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An institutional pharmacy is responsible for providing an array of services to the residents of hospitals, nursing homes, hospice care and other long term facilities. It provides deliverance of services and prescription drugs which are packaged individually. This excerpt explores various aspect of the institutional pharmacy setting.
Institutional pharmacy technicians
Pharmacy technicians are a necessary and important part of the pharmacy services deliverance process. Institutional pharmacy technician usually work in institutional or hospital pharmacy under the supervision of a pharmacist who is licensed. This is because the Pharmacy laws and regulation usually limit the technicians to performing only those tasks that are non-discretionary and non-judgmental and that do not call for professional education, judgment and training of a pharmacist. The duties such technicians perform include processing medication orders, maintaining and filling unit dose charts of the automated dispensing machines, distributing medications, inventory management and compounding sterile and non-sterile medications (Anthony, 2003).
Medication order processing
In an institutional based pharmacy, legible medication orders should contain the following information: the name of the patient and his/her location, the generic name of the prescribed medication, the dosage in metric system (only where it is feasible), the frequency of the administration, the administration route, the physician's signature, the date and hour when the medication order was written (Brown, 2006).
There are various ways in which the pharmacy receives the orders. Some hospitals have couriers who are responsible for going to the nursing units in order to collect orders as well as deliver medication. Others use a centralized model of distribution which rely on the use of pneumatic tube systems for order deliver or use facsimile devices to transmit the order. Institutions with the decentralized model pharmacy satellites that are located close to the clinical units or use pharmacy personnel (technicians and pharmacist) working directly with the nursing unit for immediate access to patients and orders. More and more computerized physician order entry is being adopted to allow for patient-specific information to be transmitted to the pharmacy from the clinical unit. Medication order processing also requires the pharmacist to follow up with the physician to provide clarification. Notification for inaccuracies and inappropriateness on the medication order needs to be communicated to the physician immediately.
This gives the pharmacist the opportunity to recommend alternative medication to the patient and as such taking responsibility for the medication regimen given to the patient. Once the order is evaluated and deemed appropriate it is entered in the computer system of the pharmacy. The system generates a label for enough doses until the fill for the next cart. The medication is them delivered to the floor for administration. The technician fills the medication by following the label contents which is then checked got accuracy and appropriateness by the pharmacist. The physician order is transcribed to a medication administration record which is used to record all the medication prescribed to the patient in their profile. This is used to ensure that any medication prescribed is appropriate. The technician has to cross reference the medication order with this profile every time they administer medication (Brown, 2006).
Differences between institutional and non-institutional pharmacy settings
The main difference between these two settings is that the institutional pharmacy setting is usually located within a health institution (long-term care facilities such as hospitals, hospice, nursing homes) while the non-institutional pharmacy is usually in the community. An institutional pharmacy provides Long-term care facilities with the required pharmaceutical services and products as well as to play an integral part in patients medication monitoring. Institutional pharmacies have mainly issues to deal with clinical medication management while those in non-institutional ones are mainly faced with issues of customer relations and business. While institutional based pharmacies are self standing, those which are non-institutional normally have a dispensary which is subject to pharmacy legislation (Remington, 2005).
Patient issues that might arise when working in an institutional pharmacy setting
Patient's issues associates with institutional pharmacy settings include complex clinical medication issues. This usually arises due to the differences in medication prescription by the physicians and the pharmacists. Contradictions between these two professionals usually resulted in delayed medication administration to the patient. This is unique to the institutional setting because in a non-situational setting the pharmacist has autonomy in medication administration. There is also the likelihood of the physician -written prescription orders getting mixed up because of the large number of patients that are usually found in an institutional setting and because of the procedures involved in getting the orders from the clinical unit to the pharmacy (Remington 2005).