Sec. 7.
(a) The
hospital shall have a pharmaceutical service that meets the needs of the
patient and complies with requirements set forth by the Indiana board of
pharmacy.
(b) The hospital shall
have a pharmacy service directed by a pharmacist, as follows:
(1) A full-time, part-time, or consulting
pharmacist shall be responsible for developing, supervising, coordinating, and
implementing the written policies and procedures to ensure appropriate
distribution, control, therapeutic monitoring, and accountability of all drugs
used in the hospital.
(2) The
pharmacy service shall be administered in accordance with accepted professional
standards and federal and state laws.
(3) The pharmacy service shall have an
adequate number of personnel to ensure quality pharmaceutical services,
including emergency services.
(c) In order to provide patient safety, the
director of pharmacy shall develop and implement written policies and
procedures for the appropriate selection, control, labeling, storage, use,
monitoring, and quality assurance of all drugs and biologicals.
(d) Written policies and procedures shall be
developed and implemented that include the following:
(1) Establish a formulary system with
specifications for the selection and procurement of all drugs and biologicals
at reasonable costs and as approved by the medical staff.
(2) Ensure the monthly inspection of all
areas where drugs and biologicals are stored and which address, but are not
limited to, the following:
(A) Separation of
drugs designed for external use from drugs intended for internal use.
(B) Appropriate storage conditions.
(C) Detection and quarantine of outdated or
otherwise unusable drugs and biologicals from general inventory pursuant to
their return to the manufacturer, distributor, or destruction.
(D) Documentation and accountability for an
accurate accounting of controlled substances from the time of receipt in the
institution through the administration to the patient or subsequent removal
from general stock and reporting of all abuses and losses of controlled
substances.
(E) Security of and
authorized access to all drug storage areas within the hospital, as approved by
the medical staff, when the pharmacist is absent.
(F) Availability of information relating to
drug interactions and information on the following:
(i) Drug therapy.
(ii) Side effects.
(iii) Toxicology.
(iv) Dosage.
(v) Indications for use.
(vi) Routes of administration.
(3) Review the use of
medications with the standards developed by the medical staff, which include
stop orders for scheduled drugs and biologicals not specifically prescribed as
to time or number of doses.
(4)
Allow for adequate drug therapy monitoring procedures to exist.
(5) Minimize medication errors and document,
monitor, evaluate, and report adverse drug reactions and medication
errors.
(6) Provide for the
maintenance of drug and poison information materials.
