Hospital pharmacy series

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Hospital pharmacy series for teachers and students of pharmacy

Hospital pharmacy for pharmacy students*

HOSPITAL
The word hospital immediately reminds us of doctors, pharmacists, nurses surrounded by sick people thronging the out-patient department, queued up before the dispensing section and the scene of ailing, moaning, weeping men, women and children lying on the bed in the wards because, the hospital is a place where the sick seek solace.
The hospital is an institution to provide ‘Medical’ care services to the sick and ‘Health’ care services to the public
Just as medical management is essential to alleviate suffering of the sick individuals and save their life, the health management is essential to alleviate the suffering of the community and to save the people from getting into suffering sickness.
The ailment of the community may be incidental to poor hygienic environment or may be due to ignorance or carelessness of any one person in the community. It may also occur by the outbreak of any endemic or epidemic diseases, again due to poor hygienic condition including pollution of food, water, air and soil or due to natural calamities like draught and flood or man-made calamities like fire hazard, bursting of crackers, unscientific disposal of wastes etc.
Medical management begins when the health management fails. Therefore, ‘Prevention is better than cure’ is the dictum.
The health of the mankind has become the immediate casualty with the changing life style, all round pollution by automation and industrialization, habits of all sorts being cultivated, misuse and abuse of nature, deforestation and over-urbanization. More and more parts and more and more systems of our body are prematurely losing their functional capability and the body and body systems are becoming easily prone to diseases, which sometimes are fatal.
Therefore, the ‘Health care’ services have acquired importance with the awareness on the etiology of various health problems. The ‘Health’ care services are provided by creating awareness among the public on the various disease preventing measures and on the needs of healthy habits through “Information, Education and Communication” [IEC] services.
Unlike medical care, which warrants the services of the qualified professionals like doctors, pharmacists, nurses and other technical and skilled supportive personals, the health care measure is to be adopted and followed by every one. Every member of the society and every home in the society is a contributor to the causes and good / bad management of health related issues.
To have a good health, the personal hygiene and the community hygiene and habits should be good. For instance a smoker when avoids / stops smoking would be rendering a greatest service not only to himself by preventing his own body deterioration but also to the community around by preventing environmental pollution through the side streams of smoking.
Since the health is the fundamental need for the social and economical well being of the society, unlike the hospitals of the yester years, the hospitals of today have a very great responsibility to provide health education and awareness, so that people:
 Do not lose their man-days required for social and economical living through effective and rational ‘Preventive’ services and habits
 Do not lose lives and / or much of their man-days caused by sickness through effective and rational ‘Curative’ services.
Public health also encompasses:
 Care of the infants and children through various immunization measures,
 Care of women all through their biological life stages and
 Care of both men and women though adequate immunization and
 Creating awareness on ill effects of various acquired habits and certain traditional unscientific illogical beliefs and practices
 Motivating the people to adopt healthy habits and to understand the myths of unscientific illogical beliefs and practices though traditional.
Hence the public health care activities are aptly called ‘primary Health Care’ and terminal end service providing institutions are more aptly called ‘Primary Health Centers’ in our country to fulfill the social obligation towards the community.
Health care activities are standardized with defined benchmarks for implementation, monitoring and evaluation. Such activities are called ‘Health care programs’. There are National health care programs, State health care programs and local or regional health care programs depending on the demographic and epidemiological data. Besides the World Health organization too will be carrying out its investigative, supportive and advisory roll to ensure effectiveness in the implementation of all the health care programs. The following are the national health care programs in our country:
1. National Malaria Control Program 2. National TB control program 3. National Blindness Control Program
4. National leprosy Control Program 5. National Goiter Control Program 6. School Health
7. AID prevention program 8. Reproductive & Child Health program (RCH) 9. IMMUNIZTION
10. Health & Nutrition program 11. Communicable diseases 12. Diarrhoeal disease control
13. Integrated health care program

Hospital which hosts the sick with a responsibility to alleviate and cure their health problems should be the ‘Embodiment of ‘Hospitality’, which means 5 ‘C’s:
Courteous reception with a smile,
Consoling reassuring words,
Confidence building atmosphere,
Convincingly rational therapy
Cheer on discharge.
Well, these are most inexpensive services requiring only dedication and little more personal touch to the activities that are being carried out routinely. The difference is:
Hospital practice without hospitality Hospital practice with hospitality
Staring the patient with a wooden expression-less / an overstrained face as the patient is approaching. Adding a light smile with a kind look when the patient is approaching .
Impatient hearing to the complaints, Scribbling the prescription well before the patient completes his narration, Impersonal approach in receiving prescription and dispensing the drugs. Listening patiently to the complaints, write the prescription after he completes his narration,
Explaining the prescription while writing,
Receive the prescription smilingly and explain the dosage while dispensing the drugs
‘Have you not been given the medicine? You go home ’ Please don’t worry; medicine given to you will make you healthy. Be happy and go home. You may please contact us if you need.
Such an attitude and approach by the service providers would be possible only by practice. This approach will have a long lasting impact in building the good rapport only if the terminal service providers follow it up with rational therapy with good quality materials at the right moment.
Any hospital will have its own organizational and functional structures. Generally a hospital will have the services like: Outpatient and Inpatient medical and surgical services supported by Pharmacy, Nursing, laboratory, physiotherapy and radiological services besides ambulance services.
Services like general medicine, general surgery, Obstetrics & gynaecology and dentistry are common services normally available in most of the hospitals. The other services are provided in the hospital depending on the need and availability of facility and experts.
The following table shows the norms prescribed by Government of India for various types / level of hospitals:
Type of hospital Eligibility for establishing Facilities Staff recommended Assigned activities
District level hospitals
Taluk level hospitals
Primary health Centers
Classification of hospitals
There is no definite thumb rule to classify the hospitals. They can be classified in several ways. Any classification is good as long as long as it helps in understanding the structure and functions of the hospital.
For the purpose of this study, the hospitals can be classified in several ways as under:
1. Classification of hospitals as per the sectors in which they function:
Public community hospitals run by the Government
Private hospitals that include all types of institutions providing curative service
2. Classification of hospitals as per the system of therapy:
Ayurvedic hospitals : Provide Ayurvedic system of therapy
Unani hospitals : Provide Unani system of therapy
Siddha hospitals : Provide Siddha system of therapy
Allopathic hospitals : Provide Allopathic system of therapy

The Ayurvedic, Unani, Siddha system of therapy are also called ‘Indigenous System of Medicine’ (ISM) as they are the oldest systems that were in practice even before the Britishers could bring the Allopathic system into India.
3. Classification of hospitals as per the type of service provided:
In India, the Government has established hospital and health-care service under the following classification:
Teaching hospitals that are attached to the medical colleges
District hospitals and general hospitals, which mainly provide curative services besides creating awareness on public health.
Health centers like: Primary Health Centers, Primary Health Units,
Primary
Health
Centers, : Established to provide mainly the health care services. They also cater to the curative needs of the people, mainly established in Rural areas. However, there are PHCs located in backward pockets of urban areas also. These centers help in implementing various national and State health care programs.
District / General
Hospitals : These hospitals are located in urban and semi-urban areas. The Government invariably establishes them. They mainly provide curative service
Teaching hospitals These are hospitals attached to the medical colleges where clinical training / teaching facilities are extended to the medical colleges. The teaching hospitals will be having advanced facility and more specialties compared to the General and District hospitals.
Specialty
Hospitals.
: These are hospitals established to treat specific health problems. Ex: Cardiac hospitals, Urology hospitals, ophthalmic hospitals, maternity hospitals etc
4. Hospitals can also be classified as under:
Organized sector : Public community hospitals established by the Government including the Autonomous hospitals could be grouped under this sector as they function under a common administrative and financial policy. The Autonomous hospitals will be having certain functional autonomy within the overall policy of the Government
Un-Organized
sector : The private hospitals that are functioning independent from one another could be considered as hospitals under Un-organized sector as they do not have a common administrative and financial policy and programs.
Example: Private hospitals, Nursing homes etc.
Semi-Organized
Sector : There could be a well-coordinated chain of hospitals functioning under a common administrative and financial policy and programs. These could be grouped as Semi-organized hospitals.

Hospital manpower:
Hospital manpower mainly consists of Doctors, Pharmacists, Nurses, technicians and non-clinical supporting staff.
The pharmacist who enters the hospital must understand that excepting he and the non-clinical staff, all the other hospital staff are the ones who have been there right from their student career. That means to say that the pharmacist should try to adopt himself with the ambient environment.
The popularity and acceptability of the pharmacist by the hospital (meaning other staff) depends on the adoptability of the pharmacist to the hospital environment. A pharmacist who offers his/her professional assistance to the hospital activity would become more popular and more liked one than the pharmacist who drastically tries to impose his knowledge and ideas on others.
Here are few tips:
1. Keep on observing the prevailing system of drugs and drugs store management right up to the point of dispensing and administration to the inpatients. Understand the policy, rules and conventional procedures including the financial scope and constraints prevailing in the hospital drugs management Strictly avoid revolutionary changes but always prefer to go by reforms however slow it may be.
2. Slowly move in to reduce the repetitive tasks if any and provide such methods that reduce their manual labour taking due care that any accountability that exists is not taken out. This will make the staff happy.
3. Sit happily with the staff and start documenting the data in the existing format. Study the existing documentation system. Identify the repetitive areas and areas that are lacking in providing full data on drug movement.
4. Make a new pilot plan and format to overcome such duplication and deficiency and work it out by yourself and put it up for implementation only after you succeed.
5. Keep your eyes and open to understand the practical difficulty if any experienced by the staff before and after introduction of your new system either in documentation or in physical handling of drugs.
6. Always keep acceptability by the staff in mind with a vision of providing good material at right time to the patient.
Example:
It is likely that in a Government hospital the tablets and capsules are purchased in bulk packing and distributed to the patients in loose units. The drugs collected by the nurses in a tray from the stores. The trays may or may not be having partitions / lids to separate drugs from one another and to keep them covered. Different drugs in tablets / capsules from may have same colour and shape and size and the staff though would be going by experience in identifying one from the other, the possibility of mix up cannot be ruled out.
What the pharmacist should do in such a situation?
A) Ask the staff to segregate one from the other, label and keep the drugs well closed or
B) Tell the staff that drugs will not be issued unless they comply or
C) Provide the right containers with label from the stores itself.

<<<>>> -to be continued
Some extra information:

Source: The Hindu ( http://www.hinduonnet.com/mp/2001/11/19/stories/2001111900050300.htm)

A choultry that became a hospital

Facade of the Stanley Hospital

INVITED TO write a brief history on modern medicare in the city for a souvenir, it was an opportunity to recall modern medicine's proud record in Madras. But that's when it suddenly struck me that the record didn't encompass the Indians of the city till nearly 175 years after the first hospital was opened in Madras.

The first hospital in India practising allopathic medicine might have been established in Goa in the early 16th Century, but it is in the hospital that Governor Edward Winter established in a rented house in Fort St. George in 1664 that there are the roots of India's vast healthcare system of today. It was from the Fort Hospital that, over several moves, the Madras General Hospital developed over the next 100 years, eventually putting down roots at its present location when a new building built for it opened its doors on October 15, 1772. But established as it was for the Europeans of Madras alone, it did not become truly general, and open to Indians as well, till 1842. In fact, it was 1859 before Indians not in government service had access to it. That rather dims that "proud record", for hospital facilities for Indians lagged years behind. And when they got them, it was more by chance than intent. More interestingly, they got them first in another hospital, Madras's second!
one.

When Madras was stricken by one of its worst-ever famines in 1781, the city's first formal charity was set up by the Government and St. Mary's Church. A Famine Relief Committee was established in 1782 and the Committee rented a house for poor feeding just beyond the north wall of George Town — in present day Royapuram that was all fields, vegetable gardens and fruit groves then. The house continued as a refuge for the poor and the sick even after conditions improved in 1784. It is around that time, it appears to have got its name. Monegar Choultry, perhaps by then being locally administered by the village headman (manugakkaran). Better known as `Kanji Thottam', it is here that East India Company Surgeon John Underwood established the city's first facility in 1799, for Indians who were sick and called it the `Native Infirmary".

The Infirmary was probably run as a charity, an assumption made from the fact that the records state the government took it over from the Famine Relief Committee in 1808. The next year, a `Native Hospital' that had existed in Purasawalkam for a couple of years was moved and merged with the Infirmary and the resulting institution was called the Monegar Choultry Hospital. The hospital was named the Royapuram Hospital in 1910 and over the next few years, its old buildings were replaced with the buildings that still survive.

Even before Royapuram found a place in the Hospital's name, the Auxiliary Royapuram Medical School was established in it in 1877 to augment the efforts of the Madras Medical School founded in 1835 and upgraded as Madras Medical College in 1850. The Royapuram school was renamed Stanley Medical School in 1933, and when it merged with Lady Willingdon Medical School for Women (founded in 1923) and became a college in 1938, both college and hospital recalled the name of the erstwhile Governor, George Stanley.

It's a name that has survived, with many an Old Stanleyan battling in the recent past for its retention.

S.MUTHIAH