Hospital Pharmacy: Location, Layout, and staff requirements
Location of Hospital Pharmacy
The pharmacy should be situated on the ground floor or the first floor to ease its accessibility and to provide adequate service to various departments and nursing stations. If the hospital has an outpatient department, the pharmacy or its branch should be near it. In a multi-story hospital, each floor should have a pharmacy. The layout of floor pharmacies should be such that a continuous flow of men and materials is maintained.
A complete unit of the hospital pharmacy includes the following areas:
1) Office of the Chief,
2) Out-patient dispensing unit,
3) Bulk compounding area,
4) Manufacturing unit for sterile and non-sterile preparations,
5) Packaging and labeling area,
6) Alcohol and volatile liquid area,
7) Narcotic vaults,
8) Radioisotope storage & dispensing area,
9) Central sterile supply area,
10) Cold storage area,
11) Research wing,
12) Pharmacy store room,
13) Library, and
14) Waiting room
An out-patient pharmacy should look pleasant and have enough space and seating arrangements for patients waiting for the medicine to avoid overcrowding. The waiting room in the outpatient pharmacy should have a professional look, bear educative posters on health and hygiene, and hold light literature for reading to engage the visitors. This puts a positive impact on the pharmacy and on the visitors.
To manufacture bulk preparations (like stock solutions, bulk powders, ointments, etc.) routinely, a suitable space adjacent to the pharmacy or in the basement directly below the pharmacy should be provided. The medical stores of the pharmacy should lie adjacent to the pharmacy or beneath the pharmacy
Layout of Hospital Pharmacy
The general design and construction of a hospital pharmacy should consider its functionality. The location and size should accommodate anticipated personnel and inventory movement, work processes, and activities.
Built-in storage and fixed equipment should be provided for storing documents, bulk supplies, dangerous drugs, psychotropic substances, portable medical gas cylinders, and refrigerated and cold-chain items. Drainage and sewerage system should be present outside the premises
Structural Design
1) Wall: The walls should be of non-porous material and plastered on both sides. The indoor wall finishing should be of washable antifungal paint and the outdoor finishing should be of weather-proof paint. The walls for the cold rooms should be of special building material and design to prevent condensation.
2) Floor: The floor should be of concrete and smoothly plastered. The floor finishing should be of a non-slippery heavy-duty material to withstand heavy loads and traffic. The floor should be non-porous, damp-proof, and resistant to detergent. The floor-to-ceiling height should range from 15 -30 feet according to the functional area and handling equipment used.
3) Ceiling: The ceiling should be of fire-retardant, asbestos-free, and non-shedding materials or mineral fibers.
4) Roof: The roof should be pitched or sloped to prevent heavy rain damage.
5) Door: The doors should be of fire-retardant material. The doors should have two leaves and should be sufficiently wide to allow free and easy movement of supplies and handling equipment (such as forklifts and stackers). The exit doors should be purposefully located and fitted with luminous emergency exit signage.
6) Window: The windows should be available at workstations, offices, and staff areas, but not in storage areas.
Receiving Area
1) Loading and Unloading Area: This area should be adequately spaced and properly sheltered by taking care of the vehicle height.
2) Receiving Counter: It should have adequate waiting space and should be equipped with suitable office furniture and equipment.
3) Sorting and Unpacking Area: This area should be adequately spaced to enable the sorting and checking of goods. The space should be sufficient for the utilization of a forklift.
4) Transit/Holding Area: The transit/holding area should be adequately spaced for storing:
i) Items requiring further clarification/investigation before receiving,
ii) Transit items not requiring special storage conditions, and
iii) Pallets.
5) Disposal Room: This room should store discarded items (like used boxes, wrappers, and plastic covers).
Storage Area
1) General Storage Requirement: The storage area should be provided with air – conditioning facilities for 24 hours. Its temperature should be effectively controlled between 160 -250C. The electrical supply to refrigerators, freezers, cold rooms, and air conditioning facilities should be linked to the hospital emergency power supply.
A computerized alarm system should be connected to the main electrical control system of the hospital for detecting the electrical failure of cold chain equipment. Adequate space should be provided for forklifts, stackers, and trolleys, and for accommodating IT facilities. The area should have sufficient numbers of pallets, shelves, and racks.
2) Drug Store: It should have adjustable, modular, heavy-duty open racks for storing packages of different sizes. It should have a sufficient storage area for bulk items. It should be equipped with heavy-duty plastic pallets for storing bulk items and larger cartons off the floor. These pallets should be designed to be used with forklifts to move around groups of larger items. The drug store should have a designated area with cautionary signage and a chemo-spill kit for cytotoxic drugs.
3) Dangerous Drugs/Psychotropic Substances Store: This area is meant for storing dangerous drugs/psychotropic substances, thus should be kept under lock and key in a special room/cabinet with an alarm system.
4) Cold Room/Pharmaceutical Refrigerator/Freezer Area: This area should be provided based on the functionality of the hospital. It should be present within the drug store for storing drugs that require low storage temperatures (like vaccines, antisera, and other biological products). Every cold room/pharmaceutical refrigerator/freezer should be equipped with a computerized temperature recorder system.
5) Intravenous (IV) Fluid Store: This area should be adequately spaced to accommodate hemodialysis and peritoneal dialysis solution, and intravenous solutions. The space should also be sufficient for using the forklift.
6) Surgical Store: This area is designed for storing bulk surgical/consumable/disposable items /X-ray films. It should have adjustable, modular, and heavy-duty open racks. It should be provided with adequate space to accommodate bulky items.
7) Non-Drug Bulk Store: This area is designed for storing dispensing bottles, containers, labels, and envelopes. It should have adjustable, modular, and heavy-duty open racks. It should be provided with adequate space to allow easy movements.
Store with Special Requirement
1) Inflammable Store: This area should be located at a minimum of 10 feet distance away from other adjacent buildings. It should be designed for storing inflammable items (ethanol, methanol, acetone, etc.) and should be equipped with fire fighting equipment, smoke detectors, and exhaust fans for proper ventilation. The location and design of an inflammable store should provide maximum air circulation so that the accumulation of fumes or gases can be avoided. Spar-proof switches should be present outside the room.
2) Corrosive Items Store: This area should be designed for the storage of corrosive items ( such as phenols and hypochlorites). It should be equipped with special plumbing and drainage system and an eye wash station.
3) Medical Gas Store: This area should be designed for the storage of portable medical gas cylinders. The floor should be reinforced to bear the weight of heavy gas cylinders. Loading and unloading areas should be made present and sheltered well. The bay should be constructed to enable direct loading and unloading of goods. All electrical facilities should fulfill the requirements of the Fire Fighting and Rescue Departments and the Department of Environment. Proper ventilation should be maintained.
4) Quarantined Item Store: A designated area or cabinet should be provided and clearly labeled.
5) Non-Conformance/Condemned Item Store: Designated store/cabinet for expired, obsolete, or damaged items should be provided prior to disposal.
Floor Space Requirements
The hospital pharmacy floor area depends on the range of its operations, number of divisions, medicaments manufactured, the number of patients served (out-patient pharmacy), the number of indoor patients, the strength of the pharmacy staff, etc. The floor space should be in accordance with the norms laid down by the Drugs and Cosmetics Act (under Schedule M). The floor area should be a minimum of 250m 2. The area requirements increase to 10m 2 per bed for 100 beds, 6m 2 per bed for 200 beds, and at least 5m 2 per bed for larger hospitals. Teaching institutes demand a greater area.
Staff Requirements
The hospital pharmacy comprises many departments as per the setup of the hospital. In a small set-up, it has a dispensing department and a medical store; while in a big set-up, it has manufacturing, quality control, and clinical pharmacy departments also.
The number of pharmacy staff members relies on the following factors:
1) Number of beds,
2) Service-out-patients and in-patients,
3) Whether the pharmacy is involved in manufacturing drugs or formulations, and
4) Whether the pharmacy is involved in stocking and dispensing surgical and laboratory supplies.
A hospital pharmacy should appoint the following staff personnel:
1) One member as the Chief pharmacist or Director.
2) At least 4 registered pharmacists in smaller hospitals so that one pharmacist handles 60 patients. Total patients involve (both in-patients and out-patients).
3) a Sufficient number of assistants, attendants, and sweepers.
4) Pharmacist-cum-clerk or clerks depending on the hospital size.
5) A hospital pharmacy manufacturing drugs and formulations should have manufacturing chemists and analytical chemists supported by additional assistant pharmacists.
6) For 50-bedded, 100-bedded, 200-bedded, 300-bedded, and 500-bedded hospitals, 3, 5, 8, 10, and 15, respectively pharmacists are needed. In big hospitals, one pharmacist is recommended for 133 patients.
Qualification
The Chief Pharmacist or Director should be a postgraduate degree holder in pharmacy (preferably in pharmacology or hospital pharmacy). The manufacturing chemist is required to have graduated in pharmacy and hold experience in manufacturing drugs and formulations for at least 18 months. The analytical chemist should be a postgraduate in pharmaceutical chemistry or analytical chemistry. Registered pharmacists and pharmacists-cum-clerk require a diploma in pharmacy and registration in-state pharmacy council.
Frequently Asked Questions (FAQs) on the location and layout of hospital pharmacy
The layout of a hospital pharmacy is essential for efficient operations, ensuring timely medication dispensing, accurate preparation of medications, and maintaining patient safety. A well-designed layout promotes a smooth workflow and minimizes the risk of errors.
Several factors influence the layout of a hospital pharmacy, including the size of the facility, the types of services provided, the volume of prescriptions, storage requirements, regulatory guidelines, and accessibility for pharmacy staff and patients.
The workflow in a hospital pharmacy is typically organized into distinct zones, such as prescription receiving and processing, medication preparation, compounding, dispensing, inventory management, and consultation areas. Each zone is strategically placed to optimize efficiency and reduce the risk of cross-contamination.
This area is where prescriptions are received, reviewed, and entered into the pharmacy information system. Pharmacists verify the accuracy of prescriptions, check for potential drug interactions, and determine appropriate dosages before proceeding to medication preparation.
Medication preparation involves compounding and assembling medications as per the prescriptions. It’s crucial to have dedicated spaces for compounding sterile and non-sterile medications, each equipped with the necessary equipment, such as laminar flow hoods for sterile compounding.
Proper inventory management is vital to ensure a consistent supply of medications. The layout should accommodate storage areas for different categories of medications, with clear labeling, proper lighting, and temperature control as required.
The layout of a hospital pharmacy should adhere to infection control protocols, including proper ventilation, segregation of sterile and non-sterile areas, and easy-to-clean surfaces. Patient safety is maintained by implementing barcoding and automated dispensing systems, reducing the risk of medication errors.
Yes, high-alert medications, which have a higher risk of causing harm if used improperly, should have a designated area in the pharmacy. These medications may require additional verification steps and double-checking to ensure accurate dispensing.
Hospital pharmacies often have consultation areas where pharmacists can interact with patients, answer their questions, provide medication counseling, and offer recommendations for proper medication use. These areas are designed to ensure patient privacy and comfort.
Technology integration, such as pharmacy information systems and automated dispensing machines, can streamline operations and reduce the physical space required for certain tasks. This can influence the allocation of workspace and storage areas within the pharmacy layout.
Pharmacy layouts must comply with local, state, and federal regulations, including guidelines from regulatory bodies such as the Board of Pharmacy and the Joint Commission. Compliance ensures the safe and effective functioning of the pharmacy.
A flexible layout is designed to accommodate potential changes in pharmacy services or expansion. Consideration should be given to the adaptability of the layout to incorporate new technologies, services, or changes in patient volume.
In summary, the layout of a hospital pharmacy is a carefully planned and organized space that promotes efficient workflow, patient safety, and compliance with regulatory standards. It encompasses various zones, each serving a specific function, and is designed to adapt to the evolving needs of the healthcare facility.
