Hospital Pharmacy Standard ASHP
Hospital Pharmacy Standard: ASHP Guidelines
HOSPITAL PHARMACY
Alok Bains
4/13/20239 min read
Hospital pharmacy standard: ASHP Guidelines
Compiled by: Alok Bains
American Society of Health-system Pharmacy (ASHP) issued guidelines for a minimum level of hospital pharmacy standards. The main aim of pharmacists is to assure best the use of medicines. Elements of the best services in a hospital pharmacy are practice management, policy development related to medication use, optimization of the therapy, drug procurement and inventory management, preparation, packaging and labelling of the medicines, medicines delivery, medicines monitoring, evaluation of the effectiveness of medicines uses system and research. In total, there are nine hospital pharmacy standards.
A) Standard 1: Practice management:
Practice management: Pharmacists are the responsible patient care provider and leaders of the hospital pharmacy. ASHP fixes following minimum standards to manage hospital pharmacy.
Pharmacy and pharmacist services:
Mission: The hospital pharmacy shall have a written mission statement. It shall reflect pharmacists' responsibility and patient care.
Goal: The hospital pharmacy shall determine short and long-term goals. All activities of pharmacists and other hospital staff will aim to achieve the goals.
Scope of services: The hospital pharmacy shall also describe the scope of hospital pharmacy services.
The mission, goal and Scope of pharmacy shall be displayed in every department. These shall be shared with all hospital staff.
Round O Clock pharmacy services: The hospital pharmacy shall have 24-hour hospital pharmacy services. If it is not possible, then shall be available on a call basis. Automated drug dispensing equipment is not a substitute for the pharmacist.
Pharmacy access: Access to a limited number of medicines shall be allowed to only licensed health care professionals under emergency conditions. Medicines for emergency use shall be decided by the multidisciplinary committee.
Pharmacy Practice Standards: Standards set by government bodies shall be practised. The hospital pharmacy shall be accreditated by the external body.
Rules and regulations: The hospital pharmacy shall observe all rules and regulations framed by the central, state and local governments.
Policies and procedure:
Manual: Hospital pharmacists develop written policies and procedure manuals to govern hospital pharmacy services. All staff shall obey these policies and procedures. The manual shall be revised on a regular basis. It shall be accessible to all staff.
Personnel safety: Pharmacists shall be responsible to develop hospital pharmacy emergency response, infection prevention and control, management of hazardous substances and wastes, ADR reporting system, etc. Staff shall be trained to perform these activities.
Emergency preparedness: There will be a clear role for pharmacy staff to deal with emergency situations and steps to provide safe and efficient pharmacy services in emergency situations.
Medical emergency: The hospital pharmacy shall decide the contents of the code cart, emergency medicine kit/box and the role of pharmacists in a medical emergency. Pharmacists shall receive training related to basic life support, advanced cardiopulmonary life support, paediatric acute life support, etc.
Immunization program: The pharmacist shall participate in the immunisation program for patients and hospital staff. If possible, they will be active immunizers for the hospital immunization program.
Substance abuse program: Pharmacists shall participate in substance abuse education, prevention, identification, treatment, etc.
Workforces:
Position description: Responsibilities and competencies of the pharmacists and other support staff shall be clearly defined. These shall be reviewed and revised upon a change in hospital pharmacy policies.
Director of the pharmacy: Director of the pharmacy shall be a professionally competent, legally qualified pharmacist with thorough knowledge and experience in hospital pharmacy practice and management. He/she shall manage the hospital pharmacy. The director shall be responsible for
To frame the mission, vision, goal and scope of the pharmacy
To develop, implement, evaluate and update plans and activities to fulfil the mission, vision, goal and scope of the pharmacy,
To work with hospital/health leadership to provide safe and effective medicines for the patients
To mobilise the resources
To ensure patient care services.
To recruit personnel.
To assign duties to personnel for optimum use of the resources.
Pharmacists: Professionally competent and legally qualified pharmacists shall fulfil the medication need of the patients.
Support personnel: Support personnel such as pharmacy technicians and clerical and secretarial personnel shall be employed to help pharmacists.
Education and training: All personnel shall have undergone proper education and training to perform their jobs. The continuing education program shall be arranged by the pharmacy for all personnel.
Orientation: A orientation program shall be arranged for newly recruited staff.
Performance evaluation: Well defined designatory shall evaluate the performance of personnel through an evaluation format.
Effective communication: The pharmacy shall establish a mechanism to communicate information to staff in a timely manner. Eg. electronic communication, newsletter, bulletin boards, staff meetings, etc.
Ethical conduct: The pharmacy shall frame an ethical code of conduct and educate staff regarding these standards.
Facilities
Pharmacy: Adequate space, equipment and supplies shall be available for administrative and professional work.
Storage and preparation areas: Suitable spaces the proper sanitation, light, moisture, ventilation, security, etc for receipt of prescriptions, medicine storage and preparation shall be available.
Consultation area: Sufficient space for a patient-pharmacist consultation area shall be available to maintain the confidentiality of the discussion.
Administrative space: Adequate space for administrative, educational, training, meeting, etc shall be available.
Record maintenance: Adequate space shall be available to store all records to comply with applicable laws, regulations, hospital policies, etc.
Automated system: Automated mechanical systems and software promote safe, accurate, and efficient pharmacy services. There shall be proper policies to select, evaluate, calibrate, monitor, use and maintain these automated systems.
Information technology: Inclusion of computers for all activities in the hospital pharmacy.
Drug information: The hospital pharmacy shall select drug information resources. to provide current and correct drug information.
Committee involvement: The pharmacist shall actively participate in the hospital committees. He/she shall be responsible implements decisions of committees.
B) Standard 2: Medication-Use Policy development
Policy development: All committees of the hospital shall have at least one pharmacist as a member. Such as P &T committee, infection control committee, patient care committee, information technology committee, etc. The pharmacist shall be responsible to develop, implement, assess the decisions of committees.
The pharmacist shall be responsible to develop and maintain written criteria related to hospital pharmacy. Such as decisions of the P & T committee, dietary supplements and other alternative therapies, etc.
Formulary management:
Formulary: The P & T committee approves a formulary for medication and regularly updates it. The pharmacy shall disseminate the formulary by electronics or any other means. The pharmacy shall develop policies for non-formulary medicines, dietary supplements etc for patients care.
Monographs: Pharmacy shall develop monographs of hospital formulary medications. Monographs shall include therapeutic effects and risk assessment of the medications, etc. It shall be used for the deletion and addition of medication in the hospital formulary.
Non-drug substances: The pharmacy shall develop policies and procedures to get approval from hospital committees to use biologicals or chemicals not approved by the FDA.
Drug information:
Drug information requests: The pharmacist shall provide accurate drug information to health professionals, patients and their caregivers. The pharmacist shall provide responses from them in time to assess the quality of the therapy.
Dissemination of the drug information: The pharmacist shall provide drug information to the hospital staff through publications, presentations, newsletters, notices, websites, etc.
C) Standard 3: Medication therapy optimization
The pharmacist in consultation with the medical staff and nursing staff develops policies and procedures for the best medication therapy.
Patient relationship:
Direct patient care: The hospital and pharmacy shall encourage pharmacists to perform medication therapy management, medication orders, medication administration, immunization programs, etc for both inpatients and outpatients.
Care continuity: The pharmacy shall play a key role to develop and implement policies and procedures for the admission, discharge and transfer of patients for medical care.
Patient confidentiality: The pharmacy shall be responsible to maintain the confidentiality of patients to comply rules and regulations of the government and hospital.
Acquiring patient data: Pharmacists shall prepare the medication history of the patients. Pharmacists shall store medication history, current medication and other data that shall be available for medical professionals for patient care.
Consultations
Pharmacist's consultation: The pharmacist shall provide oral and written consultation to the medical professionals regarding the selection and management of medication therapy.
Medica documentation: The pharmacist shall review the medical documentation of the patients. Pharmacist recommendations and actions taken shall be recorded in the patient's medical record. This record shall be accessible to medical professionals.
Therapy decision: The hospital shall clearly define the role of the pharmacist to initiate, monitor, modify medication, and order laboratory tests as per law, regulation and hospital policies.
D) Standard 4: Procurement and inventory control:
The pharmacy shall develop policies and procedures to procure medicines and other health products for inpatients and outpatients.
Selection of sources:
Medicine procurements: The pharmacist develops policies and procedures to procure medicines. Several criteria such as hospital formulary, competitive bidding, group purchasing, medication utilisation, cost-effective services, etc are considered.
Manufacturers and suppliers: The pharmacist selects manufacturers and suppliers ensuring the highest quality and best price of the products required. The purchase committee can perform this job but the pharmacist shall be responsible for the quality of the products.
Medical representative: Pharmacists shall develop policies about the activities of medical representatives in the hospital. All promotional materials of the medical representative shall be reviewed by the pharmacists. The medical representatives shall not be allowed to access patient care areas.
Inventory management:
Medicines storage: The pharmacist shall receive medicines and store them in the proper storage area mentioned on the label of the container. Sanitation, temperature, ventilation, moisture, light, etc shall be maintained to comply with the storage conditions of the medicines. Security, medicine integrity and personnel safety shall be maintained in the storage areas.
Drug shortage: The pharmacist shall develop an inventory management system to detect shortage of the medicines. The pharmacist shall also identify alternatives in the shortage of medicines.
Patient care area stock: The pharmacist shall install the automated dispensing device in the non-pharmacy area, Emergency drugs and routinely used personal care products shall be stored in the non-pharmacy areas. The multidisciplinary committee shall decide the items to be stored in the nob-pharmacy area.
Controlled substances: Government declare habit-forming drugs or drugs with abuse potential to be under the direct control of pharmacists. Pharmacists shall be liable to comply with the government rules and regulations related to these drugs.
Patient's medication: The pharmacist shall maintain the record of medicines issued to the patient and utilised during hospitalisation to assure medication order from the prescriber is complied with.
Storage area inspection: The pharmacist shall inspect all inventories and storage conditions physically in routine. This will ensure the detection of outdated, unusable, mislabeled, etc drugs and the maintenance of proper storage conditions. Pharmacists develop procedures to dispose of recalled, expired, damaged drugs.
E) Standard 5: Medicines preparation, packaging and labelling
Medication preparation:
Compounding: Some medicine dosage forms are compounded in the pharmacy due to their unavailability in the market. The pharmacy shall provide written master formula, quality assurance procedure and batch number of the finished product.
Sterile preparations: Compounding the sterile preparations in the pharmacy should be avoided. If it is necessary, then proper aseptic condition, quality assurance, expiry date and competency of the personnel, etc should be properly maintained.
Hazardous drugs: The pharmacist shall develop policies and procedures regarding precautions, equipment, training, preparation, handling, storage, disposal etc of hazardous drugs. These policies and procedures must comply with government regulations and provide adequate safety to the staff, patients, caregivers, etc.
Packaging:
Unit dose packaging: Single dose packaging and ready-to-administer shall be preferred for inpatients. This will minimise the manipulation of doses at the time of administration.
Barcoding: Bar code on unit dose packaging shall be preferred. The same bar code shall be used in inventory management, dose preparation, packaging, dispensing and administration.
D) Standard 6: Dispensing and delivery
Medication dispensing:
Prescription: The pharmacist shall assure that the medication order has been prescribed by the registered medical practitioner before dispensing. The pharmacist shall advocate the use of safe terminology and abbreviations throughout the hospital in prescriptions. Pharmacists shall discourage the use of nonstandard and unapproved terminology and abbreviations.
Diagnostic/therapeutic purpose: Pharmacists should have access to the medication for diagnostic purposes or therapeutic purposes.
Medication orders: The pharmacist shall avoid oral medication orders. If oral order medication is necessary then the pharmacist shall follow hospital policies to dispense oral order medication. Pharmacists shall dispense medicines on a hard copy of the prescription or electronic transmission of the prescription.
Review of medication orders: Pharmacists shall review the medication orders before administration of the first dose to assure patient safety except under emergency situations. Any questions regarding medication orders shall be resolved by consulting the prescriber prior to the administration of drugs.
Delivery and administration:
Drug delivery system: The pharmacist shall be responsible to develop policies and procedures for, quality assurance, automated distribution devices, administrative devices, etc to ensure safety, accuracy, and patient confidentiality.
Administration: Only an authorised person shall be allowed to administer the medicines to the patients. Administered medicines, refused or omitted medicines shall be recorded in the patient record.
E) Standard 7: Monitoring:
Patients review: The pharmacist shall conduct medication therapy monitoring. to assess medication regimen usefulness, medicines dose usefulness, medication safety, patient adherence to medication, interactions, ADR, allergies, sensitivities, etc,
Education and counselling: The pharmacist shall educate the patients and their caretakers about adherence to the medication and health benefits, The pharmacist shall review the literature developed by commercial houses for their accuracy, appropriateness and completeness.
Standard 8: Evaluation:
The pharmacist shall evaluate the quality of medicines to improve the pharmacy services.
Standard 9: Research
The pharmacist shall initiate, participate and support clinical research. They will develop policies and procedures for the proper use of the investigational drugs, their procurements, and distributions.
Compiled by: Alok Bains
Hospital Pharmacy Standard
ASHP Guidelines
Compiled by Alok Bains..