• The major criticism of small hospital was the lack of pharmaceutical service on 24 hours.• Two major reasons for that are:1. Shortage of trained personnel2. Prohibitive costs
Means of the hospitals to provide 24-hour a day pharmacy coverageA. Use of the Nursing SupervisorB. Emergency Boxes and Night Drug CabinetsC. Use of PhysiciansD. Pharmacist-On-CallE. Purchased Service
Use of the Nursing Supervisor• It permit the evening and night nursing supervisor to enter the pharmacy and provide limited type of services• The first and the most widely used
Use of the Nursing SupervisorDisadvantage:1. Dangerous2. An illegal practice (in some areas)
Use of the Nursing Supervisor• However; the advocator said:There exists a correlation between the nurse selecting a medicine from the drug cabinet on the pavilion and selecting the same item from the pharmacy.
Use of the Nursing Supervisor• The fallacy of this view: The medication in nursing station have Already had the benefit of special packaging Handling and labeling by professionally competent.• So, it should be practiced with caution(if it is the only mean available to small hospital)
Use of the Nursing Supervisor• Nursing personnel serving in this category should be:a. Specifically prohibited form compounding a mixtureb. Restricted to dispensing from the selection of pre-labeled and pre-packaged items
Emergency Boxes• Is necessary to expedite treatment in situations where time is of the essence.• So, the emergency box must be: i. Large enough ii. Sufficiently compact(to facilitate handling items) iii. Kept in a ready accessible place(known to all ward personnel) iv. Ready for use at all times
Emergency Boxes• In order to accomplish this goal; The pharmacy should’ve reserve boxes prepared so that the units may be handled on an exchange basis reduce the period of time without a ready to use emergency box
Emergency Boxes• If the hospital policy charge for the supplies used from emergency box the nurse should prepare a charge ticket and submit it to the pharmacy with the used box
Emergency Boxes• “Emergency cart” or “resuscitation cart”; Mobile units have on them the same basic supplies contained in emergency box plus : i. Facilities for the administration of oxygen ii. The application of suction iii. A cardiac pacemaker
Emergency Boxes• Emergency box must be checked on regular basis(monthly) by hospital pharmacist.• In order to: Remove outdated Deteriorated medications
Emergency Boxes• This system requires placing an inventory and product control card in the box
Emergency Boxes• The objectives of the card;1. Serves as an inventory of the emergency box2. Shows when the unit was last checked3. Provides the nursing personnel with adequate directions for replenishing any item which may have been used.
The night drug supply cabinetII. The night drug supply cabinet An adjunct to the charge floor stock medications already on the pavilion. Range from simple cabinets with drawers to large elaborate installations which include narcotic vaults and refrigerate compartments.
The night drug supply cabinet• The large cabinets are usually constructed in the wall of the pharmacy →→ serviced from within the pharmacy →→ yet is accessible from the corridor side to authorized nursing personnel
The night drug supply cabinet• It should be stocked with: Pre-packaged Labeled containers of the drugs• Many hospitals also store certain medical and surgical supplies.(oxidized cellulose)
The night drug supply cabinet• The nursing supervisor leave identified charge ticket Listing: – the item removed – To whom it was administeredThe next morning the pharmacy personnel restock the unit and forward the charged ticket to accounting office.
Purchased Service• Contracting with local community pharmacy for: • Night • Holiday • vacation relief for the staff pharmacist
Purchased ServiceAdvantages• Safe and legal• protect the drug needs of the hospital and patient• safeguard the health needs of the area on a round-the-clock basis.
Purchased Service• Where there is more than one pharmacy in the community, care should be taken to avoid any claims of favoritism or politics
Purchased Service• This may be accomplished by: • Develop a set of specifications and requirement concerning the desired service • Request the local establishments to submit their bids.• Only the retail pharmacies with adequate staff, inventory, and delivery service can qualify to bid.