Describes the meaning of the manual in simple words, need and scope of the manual in the hospitals and contents of it.

1. Hospital Pharmacy
Procedural Manual
- Devyani Joshi

2. Mission and motto of
Hospital
Excellence in health
care service

3. Guidelines of the manual focus on
professional attitude, ethics,
knowledge, commitments,
responsibilities and skills for
provision of total health care
facilities.

4. Definition
 Hospital Pharmacy Procedural Manual
contains a series of administrative and
professional policies which are formulated
to provide guidelines for development and
execution of efficient and safe
pharmaceutical services at the hospital.

5.  It is a document intended to encourage
national pharmaceutical organizations to
focus attention of pharmacist in the
community and hospital pharmacy sector.
 It provides a framework according to
which each hospital will decide
reasonable aspirations and proceed to set
its own standards.

6. Hospital in general and
pharmacy in particular should
develop written policies for
number of reasons:
 They serve as a guide for training of new employees.
 They prevent errors resulting from verbal
transmission of the policy from one employee to
another.
 They ensure that same policy applies in all similar
situations.

7.  They serve as control tool in ensuring a defined
procedure for transforming a task eliminating
wastage through error or carelessness.
 In hands of the supervisor, they serve as means
of evaluation job performance.
 In the legal case, they serve as the important
element in hospital’s defence of an action resulting
in loss arising out of an error caused by the
pharmacy department.

8. Hospital pharmacy
procedural manual is aimed
at providing efficient and
economical drug services.

9.  The Joint Commission on accreditation of
hospitals has created a standard for
pharmaceutical services which mandates for the
preparation of written policies and procedures that
pertain to the intrahospital drug distribution
systems
 The interpretation of this standard provides the
hospital pharmacist an appropriate guideline as to
what must be included in the procedural manual in
order to make the hospital accredited.

10. Scope
 First operational manual must contain the recorded
development from its very beginning, its objectives,
philosophy, motivation, policies, regulations,
departmental procedures, staffing pattern, job
specifications, organizational plans and charts,
description of the department, listing of physical
facilities and library holdings.
 It also includes inter and intra departmental
relationships, description of formulary system,
pharmacy and therapeutic committee and its
activities.

11. Contents and Format
 The procedural manual is usually divided
into policies related to the following
sections.
○Organizational policies
○Facilities and procedures
○Personnel guidelines
○Services and activities offered by
pharmacy department

12. Organization
 Organization of the hospitals
 Organization of the pharmacy department
 Objectives and functions of pharmacy services
 Responsibilities of pharmacy department
 Services offered by pharmacy department
 Inter and intradepartmental relationships
 Pharmacy and Therapeutics committee
 Pharmacy licensing policies and regulatory
requirements

13. Equipment and Physical Plant
 General policies relating to use, maintenance and
repairs of pharmacy equipments
 The distilled water still, Ointment mill, High speed
mixer, Capsule filling machine, Homogenizer etc
 Policies and procedures governing the loan of
pharmacy equipments
 Obtaining engineering department services for the
pharmacy like air conditioners
 Policies governing the use of laboratory
equipments in a controlled manner.

14. Personnel policies
 Job descriptions
 Sick leave
 Vacation period
 Holidays and on call services
 Emergency duty
 Attending training programmes, seminars etc

15. Services and activities
Administrative policies Professional policies
 Policies of pharmacy
department
 Personnel recruitment
 Hours of operation
 Performance evaluation
 Purchasing procedures
 Refund policy
 Handling of cash receipt
 Requisition of charge and non
charge floor stock drugs
 Inventory taking and records
of stock control
 Compounding and dispensing
records
 Drug distribution system for
inpatients
 Distribution of ward stock drugs
and emergency drugs
 Verification of medication order
 Employee prescriptions
 Narcotic regulations
 Use of research and
investigational drugs
 The formulary system
 Sterile compounding
 Bulk compounding procedures
 Drug information services

16. Pharmacy communications and
bulletins
o Selection of Title
o It should be specific and short
o Contents
o Editorial- by chief pharmacist
o New drug section
o Abstract of pharmacy committee meetings
o Lead articles by prominent members of the medical
staff
o Format or Duplication

17. o Distribution
oMembers of medical staff, library,
administration, nursing services and
laboratories are sent a copy of
pharmacy publication
o Advantages
oBetter means of communication
compared to telephonic or verbal
conversation