1. CHAPTER 1: INTRODUCTION TO HOSPITALS & HOSPITAL PHRMACY
Section 1.1- Definition
Classification
Organizational structure of Hospital, Administration and Functions of Hospitls

2. Hospital
Hospital is an institution for the care, cure and treatment of the sick and wounded, for the study of the diseases, and for the training of the doctors and nurses.
Definition according to WHO:
The hospital is a complex organization utilizing combination of intricate, specialized scientific equipment, and functioning through a corps of trained people educated to the problem of modern medical science.
These are all welded together in the common purpose of the maintenance of good health.

3. Classification of Hospitals
Hospitals have been classified, on the basis of different criteria.
A. Size or Bed Capacity: The size of a hospital is determined
by the number of beds it has. Based on the bed capacity,
hospitals can be categorized as follows:
Small hospital - Bed capacity of 100 or less.
Medium size hospital - Bed capacity of 101 to 300 beds
Large hospital - Bed capacity of 301 to 1000 beds
The bed strength of different types of hospitals is as follows:
Teaching and Referral Hospital to 300
District Hospital - 50 to 200
Taluka Hospital - 50 to 200
Community Health Centre - 30 to 50
Primary Health Centre - 6 to 10

4. B. Ownership or Control: On the basis of ownership or
control, hospitals are classified into the following:
Government or Public Hospital:
These are run by Central or State Governments.
These are funded by the government.
They can be general or specialized hospitals.
2. Non–Government Hospitals:
They are supported by client’s fees, donations, or endowments (relating to funds or property donated to institutions or individuals).
Non-government hospitals are further classified as either proprietary or non–profit organization.
a. Proprietary hospitals are owned by individuals, partnerships or corporation whose dividend is shared by the partners.

5. b. Non–profit organization- They can be categorized as follows:
a). Voluntary hospitals:
These are established and incorporated under the Societies Registration Act or Public Trust Act 1882 or any other Central or State Governments.
They are run by public or private funds on a non– commercial basis.
b). Private Nursing homes / hospitals:
They are generally owned by an individual doctor or group of doctors and they are run on a commercial basis.
c). Corporate hospitals:
They are public limited companies formed under the Companies Act and are run on commercial lines.
They can be either general or specialized or both.

6. C. Objectives of the Hospital: Based on the objectives, hospitals can be classified into the following:
1. Teaching-cum-Research Hospital: The primary objective is training of doctors and research. Healthcare is secondary. For example, Medical Colleges.
2. General Hospitals: These hospitals offer treatment for common diseases. The main objective is to provide medical care, whereas teaching is secondary.
3. Specialized Hospitals: These hospitals concentrate on giving medical and nursing care in a specific area, e.g. ophthalmic hospital, heart hospital, etc.
4. Isolation Hospital: This is a hospital in which client requiring isolation or clients suffering from communicable diseases are taken care of.
5. Rural Hospitals are those located in rural areas permanently staffed by at least one or more physicians.

7. D. Systems: According to the system of medicine, hospitals are classified into the following:
Long – term care hospitals or chronic care hospital:
In this client stays in the hospital for a long time and the disease may be of chronic nature (Chronic Disease is a long-lasting condition that can be controlled but not cured).
e.g. leprosy (Leprosy is an infectious disease that causes severe, disfiguring skin sores and nerve damage in the arms and legs), cancer, etc.
b) Short – term care hospital or acute care hospital:
In this the client stay in the hospital for a short period only and the disease is usually of acute nature
e.g. pneumonia gastroenteritis.

8. E. Management: According to the management, hospitals are classified as follows:
1. Hospitals run by Union Government / Government of India: These hospitals are funded by Government of India. For eg, hospitals run by railways and army.
2. Hospitals run by State Government: These are hospitals which are funded and administered by State Government.
3. Hospitals run by local bodies e.g. hospitals run by municipality, Zila parishad, Panchayat, etc.
4. Autonomous bodies: These hospital have the operational responsibility to the hospital governing board, usually granted by the government. The management authority with respect to personnel administration and budget administration rests with the governing board for more efficient performance and more discretion by management to achieve it.
5. Private hospital: A private hospital is owned by a profit company or a non-profit organisation and privately funded through payment for medical services by patients themselves.
6. Voluntary hospital: It is a hospital supported in part by voluntary contributions and under the control of a local, usually self-appointed board of governors.

9. Organizational Structure of the Hospital
A. The uppermost level of hospital management:
The hospital director = Chief Executive Officer (CEO) or president
B. Second level managers:
Chief Operating Officer (COO)
Chief Financial Officer (CFO)
Director of Nursing
C. Bigger hospital may have third level management to assist second level and called as Hospital Assistant Director
D. The next level of management:
Department heads or directors (pharmacy, nursing, other clinical and support services)
They have responsibility for managing and directing all aspects of particular service such as pharmacy services

10. ROLES Chief operating officer (COO) Chief financial officer (CFO)
Chief Executive Officer (CEO):
sets direction by creating vision & mission
reports to the hospital’s board of directors
responsible for budget, personnel, & operations
Chief operating officer (COO)
responsible for daily operations
Chief financial officer (CFO)
responsible for financial management
Hospital Assistant Director
Responsible for direct patient care departments (pharmacy, nursing etc).

11. Departments in a Hospital
The following departments are generally available in a hospital:
Outpatient Department (OPD):
An outpatient is a patient who is not hospitalized for 24 hours or more but who visits a hospital, clinic, or associated facility for diagnosis or treatment.
Treatment provided in this fashion is called ambulatory care.
The admission to the hospital involves the production of an “admission note”.
The leaving of the hospital is officially termed discharge, and involves the production of a “discharge note”.
2. Inpatient Department (IPD):
An inpatient is admitted to the hospital and stays overnight or for an indeterminate time, usually several days or weeks.
Treatment provided in this fashion is called “inpatient care”.

12. 3. Medical Departments: The medical departments may include, but not limited to the following:
1. Internal Diseases Department:
This Department includes specialties of cardiology (related to heart), dermatology (related to skin), diabetics (related to pancreas), endocrine glands (related to hormone), digestive system, hematology diseases (related to blood), infectious diseases, internal diseases, kidney unit, neurology (related to brain and nerves), psychiatry clinic, lung diseases, and rheumatic diseases (related to joints and connective tissues).
2. Surgery Department:
This department deals with general surgery unit, orthopedics unit, urinary tracts surgery, plastic surgery, brain and neurology surgery, children surgery, ophthalmic surgery, and Ear Nose Throat (ENT) surgery.
3. Anesthesia: Doctors in this department give anesthetics for operations.
4. Gynecology Department:
These departments investigate and treat problems of the female urinary tract and reproductive organs.

13. 5. Pediatrics Department:
It is the department that deals with the medical care of infants, children, and adolescents, and the age limit usually ranges from birth up to the age of 18 years.
6. Dentistry Department:
This department deals with the diagnosis, prevention, and treatment of diseases, disorders and conditions of the oral cavity, especially the teeth, and to an extent related conditions in the jaws and face area.
7. Emergency Department:
An emergency department, also known as accident and emergency department, emergency room, or casualty department is a medical treatment facility specializing in acute care of patients who are present without prior appointment, either by their own means or by ambulance.
8. Nursing:
Nursing department provides nursing to patients at all general and specialized clinics in addition to specialized care services to inpatients at all units.

14. Pharmacy Department
This department is responsible for providing patients with medicines prescribed by specialist physicians and provision of services corresponding to applicable drug precautions and professional regulations.

15. Functions of a Hospital
Diagnosis and testing
Treatment and therapy
Public processing (including admissions, record keeping, billing, and planning for post-release patient care)
Public health education and promotion, done through a variety of programs, including smoking cessation programs, weight loss programs, support group programs, and screening of community members (including mammographies and testing of blood pressure and cholesterol)
Teaching (i.e., training health professionals)
Research (i.e., carrying out programs that add to the sum of medical knowledge)

16. SECTION 1.2- Hospital Pharmacy

17. Hospital Pharmacy
Definition- The department or service in a hospital which is under the direction of a professionally competent, legally qualified pharmacist, and from which all medications are supplied to the nursing units and other services, where
special prescriptions are filled for patients in the hospital,
Where prescriptions are filled also for ambulatory patients and out-patients,
Where pharmaceuticals are manufactured in bulk, where narcotic and other prescribed drugs are dispensed,
where injectable preparations should be prepared and sterilized, and
where professional supplies are often stocked and dispensed.

18. Organization of Hospital Pharmacy
DIRECTOR OF PHARMACY
ASSOCIATE DIRECTOR OF PHARMACY
ASSISTANT DIRECTOR OF PHARMACY: Dealing with
ASSAY & QUALITY CONTROL DIVISION
DRUG INFORMATION SERVICES
CENTRAL SUPPLY DIVISION
IN-PATIENT SERVICES DIVISION
OUT-PATIENT SERVICES DIVISION
INTRAVENOUS ADMIXTURE DIVISION
PURCHASE AND INVENTORY CONTROL
MANUFACTURING AND PACKAGING
RESEARCH PHARMACIST: Dealing with PHARMMCEUTICAL RESEARCH DIVISIONS
PHARMACIST SPECIALIST: Dealing with RADIOPHARMACEUTICAL DIVISIONS
Above all are commonly dealing with;
ADMINISTRATIVE SERVICES DIVISION
UNIT DOSE DISPENSING AND ADMINSTRATION
EDUCATION & TRANING DIVISION

19. Duties & Responsibilities of Hospital Pharmacy
1. To provide the benefits of a qualified hospital pharmacist to patients and health care institutions, to the allied health professions (dental hygienists, diagnostic medical sonographers, dietitians, medical technologists, radiographers, respiratory therapists etc), and to the profession of pharmacy. 2. To assist in providing an adequate supply of such qualified hospital pharmacists. 3. To assure a high quality of professional practice through the establishment and maintenance of standards of professional ethics, education. 4. To promote research in hospital pharmacy practices and in the pharmaceutical sciences in general. 5. To disseminate (To spread) pharmaceutical knowledge by providing for interchange of information among hospital pharmacists and with members of allied specialties and professions.

20. DEPARTMENT/DIVISION WISE DUTIES OF HOSPITAL PHARMACIST
Administrative Services Division
1. Plan and coordinate departmental activities.
2. Develop policies regarding health professionals.
3. Schedule personnel and provide supervision.
4. Coordinate administrative needs of the Pharmacy and Therapeutics Committee.
5. Supervise departmental office staff.
Education and Training Division
1. Coordinate programs of undergraduate and graduate pharmacy students.
2. Participate in hospital-wide educational programs involving nurses, doctors etc.
3. Train newly employed pharmacy department personnel.

21. Pharmaceutical Research Division
1. Develop new formulations of drugs, especially dosage forms not commercially available, and of research drugs.
2. Improve formulations of existing products.
3. Cooperate with the medical research staff of projects involving drugs.
In-Patient Services Division
1. Provide medications for all in-patients of the hospital on a 24-hour per day basis.
2. Inspection and control of drugs on all treatment areas.
3. Cooperate with medical drug research.
4. Maintain prescription records.

22. Out-Patient Services Division
1. Compound and dispense out-patient prescriptions.
2. Inspect and control all clinical and emergency services
3. Maintain prescription records.
4. Provide drug consultation services to staff and medical students.
Drug Information Services Division
1. Provide drug information on drugs and drug therapy to doctors, nurses, medical and nursing students.
2. Maintain the drug information center.
3. Maintain literature files.

23. Departmental Services Division
1. Control and dispense intravenous fluids.
2. Control and dispense controlled substances.
3. Coordinate and control all drug delivery and distribution systems.
Purchasing and Inventory Control Division
1. Maintain drug inventory control.
2. Purchase all drugs.
3. Receive, store and distribute drugs.
4. Interview medical service representatives.

24. Central Supply Services Division
Develop and coordinate distribution of medical supplies and irrigating fluids.
Assay and Quality Control Division
1. Perform analyses on products manufactured and purchased.
2. Develop and revise assay procedures.
3. Assist research division in special formulations.

25. Manufacturing and Packaging Division
1. Manufacture wide variety of items in common use at the hospital.
2. Operate an overall drug packaging and prepackaging program.
3. Undertake program in product development.
4. Maintain a unit dose program.
Sterile Products Division
1. Produce small volume parenterals.
2. Manufacture sterile ophthalmologic, irrigating solutions etc.
3. Prepare aseptic dilution of lyophilize and other "unstable" sterile injections for administration to patients.

26. Radiopharmaceutical Services division
Centralize the procurement, storage and dispensing of radioisotopes used in clinical practice
Intravenous Admixture Division
1. Centralize the preparation of intravenous solution admixture.
2. Review each I.V. admixture for physio-chemical incompatibilities.