Hospital Pharmacy

Hospitalisation: pharmacotherapy monitoring

• Each pharmacist reviews and validates the electronic prescriptions (PEA) of hospitalised patients in the departments for which his/she is responsible. Validation involves reviewing the suitability of all the medicinal products prescribed. More specifically, the indication, the dosage, the method of administration, the interactions, and analytical data are reviewed and, where deemed appropriate, recommendations as to the treatment and/or advice on adjusting the dosage are given.
• The Pharmacy Department is involved in the Antibiotic Optimisation Programmes (PROA) along with the infectious diseases and clinical microbiology departments and those specifically involved, such as intensive medicine and the surgical departments.
• The Pharmacy Department currently monitors 100% of all intra-hospital electronic prescriptions during the working hours of 8-22h.

Outpatients

• Hospital outpatient medication dispensing system:
  • The electronic prescriptions of outpatient patients are validated, compliance with therapy is monitored, and spoken and written information is provided on the administering and adverse effects of medicinal products.
• Main medication programmes:
  • Antiretroviral, selective immunosuppressants, medicinal products used to treat HBV, HCV, multiple sclerosis, kidney failure, metabolopathies, pulmonary hypertension, foreign drugs, and all other medications that must be dispensed from hospital.
• Patient information:
  • Notice to users of the Pharmacy Department outpatient medication dispensing system Advice for the correct use of medicinal products Collection of medicinal products by an authorised person Collection of medicinal products by an authorised person Collection of medicinal products by a courier Collection of medicinal products by a courie
• Coordination with primary care:
  • Daily validation of the external prescription and its analysis. Working together to implement the primary care prescription and on meeting the annual CatSalut/ICS goals described in the pharmaceutical prescription quality standards. In populations of special risk, specific monitoring is provided and permanent care is ensured by reconciling the medication on discharge.

Clinical pharmacokinetics

• The Pharmacy Departments makes recommendations for personalised dosage, based on the monitoring of plasma concentrations and depending on the pathology and clinical response of the patients. The drugs involved in dosage optimisation are:
  • Antibiotics: vancomycin, aminoglycosides, beta-lactams
  • Anticonvulsants: phenytoin, phenobarbital, carbamazepine, lamotrigine, valproate, topiramate, levetiracetam, lacosamide, eslicarbazepine, perampanel and zonisamide
  • Digoxin
  • Selective immunosuppressants: infliximab, adalimumab and anti-drug antibodies.

Technical area: compounded formulas and preparation of sterile compounds

• Compounded formulas:
  • Mostly for hospitalised patients.
  • In certain pathologies, these formulas are prepared for outpatient patients, following the processing and approval of the corresponding requests.

Increased safety of the medicinal product by preparing sterile intravenous compounds with specific requirements Full, individual identification of solid oral medication (repackaging of medication) to guarantee safety when administered.

Medication management

• Procurement: medication purchasing management in line with current regulations.
• Logistics: the PD is responsible for establishing the appropriate circuits to ensure the correct supply of drugs to the Hospital. The medicinal products are distributed to hospitalised patients using the unit-dose distribution system (UDDS) every 24 hours with changes every 2h for certain units, the automated dispensing systems (critical care, emergency and short-stay units), the traditional stock replenishment system and the special distribution systems (certain drugs).
• Expenditure analysis: a report is produced on the evolution of expenditure in medicinal products at the HUB arising from prescriptions for hospitalised patients (hospital expenditure) and patients included in hospital outpatient medication dispensing programmes (outpatient expenditure) on a monthly and yearly basis.

Clinical nutrition

• Formulating and preparation of parenteral nutrition bags in hospitalised and home-care patients
  • Design of the composition adapted to the requirements and clinical situation of each patient.
  • Safe, computerised and fully robotic preparation of the process.
  • Minimised risk of catheter infection, packaging the bags produced in optimal conditions to ensure they remain sterile.
• Monitoring of correct administration, recording and focusing on any associated complications. The home parenteral nutrition programme includes:
  • Healthcare education for patients at the start of the therapy.
  • Monitoring and support in specific care to avoid any complications associated to the treatment.
  • The clinical nurse caring for patients with PN and advising on the protocol of the care plays a relevant role in this process.

Pharmacotherapy and selection of medication

• Medication information centre: answering any queries made on pharmacotherapy, informing of any news or warnings related to medication on the Department’s intranet and publishing the InfoFAR bulletin every fortnight with a summary of the most relevant news. It takes part in the correct selection and rational use of medication, preparing technical assessment reports on new medication to be consulted during the PTC decision-making process and technical reports on individual cases involving requests for medication in special situations.
• The Hospital Pharmacotherapy Commission (PTC). Coordination of the Hospital Pharmacotherapy Commission (PTC), which is responsible for selecting the medicinal products that can be prescribed within the hospital environment. The following committees are answerable to the PTC.
• Participation of the Pharmacy Department in other advisory commissions at the hospital: parenteral nutrition, infectious diseases, antibiotics, and safety and coordination with primary care.
• Participation of the Pharmacy Department with other advisory commissions of the ICS and CatSalut.