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Hospital and its organisation, BUDGET AND pHARMACY AND tHERAPEUTIC COMMITTEE

Hospital administration oversees hospital operations and policies. Therapeutic services provide medical treatment to patients, including physical, occupational, speech and respiratory therapy. Diagnostic services determine the cause of illness through medical testing. Support services maintain hospital facilities and equipment. The pharmacy and therapeutics committee advises on drug selection and use to ensure cost-effective and quality patient care.

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Hospital and its organisation Sanju Kaladharan
Hospital • A hospital is an institution which is scientifically & economically organized for prevention, diagnosis & treatment of diseases.
• Hospital arhitecture • Patient centered care by WHO
Administration Services—business people who “run” the hospital Hospital Administrators- manage and oversee the operation of departments • oversee budgeting and finance • establish hospital policies and procedures • perform public relation duties generally include: Hospital President, Vice Presidents, Executive Assistants, Department Heads
Informational Services—documents and process information A.Admissions-often the public’s first contact with hospital personnel • checks patients into hospital • responsibilities include: obtaining vital information (patient’s full name, address, phone number, admitting doctor, admitting diagnosis, social security number, date of birth, all insurance information) • frequently, admissions will assign in-house patients their hospital room
B. Billing and Collection Departments - responsible for billing patients for services rendered C. Medical Records - responsible for maintaining copies of all patient records D. Information Systems - responsible for computers and hospital network E. Health Education - responsible for staff and patient health- related education F. Human Resources - responsible for recruiting/ hiring employees and employee benefits
Therapeutic Services – provides treatment to patients 1. Physical Therapy (PT) a. provide treatment to improve large-muscle mobility and prevent or limit permanent disability b. treatments may include: exercise, massage, hydrotherapy, ultrasound, electrical stimulation, heat application 2. Occupational Therapy (OT) a. goal of treatment is to help patient regain fine motor skills so that they can function independently at home and work b. treatments might include: arts and crafts that help with hand-eye coordination, games and recreation to help patients develop balance and coordination, social activities to assist patient’s with emotional health 3. Speech/Language Pathology a. identify, evaluate, and treat patients with speech and language disorders b. also help patients cope with problems created by speech impairments
4. Respiratory Therapy (RT) a. treat patient’s with heart and lung diseases b. treatment might include: oxygen,medications, breathing exercises 5. Medical Psychology a. concerned with mental well-being of patients b. treatments might include: talk therapy, behavior modification, muscle relaxation, medications, group therapy, recreational therapies (art, music, dance) 6. Social Services a. aid patients by referring them to community resources for living assistance (housing, medical, mental, financial) b. social worker specialties include: child welfare, geriatrics, family, correctional (jail)
7. Dietary - responsible for helping patients maintain nutritionally sound diets 8. Nursing a. provide care for patients as directed by physicians b. many nursing specialties include: nurse practitioner, labor and delivery nurse, neonatal nurse, emergency room nurse, nurse midwife, surgical nurse, nurse anesthetist c. In some facilities, Nursing is a service in and of itself. 9. Sports medicine
10. Pharmacy • a. dispense medications per written orders of physician, dentists, etc. • b. provide information on drugs and correct ways to use them • c. ensure drug compatibility
Diagnostic Services – determines cause(s) of illness or injury includes the following departments: 1.Medical Laboratory (MT) - studies body tissues to determine abnormalities 2.Imaging a. image body parts to determine lesions and abnormalities b.includes the following: Diagnostic Radiology, MRI, CT, Ultra Sound 3.Emergency Medicine - provides emergency diagnoses and treatment
Support Services—provides support to entire hospital 1. Central Supply a. in charge of ordering, receiving, stocking and distributing all equipment and supplies used by healthcare facility b. sterilize instruments or supplies c. clean and maintain hospital linen and patient gowns 2. Biomedical Technology a. design and build biomedical equipment (engineers) b. diagnose and repair defective equipment (biomedical technicians) c. provide preventative maintenance to all hospital equipment (biomedical technicians) d. pilot use of medical equipment to other hospital employees (biomedical technicians) 3. Housekeeping and Maintenance a. maintain safe clean environment b. cleaners, electricians, carpenters, gardeners
Pharmaceutical services • Pharmaceutical services in a hospital comprises of the services rendered to the patient through a number of activities like: • Dispensing of drug • Management of the stores which include: a) Purchase of drugs as per the recommendation of Pharmacy and Therapy Committee b) Providing instructions for proper storage of such drugs c) Maintenance of proper records of the drugs purchased and there distribution • Manufacture and distribution of medicaments and products
Providing the therapeutic drug monitoring services • Establishment and maintenance of Drug Information Centre • Patient counseling service • Maintaining liaison with medical staff, nursing staff and the patients themselves • To maintain the nursing department and the central sterile supply unit in the hospital • Participate in teaching programme of nursing and pharmacy students
HOSPITAL PHARMACY • Hospital pharmacy is the department, service or a domain in the hospital organization managed under the direction of a professionally competent, legally qualified pharmacist. • Supply of drug • Filling of special prescriptions • Manufacturing of the drugs • Storage and dispensing of narcotic and biological products • Supply and storage of ancillary products
Functions of HP • To provide and evaluate pharmaceutical services • To draw a plan for hospital pharmacy administration • To establish liaison between administrative authorities and medical Doctors. • To estimate the requirements for the department and enforce the policies and procedures for the recruitment of adequate and competent staff • To develop and maintain an effective system of clinical and administrative records and reports • To participate in and adhere to the financial plan of the operation for the hospital
Layout
• Robotic pharmacy
INPATIENT PHARMACIST RESPONSIBILITIES: • A. CENTRAL DISPENSING AREA • to ensure than all drugs are stored, dispensed correctly • to check the accuracy of the dose prepared • to keep proper records and preparation of bills • to coordinate the over all pharmaceutical needs of the “patient care” • to ensure that the established policies and procedures laid down are followed. • to maintain professional competence • to communicate with all pharmacy staff regarding new developments • to co ordinate the activities of the area
• B. Patient care areas • • To maintain liaison between nurses • • Reviewing of drug administration in each patient • • To provide instruction and assistance to junior Pharmacist • • To co ordinate over all pharmaceutical services on the running unit level
C. Direct patient care areas • Identification of drugs bought into hospital by the patient • Obtaining all medication history and communicating all information t the attending Physician • To assist in the selection of drug products and their identities • To monitor patient’s total drug therapy for: 1)effectiveness 2)side effects 3) toxicity 4) allergic reactions 5)drug interaction • Patient counseling • Participating in cardio pulmonary emergencies
• D. GENERAL RESPONSIBILITIES • • To provide in service training and information for: • the Pharmacists • the pharmacy students • nurses and nursing students • Physicians and medical students
II. Outdoor pharmacist responsibilities A. CENTRAL DISPENSING AREA the pharmacist ensures that: • Proper techniques are used in extemporaneous compounding • Provides for adequate record keeping and billing • Correctly maintaining prescription files • Keep the outdoor pharmacy in a neat and tidy manner
B. PATIENT CARE AREA • • To periodically inspect the medical areas • • To identify drugs bought by patient to clinic and record the patient’s medication history • • Monitoring of drugs • • To council the patient on the proper use of their medication
C. GENERAL RESPONSIBILITIES • • to coordinate overall needs of the outdoor service area and exercise control over such drugs • To ensure that all drugs are handled properly such as storage of investigational drugs • To participate in cardio pulmonary emergency • To provide for in services education and training for pharmacists, pharmacy items.
• Appropriate medicine use in the hospital setting is a multidisciplinary responsibility that includes— • Selection and formulary management by a multi- disciplinary committee • Prescribing by the physician • Procurement, storage, medication order review, and preparation and dispensing by the pharmacy depart- ment • Medication administration by nurses or other health care professionals • Monitoring the effect of medicines on the patient by all members of the health care team
• The medication-use process can be divided into four components— • Prescribing. The physician has overall responsibility for the care of the patient, prescribing or ordering medications as part of the treatment plan. • The mecha-nisms to ensure appropriate prescribing within the hospital customarily fall within the purview of the medical staff committees, usually including the DTC. • The DTC may establish protocols or procedures that allow pharmacists or nurses to prescribe within spe- cifi guidelines.
• Preparation and dispensing. The pharmacy depart- ment, under the direction of a registered pharmacist, is responsible for preparing and dispensing medications. Policies and procedures for these functions should be approved by the DTC. The chief pharmacist reports to hospital administration. • Medication administration. Administering medications is generally the responsibility of the nursing staff. The chief nursing officer oversees all nursing functions. In some cases, physicians may administer medicines such as anesthetic agents. Other health care professionals may administer medicines within the scope of their practice (for example, midwives attending deliveries).
• Monitoring the effect of medications on the patient and ordering appropriate changes in therapy. • Monitoring activities are primarily the responsibility of the physician. However, observation and reporting are required from the person who administered the medication (usually the nurse) and from other members of the health care team involved in the patient’s therapy. • In some settings, a clinical pharmacist or pharmacologist monitors medication therapy in the hospital and consults on medication therapies that require special expertise to ensure safety and efficacy; for example, total parenteral nutrition, anticoagulation, or treat- ment with aminoglycoside antibiotics.
Organisation of Hospital Pharmacy • Hospital pharmacy personnel can be divided into three major categories— • Management. Management includes the chief pharmacist and sometimes deputy chief pharmacists, who are responsible for procurement, distribution, and control of all pharmaceuticals used within the institution and for management of personnel within the pharmacy department. • Professional staff. These professionals are qualifi d pharmacists who procure, distribute, and control medications and supervise support staff for these activities. In some facilities, pharmacists provide clini- cal consulting services and medicine information. • Support staff. The support staff category often includes a combination of trained pharmacy technicians, cleri- cal personnel, and messengers.
A large pharmacy department might have the following sections within one physical space or in separate locations through- out the hospital • Administrative office • Bulk storage • narcotic or dangerous drug locker • Manufacturing and repackaging • Intravenous solution compounding • Inpatient and outpatient dispensing • Medicine information resource center • After-hours pharmacy • emergency medicine storage
Pharmacy and Therapeutic committee(PTC)/ DTC • The pharmacy and therapeutics committee is a policy faming and recommending body to the medical staff and the administration of hospital on matters related to therapeutic use of drugs
Why we need PTC • poor selection of medicines, without consideration for relative efficacy, cost-effectiveness or local availability • inefficient procurement practices, resulting in non-availability, inadequate quality, wastage, or use of unecessarily expensive medicines • prescribing not in accordance with standard treatment protocols • poor dispensing practices resulting in medication errors, and patients’ lack of knowledge about dosing schedules • patients not adhering to dosing schedules and treatment advice.
The primary purposes of the Pharmacy and Therapeutics Committee are: Advisory The committee recommends the adoption of, or assists in the formulation of policies regarding evaluation, selection, and therapeutic use of drugs in the hospital. Educational The committee recommends or assists in the formulation of programs designed to meet the continuing needs of the professional staff (physicians, nurses, pharmacists, and other healthcare practitioners) on matters related to , drugs and drug use.
Goals and objectives The goal of a DTC is to ensure that patients are provided with the best possible costeffective and quality of care through determining what medicines will be available, at what cost, and how they will be used. In order to achieve this goal a DTC will have the following objectives: • to develop and implement an efficient and cost-effective formulary system which include consistent standard treatment protocols, a formulary list and formulary manual • to ensure that only efficacious, safe, cost-effective and good quality medicines are used • to ensure the best possible drug safety through monitoring, evaluating and thereby preventing, as far as possible, adverse drug reactions (ADRs) and medication errors • to develop and implement interventions to improve medicine use by prescribers dispensers and patients; this will require the investigation and monitoring of medicineuse.
Cycle of activities
Guiding Principles • Transparent and unbiased decision-making Explicit criteria and process Documentation of activities Absence of conflict of interest including pharmaceutical manufacturers and suppliers Development and enforcement of a strict ethics policy for all committee activities • Objectivity—Evidence-based approach and levels of evidence • Consistency—Activities of the committee are consistent and follow established policies and procedures. Medicines in the formulary and STGs consistent throughout the health care system. • Impact orientation—Indicators of process, impact, and outcome show improved health care results.
Organisation Members should be selected with reference to their positions and responsibilities and they should have defined terms of reference. In most hospitals, the membership includes: • a representative clinician from each major specialty, including surgery, obstetrics and gynaecology, internal medicine, paediatrics, infectious diseases, and general practice (to represent the community) • a clinical pharmacologist, if available • a nurse, usually the senior infection control nurse, or sometimes the matron • a pharmacist (usually the chief or deputy chief pharmacist), or a pharmacy technician where there is no pharmacist • an administrator, representing the hospital administration and finance department • a clinical microbiologist, or a laboratory technician where there is no microbiologist • a member of the hospital records department.
Functions : Advisory, education, Monitoring Important functions of the committee include— • Advising medical, administrative, and pharmacy departments • Developing policies and procedures for the use and distribution of medicines • Evaluating and selecting medicines for the formulary and providing for its constant revision • Identifying medicine use problems • Promoting effective interventions to improve medicine use including educational, managerial, and regulatory activities • Managing ADRs and medication errors
Eg : antimicrobial subcommittee • Address issues relating to antimicrobials including correct prescribing • Develop policies concerning use of antimicrobials for approval by the DTC and medical staff; policies should specifically include sections on methods to limit and restrict use of antimicrobials in the hospital and primary care clinics • Assist in evaluating and selecting antimicrobials for the formulary • Organize educational programs for health care staff • Assess and monitor antimicrobial sensitivities and resistance patterns in hospitals and primary care clinics; prepare monthly reports of these activities and disseminate to appropriate departments and health care professionals
Eg : infection control subcommittee • Develop and recommend policies and procedures pertaining to infection control • Address food handling, laundry handling, cleaning procedures, visitation policies, and direct patient care practices, including hand washing and immunizations • Obtain and manage critical bacteriological data and information, including surveillance data • Recognize and investigate outbreaks of infections in the hospital and community • Educate and train health care workers, patients, and nonmedical caregivers
Role of DTC in drug management
Monitoring PTC Performance- outcome indicators • Medicine selection Number of medicines on the hospital formulary Percentage of prescribed medicines on the formulary Number of antimicrobials on the formulary • Prescribing quality Percentage of patients treated in accordance with STGs Percentage of pharmaceutical treatments meeting agreed criteria of DUE • Pharmaceutical safety—Mortality and morbidity rated per annum due to adverse consequences of medicine use (ADRs and medication errors) • Financial sustainability—Cost of DTC activities versus the money saved throughimproving pharmaceutical use and decreasing waste
Budget DEFINITION: Financial or quantitative statement prepared for the purpose of attaining the given objective. FUNCTIONS: 1. The responsible person will use the budget details to determine whether the proposal is economically feasible and realistic. 2. To monitor the hospital financial activities. 3. Estimate thae cost of completing objectives identified in the proposal. TYPES OF BUDGET PREPARATION: 1. Short term budget (2 years) 2. Long term budget (5 - 10 years)
Divisions of Budget 1.Income accounts or revenue accounts 2. Expenditure accounts 3. Asking for capital investments
Income accounts or revenue accounts  Total income must be calculated for the implementation of the budget.  Pharmacy department or accounts department maintains daily, weekly, monthly & annual cost of the pharmaceuticals issued to the patient services.  The other statistics includes:  No of prescriptions  No of prescriptions dispensed by each pharmacist  Hours of work put in Prescription volume per hour of service  Medication cost per patient day  Average drug cost per clinic visit  Average salary cost per prescription  Average supply cost per requisition
EXPENDITURE ACCOUNTS: • 1. Administrative and general expenses. • 2. Professional care of the patients. • 3. Out-patients and emergency expenses. • 4. Miscellaneous expenses. The expenditure accounts includes the following categories • 1. Salaries and wages • 2. Supplies and expenses • 3. Drugs and pharmaceutical expenses • 4. Purchase expense • 5. Miscellaneous supplies and expenses.
PURCHASE EXPENSE: • It includes the cost of prescriptions purchased from an outside pharmacy. DRUGS AND PHARMACEUTICALS:  Those dispensed by prescriptions.  Those used in the outpatients and emergency departments. EQUIPMENT AND CONSTRUCTION BUDGET:  1. Budget for immediate arrangements of a new model equipment.  2. Budget for remodeling and replacement of equipment.  3. Construction of building.
Implementation of Budget • It includes the following parameters • 1. Requirement of different departments • 2. Actual fund position • 3. Utility of particular item • 4. Cost of products • 5. Quantity of products
ADVANTAGES OF PLANNING THE BUDGET: • 1. Develop better financial planning. • 2. Gives a better focus on decision making to the management. • 3. Effectively manage the financial aspects of the hospital. • 4. Exposes the reasons of over expenditure. • 5. Helps to focus on hospital priorities • 6. Enhance efficiency of staffs and others
Hospital and its organisation, BUDGET AND pHARMACY AND tHERAPEUTIC COMMITTEE