee is formed immediately ( which includes the the pharmacist) to investigate and report the accident.

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Drugs available in nursing station (nursing unit). There are certain drugs which are kept in nursing station of each ward, as spare to be used if needed by patients specially when A) The pharmacy is closed B) These drug are not apart of drug prescribed to the patient. Usually the nurse will have to ask the doctor before dispensing any of these drug (may be by phone ) or some times the doctors must come and administer some of these drugs , himself to the patients. List usually varies from ward to another, also the dosage form may vary too. e.g 1) Analgesic: specially in surgical wards when the patients may need extra dose of analgesic after waking after operation or women after delivery gynecology and obstetric ward etc . Drug may be a) Paracetamol b) Acetylsalicylic acid c) Indomethacin d) Diclofenac sodium

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Some times narcotic analgesic are kept and used when needed ,under doctors supervision. 2.Cough mixture: such as cough suppressant ,expectorants. 3.Bronchodilater : inhaler or nubilizer e.g salbutamol 4. Anti-emetic drugs: they stop nausea and vomiting specially in surgical wards. 5.Antihistamine: to stop allergic reactions developing against drugs used locally in hospital. 6. Hypnotics : sometimes patients are tense & anxious and can not sleep specially before major operation . 7.Other drugs : vary from a ward to another & doctor recommendation). These drug must be always observed and followed e,g - Expiry date of thee drug -Storage instruction eg (storage refrigerated) -Storage in wards narcotics safe.

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In-

patients medication dispensing systems

There are two main system: 1.Unit dose system (UDS) 2.Complete floor stock system(CFSS)

1. Unit dose system(UDS) It is the most modern medicine dispensing system , in which single dose (their multiple) of medications sufficient for 24 hours are (packaged, labeled and checked) before putting them in the correct drawer carrying patients hospital number or (name), These drugs are dispensed according to patients sheets from each word in the hospital, brought to the in –patient pharmacy with trolley, at specific time , and after unit dose are dispensed in the trolley it will be collected at a specific time too, both time may vary from hospital to another.

History of unit dose: a. Single tablets and capsule were individually packed in strips of foil or plastic , are also known. b. Single dose syringes containing vaccines or hormone and several ampoules or vials. 21

d. Single dose eye drops. All the above example are primary form of dosage forms, which helped the development of unit dose .

Who is involved in the unit dose system? And how? A. Unit dose system , are the responsibility of the pharmacy department in hospital , but carried out (done) by in- patient. B. Co- operation (working together or helping each other) , among : 1. Pharmacy department staff. 2. Doctors and medical staff. 3.Nursing staff. 4. Administration staff. Therefore committee responsible for planning performing and following the progress of U.D.S must be formed . Members of such committee are selected from the above 1,2,3,4 C) Pharmacy department will responsible to educate all the staff in the hospital which is involved in the U.D.S. They must be trained to do their duties and roles in the U.D.S dispensation. usually pharmacy department will hold course with( lecturers, video leaflets ,and then actual practice in other hospital with established U.D.S.

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D) Regular meeting of the committee as well as regular meeting of the pharmacy department staff are necessary ,to study methods of improving the system.

Stages of U.D.S U.D.S usuall pass through three main stages as follows:

Stages A. patient & doctors. B. in-patient sheets to in-patients pharmacy. C. Nurse & patients.

A. patient & doctorsِ after examining the (hospitalized patients) , the doctor shall prescribed suitable medication on ( hospital sheets speially for U.D.S). This sheet must be showing : 1. Day & date : this is important to find the day or date at which a specific drug was given to the patient, and to follow up the patient progress, and when to stop treatment. Some patient may spend the ( weekend)at home and U.D.S must be prepared to give them their medicines for that period before they go home. 2.Word name and code: 23

So that wrong drugs or doses can be checked e.g specific drug for women only , or in pediatric (children) words , doses must be checked. 3.Patients( name ,sex ,age hospital number & nationality : sex is necessary to be identified in case of certain drugs like hormones for example. Age is important to decide the dose for children, infant, adult or old age (geriatric). 4.Diagnosis : to classify the patient according to that disease ,and to check the right drug is prescribed to the right illness (disease ). Very important in case of multiple illness , to check drug interaction ….etc 5.Medicines prescribed: A)Generic name of drugs is best used, but some trade name of drugs may be used, as well. B)Dosage form e.g( tabs ,caps, inj(iv, im, sc, drip). C)Potency this is very important to decide the dose of that drug . NOTE. Some times drug are available in the pharmacy at higher or lower potency than a single dose. That dose must be adapted (altered ) to the correct dose prescribed. D)Frequency & rout of administration . Frequency : number of time of drug must be taken. It should be specify the relation to food i.e before or after or during meals if the drug is taken orally. 6 – Name &signature of prescribe doctor

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This is important to check & discuss with the doctors: 1. IF There was "an incompatibility or drug interaction …etc" 2. IF That doctor is allowed to prescribe that drug , because there are drug which are only to be prescribed by consultant.

B .In- patient sheet to in patient pharmacy: Sheet as describe in "stage 1" , usually be taken for all patient in the word , with special trolley " which contain drawer labeled with patients hospital number" to in –patient pharmacy. At specific time (a hour), pharmacy must start supplying unit dose as soon as possible because ,that trolley must be collected at another specific time , after supplying of unit dose. Action taken by the pharmacist, when they supply the unit doses: a. checking: 1. Incompatibility. 2. Drug interaction. 3.Therapuitic duplication. 4.Over or under dose b. Enter patient number & prescribed drug in the computer. c. prepare the unit dose of drug as prescribed in the sheet( using four checking of dispensation) d. packaging the unit doses in (sealable plastic ,bags or container.

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e. Prepare a label ( by the computer or by hand ) with clean & correct direction for use. f. After the final check , the pharmacist must be sign his (name ,date, hour).

C. Nurse & patient: - The trolley must be ready at specific time i.e (patients drawer are refilled with prescribed drug doses) to collect by the word nurse. - usually the trolley is brought to in patient pharmacy at ( 10 clock) in the morning & taken back at (12 noon). -the nurse would help the patient to administer his unit dose in time according to direction of use, - any unused medication must be returned in that patients drawers ,with note in his sheet about the reason why he or she did not take that dose &which dose was it (6 a.m ,12 noon ,6 p.m or 12 midnight) this follow up is important: 1.To better treatment & recovery of the patient. 2. To the doctor, pharmacy department to select best dosage form& drug in the future & for statistics. These ( three stage) will reported every day.

Advantage of (U.D.S):

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1.all medication despised to the patient are " checked& reviewed " by the pharmacist. 2. Involve the co- operation of " pharmacist , doctor , nurse & patient". 3. Allows (gives ) full control of drug stocks.

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2) Complete floor stock system (C.F.S.S): -This system involves the use of drugs kept in the "nursing station" -Drug are dispensed directly to the patient in the word , by the nurse according to the patient's sheet -It must be noticed that the "four checks dispensed" can not done properly by (nurse). -The role of pharmacist is only to supply refill drug to nurse station stock *Advantages of (C.F.S.S) :1-Drug are really available immediately on the site (in the nursing station ). 2-Nodrug return as in "U.D.S' 3-Less pharmacist are needed in the pharmacy department for this system. 4-Fewer (less) orders of drug form the pharmacy I,e "daily supply, but large stock is kept" 27

*Disadvantages of (C.F.S.S) 1-Errors may happen frequently (many times) on similar drug name: a-Type of drugs e.g."paracetamol& Propranolo " b-Time of administration of drugs -There error are mainly due to: a- Exhaustion of nurse b- Overlap of drug dispensation with other duties 2-No review of drug or no "four checks" Point before dispensation 3-Drug deterioration (break down) , after opening large packs& keeping them for long time. 4-No proper storage facilities (equipment) 5-Nurse must spend long times to "read sheet , dispense &help patient " to administer each dose.

Comparing between (U.D.S) & (C.F.S.S) U.D.S

C.F.S.S

‫قق‬1) 1)Take longer time for three stage to be done.

1) Short time is needed because these only Dispensed but no labeling or check.

2)Large selection of drugs in the pharmacy

2) less selection of drug in nurse station ,any drug needed must be ordered from the pharmacy.

3 3) Large number of pharmacist are needed 4 ) patient recovery can be followed up, and

3 3) Fewer (less) number of pharmacist are needed 4) Not possible to followed up accurately.

selection of best effective type of drug for the disease 5) 5) U.D.S will give the nurse more time to spend on

5) Takes a lot of nurse time, & may cause

patient care.

confusin to nurses other duties

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6) less waste of drug, since only unite does are 6 6)More waste of drug ,because large stock must dispensed

Be kept in nurse station, which may decay

7) A lot of paper work & equipment e.g.

7) No need for much paper work or computer

"computer 8)Rare mistakes

8)Frequent mistakes

9) more contact & exchange of opinion among

9)Very little or no contact or exchange of opinion

(doctors ,pharmacists & nurses)

among (doctors, pharmacists &nurses), no (U.D.S) committee

10) Accurate & effective follow up of patient

10) No real follow up of drug of administration

Administration of medication ,by (return)of

(no return) "no action of expected"

Unadministation drug to the pharmacy, also Action can be taken to correct case.

111)Several checks of each unit does by different

11) One check only by the nurse

pharmacist

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(IV Additive ( 1) T.P.N (Total parenteral Nutrition) 2) Antibiotics. 3) Cytotoxic drugs &Chemotherapy.

1.T.P.N ( Total Parentral nutrition)

There are sterile "I.V " liquid given to patients or replacement to oral nutrition " eating& drink ". Specially prepared according to patient's need , under sterile condition. These aqueous solution may be prepared to (come patients) & contain: 1- protein. 2- carbohy drate. 3- lipids. 4- vitamins. 5- minerals 30

6- water - All these according to variation in patient's need , are give (I.V as a drip).

2) Antibiotics: -These are prepared in the (I.V additives) Unit in pharmacy department, under sterile condition. - Some of advantages of preparing antibiotic this may are : 1) The needed concentration (potency) of antibiotic are not available in ready preparation : a- higher concentration are needed (sever infection). b-Low concentration are needed (infant & children). 2) Maintain stable or steady plasma level of antibiotic . 3- Control plasma level of antibiotic that will reduce ( liver or kidney damage). 4- Avoid oral drug interaction.

3) Cytotoxic: -Treatment of (cancer , leukemia & other malignant disease) is necessary to be

given by infusion to avoid serious side effect of high

toxic drug , usually used for this case.

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-Real accurate control of plasma levels of cytotoxic drug is necessary to give (maximum response)& in the same time to avoid the serious side effect Of these drug : 1-Methotrexate. 2-Cyclophosphamide. 3-Actinomycin.

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Committees 1) Pharmacy Quality Control Committee . 2)Infection Control committee. 3)The pharmacy & Therapeutic committee. 4) Antibiotics Committee.

1) pharmacy quality control committee:

- Committee member : 1- Chair man

"head pharmacist"

2-Out patient pharmacy manager. "member' 3-In- patient pharmacy manager. 'member" 32

4- Clinical pharmacist

"member".

This is an internal committee within the pharmacy department itself ,which will

hold monthly meeting , to provide (give) & maintain (keep)

, highest quality service possible to patients.

This done (achieved) by: a- keeping high standard of staff efficiency. b- Sitting (using) a system of checking ,on all pharmaceutical services.

A- keeping high standard of staff efficiency: This done by: 1- Choosing "employing" qualified & well trained staff. 2- Giving staff updating courses &seminars regularly to improve their ability.

B- Setting (using) a system of checking ,on all pharmaceutical services:

1-Check the time between receiving prescription until (to) the time dispensing

them to patients , at peak time (rush hours). Then finding

& locating any reason

which dispensing, then find a way to improve it

(correct it).

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2- Checking if labels on drug, carry clear direction for use. 3- Checking if explanation of direction for use to patients are clear. 4- Efficiency to restock the pharmacy with items is good & continues. 5- Checking the Rota (on call) of staff ,and that no gaps (shortage of staff ) of service will happen. 6- Drugs prepared (manufactured) in pharmacy department should of " high quality sterility packaging & labeling "

-After each meeting ,a circular letter, must be given to all staff about quality control committees decision (what were the new decision ) to follow them.

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