Hospital and Clinical Pharmacy Hub

CHAPTER 1 HOSPITAL PHARMACY

PCI Verified By Arvind Sharma, B.Pharm, M.Pharm, Assistant Professor, MUIT Recent 13 min read Hospital and Clinical Pharmacy

UNIT I — HOSPITAL PHARMACY

1. DEFINITION, SCOPE, NATIONAL AND INTERNATIONAL SCENARIO

1.1 Definition of Hospital

A hospital is an institution of community health or a specialised complex organisation that utilizes physicians, surgeons, and technical staff. It provides facilities for diagnosis, therapy, rehabilitation, prevention, education, and research, remaining a customer-oriented institution.

1.2 Functions of a Modern Hospital

Function
To raise the quality and general standards of medical practice.
To provide means and methods for persons to work together in groups for patient and community care.
To lower the incidence of disease through early detection and treatment.
To estimate needs for facilities, supplies, and equipment and utilize them for evaluation, control, and maintenance.
To provide a common link between the general public and policy makers.
To estimate departmental requirements and recommend policies to maintain adequate staff.
To stimulate the growth of medical science and training of doctors/nurses.
To develop and maintain effective clinical and administrative records.
To participate in financial planning for hospital operation.
To provide facilities for continuing education of all personnel.
To participate in and implement hospital safety programmes.
To initiate, utilize, and participate in research projects for the improvement of patient care.

1.3 Classification of Hospitals

A. On Clinical Basis

Type of Hospital	Main Service / Specialty
Medicine	Medical diseases and disorders
Surgery	Surgical conditions and operations
Maternity	Pregnancy, childbirth and postnatal care
Paediatrics	Healthcare of children
Orthopaedic	Bones, joints and musculoskeletal disorders
Short-term	Treatment requiring a short hospital stay
Psychiatric	Mental health and psychiatric disorders
Gynaecology	Diseases of the female reproductive system
Long-term	Treatment requiring prolonged hospital stay

B. On Non-Clinical Basis

Type	Examples
Governmental Hospitals	Army, Navy, City, Civil, AIIMS, PGI, Other Government Hospitals
Non-Governmental Hospitals	Private (Non-Profit / For-Profit), Church, Community, Missionary, Charitable Hospitals

C. On the Basis of Size (Bed Strength)

Category	Bed Strength
Large Hospitals	1000 and above
Medium Hospitals	500–1000
Small Hospitals	100–500
Very Small Hospitals	Less than 100

D. On the Basis of Cost

Category	Description
Elite Hospitals	High-technology and advanced facilities; Deluxe/private rooms; Facilities may include TV, telephone and refrigerator; Higher room charges; Room rates traditionally cited as approximately ₹500–₹1,200/day; Provision may be made for poor patients.
Budget Hospitals	Intended for moderate- and low-income patients; Provide healthcare at relatively lower cost; Examples: Civil Hospitals, Charitable Hospitals.

E. On the Basis of System of Medicine

System of Medicine
Allopathic Hospitals
Ayurvedic Hospitals
Homeopathic Hospitals
Unani Hospitals

1.4 Hospital Pharmacy — Definition, Scope and Functions

Definition:

Hospital pharmacy is defined as the department of the hospital dealing with procurement, storage, compounding, dispensing, manufacturing, testing, packaging, and distribution of drugs, also concerned with education and research in pharmaceutical services, controlled by a professionally competent and qualified pharmacist.

Scope:

Area of Scope
Procurement and purchase of drugs
Storage and inventory control
Manufacturing (IV fluids, parenterals, tablets, ointments)
Dispensing (in-patient and out-patient)
Quality control testing
Drug Information Services
Clinical pharmacy services (drug monitoring, ADR reporting)
Patient counselling
Teaching and research

Functions of Hospital Pharmacy:

Function of Hospital Pharmacy
Providing specifications for purchase of drugs, chemicals, biologicals.
Proper storing of drugs.
Manufacturing and distribution of medicaments (transfusion fluids, parenterals, tablets, capsules, ointments, stock mixtures).
Dispensing and sterilizing parenteral preparations.
Dispensing drugs as per prescriptions of medical staff.
Filling and labelling of all drug containers.
Management of stores (purchase, storage, records).
Establishment and maintenance of Drug Information Centre.
Patient counselling service (especially OPD).
Maintaining liaison between medical staff, nursing staff, and patients.
Cooperation in teaching and research programmes.
Discarding expired drugs and worn/missing label containers.
Providing drug monitoring services from patient charts.

Objectives of Hospital Pharmacy:

Objective
To ensure availability of right medication, at right time, in right dose at minimum cost.
To professionalize functioning of pharmaceutical services towards patient welfare and health education.
To act as counselling department for medical staff, nurses, and patients.
To act as a data bank on drug utilisation.
To participate in research projects.
To plan, organise, and implement pharmacy policy procedures.
To implement decisions of Pharmacy and Therapeutics Committee (PTC).
To coordinate and cooperate with other departments.

2. ORGANISATIONAL STRUCTURE

2.1 Typical Organisation of a Hospital

The Governing Body / Board of Trustees / Board of Directors, comprising eminent personalities, is responsible for framing major policies, plans, and programmes, and appoints various committees and the hospital administrator. The organizational hierarchy typically flows from the Governing Body to Committees (Executive, Finance, Development, Public Relations), then to Hospital Administration, and finally to various services including Clinical, Administrative, Ambulatory, Nursing, and Pharmacy Services.

Major Hospital Services:

Hospital Service
Nursing Services
Out-Patient Services
Radiological Services
Central Supply Services
Hospital Pharmacy Services
Medical Records
Stores
Dietary, Laundry, Transport, Mortuary, Library

2.2 Organisation Chart of Hospital Pharmacy Department

An organised hospital pharmacy has an integrated setup consisting of:

Section
Dispensing Section
Manufacturing Section
Quality Control Section
Clinical Pharmacy Section
Medical Stores

Organisation Chart

Administrator
- Head of Pharmacy Services (M.Pharm.)
  - Dispensing Chemist (D.Pharm.)
    - In-patient / Out-patient
  - Manufacturing Chemist (M.Pharm.)
    - IV Fluids / Other Manufacturing
  - Clinical Pharmacist (B.Pharm.)
  - Quality Control Pharmacist (M.Pharm.)
  - Medical Stores Pharmacist (B.Pharm. / D.Pharm.)

Flow Chart for Requirements of Hospital Pharmacists

Director
- Superintendent of Pharmaceutical Services / Chief Pharmacist (M.Pharm.)
  - Pharmacist – Drug Distribution Department (B.Pharm.)
    - Pharmacist – Medical Stores
    - Two Pharmacists – Dispensing (B.Pharm. / D.Pharm.)
  - Post-Graduate Pharmacist – Quality Control

2.3 Location, Layout, Flow Chart of Materials and Men

A. Location

Aspect	Detail
General Location	The hospital pharmacy should be located within the hospital premises and be easily accessible to patients, doctors, nurses and other hospital staff.
Multi-storey Hospital	In a multi-storeyed hospital, the pharmacy, particularly the dispensing unit, is preferably located on the ground floor for easy accessibility.

B. Layout Principles

Principle
Smooth and continuous flow of personnel and materials.
Convenient movement of patients and staff.
Adequate working space for pharmacy personnel.
An out-patient pharmacy should be pleasant and provide adequate seating/waiting space.
Manufacturing area should be located adjacent to or suitably connected with the pharmacy.
Medical stores should be located adjacent to or directly connected with the pharmacy.
Proper separation of areas wherever required to prevent contamination and mix-ups.

C. Flow of Materials

Sources →
Medical Stores →
Manufacturing Division →
Pharmacy Department →
Quality Control →
In-patients →
Out-patients

D. General Flow Chart for Out-Patients

Prescription Written by Doctor →
Prescription Received by Pharmacist →
Filling of Prescription (Selection → Labelling → Pricing) →
Dispensing to Patient →
Receipt of Payment (Free / Cash / Charge) →
Prescription Filed (Regular / Narcotic File) →
Statistics and Reports

E. General Flow Chart for In-Patients

Prescription Written by Doctor / Prescription Copied by Nurse →
Medication Order / Discharge Medication / Return to Credit →
Prescription Received by Pharmacist →
Filling of Order (Selection → Labelling → Pricing) →
Dispensing of Prescription / Order →
Free / Cash / Credit →
Credit Issue → Charge →
Statistics and Control

FLOOR SPACE AND EQUIPMENT REQUIREMENTS

A. Floor Space

The following figures are commonly given in traditional hospital-pharmacy references:

Hospital Size	Approximate Pharmacy Area
Minimum requirement	250 sq. ft.
100-bed hospital	≈ 10 sq. ft./bed
200-bed hospital	≈ 6 sq. ft./bed
Large hospitals	≈ 5 sq. ft./bed

Note: These are reference/textbook figures. Actual space requirements may vary according to hospital size, services, workflow, regulations and institutional standards.

B. Area Requirements

Area in square feet

Department / Area	100 Beds	300 Beds	700 Beds
Store Room	450	1,000	2,400
Dispensary	350	500	800
Office	110	150	200
Manufacturing – Tablets	—	—	900
Manufacturing – Capsules	—	—	200
Aseptic Manufacturing (Eye drops, etc.)	—	250	250
Parenterals	—	600	600

C. Usual Equipment of Hospital Pharmacy

Equipment Item
Prescription cases
Drug stock cabinets
Sectional drawer cabinets
Work tables
Sink
Cabinet for mortars and pestles
Cabinet for glassware
Refrigerator
Narcotics safe
Office desk
Telephone
Library / shelf space
Dispensing window

3. PROFESSIONAL RESPONSIBILITIES, QUALIFICATION & EXPERIENCE REQUIREMENTS, JOB SPECIFICATIONS, WORK-LOAD REQUIREMENTS AND INTER-PROFESSIONAL RELATIONSHIPS

3.1 Personnel

Personnel requirements depend on the nature and quantum of services. For a very small hospital, a minimum of 3 pharmacists is recommended. The number is calculated based on workload (prescriptions received/dispensed, number of beds). The chief pharmacist holds overall charge of the in-patient department. Additional pharmacy technicians, assistants, and peons are required if manufacturing is involved. Both measurable and non-measurable workload should be considered.

3.2 Pharmacist Requirement (Work-load basis — Bed Strength)

Bed Strength	No. of Pharmacists Required
Upto 50 beds	3
Upto 100 beds	5
Upto 200 beds	8
Upto 300 beds	10
Upto 500 beds	15

3.3 Requirements and Abilities

Hospitals primarily rely on D.Pharm holders. The Head of Department should ideally be a post-graduate in Pharmacy (preferably Pharmaceutics, Pharmacology, or Hospital Pharmacy), acting as a coordinator for pharmacy and non-pharmacy staff, reporting to the administrator, and interacting with other medical departments.

3.4 Responsibilities of Hospital Pharmacists

The Hathi Committee Recommendation states that IV fluid manufacturing should be done under the supervision of an M.Pharm, assisted by B.Pharm and D.Pharm holders.

Category	Key Responsibilities
Technical Ability	Thorough knowledge of basic sciences, pharmacology, toxicology, routes of administration, stability. Provide information on proper handling of drugs. Gain confidence of medical colleagues through technical competence (comparative evaluation of drug actions, dosage, toxicity, cost).
Ability to Develop a Manufacturing Section	Control over supply, quality, equipment, raw material cost. Organise manufacturing through cost-benefit analysis. Maintain quality; have readily available equipment and trained personnel.
Administrative Ability	Plan, organise, and control pharmacy functions. Prepare work schedule for staff. Frame policies and procedures. Interact with staff daily. Maintain legal and administrative records. Develop charging policies where applicable. Interview, select, and evaluate staff members.
Ability to Control Inventory	Exercise duties on inventories at nursing stations, supply rooms, clinical units. Communicate with drug suppliers. Check quality of drugs and supplies.
Ability to Conduct and Participate in Research	Maintain information about pharmaceutical journals. Advise on new methods of preservation, preparation, taste/efficacy improvement. Basic understanding of scientific methods to evaluate research data.
Ability to Conduct Teaching Programmes	Act as trainers for nursing staff (drug storage, proper use, dosage forms, conversions, percentage calculations). Responsible for practical training of pharmacy students. Maintain liaison with academic institutions. Submit report at end of training period.

Inter-Professional Relationships

Relationship With	Key Interactions
Medical Staff	Provide drug information, participate in PTC, advise on formulary.
Nursing Staff	Train on drug administration, storage, calculations; liaison for drug distribution.
Patients	Counselling, medication adherence, addressing queries.
Administration	Budget preparation, policy implementation, staffing.
Other Departments	Coordination for research, infection control, quality improvement.

4. GOOD PHARMACY PRACTICE (GPP) IN HOSPITAL

Definition

Good Pharmacy Practice (GPP) is the practice of pharmacy that ensures the optimal, safe, effective, and rational use of medicines, with the patient's well-being as the primary concern.

Objectives of GPP in Hospital

Objective
Ensure safe and rational use of medicines.
Provide patient-oriented pharmaceutical care.
Ensure proper procurement, storage, and distribution of medicines.
Promote appropriate prescribing and dispensing.
Prevent and identify medication errors.
Monitor and report Adverse Drug Reactions (ADRs).
Provide accurate drug information to healthcare professionals and patients.
Promote counselling and medication adherence.
Maintain proper documentation and records.
Ensure compliance with ethical, professional, and legal requirements.

Major Components of GPP in Hospital

No.	Component	Key Points
1.	Procurement	Selection and purchase of medicines of assured quality; procurement as per hospital formulary; avoid duplication; purchase from authorized vendors.
2.	Storage	Appropriate temperature, humidity and light; separate special storage for refrigerated medicines, narcotics and cytotoxics; follow FEFO (First Expiry, First Out); regular expiry checks.
3.	Prescription Evaluation	Check correct drug, dose, route, frequency and duration; check interactions, contraindications, allergies and therapeutic duplication.
4.	Dispensing	Ensure the 6 Rights: right patient, medicine, dose, route, time and information; proper labelling, packaging and instructions; double-check high-risk medicines.
5.	Patient Counselling	Explain name, purpose, dose, frequency, route and duration; precautions, adverse effects and storage; emphasize adherence.
6.	Drug Information Service	Provide accurate, unbiased and evidence-based information to doctors, nurses, healthcare professionals and patients; maintain a Drug Information Centre.
7.	ADR Monitoring	Identify suspected ADRs; document and report through the pharmacovigilance system (PvPI in India); take measures to prevent recurrence.
8.	Medication Error Prevention	Minimize errors in prescribing, transcribing, dispensing, administration and monitoring; maintain error reporting and conduct root-cause analysis.
9.	Rational Drug Use	Right indication, right dose, appropriate duration, lowest appropriate cost and proper monitoring.
10.	Pharmaceutical Care	Identify drug-related problems; optimize drug therapy; monitor treatment outcomes; improve quality of life.

GPP Flow Diagram

PROCUREMENT →
PROPER STORAGE →
PRESCRIPTION REVIEW →
SAFE DISPENSING →
PATIENT COUNSELLING →
DRUG THERAPY MONITORING →
ADR & MEDICATION-ERROR MONITORING →
BETTER THERAPEUTIC OUTCOME

GPP is the practice of pharmacy that ensures the provision of appropriate, safe, effective, and rational pharmaceutical services with the patient as the primary focus.

Traditional Pharmacy	GPP / Modern Hospital Pharmacy
Mainly focuses on dispensing medicines.	Focuses on safe medication use + pharmaceutical care + patient outcomes.

5. HOSPITAL PHARMACY STANDARDS

A. FIP Basel Statements

Introduction:

Developed by the International Pharmaceutical Federation (FIP) Hospital Pharmacy Section, first published in 2009 (Basel, Switzerland) and updated in 2015 (Bangkok). These are 65 Basel Statements covering the entire medicine-use process in hospitals.

Six Main Areas:

Main Area	Focus
Procurement	selection, purchasing, quality assurance.
Influences on Prescribing	formulary management, rational prescribing.
Preparation and Delivery of Medications	compounding, packaging, distribution.
Medication Administration	safe administration practices.
Monitoring Medication	ADR monitoring, therapeutic drug monitoring, medication errors.
Human Resources and Training	staffing, competency, continuing education.

Purpose:

Purpose
Roadmap for national, regional, and local hospitals.
Tool for self-assessment to identify improvement areas.
Encourage practice development worldwide.

B. ASHP Guidelines (American Society of Health-System Pharmacists)

Minimum Standard for Pharmacies in Hospitals

Standard	Description
I. Practice Management	Written mission statement; 24-hour pharmacy services (or on-call); compliance with laws; patient confidentiality.
II. Drug Information & Education	Patient-specific drug info to professionals and patients; up-to-date resources; staff familiarity with medications.
III. Optimizing Medication Therapy	Pharmacist participation in policy development; formulary system; Drug-Use Evaluation (DUE) / Medication-Use Evaluation (MUE).
IV. Drug Procurement & Inventory	Responsible for all medication procurement; safe practices; standardized concentrations; limited dosage forms.
V. Preparation, Packaging & Labeling	Safe compounding (sterile/non-sterile); unit-dose packaging; tall-man letters for LASA drugs.
VI. Medication Delivery	Barcode verification; automated dispensing cabinet oversight; safe handling of high-alert medications.
VII. Monitoring Medication Use	ADR monitoring and reporting; medication error reporting; Root Cause Analysis (RCA) and FMEA.
VIII. Evaluating Effectiveness	Ongoing quality assessment and improvement; regular audits.
IX. Research	Participation in drug therapy and pharmaceutical research.

6. INTRODUCTION TO NQAS GUIDELINES AND NABH ACCREDITATION AND ROLE OF PHARMACISTS

A. NQAS (National Quality Assurance Standards)

What is NQAS?

Developed by the Ministry of Health and Family Welfare (MoHFW), Government of India, NQAS is a comprehensive framework for public health facilities (District Hospitals, CHCs, PHCs, Urban PHCs, Ayushman Arogya Mandirs). It measures quality through eight broad areas: 1. Service Provision, 2. Patient Rights, 3. Inputs, 4. Support Services, 5. Clinical Care, 6. Infection Control, 7. Quality Management, 8. Outcome.

Key Features:

Feature	Description
ISQua accredited	Meets global benchmarks.
Alignment	Aligns with WHO quality-of-care domains and Global Patient Safety Action Plan 2021–2030.
Goal	100% NQAS certification for public health facilities.
Certified Facilities	Over 36,967+ facilities certified as of 2025.

B. NABH (National Accreditation Board for Hospitals & Healthcare Providers)

What is NABH?

A constituent board of the Quality Council of India (QCI), established in 2005. NABH sets standards for healthcare quality and patient safety in India. Accreditation is voluntary but internationally recognized (ISQua accredited). Currently, the 5th Edition (August 2020) is in use, with the 6th Edition effective January 2025.

10 NABH Standards (Chapters):

Standard Chapter	Abbreviation
Access, Assessment and Continuity of Care	AAC
Care of Patients	COP
Management of Medication	MOM
Patient Rights and Education	PRE
Hospital Infection Control	HIC
Patient Safety and Quality Improvement	PSQ
Responsibilities of Management	ROM
Facility Management and Safety	FMS
Human Resource Management	HRM
Information Management System	IMS

C. NABH — Management of Medication (MOM) Standards

Standard	Objective
MOM.1	Pharmacy services and usage of medication is done safely.
MOM.2	Organisation develops, updates and implements a hospital formulary.
MOM.3	Medications stored appropriately and available where required.
MOM.4	Medications prescribed safely and rati... [content trimmed for efficiency]

Hospital and Clinical Pharmacy Hub

CHAPTER 1 HOSPITAL PHARMACY

PCI Verified By Arvind Sharma, B.Pharm, M.Pharm, Assistant Professor, MUIT Recent 13 min read Hospital and Clinical Pharmacy

UNIT I — HOSPITAL PHARMACY

1. DEFINITION, SCOPE, NATIONAL AND INTERNATIONAL SCENARIO

1.1 Definition of Hospital

1.2 Functions of a Modern Hospital

Function
To raise the quality and general standards of medical practice.
To provide means and methods for persons to work together in groups for patient and community care.
To lower the incidence of disease through early detection and treatment.
To estimate needs for facilities, supplies, and equipment and utilize them for evaluation, control, and maintenance.
To provide a common link between the general public and policy makers.
To estimate departmental requirements and recommend policies to maintain adequate staff.
To stimulate the growth of medical science and training of doctors/nurses.
To develop and maintain effective clinical and administrative records.
To participate in financial planning for hospital operation.
To provide facilities for continuing education of all personnel.
To participate in and implement hospital safety programmes.
To initiate, utilize, and participate in research projects for the improvement of patient care.

1.3 Classification of Hospitals

A. On Clinical Basis

Type of Hospital	Main Service / Specialty
Medicine	Medical diseases and disorders
Surgery	Surgical conditions and operations
Maternity	Pregnancy, childbirth and postnatal care
Paediatrics	Healthcare of children
Orthopaedic	Bones, joints and musculoskeletal disorders
Short-term	Treatment requiring a short hospital stay
Psychiatric	Mental health and psychiatric disorders
Gynaecology	Diseases of the female reproductive system
Long-term	Treatment requiring prolonged hospital stay

B. On Non-Clinical Basis

Type	Examples
Governmental Hospitals	Army, Navy, City, Civil, AIIMS, PGI, Other Government Hospitals
Non-Governmental Hospitals	Private (Non-Profit / For-Profit), Church, Community, Missionary, Charitable Hospitals

C. On the Basis of Size (Bed Strength)

Category	Bed Strength
Large Hospitals	1000 and above
Medium Hospitals	500–1000
Small Hospitals	100–500
Very Small Hospitals	Less than 100

D. On the Basis of Cost

Category	Description
Elite Hospitals	High-technology and advanced facilities; Deluxe/private rooms; Facilities may include TV, telephone and refrigerator; Higher room charges; Room rates traditionally cited as approximately ₹500–₹1,200/day; Provision may be made for poor patients.
Budget Hospitals	Intended for moderate- and low-income patients; Provide healthcare at relatively lower cost; Examples: Civil Hospitals, Charitable Hospitals.

E. On the Basis of System of Medicine

System of Medicine
Allopathic Hospitals
Ayurvedic Hospitals
Homeopathic Hospitals
Unani Hospitals

1.4 Hospital Pharmacy — Definition, Scope and Functions

Definition:

Scope:

Area of Scope
Procurement and purchase of drugs
Storage and inventory control
Manufacturing (IV fluids, parenterals, tablets, ointments)
Dispensing (in-patient and out-patient)
Quality control testing
Drug Information Services
Clinical pharmacy services (drug monitoring, ADR reporting)
Patient counselling
Teaching and research

Functions of Hospital Pharmacy:

Function of Hospital Pharmacy
Providing specifications for purchase of drugs, chemicals, biologicals.
Proper storing of drugs.
Manufacturing and distribution of medicaments (transfusion fluids, parenterals, tablets, capsules, ointments, stock mixtures).
Dispensing and sterilizing parenteral preparations.
Dispensing drugs as per prescriptions of medical staff.
Filling and labelling of all drug containers.
Management of stores (purchase, storage, records).
Establishment and maintenance of Drug Information Centre.
Patient counselling service (especially OPD).
Maintaining liaison between medical staff, nursing staff, and patients.
Cooperation in teaching and research programmes.
Discarding expired drugs and worn/missing label containers.
Providing drug monitoring services from patient charts.

Objectives of Hospital Pharmacy:

Objective
To ensure availability of right medication, at right time, in right dose at minimum cost.
To professionalize functioning of pharmaceutical services towards patient welfare and health education.
To act as counselling department for medical staff, nurses, and patients.
To act as a data bank on drug utilisation.
To participate in research projects.
To plan, organise, and implement pharmacy policy procedures.
To implement decisions of Pharmacy and Therapeutics Committee (PTC).
To coordinate and cooperate with other departments.

2. ORGANISATIONAL STRUCTURE

2.1 Typical Organisation of a Hospital

Major Hospital Services:

Hospital Service
Nursing Services
Out-Patient Services
Radiological Services
Central Supply Services
Hospital Pharmacy Services
Medical Records
Stores
Dietary, Laundry, Transport, Mortuary, Library

2.2 Organisation Chart of Hospital Pharmacy Department

An organised hospital pharmacy has an integrated setup consisting of:

Section
Dispensing Section
Manufacturing Section
Quality Control Section
Clinical Pharmacy Section
Medical Stores

Organisation Chart

Administrator
- Head of Pharmacy Services (M.Pharm.)
  - Dispensing Chemist (D.Pharm.)
    - In-patient / Out-patient
  - Manufacturing Chemist (M.Pharm.)
    - IV Fluids / Other Manufacturing
  - Clinical Pharmacist (B.Pharm.)
  - Quality Control Pharmacist (M.Pharm.)
  - Medical Stores Pharmacist (B.Pharm. / D.Pharm.)

Flow Chart for Requirements of Hospital Pharmacists

Director
- Superintendent of Pharmaceutical Services / Chief Pharmacist (M.Pharm.)
  - Pharmacist – Drug Distribution Department (B.Pharm.)
    - Pharmacist – Medical Stores
    - Two Pharmacists – Dispensing (B.Pharm. / D.Pharm.)
  - Post-Graduate Pharmacist – Quality Control

2.3 Location, Layout, Flow Chart of Materials and Men

A. Location

Aspect	Detail
General Location	The hospital pharmacy should be located within the hospital premises and be easily accessible to patients, doctors, nurses and other hospital staff.
Multi-storey Hospital	In a multi-storeyed hospital, the pharmacy, particularly the dispensing unit, is preferably located on the ground floor for easy accessibility.

B. Layout Principles

Principle
Smooth and continuous flow of personnel and materials.
Convenient movement of patients and staff.
Adequate working space for pharmacy personnel.
An out-patient pharmacy should be pleasant and provide adequate seating/waiting space.
Manufacturing area should be located adjacent to or suitably connected with the pharmacy.
Medical stores should be located adjacent to or directly connected with the pharmacy.
Proper separation of areas wherever required to prevent contamination and mix-ups.

C. Flow of Materials

Sources →
Medical Stores →
Manufacturing Division →
Pharmacy Department →
Quality Control →
In-patients →
Out-patients

D. General Flow Chart for Out-Patients

Prescription Written by Doctor →
Prescription Received by Pharmacist →
Filling of Prescription (Selection → Labelling → Pricing) →
Dispensing to Patient →
Receipt of Payment (Free / Cash / Charge) →
Prescription Filed (Regular / Narcotic File) →
Statistics and Reports

E. General Flow Chart for In-Patients

Prescription Written by Doctor / Prescription Copied by Nurse →
Medication Order / Discharge Medication / Return to Credit →
Prescription Received by Pharmacist →
Filling of Order (Selection → Labelling → Pricing) →
Dispensing of Prescription / Order →
Free / Cash / Credit →
Credit Issue → Charge →
Statistics and Control

FLOOR SPACE AND EQUIPMENT REQUIREMENTS

A. Floor Space

The following figures are commonly given in traditional hospital-pharmacy references:

Hospital Size	Approximate Pharmacy Area
Minimum requirement	250 sq. ft.
100-bed hospital	≈ 10 sq. ft./bed
200-bed hospital	≈ 6 sq. ft./bed
Large hospitals	≈ 5 sq. ft./bed

Note: These are reference/textbook figures. Actual space requirements may vary according to hospital size, services, workflow, regulations and institutional standards.

B. Area Requirements

Area in square feet

Department / Area	100 Beds	300 Beds	700 Beds
Store Room	450	1,000	2,400
Dispensary	350	500	800
Office	110	150	200
Manufacturing – Tablets	—	—	900
Manufacturing – Capsules	—	—	200
Aseptic Manufacturing (Eye drops, etc.)	—	250	250
Parenterals	—	600	600

C. Usual Equipment of Hospital Pharmacy

Equipment Item
Prescription cases
Drug stock cabinets
Sectional drawer cabinets
Work tables
Sink
Cabinet for mortars and pestles
Cabinet for glassware
Refrigerator
Narcotics safe
Office desk
Telephone
Library / shelf space
Dispensing window

3. PROFESSIONAL RESPONSIBILITIES, QUALIFICATION & EXPERIENCE REQUIREMENTS, JOB SPECIFICATIONS, WORK-LOAD REQUIREMENTS AND INTER-PROFESSIONAL RELATIONSHIPS

3.1 Personnel

3.2 Pharmacist Requirement (Work-load basis — Bed Strength)

Bed Strength	No. of Pharmacists Required
Upto 50 beds	3
Upto 100 beds	5
Upto 200 beds	8
Upto 300 beds	10
Upto 500 beds	15

3.3 Requirements and Abilities

3.4 Responsibilities of Hospital Pharmacists

The Hathi Committee Recommendation states that IV fluid manufacturing should be done under the supervision of an M.Pharm, assisted by B.Pharm and D.Pharm holders.

Category	Key Responsibilities
Technical Ability	Thorough knowledge of basic sciences, pharmacology, toxicology, routes of administration, stability. Provide information on proper handling of drugs. Gain confidence of medical colleagues through technical competence (comparative evaluation of drug actions, dosage, toxicity, cost).
Ability to Develop a Manufacturing Section	Control over supply, quality, equipment, raw material cost. Organise manufacturing through cost-benefit analysis. Maintain quality; have readily available equipment and trained personnel.
Administrative Ability	Plan, organise, and control pharmacy functions. Prepare work schedule for staff. Frame policies and procedures. Interact with staff daily. Maintain legal and administrative records. Develop charging policies where applicable. Interview, select, and evaluate staff members.
Ability to Control Inventory	Exercise duties on inventories at nursing stations, supply rooms, clinical units. Communicate with drug suppliers. Check quality of drugs and supplies.
Ability to Conduct and Participate in Research	Maintain information about pharmaceutical journals. Advise on new methods of preservation, preparation, taste/efficacy improvement. Basic understanding of scientific methods to evaluate research data.
Ability to Conduct Teaching Programmes	Act as trainers for nursing staff (drug storage, proper use, dosage forms, conversions, percentage calculations). Responsible for practical training of pharmacy students. Maintain liaison with academic institutions. Submit report at end of training period.

Inter-Professional Relationships

Relationship With	Key Interactions
Medical Staff	Provide drug information, participate in PTC, advise on formulary.
Nursing Staff	Train on drug administration, storage, calculations; liaison for drug distribution.
Patients	Counselling, medication adherence, addressing queries.
Administration	Budget preparation, policy implementation, staffing.
Other Departments	Coordination for research, infection control, quality improvement.

4. GOOD PHARMACY PRACTICE (GPP) IN HOSPITAL

Definition

Good Pharmacy Practice (GPP) is the practice of pharmacy that ensures the optimal, safe, effective, and rational use of medicines, with the patient's well-being as the primary concern.

Objectives of GPP in Hospital

Objective
Ensure safe and rational use of medicines.
Provide patient-oriented pharmaceutical care.
Ensure proper procurement, storage, and distribution of medicines.
Promote appropriate prescribing and dispensing.
Prevent and identify medication errors.
Monitor and report Adverse Drug Reactions (ADRs).
Provide accurate drug information to healthcare professionals and patients.
Promote counselling and medication adherence.
Maintain proper documentation and records.
Ensure compliance with ethical, professional, and legal requirements.

Major Components of GPP in Hospital

No.	Component	Key Points
1.	Procurement	Selection and purchase of medicines of assured quality; procurement as per hospital formulary; avoid duplication; purchase from authorized vendors.
2.	Storage	Appropriate temperature, humidity and light; separate special storage for refrigerated medicines, narcotics and cytotoxics; follow FEFO (First Expiry, First Out); regular expiry checks.
3.	Prescription Evaluation	Check correct drug, dose, route, frequency and duration; check interactions, contraindications, allergies and therapeutic duplication.
4.	Dispensing	Ensure the 6 Rights: right patient, medicine, dose, route, time and information; proper labelling, packaging and instructions; double-check high-risk medicines.
5.	Patient Counselling	Explain name, purpose, dose, frequency, route and duration; precautions, adverse effects and storage; emphasize adherence.
6.	Drug Information Service	Provide accurate, unbiased and evidence-based information to doctors, nurses, healthcare professionals and patients; maintain a Drug Information Centre.
7.	ADR Monitoring	Identify suspected ADRs; document and report through the pharmacovigilance system (PvPI in India); take measures to prevent recurrence.
8.	Medication Error Prevention	Minimize errors in prescribing, transcribing, dispensing, administration and monitoring; maintain error reporting and conduct root-cause analysis.
9.	Rational Drug Use	Right indication, right dose, appropriate duration, lowest appropriate cost and proper monitoring.
10.	Pharmaceutical Care	Identify drug-related problems; optimize drug therapy; monitor treatment outcomes; improve quality of life.

GPP Flow Diagram

PROCUREMENT →
PROPER STORAGE →
PRESCRIPTION REVIEW →
SAFE DISPENSING →
PATIENT COUNSELLING →
DRUG THERAPY MONITORING →
ADR & MEDICATION-ERROR MONITORING →
BETTER THERAPEUTIC OUTCOME

GPP is the practice of pharmacy that ensures the provision of appropriate, safe, effective, and rational pharmaceutical services with the patient as the primary focus.

Traditional Pharmacy	GPP / Modern Hospital Pharmacy
Mainly focuses on dispensing medicines.	Focuses on safe medication use + pharmaceutical care + patient outcomes.

5. HOSPITAL PHARMACY STANDARDS

A. FIP Basel Statements

Introduction:

Six Main Areas:

Main Area	Focus
Procurement	selection, purchasing, quality assurance.
Influences on Prescribing	formulary management, rational prescribing.
Preparation and Delivery of Medications	compounding, packaging, distribution.
Medication Administration	safe administration practices.
Monitoring Medication	ADR monitoring, therapeutic drug monitoring, medication errors.
Human Resources and Training	staffing, competency, continuing education.

Purpose:

Purpose
Roadmap for national, regional, and local hospitals.
Tool for self-assessment to identify improvement areas.
Encourage practice development worldwide.

B. ASHP Guidelines (American Society of Health-System Pharmacists)

Minimum Standard for Pharmacies in Hospitals

Standard	Description
I. Practice Management	Written mission statement; 24-hour pharmacy services (or on-call); compliance with laws; patient confidentiality.
II. Drug Information & Education	Patient-specific drug info to professionals and patients; up-to-date resources; staff familiarity with medications.
III. Optimizing Medication Therapy	Pharmacist participation in policy development; formulary system; Drug-Use Evaluation (DUE) / Medication-Use Evaluation (MUE).
IV. Drug Procurement & Inventory	Responsible for all medication procurement; safe practices; standardized concentrations; limited dosage forms.
V. Preparation, Packaging & Labeling	Safe compounding (sterile/non-sterile); unit-dose packaging; tall-man letters for LASA drugs.
VI. Medication Delivery	Barcode verification; automated dispensing cabinet oversight; safe handling of high-alert medications.
VII. Monitoring Medication Use	ADR monitoring and reporting; medication error reporting; Root Cause Analysis (RCA) and FMEA.
VIII. Evaluating Effectiveness	Ongoing quality assessment and improvement; regular audits.
IX. Research	Participation in drug therapy and pharmaceutical research.

6. INTRODUCTION TO NQAS GUIDELINES AND NABH ACCREDITATION AND ROLE OF PHARMACISTS

A. NQAS (National Quality Assurance Standards)

What is NQAS?

Key Features:

Feature	Description
ISQua accredited	Meets global benchmarks.
Alignment	Aligns with WHO quality-of-care domains and Global Patient Safety Action Plan 2021–2030.
Goal	100% NQAS certification for public health facilities.
Certified Facilities	Over 36,967+ facilities certified as of 2025.

B. NABH (National Accreditation Board for Hospitals & Healthcare Providers)

What is NABH?

10 NABH Standards (Chapters):

Standard Chapter	Abbreviation
Access, Assessment and Continuity of Care	AAC
Care of Patients	COP
Management of Medication	MOM
Patient Rights and Education	PRE
Hospital Infection Control	HIC
Patient Safety and Quality Improvement	PSQ
Responsibilities of Management	ROM
Facility Management and Safety	FMS
Human Resource Management	HRM
Information Management System	IMS

C. NABH — Management of Medication (MOM) Standards

Standard	Objective
MOM.1	Pharmacy services and usage of medication is done safely.
MOM.2	Organisation develops, updates and implements a hospital formulary.
MOM.3	Medications stored appropriately and available where required.
MOM.4	Medications prescribed safely and rati... [content trimmed for efficiency]