Purchasing

Rational use of medicine

The rational use of drugs requires that patients receive medications
appropriate to their clinical needs, in dose that meet their own
individual requirements for an adequate period of time, and at the
lowest cost to them and their community
• Purchasing: to obtain an item by paying
money per its equivalent or to buy for a price.

• Procurement involves the process of selecting

vendors, establishing payment terms, strategic
evaluation, selection, the negotiation of
contracts and actual purchasing of goods.
 Procurement procedure
• It includes
– Selection of drugs items
– Authority or purchase
– Storage
– Stock control
• Selection of items:
– It is an important and basic function that must be
performed by a pharmacist
– Pharmacist can make better decisions regarding
products, quantities required, product
specifications and source of supply
– A purchasing department can perform purchasing
functions but setting of quality standards and
specification requires professional knowledge and
judgment so must be performed by a pharmacist
• A formulary system should be present. Which gives the
authority of setting the specification to pharmacist
• There should be a criteria to evaluate acceptability of
manufacturers and distributers of items.
• A pharmacist should have the authority to reject an item
or supplier when professional judgment dictates so
• PTC recommends guidelines for selection of drugs
• Economy, quality and efficacy must be considered in
selection of items.
• In selecting suppliers, pharmacist consider price, terms,
shipping times, quality of service, returned goods
policy and packaging.
 Purchasing
Drugs and allied items can be purchased by
• Bidding from manufacturer or whole sellers
– Pharmacist estimates drug usage for a given period
– Reputable manufacturer or whole sellers are invited to
quote their prices for selected items
– Manufacturer or whole sellers submit their quotations
– The drug purchase order is hence given to the
company with lowest price, yet with standard quality
• Purchase from local retail pharmacy
– Costly, only in emergency situations
• Contract Purchase
– Also known as prime vendor system
– Contract with a manufacturer, whole seller or a
company
– The institution and a single manufacturer enters into a
contract for supply of drug products.
– Orders are facilitated using computers and emails
– Provides items for small percentage fee
– Provides minimum inventory and an optimum
inventory rate
• Private hospitals use any of the above mentioned
procedures
• Governmental hospitals
– Routine purchase [Public procurement regulatory authority
(PPRA)], Medicine coordination cell (MCC)
– Purchase section in secretariat of health department
– Purchase cell advertise for prequalification notice for
pharmaceutical firms, those showing interest and having
accomplished the pre requisites are selected as pre qualified
firms
– Advertisement for bid is given in papers
– And the quotation of those prequalified firms are accepted
that have lowest price and acceptable quality
 Public Procurement Regulatory
Authority

The Public Procurement Regulatory Authority is

an autonomous body, with the responsibility of
prescribing regulations and procedures for public
procurements by Federal Government owned
public sector organizations

28 June 2020 10
 Objectives of Procurement

•Economy (Value for money)

•Efficiency
•Transparency
•Accountability
•Competitiveness
•Fairness

28 June 2020 11
 PROCUREMENT
PROCESS
INVITATION FOR BIDS ( BY ANY DEPARTMENT)
THROUGH ADVERTISEMENT

• Name of the Procuring Agency/Department

• Availability of Bidding Documents @ given address,

Date & with non-refundable Fees

• Bidding Process:
 Single Stage (Two Envelop)
28 June 2020 12
SCOPE OF BID:

“Any Department (Procuring Agency) invites Bid

for Supply of Medicines & Surgical Items as
Specified in the Schedule of Requirements along
with Technical Specifications.”

28 June 2020 13
 ELIGIBLE BIDDERS
• BID is open to all:
 All Manufacturers

 Sole Agents of Foreign Principals/Importers

“Valid Authorization/Distribution from Manufacturer”

 NOTE; (Already Pre-qualified by the Department for

the Fiscal Year 2018 & 2019)

28 June 2020 14
CORRUPTION & FRAUD

“Indulgence in corrupt & fraudulent practices is

liable to result in the rejection of Bids,
Cancellation of contracts & blacklisting of the
Bidder for a stated & indefinite period of time”

COST OF BIDDING

“The Bidder shall bear all costs associated with

the preparation & submission of its Bid, the
Procuring Agency shall in no case be responsible
or liable for those costs in any case”
28 June 2020 15
BIDDING FOR SELECTIVE ITEMS

• A Bidder can choose selective items from the list

• A Bidder is also @ liberty to bid for all required
items
NOTE;
Bidder’s can not bid for Partial Quantities of an
item, means BID MUST BE FOR WHOLE
QUANTITY AS REQUIRED”

28 June 2020 16
WHAT IS SINGLE STAGE (TWO ENVELOP
PROCEDURE)????????

• The bid shall comprise a single package containing

(02) separate envelops.
 Technical Proposal (Envelop 1)
 Financial Proposal (Envelop 2)

Note:
The Envelops shall be marked as “TECHNICAL
PROPOSAL” & “FINANCIAL PROPOSAL” in Bold
& legible letters.

28 June 2020 17
• Initially envelop marked as “TECHNICAL
PROPOSAL” shall be opened.

• The envelop marked as “FINANCIAL PROPOSAL”

shall be retained in the custody of Procuring Agency
without being opened.

• The Procuring Agency shall evaluate the Technical

Proposal without reference to the price of medicines
and reject any proposal which do not conform to the
specified requirements.

28 June 2020 18
• During the Technical Evaluation no amendments
in the Technical Proposal shall be permitted.
• After Technical Evaluation & Approval of
Technical Proposal, Financial Proposal shall be
opened Publicly at given Date, Time & Place .
NOTE:
“REPRESENATIVES OF THE BIDDERS MAY BE
PRESENT AT THE TIME OF OPENING OF
FINANCIAL PROPOSAL”

28 June 2020 19
SAMPLES OF QUOTED DRUGS:
• The Bidder shall provide samples of quoted
Medicines along with Technical Bid @ his own
cost in a quantity prescribed by the Procuring
Agency.

• These samples will be evaluated as per

technical specification laid in bid documents
and will be finally approved or rejected as
the case may be.

28 June 2020 20
 The Bid found to be the lowest evaluated in
the “Financial Proposal” shall be accepted,
means lowest offered price after meeting all
the legal requirements & Technical
specifications as laid down in the Bid
document.

28 June 2020 21
• AWARD OF CONTRACT
• SUPPLY ORDERS
• DELIVERY OF STOCK BY BIDDER
• WARRANTY/INVOICE
• PHYSICAL INSPECTION & VERIFICATION
OF STOCK
• TEST/ANAYLSIS OF MEDICINES BY DTL
• FEES
• Payments to the Contractor

28 June 2020 22
• Purchasing authority
– Centralised purchase
• Material purchase department or its purchasing agent is
responsible for purchase
• In such case pharmacist requests the items to be
purchased with specifications. Selection of brands and
vendors are on the discrete of purchasing agent
• In another system, Pharmacist can be given the
authority to reject any item below standard or not
complying with the specification
• Pharmacist may consult PTC about the specification for
drugs
• Purchase by hospital pharmacist
– All the selection and purchasing procedures are
carried out by pharmacist.
– In this case the material purchase department is
responsible for the payment
Purchasing 2
 Purchasing Procedure
• Purchase Order Prepared By Pharmacist
– Order contains Specification, packaging, quantity
needed as well as information concerning the
inventory balance and anticipated monthly use.
• Forwarded to administrator for approval
• After approval forwarded to purchasing agent
• Upon receipt, purchasing agent prepare official
purchase order. Data from previous document is
utilized in this case.
• A copy of official purchase order is sent to
vendor, another to accounts department, and one
copy for record, three copies to pharmacy for
matching with the items on receipt and record.
• On receiving the items, pharmacist record it.
 Receiving drugs
• Drugs must preferably be delivered to main pharmacy
or other receiving area
• Special storage area for radiopharmaceuticals and
controlled drugs
• If the drug items are received in main store then must
immediately be sent to pharmacy without opening it.
• At delivery stock must be checked against the purchase
order. Any difference must be recorded along with
expiry, date, batch number, manufacturer.
• All unprofessional involved in receiving drugs must be
trained and supervised by pharmacist.
• All drugs must be arranged in stock promptly upon
receipt and controlled substances must be directly
transferred to safe and secure area.
 Drug Storage:
• Storage is an important aspect of total drug control
system
• Following consideration should be undertaken
• Stability compatible storage
– Proper storage control in terms of temperature, light,
humidity, sanitation and ventilation conditions.
• Secure storage;
– Storage areas must be well secured. Accessibility only to
authorised personnel
• Safe storage:
– Consideration to poisons and inflammables
• Segregate storage:
– Radiopharmaceuticals, controlled drugs, refrigerated drugs
 Store Room Arrangement
• After receiving, drugs are either stored in hospital
pharmacy or hospital supply storage facility,
• Advantages of storage in pharmacy is Reduction in
labour and record keeping and responsibility is on
professional (Pharmacist) or authorised person under
his supervision
• Pharmacist is given the freedom for storeroom
arrangement.
• For arrangement, He keeps in mind inventory control,
adjustment of inventory based upon prescribing trends
and easy and safe access to drugs.
• No definite rule of arrangement of storeroom
• Depends upon local and personnel comfort
• May be stocked in alphabetical order, code number
sequence, separating the dosage forms.
• Each shelf, drawer or bin is numbered or
identified. This helps in identification, safe
dispensing and reduces medication error.
• Identification by shelf stripping
• Identification by floor marking
•
 Stock Control

• Adequate stock control is required where ever

drugs are stored like main pharmacy, satellite
pharmacies, nursing units, OTs, PCAs, ERs etc.
• Expiration dates must be monitored periodically.
• For Those products agreed to be held in stocks all
the times, out of stock situations must be
prevented.
• Method should be adopted to dispose off
outdated, deteriorated, recalled, or obsolete drugs.
• Record keeping procedure must be strictly
followed.
31
 Inventory Control

Inventory is a list of goods and materials available in

stock by an organization for some future use

" Inventory control is the process of managing

inventory in order to meet customer demand at
the lowest possible cost and with a minimum
of investment ".
• If Inventory level is High
– Blocking the finance
– Large Storage space
– Large handling and Administration Charges
– Obsolescence (no longer wanted but in working condition)
– Spoilage
• If inventory Level is Low
– Frequent Stock outs
– High Shortage Costs
• So Balance should be there Which can be achieved by
inventory control
• Management consultants all agree that money invested in
drug inventories should have a turn over of 4-5 times a year.
• The turnover less than four indicates overstocking and a
turn over of more than five may indicate under stocking
• Inventory Turnover: Number of times inventory is sold or used
 Objective of the inventory control
• Maintain availability of material whenever and
whatever required in optimal quantity
• Minimize ineffective stocks
• Optimize the various costs associated with
inventory
While keeping in mind factors of
1. Seasonal variation
2. Monitoring for pilferage
3. Changing patterns in usage/prescribing.
 Disadvantages
of not fulfilling the objectives of inventory
control
• Pharmacy may lose business.
For example, in a retail pharmacy, if a customer is
unable to obtain their medication, they may go
somewhere else and the pharmacy may lose future
purchases.
• In a hospital pharmacy, in case of run out of item:
2 possible outcomes
1. Result in lost of life
2. you might be required to obtain it by a more
expensive method (over-night delivery, etc.).
 Contradictory demands of inventory control

•Keeping a wide variety of stock while also

maintaining a large supply that moves quickly
•Increasing inventory turnover without affecting
service
•Maintaining minimal stock without affecting
service
 Methods / tools for inventory management
• ABC Concept (Always Better Control)
– Depends upon annual consumption and not upon unit price
• VED Concept (Vital, Essential and Desirable)
– Based on importance, criticality and shortage cost of items
in terms of availability, function, specification and storage
• HML Concept (High, Medium Low)
– Based on unit price. Doesn't depend on consumption
• SDE Concept (Scarce(insufficient for demand), Difficult, easy
to obtain)
– Based on purchasing terms with respect to availability
• GOLF (Governmental Ordinary, local and foreign)
– Based on source of supply
• SOS (Seasonal, off Seasonal)
– Based on seasonal requirements
 INVENTORY MANAGEMENT COMPUTER SYSTEMS

1. Perpetual inventory systems

• method of recording the quantity of medication
continuously as prescriptions are filled. After each
prescription is filled and dispensed to the patient, the
amount of medication used for the prescription is
removed from the inventory to ensure the quantity on
hand in the computer is always current. Deliveries and
returns are also recorded, often automatically, as they
occur. Modern inventory control systems often rely
upon barcodes and radio-frequency
identification(RFID) tags to provide automatic
identification of inventory objects..
• In a perpetual inventory system, many
pharmacies use reorder points, or periodic
automatic replacement (PAR) levels, to
automatically order more medication when
levels are low. These points can be set in the
computer system for each medication, which
allows the user to set a maximum amount of
medication that the pharmacy would like to
have at any point in time and a minimum level
that should be maintained at all times.
2.Periodic Review: This process involves
regular review of usage and reorder to a
carrying point.
3.Visual review
 Role of Purchasing Agent
• Depends upon hospital size
• In small hospital an administrator, his assistant or a store
keeper may function as purchasing agent
• In large hospital where a lot of purchasing is carried out, a full
time purchasing agent/s is required.
• In relation to the drugs, purchasing agent duties may be
– Issues purchase order
– Maintain purchase record
– Follow ups on delay order
– Initiates competitive bidding procedures
– Obtain quotation from specific source
– May have the power of selecting the brand and vendor

41
 Discount in Purchasing

• Three ways in which items can be purchased at a discount or savings

• Volume Contract:
– Institute estimates its annual consumption of the particular products and
sign an agreement with the company to purchase this amount on a
contracted price which is usually less than the price for normal
purchase
• Bonus Deals:
– Special discount on a product
– Specific Quantity of items free of cost after purchasing certain limit
• Discount:
– Special discount is given to an institution on prompt paying.

A hospital Pharmacist should investigate the discount policy of the

firm with which he deals

42
Bulk and Sterile Manufacturing
• Bulk Compounding
– Mainly those drugs which are not commercially
available and modified formulations intended for
clinical/ investigational use
• Sterile preparation
– Sterile topical solutions, Small volume injectable,
I/V admixtures, TPN and special parenterals for
clinical/ investigational use
 Benefits
• Development of a close relationship between
physicians and pharmacists
• Promote economy for hospital
• Operation of formulary system
• Making drugs available that are not commercially
available
• Opportunity to develop new pharmaceutical
formulation
• Enhancing the prestige of pharmacist
 Control Systems
Decision of bulk and sterile preparation in
hospital depends upon certain control systems.
– Manufacturing Process Control

– Quality Control

– Budgetary Control
 Manufacturing Process Control
• Responsibility of pharmacist to make a product
that meet the high pharmaceutical standards.
• Good manufacturing practice should be
followed
• Identity, strength, purity and quality control
• Sufficient packaging and labelling control.
• Palatability and stability should be considered
 Quality Control
• Validation
• Quality Control of Raw material
• Quality control of Instruments used
• Quality Control of Area to ensure specified
pharmaceutical environment
• Quality Control of Finished Product (including
label)
 Budgetary Control
• Also called economic consideration
• Regulate economic aspects of manufacturing program
• Feasibility of manufacturing depends upon budget.
Includes
– Manufacturing requirements
– Material requirements
– Manufacturing capacity
– Manufacturing staff
– Operating costs
• Manufacturing Requirement
– Includes quantitative estimation of manufacturing
frequency and the number of particular drugs to be
manufactured per annum
– Can be estimated in terms of rate or production
volume, batch quantity or manufacturing frequency.
– Depends on consumption rate
• Material requirement
– The estimated manufacturing requirements provides a
basis for the prediction of material requirements
– Includes raw material, containers, labels, ancillary
materials, boxes.
• Manufacturing capacity
– Availability of particular equipment and
manufacturing capacity of each equipment must be
considered
– Most of the times selection of equipment is based
upon economy and its multiple function performed
by single instrument.
– Selection of such equipment which is capable of
multifunction also prevent space allocation
problem
• Manufacturing Staff
– It is an important consideration in bulk and sterile
manufacturing.
– Pharmacist as supervisor and supportive personnel
– Number of personnel should be optimum
– Too many personnel will increase the cost of manufacturing
– Too less personnel-------------
• Operating Cost
It includes
– Direct cost
• Cost being spent on purchase of materials
• Labour cost
– Indirect cost
• Maintenance of machinery
• Maintenance of building
• housekeeping
 Sterile Preparations
• It requires the same controlled environment as
that of bulk Manufacturing except additional
stringent environmental control is needed.
• Besides various control discussed
environmental control is also needed.
 Intravenous Additive Program
• Pharmacist is responsible for
– Preparation of final product under aseptic
condition
– Judicious choice of additive and mixing techniques
to avoid interaction
– Appropriate labelling
• Such products are prepared in aseptic
environment using laminar flow hood
Laminar Flow Hood
 Preparation of I/V additive solution
• Physician prescription order
• Label preparation (information on labels)
• Affixed upside down to the container----Why?
• Preparation is carried in laminer flow hood
• Final inspection before handing over
 TPN and Cytotoxic Drugs
• Preparation of TPN is the integral part of sterile
preparation
• Stability and compatibility
• Facility and environment
• Personnel and training
• Documentation
• Manufacturing procedures
• Collection of materials and preparation
• Formulation
• Inspection
• Labelling and packaging
• Storage
 Sterile supply room
Central sterile supply room
Central sterile supply Department
 Definition
“as that service, with in the hospital, catering or
the sterile supplies to all departments, both to
specialized units as well as general wards and
OPDs.”

Professional supplies : tubings, urine collection sets, IV

admixture sets, needles , blood begs, Diagnostic sets like L.P
set (lumbar puncture), Sternal Puncture set etc -Treatment sets
like Cut down sets, aspiration set etc. -Dressing materials -OT
linen & instruments -Rubber Gloves, Catheters, -

Special departments: clinics, special labs, operating

room, burn rooms,
 AIM
• Centralizing the activities of receipt, cleaning, assembly, sterilization,
storage and distribution of sterilized materials from a central department
where safe sterilization is done under controlled conditions with adequate
managerial and technical supervision at an optimum cost.

• To provide an efficient, economic, continuous and quality supply of

sterilized material to various areas of the hospital to deliver quality and
infection free patient care.

• Contributes to reduction in hospital infection rate

• To reduce the burden of work of the nursing personnel, there by enabling

them to devote more of their time to patient care .
• To provide sterilized material.

• Contributing to a reduction in the incidence of

hospital infection.

• To avoid duplication of costly equipment.

• To maintain record of effectiveness of cleaning,

disinfection and sterilization process.
Functions and Activities
 Rinsing
 Cleaning
 Drying
 Checking
 Sterilization
 Labelling
 Storage
 Issue and Distribution
 Receipt
Advantages
 Processing issue and control
 Infection free atmosphere
 Economic, efficient and uniform source
 Maintains standard
 Reduces burden on nursing staff
 Prevents cross infection
 Shortens Patient’s stay
 Ensures safe environment
 Inventory Maintenance
 Quality Care
The CSSD can broadly be classified into two parts
CSSD
1) Central UniT
• Responsible for receiving dirty utilities cleaning, processing, sterilization
storage and supply
2) Peripheral Unit
• Mainly responsible for distribution to various areas of hospital
• TSSU (theater Sterile Supply unit)
Requirements

Requirement
Central unit
• Location
• Size
• Physical facility
• Staffing
• equipment
• Water and steam supply
LAYOUT DESIGNING PRINCIPAL
• There no back tracking of sterile goods
• One way movement from receiving counter to issue counter
• Sterile area should be prior to sterile storage and issue
• The receiving counter must be away from the issue counter
• Separate receiving and issuing counter
There should be six basic division in CSSD
• Cleaning area
• drying area
• Packaging area
• Sterilization area
• Storage
• Issue counter
STRUCTURAL DSIGNING
 EQUIPMENT
CLEANING AREA
 High capacity pass through washer disinfector at 80°C to 90° C having various
shapes and sizes.
 Cold and hot water streams.
 Detergent Solution.
 Steam when available.
 Hot air ovens for drying instruments.
 Wall fixtures for drying.

STEIREATATION AREA
 Autoclaves using dry heat, moist heat.
 Ethylene oxide sterilizers.
 Testing material to check effectiveness of sterilization.

STORAGE AND DISTRIBUTION

 Cup boards, selves, tables, chairs, racks.
 Trolleys, instrument trays, wire baskets and containers.
 OTHER EQUIPMENT
 Cleaning and decontamination devices
 Hot air Oven for drying & heat sterilization
 Glove processing unit for surgical gloves
 Instrument sharper e.g.. Needle sharper
 Testing apparatus for emergency sterilization
 Others :- trolleys, work surface, telephones
 Maintenance and repair of equipments
 Material : chemicals for washing and cleaning
 Steam Boiler
Organization and Management
Administration
 It is a one of the specialized sections of hospital and
may or may not function under pharmacy.
 So administration varies from hospital to hospital
 When it is not a major department and comes under
another department then its manager report to the head
of that department and not to the administrator of
hospital like manager of Pharmacy, OT supervisor, head
of surgical department or nursing services administrator
Management control of supply room
 It may function under
 Pharmacist control: procurement, storage, distribution preparation
of sterile solutions should be done by pharmacist so in some hospitals
pharmacist is the incharge.
 Nurse control: Nurse use majority of the sterilized items dispensed.
Furthermore nurse has full understanding of the intended use so can
logically be responsible for CSSR
 Pharmacist, Nurse Dual Control: some consider functions of CSSR
of dual nature
 Nurse: Cleaning, packaging, and distribution of medical
equipment
 Pharmacist: manufacture, sterilization of sterile fluids
 OT supervisor: in some hospital CSSR is not accorded a full
department but is under OT supervisor. In this case no preparation of
sterile fluids can be carried out.
Staffing
 Personnel must be skillful and trained in the principles
of sterilization, use of autoclave, identification of
surgical instruments, disassembly, cleaning and
assembling equipment, decontamination.

 Pharmacist incharge can arrange training sessions

Pharmacist as manager of sterile
room
 Pharmacist has a diversity of knowledge that enables
him to perform various jobs.

 Purchasing of supplies

 Receiving and storing of supplies

 Dispensing and distribution

 Charging, inventory and accountability

 Manufacturing sterile fluids

CSSD
• Transport to OT
• Used material
• Transport
• Cleaning
• Disinfection
• Inspection
• Tray assembly
• Packaging
• Sterilization
• Sterile storage
TPN
 IV Admixture:

• The preparation of parenteral admixture

usually involves the addition of one or
more drugs to large volume solutions such
as intravenous and nutrients fluids.
 Introduction:

• Components of an IV program
• Preparation area
• Policies and procedures
• Personnel
• Storage space
• Admixture systems
 Cont’:
Components of an IV program
Preparation area
• Ideally in separate room in the pharmacy
“clean room”
• Size vary
 Cont”:
Components of an IV program
Polices and procedures
• Guidelines for preparing parenteral products should
be outlined in the pharmacy’s policy and procedure
manual.
• Detailed information regarding preparation,
labeling, storage and expiration dating of parenteral
products should be readily available in the pharmacy
• These policy help to provide quality control for the
parenteral products
 Cont”:
Components of an IV program
Polices and procedures
• Stability
• stability is affected by place, environmental
condition, diluent used to administer the
product, other drugs that may be mixed with
• Stability and sterility! Gives the expiration
date
 Cont”:
Components of an IV program
Polices and procedures
 incompatibility
Physical: visible change e.g. precipitation
Chemical: may or not visible change, deterioration
or inactivation of an active ingredient.
Therapeutic: drug-drug or drug-disease interaction
that lead to potentiating of drug effect, drug
toxicity, deterioration.
 Cont”:
Components of an IV program
Polices and procedures
• Aseptic Technique
Method of handling sterile products, a sterile
parenteral dosage form is free from living
microorganisms, particulate matter, and
pyrogens.
 Cont”:
Components of an IV program
Polices and procedures
• Labeling and check systems
Reviewed against the patient’s current
medication profile.
 Cont”:
Components of an IV program
Personnel
Carefully trained
Who will prepare? Pharmacist or technician
Proper training in aseptic technique and sterile
product information is necessary.
 Cont”:
Components of an IV program
Storage space
Will depend on the type of system one chooses
to use.
Aseptic Dispensing
 Total Parenteral Nutrition
• A method of feeding patients by infusing a mixture of all necessary
nutrients into the circulatory system thus by passing the GIT
• It is also known as artificial nutrition or parenteral alimentation
• Categories of PN
– If enteral feeding is completely stopped or ineffective then total PN is used
– If the enteral feeding is not enough or sufficient then partial PN is used
• Indications of Parenteral Nutrition
• General: if a well nourished adult is starved for 7-10 days, then partial
PN is accepted, but when starvation exceed 10 days, then TPN is used
• Short Term: Bowel injury, Major trauma, burns, malabsorption,
malnutrition
• Long term: TPN’s indicated for long terms due to crohn’s syndrome,
Bowl resection
• Composition of TPN
– Macro components
• Carbohydrates
• Lipids
• Proteins
– Micro components
• Vitamins
• Electrolytes
• Trace elements
 TPN in Hospital Pharmacy
• TPN is a part of total care of any patient
• Therefore the preparation of TPN must be an
integral part of hospital pharmacy manufacturing
program irrespective of its size
• Its method of preparation are simple so does not
require any extensive budget or equipment
• Prepared in controlled environment like……
• Pharmacist should have knowledge of preparation
method, stability and compatibility, facilities,
equipment and environment required for TPN
preparation
• Stability and Compatibility
• As TPN is a mixture of complex pharmaceutical
systems (specially lipids), there is a chance of
interaction or incompatibilities between the ingredients,
leading to impaired therapeutic value or increase risk
for its toxicity to the patients
• pharmacist must have knowledge about the
incompatibilities between ingredients, so can advise
physicians accordingly, and the available literature must
be consulted prior to the preparation
• Facility and environment
• As with other aseptic processes, environment can effect
the quality of TPN, so the facilities must thus be
designed, cleaned, maintained and monitored to the
highest achievable standards. For this purpose laminar
flow hoods are used.
• Personnel and Training
– Personnel having suitable training should carry out aseptic
preparation of TPN.
– It covers aseptic techniques, and validation, and theoretical
aspects like patient’s requirements and use of products
• Documentation
– Complete documentation of the patient history, labels
details, raw material records, environmental record,
preparation records all according to GMP
• Manufacturing procedures/ guidelines
– Should be prepared by production and QC staff.
– All personnel should adhere to these guidelines.
• Preparation is initiated on receipt of the request for
TPN. After checking the feasibility and stability of the
requested combination, information can be then
transferred to dispensing area
• Formulation and preparation
– Firstly identification and collection of required materials
and then assembling in aseptic condition
– Checked against the request sheet and prepared accordingly
in laminar air flow
– Care should be taken when more than one TPN’s are under
process.
• Inspection
– The nutrition beg should be checked for leaks, splits, and
particulates.
• Labelling
Patient name ward product constituents
Batch (dispensing number) expiry date/time
Storage conditions
• Storage
• Packaging
• Dispensing
• Charging of TPN (according to the cost of
ingredients)
CYTOTOXIC
 Cytotoxic agents
• Substances used in the treatment and control of malignant
and other diseases.
• They are designed to destroy/killing rapidly growing cancer
cells
• Most of the injectable cytotoxic agents are powdered
preparations that needs to be reconstituted before use.
– Chemotherapy: the use of any chemical agent to treat or control
a disease. Most often used to describe treatment of malignant
and other diseases with cytotoxic agents
– Antibiotics: obtained from life (naturally) and used against life
(microorganisms)
– Chemotherapeutics: obtained artificially and used against
microorganism
– Mutagenic: capable of causing damage to genes
– Carcinogenic: Capable of causing cancer
– Teratogenic: Capable of causing foetal damages either
physiological or anatomical
• Symbol of cytotoxic materials
 General considerations
• All medical, nursing and pharmacy personnel must
ensure that they are familiar with the proper guidelines
involved in handling transport, preparation,
administration or disposal of waste of any cytotoxic
agent
• All personnel involved in the handling, transport,
preparation or disposal of cytotoxic agent should have
access to health monitoring staff
• The handling, preparation, storage or disposal of
cytotoxic agents are consistently lined with adverse
health risks and these adverse health risks may be
reduced by implementation of suitable safety
precautions
 Role of Pharmacist
• Pharmacist can provide a cytotoxic
reconstitution service
• Due to his background of pharmacy, he is the
one in handling cytotoxic agents
• Should be well trained in aseptic techniques.
• Provide a safe and efficient service for
dispensing of cytotoxic agents
• Safe handling
• As these agents are non selective generally and
destroy some healthy tissue as well, thus
personnel handling the drugs may be at risk if
sensible precautions are not taken.
• Exposure for short time can cause irritation,
dizziness, nausea and allergic reactions.
• Exposure for prolong period of time may have
risks of malignancies, leukaemia's, teratogenesis,
and infertility.
• Exposure can be minimised by following strict
safety procedures.
• Preparation
• All cytotoxic agents should be prepared by oncology pharmacy
• Use separate laminar flow hood. Avoid horizontal LFH.
• Proper ventilation of the area but windows and doors should be
closed.
• Working surface should be non porous and easily cleanable.
• Equipment and cytotoxic drugs should be properly and separately
stored.
• Neutralizing solutions should also be close to hand.
• Preparation and dispensing must be in accordance with the country
rules and regulations
• Proper dressing should be followed.
• Use of solid non porous surface or use of large tray in laminar flow
hood.
• Preparations will be packaged as required for direct administration
to the patient and shall not be further modified
• All cytotoxic agents should be labelled with cytotoxic symbol
• Packaging
• Packaged in sealed, leak proof containers, with outer
bags, heat sealed where possible. The container should
protect the agent from breakage in transport,
• Transport of cytotoxic agents
• Transported in sealed inflexible containers resistant to
breakage. The containers should be labelled with the
sign and should be returned to pharmacy after use
• Storage
• Clearly marked storage areas must be available for all
cytotoxic agents. Safe storage areas must be designed
to minimize the risk of breakage. Cytotoxic agents must
not be stored in food storage and preparation areas
• Spills and Disposal
• Detailed procedures for coping with spills and
waste disposal must be distributed to all staff
handling cytotoxic agents.
• IV admixture sets, syringes, and other
contaminated materials should be placed in
high risk waste containers and labelled as
hazard.
• Control of Substances Hazardous to Health
(COSHH)
 Spillage
• Chemical spillage is defined as the uncontrolled release of
hazardous chemicals which may be solid, liquid or gas.
• Worksite measure to reduce the potential for spills and plans
for responding to chemical spillage is necessary regardless of
the type or quantity of hazardous chemical. Preparations for
chemical spillage include safety equipment for spills and
emergency procedures.
 Cytotoxic Spill Management Procedure

The following step is recommended for dealing with cytotoxic spill

using a spill kit.
a. Notify surrounding personnel of the spill.
b. Open the spill kit and display the warning signage while
isolating the spill area.
c. Prevent the spill from spreading.
d. Put on the cytotoxic gown, booties, overshoes, gloves and
masks with isolation gown.
e. Obtain set of pre-mix cleaning detergent and start to prepare
5% decon 90 solution by pour all amounts liquid in a bottle A
to the bottle B. shake gently and 5% decon 90 solutions ready
to used.
f. Scoop up any broken glass. Place broken glass and any other
sharp items into the sharp bin.
g. Use gauge to clean up the actual spill using 5% decon 90
solution as necessary. Repeat several times. Dispose of
all waste into first cytotoxic waste bag.
h. Working from the area of least contamination to the
greatest clean with decon 90 solutions to remove all
spillage residues and rinse the area with distilled water
and dry. Repeat at least twice.
i. All contaminated equipment and gauze used in the
cleaning procedure must be discarded into the first
cytotoxic waste bag including unused cleaning solution.
Remove shoes cover and outer layer latex gloves,
isolation gown and discard into the first cytotoxic waste
bag.
j. Seal the bag with the plastic ties.
k. Place the first bag into the second waste bag.
l. Remove the cytotoxic gown, masks and remaining
gloves and discard into the second cytotoxic waste
bag. Seal the second waste bag with the plastic tie.
m. Wash hand thoroughly.
n. Notify supervisor of the spill and complete an incident
report form as soon as possible.
o. Obtain a replacement spill kit immediately from
pharmacy services.
NURSING HOMES
 Kinds of Care
Curative Care:
• Focuses on a cure to an illness and the
prolonging of life.
Palliative Care:
• Focuses on comfort and quality of life that may
be provided with other treatments.
Hospice Care:
• Focuses on comfort and quality of life when a
cure is not possible with specialize care and
services.
When a patient’s disease process is no longer curable or reversible, aggressive curative
treatment begins to be less appropriate and may be considered harmful.
Hospice philosophy emphasizes palliative care, which can be as aggressive as curative care,
with a
focus on comfort, quality of life, and patient-/family-directed care that promotes the patient’s
right to
self-determination and decision-making.
Curative care: Focuses on quantity of life and prolonging of life.
•Curative care can actually cause more suffering when cure is no longer possible and
treatments and procedures needlessly extend the period of suffering.
•Quality of life is often elusive if a patient is subjected to treatments and interventions that
he/she did not choose, such as respirators, intravenous infusion and tube feedings.
•Within the hospice philosophy, patients are encouraged to complete advance directives.
patients’ choices regarding resuscitation measures and curative treatments are respected and
honored by hospice.
Palliative care: Focuses on quality of life and death, and views death as a natural part of life.
•Palliative care is a lessening and relief of physical, psychosocial and spiritual suffering so that
the patient can accomplish his/her goals and life-closure tasks.
•Closure tasks may include saying goodbye, letting go, finding meaning and value in life and
death, and mending relationships.
•Control and management of physical, emotional, psychosocial and spiritual pain and suffering
and other end-of-life issues are paramount.
•Determining specific things that bring quality of life to each patient
Hospice care: The most intensive comfort care available that focuses on quality of life;
generally intended for the final months of life when a patient with a terminal illness decides
to forgo other treatments for that disease.
•Questions?
 Role of Pharmacist in Small Hospitals and
Nursing Homes

• NURSING HOME:
– A residential facility for people with chronic
illness or disability.
– Also known as a convalescent home and long term
care facility
– includes adults who suffer from chronic (long-
lasting) or such illnesses as stroke or Alzheimer’s
disease .
– both medical and residential care is provided.
• Methods of handling drugs in hospitals
without pharmacist:
– Most extended care facilities and small hospitals
do not employ full time pharmacist, many of them
contract for such services.
– Medical staff rely upon community pharmacist to
dispense medication from local pharmacy and
deliver the facility .
– Pharmacy service in small hospital may be
provided by department of pharmacy of a nearby
large hospital
• Extended care facility and pharmacy
department :
– If extended care facility has pharmacy department
a licensed pharmacist is employed to administrate
pharmacy department.
– If no pharmacy depart. Then obtaining required
drugs & biologicals from community pharmacist
• If facility has only drug room where bulk
drugs are stored consultant pharmacist is
responsible for control of bulk drugs
• Consultant pharmacist dispenses drug from
drug room properly labelled and make them
available for nursing personnel.
• Small-large hospital relationship:
– Sharing of departments like
• Pharmacy
• Radiology
• Pathology
– Services are provided by the pharmacist on call in
large hospitals.
• Roles of pharmacist in ECF::
– Drug regimen review :
• encompasses the clinical activities of consultant pharmacist
• Drug regimen must be reviewed at least monthly by
pharmacist
• patients drug regimen should be free from unnecessary drugs.
• Any irregularity found during review must be reported to
physician and director of nursing.
• Examples of irregularities include
• Use of three or more analgesics at a same time
• Use of iron therapy without red blood cells assessment
• Concurrent use of two or more hypnotics
• Pharmacist should check the medication order.
– appropriate medication order includes drug, dose,
route of administration, frequency and reason of use.
• Medication error and ADRs:
– The consultant pharmacist should report and document
any drug irregularities, drug interaction and clinical
recommendations promptly to the attending physician
or nurse-in-charge and the nursing home administrator.
– Drug interactions, including interactions between
prescription drugs and over-the-counter drugs, drugs
and disease, and interactions between drugs and
nutrients.
– Contraindications and precautions.
• Medication pass observation:
– To observe the preparation and administration of
medication
– Compare medication label with medicine
administration sheet
– Ensure drug dose, time
– 5 RIGHTS(resident, drug, dose, time and route)
– Adequate hydration when administering drug
• The consultant pharmacist should ensure the
automatic stop order in case where duration and
number of dose is not specified.
• The consultant pharmacist ensures that all known
allergies are documented in plain view in the
patient's medical record.
• Periodic inspection of nursing station medication
cabinet to ensure external & internal med. Are
separately placed
– No outdated med.
• proper record of narcotics being administered to
the patient .
• Provision of information and training
• Advice to the patient regarding use of OTC
products
• Patient counselling for patient care and
boost/builtup confidence of patients
• HOSPICE CARE
Home Care

120
 What is meant by home Care?
• Home care is a form of health care service

provided where a patient lives.

• Patients can receive home care services whether

they live in their own homes, with or without

family members, or in an assisted living facility.

121
Purpose of Home Care
• To promote, maintain, or restore a patient's health

and reduce the effects of disease or disability.

Definition
• A health service provided in the patient's place of

residence for the purpose of

promoting, maintaining, or restoring health

or minimizing the effects

of illness and disability.

122
 Frequently used terms for Home
Care
• The most frequently used terms for Home Care includes ;

1. Domiciliary care,

2. Social care,

3. In-home care.

123
 Who can provide Home care
service?
• Care may be provided by licensed healthcare professionals
who provide medical treatment needs or by professional
caregivers who provide daily assistance to ensure the activities
of daily living (ADL) are met.

124
 Home Health Care Vs Home Care
in USA
• “Home health care" is used to describe medical services
performed at home by a healthcare professional, whereas
"home care" describes non-medical, private duty care.

125
 Aim of Home Care
• Home care aims to make it possible for people to remain at
home rather than use residential, long-term, or institutional-
based nursing care. Home care providers deliver services in
the client's own home.

126
 Professional home health
services include
• Medical or psychological assessment,

• Wound care,

• Medication teaching,

• Pain management,

• Disease education and management,

• Physical therapy, speech therapy, or occupational therapy.

127
 Home Care Services includes;
• Daily tasks such as meal preparation,

• Medication reminders,

• Laundry,

• Light housekeeping,

• Shopping,

• Transportation and

• Companionship.

128
 When home care is critically
essential?
• Home care is often an integral component of the post-
hospitalization recovery process, especially during the initial
weeks after discharge when the patient still requires some level
of regular physical assistance.

129
 Activities of daily living (ADL)
includes;
• Bathing

• Dressing

• Transferring

• Using Toilet

• Eating

• Walking etc. that reflect the patient capacity of self care.

130
Instrumental activities of daily
living (IADL)
• Includes daily tasks such as light housework,

• preparing meals,

• taking medications,

• shopping for groceries or clothes,

• using the telephone,

• and managing money, that enables the patient to

live independently in the community.
131
 Worldwide Home Care Programs

• Medicaid (USA) 1993 onward

• Medicare (USA) 2000 onward

• India Home Health Care (IHHC) in Chennai, Bangalore,

Hyderabad, Pune & Gujrat in 2009.

132
 Home Care Services in Pakistan
• Mamoo in Pakistan since 2003 in Karachi,
Lahore (Teemar Dar Pharmacy).

133
 Home Care Services in Pakistan
• Jacob Javed Home Based Patient Care
Services in Pakistan since 1997

134
Nuclear Pharmacy

135
• A specialty area is the one that requires a
concentration of knowledge in a once specific
area.
• The development of nuclear pharmacy as a
specialty area followed the development of
nuclear medicine as a recognized specialty by
the American Medical Association in the early
1970's.

136
• Nuclear Medicine
A specialty of medicine and
medical imaging that uses
radiopharmaceuticals in the
diagnosis and treatment of
diseases.

137
• Nuclear Pharmacy
A specialty area of pharmacy dedicated to the receiving,
preparation, quality control, storage, compounding and
dispensing radiopharmaceuticals. Also deals with the disposal
of radioactive wastes and documentation
Nuclear pharmacy is a service to improve and promote health
through safe and effective use of radiopharmaceuticals for
diagnosis, therapy and palliation. Some time it is called radio
pharmacy

138
 What are the applications of
Radiopharmacy?
1. Diagnostic

– The radiopharmaceutical accumulated in an organ of

interest emit gamma radiation which are used for
imaging of the organs with the help of an external
imaging device called gamma camera.

2. Treatment

– They are radiolabeled molecules designed to deliver

therapeutic doses of ionizing radiation to specific
diseased sites.
3. Palliative
4. Research
139
 Operation of a Nuclear Pharmacy

1. Receiving of radioactive materials

2. Preparation of radiopharmaceuticals
3. Quality control tests of radiopharmaceuticals
4. Storage
5. Dispensing
6. Radioactive waste disposal
7. Infectious waste disposal

140
 Receiving radioactive materials
• Delivered directly to nuclear medicine
department or nuclear pharmacy (short half-
lives)
• Packages should be monitored within 3 hr if
delivered during normal hours
• Packages should be monitored within 3 hr from
the beginning of the next working day if
delivered after working hours
 Preparation of radiopharmaceuticals
• Only trained people should be responsible
for and participate in the preparation
• Aseptic technique
• Lead barrier shields (Adequate shielding
must be used to protect laboratory personnel
from ionizing radiation.)
• Syringe shields
• Leaded gloves, aprons, and eye glasses
should be worn
• Quantity
• Radiopharmaceuticals should be identified
with a label containing the information as to
the total activity concentration
 Radiation shielding
• Alpha and beta radiations are readily shielded because of their limited range of penetration.

Radiation Protection
Alpha particles Piece of paper
•Mono-energetic and have a range of a few
centimeters in air
Beta radiation •Aluminum
•Glass
•Transparent plastic materials
Gamma radiation •Lead
•Tungsten
Radiation
Alpha Particles
Piece od paper
Mono-energetic and have a range of a few centimeters in air.
Beta radiation
Aluminum
Glass
Transparent plastic materials
Gamma Radiation
Lead
Tungsten
Quality Control Tests of Radiopharmaceuticals

• Before dispensing for humans

• Colloidal and macro-aggregated preparation
should be checked for particle size.
• Workstations and their environment should
regularly be monitored with respect to aseptic
quality.
Quality control tests of radiopharmaceuticals

• Visual Inspection of Product

- Visual inspection of the compounded radiopharmaceutical shall
be conducted to ensure the absence of foreign matter
- Assessment of Radioactivity
-The amount of radioactivity in each compounded
radiopharmaceutical should be verified and documented prior to
dispensing, using a proper standardized radionuclide (dose)
calibrator.
 Storage
• Should be properly stored to
prevent degradation by light or
temperature
• Must be stored in lead containers
or behind lead shields

146
 Dispensing
• Starts with a prescription
• Prescription should contain
1. Patients name
2. Identification no.
3. Age
4. Date time
5. Physician signature

147
 Radioactive waste disposal
• Syringes, vials containing residual activities,
needles, contaminated papers, liquid waste
• According to guideline
1. Decay in storage
2. Release into a sewerage system
3. Transfer to an authorized recipient (disposable
facility)
4. Others (incineration and atmospheric release of
radioactive gases)

148
 • For soluble radioactive materials in water
• Disposed quantity should not exceed the limits of the maximum permitted
concentrations (MPCs)
• Flow rate of water
• Number of radionuclide

• Radionuclides that have lives less than 120 days usually are disposed of by
this method
• Radio active should be stored separately according the similar half lives

• For long-lived radionuclide

• They bury or incinerate at approved sites and facilities

King Saud University 149

 Infectious waste disposal
• Should be stored in puncture
resistant, leak resistant bags or
containers
• Should be labeled with
international biohazard symbol
• Storage period

150
• Biohazard Sign

Ionizing radiation

Radiation Danger

High Level Source

Non Ionizing radiation

151
 organisation
• Speciality Part of hospital pharmacy
– Performs under the direction of pharmacy director.
• Or
• Section of nuclear medicine department
– function under the head of NMD
– Radio pharmacist will be the incharge of
radiopharmaceuticals

152
RADIO 2
 Discriminatory features of radiopharmaceuticals

Difference from ordinary pharmaceuticals

• Presence of radioactivity
• Scarcity of pharmacologic effect
– Do not produce pharmacologic effect due to very minute
quantity
• Having short half life
– Expiry would be monitored
• Route of administration
• Dose measurement in terms of radioactivity rather than mg or
ml
• Practice regulation
– Practice requires NOC from PAEC
154
• Diagnostic
– Gamma rays
– Gamma energy between 100 KeV and 200 KeV
– Examples technetium-99m, iodine-123, indium-111, thalium-201 and
gallium-67
• Therapeutic
– Beta particles
– Energy 0.5-1.0 MeV.
– Half life is long for several days
– Iodine-131, Phosphorus-32
• Palliative
– Strontium-89 and Phosphorus-32

155
Basic requirements for radio pharmacy

• Licensure
• Radioisotopes can only be used by duly
licensed individuals in premises complying
with the requirements of Atomic energy
regulations
• Medical isotope committee for evaluation of
all proposals for research, diagnostic and
therapeutic uses of isotopes

156
• Facilities
– Space
• Adequate space matching with the scope and services required
• Nuclear pharmacy area shall be separated from the pharmacy and non radioactive
drugs.
• Secure from unauthorised persons
• Radioactive storage, product decay area, compounding and dispensing, QC and
office area
• Floor plans to be approved from PAEC
– Equipment
• Minimum equipment required
– Isolators or LFH
– Fume hood for fume generating radiopharmaceuticals
– Dose calibrator
– Refrigerator (Lead Lined)
– Class A prescription balance
– Single or multiple channels gamma scintillation counter
– Microscope
– Radiochemical hood and filter system 157
• Nuclear Pharmacist
• Not a legal requirement in Pakistan
• Should have knowledge and training in
• Radiopharmacy
– Elementary aspects of structure of matter
– Mode of radioactive decay
– Technology and QC
– Application of radiopharmaceuticals
– Distribution and inventory control
– Research methodology
– Safe handling
– Production
– Formulation and uses
• Instrumentation
– Principle of radiation detection and detector
– Dose calibrator
– Gamma well counter
– Fundamental concepts of mathematics and computer science
– Compartmental analysis and mathematical models of physiological systems 158
 Radioisotope Committee
• Established for supervision and control of hospital isotope program.
– Medical Physicist
– Radiologist
– Haematologist
– Surgeon
– Representative from administration
– Pharmacy
– Nurse
• Responsibilities
• Review and approval of the use of isotopes within the institution
• Prescribe special conditions like training of personnel, designation of limited area
of use, disposal methods
• Receive reports from the radiation protection officer and review records
• Recommend remedial action when an individual fails to observe protection
recommendations, rules and regulations
• Keep record of actions taken in approving the use of isotopes
159
 Role of Pharmacist
• Responsibilities include
• Ordering, receiving and keeping the record of all radioactive
materials and cold kits
• Labelling and dispensing of kits
• Implementation of cGRP.
• Radiation monitoring in the area
• Implementation of radiation protection and safety policy
• Performing all QC tests on RPs
• Support research and participate in research
• Training to the technologists on pharmaceutical aspects of
nuclear medicine, radiation and protection

160
• Refers to location, physical space, temperature and
environmental control, equipment and their space
allocation and furnishing of a particular service
• The plant facilities and equipment in hospital pharmacy
must comply with the rules and regulations of that
country
• Two types of planning is carried out
• Master planning: dictates goals and objectives
• Functional planning: sets forth the operational demands
(architectural design, control environment, plumbing
and finishing) and equipment planning
• Pharmacist can guide architect regarding departmental
objectives, functional and equipment planning, space
needed and other requirements
Location
• Location of hospital pharmacy should be so as it can
conveniently provide services to many departments of
the hospital.
• Should be easily accessible to in and out patients
• Should be located on first floor to provide services to
all departments and nursing stations. May be changed
in case of large hospital or when first floor is not
enough. But basement is not desirable
• Concept of sub-pharmacies
• Satellite pharmacy in case when various clinical
departments are not in close vicinity
• Comes Under main pharmacy and staffed with a
pharmacist.
• Number depends upon diversity of clinical services and
distance from main pharmacy
Floor Space
• Allocation of space depends upon number of beds and
work load.

• Now a days due to varied services depends mainly on

different functions like unit dose dispensing,
compounding bulk and sterile, drug information centre,
clinical pharmacy program

• Space requirements depends upon

– Degree and scope of services

– Type of equipment used
– Expected future expansion
• Separate Floor space is required for the following
areas
• Clean-up area
– Demanded for compounding and manufacturing
– May be shared with pharmacy sterile services
– Desirable features are appropriately located pass
through windows and floor area with floor drain
• Non sterile mixing and filling room
– Mixing and filling of liquids separated from ointments
– Beside mixing and stirring, weighing, measuring,
homogenization, filtration and filling should also be
carried out
• Pre-packaging area
– For oral solid dosage forms
• Injection reconstitution area
– Addition of water for injection for powder injectable.
– Laminar Flow Hoods

• Labelling and inspection room

– Located adjacent to filling areas separated by pass-through
windows (eliminate premature use).
– Sufficient storage space must be available for labels, printing
machines forms etc

• Storage of drugs and Para pharmaceuticals

• Quarantine Storage area

– Where manufactured or filled products are stored until declared
pass by the QC tests
•
Temperature Control and Storage Facilities
• Storage requirements are important for stability of
drugs
• Storage Temperature
• Refrigerator: 2oC- 8oC
• Cold Place: not exceeding 8oC
• Cool Place: 8oC-15oC
• Room Temperature: 15oC-30oC
• Excessive Heat: above 40oC. This temperature is
forbidden for some drugs.
• For large hospitals a large number of refrigerators may
be required.
• An innovative approach is construction of cold room
Environmental Control Facility
• Ventilation

• Air Conditioning of Pharmacy is desirable due

to
– Provides ventilation even when doors and
windows are closed
– Use of autoclave, ovens, and steam jacketed kettles
cause a hot environment
– Maintain the temperature for most of the drugs
Equipment planning
• Equipment planning and purchase is responsibility of
administrator, pharmacist, purchasing agent and architect.
• Depends upon number, varieties and per day duration of
services offered.
• Parameters that dictate the equipment planning
– Services option: in and out patient services, bulk and sterile
preparation, pharmacy education, research program, DIC, PCC,
night time pharmacy services.
– Choices of Internal services: delivering the order, handling I/V
admixtures and controlled drugs, maintain medical profile
– Workload and Work Flow: in the department
– Automation: degree of automation and where it is required
– Work areas: for offices, personnel
– Ways of communication: telephone, faxes, internet
– Environmental control requirements
• Equipment Selection Criteria
• Equipment should be selected on the basis:
– Efficient provision of services
– Affordable operating cost
– Requiring minimal maintenance
– Offering maximum safe performance
• Equipment are categorised in to
• Fixed Equipment
– Requiring installation and attached to the building.
– Cabinets, counters, sinks, elevators
– Special attention should be given to counter tops
• Movable Equipment
– Not intended to be permanently fixed to the building
– Balances, carts, desks, analytical equipment, mixers,
furniture.
 Other utilities
• Electric lighting
• Transport system
• Plumbing
• Floors
• walls