33. Hosopital pharmacy series - Hospital pharmacy services - Organization and functions
Unlike its counterpart in the west, the 'Hospital pharmacy' service has not established itself in India to its full / rather desired bloom form, as such is not popular enough among the hospital administrators and clinicians. It is also not correct to compare with the western pharmacies and pharmacists as they are not equals and at the same time there is no level playing. Hence I have made an attempt to discuss the organization and structure to suite the Indian scenario. However, to put it optimistically; "There is a great potential in the Indian hospitals to establish and develop 'Hospital pharmacy' service". One of the main reasons for such backwardness in 'Hospital pharmacy service' is the isolation of the pharmacy education with no scope for mutual exposure of the pharmacy education and hospital management system. Hospital pharmacy and Clinical pharmacy are the two main types of services the pharmacist could render in the hospital. Hospital pharmacy concerns itself with the drugs logistics - supply chain management that includes Policy, Planning, warehouse management, procurement and dispensing / distribution. Clinical pharmacy is a specialty, which helps the hospital therapeutic system with updated rational support to the clinicians in selection of drugs and formulations, dose management, Optimizing therapeutic efficacy, economizing the cost of medication and Drug Information Service. So to say the Clinical pharmacy helps the clinician in ensuring correct, rational therapy and takes care of the patient medication regimen Whereas, the hospital pharmacy is logistics support system that helps the terminal service providers and consumers with materials and information. Hospital pharmacy and Clinical pharmacy have got their own scope and limitations both in relation to one another and in relation to the Co-professionals but do have some overlapping functions also in certain area. However, one cannot assume the total role of the other. That means to say, a hospital pharmacist cannot be asked to serve as a full-fledged Clinical pharmacist and the clinical pharmacist to take care of the logistics. The clinical pharmacist is more clinical oriented in his job and the hospital pharmacist is concerned mainly with supply chain management. Here, I wish to discuss mainly the hospital pharmacy, as my experience in and exposure to clinical pharmacy is very much superficial with no depth of any worth. Besides, I did not get any opportunity to visit any overseas pharmacies. Hence the hospital pharmacy I am discussing is my vision and mission suitable to Indian scenario. Since in India, clinical pharmacy is yet to have a footing I will discuss the hospital pharmacy with no clinical pharmacy facility. The only difference that perhaps may happen when the clinical pharmacy comes into being is that the hospital pharmacist instead of discussing the issues with clinicians would be discussing with the Clinical pharmacist. These two sectors should learn to co-exist with mutual respect and support from the beginning itself with no prejudice, ego and interference with one another. I wish every one understands this as a word of caution in the interest of the profession. Such a feeling of mine is out of my observed experience as well as out of reported information. Hospital pharmacy The hospital pharmacy is one of the service departments in a hospital. It is a support service to the terminal service providers that includes the dispensing pharmacist also. It is a guiding beacon to the hospital administration and is a technical support to the clinicians and other service providers through a healthy Supply chain Management. Therefore, besides a good communicating skill a good knowledge of the following is essential for a Pharmacist heading the hospital pharmacy department to serve effectively and responsibly; 1. Objective, Vision, Mission and SOP of the institution 2. The formulations and Drug molecules in use 3. Utility knowledge of drugs in brief 4. Shelf-life and stability of the drugs 5. Procurement procedure and skill 6. Storage needs of the drugs 7. Inventory management and skill 8. Quality auditing 9. Supply management and skill 10. Dispensing and counseling skill 11. Documentation needs and methodology 12. Stock auditing knowledge and skill 13. Legal Rules and regulations applicable 14. Total vision on the whole functioning system The hospital pharmacy will have the following sections; A. Main store B. Sub-store with or without Satellite stores C. Emergency store D. Dispensing section E. A small simple library for reference F. A small laboratory to carry out simple tests like; Physical characters and some simple chemical tests that doesn't require elaborate facilities. Each of these sections is manned by Pharmacists and a Chief pharmacist would be the overall head of the Hospital pharmacy who controls and regulates all sections. The Central sterile supply division [CSSD] is the domain of the nurses and pharmacist's role is insignificant. Hence, I have not included CSSD in the above listed sections. Functions of the hospital pharmacy head The Pharmacist heading the hospital pharmacy will have the following functions and responsibilities; 1. Pharmacy manpower management 2. Pharmacy Supply chain management; Procurement Storage, Inventory management Distribution of drugs and other allied materials used for treating the patients. 3. Space and equipment management 4. Documentation and its management 5. Pharmacy operation / system management 6. Quality management 7. Auditing of material, service and system 8. Public awareness creating program 9. Drug budgeting and budget management 10. Information management and service Qualities of the hospital pharmacy head The Pharmacist heading the hospital pharmacy should have the following qualities; 1. He / she should be a team leader with a good integrity with discipline, 2. He / she should have a good vocabulary and communicating skill 3. He / she should be technically a good teacher, trainer, besides being a good motivator and administrator. 4. He / she should have good rapport and credibility not only among his staff but also with the administration and the clinical team 5. He / she should be pro-active in nature Organization Two components are necessary for the healthy functioning of an organization; 1. Well defined organization structure; - This defines the department, various sections with in the department and their administrative inter-relationship - This also defines the hierarchy and administrative authority of each level of functionaries. - This will be made known to every employee at the time of induction. 2. Well defined policy and procedure; - This defines the scope, limitations, authority, rules and procedure - This is issued in the form of a memorandum / notification / Circulars / Executive order / SOP that directs and guides the functionaries to function at their optimum efficiency to match with the vision and mission of the institution as a whole. Organization structure A Well defined organization is the fundamental requirement for any system to function with due accountability. Inherently, this defines the functions, scope, responsibilities, authority & empowerment and limitations given to each individual or to a position or people in a cadre. The hospital pharmacy can function with full accountability and render reliable professional service only when it is established with well-defined organization structure and allowed to work under a well-defined operating procedure (S O P). The organization structure, status, functional scope and responsibilities given should be a well-balanced one so that the pharmacy and the pharmacists function with professional freedom, dignity and confidence. This doesn't mean a total independent authority to the hospital pharmacy. The hospital pharmacy does enjoy the freedom and authority like any other department in the hospital within the ambit of the administration and administrative policy and procedure of the hospital. Structure and size The structure, size and strength of the pharmacy services depend on the following factors: 1. Size and Jurisdiction of the institution, 2. Organization structure of the institution 3. Type of services rendered by the institution 4. Lay out spread of the hospital - more pharmacy outlets at least for the inpatient service are required when the hospital has a very wide-spread layout. 5. Working hours of the hospital or the duration of pharmacy service required 6. Budget, type and quantum of Inventory load to be managed. 7. Authority to be delegated to the functionaries 8. Other related services and responsibilities that could be delegated Etc. The following staff structure is suggested to establish a hospital pharmacy service in a hospital; A Chief pharmacist -1 1. Equivalent in the cadre to that of a seniour medical officer 2. He would be heading the hospital pharmacy department Secretarial assistant 1. A non technical person 2. Reporting to the Chief pharmacist 3. He would be assisting the Chief pharmacist in secretarial jobs Graduate pharmacist - 1 To assist and provide technical and managerial support to the Chief pharmacist 1. Equivalent to the cadre of a medical officer 2. Reporting to the Chief pharmacist 3. He supervises, guides and takes care of the supply chain management Junior and Seniour pharmacists - To work in main store, sub-store, Dispensing section, Emergency stores, satellite stores if any. 1. They are under-graduate pharmacists 2. Reporting to Graduate pharmacist 3. They are posted to various sections of pharmacy 4. They Work under the guidance and supervision of the Graduate pharmacist Helpers; - to support the functions and functionaries in pharmacy In case of community hospitals under a common mismanagement [CORRECTION: Please read this as MANAGEMENT not mismanagement. Thanks to Dr Vijayaratna for the correction]like Government hospitals and health care centers it is necessary to have District level, Division level and state level Pharmacy officers to support, supervise and co-ordinate to ensure effective pharmacy services. Policy and procedure The vision and mission statements of the organization / Institution guide the policy and procedure of operation. Therefore, the Vision and Mission statements are published and popularized among the staff and the public as guiding factors for the knowledge of every one concerned. Besides, the hospital pharmacy department itself can have its own Vision and Mission statements to accentuate and reinforce the broader vision and mission statement of the institution. Issues before management The management of an institution has to address various issues like; 1. Administrative issues 2. Operational issues 3. Service issues 4. Financial issues and 5. Legal and regulatory issues Hence, any institution will have laid down well defined policy and procedures to address the above issues for healthy functioning. Broadly the policies are; Administrative policy that includes; 1. Human Resource (Manpower) Development and management 2. Recruitment and training; 3. Service matters; 4. Office Infrastructure and supply of consumables Financial policy that includes; 1. Fund sourcing, Money management, Accounting and auditing 2. Supply Chain management; Procurement, inventory management, bills payment, distribution system, disposal of waste etc. The hospital pharmacy also should function within the Administrative and financial policy of the hospital. However without prejudice to the hospital administrative and financial policy, the pharmacy can have its own executive regulatory measures that might be desired to improve the quality, efficiency in service. Authorization and delegation The functionaries at different level have to be empowered with defined scope for working and also have to be regulated by defining their limitations to ensure accountability on their performance. These are enlisted in the SOP for the entire operation. Each functionary is given job responsibilities with well identified and defined 'Key Responsibilities Assigned' [KRA]. The performance of the functionary is evaluated on the basis of the quality of KRA discharged. >> Add on: I am sorry to have missed 'Therapeutic committee' under hospital pharmacy (TC). TC can be established even without clinical pharmacy. The only difference would be hospital pharmacist may not be able to into go to deep into therapeutics. Secondly, except in teaching hospitals the doctors elsewhere dont go too deep into theoretical therapeutics. Hence the head of the hospital pharmacy should be able to manage the TC meetings and follow up actions. Even after the Clinical pharmacy is established, it is preferable to have a hospital pharmacist in TC meetings as it helps in bettering the qiuality of procurement and dispensing. Thank you.