HISTORY

Changes over the last 50 years:

1. In-charge of drug product acquisition, distribution, and control
Major elements of hospital pharmacists' professional identity
Bulk compounding and sterile solution manufacturing - unsuitability of many commercially
available dosage forms for hospital use; close relationship between phycisians and
pharmacists
2. Major role in patient safety
Getting involved in the medication-use process - greater accuracy in dispensing and
administration; improving prescribing and monitoring; improve drug product distribution
Medication Use Process:
Prescribing (Physicians) - influence prescribing of other health professionals
Transcribing (Nurse/Ward Clerk) - prescriber's written order is copied and entered
into pharmacy records; must understand potential breakdowns
Dispensing (Pharmacists) - physically transferring drug product following review
and approval of prescription to area responsible for administering medication to the
patient
Administration (Nurse) - clearly label medications, using barcoding systems, and
unit dose packaging, reducing time and effort involved in accessing drugs, and
using technology
Monitoring (Physician/Nurse/Pharmacist) - reviewing laboratory values that are
correlated with the expected medication-therapy outcomes
Drug Distribution Systems:
Floor Stock Systems - every floor = stock; fast supply for emergencies
Patient Prescription Systems - physician writes prescription for limited number
of drugs; transcribed by nurse or ward
Unit Dose Drug Distribution System - receives original/direct copy > reviewing
of medication order before first dose is dispensed > single unit packaging > ready
to administer form as possible > not more than 24-hour supply of doses is
delivered/available at patient care area > patient medication is concurrently
maintained per patient
Advantages: Greater nursing efficiency, better use of pharmacists' talents, cost
savings, improve patient safety
o Centralized - one supplier; more effecient for preparation and distribution
of medication
o Decentralized - come in contact regularly with physicians, nurses, and
patients
3. Major role in promoting rational drug therapy
Pharmacy and Therapeutics (P&T) Committee - medical staff of
hospital/health system with oversight for medication management; formulary,
assesses medication use, makes recommendations on policies; medical staff,
administration, pharmacy, nursing, and other parties interested in medication use
process; pharmacist=secretary of committee; promulgated by Edward Spease and
Robert Porter
AHA and ASHP - developed guidance on P&T committee and on the operation of a
hospital formulary systems
Formulary System - selection of drug products most useful in patient care;
framework on how medication-use policies are established and implemented
Formulary - approved drug list
4. Foster optimal patient outcomes from medication use
Right drug, right patient, right time
Achieving optimal outcomes from medication use
"The mission of pharmacists is to help people make the best use of medicines."
Answer drug information questions related to dosage, dosage forms, and
pharmacology
Asked for advice on ADR and clinical comparisons of products
Hilton Head Conference - directions for clinical practice in pharmacy:
o Clinical pharmacy should not be thought of as something separate from
pharmacy practice at a whole
o Hospital pharmacies should function as clinical department