Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5739_Библиотеки_им_академика_М_И_Перельмана.pdf
Pharmacy Practice98
following are some of the factors which should be considered
during selection of the appropriate site.
1. Population density: The drug store should ideally be
located in a thickly populated area since this will ensure
more number of customers.
2. Number of physician in the area: More is the number of
physicians in the area, more will be the prescriptions
leading to more number of customers for the drug store.
3. Nearness to physicians and other health care facilities:
The drug store should preferably be located near a hospital
or a nursing home or a practicing physician since this will
tremendously boost up the sale of drugs as well as surgical
and other accessory items.
4. Number of already existing drug stores: This is an
important criterion for selection of the site because more
number of drug stores in an area will cause a reduction in
the business of each.
5. Nearness to market: A drug store that is located near a
market has better chances of attracting the customers.
6. Availability of parking facilities: A drug store should not
be located at a place where parking becomes a problem
since this will reduce the number of customers visiting the
place.
7. Traffic count: A drug store should preferably be situated
on that side of the road which falls on the route of
maximum number of people returning from their work-
place.
8. Income group of people in the area: A drug store located
in an affluent area will have better chance of doing good
business because of the good purchasing capacity of the
people and also because of better awareness towards their
health.
9. Age group of people in the area: A drug store located in
an area having a large number of aged persons and infants
is likely to do better business in comparison to a drug store
located in an area having maximum number of young
people.
Community Pharmacy Management 99
10. Scope of expansion: The site selected for a drug store
should have a scope for expansion in case of the need
arising in future.
11. Economic factors: The site for drug store includes elements
of total cost-like cost of land and building, transportation
costs of material, power and water rates, taxes and labor
and administrative costs.
ISOLISOL
ISOLISOL
ISOL
AA
AA
A
TED KEY POINTSTED KEY POINTS
TED KEY POINTSTED KEY POINTS
TED KEY POINTS
• The community pharmacy medicines management
(CPMM) objective is to introduce a structured intervention
process into the relationship between the community
pharmacist, the patient and the general practitioner.
• The records pertaining to the purchase of all drugs whether
intended to be sold in retail or by wholesale should be
maintained under the following heading:
i. Date of purchase.
ii. Name and address of the licensee from whom purchased
and his license number.
iii. Name and quantity of the drug and its batch number.
iv. Name of the manufacturer of the drug and its batch
number.
• The records of the purchase of all drugs should be
maintained under the following heading:
i. Date purchased.
ii. Name and address of the licensee from whom
purchased, with license number.
iii. Name and quantity of drug and its batch number.
iv. Name and address of manufacturer of the drugs.
• Before opening a drug store (whether retail or wholesale),
specific laws are imposed such as:
i. Drugs and Cosmetics Act and Rules (1940 and 1945)
ii. Poison Act, 1919
iii. Dangerous Drug Act
iv. Prohibition and Excise Rules
v. Pharmacy Act, 1948
vi. Shops and Establishment Act.
Pharmacy Practice100
• Materials which are stocked are listed as under:
i. Capsules, tablets, liquid dosage form, injections, etc.
ii. Biological, antibiotics are stored properly in refrigerator.
iii. Narcotics and psychotropic substances are stored in
racks, labeled and kept under lock and key.
iv. ‘Poisons’ are stored in separate closed rack, labelled as
“Poison”.
v. Large bulk items on bottom.
• Vaccines and other thermolabile drugs are required to be
stored at cold store at. 2–10°C. Antibiotics, vitamins,
liver preparations, etc. should be stored at cool temperature
(15–20°C).
• To avoid pilferage costly drugs and prescribed schedule X
drugs should be stored separately under lock and key.
• The staff of a drug store depends on the type of store (retail
or wholesale), sale turnover, space of the drug store, and
financial position of the drug store. For a medium-sized
drug store, the following manpower is required:
i. Owner or manager
ii. Salesman and two counter salesmen
iii. Two delivery boys
iv. One clerk
v. One part-time or full time accountant
vi. Driver of the vehicle
• The selection of the exact site or piece of land at which the
drug store is proposed to be established is of prime
importance. The following are some of the factors which
should be considered during selection of the appropriate
site:
a. Population density
b. Number of physician in the area
c. Nearness to physicians and other health care facilities
d. Number of already existing drug stores
e. Availability of parking facilities
f. Traffic count
g. Income group of people in the area
h. Age group of people in the area
Community Pharmacy Management 101
PRAPRA
PRAPRA
PRA
CTICE QUESTIONSCTICE QUESTIONS
CTICE QUESTIONSCTICE QUESTIONS
CTICE QUESTIONS
VV
VV
V
erer
erer
er
y Shory Shor
y Shory Shor
y Shor
t Answer Tt Answer T
t Answer Tt Answer T
t Answer T
ype Questionsype Questions
ype Questionsype Questions
ype Questions
1. Define community pharmacy management.
2. Describe the role of a community pharmacist in women
healthcare.
3. Write any two functions of a community pharmacist.
4. What is the minimum qualification required to start a
community pharmacy?
5. What are the instructions for storage of materials in
community pharmacy?
ShorShor
ShorShor
Shor
t Answer Tt Answer T
t Answer Tt Answer T
t Answer T
ype Questionsype Questions
ype Questionsype Questions
ype Questions
1. How does the community pharmacy manages the materials
and finance?
2. Write a note on community pharmacy.
3. Enlist the types of records needs to be maintained in a
community pharmacy.
4. Draw the design and layout of community pharmacy.
5. Give specifications for selection of site for a community
pharmacy.
LL
LL
L
ong Answer Tong Answer T
ong Answer Tong Answer T
ong Answer T
ype Questionsype Questions
ype Questionsype Questions
ype Questions
1. Define community pharmacy. Explain the role of
community pharmacist.
2. Explain in detail the staff and infrastructure requirement for
community pharmacy.
3. Write a note on record of sale of drugs. Briefly explain the
sale of drugs for the following:
A. Other than those specified in Schedule X
B. Specified in Schedule X
Objective TObjective T
Objective TObjective T
Objective T
ype Questionsype Questions
ype Questionsype Questions
ype Questions
1. What is CPMM?
A. Communist pharma medical management
B. Community pharmacy medicines management
C. Continuous pharmacy management of medicines
D. None of these
Pharmacy Practice102
2. What is the objective of CPMM?
A. To introduce a structured intervention process between
community pharmacist, patient and the practitioner
B. To keep check on the community medical stores
C. To manage the drugs that are being manufactured
D. All of the above
3. What is RCT?
A. Random control task
B. Random committee trial
C. Randomized controlled trial
D. None of these
4. What is the temperature required for vaccines and other
thermolabile drugs?
A. 0–5 degree Celsius B. 5–10 degree Celsius
C. 5–0 degree Celsius D. 2–10 degree Celsius
5. ____________ and _________ substances are stored in
labeled racks and kept under lock and key.
6. Antibiotics, vitamins, liver preparations, etc. should be
stored at cool temperature between _________.
AnswersAnswers
AnswersAnswers
Answers
1. B 2. A 3. C 4. D 5. Narcotics and psychotropic
6. 15–20°C
The Pharmacy and Therapeutics Committee (PTC) is a policy
framing and recommending body of a hospital which directs
the medical staff and the administration of the hospital about
therapeutic use of drugs. This committee is composed of
physicians, pharmacists and other health professionals with
the inclusion of the medical staff.
Pharmacy and therapeutic committee is the small group of
persons representing the medical, nursing and pharmacy staff
of the hospital which frames policies for the rational and
effective use medicines.
• It gathers information and decides the reasonable drugs to
be used in the hospital.
• It plays a dual role of educational and advisory committee.
ORGANIZAORGANIZA
ORGANIZAORGANIZA
ORGANIZA
TION OF PHARMATION OF PHARMA
TION OF PHARMATION OF PHARMA
TION OF PHARMA
CY ANDCY AND
CY ANDCY AND
CY AND
THERAPEUTIC COMMITTEETHERAPEUTIC COMMITTEE
THERAPEUTIC COMMITTEETHERAPEUTIC COMMITTEE
THERAPEUTIC COMMITTEE
Composition of Pharmacy and Therapeutic Committee might
vary from hospital to hospital. However, the following scheme
is suggested for general adoption. The Pharmacy and
Therapeutics Committee may by and large be composed of:
• At least three physicians from the medical staff
• A pharmacist
• A representative of the nursing staff
• A hospital administrator with his/her designated an ex-
officio member of the committee one of the physicians may
be appointed as the chairman of PTC. The pharmacist
functions usually as the secretary and therefore, he is
designated as the ‘Secretary’ of the committee (Fig. 11.1).
Pharmacy and Therapeutic
Committee
11
Pharmacy Practice104
Fig. 11.1: Organization pattern of PTC
FUNCTIONS OF THE PHARMAFUNCTIONS OF THE PHARMA
FUNCTIONS OF THE PHARMAFUNCTIONS OF THE PHARMA
FUNCTIONS OF THE PHARMA
CY ANDCY AND
CY ANDCY AND
CY AND
THERAPEUTIC COMMITTEETHERAPEUTIC COMMITTEE
THERAPEUTIC COMMITTEETHERAPEUTIC COMMITTEE
THERAPEUTIC COMMITTEE
The major functions of Pharmacy and Therapeutic Committee
are:
• Advisory: The committee assists in the formulation of
professional policies regarding evaluation, selection, and
therapeutic use of drugs in hospital. It makes recom-
mendations concerning the drugs to be stocked in hospital
patient care areas. The committee advises the pharmacy in
the implementation of effective drug distribution and
control procedures.
• Educational: The committee recommends and assists in
various functions designed to meet the need of the pro-
fessional staff, the physicians, nurses, pharmacists and other
healthcare personnel for the complete current knowledge of
the matters pertaining to the drugs. The committee
evaluates the problems related to the distribution and
administration of medications, including medication
incidents. It reviews adverse drugs reactions occurring in
the hospital and to initiate or direct the drug activity studies
and to review and to study the result of such activities.
• Drug safety and adverse drug monitoring: With the advent
and increase of each new class of therapeutic agents, the
scope, knowledge and responsibility of the hospital
pharmacist increases proportionately. Along with the
increased responsibility also devolves on him the moral,
legal and professional obligations of ensuring safety in
handling and administration of drugs. Unfortunately, the
safety aspects are more or less taken for granted by
pharmacy, medical and nursing profession, less so in
western countries but very much so in our country. Other
functions of PTC (Fig. 11.2) are:
Pharmacy and Therapeutic Committee 105
Fig. 11.2: Functions of PTC
• To serve as an advisory council to medical staff and hospital
administration in all matters related to the use of drugs.
• The committee recommends written policies and proce-
dures for selection, procurement, storage, distribution and
use of drugs.
• To study problems related to the distribution and
administration of medications.
• To make recommendations concerning the drugs to be
stocked in wards and emergency.
• To establish or plan suitable educational schemes for the
hospital professional staff on the matters related to the use
of drugs.
• To advise the pharmacy in the implementation of effective
drug distribution and control procedures.
• To develop and compile a formulary of drugs and pres-
criptions accepted for use in various hospitals.
POLICIES OF COMMITTEEPOLICIES OF COMMITTEE
POLICIES OF COMMITTEEPOLICIES OF COMMITTEE
POLICIES OF COMMITTEE
In order to avoid misunderstanding amongst members and
medical staff, these policies were developed.
Policies should be reviewed periodically to ensure that they
are updated.
Proposal of a new drug for the hospital formulary shall be
submitted to the pharmacy department by any medical staff.
Committee decides whether to accept or to reject.
Drugs evaluated and approved by committee will be
assigned to one of the following:
Pharmacy Practice106
• Formulary drug
• Drugs approved on a conditional trial period
• Investigational drugs
• Specialized formulary drugs: Drugs which cannot be placed
under the above categories are considered as non-formulary
drug. The pre-signing of prescription blanks is prohibited.
All drugs should be dispensed on the basis of generic names
to achieve cost-savings.
According to the rules and regulations of the committee this
committee should meet regularly at least six times in a year
and also as and when necessary. The agenda and the
supplementary materials should be prepared by the secretary
and furnished to the committee member’s well in advance so
that the members can study them properly before the meeting.
A typical agenda may consist of the following categories in
general:
• Minutes of the previous meeting
• Review of the contents of hospital formulary for the purpose
of bringing it up-to-date.
• Review of ‘Drug Safety’ in the hospital.
• Review of investigational drugs currently under processing
in the hospital.
• Review of side effects, adverse drug reaction, toxic effects,
and drug interactions of drugs reported by various units of
the hospital and brought to notice of the committee by the
Drug Information Centre.
• Reports of various sub-committees.
• Repots of medical audit.
• Any other matter with the permission of chair.
• Vote of thanks.
The minutes of all meeting hold should be prepared by the
secretary and a permanent record of these minutes should be
maintained in the hospital.
Appropriate changes within the formulary list or other
interventions may correct a number of problems in how
medicines are used. It is important for the PTC to identify the
priority problems and make appropriate recommendations.
Perhaps the most important function of a PTC is the evaluation
Pharmacy and Therapeutic Committee 107
and selection of medicines for the essential medicines list or
formulary list. Drugs should be selected on the basis of the
standard treatment guidelines or protocols that have been
developed or adapted for use in the hospital or health facilities.
The evaluation of medicines requires significant expertise and
time commitment and a rigorous, transparent approach.
Inpatient prescribing: The inpatient prescribing consists of
following
• Routine drug orders
• Self medication
• Medications brought to hospital by patients
• Automatic stop order for dangerous drugs
• Discharge prescriptions
Outpatient prescribing: Outpatient prescribing should be
written only on hospital prescriptions and should contain
details of patient, drug information and name and signature
of physician.
• For control drug prescriptions, it requires physician’s DEA
number.
• In case of schedule 2 drugs (narcotics), are limited to 30-day
supply, no refills
• Schedule 3 drugs (barbiturates) and schedule 4 drugs
(benzodiazepines), limited to 30 day supply, refilled up to
5 times within 6 months of issue date.
AUTONOMIC STOP ORDERS FOR DAUTONOMIC STOP ORDERS FOR D
AUTONOMIC STOP ORDERS FOR DAUTONOMIC STOP ORDERS FOR D
AUTONOMIC STOP ORDERS FOR D
ANGEROUS DRUGSANGEROUS DRUGS
ANGEROUS DRUGSANGEROUS DRUGS
ANGEROUS DRUGS
All drug orders for narcotics, sedatives, hypnotic, anti-
coagulants and antibiotics should be automatically dis-
continued after 48 hours unless
• Order indicates exact number of doses,
• Exact period of time,
• Attending physician reorders. All PRN (pro re nata) and
standing order medications shall expire as determined by
the pharmacy and therapeutic committee in consultation
with concerned medical staff and recommend the hospital
administration. A typical automatic drug stop order is
shown in Fig. 11.3.