Hospital Pharmacy Operations

With the introduction of new technologies in software, server management, database systems, and hardware innovations in the past decade, hospital pharmacy operations have been improved from vendors who build such products geared towards streamlining many of the time-consuming workflow processes of medication dispensing. In the not too distant past, many pharmacies held patient medication records on paper or paper cards for storage in file cabinets and bins; this kind of record keeping seems unheard of with the growing prevalence of smartphones, tablets, and laptops. You could imagine the burden of sifting through hundreds to thousands of files within file cabinets to retrieve a patient’s medication record given the volume of the patients that routinely come in and out of a hospital each day. Hospital pharmacy operations are significantly different from retail pharmacy operations, especially when it comes to the steps required to process a medication between preparation steps and delivery to the patient.

Understanding the role of the pharmacy technician in a hospital requires a fundamental knowledge of basic hospital pharmacy operations. In short, pharmacies store medications that will be ordered by prescribers, and deliver them to nurses for proper administration to patients. The process isn’t as simple as written here because of the existence of different measures involved that are dependent on the due date of a medication, the stability (shelf-life) of the medication, and policies of the medication in question for the hospital. Unlike retail pharmacies (or outpatient pharmacies), hospital pharmacies do not dispense a thirty day supply, sixty day supply of medications, or what have you for the patient to pick up and go home. Usually pharmacies dispense as much as needed for a 24 hour day due to the fact that the patient’s medication may change, the medication may expire (eg. injectable medications), or if the patient is expected to be discharged (sent home) soon. There isn’t much sense in preparing a month’s supply of medication for a patient that could be discharged the next day or within the week, or if the medication has a short shelf-life.

Also unlike retail pharmacies, hospital pharmacists carry many different formulations of medications that include injectables, oral liquids, tablets, capsules, creams, lotions, ointments, emulsions, gels, eye/ear/nose drops, inhalers, nasal sprays, sublinguals, buccals, intravenous solutions, patches, and many more. Injectable medications could further be divided into different categories based on the site of administration such as intravenous, intramuscular, subcutaneous, intra-articular, intra-dermal, etc. Many injectables have to be further diluted in a larger volume of fluid for proper administration to a patient.

There are numerous classes of medications such as antihypertensives, antipsychotics, proton-pump inhibitors, narcotics, chemotherapeutics, investigational, and many more. Each medication has their own clinical information and usage guidelines from the manufacturer for proper dosages, adverse effects, drug interactions with other drugs/food/labs/allergies, contraindications, stability, compatibility with solutions, etc. Some even have regulatory oversight on proper usage such as narcotics and hazardous medications. Even more, the hospital may also determine how certain medications are to be processed and ordered, and could hold restrictions on which prescribers are permitted to order these medications.

As you could see, the amount of information and work required to operate a hospital pharmacy could seem overwhelming. Today’s hospital pharmacies require pharmacists AND pharmacy technicians to be versed in the proper dispensing of medications within the limits of regulatory and hospital policies in order to operate an efficient pharmacy operation.

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