New 23 ms c- pro

H.T No: 11HA1R0043 Page No: ______
1. Defination of hospital pharmacy:-
 Hospital pharmacies can usually be found within the
premises of a hospital. Hospital pharmacies usually stock a
larger range of medications, including more specialized and
investigational medications (medicines that are being
studied, but have not yet been approved), than would be
feasible in the community setting. Hospital pharmacies
typically provide medications for the hospitalized patients
only, and are not retail establishments.
 They typically do not provide prescription service to the
public. Some hospitals do have retail pharmacies within them
(see illustration), which sell over-the-counter as well as
prescription medications to the public, but these are not the
actual hospital pharmacy.
The classifications of pharmacy are given below:-
1. Indoor pharmacy in the hospital.
2. Outdoor pharmacy in the hospital.
3. Retail pharmacy.
4. Whole shale pharmacy.
5. Industrial pharmacy.
Indoor pharmacy:- Indoor pharmacy is very important
department of the hospital. The physician prescribes to the
patient. The nursing personal copies it & write it on
requisition form or books & send it to the pharmacy. The
VISION COLLEGE OF PHARMACEUTICAL SCIENCES & RESEARCH

H.T No: 11HA1R0043 Page No: ______
pharmacist compounds & dispenses according with usual
labeling as unite dose or multiple dose system as desired by
hospital authority.
Outdoor Pharmacy:- Outdoor pharmacy is very important of
the hospital. Here medicines are prepared in bulk form.
According the hospital formulary for the extensively used
selected medicines & dispenses them to the outdoor patient
according to the prescription of the medical officers.
Retail Pharmacy:- Retail Pharmacy is an industry-
leading publication that has firmly established itself as the
most informative magazine for Pharmacy-specific business
and retail-related topics.
Distributed to pharmacies nationally, the monthly business to
business publication reaches pharmacists not only as
influential health professionals but also as business
operators, helping them make informed and responsible
decisions about their pharmacy within a retail environment.
Whole shale pharmacy:- Our pharmaceutical wholesale
businesses, together with our associates and joint ventures,
supply medicines, other healthcare products and related
services to more than 180,000 pharmacies, doctors, health
centres and hospitals from more than 370 distribution
centres in 20 countries.
Industrial pharmacy:- The mission of the Industrial
Pharmacy Lab is to focus on research in process technology
and dosage form design. This research is very close to the
today’s needs of the pharmaceutical industry looking for

H.T No: 11HA1R0043 Page No: ______
robust formulations and process technologies, which should
enable to shorten the development time and to increase the
product quality. A close cooperation with the pharmaceutical
industry is a prerequisite to be able to do studies in the area
of scale-up. Thus a win-win situation is created as there is no
time for basic studies in scale-up in the industry and there is
no large scale equipment for such studies at the university.
Special reference to neonatal death:-
causes of neonatal death or newly bron death:-
Definitions:-
Stillbirth:- the death of a baby before or during birth after 24
weeks of gestation in the UK. (The World Health
Organization (WHO) definition is after 28 weeks.)
Neonatal death:- the death of a baby within the first 28 days
of life.
Perinatal mortality:-stillbirths plus early neonatal deaths
(under 7 days). (This is a universal definition.)
Stillbirth rate:- the number of stillbirths per thousand total
births.
Low birth weight:- weight at birth under 2500 g. (The
universally accepted definition.)
Incidence:-

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According to the Office for National Statistics (ONS) in
England and Wales, there were 3,558 stillbirths in 2012 - a
stillbirth rate of 4.9 per 1,000 live births. This had dropped
from 5.3 in 2011. There were 2,042 neonatal deaths - a rate
of 2.8 per 1,000 live births - of which 2.2 were early neonatal
deaths. Both rates have continued to fall over a period of two
decades, and perinatal mortality rates have fallen by a third
since 1982. It is felt that improvements in general healthcare,
midwifery and neonatal intensive care are bringing about the
gradual decline in deaths. Worldwide figures are higher. A
recent WHO survey gives the stillbirth rate (although note the
variable definition affects numbers) as 17.7 across 29
countries, and the early neonatal death rate as 8.4
Risk factors:-
Fetal growth restriction:
 The biggest risk factor for stillbirth.
 A 2012 study of stillbirths in England showed the risk to be
significantly higher where the growth restriction was not
detected antenatally, suggesting this as an important avenue
for reducing stillbirth rates in the future.[3]
It concluded
strategy should focus on improving antenatal detection of
growth restriction, and subsequent management of pregnancy
and delivery.
Preterm birth:-
 This is the biggest risk factor for neonatal death.
 Obstetric and neonatal care can have a major impact on
death rates of preterm babies. (For example, antenatal

H.T No: 11HA1R0043 Page No: ______
steroids for women in preterm labour, and advanced neonatal
intensive care which may not be available in some parts of
the world.)
Age of mother:-
 The rate of neonatal death is higher in babies born to
women under the age of 25, and women over the age of 40. In
the UK, women aged 40 or over are 1.3 times more likely to
have a neonatal death compared to women aged 25-29.
Stillbirth rates increase with advancing maternal age. The
rate increases from 4.6 in the 25- to 29-year age group to 7.6
for mothers aged 40 or over.
Systematic reviews have confirmed advancing maternal age as
a risk factor. However, the most recent UK-based study of
risk factors did not bear this out.This may have been because
babies with congenital abnormalities, known to occur more
often in pregnancies of older women, were excluded from the
study. Cochrane reviews have demonstrated that induction of
labour in women going past term reduces the risk of
perinatal death. National Institute for Health and Care
Excellence (NICE) guidelines therefore recommend that
women going past their term dates be induced at 41
weeks.There is discussion ongoing about whether older
women should be offered induction earlier, at 39-40 weeks of
gestation, in order to reduce the risk of perinatal deaths.
 Obesity:- a mother's BMI ≥30 increases risk of stillbirth
and neonatal death, and possibly as much as doubles it.

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 Smoking:- smoking causes increased risk of stillbirth where
it leads to growth restriction but not as an independent
factor. It increases the risk of neonatal death in a number of
ways, including adding to the risk of preterm birth.
 Chronic diseases :- eg, diabetes, renal failure,
hypertension, haemoglobinopathy, rhesus disease,
thrombophilias, antiphospholipid syndrome. Pre-existing
diabetes increases risk of stillbirth significantly, whereas
gestational diabetes does not appear to increase risk.
 Infection - eg, erythema infectiosum, varicella, measles.
 Substance abuse, especially cocaine.
 A history of mental health problems increases risk.
Obstetric complications:-
 Pre-eclampsia and antenatal haemorrhage increase the
risk of stillbirth.
 Intrapartum complications, such as malpresentation or
obstructed labour, confer high risk of perinatal mortality.
Multiplicity of pregnancy:-
 The risk of perinatal death is 2-5 times higher for multiple
pregnancies compared to singleton pregnancies.
 Stillbirth and neonatal death rates are significantly higher
in monochorionic twins than in dichorionic twins (44.2 vs
12.2 per 1,000 births in the North England study of twin and
multiple pregnancy).
Parity:-

H.T No: 11HA1R0043 Page No: ______
 Nulliparous women have a higher risk of stillbirth than
multiparous women across all ages.
 Third and subsequent pregnancies have a higher risk than
second pregnancies.
Congenital abnormality:-
 Increases risk of stillbirth and neonatal death. In the main
not a potentially avoidable risk factor so it is often left out of
analyses.
 Fewer than 10% of stillbirths are caused by congenital
abnormalities.
Low birth weight:-
 Strongly linked with neonatal death and infant mortality.
 Inter-related with other factors, such as prematurity,
multiple pregnancy, smoking.
 In 2012, there were 173 deaths per 1,000 live births for
very low birth weight babies (<1500 g), 35.2 per 1,000 for
low birthweight babies (<2500 g), compared to 1.3 per 1,000
for normal birth weight babies. These ONS figures are for
infant mortality as a whole, ie deaths up to the first year of
life, but neonatal deaths show a similar trend.
Region of maternal residence:-
 Most regions in the UK show fluctuations in stillbirth rates.
 In 2012, rates of both stillbirths and neonatal deaths were
highest in the West Midlands and lowest in the South of
England.[1]
Social factors:-

H.T No: 11HA1R0043 Page No: ______
 Lack of employment and high deprivation index increase
risk of stillbirth.
 Later antenatal booking appointments past 13 weeks was
associated with increased risk of stillbirth.
Ethnicity:-
 African and African-Caribbean women have significantly
higher risk of stillbirth. Risk is also increased in Indian
mothers and first-generation migrants from Pakistan.[3]
Sex:-
 Trends show that stillbirth rates are slightly higher among
males compared to females.
Causes of neonatal death:-
 Prematurity (causing particularly respiratory and
neurological conditions)
 Congenital abnormality
 Obstetric complications
 Infection
Causes of stillbirth:-
 Congenital abnormality
 Haemorrhage, during pregnancy or labour
 Placental insufficiency
 Placental abruption
 Pre-eclampsia

H.T No: 11HA1R0043 Page No: ______
 Obstetric complications
o Spontaneous premature labour
o Premature rupture of membranes
o Polyhydramnios
o Oligohydramnios
o Intrapartum asphyxia
o Birth trauma
 Cord prolapse
 Intra-uterine growth restriction
 Liver disease - obstetric cholestasis, intrahepatic
cholestasis of pregnancy
 Diabetes
 Infections during pregnancy
 In England the latest report into causes of perinatal death
was the Centre for Maternal and Child Enquiries (CMACE)
report of 2009, published in 2011.This long-term audit has
been now passed on to 'Mothers and Babies: Reducing Risk
through Audits and Confidential Enquiries in the UK'
(MBRRACE UK), and there are currently no more recent
reports. The classification system for causes of death
changed in 2008, in an attempt to reduce the number of
previously "unclassifiable" deaths.

H.T No: 11HA1R0043 Page No: ______
 In the 2011 UK report, 28% of stillbirths remained
unexplained. Placental conditions caused 12% of stillbirths,
antepartum/intrapartum haemorrhage 11%, and major
congenital abnormality 9%. 8% of stillbirth deaths occurred
during labour or delivery.
 For neonatal deaths, 27% were from obstetric factors, of
these spontaneous premature labour being the most common.
25% were due to congenital abnormality, and 10% due to
infection. A further neonatal classification system uses the
specific cause of death in premature babies, the most
common causes being respiratory disorders (of which the
most common was severe pulmonary immaturity), followed by
neurological disorders (particularly hypoxic-ischaemic
encephalopathy and intraventricular/periventricular
haemorrhage).
 Reports for Scotland, Wales and Northern Ireland have
continued. Differing classification systems are used. In
Scotland, the 2011 report showed for stillbirths the most
common cause was fetal growth restriction (38%), followed
by APH (15%) and congenital abnormality (12%).
Conditions associated with prematurity were the most
common cause of neonatal death (41%) followed by
congenital abnormality. In the 2012 report for Wales, 42%
of stillbirths are classified as unexplained, with APH the most
common classifiable cause (13.3%), and congenital
abnormality next (6.6%). For neonatal deaths, preterm birth
caused 37%, congenital abnormality 22% and infection
14.5%.The 2012 report for Northern Ireland gives placental

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conditions and congenital abnormalities as the most common
cause for stillbirths.
Diagnosis:-
 The mother may be aware of a decrease in fetal movements
in many cases of stillbirth.
 Other stillbirths may be discovered at the routine antenatal
check.
 An ultrasound examination is used to confirm that the fetus
has died; this is seen as lack of a visible heartbeat.
Management:-
 "The quality of care that bereaved families receive when
their baby dies has long-lasting effects. Good care cannot
remove parents' pain and grief, but poor care can and does
make things much worse.”
Where the death of the baby is diagnosed antenatally, labour
is induced using prostaglandins administered vaginally. This
does nThe mother will need to have:
 Blood pressure checked.
 Urine tested for protein.
 Temperature taken.
 Cervical and vaginal swabs for MC&S.
 Blood taken for FBC, clotting screen (including
antiphospholipid antibody and thrombophilias), Kleihauer

H.T No: 11HA1R0043 Page No: ______
test, HbA1c, cultures (Listeria spp.) and serology (parvovirus
B19, toxoplasmosis and cytomegalovirus) and cytogenetics.
out need to be immediate, but should happen within 2-
3Bereavement care:
 Hospital counsellors and chaplains may provide comfort to
families of stillborn infants.
 All maternity units should have specially trained
bereavement midwives.
 Discuss the need, and arrange consent, for post-mortem
examination.
Inform GP practice, so that GP and practice staff are aware
of the death, and so GP can provide support where
appropriate. Registering a stillbirth
 Stillbirth registration began on 1 July 1927, to help protect
infant life.
 As well as being an important source of historical and
statistical information, it also gives parents the opportunity
to have their child officially acknowledged and to give him or
her names if they wish to, which can help with grief.
 Stillbirths in England and Wales must normally be
registered at the hospital or local register office within 42
days of the stillbirth, but cannot be registered more than 3
months after its occurrence.
 To register the stillbirth, the medical certificate of stillbirth
issued by the doctor or midwife present at the time is
required.

H.T No: 11HA1R0043 Page No: ______
 The registrar will issue a certificate for burial or cremation
of the stillborn infant. This certificate is usually passed to the
funeral director who will make the arrangements.
 Following a stillbirth or neonatal death, parents are
entitled to maternity leave, paternity leave, statutory
maternity pay/allowance or statutory paternity pay as
relevant.
ROLE OF HOSPITAL PHARMACISTS IN TRANSITIONS OF
CARE:-
Transition of Care:-
 “care transitions" refers to the movement patients make
between health care practitioners
 Transitional care is defined as a set of actions designed to
ensure the coordination and continuity of health care as
patients transfer between different locations or different
levels of care within the same location.
 Representative locations include (but are not limited to)
hospitals, sub-acute and post-acute nursing facilities, the
patient's home, primary and specialty care offices, and long-
term care facilities.
Medication Errors in Transitions of Care:-
Study Design: Prospective

H.T No: 11HA1R0043 Page No: ______
Results:
After screening 523 admissions, 151 patients were
enrolled based on the inclusion criteria
81patients (53.6%; 95% confidence interval, 45.7%-
61.6%) had at least 1 unintended discrepancy.
Most common error (46.4%) was omission of a regularly
used medication.
61.4% of the discrepancies were judged to have no
potential to cause serious harm.
38.6% of the discrepancies had the potential to cause
moderate to severe discomfort or clinical deterioration.
Study Design:
Population-based cohort study using admin records from
2007 to 2009 of hospitalizations and outpatient
prescriptions
Results:
Patients admitted to the hospital (n = 187,912) were
more likely to experience potentially unintentional
discontinuation of medications than controls (n =
208,468) across all medication groups examined.

H.T No: 11HA1R0043 Page No: ______
Admission to an ICU was associated with an additional
risk of medication discontinuation in 4 of 5 medication
groups vs hospitalizations without an ICU admission.
One-year follow-up of patients who discontinued
medications showed an elevated AOR for the secondary
composite outcome of death, emergency department
visit, or emergent hospitalization of 1.07 (95% CI, 1.03-
1.11) in the statins group and of 1.10 (95% CI, 1.03-1.16)
in the antiplatelet/anticoagulant agents group.
Patients prescribed chronic medications were at higher
risk for unintentional discontinuation following hospital
discharge, and ICU stay during hospitalization increased
the risk of medication discontinuation even further.
Study Design: Prospective
Method:
60 randomly selected patients at a Canadian Community
hospital
At admission, compared patients’ medication ordesr
with pre-admission medication use based on med vials
and interviews with patients, caregivers and/or
outpatient healthcare providers

H.T No: 11HA1R0043 Page No: ______
At discharge, pre-admission and in-patient medications
were compared with discharge orders and written
instruction
Variances were discussed with prescriber and classified
either as intended or unintended.
Results:
Overall, 60% (95% CI 48 to 72) of patients had at least
one unintended variance and 18% (95% CI 9 to 28) had
at least one clinically important unintended variance.
None of the variances had been detected by usual
clinical practice before reconciliation was conducted.
Of the 20 clinically important variances, 75% (95% CI 56
to 94) were intercepted by medication reconciliation
before patients were harmed.
Study Design: Prospective
Method: studied patients who were consecutively
discharged home or to a seniors' residence from the
general internal medicine service during a 14-week
interval in 2002; phone interview and chart review to
identify outcomes; 2 physicians conducted an

H.T No: 11HA1R0043 Page No: ______
independent review the outcomes to determine
occurrence of AE
Results:
outcomes were determined for 328 of the 361 eligible
patients, who averaged 71 years of age
After discharge, 76 of the 328 patients experienced at
least 1 AE (overall incidence 23%, 95% confidence
interval [CI] 19%–28%).
AE severity ranged from symptoms only (68% of the AEs)
or symptoms associated with a nonpermanent disability
(25%) to permanent disability (3%) or death (3%).
Most common AEs were adverse drug events (72%),
therapeutic errors (16%) and nosocomial infections
(11%). Of the 76 patients, 38 had an AE that was either
preventable or ameliorable (overall incidence 12%, 95%
CI 9%–16%).
Case in point:
MEDICATION ERRORS HAPPEN During patient hand-offs
Medication Reconciliation:-
“the process of creating the most accurate list possible
of all medications a patient is taking — including drug

H.T No: 11HA1R0043 Page No: ______
name, dosage, frequency, and route — and comparing
that list against the physician’s admission, transfer,
and/or discharge orders, with the goal of providing
correct medication to the patient at all transition points
within the hospital.”
Impact of Medication Reconciliation during Admission:-

H.T No: 11HA1R0043 Page No: ______
 Study Method: Study pharmacist and hospital-
physician medication histories were compared with
medication orders to identify unexplained history and order
discrepancies in 651 adult medicine service inpatients with
5,701 prescription medications
Results:
35.9% experienced 309 order errors85% of patients
had errors originate in medication histories, and
almost half were omissions.
Cardiovascular agents were commonly in error (29.1%).
If undetected, 52.4% of order errors were rated as
potentially requiring increased monitoring or
intervention to preclude harm; 11.7% were rated as
potentially harmful.
In logistic regression analysis, patient's age > or = 65
[odds ratio (OR), 2.17; 95% confidence interval (CI), 1.09-
4.30] and number of prescription medications (OR, 1.21;
95% CI, 1.14-1.29) were significantly associated with
errors potentially requiring monitoring or causing harm.
Presenting a medication list (OR, 0.35; 95% CI, 0.19-
0.63) or bottles (OR, 0.55; 95% CI, 0.27-1.10) at
admission was beneficial.

H.T No: 11HA1R0043 Page No: ______
Pharmacist Facilitated Discharge:-
Study Design: Descriptive Report
Methods:
Clinical pharmacist participated in multidisciplinary
discharge rounds in selected medicine services
Patient selection: (1) discharge to home, (2) with >5
medications with at least 1 high risk medicine; (3)
English speaking; (4) active telephone service
CP activities: (1) reconciled with clinicians discharge
medication discrepancies; (2) counseled patients and
families; (3) provided reconciled medication list to
subsequent providers; (4) contacted patients within 72
hours after discharge and at 30 days to identify and
address post-discharge medication problems.
Results (10-month period):
958 out 1122 patients (85%) were screened
(75%) patients met the inclusion criteria
477 (66.2%) patients were interviewed to assess current
medication use 248 (34%) patients were counseled at
discharge 486 discrepancies identified and resolved in

H.T No: 11HA1R0043 Page No: ______
63% of patients counseled with an average of 3
discrepancies per patient
Missing Meds (41.2%)
Failure to Discontinue unnecessary or inactive meds
(23.7%)
Wrong dose/frequency (16.3%)
Discrepancy occurred most frequently in the following
therapeutic classes: CV, analgesic, endocrine,
antimicrobial and gastric acid suppression
Follow-up phone call within 72 hrs. and at 30 days are
completed in 24% (59) and 8.5%(21), respectively.
123 post-discharge problems were identified and
resolved.
ONE SOURCE OF TRUTH:-
Develop a single medication list, shared by all disciplines
for documenting the patient's current medications
A SEMINAR TOPIC ON hOSPITAl
PhARMACy.

H.T No: 11HA1R0043 Page No: ______
BACHLOR OF PHARMACY
DEPT: PHARMACEUTICS
By
ARTHAM.RAJASHEKAR(11HA1R0043
)
UNDER GUIDENCE OF
Mrs.JHARANA MALLICK
Assistant professor
GUIDENCE SIGNITURE PRINCIPAL SIGNITURE

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-

H.T No: 11HA1R0043 Page No: ______
 -

H.T No: 11HA1R0043 Page No: ______

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