SHORT TERM: MIDTERMS

PHARM 231: HOSPITAL PHARMACY

LECTURE

UNIT 1: THE HOSPITAL AND ITS ORGANIZATION

OUTLINE BASIC FUNCTIONS OF A HOSPITAL
A. The Hospital • PATIENT CARE: the hospital is involved with inpatient
B. Hospital Classification services, outpatient services, medications and other
a. Type of service relevant services intended directly to patients.
b. Length of stay • EDUCATION: a hospital can be utilized as training sites/
c. Ownership internship for future health care workers and ensuring the
d. Hierarchy of services rendered continuing education for staff as well.
e. Bed capacity • RESEARCH: a hospital can participate in a review and/or
f. Teaching affiliation documentation of cases, administration of clinical trials.
C. Hospital Organization • PUBLIC HEALTH: make the public more aware by
D. Clinical Departments conducting information dissemination via posters and
E. General and Other Services other printed media.
B. HOSPITAL CLASSIFICATION
A. THE HOSPITAL
• The HOSPITAL is a complex organization utilizing
ACCORDING TO TYPE OF SERVICE
combinations of intricate specialized scientific equipment, • GENERAL HOSPITAL: a type of hospital that is intended
and functioning through a corps of trained people educated to treat a wide variety of disease through provision of
to the problems of medical science. patient care with various type of illnesses. This hospital
also involves treatment of all kinds of diseases.
• A hospital is a community institution which is an instrument
o Equipped with the service capabilities
of society. It serves as the focal point for coordination and
needed to support board certified/eligible
delivery of patient care to its community. While the hospital
medical specialists and other licensed
was once considered only as a place where patients were
treated, today it is considered as a viable institution which physicians rendering services in, but not
extends its services to patients wherever they may be limited to, the following:
▪ Clinical Services (family medicine,
located.
pediatrics, internal medicine,
• For example, hospitals provide services to patients:
obstetrics and gynecology,
o Within the institution itself
surgery)
o In ambulatory care clinics
▪ Emergency Services
o Emergency rooms and emergency care
▪ Outpatient Services
centers
▪ Ancillary and Support Services
o In physician’s offices at the hospital
such as, clinical laboratory,
o In extended care facilities and nursing
imaging facility and pharmacy.
homes either affiliated with or owned by the
o Examples:
hospital
▪ Philippine General Hospital (PGH)
o In the homes of those who require home
▪ Baguio General Hospital – Medical
health-care services
Center (BGH-MC)
o At wellness centers and at community or
• SPECIALTY HOSPITAL: a hospital that treats patient with
neighborhood health clinics
only selected diseases.
RP Health Craft Carrier
o Tx of a particular type of illness or for a
• The hospital on wheels particular condition requiring a range of
• GOAL: reaching Filipino families which are unable to get treatment.
medical treatment in surgery due to lack of resources. o Tx of patients suffering from diseases of a
• “mobile hospital on wheels”, make shift medical facility in particular organ or groups of organs.
times of need. o Tx of patients belonging to a particular
• HEAD: Dr. Juan “Jim” Sanchez, a general and plastic group such as children, women, elderly and
surgeon. others.
• Conducted more than 200 surgical missions and served HOSPITAL SPECIALIZATION
10,000 indigent surgical patients. Fabella Memorial Hospital Obstetrics, newborn,
• Most common surgeries: external soft tissue tumors, cleft, maternal patients
lip, and inguinal hernia cases. Philippine Orthopedic Orthopedics,
• According to Dr. Sanchez, its purpose is to bring Center neuromuscular diseases
healthcare to the people, instead of people going to the San Lazaro Hospital Communicable diseases
hospital. Philippine Heart Center Heart diseases
• Help the government reduce the load of patients. Philippine Lung Center Lung diseases
 UNIT 1: THE HOSPITAL AND ITS ORGANIZATION

In this classification, hospitals can be easily distinguished • a hospital setting where patients
through their names “general” or “hospital + specialty”. are referred for very intensive
ACCORDING LENGTH OF STAY subspecialty care. It requires the
CHRONIC CARE services of a physician and a
ACUTE CARE HOSPITAL hospital equipped to treat
HOSPITAL
“Short-term” “Long-term” extremely complex problems
admits patients who have provides for patients TERTIARY CARE less frequently seen or managed
either temporary or acute requiring either permanent HOSPITAL in a community hospital setting.
illnesses that can be treated or prolonged hospitalization • Examples of admission:
in a relatively short period of for rehabilitation, or inability Treatment of cystic fibrosis,
time to be managed in the organ transplants, management
ambulatory setting of neoplastic diseases.
Usually less than 30 days Usually greater than 30 • Hospital: Cagayan Valley
days Medical Center
ACCORDING TO OWNERSHIP Although some hospitals generally provide tertiary care, they
also often treat a combination of primary, secondary and
GOVERNMENT NON-
HOSPITAL GOVERNMENT/PRIVATE tertiary care hospitals.
HOSPITAL
non-profit hospital owned by hospital that is responsible ACCORDING TO BED CAPACITY
federal, state, or municipal for their own funding. It is SMALL HOSPITAL Covers up to 100 beds
governments (country and typically owned and Caters for more than 100
city hospitals). This type of operated by religious MEDIUM HOSPITAL beds but not less than 300
hospital generally receives organizations, nonsectarian bed capacity
some funding from a branch organizations, or other Contains more than 300
LARGE HOSPITAL
of the government and are corporations, or associated beds
responsible to it. with universities. Note: This type should not limit one’s admission.
TYPES:
• PROFIT: profits or ACCORDING TO TEACHING AFFILIATION
dividends are paid to
• A hospital that operate
owners or shareholders
residency training
(whether individual,
programs in medicine,
partnership (at least 3),
surgery, pediatrics, and
or as corporation (at
other specialty areas.
least 15).
• Resident physician (the
• NON-PROFIT: there is TEACHING HOSPITAL
one receiving
no profit or dividends
specialized clinical
involved (ie. Church,
training in a hospital)
community, private)
provide patient care
ACCORDING TO HIERARCHY OF SERVICES under supervision of the
RENDERED hospital’s medical staff.
• this hospital is the starting point • a hospital that do not
for entry into the health care operate their own
system. residency training
• Primary care patients are TEACHING-AFFILIATED programs but serve as a
typically admitted by a family HOSPITAL training site for residents
practitioner, pediatrician or or students from a
PRIMARY CARE nearby university
general surgeon.
HOSPITAL
• Examples of admission: hospital.
Common acute illnesses such as • Offers no residency
flu, tonsillitis, emergency NON-TEACHING training programs and
appendectomy. HOSPITAL no university hospital
• Hospital: Batanes General affiliation
Hospital SUMMARY OF THE NEW CLASSIFICATION OF
• a type of hospital in which HOSPITALS AND OTHER HEALTH FACILITIES
referral services are immediate OTHER HEALTH
in intensity (ie. referral to a HOSPITALS
FACILITIES
specialist). GENERAL A. Primary Care Facility
• Examples of admission: A • Level 1 B. Custodial Care Facility
patient who receives a referral • Level 2 C. Diagnostic/Therapeutic
SECONDARY
from his general practitioner to a
CARE HOSPITAL • Level 3 Facility
cardiologist, resulting in a
(Teaching/Training)
hospital admission for evaluation
SPECIALTY D. Specialized Out-Patient
and treatment of coronary artery
Facility
disease.
Refer to the DOH A.O. No. 2012-0012
• Hospital: Grupo Medico De Dios,
Inc.

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 UNIT 1: THE HOSPITAL AND ITS ORGANIZATION

C. HOSPITAL ORGANIZATION MAIN TYPES OF MEDICAL STAFF

• Refers to levels of management within a hospital. These • One in which certain physicians,
levels allow efficient management of hospital departments other than those on the attending
and aid in understanding the hospital’s chain of command. or active medical staff, are allowed
OPEN STAFF
to use the private room facilities.
• These staff comply with all rules &
regulations of the institution.
• One in which all professional
services, private & charity are
CLOSED STAFF
provided & controlled by attending
or active medical staff.

MEDICAL STAFF MEMBERS

• Responsible for the delivery of
majority of medical services within
the hospital.
A. GOVERNING BODY AND MANAGEMENT • Most involved in the organizational
ACTIVE
• Has the over-all responsibility for the conduct of the MEDICAL
and administrative duties
hospital in a manner consonant with the hospital’s STAFF/
pertaining to the medical staff
objective of making available high-quality patient care. ATTENDING • Regular patient care, responsible
• The management adopts by-laws identifying the for taking care of patient who has
management of the hospital and the means of fulfilling direct involvement w/ staff
organization & administrative
them.
duties.
• They are considered the policy-making body and provide
• Individuals who are being
the overall mission & goals of the hospital.
considered for advancement to the
B. ADMINISTRATION ASSOCIATE
active medical staff appointed and
MEDICAL
• It provides the active management of the hospital. assigned to the various services in
STAFF/JUNIORS
• This level establishes an organizational structure to carry the same manner as the members
out the programs of the hospital to meet the needs of of the active medical staff.
patients, implement hospital policies and procedures. • May neither vote nor hold office in
• The administration oversees budgeting and finance. the medical staff organization.
MEMBERS OF ADMINISTRATION • They are given privileges to admit
COURTESY
an occasional patient to the
Composed of interested MEDICAL
hospital.
community members who STAFF
BOARD OF TRUSTEES
donate their time in the • They are considered not a
OF GOVERNING member but allowed to attend a
hospital in being responsible
BOARD private patient.
for philosophy, personnel,
policies and standard of care. CONSULTING • Medical practitioners of
Appointed by the Board, MEDICAL recognized professional ability
he/she is responsible for the STAFF
overall operational of the • Former staff members, retired or
ADMINISTRATOR emeritus, and other practitioners
hospital to see that the policies
and standards set for the by whom the medical staff chooses to
HONORARY
the Board are maintained. honor.
MEDICAL
Approved by the Board after • They are resident Medical staff
STAFF
careful consideration if each which are full time employees that
application. The medical provide patient services in
MEDICAL DIRECTOR director supervises all the staff exchange for training/ experience.
members who are responsible
for student doctors and CLINICAL DEPARTMENTS OF A HOSPITAL
residents • Hospitals vary widely on the service they offer and
Responsible for the particular therefore, also the departments they have.
function of the specific • Hospitals may have acute services such as an emergency
department, it also includes department or specialized trauma center, burn unit,
DEPARTMENT
hiring and firing personnel,
DIRECTORS surgery, or urgent care.
supervising department
DEPARTMENT OF MEDICINE
personnel, and maintaining
policies and standards. • The field of health and healing.
C. MEDICAL STAFF • It includes nurses, doctors, and various specialists.
• It covers diagnosis, treatment, and prevention of
• Backbone of any hospital disease, medical research, and many aspects of health.
• Responsible for quality of all medical care provided to • Backed up by more specialized units.
patients. Apply scientific knowledge and
• This level is composed of physicians or doctors. They are clinical expertise to the
INTERNAL MEDICINE
responsible for the delivery of majority of medical services diagnosis, treatment, and
within the hospital. compassionate care of adults

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 UNIT 1: THE HOSPITAL AND ITS ORGANIZATION

across the spectrum from DEPARTMENT OF SURGERY

health to complex illness. • Mostly involved in preoperative diagnosis of the patient,
Diagnose, treat and manage for performing the operation, and for providing the
allergies, asthma and patient with postoperative surgical care and treatment.
ALLERGY AND
immunologic disorders Focuses on surgical treatment for
IMMUNOLOGY
including primary gastrointestinal diseases. In
immunodeficiency disorders. particular, it offers hepatectomy
GENERAL
Provides medical care to for liver cancer (primary,
SURGERY
CARDIOLOGY patients who have problems metastasis) and laparoscopic
with their heart or circulation. surgery for colonic and rectal
Deals with the skin, its cancer and gallstones.
DERMATOLOGY structure, functions, and Concerned with conditions
ORTHOPEDIC
diseases. involving the musculoskeletal
SURGERY
Concerned with the structure, system.
ENDOCRINOLOGY function, and disorders of the Deals with cerebrovascular
endocrine glands diseases, brain tumors, spinal
Prevent disease, disability, cord tumors, and diseases
and death caused by a wide NEUROLOGIC related to the craniospinal nerves
range of infectious diseases. SURGERY such as cranial injuries. It also
The center focuses on treats functional disorders such
diseases that have been as trigeminal neuralgia and facial
INFECTIOUS around for many years, spasms.
DISEASES emerging diseases (those that Capability in the medical and
are new or recently identified), OBSTETRICS AND surgical care of the female
and zoonotic diseases (those GYNECOLOGY reproductive system and
spread from animals to associated disorders.
people) Involving complex surgical
procedures, such as
OPHTHALMOLOGY
Investigates and treats reconstructive surgery or
GASTROENTEROLOGY digestive and upper and lower advanced vision repair.
gastrointestinal diseases. Refers to a broad range of
DENTAL AND ORAL
Deals with the problems and medical procedures that involves
SURGERY
diseases of old age and the the gums and teeth.
GERIATRICS
medical care and treatment of Focused on the ears, nose, and
aging people. throat, it involves head and neck
monitors and assesses OTOLARYNGOLOGY surgery because specialists are
patients with various kidney trained in both medicine and
NEPHROLOGY
(renal) problems and surgery.
conditions. Special type of surgery that can
A medical specialty dealing PLASTIC SURGERY change a person's appearance
with disorders of the nervous and ability to function.
system. Specifically, it deals perform corrective colorectal
with the diagnosis and PROCTOLOGY surgeries to repair the colon,
NEUROLOGY
treatment of all categories of rectum or anus.
disease involving the central, Works in close cooperation with
peripheral, and autonomic the Department of Pulmonary
nervous systems Medicine it involves surgery on
Deals with the health and the lungs, mediastinum, thoracic
medical care of infants, wall, diaphragm, and
PEDIATRICS THORACIC
children, and adolescents from trachea/bronchi is conducted by
SURGERY
birth up to the age of 18. well experienced team consisting
Concerned with the anatomy, of various specialists such as
PULMONARY
physiology, and pathology of thoracic surgeons,
DISEASES
the lungs. anesthesiologists, OR staffs, and
Treat patients for pathologists.
musculoskeletal disorders Focuses on the urinary tracts and
RHEUMATOLOGY such as: bones, joints, reproductive system of males and
ligaments, tendons, muscles females, the integration of
and nerves. surgical activities for the pelvis-
UROLOGIC
Deals with mental, emotional, the colon, urogenital, and
PSYCHIATRY SURGERY
or behavioral disorders. gynecological organs-primarily
for the treatment of obstructions,
dysfunction, malignancies, and
inflammatory diseases.

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 UNIT 1: THE HOSPITAL AND ITS ORGANIZATION

GENERAL SERVICES operating room packs, needles,

• One of the most important syringes and other medical
aspect in the process in surgical supplies.
distinguished medical care. • “Dispensary”
• Encompasses health • Supplies patient medications to
PHARMACY
NURSING promotion, the care and the hospital units via single
SERVICES prevention of disease or doses.
disability, rehabilitation, • Responsible in dispensing
teaching, counseling and items needed for patient
emotional support as well as CENTRAL SUPPLY comfort, administration of IV
the care of the sick. DEPARTMENT fluids and blood, care of
• Purchase, plan, and prepare wounds, catheters, and trays
menus, both for patients and for special examinations.
employees and maintain • Responsible for the cleanliness
nutritionally sound diets for in the hospital, they are
DIETETIC patients. involved in preparing rooms for
SERVICES • Responsible for recording new patients.
OTHERS
dietary histories of patients • Housekeeping supplies the
(maintenance,
such as those with food units with linen for the patient’s
allergies and those unable to housekeeping,
needs.
environment)
accept a limited diet regimen • Maintenance and engineering
• Document medical records, are responsible for maintaining
such as patient profiles, that equipment and inspects safety
MEDICAL
should be readily accessible and upkeeps hospital grounds.
RECORDS
and can easily be used for
DEPARTMENT
retrieving and compiling OTHER SERVICES
information. Designed to facilitate the process
• Directed by a qualified REHABILITATION of recovery from injury, illness, or
physician and include AREAS disease to as normal a condition as
PATHOLOGY laboratory services such as possible.
SERVICES clinical chemistry, microbiology, Means a facility that provides
clinical microscopy, extended medical and rehabilitative
hematology, and serology. LONG-TERM or
care to individuals who are
• Under supervision of a licensed CHRONIC HEALTH
BLOOD BANK clinically complex and have
physician FACILITIES
multiple acute or chronic
• Consists of physicians and staff conditions.
who are trained as radiologists, Coordinate the response to an
RADIOLOGY physicists, technicians, EMERGENCY emergency and to deal with some
radiotherapists, isotope CENTERS of the problems that arise during
pharmacists, and the like. the emergency.
• Serves as an important liaison Provides information about the
between the hospital, the departments through incoming call
patient and his community. or paging medical staff as
COMMUNICATION
• Provides information relating to: requested, makes announcements
SERVICES
o Social study of and announces emergency
appropriate patients situations according to hospital
MEDICAL SOCIAL
o Social therapy and policies
SERVICES
rehabilitation of patients
o Cooperative activities with Reference:
community agencies MVPCanariaRPhMSPharm©2020
o Social service summaries
o Follow-up reports of
discharged patients
• Responsible for the quality of
anesthesia care rendered by
the anesthetist in the surgical
and obstetrical areas.
• Sees to the availability of
ANESTHESIA equipment necessary for
SERVICE administering anesthesia and
for related resuscitative effects.
• Development of regulations
concerning anesthetic safety.
• Retrospective evaluation of all
anesthesia care.
CENTRAL • Furnishes all supplies required
SERVICE for the nursing units such as
DEPARTMENT sterile linen, sterile kits,
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