CHAPTER 2

HOSPITAL AND ITS

ORGANIZATION
HOSPTIAL

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A hospital is an organization utilizing
combinations of specialized scientific equipment,

Hospital Pharmacy Chapter 2 ( Noman)

and functions through qualified and trained
personnel for restoration and maintenance of good
health.
 The hospital is also serves as medium through
which the medical professional staff-pools their
efforts for the betterment of public health.
 The patient is a focal point about which all the
activities of a hospital revolve. 7
 Patient may be an in-patient (cloistered
within the hospital and occupy a bed for

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some period) or
 An out-patient (utilizing the hospital facility

Hospital Pharmacy Chapter 2 ( Noman)

by not occupying its bed).
 Hospitals are assuming more responsibility
for preventive medicine programs for
improvement of the overall public health.

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CLASSIFICATION OF
HOSPITALS

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 Hospitals may be classified in number of ways.
 However, it's worthy to note that a single

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institution may fall into more than one grouping.
 The following is a general classification of
hospitals.
1. Based on services
2. Based on ownership and control

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BASED ON SERVICES
1. General hospitals
2. Specialty

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2.1. Medicine
 Internal Medicine

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 Psychiatric and nervous diseases
 Tuberculosis
 Communicable disease
 Pediatrics
2.2 Surgery
 Orthopedic
 Gynecologic
 Cardiologic
2.3.Maternity 10
BASED ON OWNERSHIP AND CONTROL

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3.1. Governmental
 Armed forces (Naval, Combined Military Hospitals

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etc)
 Federal Governmental Hospitals
 Provincial Hospitals (Head Quarter Hospitals,
Social Security Hospitals. Civil Dispensary. Rural
dispensary, Basic health units etc.)
 Teaching hospitals
3.2. Non-governmental
3.3. private for profit
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3.4 Private charity
ORGANIZATIONAL PATTERN

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 The organizational pattern of a hospital
resembles with that of pharmaceutical

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industries (any other
institution/organization)
 The only difference is of positions and
titles assigned in hospitals.

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5/10/2019 Hospital Pharmacy Chapter 2 ( Noman)
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Teaching hospital
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MANAGEMENT

 The government, military and private

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hospitals have different management
systems.

Hospital Pharmacy Chapter 2 ( Noman)

 A medical Superintendent who is appointed
by ministry of health
 military hospital is managed by
commanding officer.
 While a private hospital usually has all
organized governing body, the total number
of members in governing body will vary from
hospital to hospital. 16
The governing body is responsible for
defining of the:

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1. Powers and duties of the governing body officers,
committees and chief executive officer.

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2. Qualification for governing body membership.
3. Method of selection for membership.
4. Tenure.
5. Committees, kinds, appointment and
memberships tenure.
6. Evaluation of performance of employees.

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ADMINISTRATION
 The board of trustee of a hospital delegates
hospital's active management to an administrator

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and his staff of associates, assistants, supervisors
and departmental heads.

Hospital Pharmacy Chapter 2 ( Noman)

 The administration of a hospital is responsible for
operation of the entire institution, assuring
institutional staffs and patients of highest possible
standards of services and economy by planning,
directing and coordination of the activities.

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 The administration of the hospital is
described as specialistin administration

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 must specially be qualified and trained
for his position.

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 Usually an administrator holds the
degree of master of Hospital
administration.

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The main functions of the administrator are to:
1. Enforce the trustees policies in the daily
management.
2. Establish organizational structure to carry out

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programs or the hospital and to meet needs or
the to patients.
Implement the governing body's policy on the

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3.
financial management of the hospital.
4. Developing and implement a comprehensive
management reporting system throughout the
hospital.
5. Provide, maintain and safeguard appropriate
physical resources in the institution.
6. Look at the weakness influencing any aspect of
institution.
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MEDICAL STAFF
 Group of individuals who are fully licensed to

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practice.
 It is the back bone of Health care institution.

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 The proper management of such staff is required.

 Thy are accountable to governing body.

 The structure of the staff vary from hospital to

hospital.
 Active Medical Staff
 Supportive Medical Staff
 Honorary Medical Staff
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DEPARTMENTALIZATION

 Itis grouping of various sections and

divisions according to the same nature of

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services provided.

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 Degree of departmentalization depend upon
the extent of specialization of the staff.
 Clinical Departments
 Support Services
 Shared Services

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CLINICAL DEPARTMENTS

Medicine Surgery

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 Cardiology  General surgery
 Dermatology  Neurologic surgery

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 Pediatrics  Ophthalmology
 Neurology  Gynecology
 Pulmonary diseases  Dental & oral surgery
 Infectious diseases  Urology
 Endocrinology  Plastic surgery, etc…
 Immunology
 Nephrology
 Psychiatry
 Gastroenterology, etc…
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SUPPORT SERVICES
 Pharmacy Department
 Nursing Services

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 Dietetic Services
 Medical Records Department
 Pathology Services

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 Blood Bank
 Radiology
 Nuclear Medicine
 Radiotherapy Department
 Diagnostic Services
 Medical Social Services
 Anesthesia Services
 Material Management Department
 Biomedical engineering department
 Central Sterile services Department
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 Finance/Account department
 PHARMACY DEPARTMENT
 The pharmacy department is staffed with

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pharmacists and is supervised by director of
pharmacy or pharmacist-in-chief.

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 This department offers the following services:
1. Drug distribution, including floor-stock and unit dose
distribution
2. Dispensing of drugs to out-patients
3. The intravenous admixture program

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4. The clinical services provided from tile hospital
pharmacy may include therapeutic consultation, drug
information
Clinical pharmacy practice also encompasses
 Preparation of patient drug profiles,

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 Recording patient drug history,
 Advising physicians of possible drug-drug interactions

Hospital Pharmacy Chapter 2 ( Noman)

and drug effects on clinical laboratory test results.
 It also involves preparation of patient drug use review,
 Collection of the pharmacy patient data base,
 Therapeutic monitoring,
 Auditing of therapeutic regimens,
 Monitoring of specific adverse drug reactions to
decrease their incidences,
 Management of chronic care patients.

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5. Purchasing and inventory control of drugs and allied
Items.
6. Conduct and support of pharmaceutical and clinical
research, respectively.

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7. Education service for pharmacy personnel, medical
profession, nursing staff and for patients.

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8. Serving function for vital committees such as
pharmacy and therapeutics committee, infection
control, research review, antibiotics, ambulatory and
standardization committees.
9. Special services may include the provision of
radiopharmaceutical services, total parenteral
preparation, central sterile service and poison
control centre.
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 The pharmacy department is one of the many
departments of a hospital that exerts a great deal of
influence on professional position of the institution as
well as upon its economics of the total operational

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costs. It is all due to its inter-relation with and the
interdependency of other services upon it.

Hospital Pharmacy Chapter 2 ( Noman)

 In a hospital setting, the doctor diagnoses and
prescribes, the pharmacist dispenses the medication
and the nurse administers the drugs to the patient
(unless the patient is oil a self-medication regimen).

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NURSING SERVICES
 Nurse is an individual who attends, helps, teaches,
counsels and takes care of the patients,

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particularly who acquire beds in hospital.
 Nursing care is an integral part of total health care

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system and necessary for regaining and
maintaining health.
 Nurse may be specialized in oncology. blood bank.
night nursing care, floor nursing care etc.
 Nursing is a noble job and a nurse must respect
individuality, dignity, and rights of every patient,
regardless of race, color. national origin, and social
or economic status.
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 The nursing service is organized similarly to other
service in the hospital and is headed by Director of
Nursing with administrative authority. The

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director of nursing must be an experienced nurse
with administrative talent.

Hospital Pharmacy Chapter 2 ( Noman)

 As an administrative staff, the director nursing
participates in formulating policies and devising
procedures required for achievement of objectives,
and in developing and appraisal of the quality ol'
nursing services.
 In some institutions, the director of nursing service
is also responsible for administration and
operation of the school of nursing 30
 DIETETIC SERVICES
 Dietetic service is one of the essential services in an
institution.

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 It is staffed by adequate numbers of dietitians,
technical and clerical personnel and is directed by a

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person with professional qualifications in nutrition.
 This is responsible for preparation of palatable and
appropriate food by applying effectively the principles
of nutrition science.
 The dietetic service, if existed is responsible for:

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1. Purchasing, planning and preparation of menus for
both patients and employees.
2. Recording of dietary needs of patients such as those

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unable to accept a limited diet regimen.
3. Interviewing patients regarding their food habits.

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4. Counseling patients and their families concerning
normal or modified food regimens.
5. Encouraging patients to participate in planning their
own normal or modified regimens.
6. Participate in appropriate ward rounds, research
activities and conferences.

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MEDICAL RECORDS DEPARTMENT
 Patient record keeping is the responsibility
of medical records department of the

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hospital.

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 This department is staffed by technically
skilled personnel and is headed by suitable
qualified individual.
 Every hospital is required by law to
maintain adequate medical records of their
patients.
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 The purposes of the medical record are to:
1. Serve as a basis for planning and for continuity of
patient care.
Provide a means of communication among the

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2.
physician and professionals contributing to the
patient's care.

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3. Furnish documentary evidence for course of a
patient's illness and treatment during each hospital
stay.
4. Serve as a basis for review, study and evaluation of
the care rendered to the patient.
5. Assist in protecting the legal interest of the patient,
hospital and responsible practitioner.
6. Provide data for use in retrospective research, 34
education and for legal issues.
A sufficiently detailed medical record includes:
1. Identification of patient.
2. Patient's sociological data.
3. Personal family history.

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4. History of present illness.
5. Physical examination. .
Special examination such as consultations, clinical laboratory

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6.
data, x-ray etc.
7. Provision of working diagnosis.
8. Medical or surgical treatment.
9. Gross and microscopic pathological findings.
10. Progress notes.
11. Final diagnosis.
12. Conditions on discharge.
13. Follow-up.
14. Autopsy findings in case of the death of patient. 35
Parts of Medical Record:
 Admission sheet: This sheet generally is used for
placing of the patient 'identification data. .

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 It contains unit record number, patient's name,
address. sex, age, marital status, home telephone
number, name and address of referring physician,

Hospital Pharmacy Chapter 2 ( Noman)

admission diagnosis, date and time of admission, and
destination within the hospital.
 Admission sheet also attaches consent forms for
authorization for medical or surgical treatment,
release of information to other physicians and for
release of information to reimbursing authority if any.

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 Admission history sheet: On the admission history
sheet generally recorded the informant's name, name
of individual taking the history, patient's chief
complaints and a description of present illness.

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 A provisional or admitting diagnosis is also
mentioned on it which is usually made on every

Hospital Pharmacy Chapter 2 ( Noman)

patient at the time of admission.
 It also includes past illness, with their subsequent
diagnosis, operations and major injuries experienced
by the patients, immunization. histories of transfusion,
reactions and complications, current medications, diet,
height, weight, occupational history, health of spouse,
in case of female patients the pregnancies, their
outcomes and complications and family history.
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 Physical examination sheet: Physical
examination sleet consists of a routine systematic
review of skin, head and neck, breast
gastrointestinal, genitalia, lymph nodes, muscular
skeletal and extremities and allergy.

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 This information helps the physician to proceeds
for a suggested treatment program on medical
record to be followed during hospitalization of the

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patient.
 Laboratory sheet: The laboratory sheets are
entered into the patient's medical record after each
laboratory test during patient's hospitalization.
 This includes reports on preprinted forms obtained
from chemistry, hematology, microbiology,
serology, pathology as well as radiology. Some
reports, instead of recording are directly pasted as
original on to the medical records.
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 Medical record sheet: The medical record
sheet provides the space for recording of all
treatment procedures performed upon the
patient.

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 It also includes the operative notes containing
description of findings detailed account of
techniques used and tissue removed. .

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 Progress notes are made in the medical record
for the purpose of providing the physician with
a chronological picture and analysis of the
clinical course of the patient.
 It definitive final diagnosis can also be entered
in the same sheet of patient's medical record
after the completion of all of the diagnostic
procedures. 39
 Discharge summary sheet: Upon discharge from the
hospital, a discharge Summary sheet is entered into the
patient's medical record as an outlines of patient's
hospitalization. This sheet contains a brief history;-

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results of the physical examination, laboratory data,
description of patient's hospital course, diagnosis,

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operation performed, complications, disposition, present
condition, medications prescribed during and after
hospitalization, and an estimated length of disability if
any.
 Autopsy sheet: The autopsy report sheet is included if
the patient dies during hospitalization. This contains
complete protocol of the findings resulted from the
autopsy. 40
A complete and ideal medical record has the following
features:
1. Accurately documented so as an effective patient
care can be provided at another time.

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2. Readily accessible as this will facilitate the easy
consultation with other physicians and enable an
emergency treatment.

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3. Easily used for retrieving and compiling information.
This helps in the retrospective data analysis etc.
4. Containing all significant and detailed clinical
information to enable an effective continuing care to
patient in the same institution at another time,
another practitioner can assume the care of patient
at any time and a consultant can give opinion after
the examination of medical record of the patient.
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 PATHOLOGY SERVICES
 The department of pathology services has personnel
who are adequately trained and experienced in

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laboratory work.
 This department is supervised by a qualified physician

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with training in pathology and is able to assume
professional, organization and administrative
responsibility for the services rendered.
 The cytological section, clinical lab, clinical chemistry,
microbiology, clinical microscopy, hematology, serology
and the section for drug analysis in blood samples may
be the subdivisions of a pathology department.
 In some institutions, blood hank is also included under
the pathology services.
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BLOOD BANK

 Most hospitals operate their own blood bank

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because of the essential nature of blood as I
therapeutic agent and to get ensured quality.

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 In some hospitals, this service is operated
independently while in Other, it function as a
subsection of the pathology department because of
Its laboratory like operation.
 If operating independently it is staffed by
hematology technician and supervised by a
licensed physician having basic interest in
hematology.
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 RADIOLOGY
 The department of radiology is a vital department for
the diagnostic application of radiant energy

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particularly in the form of x-rays.
 This department is under the supervision of a qualified

Hospital Pharmacy Chapter 2 ( Noman)

physician who has also obtained an adequate training
and experience in general radiology.
 An adequate number of radiology technologists are
staffed to provide services from this department. This
service is provided only after a written direction from
an entitled physician

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 NUCLEAR MEDICINE
 Nuclear medicine department is an integral
part of an institution which provides oncology

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service.
 The services of this department include the use

Hospital Pharmacy Chapter 2 ( Noman)

of radiopharmaceuticals for the diagnosis,
palliation and treatment.
 This department is staffed with physician with
specialization of nuclear medicine,
health/medical physicist, nuclear pharmacist,
technologists, and oncology nurse.
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 RADIOTHERAPY DEPARTMENT
 The radiotherapy department generally consists
of physicians who are trained as radiotherapist,

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medical physicists, radiation technologists,
radio-pharmacist, nurses, and secretarial

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personnel.
 A physician adequately trained and experienced
in general radiation principles supervise this
department.
 The services provided from the radiotherapy
department are performed only on the written
order of medical staff members who has been
entitled to direct for such services. 46
DIAGNOSTIC SERVICES
 Radiology (x-ray), computerized tomography.

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(CT), ultrasound, nuclear magnetic resonance
and radioisotope imaging are the diagnostic

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services offered in major institution.
 Due to their different basic principles,
techniques and obviously skilled, all these can
not be grouped under one department.

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 MEDICAL SOCIAL SERVICES
 The medical social service department is an important
relationship between the hospital and the patient and

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his community.
 This department has a professional focus on the social

Hospital Pharmacy Chapter 2 ( Noman)

aspects of the patient and patient's family.
 Social service personnel generally provide information
relating to medical social study of appropriate patients,
social therapy and rehabilitation of patients, home
environmental investigations for attending physician,
cooperative activities with community agencies,
monitory helping patient.
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 ANESTHESIA SERVICES
A trained physician who is a medical staff member
directs the anesthesia service of a hospital.

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 The director of anesthesia service is responsible far
quality of anesthesia care in surgical and obstetrical

Hospital Pharmacy Chapter 2 ( Noman)

areas and availability of equipment necessary for
administering anesthesia and for related resuscitative
effects.
 The other duties of the head of anesthesia service are
the development of regulations concerning anesthetic
safety and retrospective evaluation of all anesthesia
care.
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 MATERIAL MANAGEMENT DEPARTMENT

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 A department having operational responsibility over
purchase, receiving, inventories, print shop, central

Hospital Pharmacy Chapter 2 ( Noman)

sterile supply, laundry, distribution, messenger
service, traffic and disposal activities.
The other duties of this department are:
1. Issuance of purchase orders.
2. Maintenance of purchase records.
3. Follows-up on delayed orders.
4. Initiates competitive bidding procedures.
5. Obtains quotations from specified sources. 50
 BIOMEDICAL ENGINEERING DEPARTMENT
 The biomedical engineering department is under the

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control of a qualified biomedical, electrical or electronic
engineer.

Hospital Pharmacy Chapter 2 ( Noman)

 For functioning of this department, an adequate
number of engineers in the fields of biomedical
electrical, electronics and mechanical and well trained
technicians are required.
 The basic responsibility of this department is to keep
all clinical and laboratory instruments working.

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 CENTRAL STERILE SERVICES
DEPARTMENT
 The central sterile service department provides

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professional supplies and equipments, sterile and non-
sterile, to all specialized departments.

Hospital Pharmacy Chapter 2 ( Noman)

 The special departments that are served through this
division are nursing stations, clinics and the operating
rooms.
 This department practices total decontamination and
gives professional support and service for improved
patient care by maintaining high processing
standards.
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 The sterile supply may include the re-usable and
disposable materials.
 In addition to dispensing these materials, central

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sterile supply room may also be involved in the
cleaning, storage and dispensing of specialized

Hospital Pharmacy Chapter 2 ( Noman)

equipments such as suction pumps, cardiac catheters,
monitoring equipment, surgical dressing carts,
resuscitation carts, and a myriad of special kits and
trays.

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 FINANCE/ACCOUNT DEPARTMENT
 Though a pharmacist may believe that finance is a
subject which does not concern him or his department.

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 In reality, the finances of the hospital affect every
patient, employee, staff member, trustee and the

Hospital Pharmacy Chapter 2 ( Noman)

community at large.
 The finance department is staffed by accountants and
financial personnel and a well trained and qualified
individual supervisors.
 This department is responsible for the financing of all
operations of a hospital and delivery of salaries to the
institutional employees.
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 SHARED SERVICES
 Sharing of services offers a viable option to any
organization in providing high quality technical

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services in a very cost effective manner.
 Such services include both administrative and clinical

Hospital Pharmacy Chapter 2 ( Noman)

activities. Shared services of an administrative nature
are support services not involving the delivery of
direct patient care and are not normally revenue
producing.
 These services are easier to develop than clinical
shared services programs because they do not directly
involve the medical staff, have less. external elements,
and often can be implemented easily.
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 Clinical shared services involve delivery of
direct patient care services or research on
clinical aspects of drugs.

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 Shared services enables an institute to
protect present and future assets, develop

Hospital Pharmacy Chapter 2 ( Noman)

and safeguard a wide variety of new sources
of revenue, attract additional funds through
charity, and to raise venture and equity
capital through cooperative ventures.

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