Pharmacists as the key components in hospital pharmacy practice

There are several key individuals or components in hospital pharmacy services. The first, of course is Pharmacists. Pharmacists can play a number of different roles in hospital. The traditional role is dispensing. They are responsible for preparation of medications, either directly or through supervising the preparatory work of pharmacy technicians. Dispensing pharmacists play an important role in verifying that medications are prepared correctly and are dispensed accurately. Because of the increasing use of technicians, coupled with greater use of automation and technology and more dosage form being commercially available, positions for dispensing pharmacists are declining in some institutions. Although the dispensing pharmacist is less common in advanced system like in the US, pharmacist oversight over the dispensing and preparation process remain critical.

Fortunately, pharmacy education is preparing new pharmacy graduates to fulfill both dispensing and non-dispensing roles. Clinical pharmacy practice is another role for pharmacists. Clinical pharmacists are likely to serve on interdisciplinary patient-care teams and interact directly with patients. Clinical pharmacists usually have clinical pharmacy training and often have completed a pharmacy residency. Clinical pharmacists may be generalists and provide clinical pharmacy services to a wide range of patients, or they may be specialists who have a defined expertise in one or more area. For example, critical care or oncology. The prevalence of these clinical pharmacy role continue to increase and this trend will likely continue.

The most prevalent role in institutional practice is one where the pharmacist has both dispensing and clinical roles, usually referred to as an integrated practice. This type of role may involve the pharmacist spending a designated amount of time in each area. For example, 1 month dispensing alternating with a month of clinical practice or time split in a given day, for example, mornings spent in patient care area rounding and providing order review followed by afternoon in the pharmacy verifying technician preparation medications. For the most part, these pharmacists are considered generalists in both dispensing and clinical activities. Pharmacists in management usually serve as supervisor for pharmacy activity or as director for the pharmacy department.

These roles require an understanding of the practice of pharmacy and how medications are used, a good knowledge of regulations and laws that govern pharmacy practice,

and basic skill in human resources management: leadership, budget management, and ensure quality of medication use. Good manager are especially important since the effective of pharmacy services often depend on how well pharmacy manager are able to manage and lead the department. Other pharmacist role are evolving. Examples include pharmacists who are responsible for informatics, investigational drug services, research, sterile compounding, and emergency care. Pharmacy technicians continue to play an expanding role in virtual all practice models. Technicians have been integral in the purchasing, stocking, preparation and compounding of medications. This has been and continue to be under the direct supervision of the pharmacist. The scope of this role varies, depending on the experience, training and skills of the pharmacy technician.

The scope and responsibility often varies because technicians do not have consistent and standardized training requirement. Because technicians play an increasing important role in drug preparation and dispensing, technician training standards are being established. This will allow greater responsibility to be transferred to pharmacy technicians since each will meet a define training and certification standard. Pharmacy technicians are also taking on new and expanded role beyond preparation and dispensing. Some technicians are assuming role that involve the maintenance of automated dispensing technology and other information technology systems. Others are assuming role that assist clinical pharmacists in the collection of laboratory value and other clinical data.

In some organization, pharmacy technicians are interviewing patient and reconciling medication regimens at home with those orders during their hospital stay. Regardless of whether technician are in traditional education preparation role or in one of these new capacities, their importance in freeing the pharmacist for more direct patient care responsibilities is increasing, and so is need for training and certification. Let’s talk about another key components- the Importance of automation and technology. Automation and technology have been used in pharmacy since 1990 but are becoming increasingly used in hospitals. Pharmacy automation served to increase efficiency and accuracy of dispensing. Medication-related technology used outside of the pharmacy is usually focused on safety. For example, bar-coded medication administration, smart pumps, computerized prescriber order entry.

Pharmacy automation is important to the practice model because utilization of many of the available technologies can influence what the pharmacist and pharmacy technician do in support of medication dispensing. Full use of automation can re-direct staff time away from routine technical tasks and towards more direct patient care activities. The most common type of pharmacy automation is the automatic dispensing cabinet. As you know some famous brand like Pyxis, Omnicell. These cabinet-based technologies are usually located strategically in the patient care area and contain compartment where individual medication are stored. The compartment only open and give access to the medication when the user is authorized to do so.

Usually this authorization is based on the computer in the cabinet verifying that the medication has been approved through an interface with the pharmacy computer system. These system have been successful because they place medications much closer to the user, but still allow electronic verification that the medication and dose is correct for the patient. They also simplify billing and documentation of medication administration. The second most common type of pharmacy automation is the pharmacy robot, for example, McKesson Robot-Rx. These system contain hundreds of bar-coded packages placed in designated spaces on long rods. The robot move to the designated space verify that it is the correct medication using the bar-code, and removes the numbers of doses needed.

The robot is usually used to prepare a 24-hours supply of oral and prepackaged injectable medications. Pharmacist and technician time needed to prepare and check these medications is greatly reduced when this technology is used. Automation used in sterile compounding ranges from small pumps used to fill syringes and prepare parenteral nutrition solutions to large system with robotic arms capable of preparing all types of sterile IV solutions and infusions. These systems improve the efficiency of sterile product preparation while improving the accuracy of the preparation and minimization of potential contamination. There are a number of medication-related technology that are used outside of the pharmacy to improve safety.

These system have a direct impact on patient and require active involvement by the pharmacy in making sure that systems are designed and used optimally to realize their safety benefits.

Example include: bar-coded medication administration, that is BCMA system, requiring pharmacy involvement in assuring that drug packages has appropriate, readable bar-code and that information systems capture and document information.

Computerized Prescriber Order Entry systems, CPOE, require an interface or integration with pharmacy information systems so that medication ordering information is able to transfer between the prescriber and the pharmacy. Standard order set and verification mechanism also require pharmacy involvement for these system. Smart pumps are programmable pumps that allow the user to predefine minimum and maximum rates of administration. Pharmacy play an important role in making sure that the limits contained in the drug library are clinically appropriate administration, preventing errors from patients are under or over dosed with medication.