Drug provision for inpatients. Main tasks and functions of hospital pharmacies. Tasks and functions of a hospital pharmacy. Its features

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Drug provision for inpatients.

Completed by: 5th year student

14th group Petrov V.V.

Scientific adviser:

Tyumen 2017

List of abbreviations

Introduction

Chapter 1. Literature Review

1.1 Medicine provision for inpatients

1.2 Dispensing of drugs according to the requirements of health care facilities. Accounting for stationary recipes

Chapter 2. Main tasks and functions of hospital pharmacies

Conclusion

Bibliography

List of abbreviations

LPU - medical and preventive institution;

medicinal products - medicines;

PKU - subject-quantitative accounting;

FPP - finished medicinal products;

Medical devices - medical products;

IBA - interhospital pharmacy;

BA - hospital pharmacy.

INN is an international nonproprietary name.

Introduction

providing the patient with medicine

The current trend in European and Russian healthcare is to strengthen the mechanisms for regulation and rational use of medicines, and, accordingly, contain the costs of their consumption during treatment in hospital conditions.

The relevance of the problem is due to the dominant share of drug therapy (95%) in the structure of treatment, which explains its large share in the insignificant budget funds for the maintenance of inpatient medical institutions. In this regard, the economic service of health care institutions is faced with the task of optimally spending funds allocated by the state, since currently neither the federal nor territorial health care budgets, nor compulsory medical insurance funds can fully satisfy the needs of hospitals in financing their costs in full.

The above explains the choice of the topic of the course work, the purpose of which is to analyze methods of providing medications to patients in a hospital. To achieve this goal, the following tasks were solved:

1. The features of drug provision for inpatients are revealed;

2. The main tasks and functions of hospital pharmacies are analyzed.

Chapter 1.Literature review

1.1 Medicine provision for inpatients

Organizing an effective supply of medicines and medical products to medical institutions makes it possible to ensure high quality of medicinal care for inpatients (i.e., patients undergoing inpatient treatment in medical institutions). Medicines for inpatients can be provided through pharmacies serving the population, and through pharmacies of treatment and preventive institutions, incl. sick leave and inter-hospital leave.

In the medical care system, an important role is played by the supply of medicines to health care institutions intended to provide medical care to inpatients. According to the current procedure, the provision of medicinal care to inpatients is paid for from budgets of all levels and compulsory health insurance funds.

Medicines are provided to inpatients by:

Urban, rural pharmacy (any pharmacy serving the population, if it has a license and an agreement with a medical institution, can supply this institution with medicines).

Interhospital pharmacy - IBA (provides medicines and medical products to several treatment and preventive institutions with a total number of beds of at least 500, and in small settlements with a total number of beds in all health care facilities of at least 100; also educational institutions, social security, etc. ).

Hospital pharmacy - BA (independent - provides medicines and medical products to one medical institution with a number of hospital beds of 500 or more, as well as in small settlements if the medical institution has at least 100 beds).

Hospital pharmacy - department of health care facility (organized at a medical institution with a number of beds of 100 or more and is one

from its branches).

The purpose of pharmacies serving inpatients is to provide healthcare institutions with medicines and medical products.

Operating conditions:

1. State registration (charter, constituent agreement).

2. License for activities

Based on the main task, hospital and interhospital pharmacies perform the following functions.

Functions characteristic of a pharmacy as a retail link in the system of promoting pharmaceutical products: reception, storage, sale of goods, marketing, information; production (pharmaceutical) (preparation according to the requirements of medical institutions and quality control of prepared drugs).

Monitoring the correct storage and use of medications in medical institutions.

To perform its assigned functions, the pharmacy has the right:

*request information from health care facilities about the volume of allocations allocated for the purchase of medicines, dressings, and patient care items;

*request data on the effectiveness of new drugs transferred for introduction to health care facilities;

*make proposals to improve the distribution, storage, and accounting of medications in hospital departments.

Depending on the profile of the health care facilities served, pharmacies can be classified:

1. By type:

1.1. Hospital pharmacies of general hospitals, specialized hospitals (including neuropsychiatric, tuberculosis, etc.), clinics of medical institutes, sanatoriums.

1.2. Interhospital pharmacies of a mixed type (serving hospitals and other institutions), intersanatorium, small wholesale (serving educational and social security institutions).

2. By groups depending on the amount of work:

1.1. The volume of work for hospital pharmacies is determined by the number of beds, taking into account their profile (general type or neuropsychiatric) and turnover.

1.2. The volume of work for interhospital pharmacies is determined by the amount of turnover or the amount of turnover and the number of beds served.

Depending on the volume of work performed, the staffing of hospital and interhospital pharmacies is calculated.

The supply of hospital and interhospital pharmacies is carried out by the pharmacy warehouse based on the requirements of the pharmacies. The procedure for drawing up requirements for a warehouse, organizing the reception and storage of goods in a pharmacy is carried out as for pharmacies serving the population in accordance with regulatory documents.

Storage of inventory items in pharmacies of medical institutions and medical hospitals is carried out with the same approved regulations as for pharmacies serving the population. The stock of medicines in pharmacies is established for the purpose of uninterrupted supply of health care facilities and other institutions. The size of the stock of medicines is limited in order to avoid overstocking of pharmacies and control their correct use.

In hospital pharmacies, the stock of medicines is established:

* for poisonous and narcotic drugs -1 month;

* for other medicines - no more than 2 months.

In interhospital pharmacies, the stock of medicines is established:

For poisonous and narcotic medicines - 1 month, for remote pharmacies - no more than the standard inventory in days;

For other medicines - no more than the standard inventory in days.

Accounting for inventory in pharmacies of health care institutions and medical hospitals is carried out, as in pharmacies serving the population:

1. In total (monetary) terms, all inventory items are taken into account.

2. In physical terms (subject-quantitative accounting) for specific groups of medicines.

The release of inventory items from pharmacies to health care facilities is carried out on the basis of invoice requirements.

The requirement to receive medicines from pharmaceutical institutions (organizations) must have a stamp, a round seal of the medical institution, and the signature of its head or his deputy for the medical department.

The requirement specifies the name of the drug, dosage and form of manufacture (tablets, ampoules, ointments, suppositories, etc.) and the total quantity and type of packaging (boxes, bottles, tubes, etc.).

The names of medicines are written in Latin. The requirement specifies the method of use of the drug: for injection, for external use, oral administration, eye drops, etc.

Requirements for narcotic drugs, psychotropic, potent and toxic substances and other drugs containing these groups of drugs, as well as apomorphine hydrochloride, atropine sulfate, homatropine hydrobromide, dicaine, silver nitrate, pachycarpine hydroiodide, ethyl alcohol, indicating the concentration, are written out on separate demand forms for each group of drugs with a stamp, a round seal of the medical institution, and the signature of the head of the institution or his deputy for the medical department.

When drawing up requests for narcotic drugs, treatment and prevention institutions must be guided by the calculation standards approved by the PCPN.

If the demand invoice does not contain complete data on the prescribed medications, then the pharmacy manager is obliged to make appropriate corrections. It is strictly forbidden to make corrections in the direction of increasing the number of medicines. All invoices received by the pharmacy are checked and taxed by the pharmacy manager or his deputy.

Request invoices, according to which goods were released, are registered in the pharmacy in the “Book of Taxed Invoices”. At the end of the month, the “Book” calculates the total amount for each group of released inventory items: medicines, dressings, containers, auxiliary materials. The numbers of invoices with medicines subject to subject-quantitative accounting are underlined.

Pharmacies dispense medications to departments (offices) in the amount of current needs:

* narcotic drugs - 3 days (in the emergency department - 5 days);

* poisonous drugs - 5 days;

* all others - 10-day needs for them.

Medicines are dispensed from pharmacies to financially responsible persons of the departments (by order of the chief physician, a responsible person is appointed).

When dispensing medications from a hospital pharmacy, a power of attorney is not required.

Medicines from MBA are dispensed to senior medical officers. nurses of departments or outpatient clinics by proxy. The validity period of the power of attorney is set for no more than the current quarter for general list medicines and medical names (permanent). To receive poisonous medicines, as well as ethyl alcohol, separate powers of attorney are issued, valid for a month. To receive narcotic and psychotropic drugs, the power of attorney is valid for 15 days. If necessary, the LPU can issue a one-time power of attorney, which is valid for 15 days.

Financially responsible persons of departments (offices) sign on the delivery note for receiving medications from the pharmacy, and the head of the pharmacy signs for their issuance.

The first copies of demand invoices executed by the pharmacy are stored in the pharmacy for one year (calendar), not counting the current one. Invoices for the dispensing of medicinal products subject to subject-quantitative accounting are stored for three years.

According to Federal Law No. 44 of 04/05/2013. (as amended on July 29, 2017) “On the contract system in the field of procurement of goods, works, and services to meet state and municipal needs,” health care facilities and pharmacies themselves do not enter into agreements between suppliers. Part 2 of Art. 59 Federal Law No. 44 requires customers to conduct purchases in the form of an electronic auction. When describing the procurement object, one should take into account the features provided for in clause 6, part 1, art. 33 Federal Law No. 44. In the description:

It is not the name of a specific drug that is indicated, but its INN;

In the absence of such a name, the chemical or group names of the drug must be indicated.

1.1 Dispensing of drugs according to the requirements of health care facilities. Accounting for stationary recipes

Servicing of wholesale customers is carried out on the basis of agreements concluded between them and the pharmacy. If there are structural divisions in the pharmacy, this is handled by the inventory department.

Goods to health care facilities and other institutions are sold at retail prices for non-cash payments based on the requirement of the invoice (A-2.20).

Requirements are written out in 3 copies, and for medicinal products subject to PCU, in 4 copies. The procedure for issuing requirements is regulated by Order of the Ministry of Health of the Russian Federation No. 110 dated February 12, 2007 (as amended on February 26, 2013) “On the procedure for prescribing medicines, medical devices and specialized food products”

The names of medicines are written in Latin. The dosage, dosage form, packaging, type of packaging, quantity and method of administration must be indicated. When prescribing a medicine for an individual patient, his last name, initials and medical history number are additionally indicated. Requirements for narcotic drugs, psychotropic, poisonous, potent substances and other drugs containing these groups of drugs, as well as apomorphine hydrochloride, atropine sulfate, homotropine hydrobromide, dicaine, silver nitrate, pachycarpine hydrochloride, ethyl alcohol indicating the concentration, are written out on tear-off notes forms for each group of drugs. Separate requirements for newborns are also written out. Invoice requirements for other goods other than medicines are issued in Russian.

The request indicates the name of the department or office of the health care facility and affixes the signature of the head of the corresponding inpatient unit. The requirements are signed by the head of the healthcare facility or his deputy for medical treatment, as well as the chief accountant and certified with the stamp and round seal of the healthcare facility.

Narcotic drugs and psychotropic substances are prescribed in the amount of 3-day requirements. Toxic substances and drugs of list A in the amount of a 5-day requirement, and other drugs in the amount of a 10-day requirement.

Privately practicing doctors who have a license to practice medicine and have entered into an appropriate agreement with a pharmacy can also write out requests for the dispensing of drugs and other pharmaceutical products, certifying them with a personal stamp, signature and seal. At the same time, private practicing doctors do not have the right to prescribe narcotic drugs, psychotropic substances and their precursors, which are subject to PCU in pharmacies.

Requirements are accepted and checked by a pharmacist-technologist and defector. When checking, attention is paid to the correctness of the requirements, the writing of medicines, their compatibility, the correct writing of dosage forms and packaging. (Federal Law No. 751n dated October 26, 2015).

Medicines prescribed in the requirement must correspond to the profile of the beds.

After checking the requirements, they are adjusted by the Deputy Director for Supply, i.e., the quantities allowed for release are entered. It is strictly forbidden to adjust the quantity of goods upward. If the packaging or dosage is changed, the total amount of the drug dispensed should not exceed the prescribed amount.

If the drug is not available, put “no” or “-”. After adjustment, the requirements are numbered from the beginning of the year and are charged by the pharmacist technologist at retail prices. An order is formed, and if necessary, individual dosage forms are made.

The labels of extemporaneous drugs containing narcotic drugs, psychotropic, toxic substances and list A drugs must bear a black letter A and a stamp in black ink “Poison”. On the labels of drugs containing potent substances and drugs of list B, respectively, there is a red letter B. When dispensing drugs that are on the PKU, the fourth copy of the invoice request remains with the financially responsible person as a supporting document. Medicines and other goods issued according to the requirements of invoices can only be received by a medical worker (head nurse in the name to whom the requirement was issued). Leave is made by power of attorney, signed by the chief physician and chief accountant of the health care facility. A power of attorney is issued for a period of up to 1 month to receive narcotic drugs, psychotropic, toxic substances, list A drugs and ethyl alcohol. And for a period of up to three years to receive other drugs and other pharmaceutical products.

When the goods are first issued, the power of attorney is withdrawn and subsequently stored in the pharmacy. The buyer's representative signs on all copies of the invoice request for the goods received from the pharmacy, and the pharmacist technologist signs for the issuance of the goods and the correctness of the taxation. Along with the order, the health care facility employee is given a third copy of the invoice request. All invoice requirements, according to which the goods were released to health care facilities and other buyers, are deciphered:

I. By type of leave

1) Medicines, including:

a) extemporal (individual).

b) ready.

2) Others.

II. By product groups.

After decoding, they are recorded in the journal for accounting for wholesale supply and settlement with the buyer (A-2.19). In this journal, a personal account is opened for each customer, in which the release of goods from the pharmacy in groups is reflected in chronological order.

The procedure for payment for pharmaceutical products sold is specified in the contract concluded with the buyer. If the calculations are systematic, then the goods can be released without advance payment, and the received drugs are paid on the basis of advances or upon delivery. Other institutions receive goods only after advance payment and only within the limits of the listed amounts. To pay for the goods, the pharmacy issues an invoice to the buyer, to which is attached a 2nd copy of the invoice request. At the end of the month, the first copy of the delivery note is attached to the report of the financially responsible person and is transferred to the accounting department of the pharmacy.

If the goods are released without advance payment, then the invoice can be drawn up for a certain period based on several invoices attached to it. The invoice is drawn up in 2 copies. The first copy is sent to the buyer, and the second remains in the pharmacy. All issued invoices during the month in chronological order are registered in the sales book and in the register of invoices (invoices) issued by the buyer (Form A-2.22).

The register reflects the amount of wholesale trade turnover for the month, broken down by type:

1) Cost of extemporaneous and ready-made drugs.

2) Dispensing medications (angro).

3) Other leave.

Invoices for payment of preferential and free dispensing of drugs to outpatients with a prescription from health care facilities are also entered into the same register.

Determination of the number of inpatient prescriptions for drugs.

At the end of the month, the number of inpatient prescriptions for ILS and OTC drugs is determined by calculation. To do this, the cost of ILS dispensed according to the requirements of health care facilities is divided by the average cost of 1 outpatient prescription for ILS. And the cost of OTC drugs dispensed by health care facilities is divided by the average cost of 1 outpatient prescription for OTC drugs. At the same time, the average cost of 1 outpatient ILS is conditionally equated to the average cost of 1 inpatient ILS, and the average cost of 1 outpatient OTC drug is conditionally equated to the average cost of 1 inpatient OTC drug.

Chapter 2.Main tasks and functions of hospital pharmacies

The main goal of hospital and interhospital pharmacies is the timely and high-quality provision of inpatients with medicines and medical products.

Pharmacies perform the following functions:

Determining the needs of healthcare facilities for drugs, patient care items and other medical products;

Purchasing and dispensing medications, dressings, and patient care items to the hospital department;

Preparation of extemporaneous medications according to the requirements - orders of departments of health care facilities;

Quality control of prepared drugs;

Monitoring the correct storage and rational use of medicines in the departments and offices of health care facilities;

Control over the rational use of funds allocated for the purchase of honey. goods;

Information work.

Depending on the profile and structure of health care facilities, hospital pharmacies can be:

1. General hospital pharmacies;

2. Pharmacies of specialized hospitals (tuberculosis, infectious diseases, psychoneurological);

3. Clinic pharmacies;

4. Health resort pharmacies.

Pharmacies that serve health care facilities can be budgetary (financing of these pharmacies is carried out from budgetary funds) and self-supporting. Self-supporting pharmacies operate as a legal entity, carry out wholesale and retail sales of medicines and medical devices, and are also engaged in the manufacture of extemporaneous drugs.

Pharmacies are opened to serve one health care facility (hospital pharmacy) or several health care facilities (interhospital pharmacy). Such pharmacies must be located in a separate room or in a health care facility with a separate entrance.

The acquisition of drugs and medical devices is carried out from distributors and pharmacy warehouses on the basis of contracts with a license through participation in tenders (if there are at least 3 suppliers, with a purchase of no less than 30 thousand UAH). The range of purchased drugs is regulated by the state.

Incoming control is carried out by an authorized person (head nurse, pharmacist or pharmacist of a health care facility pharmacy, approved by order of the head of the health care facility, their data is reported to the territorial state inspections).

Boundary standards for the storage of narcotic, psychotropic drugs and precursors in the structural divisions of health care facilities.

- Pharmacy of health care facilities - two-week requirement;

- Medical facility department - three-day requirement;

- Posts (offices) of health care facilities - two-day requirement;

- Hospital admission department for providing emergency medical care for vital signs in the evening and at night - five-day reserve;

- Outpatient clinics and first aid stations are a weekly requirement.

- The procedure for prescribing drugs and medical devices and PKU in the structural divisions of health care facilities.

- Medicines for the needs of health care facilities are prescribed separately to each department. The demand-order is issued with a stamp, a round seal of the health care facility, and the signature of the head or his deputy from the medical unit. The order requirement specifies the name, dosage, release form and total quantity of the drug (in 3 copies).

- Requirements-orders for drugs that are subject to PCU, drugs for anesthesia are written out on separate forms for each group of drugs (4 copies). They must indicate the name of the department or offices, the purpose of the drug (for injection, internal, etc.). Narcotic, psychotropic drugs, precursors of list No. 1 are prescribed in Latin and the quantity is indicated in words.

- For narcotic drugs, in addition to the above, there must be: the medical history number, the patient’s full name, the name and dosage of these drugs, as well as their purpose. To receive drugs, a power of attorney is issued (valid for 10 calendar days).

PCU in health care facilities are subject to:

- Narcotic drugs.

- Psychotropic drugs.

- Precursors of list No. 1.

- Poisonous drugs (atropine and its salts - powder, tetracaine, trihexyphenidyl, peripheral muscle relaxants).

- Potent drugs (butorphanol, diphenhydramine (solid forms), clonidine (substance and liquid forms), methandienone, retabolil, promethazine).

- Combined drugs (solid forms) that contain tramadol, ephedrine, pseudoephedrine.

Budget pharmacies purchase medicines within the limits of allocations that are allocated from the state budget for the treatment of hospital patients. Self-supporting pharmacies have the ability to form inventories in significant volumes, which allows the pharmacy to quickly respond to requests from healthcare facilities.

To serve health care facilities, pharmacies must have a number of additional premises, namely:

- medical personnel service room (information);

- order picking room;

- procurement of concentrates and semi-finished products;

- storage room for clean dishes;

- material for poisonous and narcotic drugs;

- material for storing thermolabile substances;

- material for storing medical products and others;

- unpacking.

Interhospital pharmacy staff:

- Administrative staff (pharmacy manager, pharmacist, chief accountant, safety engineer, economist);

- Pharmaceutical personnel (pharmacists, pharmacists);

- Support staff (packers, nurses);

- Maintenance personnel (premises repair worker, driver).

Responsibilities of a healthcare pharmacist

To perform functions regarding the organization of drug provision for inpatients in health care facilities that are attached to pharmacies, the position of a pharmacist (but not more than two persons) is introduced, who is directly subordinate to the chief physician or his deputy.

Responsibilities of such a pharmacist:

- acceptance and verification of orders from health care facilities;

- acceptance of completed orders from the pharmacy and timely transfer of drugs and medical devices to the appropriate departments;

- constant communication with doctors, informing them about medications;

- control over compliance in departments and offices of health care facilities with established rules for storing drugs.

Conclusion

Regulation of pharmacy activities aims to ensure the quality of medicinal care, which includes the quality of the product itself, the quality of the facility, equipment and the quality of the sales process. It is also necessary to regulate the pharmaceutical procedure (this is a set of requirements for the premises, personnel, sanitary regime, storage conditions, forms of service, dispensing rules, incoming control of drugs and other indicators that ensure the quality of the medicinal care provided in a particular pharmacy enterprise, regulated by legal regulations acts of the Russian Federation).

In connection with the commercialization of pharmacies and the appearance of falsified and counterfeit products on pharmacy shelves, the development of a system for regulating pharmacy activities is of particular relevance.

Bibliography

1. Bagirova V.L. Management and Economics of Pharmacy: Textbook / Ed. V.L. Bagirova. - M.: OJSC “Publishing House “Medicine”, 2004. - 720 p.;

2. Dremova N.B., Solomka S.V. Computer technologies for marketing research in medical and pharmaceutical organizations. - Kursk: KSMU, 1999. - 147 p.

3. Order of the Ministry of Health of the Russian Federation dated February 12, 2007. (as amended on February 26, 2013) No. 110 “On the procedure for prescribing medications, medical devices and specialized food products”

4. Order of the Ministry of Health of the Russian Federation dated October 26. 2015 No. 751n “On approval of the rules for the manufacture and dispensing of drugs for medical use by pharmacy organizations and individual entrepreneurs with a license for pharmaceutical activities.”

5. Federal Law of 04/05/2013 (as amended on July 29, 2017) No. 44 “On the contract system in the field of procurement of goods, works, services to meet state and municipal needs”

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2. Assortment of medicines in a hospital pharmacy

Hospital pharmacies are necessary and should be in every clinic. Today they are available at every hospital. Any inpatient facility must have its own pharmacy for ready-made medicines, a room for storing medicines and a specialist. This would make it possible to strictly observe the storage conditions of finished dosage forms and maintain a professional approach to working with medicines.

The list of vital medications is the standard treatment for each nosology. It follows from this that each treatment and prevention organization must necessarily have standards for treating diseases of its patient population.

Provide medications for the treatment process both when providing free medical care and paid services;

Provide medical personnel with professional information about medications;

Organize pharmaceutical supervision in the hospital.

Hospital pharmacies play an important role in providing medications to medical institutions. An analysis of the nomenclature of some hospital pharmacies shows that a significant part of the dosage forms of the pharmacy are sterile dosage forms: solutions for injections, eye drops, as well as sterile dosage forms for external use. These dosage forms are prepared in large quantities at the pharmacy.

Thus, an isotonic sodium chloride solution is produced in quantities of more than 200 liters per shift. It should be noted the low cost of pharmaceutically manufactured dosage forms. For example, the cost of isotonic sodium chloride solution in a hospital pharmacy is almost six times cheaper than industrially produced solution.

They are prepared in large quantities in pharmacies. solutions of furatsilin with and without isotonic sodium chloride solution. Such solutions of furatsilin are not produced by the pharmaceutical industry. Among dosage forms for internal use, common potions with motherwort of various compositions, Pavlov’s mixture, cough mixtures with thermopsis and marshmallow of various compositions, as well as one-component solutions of calcium chloride 5 and 10%, potassium iodide 0, 25 and 3%, magnesium sulfate 33% and others.

In pharmacy recipes there are also aqueous extracts, which can be used for both internal and external use, in particular for inhalation. An example of the former is breast tea, the latter - infusion of chamomile, peppermint, decoctions of wild rosemary, and pine buds.

External dosage forms are represented by numerous ointments, such as sulfuric simplex of various concentrations, Lassar paste, zinc paste and packaged powdered medicinal substances - powders.

A special group consists of one-component solutions for electrophoresis. Their range is quite diverse - solutions of papaverine hydrochloride 2%, nicotinic acid 2%, novocaine 2%, potassium iodide 1 and 3%, etc. Suppositories are rarely found in pharmacy formulations. An analysis of the formulation and operation of hospital pharmacies showed that the range and production volumes not only do not decrease, but also increase.

In the event of an emergency, the workload of hospital pharmacies can increase dramatically, especially for groups of sterile drugs. In the future, hospital pharmacies will have to switch to the manufacture of medicines in accordance with GMP rules, so now it is necessary:

Bring production premises into appropriate condition;

Introduce complexes for producing purified water and water for injection using the reverse osmosis method;

Use membrane technologies more widely;

Purchase high-quality and efficient sterilizers;

Conduct staff training in accordance with specified rules.

3.Features of drug technology in a hospital pharmacy

If we consider the performance of production functions by hospital (hospital) pharmacies as an important component of their activities, then the most rational solution may be the following:

Organization of small-scale production using small-sized automatic lines and other types of equipment that meet GMP requirements;

Creation of mobile autonomous complexes for the production of sterile solutions in the field, which is relevant for medical units of the Ministry of Defense and the Ministry of Emergency Situations.

In hospital (hospital) pharmacies, the share of sterile solutions accounts for about 70%, annually measured in tens of thousands of bottles of the entire extemporaneous formulation. Sterile dosage forms require not only special manufacturing conditions, but also significant labor and time costs.

Injection solutions must be prepared from medicinal substances that fully comply with the requirements of private articles of the Global Fund X or other scientific and technical documentation. In some cases, special purification of medicinal substances intended for injection is required. Glucose, calcium gluconate, sodium caffeine benzoate, sodium citrate, quinacrine, calcium chloride, magnesium sulfate and some others should have a higher degree of purity.

Excipients (stabilizers, solubilizers, preservatives, etc.) must also comply in quality with the specific articles of the State Fund of X (if these substances are official) or other scientific and technical documentation.

Among injection solutions in hospital pharmacies, a special group is made up of isotonic solutions, which are understood as solutions with an osmotic pressure equal to the osmotic pressure of body fluids: plasma, blood, tear fluid, lymph, etc. Solutions with a lower osmotic pressure are called hypotonic, with a higher one - hypertonic.

The isotonicity of injected solutions is very significant. Solutions that deviate from the osmotic pressure of blood plasma cause a pronounced sensation of pain, and the sharper the osmotic difference, the stronger it is.

When anesthetics are administered (in dental and surgical practice), osmotic trauma causes sharp pain after anesthesia that lasts for hours. Sensitive tissues of the eyeball also require isotonication of the solutions used. Injections into the spinal canal should also not cause an osmotic jump. The osmotic pressure of blood and tear fluid normally remains at the level of 72.52-104 N/m2 (7.4 atm).

Technology for the production of injection solutions. Water for injection, peach and almond oils are used as solvents for preparing injection solutions. Injection solutions must be transparent. They are prepared using a mass-volume method: the medicinal substance is taken by mass (weight), the solvent is taken to the required volume. Quantitative determination of medicinal substances in solutions is carried out according to the instructions in the relevant articles.

The original medicinal products must meet the requirements of the State Fund X. Calcium chloride, sodium caffeine benzoate, hexamethylenetetramine, sodium citrate, as well as magnesium sulfate, glucose, calcium gluconate and some others must be used in the form of an “injection” grade with a high degree of purity.

To avoid contamination by dust, and with it microflora, preparations used for the preparation of injection solutions and aseptic medicines are stored in a separate cabinet in small jars, closed with ground glass stoppers, protected from dust by glass caps. Strict adherence to technology is required.

Toxic substances necessary for the preparation of injectable medicines are weighed by the controller in the presence of an assistant and are immediately used by the latter to prepare the medicine. When receiving a toxic substance, the assistant must ensure that the name of the rod corresponds to the purpose in the recipe, as well as that the weights are set and weighed correctly.

For all injectable medications prepared by the assistant, without exception, the latter must immediately draw up a control passport (coupon) with an exact indication of the names of the drug ingredients taken, their quantities and a personal signature.

Before sterilization, all injectable drugs must be subjected to chemical control for authenticity, and, if there is an analytical chemist in the pharmacy, to quantitative analysis. Solutions of novocaine, atropine sulfate, calcium chloride, glucose and isotonic sodium chloride solution are subject to qualitative (identification) and quantitative analysis under any circumstances.

In all cases, injectable medications should be prepared under conditions that minimize contamination of the drug with microflora (aseptic conditions). Compliance with this condition is mandatory for all injectable drugs, including those undergoing final sterilization.

Rp.: Sol. Calcii chloridi 10% 50.0

D.S. Intravenous injection

To prepare the injection solution, you need sterilized containers: a dispensing bottle with a stopper, a volumetric flask, a funnel with a filter, a watch glass or a piece of sterile parchment as a lid for the funnel. To prepare a solution of calcium chloride for injection, you also need a sterilized graduated pipette with a bulb for measuring a concentrated solution of calcium chloride (50%). Before preparing the solution, wash the filter many times with sterile water, and wash and rinse the dispensing bottle and stopper with filtered water.

Measure (or weigh out) the required amount of the drug, rinse it into a volumetric flask, add a small amount of sterile water, then adjust the volume of the solution to the mark. The prepared solution is filtered into a release bottle. The vessel with the solution and the funnel are covered with a watch glass or sterile parchment during filtering. Inspect the solution for the absence of mechanical impurities. After capping the bottle with the injection solution, tightly tie the stopper with damp parchment, write the composition and concentration of the solution on the tie, put a personal signature and sterilize the solution at 120°C for 20 minutes.

In pharmacy practice, bottles of appropriate capacity are used to dispense sterile solutions. It is very important that they are made of neutral grades of glass to avoid leaching and the appearance of sediments and other undesirable changes in solutions. In some cases, containers made of AB-1 glass (weakly alkaline) are allowed.

Bottles used for dispensing injection solutions must be tested for chemical resistance using certain methods. Bottles for sterile solutions must have well-ground stoppers. Ordinary cork plugs, which generate dust and transfer coloring and extractive substances into the solution, are not allowed.

It is allowed to use rubber stoppers that have been previously sterilized by prolonged boiling in water. In hospital pharmacies, when sterile solutions are prepared for immediate use, the bottles are allowed to be sealed with a swab of non-greasy sterile cotton wool, tied with sterile parchment. A piece of sterile gauze should be placed under the tampon. M.I. Mamaichuk and V.A. Brailovskaya proved the possibility of sealing bottles with sterile solutions with rubber and polyethylene caps, allowing the solution to be taken with a syringe by piercing the cap with a needle without violating the sterility of the solution.

A more advanced form of dispensing sterile solutions from pharmacies of medical institutions to the hospital department is dispensing in wide-necked standard bottles of various capacities with a standard rubber stopper secured with a crimped aluminum cap, similar to bottles with antibiotics.

Potions. Pavlov's mixture is a complex preparation containing caffeine-sodium benzoate - 0.2 g, sodium bromide - 0.2 g, distilled water - 200 ml. Doses of the components of Pavlov’s mixture may vary depending on the characteristics of the patient’s higher nervous activity and are determined by the doctor. The mixture is produced in glass bottles of 200 ml. The drug regulates higher nervous activity. Has a calming effect.

Rp.: Inf. herbae Thermopsidis 0.1 – 200 ml

Sodium hydrocarbonatis

sodium benzoatis

Liq. Ammonii anisati aa 1.0

Sirupi Althaeae 20 ml

M.D.S. 1 tablespoon 3 times a day.

The total volume of the mixture is 221 ml. In its production, dry thermopsis extract (1:1) is used, which is placed in a stand in an amount of 0.1 g and dissolved in 170 ml of water. The resulting solution is filtered into a dispensing bottle, into which 20 ml of a 5% solution of sodium bicarbonate (1:20) and 10 ml of a 10% solution of sodium benzoate (1:10) are previously placed. Add pre-mixed 20 ml of marshmallow syrup and 1 ml of ammonia-anise drops to the mixture.

Pharmacy production of medicines for hospitals remains relevant today, especially for hospitals - after all, the existing range of industrially produced medicines cannot fill the entire range of medicines needed by patients, especially since there are some that are not produced by industry at all due to various reasons. This is, first of all, medications necessary for children and newborns .

The first group of drugs prepared in a hospital pharmacy are sterile solutions for internal use by newborns. These solutions are prepared under aseptic conditions; purified water is used as a solvent, then the solution is sterilized. The presence of stabilizers in solutions for injections and infusions for feeding newborns is unacceptable. The only exception is a 0.25% novocaine solution.

A glucose solution of 5, 10, 25% is prepared for newborns without a stabilizer. They cannot be replaced with infusion solutions of the same concentration, since the latter contain a Weibel stabilizer - a solution of HCl and NaCl - and its pH is 3-4. The shelf life of glucose solutions for drinking newborns is only 1 month. For example, a common prescription for newborns is: glucose solution 10% or 20% - 100.0, glutamic acid - 1.0 g; such a drug is not available in the factory industry.

Dibazole solution is also not applicable for internal use in the treatment of newborns, since the factory preparation contains hydrochloric acid.

There is another group of substances that can only be prepared in pharmacies - solutions for medicinal electrophoresis, the essence of which boils down to the therapeutic effects of electric current on the patient’s body and the introduction of a medicinal substance into the patient’s tissue. Electrophoresis is widely used in various areas of healthcare, in most medical and treatment-and-prophylactic institutions: in sanatoriums, clinics, antenatal clinics and in all hospitals.

Electrophoresis requires aqueous solutions of medicinal substances: analgin, dibazole, diphenhydramine, papaverine, ichthyol, zinc sulfate, potassium chloride and many others. In this case, preservatives cannot be used due to their electrical indifference. As of today, there are no industrial dosage forms for electrophoresis.

In hospital pharmacies also produce ointments. Lassara pasta is in great demand. This is a homogeneous ointment of yellowish color, thick consistency. In a thin layer of paste ground on paper, when viewed with the naked eye, no grains should be detected.

Expense norms. To prepare 1 kg of Lassara paste you need:

Vaseline 480.5 g

Salicylic acid 19.9

Wheat starch 251.2

Zinc oxide 251.2

Technological process. Salicylic acid, starch and zinc oxide are ground by sifting each powder separately through a No. 2 sieve.

Vaseline is loaded into a digester with a steam jacket and melted at a temperature of 50 - 55 ° C, then passing it through the canvas.

About half the required amount of petroleum jelly is placed in a mixing kettle and thoroughly mixed with zinc oxide and salicylic acid. Then sifted starch and the rest of the amount of petroleum jelly are introduced into the cauldron in parts, everything is thoroughly mixed until the mass is completely homogeneous.

The ointment from the mixing boiler is passed through a maze grater until the smallest grains disappear (the quality control inspector takes a sample for analysis).

Gray mercury ointment is an emulsion in which liquid metallic mercury is dispersed in a base. To obtain this ointment, it is necessary to expend a significant amount of mechanical energy, because mercury has a very high surface tension.

The ointment should be a completely homogeneous mass containing 30% metallic mercury. When examining the ointment, rubbed into a thin layer on glossy paper, individual droplets of mercury should not be visible even with a magnifying glass.

Technological process. The entire manufacturing process is divided into the following main stages:

Production of concentrated mercury ointment;

Preparation of fat base;

Mixing mercury concentrate with a fat base;

Packaging and storage.

Making concentrated mercury ointment. To make the concentrate, take 85 parts of mercury and 15 parts of anhydrous lanolin.

Depending on the amount of ointment produced, mortars of various sizes are used, which have a special device. Small mortars, as a rule, are cast iron, and large ones are stone (agate). During operation, the pestles perform a double planetary movement: they rotate around their own axis and around the center of the mortar. 15 parts of anhydrous lanolin are placed in a mortar, then 85 parts of mercury are added in small portions. Grinding is continued for 14 - 18 hours, after which an average sample is taken to determine the homogeneity and percentage of mercury content. In pharmacies, the fat base is added to the concentrate as needed, since during prolonged storage fatty acids are released from fats, which form toxic compounds with mercury. If there is a lack of lanolin, the concentrate is sometimes made on a special emulsion base obtained from zinc oxide, vegetable oil and water.

Obviously, the future fate of healthcare facility pharmacies requires the speedy development of an industry standard “Pharmacy of a healthcare facility”, a precise procedure for licensing pharmaceutical activities in healthcare facilities. It is necessary to develop criteria for compliance of pharmaceutical activities with established rules and regulations on the pharmacist of a hospital pharmacy.

It is also necessary to change the regulatory framework for calculating the staffing level of pharmaceutical staff in hospital pharmacies and develop regulatory documents that meet the new requirements for healthcare facility pharmacies.

There are about 70 thousand pharmacy enterprises in Russia. These are special organizations that, by the nature of their activities, must ensure the quality of drug care and its accessibility to the population. Carrying out the functions of providing medicines, pharmacy enterprises conduct economic activities. Legislative regulation of both general economic and pharmaceutical aspects of the activities of pharmacy enterprises, especially hospital pharmacies, is of great importance. The regulatory framework is very extensive, but today the law “On Technical Regulation” is becoming increasingly important, which will play a huge role in the future.

The problem of hospital pharmacy today is more acute than all others, since this sector is now at a more backward level compared to other segments of the industry.

Currently, there are no standards for the activities of hospital pharmacies; a licensing system for hospital pharmacies has not yet been prescribed (they are not legal entities, and only legal entities are subject to licensing). To obtain a license, a pharmacy must be registered in the Charter of a medical institution; this does not always happen, and now a number of hospital pharmacies operate without a license at all.

Traditionally, there are four functions of a healthcare facility pharmacy:

Accepting requests for medications;

Preparation of medicines;

Control of their quality;

Leave to hospital departments.

However, these functions are clearly not enough. In particular, it is necessary to control the storage of medicines in departments, inform medical workers about the medicines available in the pharmacy, etc.

To optimize the process of dispensing medicines, it is necessary to introduce in-pharmacy packaging and dispense already packaged medicines into departments. It is necessary to maintain personalized records in medical institutions.

The pharmaceutical procedure is a set of requirements for the premises, personnel, sanitary regime, storage conditions, forms of service, dispensing rules, incoming control of drugs and other indicators that ensure the quality of the medicinal care provided in a particular pharmacy enterprise, regulated by regulatory legal acts of the Russian Federation.

Analysis of the process of providing medicinal care allows us to propose a triad of ensuring the quality of this care provided by a pharmacy:

Quality of the premises (set of premises, design of the sales area, equipment, compliance with sanitary rules);

Initial quality of medicines (availability of documents confirming their quality, compliance with storage rules, monitoring expiration dates, etc.);

Quality of implementation (necessary qualifications of personnel, high-quality assortment, compliance with supply rules, information services, pricing, documentation).

These three main points will form the basis of the technical regulations on retail trade in medicines, which are currently being prepared.

Elements of the pharmaceutical order are personnel, premises, reception of medicines, dispensing, medicines themselves, sanitary regime, operating mode, information system, etc.

Bibliography

1. Weekly “Pharmacy” No. 42, 2004.

2. Weekly “Pharmacy” No. 22, 2005.

3.Internet: www. medicalcom.ua

4. Vestnik Pharmacy, 2005.

5. Magazine “Provisor” No. 16, 2004.

6.Internet: www. provizor. kharkov. ua.

7. Besedina I.V., Griboedova A.V., Korchevskaya V.K. Improving the conditions for the preparation of injection solutions in a pharmacy in order to ensure their non-pyrogenicity // Pharmacy. - 1988. - No. 2. - p. 71-72.

8. Besedina I.V., Karchevskaya V.V. Evaluation of the purity of pharmaceutically manufactured injection solutions during use // Pharmacy. - 1988. - No. 6. - p. 57-58.

9. Gubin M.M. Problems of manufacturing injection solutions in industrial pharmacies // Pharmacy. - 2006. - No. 1.

10. Moldover B.L. Aseptically prepared dosage forms St. Petersburg, 199

11. Svetlanova S. Without a hospital pharmacy, the healing process will stop. // Pharmaceutical Bulletin. - 2005. - No. 26 (389) dated August 16, 2005.

12.www.medkurs.ru/pharmacy/sterile_medicine/section2315/11725.html

13. Avamesyants E. M. Technology of manufacturing dosage forms. Rostov-on-Don, “Phoenix”, 2002.

14. State Pharmacopoeia of the USSR. - 10th ed. M.: Medicine, 1968.

15. Klimova L.D., Ber O.V. Making potions. Educational and methodological recommendations. - Samara; GOUVPO "SamSMU Roszdrav", 2006. - 70 p.

16. Order of the Ministry of Health of the Russian Federation dated December 31, 1971. No. 949

17.Order of the Ministry of Health of the Russian Federation dated August 18, 1972. No. 689

18. Order of the Ministry of Health of the Russian Federation dated June 23, 1983. No. 758

19.Order of the USSR Ministry of Health No. 758 of June 23, 1983 “On the position and staffing of self-supporting interhospital (hospital) pharmacies”

"Pharmaceutical Review", 2005, N 12

HOSPITAL PHARMACIES:

WITHOUT STATUS, EMPLOYEES AND MONEY

In the wake of widespread reforms in Russia, the medical care system is gradually being modernized. State healthcare institutions organize paid beds and departments, and private medical institutions are actively developing. Paid services are not the only factor that unites them. Most of these health care facilities have pharmacies that provide the treatment process with the necessary medications.

INTERMEDIATE POSITION

Hospital pharmacies differ significantly from ordinary institutions with a green cross - both in function and in the essence of their activities. The task of healthcare facility pharmacies is to meet the needs of the treatment process for pharmaceutical goods and services. Therefore, hospital pharmacies are given certain tasks: to provide medications for the treatment process both when providing free medical care and paid services, to provide medical personnel with professional information about medications, to organize pharmaceutical supervision in the hospital.

Sounds nice. However, in reality the picture that emerges is extremely unsightly. Hospital pharmacies are in dire straits. And there are several reasons for this: limited funding and rising prices for drugs, shortcomings in the organization of the drug supply system for hospitals and in controlling the use of financial resources.

The root of all health care problems lies in the regulatory framework. A health care facility pharmacy operates on the basis of a pharmaceutical license. However, the existing definition of pharmaceutical activities does not correspond to the functions performed by hospital pharmacies. The Federal Law “On Medicines” defines pharmaceutical activities as “activities carried out by wholesale trade enterprises and pharmacies in the field of circulation of medicines, including wholesale and retail trade of medicines, manufacturing of medicines.” According to Anna Soloninina, vice-rector of the Perm State Faculty of Facility, head. department Management and Economics of Pharmacy, Faculty of Additional Professional Education, Doctor of Philosophy, for the activities of pharmacy departments in health care facilities, the definition of “pharmaceutical services” is more suitable as “a set of pharmaceutical services provided by pharmacy departments in organizing the drug supply of health care facilities.”

Regulatory documents regulating the activities of pharmacies, in particular OST 91500.05.0005-2002 "Rules for the wholesale trade of medicines. Basic provisions" and OST 91500.05.0007-2003 "Rules for the dispensing (sale) of medicines in pharmacies. Basic provisions", also do not reflect modern requirements for organizing the activities of pharmacies serving health care facilities. As A. Soloninina notes, by the nature of their activities, hospital pharmacies occupy an intermediate position between wholesale and retail trade enterprises, since, on the one hand, they do not sell drugs for cash, and on the other hand, in most cases they carry out production activities related to the manufacture Medicines, which is typical for retail pharmacies.

To summarize, it can be noted that the existing regulatory documents do not regulate the issues of drug provision to hospitals in the compulsory medical insurance system. They do not define the status, tasks and functions of hospital pharmacies, industry standards of activity have not been developed, there are no regulatory documents on licensing, etc.

PROBLEMS OF CORRECT ORGANIZATION

The lack of proper legal regulation brings with it a trail of other ills of hospital pharmacies. Low wages lead to a shortage of employees and increased workload for working specialists. Poor funding makes it impossible to repair and replace outdated equipment. Therefore, it makes no sense to talk about the compliance of hospital pharmacies with international production quality standards.

The pharmacy that exists on the territory of the healthcare facility primarily provides medicine to patients who are undergoing treatment here. But not everything is smooth here either. Research conducted by specialists from the Perm Pharmacy Academy has revealed that not all hospitals have a pharmaceutical specialist on staff and adequate drug formularies, which leads to the use of drugs with unproven clinical effectiveness, but high cost. The current practice of determining the need, stock standards, procurement, storage, and use of drugs does not always correspond to reality. The results of these studies can be extended to any region of Russia - the situation in hospital pharmacies is the same everywhere.

Today, probably, the overwhelming majority of health care facilities provide some kind of paid medical services. This is a natural phenomenon in market conditions and additional income for budgetary institutions. However, everything again comes down to the organization of the process. The need for drugs for paid services, as a rule, is not clearly defined. Therefore, purchases are chaotic and are made as needed. When a drug is out of stock, it is bought urgently at any pharmacy for cash, regardless of its cost, which affects the cost of medical services. Medicines purchased at the expense of the budget and compulsory medical insurance are often used, but their cost is not always reimbursed if they were used for paid medical services. In practice, there is no separate storage, accounting for the acquisition and consumption of drugs purchased for the provision of free drug care and for the provision of paid medical services.

NO PHARMACY IS DIFFICULT, THERE IS EVEN DIFFICULT

Analyzing the situation with pharmacies at health care facilities, we can conclude that there are two types of problems: when there is a pharmacy at health care facilities and when there is not one. In cases where this is not the case, drug provision is carried out by people without pharmaceutical education. As a result of their incompetence, certified drugs of proper quality are not always purchased. The conditions for storing drugs in health care facilities are called into question; outside the pharmacy premises they do not always meet the standards. Often, patients themselves purchase the medications they need (the question of their quality and effectiveness again arises). As a result, there is a significant weakening of internal pharmaceutical control over the circulation of drugs in health care facilities (there is no accounting for the issuance of drugs to patients, no control over the rationality of procurement).

The problems are, of course, serious. But the paradox is that the problem is much more serious and larger-scale when there is a pharmacy at a health care facility. This is primarily the mentioned range of legal problems. Often, pharmacies in hospitals are organized as departments, and the manager acts as the head of the department. Pharmacies do not operate around the clock, which creates difficulties due to the unavailability of drugs in emergency situations. Due to problems with premises and equipment, the preparation of drugs for injections and infusions in hospital pharmacies is problematic. Personalized records of drug dispensing to patients are not maintained everywhere. Another problem that can seriously complicate the life of hospital pharmacies: the list of paid medical services does not include pharmaceutical services.

The question arises how to solve all these problems. The main role in this is given to the state, which must finally determine the regulatory framework for hospital pharmacies. But reforms must also take place in health care facilities themselves. Among them are measures to rationalize the use of drugs and financial resources for drug provision:

Introduction of a formulary system in each health care facility, which will allow the use of the safest and most cost-effective drugs in the treatment process, more accurately determine the need for the necessary drugs and plan their purchases;

Introduction of a two-level management and control system: at the level of the Compulsory Medical Insurance Fund and health care facilities;

Introduction of a system for recording the consumption of drugs in health care facilities, including for paid medical services, as well as monitoring the rationality of their purchases and use;

Centralization of drug storage in health care facilities based on pharmacy departments, ensuring their round-the-clock availability;

A radical change in the practice of purchasing drugs (on a competitive basis, planning purchases taking into account the required standards for the need for inventory in terms of range and quantity, introducing a system of disposable packaging);

Introduction of subject-quantitative accounting of all drugs and personalized accounting of their release.

A VIEW FROM INSIDE

An employee of pharmacy No. 744 at the Dolgoprudnenskaya Central City Hospital, who wished to remain anonymous:

We had a good pharmacy, but now everything has changed. There are no staff, two people work (some are on vacation, some are in the hospital, the manager quit). There has been no renovation for a long time. The pharmacy serves the entire hospital: maternity hospital, traumatology, infectious diseases department, cardiology and other departments - the load.

Previously, there were three municipal pharmacies in the city, they were reorganized into a closed joint stock company. Now it is a pharmacy chain. The central pharmacy, which also sold narcotic drugs, closed at some point. And then all the burdens of supplying numerous surrounding units fell on our hospital pharmacy. But we only have a license to serve 466 beds. However, there are many patients in the city who require the same narcotic drugs. After the central pharmacy was locked, ambulances had to go to patients (this happened with cancer patients) and give them injections of the necessary narcotic drugs at home. At some point, the central pharmacy opened, but did not receive a drug license. In addition, the production department was removed from it. Now there is no industrial pharmacy in the city at all. Then the central pharmacy finally received a drug license, but the volume of its work today cannot be compared with what it was before.

Funding for us, in principle, has always been decent. But in the summer problems arise. Therefore, at the end of August there is a debt for two months. We work with suppliers according to a tender held by the regional Ministry of Health, but, unfortunately, supplier companies with really low prices are not always selected.

Svetlana Rybitskaya, pharmacy at the Mytishchi City Clinical Hospital:

Our biggest problem is financing. It has become especially bad since 2005: volumes have decreased, constant debt. Perhaps this is due to the fact that there are more seriously ill patients, so they require more expensive drugs. Perhaps the problem is in combination treatment, when several drugs are needed at once, but previously they managed with one. Or patients neglect their illnesses, come to the doctor only as a last resort, and the treatment of such diseases is more expensive. Then don’t forget that we have an oncology hospital and a certain range of drugs. I am glad that suppliers understand our situation and always deliver orders on time.

The employees in the pharmacy are almost all of retirement age, there are no young people. You have to work in teams.

The work is very stressful, monotonous and monotonous, not the same as in a regular pharmacy. But you have to work everywhere.

Tatyana Bychkova, pharmacy at the Moscow Regional Oncology Hospital, Balashikha:

Our difficulties are the same as everyone else’s, as they have been for several years: low wages. Therefore, there is no one to work. According to the staffing schedule, our pharmacy should have 18 employees, but only seven work. We do not have movers or pharmacists. You have to deal with everything yourself.

Antonina Grushina, pharmacy at the Moscow Regional Psychiatric Hospital No. 5:

Since we are a closed pharmacy at a psychiatric hospital, we dispense drugs only for the inpatient department. The direction of the hospital dictates its specifics - drugs for the treatment of depression and mental illness. The hospital is a budget hospital, so funding is low. How much money is allocated to us, so many drugs we will purchase. You always have to wait for money before placing an order. Young people generally don’t want to come to work here because of the low wages. In order to somehow change the situation, it is necessary, first of all, to change the regulatory framework. In other pharmacies everything changes: time, attitude, style of work, but with us everything is the same, we still work according to the Soviet regulatory framework.

S.GRACHEVA

The association assists in providing services in the sale of timber: at competitive prices on an ongoing basis. Forest products of excellent quality.

Modern people have a clear understanding of pharmacies. But what are the types and functions of pharmacy organizations? Not everyone knows about this. Their activities are regulated and controlled by legislative acts and internal affairs bodies. We live in a rule-of-law state, where individuals and legal entities are obliged to comply with laws. Pharmacy activities are also regulated by several laws, acts and other documents.

Pharmaceutical activities

The article will describe pharmacy organizations, their types, comparative characteristics and other important points in this area. This concept refers to companies that retail, manufacture and dispense medicines.

As for retail, this is a type of trade and provision of services to customers for personal, family, and household purposes, which has nothing to do with business activities.

List of such companies:

pharmacy points;
pharmacy kiosks;
pharmacies;
pharmacy stores.

Based on external and functional characteristics, existing types of pharmacy organizations have their own characteristics and differ from each other. As a rule, trading outside the premises of a pharmacy is prohibited. This means that the pharmacist does not have the right to sell medicines and other products outside a specialized company.

Types of pharmacies

Pharmacies that are created to serve the population. Such institutions sell medicines of both narrow and general profiles. They may have their own assortment, which is specified in their classification. For example, homeopathic pharmacies have a range of products in this area and specialize in their sale. Core activities vary. For example, an oncology pharmacy produces and sells drugs designed to combat cancer.
Hospital pharmacies. Each medical institution has its own pharmacy organization. In any case, she should be there.
Interhospital pharmacies - such organizations supply medical, preventive and other institutions with drugs.

This list classifies the types of pharmacy organizations by type of activity. There are other indicators according to which pharmacies have their own characteristics.

The nature of the production activities of pharmacies

Production. These points produce medicines according to doctors’ prescriptions and the requirements of medical institutions. Companies of this kind have the right to sell finished products.
Institutions for the sale of finished medicinal forms. These types of pharmacy organizations and the functions they perform are limited to the sale of medicines to the population and their sale to medical institutions.
Night pharmacies. As the name suggests, such points are designed to serve the population at night.

Order 553n “On approval of types of pharmacy organizations” contains the basic concepts and characteristics adopted in this area. According to this document, all pharmacies' activities are regulated based on the contents of this paper.

In this area, as in any other, it is important to know the laws and apply them correctly. Some unscrupulous sellers, taking advantage of people's legal illiteracy, do not provide adequate services to the population in accordance with the law. Therefore, in addition to the book of complaints and suggestions, any type of pharmacy organization must have the specified document in the consumer’s corner. This is necessary so that a pharmacy visitor can calmly study it. The order on approval of types of pharmacy organizations is also necessary for periodic familiarization with it directly by pharmacy workers. This is understandable, since the standards prescribed in it will help you cope with your responsibilities better.

Functions of pharmacies

As noted above, Order 553n “On approval of types of pharmacy organizations” not only regulates the legality of the activities of pharmacies, but also contains a list of functions of these institutions.

The functions of pharmacies depend not only on the type of activity, but also on its type. Scroll:

Production. As a rule, this item includes the manufacture and production of medicines both according to doctors’ prescriptions and for healthcare organizations in the Russian Federation.
Supply. Dispensing and dispensing of medications/medicines for healthcare organizations and their structural divisions.
Informational. Employees of each pharmacy must be notified of the absence and availability of drugs in the institution, informed about new drugs and their correct use.
Trading. Sale of medicines to the public both with and without a doctor’s prescription.
Financial. Pharmacies have the right to accept cash, payment by bank card, process these monetary transactions, keep records of them, deposit funds in the bank and make other payments.
Packaging and dispensing of medicinal products.
Sale of medical goods and pharmaceutical assortment.
Control over quality, shelf life, integrity of packaging, proper storage location.
Compliance with the required sanitary standards and hygiene rules.
Consulting. The pharmacist must have sufficient knowledge about the drugs he sells and always explain to the public if there are questions of an informative nature regarding medicines, medical equipment, and other pharmacy products.
Development of instructions that affect the quality of service to the public and the work of staff.
Compliance with reporting.
Conducting self-inspection in accordance with the norms of the legislation of the Russian Federation.

All types of pharmacy organizations in the Russian Federation are subject to a single rule: their employees are required to know the latest updates in the law on medicinal products.

Job responsibilities of employees

Employees are required to know:

Rules for selling goods.
The law according to which pharmacy activities are carried out.
Acts regulating the rules of conduct of pharmacy workers.
Internal working hours of the pharmacy.
Own rights and obligations.
Rules for communication with the public.
The latest information about medicines sold by a particular pharmacy.
Rules for using a cash register and computer programs.
Approximate quantity of assortment.
In what place, department and on what shelf are the drugs located?
Answer questions competently, express your thoughts clearly and on medical topics.

Location of pharmacies

Each building in which a pharmacy is located must be located in the most populated area, within walking distance of hospitals, clinics, schools and other crowded places. It doesn’t matter what types of pharmacy organizations they are, their tasks and functions are to consistently serve the population and provide people with the opportunity to purchase the necessary medications at the right time. Accordingly, the location of pharmacies on the map of a locality is an important issue.

Nowadays, there are a lot of pharmacies that carry out their legal activities on the territory of the Russian Federation. It is worth noting that, according to all civil standards, pharmacies must be in any locality, regardless of whether it is a metropolis or a remote village.

Today, not every city with a small number of inhabitants can boast of having a pharmacy. People are forced to wander around in search of medications and call emergency medical care if they don’t have the necessary supplies at home. The Ministry of Health of the Russian Federation is closely involved in this issue, but its implementation may take years.

Existing types of pharmacy organizations are able to carry out their activities in the territory where they are located if their geographical location allows customers to easily and quickly reach them. Some citizens note that pharmacies located in cities and villages are located too far from their places of residence. Therefore, to visit a pharmacy, you sometimes need to go through a thorny path.

Central district pharmacy

The most important and large-scale institution in a district or city is the central pharmacy. In accordance with the document on approval of types of pharmacy organizations, it controls many processes related to medical products.

Responsibilities:

Providing pharmacies with toxic substances and ethyl alcohol.
Informing pharmacies and health care facilities about the receipt of medications.
Control of receipt and delivery of drugs from the warehouse.
Reception and correction of applications for the issuance of medicines.
If there is a body that manages pharmacies, deliver applications for drugs and medical equipment there.
Monitoring the supply, availability and condition of drugs for rural pharmacies.

Pharmacy staff according to regulations

All types of pharmacy organizations contain a minimum staffing table, which may include the following vacancies:

Pharmacist.
Nurse.
Defect.
Pharmacist-technologist.
Head pharmacist.

Each employee performs separate functions in accordance with the charter and regulations of the pharmacy organization. Personnel are required to comply with the regime and rules of the institution.

Pharmacist

Appointment and dismissal from this position is carried out by the head of the pharmacy of the healthcare facility. The performance of the pharmacist's duties is monitored by pharmacists: technologist and analyst. In order to work in this position, it is not necessary to have a higher education - a secondary pharmaceutical education is sufficient.

The pharmacist is obliged:

Manufacture drugs as prescribed by medical institutions.
Manufacture products according to medical prescriptions.
Prepare medications before dispensing.
Register the drug before dispensing.

Nurse

Appointment and dismissal from this position are made by the head of the medical institution.

Responsibilities:

cleaning of premises;
washing dishes and processing them.

Defectar

To apply for this position, an employee must have a higher pharmacological education. The head of the pharmacy institution or his deputy appoints and dismisses from this vacancy.

Responsibilities:

control of medication records;
accounting of medical supplies;
in-pharmacy preparations;
checking the presence of required labels and information on drug packages;
control of the shelf life of the drug, information about the manufacturer;
work with other information about medicines sold by a pharmacy.

Pharmacist-technologist

To be hired for this position, an employee must have a higher pharmacological education. He is appointed and dismissed by the head of the pharmacy institution, and the employee reports exclusively to the head of the pharmacy and his deputy.

Responsibilities of a pharmacist-technologist:

control over the preparation of prescriptions;
receiving prescriptions and requirements;
explaining information about medicines to the population;
registration of medicines and medical products that are available;
control over the storage of drugs;
accounting for the use of medications in departments and offices;
bringing information to medical personnel of hospitals, clinics and other institutions about the availability/absence of medications in the pharmacy.

Head pharmacist

In order to get this position, the employee must have a higher pharmacological education and more than 5 years of work experience in the field of pharmacology. This position is appointed by the chief physician of the medical institution by order. The head pharmacist has identical rights with the head of the health care facility department.

Responsibilities:

control over the work of the pharmacy as a whole;
monitors the correct production of medicines;
accounting for the dispensing of medications according to doctor’s prescriptions;
control over the supply of medical equipment to medical offices and laboratories;
ensuring proper storage of drugs and medical instruments;
controls the consumption of medications;
maintains special records of the consumption of narcotic and toxic substances;
ensuring pharmaceutical order in the pharmacy;
monitoring employees' compliance with sanitary and hygienic standards;
drawing up an estimate for obtaining medical equipment;
monitors how staff perform their duties;
issuing orders, instructions and other documents related to work in the pharmacy.

This list of pharmacy employees can be more extensive - it all depends on what types of pharmacy organizations are meant. Their characteristics and functions were described above.

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MANUAL FOR DESIGNING HEALTHCARE INSTITUTIONS (to SNIP 2-08-02-89) - SECTION V - AMBULANCE AND EMERGENCY MEDICAL STATION... Relevant in 2018

HOSPITAL PHARMACIES

1. The main tasks facing hospital pharmacies are the preparation, control and dispensing of medicines to departments of medical and preventive institutions.

For rational design, hospital pharmacies are divided according to the number of beds served into 5 groups: up to 200, 400, 600, 800 and 1000 beds.

<*>It is administered if there is an infectious diseases department in the treatment and prophylactic institution. Providence. separate external entrance through the vestibule.

<**>For the production of eye drops and dosage forms for newborns.

<***>It is allowed to place non-flammable substances in the basement, provided that the necessary storage conditions are created.

<****>When storing more than 100 kg - a separate building.

N p/p	The name of a room	Area, sq. m
		Number of beds served
		up to 500	501 - 1200	1201 - 1700	1701 - 2300
1	2	3	4	5	6
	Industrial premises
1.	Service room (information)	8	12	14	14
2.	Prescription - forwarding	12	16	28	28
3.	Assistant	24	42	48	56
4.	Washing	24	24	36	36
5.	Analytical	-	-	10	10
6.	Distillation	8	10	12	14
7.	Unpacking	8	15	20	24
8.	Room for the preparation of dosage forms requiring aseptic conditions:	10+3	14+4	14+4	14+4
	- assistant (with gateway)
	- aseptic
	- sterilization of dosage forms (autoclave)	10	18	18	18
Storage premises:
9.	Finished medicinal products	14	24	30	36
10.	Psychotropic drugs	6	8	16	18
11.	Medicinal substances: dry, liquid, thermolabile	14	30	30	33
12.	Disinfectants and acids	5	4+4	5+5	5+5
13.	Combustible and flammable liquids, as well as medicines containing alcohols, oils, etc. flammable liquids and gases.	6	8	10	10
14.	Medical supplies
	- dressings and medical instruments,	10	10	13	13
	- items for patient care, sanitation and hygiene	6	9	14	18
15.	Glass, containers, household products and auxiliary materials	6	10	14	18
Service and household premises:
16.	Manager's office	10	10	10	10
17.	Accounting	-	10	10	10
18.	Staff training room	8	15	24	24
19.	Staff wardrobe for work and home clothes	0.55 per double cabinet
20.	Cleaning storage room	4	4	4	4
21.	Staff room	8	10	15	18
22.	Restroom	3	3	3	3
23.	Shower	3	3	3	3
21.	Personal hygiene cabin	-	-	3	3
25.	Archive	4	4	4	4

7. The doors of premises for storing poisonous and narcotic drugs must be lined with iron; storage is carried out in safes; The premises are equipped with security and light and sound alarms.

8. In accordance with the progress of the production process, the prescription room should be located adjacent to the service (information) room. The service room must be moved closer to the expedition room.

The number of sections in the walk-through cabinet for storing completed orders in the forwarding room must correspond to the number of functional units of the medical institution.

9. The assistant must be brought closer to the analytical and, expediently, to the distillation. It is advisable to place a coctorium in close proximity to the assistant's room. The washing area and the storage room for clean dishes should be as close as possible to the assistant's room.

10. The blank (with a sluice) must have a direct relationship with the packaging and be as close as possible to the analytical one.

11. Between the premises of the aseptic complex, in accordance with the stages of the technological process, a consistent direct relationship must be ensured: washing of the aseptic complex - sterilization of utensils - assistant - aseptic (for the production of injectable dosage forms) - assistant aseptic (for the production of eye drops and dosage forms for newborns) - packaging with a sluice - seaming - sterilization of dosage forms - control - marking.

12. Assistant rooms - aseptic, packaging, seaming, sterilization of dosage forms, control and labeling can be connected sequentially to each other by transfer windows or through a door. The seaming station must be directly adjacent to the filling station and have a transfer device that ensures aseptic conditions.

13. All dosage form production and washing rooms must be provided with distilled water. The distillation room must be directly adjacent to the assistant room, the assistant room must be aseptic, or be as close as possible to them.

Drug provision for inpatients. Main tasks and functions of hospital pharmacies. Tasks and functions of a hospital pharmacy. Its features

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Depending on the profile and structure of health care facilities, hospital pharmacies can be:

1. General hospital pharmacies;

2. Pharmacies of specialized hospitals (tuberculosis, infectious diseases, psychoneurological);

3. Clinic pharmacies;

4. Health resort pharmacies.

Incoming control is carried out by an authorized person (head nurse, pharmacist or pharmacist of a health care facility pharmacy, approved by order of the head of the health care facility, their data is reported to the territorial state inspections).

Boundary standards for the storage of narcotic, psychotropic drugs and precursors in the structural divisions of health care facilities.

- Pharmacy of health care facilities - two-week requirement;

- Medical facility department - three-day requirement;

- Posts (offices) of health care facilities - two-day requirement;

- Hospital admission department for providing emergency medical care for vital signs in the evening and at night - five-day reserve;

- Outpatient clinics and first aid stations are a weekly requirement.

- The procedure for prescribing drugs and medical devices and PKU in the structural divisions of health care facilities.

- For narcotic drugs, in addition to the above, there must be: the medical history number, the patient’s full name, the name and dosage of these drugs, as well as their purpose. To receive drugs, a power of attorney is issued (valid for 10 calendar days).

PCU in health care facilities are subject to:

- Narcotic drugs.

- Psychotropic drugs.

- Precursors of list No. 1.

- Poisonous drugs (atropine and its salts - powder, tetracaine, trihexyphenidyl, peripheral muscle relaxants).

- Potent drugs (butorphanol, diphenhydramine (solid forms), clonidine (substance and liquid forms), methandienone, retabolil, promethazine).

- Combined drugs (solid forms) that contain tramadol, ephedrine, pseudoephedrine.

To serve health care facilities, pharmacies must have a number of additional premises, namely:

- medical personnel service room (information);

- order picking room;

- procurement of concentrates and semi-finished products;

- storage room for clean dishes;

- material for poisonous and narcotic drugs;

- material for storing thermolabile substances;

- material for storing medical products and others;

- unpacking.

Interhospital pharmacy staff:

- Administrative staff (pharmacy manager, pharmacist, chief accountant, safety engineer, economist);

- Pharmaceutical personnel (pharmacists, pharmacists);

- Support staff (packers, nurses);

- Maintenance personnel (premises repair worker, driver).

Responsibilities of a healthcare pharmacist

To perform functions regarding the organization of drug provision for inpatients in health care facilities that are attached to pharmacies, the position of a pharmacist (but not more than two persons) is introduced, who is directly subordinate to the chief physician or his deputy.

Responsibilities of such a pharmacist:

- acceptance and verification of orders from health care facilities;

- acceptance of completed orders from the pharmacy and timely transfer of drugs and medical devices to the appropriate departments;

- constant communication with doctors, informing them about medications;

- control over compliance in departments and offices of health care facilities with established rules for storing drugs.

Similar documents

2. Assortment of medicines in a hospital pharmacy

3.Features of drug technology in a hospital pharmacy

Bibliography

INTERMEDIATE POSITION

PROBLEMS OF CORRECT ORGANIZATION

NO PHARMACY IS DIFFICULT, THERE IS EVEN DIFFICULT

A VIEW FROM INSIDE

Pharmaceutical activities

Types of pharmacies

The nature of the production activities of pharmacies

Functions of pharmacies

Job responsibilities of employees

Location of pharmacies

Central district pharmacy

Pharmacy staff according to regulations

Pharmacist

Nurse

Defectar

Pharmacist-technologist

Head pharmacist

HOSPITAL PHARMACIES