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Pharmaceutical Services & Sciences

Overview

Overview
  • Pharmaceutical Care is a process of drug therapy management which is patient centered, drug focused and outcome oriented; in which the pharmacist makes a therapeutic relationship with the patient in order to identify patient drug related needs, identify, prevent, manage and treat patient drug related problems.

  • The DPS is fully automated since Nov. 2009. Our strategy is to provide the hospital with cost effective state of art Pharmaceutical services.

  • The Department of Pharmaceutical Services & Sciences at CCHE works 24 hours a day, 365 days a year, to optimize, compound, dispense and monitor every single one of the millions of medication doses prepared by the pharmacy each year.
Clinical Pharmacist Scope of Services
  1. Safe and Effective Medication Use
  2. Pharmacists will take clinical action and make recommendations based on evidence to ensure safe and effective use of medications to meet therapeutic goals.


  3. Evaluation of Patient Profile and Medication Orders
    • A pharmacist reviews the appropriateness of medication orders for medications to be dispensed in the hospital
    • Each order will be evaluated for appropriateness prior to the first dose being dispensed (except in emergency situations or in those instances where a medication is administered under the direct supervision of a physician)
    • Order verification in timely manner: For priority medications, verification within 15 minutes of receiving order, for non-urgent medications, verification within 60 minutes of receiving the order

    Patient profile review upon order verification and continuously based upon team and patient acuity, Known drug allergies, and review of medication list for:

    • Drug-drug interactions
    • Drug-disease interactions
    • Duplicate or missing medications
    • Appropriate lab orders
    • Cost effective therapy
    • Assessment of therapeutic appropriateness:
      • Indication
      • Route and method of administration
      • Anticipated toxicity or adverse effects
      • Assessment of renal dosing upon order verification and upon profile review
      • Therapeutic drug monitoring and ordering of associated laboratory procedures as indicated
      • Daily antibiotic stewardship efforts to require indication and duration of therapy for each antibiotic ordered and to enforce current antimicrobial formulary restrictions and practice guidelines
      • Ensure appropriate compliance for Risk Evaluation and Mitigation Strategy medications
      • Support distribution needs to patient care area by coordinating with central pharmacy staff
      • Direct pharmacy technicians and interns in their daily work through observing their performance, giving timely feedback, answering questions, providing guidance, and checking the accuracy of their work

  4. Pharmacist Medication Dosing Services
  5. Pharmacists are responsible for the pharmacy consultation services


  6. Medication Histories and Reconciliation
  7. Pharmacists are accountable for the following:

    • Obtain medication histories within 24 hours of patient admission
    • Complete admission medication reconciliation within 24 hours of patient admission
    • Complete transfer medication reconciliation with each level of service transfer and with transfer out of the operating room
    • Review and verification of medications ordered more than 27 days ago

  8. Discharge Reconciliation and Coordination
    • Pharmacists are held accountable for the following:
      • To complete discharge medication reconciliation prior to patient discharge
      • To Complete discharge medication counseling to patient prior to discharge
      • To Facilitate access to outpatient prescriptions prior to discharge as appropriate
    • A primary focus for pharmacists on a daily basis includes:
      • Provision of consultations in a timely and accurate manner to support other health professionals regarding medication therapy selection and management
      • Provision of disease state and medication specific education during hospitalization

  9. Multidisciplinary Team Involvement
  10. In order to better integrate into the medical team, pharmacists:

    • Attend daily care coordination rounds to facilitate discharge medication needs
    • Support and augment patient care rounds
    • Pharmacists document notes and care plans are logged in the electronic medical record as appropriate

  11. Communication between Pharmacists
  12. To ensure proper care of patients through shift changes and transfers, pharmacists are to:

    • Proactively identify hand-off needs prior to the end of shifts and coordinate key hand-offs in the sign-out notes
    • Contact receiving pharmacy team members when appropriate regarding patient transfers from unit to unit to ensure continuity of care

  13. Precepting and Teaching
  14. As part of an academic medical center, pharmacist duties include the following:

    • Daily teaching and incorporation of evidence-based learning into resident and student rotations
    • Evaluation and feedback for residents and students on a regular basis
    • Timely coordination of rotation activities
    • Effective use of residents, students and interns as pharmacist extenders

  15. Formulary Management
  16. Pharmacists assess the following during the course of their daily duties:

    • Approved use and indication of formulary or restricted agents
    • Compliance and support of evidence-based guidelines and medication use policies
    • Approved therapeutic interchanges for medications at order verification o Assessment and prospective planning of switching patients from IV to PO regimens when able
    • Completion of non-formulary request process
    • Supply documentation to health care providers regarding medication use and patient outcomes from medication therapy
    • Participate and provide input in the development and application of policies, procedures, clinical care plans, guidelines, order sets, interdisciplinary standards of care and protocols involving medication use
    • Verify the validity of off-label medication use with primary, secondary, and tertiary medication references

  17. Emergency Management
  18. Pharmacists support and participate in emergency management:

    • ICU or Emergency Department pharmacists respond to all Code 4 emergencies
    • Pharmacists will respond to all rapid responses in their assigned area
    • Timely response to emergency or disaster management process
    • Support rapid sequence intubation and conscious sedation

  19. Quality and Process Improvement
  20. Pharmacists are actively engaged in quality and process improvement:

    • Represent the Pharmacy Department on committees, task forces, workgroups and unit-based councils that make decisions concerning medication use or engage in improvement initiatives which support patient-focused care
    • Lead and support medication use related to achieving outcomes around quality measures (national patient safety goals, core measures, value-based purchasing)
    • Active and timely participation and support of multidisciplinary process improvement
    • Actively participate in business process committees throughout the hospital
History
  • 2007 Specialities:
    • Automated dispensing devices inpatient
    • Critical Care
    • Day Care
    • Dispensing Pharmacy
    • Inpatient
    • IV Clean Room
    • Patient Education
    • PK Lab
    • Store

  • 2009 Specialities:
    • Pharmacy Information System

  • 2010 Specialities:
    • Clinical Pharmacy Education
    • MSC

  • 2012 Specialities:
    • OR Pharmacist

  • 2013 Specialities:
    • Pain & Pallative

  • 2014 Specialities:
    • ER
    • Internal Audit

  • 2015 Specialities:
    • DIC

  • 2016 Specialities:
    • Nuclear Pharmacy
    • Radiology Pharmacy

  • 2017 Specialities:
    • Nutrition support services
    • Perceptorship program
    • Residency program

  • 2018 Specialities:
    • Extemporanous preparation
    • Infecious disease
    • Mentorship program
    • PGx
    • Stewardship program

  • 2019 Specialities:
    • Cardiology
    • QC Lab
    • TPN Room
Statistics
Structure