HospitalPharmacy ChapterNo. Dated:1/3/2011 AtTime:12:50:36 Hospital Pharmacy HospitalPharmacy ChapterNo. Dated:1/3/2011 AtTime:12:50:36 HospitalPharmacy ChapterNo. Dated:1/3/2011 AtTime:12:50:36 Hospital Pharmacy SECOND EDITION Edited by Martin Stephens BPharm,MSc,MRPharmS,MCPP AssociateMedicalDirector,ClinicalEffectivenessandMedicinesManagement SouthamptonUniversityHospitalsNHSTrust Southampton,UK HospitalPharmacy ChapterNo. Dated:1/3/2011 AtTime:15:42:19 PublishedbyPharmaceuticalPress 1LambethHighStreet,LondonSE17JN,UK 1559St.PaulAvenue,Gurnee,IL60031,USA (cid:1)RoyalPharmaceuticalSocietyofGreatBritain2011 isatrademarkofPharmaceuticalPress PharmaceuticalPressisthepublishingdivisionofthe RoyalPharmaceuticalSociety Firsteditionpublished2003 Secondedition2011 TypesetbyThomsonDigital,Noida,India PrintedinGreatBritainbyTJInternational,Padstow,Cornwall ISBN9780853699002 Allrightsreserved.Nopartofthispublicationmaybereproduced, storedinaretrievalsystem,ortransmittedinanyformorbyanymeans, withoutthepriorwrittenpermissionofthecopyrightholder. Thepublishermakesnorepresentation,expressorimplied, withregardtotheaccuracyoftheinformationcontainedinthis bookandcannotacceptanylegalresponsibilityorliabilityforany errorsoromissionsthatmaybemade. TherightofMartinStephenstobeidentifiedastheauthorofthiswork hasbeenassertedbyhiminaccordancewiththeCopyright,Designsand PatentsAct,1988. AcataloguerecordforthisbookisavailablefromtheBritishLibrary. HospitalPharmacy Dedication Dated:18/2/2011 AtTime:18:35:9 Dedication Marjorie,thankyouforyourpatientsupport. HospitalPharmacy Dedication Dated:18/2/2011 AtTime:18:35:9 HospitalPharmacy ChapterNo. Dated:1/3/2011 AtTime:15:59:0 Contents Preface xv Abouttheeditor xvii Contributors xix Abbreviations xxiii Introduction xxvii 1 HospitalpharmacywithintheNationalHealthService 1 MartinStephens History 1 Paymentbyresults 3 TheNextStageReview 4 TheNHSfrom2010 6 HospitalpharmacywithintheNHS 7 Thefuture 12 References 12 Furtherreading 13 2 Pharmacyintheacuteindependentsector 15 KarenHarrowing Introduction 15 IndependentsectorandtheNHS–fromconcordattofreechoice 17 Pluralityofprovisionandpatientchoice 19 References 26 Furtherreading 26 3 Purchasingmedicines 27 HowardStokoeandPhilDeady Background 27 Aimsoftheservice 28 Howtheservicehasdeveloped 29 HospitalprocurementandtheapplicationofEUlegislation 30 HospitalPharmacy ChapterNo. Dated:1/3/2011 AtTime:15:59:0 viii | Contents Lookingforward 38 References 39 Furtherreading 39 4 Medicinessupplyandautomation 41 ChrisGreenandDonHughes History 41 Currentsystems 42 Storagearrangements 46 Orderingwardstock 48 Supplytooutpatients 49 Newandemergingtechnologies 53 References 54 Furtherreading 55 5 Controlleddrugsinhospitalpharmacy 57 LizMellor Background:legislativeframework 57 Theaccountableofficer 58 Standardoperatingprocedures 59 Routinemonitoringandauditing 59 Inspection,self-assessmentanddeclarationtotherelevant authority 61 Collaborationandlocalintelligencenetworks 61 Medicinesmanagement 62 Conclusion 66 References 66 Furtherreading 68 6 Technicalservices 69 GrahamSewell History 70 Licensingissues 72 Repackaging(prepacking,assembly) 72 Non-sterilemanufacture 76 Sterilemanufacture 79 Asepticpreparation 81 Intravenousadditives 82 Totalparenteralnutrition 83 Cytotoxics 84 Radiopharmaceuticals 84 Facilitiesandequipment 85 HospitalPharmacy ChapterNo. Dated:1/3/2011 AtTime:15:59:0 Contents | ix Educationandtrainingforhospitaltechnicalservices 88 Healthandsafetyandenvironmentalissues 89 Thefuture 89 Acknowledgement 91 References 91 Furtherreading 92 7 Qualityassurance 93 IanMBeaumont TheNHSqualityagendaandtheroleofthequality assurancepharmacist 94 Clinicalgovernance 95 Riskmanagement 96 Medicationerrors 96 TheaimsofNHSpharmaceuticalqualityassuranceservices 96 Development,issue,implementationandmonitoring ofstandardsandguidance 97 Qualityassuranceandqualitycontrolofmedicines 98 Thefuture 106 References 107 Furtherreading 109 8 Medicinesinformation 111 PeterGolightlyandChristineProudlove History 111 Structureandactivities 112 Aimsandstrategy 113 Rolesandskills 116 Ethicsandlegalissues 117 Clinicalgovernanceandriskmanagement 117 Activities 122 Supportfordecision-makingonnewmedicines 124 Conclusion 135 References 136 Furtherreading 138 9 Clinicalpharmacy 139 DamianChild,JonathanCookeandRichardHey Introduction 139 Whatisclinicalpharmacy? 139 ThehistoryofclinicalpharmacyintheUK 140 Prescriptionmonitoring 144