HOSPITAL PHARMACY STAFFING and SEAMLESS CARE
Hospital Pharmacy Staffing Requirements
Staffing requirements will differ depending on the size of the hospital. For instance, a Small Hospital may employ a Director (alternatively referred to as the Manager or Coordinator), a Staff or Clinical Pharmacist and a Pharmacy Technician. In a very small hospital, the Director may act as the Staff or Clinical Pharmacist. Meaning there would be one Registered Pharmacist on site, and in some cases offsite, and a single Technician. Whereas, larger medium sized-hospitals may employ a Director of Pharmacy, an Assistant Director, a Clinical Pharmacist, several Staff Pharmacists and Pharmacy Technicians, an Inventory Technician, a Secretary and a Porter .
In very large teaching hospitals you are likely to find a wide range of positions including, a Director of Pharmacy, several Associate Heads (e.g. Clinical and Education Services, Administration), a Drug Use Evaluation Pharmacist, several Pharmacy Residents and Doctor of Pharmacy ("PharmD") Students, several Clinical Coordinators (e.g. in charge of Extended care, Medicine, ICU, Quality Control, Oncology, Drug Information), several Coordinators of Drug Distribution (e.g. in charge of Manufacturing, Medical/Surgical Floors, Pediatrics/Obstetrics/Gynecology, Chronic Care, Psychiatry), Senior and Assistant Supervisors overseeing Drug Distribution, several Senior Pharmacy Technicians (may be called Coordinators or Supervisors), dozens of Pharmacy Technicians, an Inventory Technician, a few Secretaries and Clerk Typists and several Porters.
Director of Pharmacy Services
The Director of Pharmacy in Ontario must be a licensed pharmacist (RPh). This person is responsible for the organization, administration and staffing of the department. He or she supervises pharmacy staff and has direct contact with the medical staff. The Director of Pharmacy typically reports directly to the Administrator or CEO of the hospital. Their role is to supervise and ensure the efficiency of the overall operation of the pharmacy department. This includes implementing and updating Standards of Practice, communicating with medical staff on drug policies, preparing reports on safety practices (e.g. documenting and filing accident or incident reports for the department), establishing Quality Control (QC) procedures, maintaining a current manual on Quality Assurance (QA), arranging and enforcing equipment maintenance and planning and attending meetings (e.g. Departmental, P & T, Nursing, Pharmacy, Environmental, QA, Fund Raising). The Director of Pharmacy Services may be a member of a pharmaceutical buying group or association (e.g. Medbuy) on behalf of the hospital.
Assistant Director of Pharmacy Services
The Assistant Director (Manager, Coordinator, Associate Director) of the pharmacy department is responsible for the day to day operations and provision of services. He or she assists the Director by performing drug product evaluations, verifying or reporting on Adverse Drug Reactions (ADRs) and Drug Utilization Reviews (DURs), assigning tasks to other pharmacy staff members and preparing work schedules, including duty or on-call rosters. The Assistant Director may verify the therapeutic appropriateness of physicians’ orders, check the critical dose calculations performed by other pharmacists and supervise the storage, handling and disposal of chemotherapy and expired stock for credit. In addition, the Assistant Director assists in monthly statistical information preparation, attends meetings with or on behalf of the Director, communicates policy changes to other hospital departments, assists in initiating educational programs and meets with pharmaceutical representatives as needed.
Clinical Services and the Clinical Pharmacist: Clinical Pharmacology
Clinical pharmacology is a specific area of pharmacology that involves applying the Pharmacist’s knowledge of pharmacological principles related to effects of drugs on the body to particular drug therapies and to institutional practices and procedures. It includes careful monitoring of drugs (Drug Use Evaluation or DUE), performing pharmacokinetic (ADME) consultations, managing ADRs and drug protocols, providing in-service education, monitoring drug therapy and counseling patients. The Clinical Pharmacist may be a member of the TPN team, CPR team and or medical (multidisciplinary) rounds team. This role involves providing Drug Information, including information on poison control, conducting, assessing and disseminating clinical research and collecting drug histories on admission to hospital.
Goal of Pharmacy Clinical Services
The goal of pharmacy clinical services is to promote the correct and appropriate use of medical products and services. According to your textbook, Clinical Pharmacists “provide patient care that optimizes medication therapy and promotes health, wellness and disease prevention” (see p. 83). They focus on therapeutic problem solving using a recognized method of documentation (e.g. SOAP, FARM). Clinical Pharmacists maximize the effect of medicines using the best treatment available and at the same time minimize the risk of treatment-induced adverse effects. Clinical Pharmacists are directly involved in monitoring the course of therapy and patient compliance which has proven to minimize drug expenditures.
Pharmacy Clinical Service Effects
Pharmacy clinical services may influence the correct use of medicines before, during or after the physician or prescriber order is written. Clinical Pharmacists may suggest certain medications to the prescriber based on knowledge of clinical trials or drug related policies. During the processing of the physician order the drug and/or dosage schedule may be changed according to predetermined Automatic Therapeutic Substitution (Auto-Sub) hospital pharmacy policies. After the physician order is written the Pharmacist may be responsible for counseling the patient on the therapeutic effects of the drug and how to take the medication properly.
Impact of Clinical Pharmacy Services
Many studies support the positive effect that clinical services have on patient outcomes. The outcomes can be classified as Humanistic, Clinical and Economic. Examples of positive Humanistic outcomes of Clinical Pharmacy are a better quality of life and a reduced mortality rate. Positive Clinical outcomes include better control or management of a disease and reduced Adverse Drug Reactions. Reduction in overall health care costs is an example of a positive Economic outcome of clinical services.
Senior Pharmacist
The senior Pharmacist performs some or all of the functions of a staff pharmacist in addition to being responsible for the Quality Assurance program of the department. Pharmacists in this role may be required to assists the Director or Assistant Director in administrative functions such as training and supervision of staff. Other duties may involve procuring supplies and inventory control, being an active member of the Nursing - Pharmacy Committee, coordinating educational programs and assisting in revising and updating the department manual. In addition, the senior Pharmacist may be asked to fulfill the duties of the Assistant Director in his or her absence.
Staff Pharmacist
Staff Pharmacists are directly involved with in-patient medication dispensing including floor stock drug dispensing. They ensure Quality Control procedures have been implemented and followed for compounded products such as bulk compounding and packaging of sterile and non-sterile products. Staff Pharmacists ensure the safe use of all drugs including "dated" drugs (i.e. drugs with a short shelf-life). In addition, they maintain drug information files, supervises the work of Pharmacy Technicians, prepare reports, perform or assume responsibility for inventory (i.e. a physical count of all medications including narcotics) and participate in continuing education programs. Staff Pharmacists typically assume a rotation on the "on-call" roster and may provide assistance to the Director.
Drug Distribution Role of the Hospital Pharmacist
The role of a hospital in-patient or drug distribution pharmacist includes editing prescriber orders and entering patient data into the profile, checking for drug-drug interactions, performing quality assurance checks of packaged medication (e.g. unit dose system, traditional system, floor stock and specialty stock) and performing end-product verification (e.g. for IVs, TPN and chemo)therapy drugs). Other drug distribution activities (e.g. preparing IVs) are now mainly a Pharmacy Technician role.
Standards of Practice for Hospital Pharmacists
See NAPRA “MSOPs for Canadian Pharmacists” and Manitoba Pharmaceutical Association’s “Hospital Standards of Practice” on FOL for an example of SOPs specific to hospital pharmacy.
Seamless Care
Seamless Care is the provision of continuous care to a patient in the health care system across a spectrum of care givers from the time of admission to, transfer between nursing units or floors and discharge from a hospital. Many nursing professionals prefer the term "transition in care" rather than "discharge." Their argument is that "transition" more adequately conveys the importance of continuing with care once a patient leaves an acute care setting such as a hospital.
Pharmaceutical care is ideally carried out without interruption. It represents a continuum in the health care journey. When one pharmacist ceases to be responsible for the patient’s care, another pharmacist or health care professional accepts responsibility for the patient. This includes a patient's movement between ALL health care settings including institutional or acute care to home care to self care.
CHECKPOINT Question TWO: Read the Ontario College of Pharmacists policy on "MMT and Dispensing." In particular, focus on the paragraph describing "Collaboration and Seamless Care." How does OCP describe Seamless Care? Why is it important in MMT? What types of patients do you think would benefit most from Seamless Care?
Hospital Pharmacy Staffing Requirements
Staffing requirements will differ depending on the size of the hospital. For instance, a Small Hospital may employ a Director (alternatively referred to as the Manager or Coordinator), a Staff or Clinical Pharmacist and a Pharmacy Technician. In a very small hospital, the Director may act as the Staff or Clinical Pharmacist. Meaning there would be one Registered Pharmacist on site, and in some cases offsite, and a single Technician. Whereas, larger medium sized-hospitals may employ a Director of Pharmacy, an Assistant Director, a Clinical Pharmacist, several Staff Pharmacists and Pharmacy Technicians, an Inventory Technician, a Secretary and a Porter .
In very large teaching hospitals you are likely to find a wide range of positions including, a Director of Pharmacy, several Associate Heads (e.g. Clinical and Education Services, Administration), a Drug Use Evaluation Pharmacist, several Pharmacy Residents and Doctor of Pharmacy ("PharmD") Students, several Clinical Coordinators (e.g. in charge of Extended care, Medicine, ICU, Quality Control, Oncology, Drug Information), several Coordinators of Drug Distribution (e.g. in charge of Manufacturing, Medical/Surgical Floors, Pediatrics/Obstetrics/Gynecology, Chronic Care, Psychiatry), Senior and Assistant Supervisors overseeing Drug Distribution, several Senior Pharmacy Technicians (may be called Coordinators or Supervisors), dozens of Pharmacy Technicians, an Inventory Technician, a few Secretaries and Clerk Typists and several Porters.
Director of Pharmacy Services
The Director of Pharmacy in Ontario must be a licensed pharmacist (RPh). This person is responsible for the organization, administration and staffing of the department. He or she supervises pharmacy staff and has direct contact with the medical staff. The Director of Pharmacy typically reports directly to the Administrator or CEO of the hospital. Their role is to supervise and ensure the efficiency of the overall operation of the pharmacy department. This includes implementing and updating Standards of Practice, communicating with medical staff on drug policies, preparing reports on safety practices (e.g. documenting and filing accident or incident reports for the department), establishing Quality Control (QC) procedures, maintaining a current manual on Quality Assurance (QA), arranging and enforcing equipment maintenance and planning and attending meetings (e.g. Departmental, P & T, Nursing, Pharmacy, Environmental, QA, Fund Raising). The Director of Pharmacy Services may be a member of a pharmaceutical buying group or association (e.g. Medbuy) on behalf of the hospital.
Assistant Director of Pharmacy Services
The Assistant Director (Manager, Coordinator, Associate Director) of the pharmacy department is responsible for the day to day operations and provision of services. He or she assists the Director by performing drug product evaluations, verifying or reporting on Adverse Drug Reactions (ADRs) and Drug Utilization Reviews (DURs), assigning tasks to other pharmacy staff members and preparing work schedules, including duty or on-call rosters. The Assistant Director may verify the therapeutic appropriateness of physicians’ orders, check the critical dose calculations performed by other pharmacists and supervise the storage, handling and disposal of chemotherapy and expired stock for credit. In addition, the Assistant Director assists in monthly statistical information preparation, attends meetings with or on behalf of the Director, communicates policy changes to other hospital departments, assists in initiating educational programs and meets with pharmaceutical representatives as needed.
Clinical Services and the Clinical Pharmacist: Clinical Pharmacology
Clinical pharmacology is a specific area of pharmacology that involves applying the Pharmacist’s knowledge of pharmacological principles related to effects of drugs on the body to particular drug therapies and to institutional practices and procedures. It includes careful monitoring of drugs (Drug Use Evaluation or DUE), performing pharmacokinetic (ADME) consultations, managing ADRs and drug protocols, providing in-service education, monitoring drug therapy and counseling patients. The Clinical Pharmacist may be a member of the TPN team, CPR team and or medical (multidisciplinary) rounds team. This role involves providing Drug Information, including information on poison control, conducting, assessing and disseminating clinical research and collecting drug histories on admission to hospital.
Goal of Pharmacy Clinical Services
The goal of pharmacy clinical services is to promote the correct and appropriate use of medical products and services. According to your textbook, Clinical Pharmacists “provide patient care that optimizes medication therapy and promotes health, wellness and disease prevention” (see p. 83). They focus on therapeutic problem solving using a recognized method of documentation (e.g. SOAP, FARM). Clinical Pharmacists maximize the effect of medicines using the best treatment available and at the same time minimize the risk of treatment-induced adverse effects. Clinical Pharmacists are directly involved in monitoring the course of therapy and patient compliance which has proven to minimize drug expenditures.
Pharmacy Clinical Service Effects
Pharmacy clinical services may influence the correct use of medicines before, during or after the physician or prescriber order is written. Clinical Pharmacists may suggest certain medications to the prescriber based on knowledge of clinical trials or drug related policies. During the processing of the physician order the drug and/or dosage schedule may be changed according to predetermined Automatic Therapeutic Substitution (Auto-Sub) hospital pharmacy policies. After the physician order is written the Pharmacist may be responsible for counseling the patient on the therapeutic effects of the drug and how to take the medication properly.
Impact of Clinical Pharmacy Services
Many studies support the positive effect that clinical services have on patient outcomes. The outcomes can be classified as Humanistic, Clinical and Economic. Examples of positive Humanistic outcomes of Clinical Pharmacy are a better quality of life and a reduced mortality rate. Positive Clinical outcomes include better control or management of a disease and reduced Adverse Drug Reactions. Reduction in overall health care costs is an example of a positive Economic outcome of clinical services.
Senior Pharmacist
The senior Pharmacist performs some or all of the functions of a staff pharmacist in addition to being responsible for the Quality Assurance program of the department. Pharmacists in this role may be required to assists the Director or Assistant Director in administrative functions such as training and supervision of staff. Other duties may involve procuring supplies and inventory control, being an active member of the Nursing - Pharmacy Committee, coordinating educational programs and assisting in revising and updating the department manual. In addition, the senior Pharmacist may be asked to fulfill the duties of the Assistant Director in his or her absence.
Staff Pharmacist
Staff Pharmacists are directly involved with in-patient medication dispensing including floor stock drug dispensing. They ensure Quality Control procedures have been implemented and followed for compounded products such as bulk compounding and packaging of sterile and non-sterile products. Staff Pharmacists ensure the safe use of all drugs including "dated" drugs (i.e. drugs with a short shelf-life). In addition, they maintain drug information files, supervises the work of Pharmacy Technicians, prepare reports, perform or assume responsibility for inventory (i.e. a physical count of all medications including narcotics) and participate in continuing education programs. Staff Pharmacists typically assume a rotation on the "on-call" roster and may provide assistance to the Director.
Drug Distribution Role of the Hospital Pharmacist
The role of a hospital in-patient or drug distribution pharmacist includes editing prescriber orders and entering patient data into the profile, checking for drug-drug interactions, performing quality assurance checks of packaged medication (e.g. unit dose system, traditional system, floor stock and specialty stock) and performing end-product verification (e.g. for IVs, TPN and chemo)therapy drugs). Other drug distribution activities (e.g. preparing IVs) are now mainly a Pharmacy Technician role.
Standards of Practice for Hospital Pharmacists
See NAPRA “MSOPs for Canadian Pharmacists” and Manitoba Pharmaceutical Association’s “Hospital Standards of Practice” on FOL for an example of SOPs specific to hospital pharmacy.
Seamless Care
Seamless Care is the provision of continuous care to a patient in the health care system across a spectrum of care givers from the time of admission to, transfer between nursing units or floors and discharge from a hospital. Many nursing professionals prefer the term "transition in care" rather than "discharge." Their argument is that "transition" more adequately conveys the importance of continuing with care once a patient leaves an acute care setting such as a hospital.
Pharmaceutical care is ideally carried out without interruption. It represents a continuum in the health care journey. When one pharmacist ceases to be responsible for the patient’s care, another pharmacist or health care professional accepts responsibility for the patient. This includes a patient's movement between ALL health care settings including institutional or acute care to home care to self care.
CHECKPOINT Question TWO: Read the Ontario College of Pharmacists policy on "MMT and Dispensing." In particular, focus on the paragraph describing "Collaboration and Seamless Care." How does OCP describe Seamless Care? Why is it important in MMT? What types of patients do you think would benefit most from Seamless Care?