Appropriate medicine use in the hospital setting is a multidisciplinary responsibility that includes -

• Selection and formulary management by a multidisciplinary committee
• Prescribing by the physician
• Procurement, storage, medication order review, and preparation and dispensing by the pharmacy department
• Medication administration by nurses or other health care professionals
• Monitoring the effect of medicines on the patient by all members of the health care team

The drug and therapeutics committee (DTC) is responsible for developing policies and procedures to promote rational medicine use. Its functions include -

• Management of the approved medicine list or hospital formulary
• Ongoing drug use review
• Adverse drug event reporting and implementation of safe medication practices

Members of the DTC should include representatives from the medical, pharmacy, and nursing staffs; hospital administrators; and the quality assurance coordinator. Subcommittees are often formed for in-depth analysis of particular issues.

The pharmacy department, under the direction of a qualified pharmacist, is responsible for the procurement, storage, and distribution of medications throughout the hospital. In larger hospitals, satellite pharmacies may bring the pharmacist closer to patient care areas, facilitating interactions between pharmacists and patients. In some settings the pharmacist is used as a resource for medicine information and specialized medication therapy management.

Medications may be distributed in bulk, in courses of therapy, or in unit doses. Unit-dose distribution is optimal for patient care but requires initial capital outlay for repackaging equipment and medication cabinets. Recent technological advances, such as computerized dispensing machines and bar coding, are now available to further promote safe medication practices.

Additional mechanisms for inpatient medicine management include -

• Patient medication profiles, maintained in the pharmacy department
• Medication administration records, maintained by nurses
• Periodic inspection of medicine storage areas
• Procedures for strict control of dangerous drugs and controlled substances
• Responsible disposal of pharmaceutical waste
• Procedures for after-hours pharmacy service

Small-scale pharmaceutical production often is not cost effective and should be evaluated by the DTC.

The control of narcotics is of particular concern in the hospital setting and requires a systematic approach for the prevention and detection of abuse.

A hospital exists to provide diagnostic and curative services to patients. Pharmaceuticals are an integral part of patient care. Appropriate use of medicines in the hospital is a multidisciplinary responsibility shared by physicians, nurses, pharmacists, administrators, support personnel, and patients. A medical committee, sometimes called the drug and therapeutics committee, pharmacy and therapeutics committee, or the medicine and therapeutics committee, is responsible for approving policies and procedures and monitoring practices to promote safe and effective medicine use. The pharmacy department, under the direction of a qualified pharmacist, should be responsible for controlling the distribution of medicines and promoting their safe use. This task is challenging because medicines are prescribed by physicians, administered by nurses, and stored throughout the hospital.

This chapter covers hospital-specific pharmaceutical management issues, such as pharmacy department organization and alternative pharmaceutical distribution systems.