Dispensing medicines in a hospital pharmacy. Hospital pharmacies. the main directions and principles of medical therapy

• This is an organizational form of providing drug supply to the population and health facilities. There are such types of specialization:

• 1. For the specifics of production activities.

• 2. For the specifics of marketing activities.

• 3. For the specifics of the patients who are served.

• 4. Behind the specifics of the groups of drugs that are dispensed.

• 5. Behind the specifics of the sale of over-the-counter drugs.

• 6. For the specifics of additional functions.

• 7. Behind the specifics of the business environment (traditional pharmacies - offline; Internet pharmacies - online, specialize in e-commerce).

• The main goal of hospital and interhospital pharmacies is the timely and high-quality provision of inpatients with medicines and medical products. To carry out this task, pharmacies perform the following functions:

• - Determining the needs of health facilities for drugs, patient care items and other medical supplies;

• - purchase and release of medicines, dressings, patient care items to the department of health care facilities;

• - preparation of extemporaneous medicines according to the requirements - orders of health care facilities;

• - quality control of prepared medicines;

• - control over the correct storage and rational use of medicines in the departments and offices of healthcare facilities;

• - control over the rational use of funds allocated for the purchase of honey. goods;

• - information work.

Types of pharmacies

• Depending on the profile and structure of health facilities, hospital pharmacies can be:

• 1. Pharmacies of general hospitals;

• 2. Pharmacies of specialized hospitals (tuberculosis, infectious diseases, neuropsychiatric);

• 3. Pharmacy clinics;

• 4. Pharmacies of sanatoriums.

• Pharmacies that serve health care facilities can be budgetary (funding of these pharmacies is carried out at the expense of budgetary funds) and self-supporting. Self-supporting pharmacies - operate as a legal entity, carry out wholesale and retail sales of medicines and medical devices, and also manufacture extemporaneous drugs.

• Pharmacies are opened to serve one health facility (hospital pharmacy) or several health facilities (interhospital pharmacy). Such pharmacies should be located in a separate room or in a medical facility with a separate entrance.

• The purchase of drugs and medical devices is carried out from distributors, pharmacy warehouses on the basis of contracts with a license by participating in tenders (if there are at least 3 suppliers, with a purchase of at least 30 thousand hryvnias).

• The range of purchased drugs is regulated by the state.

• Responsibilities of an authorized person

• regulated by the order of the Ministry of Health of Ukraine No. 584 dated 12.16.03.

• Input control is carried out by an authorized person (head nurse, pharmacist or pharmacist of the pharmacy of the health facility, approved by order of the head of the health facility, their data is reported to the territorial state inspections).

Boundary standards for the storage of narcotic, psychotropic drugs and precursors in the structural divisions of healthcare facilities

• Pharmacy of health care facilities - a two-week requirement;

• Department of health care facilities - a three-day requirement;

• Posts (offices) of healthcare facilities - a two-day requirement;

• Reception department of a hospital for the provision of emergency medical care for vital signs in the evening and at night - a five-day reserve;

• Outpatient clinics, FAPs - a weekly need.

• The procedure for prescribing drugs and medical devices and PKU in the structural divisions of health facilities.

• Medicines for the needs of health care facilities are prescribed separately for each department. The requirement-order is made out with a stamp, a round seal of the medical facility, the signature of the head or his deputy from the medical unit. The requirement-order indicates the names, dosage, forms of release and the total number of drugs (in 3 copies).

Requirements-orders for drugs that are subject to PKU, drugs for anesthesia are issued on separate forms for each group of drugs (4 copies). They must indicate the name of the department or offices, the appointment of drugs (for injection, internal, etc.). Narcotic, psychotropic drugs, precursors of list No. 1 are prescribed in Latin and the amount is indicated in words.

• For narcotic drugs, in addition to the above, there should be: the number of the medical history, the full name of the patient, the name and dosage of these drugs, as well as their purpose. To receive drugs, a power of attorney is issued (valid for 10 calendar days).

• PKU in health care facilities are subject to:

• 1. Narcotic drugs.

• 2. Psychotropic drugs.

• 3. Precursors of list No. 1.

• 4. Poisonous drugs (atropine and its salts - powder, tetracaine, trihexyphenidyl, peripheral muscle relaxants).

• 5. Strong drugs (butorphanol, diphenhydramine (solid forms), clonidine (substance and liquid forms), methandienone, retabolil, promethazine).

• 6. Combined drugs (solid forms) that contain tramadol, ephedrine, pseudoephedrine.

• Budget pharmacies purchase medicines within the limits allocated from the state budget for the treatment of inpatients. Self-supporting pharmacies have the ability to form stocks in significant volumes, which allows the pharmacy to quickly respond to requests from healthcare facilities.

Characteristics of pharmacies that provide drug supply to healthcare facilities

• Small health facilities, especially those located in rural areas, are provided with medicines and medical devices through territorial pharmacies.

• Large health facilities are provided with drugs through a network of interhospital and hospital pharmacies.

• An interhospital pharmacy is organized to provide two or more health facilities with a total number of beds of at least 500, as well as in settlements where the total number of beds in all health facilities is from 100 to 500.

• A hospital pharmacy is organized to provide one health facility with 500 or more beds, as well as in a locality where there is only one hospital with at least 100 beds.

• Pharmacies should have a number of additional premises to serve health care facilities, namely:

• - service room for medical personnel (information room);

• - a room for picking orders;

• - billet concentrates and semi-finished products;

• - room for storing clean dishes;

• - material for poisonous and narcotic preparations;

• - material for storage of thermolabile substances;

• - material for the storage of medical products and others;

• - unpacking.

Interhospital pharmacy staff:

• 1. Administrative staff (pharmacy manager, pharmacist, chief accountant, safety engineer, economist);

• 2. Pharmaceutical staff (pharmacists, pharmacists);

• 3. Support staff (packers, nurses);

• 4. Service personnel (premises repair worker, driver).

Responsibilities of a pharmacist

• To perform functions regarding the organization of drug supply for inpatients in health facilities that are attached to pharmacies, the position of a pharmacist (but not more than two persons) is introduced, which is directly subordinate to the head physician or his deputy.

• Responsibilities of the pharmacist:

• - Acceptance and verification of orders from the departments of healthcare facilities;

• - acceptance of completed orders from the pharmacy and timely transfer of drugs and medical devices to the appropriate departments;

• - constant communication with doctors, informing them about medicines;

• - control over compliance with the established rules for the storage of medicines in the departments and offices of healthcare facilities.

Position of clinical pharmacist

• introduced into the staff of health care facilities at the rate of 1 clinical pharmacist per 300 hospital beds, but not more than 2 people per hospital.

• Functions:

• - participation in the choice of the method of pharmacotherapy for a particular patient, determining its cost and end time;

• - interpretation of the doctor's instructions regarding drugs in connection with previously prescribed drugs, the patient's diagnosis and medical history, his condition, laboratory test results and hereditary diseases;

• informing doctors about changes in legal documents that regulate pharmaceutical activities;

• advising medical personnel on possible adverse reactions, dosage, optimal medical form, method and time of use of the drug;

• - advising the patient on the use of drugs prescribed to him, the need to comply with a certain diet and medication regimen;

• The clinical pharmacist must have:

• the main methods of clinical, laboratory and instrumental examination of patients;

• the main directions and principles of medical therapy;

• methods for assessing the clinical efficacy of drugs of the main pharmacological groups;

• systemic knowledge of clinical pharmacology, drug compatibility in complex therapy;

• methodology for predicting and preventing the facts of the risk of side effects of drugs.

The main activities of the clinical pharmacist

• pharmaceutical care in the departments of healthcare facilities, hospital pharmacies;

• issues of rational procurement and use of drugs on the basis of clinical and pharmaceutical management and pharmacoeconomic studies, improvement of drug supply for health facilities;

• quality control of pharmacotherapy by evaluating prescription lists;

• clinical and clinical laboratory work;

• organizational and methodological work.

Hospital pharmacy abroad

• The main functions of the hospital pharmacy are the purchase, distribution and control over the use of drugs. In addition, the pharmacy is engaged in:

• - providing medicines for special programs of drug therapy;

• - providing drugs to polyclinics, houses for the maintenance of the elderly, and other medical institutions;

• - collection and provision of information about drugs;

• - holding seminars for the medical staff of the hospital on pharmacy issues;

• - conducting clinical trials of drugs in order to determine their effectiveness;

• - provision of information about drugs;

• - work on the compilation of equally effective, inexpensive drugs that are recommended for use in the hospital;

• - periodic monitoring of the use of medicines in the hospital.

Typical hospital pharmacy models:

• 1. Pharmacy - a warehouse dispenses ready-made drugs on the orders of doctors.

• 2. Clinical pharmacy - together with doctors, develops a list of drugs necessary for the operation of the hospital and takes part in the introduction of new drugs and determining their effectiveness.

• 3. Pharmacy of a specialized type performs the functions of the first two.

Drug distribution systems.

• Traditional system is that:

• - in accordance with the doctor's order, which was received, the pharmacy dispenses the drug for several days to the hospital, where it is stored in the drug cabinet;

• - nurses form a set of individual doses from the reserve;

• - at the end of the supply, the nurse writes out a new order.

• The second system provides for the issuance of ready-made medicines dosed by a doctor from a pharmacy, when a container with a drug is issued for only one patient. It is also possible to use the two-container method: one container is in the hospital, the other in the pharmacy. An empty container is replaced with a full one from the pharmacy every day.

• The main types of documents of a hospital pharmacy are orders for medicines from doctors and documents for dispensing medicines.

Chapter 4

At present, a wide network of medical and preventive treatment institutions (MPU) has been created in our country: hospitals, dispensaries, polyclinics, maternity hospitals, etc.

The main function of the HCI pharmacy is to manufacture and dispense, according to the requirements (prescriptions), medicines ordered by certain units of the HCI, to dispense finished medicines, dressings, patient care items, medical instruments and other medical supplies. Thus, the scope of work of HCI pharmacies is wider than that of pharmacies serving the population, since they supply this institution not only with the usual pharmacy assortment, but also with reagents, surgical and other instruments, medical equipment, etc.

Pharmacies of health care facilities are divided into categories depending on the number of beds in a hospital (Table 4.2).

The technology for the manufacture of medicines in the pharmacies of health care facilities is no different from pharmacies serving the population, therefore, the staff units in them are the same, with some exceptions. Thus, in the pharmacies of health care facilities there is a position of a pharmacist-clinician, a pharmaceutical inspector, a head of a gas-balloon economy and an engineer (technician) for the repair of equipment.

In terms of the volume of work performed in pharmacies of healthcare facilities, 40-50% are requirements for sterile dosage forms (in pharmacies serving the population - 5%). In this regard, the set of premises and their sizes are somewhat different from those in self-supporting pharmacies serving the population (Table 9.3).

Pharmacies of healthcare facilities, as well as pharmacies serving the population, have production, auxiliary (for storage), administrative and household premises; They are placed on the first floor in compliance with the relevant sanitary and hygienic requirements. These rooms should be convenient for reception and storage. a large number medical property, placement of mechanization, equipment and pharmacy furniture.

Table 4.3 - Area of ​​​​premises of pharmacies of medical institutions (extract from SNiP 1169-78)

An important sanitary-hygienic and anti-epidemic requirement is the reliable isolation of the premises of the HCI pharmacy from the treatment and diagnostic departments intended for the stay of patients, but at the same time, the pharmacy must have a convenient, safe connection with the hospital departments in terms of pollution and infection. It is most expedient to place a pharmacy in the main building of the hospital or in a separate building. In this case, the pharmacy must have basement and good access roads. Pharmacies of large clinical hospitals and multidisciplinary health facilities have special room, consisting of two rooms with a total area of ​​45-50 m 2 for small-scale production of tablets and ampoules. The pharmacy of the health care facility is responsible for supplying hospitals with oxygen and other gases. In this case, the pharmacy provides for the construction of a central oxygen station. There are no medical facilities in pharmacies trading floor; instead, there is a waiting room intended for medical personnel who come to the pharmacy from one or another department (hospitals, clinics, etc.) in order to deliver requirements, applications, prescriptions and receive prepared medicines or goods medical purpose. Unlike pharmacies serving the population, the pharmacies of healthcare facilities have a prescription-forwarding office, which performs a large amount of work on receiving and fulfilling requirements and prescriptions. In addition, health care facility pharmacies are distinguished by the presence of a large (total area from 80 to 120 m 2) well-equipped aseptic unit for the preparation of a large number of sterile drugs. A separate room for a pharmacist-analyst is not provided in the pharmacies of healthcare facilities. In the assistant's office there is a pharmacist-analyst's table with the necessary equipment for physical and chemical analyses. These pharmacies are equipped with two washing rooms (rooms for processing dishes). One of them is designed for receiving, sorting and processing dishes prepared for eye drops and other sterile injectable solutions, the other is for collecting, processing and sorting ordinary pharmacy glassware and pharmacy equipment. The pharmacy has a large number of pantries for special purposes.

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MANUAL FOR THE DESIGN OF HEALTH CARE INSTITUTIONS (K SNIP 2-08-02-89) - SECTION V - AMBULANCE AND EMERGENCY MEDICAL STATION ... Relevant in 2018

HOSPITAL PHARMACIES

1. The main tasks facing hospital pharmacies are preparation, control and dispensing medicines departments of medical and preventive institutions.

For rational design, hospital pharmacies are divided into 5 groups according to the number of beds served: up to 200, 400, 600, 800 and 1000 beds.

<*>It is introduced in the presence of an infectious diseases department in a medical and preventive institution. Provision separate outdoor entrance through vestibule.

<**>For the manufacture of eye drops and dosage forms for newborns.

<***>It is allowed to place non-combustible substances in the basement, when creating necessary conditions storage.

<****>When storing more than 100 kg - a separate building.

7. The doors of the premises for the storage of poisonous and narcotic medicines must be upholstered with iron; storage is carried out in safes; The building is provided with a security and light-sound alarm system.

8. According to the move production process the prescription room should be located adjacent to the service room (information room). The service room must be brought closer to the forwarding room.

The number of sections in the walk-through cabinet for storing completed orders in the forwarding room should correspond to the number of functional units of the medical institution.

9. The assistant must be brought closer to the analytical and, expediently, to the distillation. In the immediate vicinity of the assistant, it is desirable to place a coctorium. To the assistant should be as close as possible to the washing room, the storage room for clean dishes.

10. The blank (with a lock) should have a direct relationship with the packaging, as close as possible to the analytical one.

11. Between the premises of the aseptic complex in accordance with the stages technological process a consistent direct relationship should be provided: washing of the aseptic complex - sterilization dishes - assistant - aseptic (for the manufacture of injectable dosage forms) - assistant aseptic (for the manufacture of eye drops and dosage forms for newborns) - filling with a gateway - seaming - sterilization of dosage forms - control - marking.

12. The premises of the assistant - aseptic, filling, sealing, sterilizing dosage forms, control - marking can be connected in series with each other by transfer windows or through a door. Seaming should be directly adjacent to the filling and have a transfer device that provides aseptic conditions.

13. All premises for the manufacture of dosage forms and washing facilities must be provided with distilled water. The distillation room should be directly adjacent to the assistant room, the assistant room should be aseptic or as close as possible to them.

Modern people have a clear idea about pharmacies. But what are the types and functions of pharmacy organizations? Not everyone knows about it. Their activities are regulated and controlled by legislative acts and internal affairs bodies. We live in a state of law, where physical and legal entities obliged to abide by the laws. Pharmacy activity is also regulated by several laws, acts and other documents.

Pharmaceutical activity

The article will describe pharmacy organizations, their types, Comparative characteristics and others important points this area. This term refers to companies that carry out retail, manufacture and dispensing of medicines.

As for retail, this is a type of trade and provision of services to customers for personal, family, home purposes, which have nothing to do with entrepreneurial activity.

List of such companies:

• pharmacy points;
• pharmacy kiosks;
• pharmacies;
• pharmacy stores.

Based on external and functional characteristics, existing species pharmacy organizations have their own characteristics and differ from each other. As a rule, trading outside the premises of the pharmacy is prohibited. This suggests that the pharmacist does not have the right to sell medicines and other products outside of a specialized company.

Types of pharmacies

1. Pharmacies that are created to serve the population. Such establishments sell both narrow and general medicines. They may have their own assortment, which is spelled out in their classification. For example, homeopathic pharmacies have a range of products of this direction and specialize in their sale. Profile activities are different. For example, an oncology pharmacy produces and sells drugs designed to fight cancer.
2. Hospital pharmacies. At every medical institution has its own pharmacy. In any case, she should be there.
3. Interhospital pharmacies - such organizations supply drugs to medical and preventive and other institutions.

This list classifies the types of pharmacy organizations by type of activity. There are other indicators according to which pharmacies have their own characteristics.

The nature of the production activities of pharmacies

• Production. These points carry out the manufacture of medicines according to the prescriptions of doctors and the requirements of medical institutions. Companies of this kind have the right to sell finished products.
• Institutions for the implementation of ready-made medicinal forms. Such types of pharmacy organizations and the functions they perform are reduced to the sale of medicines to the population and their sale to medical institutions.
• Night pharmacies. As the name implies, such points are designed to serve the population at night.

Order 553n "On approval of types of pharmacy organizations" contains the basic concepts and characteristics adopted in this area. According to the data of this document, all the activities of pharmacies are regulated based on the content of this paper.

In this area, as in any other, it is important to know the laws and apply them correctly. Some unscrupulous implementers, taking advantage of the legal illiteracy of people, do not provide proper services to the population, taking into account the law. Therefore, in addition to the book of complaints and suggestions, any type of pharmacy organizations must have the specified document in the consumer's corner. This is necessary so that the visitor to the pharmacy can easily study it. The order on the approval of the types of pharmacy organizations is also necessary for periodic acquaintance with it directly by pharmacy workers. This is understandable, since the norms prescribed in it will help to better cope with their duties.

Functions of pharmacies

As noted above, Order 553n “On Approving the Types of Pharmacy Organizations” not only regulates the legality of the activities of pharmacies, but also contains a list of the functions of these institutions.

The functions of pharmacies depend not only on the type of activity, but also on its type. Scroll:

• Production. As a rule, this item includes the manufacture and production of medicines both according to prescriptions of doctors and for healthcare organizations in the Russian Federation.
• Supply. Dispensing and dispensing of medicines/funds for healthcare organizations and their structural divisions.
• Informational. Employees of each pharmacy should be informed about the absence and availability of drugs in the institution, informed about new drugs and their correct use.
• Trading. Sale of medicines to the population both by prescription and without it.
• Financial. Pharmacies are allowed to accept cash cash, payment by bank card, process these monetary transactions, keep records of them, transfer funds to the bank and make other calculations.
• Packing and packaging of medicines.
• Sale of medical goods and pharmacy assortment.
• Quality control, expiration date, compliance with the integrity of the package, proper storage location.
• Compliance with the established sanitary standards and hygiene rules.
• Consulting. The pharmacist must have sufficient knowledge about the drugs that he sells, always explain to the public if there are questions of an informative nature regarding medicines, medical equipment, and other pharmacy assortment.
• Development of instructions that affect the quality of public service and the work of staff.
• Reporting compliance.
• Carrying out self-inspection, in accordance with the norms of the legislation of the Russian Federation.

All types of pharmacy organizations Russian Federation are subject to a single rule: their employees are required to know the latest updates in the law on medicines.

Job responsibilities of employees

Employees must know:

• Rules for the sale of goods.
• The law under which pharmacy activities are carried out.
• Acts regulating the rules of conduct for pharmacy workers.
• Pharmacy's internal working hours.
• own rights and obligations.
• Rules for communicating with the public.
• The latest information about the medicines that a particular pharmacy sells.
• Terms of use cash register and computer programs.
• Approximate assortment.
• In what place, department and on which shelf the drugs are located.
• Competently answer questions, express your thoughts clearly and on medical topics.

Location of pharmacies

Each building in which a pharmacy is located should be located in the most populated area, be within walking distance from hospitals, clinics, schools and other crowded places. It does not matter what types of pharmacy organizations they are, their tasks and functions are to consistently serve the population and provide people with the opportunity to purchase the necessary medicines at a set time. Accordingly, the location of pharmacies on the map of the settlement is an important issue.

Nowadays, there are a lot of pharmacies that carry out their legal activities on the territory of the Russian Federation. It is worth noting that, according to all civil norms, pharmacies should be in any locality, regardless of whether it is a metropolis or a remote village.

Today, not every city with a small number of inhabitants can boast of having a pharmacy in it. People are forced to wander in search of drugs, call an ambulance medical care if the house does not have the necessary funds. The Ministry of Health of the Russian Federation is closely involved in this issue, but it may take years to implement it.

Existing types of pharmacy organizations are able to carry out their activities in the territory of location, if their geographical location allows customers to easily and quickly reach them. Some citizens note that pharmacies located in cities and villages are located too far from their places of residence. Therefore, to visit a pharmacy, you sometimes need to go through a thorny path.

Central District Pharmacy

The most important and large-scale institution in a district or city is the central pharmacy. In accordance with the document on the approval of the types of pharmacy organizations, it controls many processes related to medical devices.

Responsibilities:

• Provision of pharmacies with toxic substances and ethyl alcohol.
• Informing pharmacies and healthcare facilities about the receipt of drugs.
• Monitoring the receipt and delivery of drugs from the warehouse.
• Reception and correction of applications for the issuance of medicines.
• If there is a body managing pharmacies, deliver applications for obtaining drugs and medical equipment there.
• Control of supplies, availability and condition of drugs for rural pharmacies.

Pharmacy staff according to the regulations

All types of pharmacy organizations contain a minimum staffing which may include the following vacancies:

• Pharmacist.
• Nurse.
• Defector.
• Pharmacist-technologist.
• Head inspector.

Each of the employees performs separate functions, in accordance with the charter and regulations of the pharmacy organization. The staff is obliged to comply with the regime and rules of the institution.

Pharmacist

Appointment and dismissal from this position is carried out by the head of the pharmacy of the health facility. Execution control official duties the pharmacist is led by pharmacists: a technologist and an analyst. In order to work in this position, it is not necessary to have higher education- Enough of the average pharmaceutical.

The pharmacist must:

• Manufacture drugs for the purpose of medical institutions.
• Prepare products according to medical prescriptions.
• Prepare medicines before dispensing.
• Issue the drug before the holiday.

Nurse

Appointment and dismissal from this position is carried out by the head of the medical institution.

Responsibilities:

• cleaning of premises;
• dishwashing and handling.

defector

To enter this position, the employee must have a higher pharmacological education. Appoints and dismisses from this vacancy the head of the pharmacy institution or his deputy.

Responsibilities:

• control of medication records;
• accounting for medical supplies;
• intra-pharmaceutical blanks;
• checking the presence of the required inscriptions and information on the packages of drugs;
• control of the drug expiration date, information about the manufacturer;
• work with other information about medicines sold by the pharmacy.

Pharmacist-technologist

To be accepted for this position, the employee must have a higher pharmacological education. He is appointed and dismissed by the head of the pharmacy, and the employee reports exclusively to the head of the pharmacy and his deputy.

Responsibilities of a pharmacist-technologist:

• prescription control;
• acceptance of prescriptions and requirements;
• clarification of information about medicines to the population;
• registration of medicines and medical products that are in stock;
• control over the storage of drugs;
• accounting for the use of medicines in departments and offices;
• bringing information to the medical staff of hospitals, clinics and other institutions about the presence / absence of medicines in the pharmacy.

Head pharmacist

In order to get hired this position, the employee must have a higher pharmacological education and work experience of more than 5 years in the field of pharmacology. Appointed to this position chief physician medical institution by order. The head pharmacist has identical rights with the head of the department of health facilities.

Responsibilities:

• control over the work of the pharmacy as a whole;
• monitors the correctness of the manufacture of medicines;
• accounting for the release of medicines according to doctor's prescriptions;
• control over the supply of medical equipment to medical rooms and laboratories;
• ensuring proper storage of drugs, medical instruments;
• controls the consumption of medicines;
• keeps a special account of the consumption of narcotic and poisonous drugs;
• ensuring pharmaceutical order in the pharmacy;
• control over the implementation of sanitary and hygienic standards by employees;
• preparation of estimates for the receipt of medical property;
• monitors how the staff performs their duties;
• issuance of orders, instructions and other documents related to work in the pharmacy.

This list of pharmacy employees may be more extensive - it all depends on what types of pharmacy organizations are meant. Their characteristics and functions have been described above.