Hospital pharmacy
A hospital pharmacy (in Switzerland: Spitalapotheke ) is a pharmacy in a hospital that supplies the wards, outpatient departments and other sub-units of the hospital with medicines and other typical pharmacy goods such as medical and blood products, X-ray, dialysis and laboratory supplies, medical gases and disinfectants . Medicines can still be given to hospital employees for their own immediate needs.
history
Medical care for humans has its roots in ancient times . What began in the early advanced civilizations with healing cults based on religious and philosophical, but also with the treatment of wounded soldiers, has developed over the centuries in the poor and sick care of early Christian orders ( Johanniter, Maltese ). Later in the Middle Ages, hospitals were built in the Christian spirit . During this time, which was shaped by Greek, Byzantine and, in particular, Arabic influences, treatment with medicinal products - and with it the pharmacist profession - became increasingly important.
In 1231 the Hohenstaufen emperor Friedrich II issued a medical ordinance. It formed the legal basis for the operation of pharmacies and stipulates the separation of the professions of doctor and pharmacist. The pharmacists working in the hospitals produced not only oral medicinal preparations such as juices, tinctures and pills (“ pill- makers”), but also ointments and plasters for external use. The development from hospital to hospital finally took place between the 14th and 16th centuries. The increasing influence of the city administrations on the non-profit institutions of the nursing and the slowly developing health system led to an expansion of the range of services of the hospitals, as a result of which the hospital in today's sense emerged.
The growing enthusiasm for the natural sciences , successes in medicine , pharmacy and chemistry promoted the construction of numerous hospitals in Germany in the 18th and 19th centuries. At the same time, more and more in-house pharmacies were founded to ensure fast, inexpensive and independent drug supply as well as close cooperation between doctor and pharmacist. One of the most famous hospital pharmacist of the 19th century was Theodor Fontane , the pharmacy of the deaconesses -Krankenhauses Bethany ran in Berlin.
At the end of the 19th century, pharmacy was assigned to the natural sciences by law and a university education was prescribed. Quality-oriented training should, among other things, prevent counterfeiting of drugs in the context of the free movement of goods. In the period that followed, drug therapy was increasingly intensified. The hospital pharmacy developed into an independent organizational unit within the hospital.
Fields of activity of a hospital pharmacy
Pharmaceutical logistics
Pharmaceutical logistics encompasses all services and processes in the hospital pharmacy that ensure that the right drug is available to the right patient on time and in optimal quality. From the approximately 60,000 registered in the Federal Republic of pharmaceuticals that creates Drug Commission of the hospital, a positive list of up to 2,000 specimens that are available for drug therapy immediately available, composed of hospital pharmacist. For the economically advantageous direct purchase of these drugs from the pharmaceutical industry, hospital pharmacies belong to purchasing groups that collect their needs.
In larger hospital pharmacies which occurs picking the medicines for the required locations with semi or fully automatic picking. The pharmacy receives the drug order online. With semi-automatic order picking, several orders are combined into a batch. The picking person receives the information on the article name and the number of packs to be removed from the storage rack via a handheld (PDA). She places these packages on a belt for transport to an object recognition unit. After optical comparison with a stored photo and hybrid barcode recognition , the ordered drug packs are then put together with the downstream sorter to make an error-free delivery. With the fully automatic order picking systems, both the storage and removal of articles are carried out in a robot-controlled manner without manual intervention.
Some hospital pharmacies supply their patients with individually packaged drugs (unit dose) to increase drug therapy safety. With unit-dose supply , the drugs are automatically packaged individually for each patient in the pharmacy, labeled in detail and delivered to the ward once or several times a day.
Outside of the regular pharmacy opening times, the acute and emergency supply of medicines is guaranteed by an on-call or on-call service.
Drug manufacturing
Large-scale manufacturing
Medicines that are not offered by the pharmaceutical industry, so-called “house specialties”, or for which in-house production is more economical, can be produced in batches of up to 100 ready-to-sell units per day in hospital pharmacies within the legal framework of the defect . The main focus is on the production spectrum
- sterile drugs for infusion or injection, ophthalmic drugs ,
- non-sterile medicinal products such as capsule, juice, drop and powder formulations as well as semi-solid formulations for external use.
For reasons of drug therapy safety and time savings for the nursing staff, the drug production of standardized dosages (ready-to-use, ready-to-administer) of frequently required parenterals , such as anticoagulants , catecholamines , electrolytes and diuretics , is becoming increasingly important.
Individual manufacture
Medicines for the special needs of an individual patient are manufactured within the legal framework of the formulation . These are in particular low-dose medicinal substances in the form of capsules, juice, drops or suppositories for pediatrics, or special doses or application forms that are also not available as finished medicinal products . Complex total parenteral nutrition (TPN) for the individual needs of premature and newborn children who cannot be adequately fed orally are still aseptically produced in the pharmacy under clean room conditions . The aseptic production of special formulations , such as pain cartridges containing anesthetics for patient-controlled analgesia , intraocular injections and the patient-appropriate dosage of antimycotics , anti-infectives and preparations for enzyme replacement therapy also takes place under these clean room conditions .
The patient-specific production of cytostatics for parenteral application takes place under separate safety measures and by specially trained staff . Clean room conditions in accordance with the internationally valid Good Manufacturing Practice (GMP) standard guarantee both the sterility of the product (product protection) and the protection of the manufacturing staff from the harmful cytotoxic effects of cytostatic drugs (personal protection). Large hospital pharmacies produce more than 60,000 individual forms of application of these highly effective drugs every year .
In clinical drug testing of phases 2–4, hospital pharmacies are involved in the preparation of study medications to be administered parenterally for each patient in the Good Clinical Practice (GCP) - appropriate storage, administration, blinding and documentation of the pharmacy's internal processes for handling study medications.
quality control
Comprehensive control examinations in accordance with the regulations of the German Pharmacopoeia (DAB) and the European Pharmacopoeia ( Ph. Eur. ) Ensure the quality of the pharmaceuticals manufactured according to the specifications and formulations. This includes
- the quality analysis of the raw materials and packaging used
- the qualitative and quantitative analysis of the drugs produced
- the random qualitative examination of finished medicinal products
- securing GMP conditions in the clean room areas
- the validation and qualification of test devices
Common investigation methods are UV / VIS and IR spectroscopy , high-performance liquid ( HPLC ), gas ( GC ) and thin-layer chromatography (DC), titrimetry , melting point , density and refractive index determination . Microbiological examinations are generally commissioned in external laboratories.
Control of drug use
Hospital pharmacies offer numerous other clinical-pharmaceutical services to control the correct and economical use of medicines.
- Antibiotic Advisory Service (ABS)
- Drug information on all aspects of drug use, in particular on dosages, side effects and interactions
- pharmacokinetic dose calculations
- Pharmacist on the ward
- Visit participation
- interdisciplinary creation of therapy plans
- Advice and training for special patient groups such as anticoagulants, asthma and dialysis patients
- Implementation of drug recalls
- Station inspections according to §14 Pharmacy Act
- Chair or management of the drug commission
- Analysis of business data on drug consumption and budget advice
Drug information points of the regional pharmacists' chambers process complex drug-related questions for public pharmacies and provide extensively referenced and valid information for advising doctors and patients. These information points are located in hospital pharmacies in many federal states.
Initial and continuing education
Hospital pharmacies are approved training centers for pharmaceutical commercial employees (PKA). A pharmaceutical technical assistant (PTA) can complete his six-month pharmacy internship in hospital pharmacies. Pharmacy students have the opportunity to do an internship or, after passing the 2nd state examination, to complete half of their practical year (PJ). Hospital pharmacies approved for this purpose by the Chamber of Pharmacists offer specialist training in the areas of " clinical pharmacy " and " drug information ".
Research and Teaching
Some hospital pharmacies in university clinics have a manufacturing license in accordance with Section 13 of the Drugs Act (Germany) and manufacture GMP-compliant investigational drugs , which are further clinically researched in close cooperation with study centers and investigators. Scientific questions about pharmaceuticals are also dealt with in individual hospital pharmacies together with university research institutions in joint doctoral projects. With the establishment of the university subject “Clinical Pharmacy”, some hospital pharmacies are still integrated into university teaching. The pharmacy students are given patient-oriented teaching content with a focus on and strong practical relevance.
Web links
Individual evidence
- ↑ Pharmacy of the clinic on the right of the Isar of the Technical University of Munich
- ↑ a b c d Pharmacy of the University Clinic Erlangen
- ↑ Number of drugs approved under the AMG
- ^ Hospital purchasing groups
- ↑ Unit-dose supply from the hospital pharmacy
- ↑ Zytostatahandhabung ( Memento of the original from March 12, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ↑ a b c d Pharmacy of the Heidelberg University Hospital
- ↑ Pharmacy of the Fulda Clinic
- ↑ a b c Pharmacy of the University Hospital Mainz
- ↑ Drug information points of the regional pharmacists' chambers
