Hospital Functions and Support Functions

Assignment – 1
Pharmacy and Emergency Department
By Prasoon Banerjee (19MBMH17)
Pharmacy Location and layout of hospital pharmacy

What is pharmacy? Location of hospital pharmacy

Pharmacy is the science and technique of • Located in hospital premises so that

preparing, dispensing, and reviewing drugs and patients and staff can easily approach
providing additional clinical services. It is a it.
health profession that links health sciences with • In multi-storied building of a hospital,
pharmaceutical sciences and aims to ensure the the pharmacy should be
safe, effective, and affordable use of drugs. preferably located on ground floor
Pharmacy involves- especially the dispensing unit.

• Interpretation The pharmacy requires a minimum of 250 sq.

• Selection feet for any sized hospital. From that point
• Reviewing of drug utilization onward, basic requirements vary from hospital
• Patient monitoring and to hospital like-
intervention
• 10 square feet per bed in 100
• Cognitive services-
bedded hospital
Compounding, Labeling and
• 6 square feet in 200 bedded hospitals
Dispensing
• An average of at least 5 square feet per
Pharmacists are the persons who advise bed in large hospital.
patients and health care providers on the
Types of pharmacy
selection, dosages, interactions, and side effects
of medications, and act as a learned Pharmacists practice in a variety of areas
intermediary between a prescriber and a including community pharmacies, hospitals,
patient. One of the most important roles that clinics, extended care facilities, psychiatric
pharmacists are currently taking on is one of hospitals, and regulatory agencies. On the basis
pharmaceutical care. Pharmaceutical care of medication and services required we can
involves taking direct responsibility for patients classify the pharmacy as follows-
and their disease states, medications, and
management of each to improve outcomes. 1.) Community pharmacy
Pharmaceutical care has many benefits that Community pharmacies usually consist
may include but are not limited to: of a retail storefront with a dispensary,
where medications are stored and
• Decreased medication errors dispensed. In most countries, the
• Increased patient compliance in dispensary is subject to pharmacy
medication regimen legislation; with requirements for
• Better chronic disease state storage conditions, compulsory texts,
management, including hypertension equipment, etc., specified in legislation.
and other cardiovascular disease risk It was once the case that pharmacists
factors stayed within the dispensary
• Strong pharmacist–patient relationship compounding/dispensing medications,
• Decreased long-term costs of medical but there has been an increasing trend
care. towards the use of trained pharmacy
technicians, with the pharmacist

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 spending more time communicating for patients in all healthcare settings,
with patients. Pharmacy technicians are but the clinical pharmacy movement
now more dependent upon automation initially began inside hospitals and
to assist them in their new role dealing clinics. Clinical pharmacists often
with patients' prescriptions and patient collaborate with physicians and other
safety issues. healthcare professionals to improve
Community pharmacies offer a unique pharmaceutical care. Clinical
added value by building direct pharmacists are now an integral part of
relationships with their customers. the interdisciplinary approach to patient
They are able to provide more care. They often participate in patient
personalized, dedicated care to local care rounds for drug product selection.
members of their community and even The clinical pharmacist's role involves
offer enhanced services such as creating a comprehensive drug therapy
Medication Therapy Management plan for patient-specific problems,
(MTM), Medication Synchronization, identifying goals of therapy, and
and compounding. reviewing all prescribed medications
prior to dispensing and administration
2.) Hospital pharmacy to the patient. The review process often
Pharmacies within hospitals differ involves an evaluation of the
considerably from community appropriateness of drug therapy (e.g.,
pharmacies. Some pharmacists in drug choice, dose, route, frequency, and
hospital pharmacies may have more duration of therapy) and its efficacy.
complex clinical medication
management issues, and pharmacists in 4.) Ambulatory care pharmacy
community pharmacies often have Since the emergence of modern clinical
more complex business and customer pharmacy, ambulatory care pharmacy
relations issues. practice has emerged as a unique
Because of the complexity of pharmacy practice setting. Ambulatory
medications including specific care pharmacy is based primarily on
indications, effectiveness of treatment pharmacotherapy services that a
regimens, safety of medications (i.e., pharmacist provides in a clinic.
drug interactions) and patient Pharmacists in this setting often do not
compliance issues (in the hospital and dispense drugs, but rather see patient’s
at home), many pharmacists practicing in-office visits to manage chronic
in hospitals gain more education and disease states.
training after pharmacy school through
a pharmacy practice residency and 5.) Compounding pharmacy
sometimes followed by another Compounding involves preparing drugs
residency in a specific area. Those in forms that are different from the
pharmacists are often referred to as generic prescription standard. This may
clinical pharmacists and they often include altering the strength,
specialize in various disciplines of ingredients, or dosage form.
pharmacy. Compounding is a way to create custom
drugs for patients who may not be able
3.) Clinical pharmacy to take the medication in its standard
Pharmacists provide direct patient care form, such as due to an allergy or
services that optimize the use of difficulty swallowing. Compounding is
medication and promote health, necessary for these patients to still be
wellness, and disease able to properly get the prescriptions
prevention. Clinical pharmacists care they need. Compounding pharmacies

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 specialize in compounding, although pharmacies) are also recommended to
many also dispense the same non- some patients by their physicians if they
compounded drugs that patients can are home-bound. The filling pharmacy
obtain from community pharmacies. has a corresponding responsibility to
ensure that the prescription is valid.
6.) Consultant pharmacy
Consultant pharmacy practice focuses 8.) Nuclear pharmacy
more on medication regimen review Nuclear pharmacy focuses on preparing
(i.e. "cognitive services") than on actual radioactive materials for diagnostic
dispensing of drugs. Consultant tests and for treating certain diseases.
pharmacists most typically work Nuclear pharmacists undergo additional
in nursing homes, but are increasingly training specific to handling radioactive
branching into other institutions and materials, and unlike in community and
non-institutional hospital pharmacies, nuclear
settings. Traditionally consultant pharmacists typically do not interact
pharmacists were usually independent directly with patients.
business owners, though in the United
States many now work for a large 9.) Veterinary pharmacy
pharmacy management company such Veterinary pharmacies, sometimes
as Omnicare, Kindred called animal pharmacies, may fall in
Healthcare or PharMeric. This trend the category of hospital pharmacy,
may be gradually reversing as retail pharmacy or mail-order
consultant pharmacists begin to work pharmacy. Veterinary pharmacies stock
directly with patients, primarily because different varieties and different
many elderly people are now taking strengths of medications to fulfill the
numerous medications but continue to pharmaceutical needs of animals.
live outside of institutional settings. Because the needs of animals, as well as
Some community pharmacies employ the regulations on veterinary medicine,
consultant pharmacists and/or provide are often very different from those
consulting services. related to people, in some jurisdictions
veterinary pharmacy may be kept
7.) Internet pharmacy separate from regular pharmacies.
Since about the year 2000, a growing
number of Internet pharmacies have 10.) Military pharmacy
been established worldwide. Many of Military pharmacy is a different
these pharmacies are similar to working environment to civilian
community pharmacies, and in fact, practice due to the fact that military
many of them are actually operated pharmacy technicians perform duties
by brick-and-mortar community such as evaluating medication orders,
pharmacies that serve consumers online preparing medication orders, and
and those that walk in their door. dispensing medications. This would be
The primary difference is the method illegal in civilian pharmacies because
by which the medications are requested these duties are required to be
and received. Some customers consider performed by a licensed registered
this to be more convenient and private pharmacist. In the US military, state
method rather than traveling to a laws that prevent technicians from
community drugstore where another counseling patients or doing the final
customer might overhear about the medication check prior to dispensing to
drugs that they take. Internet patients (rather than a pharmacist solely
pharmacies (also known as online

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 responsible for these duties) do not
apply.
Military pharmacy is a different
working environment to civilian
practice due to the fact that military
pharmacy technicians perform duties
such as evaluating medication orders,
preparing medication orders, and
dispensing medications. This would be
illegal in civilian pharmacies because
these duties are required to be
performed by a licensed registered
pharmacist. In the US military, state
laws that prevent technicians from
counseling patients or doing the final
medication check prior to dispensing to
patients (rather than a pharmacist solely
responsible for these duties) do not
apply.

The scope of pharmacy practice includes more

traditional roles such as compounding and
dispensing of medications, and it also includes
more modern services related to health care,
including clinical services, reviewing
medications for safety and efficacy, and
providing drug information.
Pharmacists empower patients by helping them
tackle illness and boosting their confidence.
They impart knowledge, they motivate, they
help patients to help
themselves. Pharmacists are the first port of
call in a health crisis, and sometimes even save
lives! Care beyond prescriptions and medicine.

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 EMERGENCY Due to the unplanned nature of patient
attendance, the department must provide initial
An emergency department (ED), also known as treatment for a broad spectrum of illnesses and
an accident & emergency injuries, some of which may be life-
department (A&E), emergency threatening and require immediate attention. In
room (ER), emergency ward (EW) or casualty some countries, emergency departments have
department, is a medical treatment facility become important entry points for those
specializing in emergency medicine, without other means of access to medical care.
the acute care of patients who present without The emergency departments of most hospitals
prior appointment; either by their own means or operate 24 hours a day, although staffing levels
by that of an ambulance. The emergency may be varied in an attempt to reflect patient
department is usually found in a hospital or volume.
other primary care center.
Regardless of naming convention, there is a
A condition determined clinically, a threat to widespread usage of directional signage in
life or limb or considered by the patient or his white text on a red background across the
relatives as requiring urgent management by world, which indicates the location of the
medical, dental, or allied services, a condition, emergency department, or a hospital with such
which they perceive as requiring immediate facilities.
attention by doctor. Signs on emergency departments may contain
additional information. In some American
Accident and emergency department is very
states there is close regulation of the design and
important in a hospital because-
content of such signs. For example, California
 It deals with patients during the most requires wording such as "Comprehensive
crucial phase after disease or injury. Emergency Medical Service" and "Physician
on Duty", to prevent persons in need of critical
 One place in the community where care from presenting to facilities that are not
attention to the patient needs is fully equipped and staffed.
available round the clock, every day of
the year.
 Also provides services as in the regular
outpatient department outside the Triage
regular working hours. A typical hospital has its emergency
department in its own section of the ground
 Many of the patients require emergency floor of the grounds, with its own dedicated
admission to the hospital. entrance. As patients can present at any time
 A&E department responsible for 16- and with any complaint, a key part of the
30% of hospital admissions. operation of an emergency department is the
prioritization of cases based on clinical need.
An emergency department can make or break This process is called triage.
the image of the hospital in various ways and Triage is normally the first stage the patient
some of them are as following- passes through, and consists of a brief
• Life or limb of patient assessment, including a set of vital signs, and
the assignment of a "chief complaint" (e.g.
• Reputation and image of hospital and
chest pain, abdominal pain, difficulty
treating physician
breathing, etc.). Most emergency departments
• Legal proceeding of negligence
have a dedicated area for this process to take
• Wrath of relatives and friends of patient place, and may have staff dedicated to
performing nothing but a triage role. In most

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departments, this role is fulfilled by a lab technicians, and medical administrative
triage nurse, although dependent on training assistants. They are most likely to be treated by
levels in the country and area, other health care an emergency room nurse.
professionals may perform the triage sorting,
including paramedics and physicians. Triage is Location
typically conducted face-to-face when the
patient presents, or a form of triage may be  Ground floor
conducted via radio with an ambulance crew; in  Direct access from main road
this method, the paramedics will call the  Separate approach, other than the OPD
hospital's triage center with a short update with a spacious parking area for cars
about an incoming patient, who will then be and two wheelers
triaged to the appropriate level of care.  Location should meet functional
Most patients will be initially assessed at triage relationship
and then passed to another area of the  Location should be clearly identified
department, or another area of the hospital, with from all approaches and use of
their waiting time determined by their clinical illuminated signage.
need. However, some patients may complete
their treatment at the triage stage, for instance Types of emergency department
if the condition is very minor and can be treated
quickly, if only advice is required, or if the Emergency department can be divided on the
emergency department is not a suitable point of basis of the availability of the doctors and other
care for the patient. Conversely, patients with paramedic staff. On the basis of availability
evidently serious conditions, such as cardiac there are four types of emergency departments
arrest, will bypass triage altogether and move are present and they are as follows-
straight to the appropriate part of the
department. • Type I: Large hospitals with all
specialists available round the clock.
Functions of the department • Type II: Emergency room physician
The emergency department of a hospital available round the clock and specialists
responsible for the provision of medical and on call.
surgical care to patients arriving at the hospital • Type III: Standby emergency facilities
in need of immediate care. Emergency with physicians & nurses on call.
department personnel may also respond to • Type IV: Referral emergency service
certain situations within the hospital such where only nurse available - first aid &
cardiac arrests. The emergency department refer.
performs many functions in a hospital and some
of them are as follows- Space requirements

• Collection of casualties • Total internal area (excluding

• Rapid institution of BLS at site, en – observation ward and internal imaging
route & in hospital area)
• Initial diagnosis & speedy assessment • 50 sq m/1000 annual attendance
• OPD for minor ailments • 145 sq m/1000 annual
• Information centre during disaster admission (Whichever is
• Training & research higher)
• Minimum size to incorporate all major
Once admitted into the ER, a patient will see areas – 700 sq m
and interact with any number of medical • Allowance for future expansion
professionals, including emergency
room technicians, doctors, physician assistants,

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 • Size also influenced by – patient oxygen and oxygen masks, cervical (neck)
numbers, case mix, in-patient bed collars, splints, bandages and a range of drugs
accessibility, level of emergency and intravenous fluids.

Different areas within emergency • A vehicle for emergency care, not a

department patient carrying vehicle.
• Which can accommodate two
• General area emergency medical technicians and two
• Reception, registration and lying patients so positioned that at least
general waiting one patient can be given intensive life
• Medico-legal desk, patient support during transit.
support desk • A two-way radio communication for
• Treatment areas safeguarding personnel and patient's
• Resuscitation room – 35 sq.m. under hazardous condition and light
per room or 25 sq.m. per bed rescue procedures.
• Acute treatment area • Which is designed and constructed to
• Isolation room afford maximum safety and comfort.
• Decontamination room • To avoid aggravation of the patient's
• Acute mental health area condition, exposure to complication
• Consultation area and threat to survival.
• Plaster room
• Procedure room
• Support areas
• Staff station
• Short stay unit (emergency
observation ward)
• Waiting rooms
• Security room
• Clean utility and dirty utility
• Equipment store room
• Pharmacy / medication room
• Trolley/wheelchair bays /
alcoves
• Disaster store room
• Janitor’s closet
• Distressed relative’s room
• Washrooms and toilets

Ambulance services

Ambulances are used to respond to medical

emergencies by emergency medical services.
They can rapidly transport paramedics and
other first responders to the scene, carry
equipment for administering emergency care
and transport patients to hospital or other
definitive care. It contains the equipment
needed to stabilize someone who is ill or
injured and to get them to hospital. That
includes stretchers, defibrillators, spine boards,