Hospital and interhospital pharmacies. Location of pharmacies. methods for assessing the clinical efficacy of drugs of the main pharmacological groups

"Organization of the work of a pharmacy serving the population"

Tasks and functions of a pharmacy serving the population

1. Providing the population with medicines and other pharmacy products;

2. Trade in medical instruments and optics;

3. Trade in means and items for veterinary purposes;

4. Trade in children's and dietary food, medical and cosmetic products;

5. Bringing information about medicines to the public;

6. Informing medical workers about the drugs available, the arrival of new drugs and how to use them;

7. Provision of emergency first aid.

1. Production.

2. Trading.

3. Supply.

4. Storage function.

5. Financial.

6. Household.

Basic principles of the territorial location of a pharmacy

The main principles of the territorial location of a pharmacy serving the population are:

The pharmacy should be located in the most accessible place for the population (10-15 minutes walk)

The higher the population density of the area, the more profitable the pharmacy

placement of a pharmacy near roads, transport stops, large stores, food markets, medical institutions

You need to evaluate the rationality of the location of your pharmacy.

Opening a pharmacy. Procedure for accreditation and licensing

In order to obtain the status of a legal entity, a newly created pharmacy organization must be registered with the registration authorities, and a registration number is issued (it is entered in the unified State Register of Legal Entities). The pharmacy receives a certificate of state registration.

A legal entity is an organization that owns or manages separate property that is liable for its obligations with this property.

To obtain the status of a legal entity, an organization must be registered with local governments. They register the organization, assign it a registration number, which is entered in the unified state register of legal entities, and also approve the form of ownership. The organization receives a temporary certificate of state registration.

To register an organization, you must provide:

application of the established form, signed by the founders

minutes and memorandum of association

statute of the pharmacy

document confirming the payment of the state fee

The charter of pharmacy registration indicates its founders (for state pharmacies - these are state authorities, the federation or its subjects; for municipal pharmacies - local governments; for private pharmacies - various legal entities and individuals). The charter fixes the address and legal status of the pharmacy, it is noted that it has a seal with its name and an indication of the organizational and legal form, a corner stamp, an independent balance sheet and a bank account. The charter defines the tasks and functions of the pharmacy, as well as other activities. The charter defines the property and funds of the pharmacy, the rights of the pharmacy, the procedure for managing the pharmacy, the rights of the manager and the team, the procedure for hiring and dismissal, the procedure and guarantees of remuneration, the procedure for monitoring the activities of the pharmacy, its reporting, the procedure for terminating activities and reasons.

A legal entity created by one founder acts on the basis of the charter approved by the founder. If there are several founders, then a memorandum of association must be concluded between them, which is submitted to the registration authorities along with the charter.

The memorandum of association is an agreement concluded in writing between representatives of an organization, in which they undertake to create a legal entity, determine the procedure for joint activities to create it, the condition for transferring their property to it and participating in its activities.

The memorandum of association also determines the procedure and conditions for the distribution of profits and losses among the founders, the management of the activities of the legal entity and the withdrawal of the founders from its composition.

After registration, on the basis of the received temporary certificate, the pharmacy opens a bank account. To open an account, she needs to register:

1) in the tax authorities

2) bodies of state statistics

3) in the employment fund

4) in a pension fund

5) territorial fund of obligatory medical insurance

6) social insurance fund

After that, the pharmacy exchanges a temporary certificate for a permanent one and from that moment officially exists as a legal entity. However, it does not yet have the right to provide pharmaceutical services to the population and healthcare facilities. To obtain such a right, each pharmacy organization must undergo accreditation, certification and obtain a license for pharmaceutical activities.

Accreditation is a process that determines the compliance of the place and conditions of pharmaceutical activity with the established requirements for the organization of drug care and services.

After accreditation, the pharmacy and the specialists working in it are certified.

Certification- this is the process of obtaining a certificate confirming the compliance of the operating conditions (for organizations) or the level of training (for specialists) with established standards.

The purpose of accreditation and certification is to guarantee the quality of public service. Accreditation, certification and licensing of a newly opened pharmacy organization are carried out simultaneously by specially authorized executive authorities of the territory of the Russian Federation.

Before a pharmacy organization receives a certificate and a license, the qualification composition of the organization, the availability of its own or rented material and technical base, the current normative documents in the relevant types of pharmaceutical activities, compliance with sanitary and hygienic standards, fire safety and security measures, labor protection and safety measures are checked , trade and sale of pharmaceutical products, the availability of quality certificates for goods.

To check the organization's compliance with existing standards, licensing authorities engage independent experts on a contract basis, which are experienced specialists with higher pharmaceutical education. Based on the results of the expert examination, an examination report is drawn up. As a result of certification of a pharmacy organization, an accreditation certificate is issued for the compliance of the operating conditions with established standards.

Persons who have received a pharmaceutical education and a special title, having a diploma and a certificate of a specialist, are allowed to engage in pharmaceutical activities in the Russian Federation. Certification of specialists is carried out by state educational institutions that provide additional professional education and professional pharmaceutical associations that have received permission from the federal authorities for this. Specialists who have completed the full course of study pass a certification exam. Those who successfully passed it receive a certificate of a specialist, indicating that the level of training of a specialist meets state educational standards and qualification requirements. The certificate of a specialist is valid throughout the Russian Federation and is confirmed every 5 years after appropriate training in the system of additional professional education. Certificates of a pharmacy organization and specialists are necessary to obtain a license for pharmaceutical activities.

The Federal Law on Licensing Certain Types of Activities of 1998 established a list of activities for which licenses are required. These include: pharmaceutical activities and activities related to the circulation of narcotic drugs and psychotropic substances. The law also approved the general procedure for licensing and licensing authorities.

The provisions of this law are in addition to the federal laws on medicines, on narcotic drugs and psychotropic substances. In accordance with these laws, the Government of the Russian Federation, by its Decree No. 387 of 1999, approved the regulation on licensing pharmaceutical activities and wholesale trade in medicines and medical products, which establish a specific procedure for licensing pharmaceutical activities. In addition, Decree of the Government of the Russian Federation No. 326 of 2000 defines a list of activities that are licensed by the Ministry of Health of the Russian Federation. These include activities related to the circulation of narcotic drugs and psychotropic substances.

Licensing- this is an event related to the issuance of state permits, their suspension and cancellation, as well as the supervision of licensing authorities over compliance by organizations with licensing requirements and conditions.

Licensing is a form of state regulation of pharmaceutical activities, in accordance with the legislation of the Russian Federation, orders and orders of the Ministry of Health of the Russian Federation, as well as methods of state control over compliance by pharmaceutical organizations with the requirements of regulatory legal acts for activities related to the provision of drug care to the population.

Main Purpose of Licensing– assessment of the possibility of providing a pharmaceutical organization with various types of qualified medical care and issuance of a state permit for the right to engage in pharmaceutical activities.

License- this is an official document authorizing the implementation of the type of activity specified in it within the established period and determining the mandatory requirements for fulfillment and the conditions for its implementation. The license form has a degree of security at the level of a bearer security, an accounting series and a number.

• This is an organizational form of providing drug supply to the population and health facilities. There are such types of specialization:

• 1. For the specifics of production activities.

• 2. For the specifics of marketing activities.

• 3. For the specifics of the patients who are served.

• 4. Behind the specifics of the groups of drugs that are dispensed.

• 5. Behind the specifics of the sale of over-the-counter drugs.

• 6. For the specifics of additional functions.

• 7. Behind the specifics of the business environment (traditional pharmacies - offline; Internet pharmacies - online, specialize in e-commerce).

• The main goal of hospital and interhospital pharmacies is the timely and high-quality provision of inpatients with medicines and medical products. To carry out this task, pharmacies perform the following functions:

• - Determining the needs of health facilities for drugs, patient care items and other medical supplies;

• - purchase and release of medicines, dressings, patient care items to the department of health care facilities;

• - preparation of extemporaneous medicines according to the requirements - orders of health care facilities;

• - quality control of prepared medicines;

• - control over the correct storage and rational use of medicines in the departments and offices of healthcare facilities;

• - control over the rational use of funds allocated for the purchase of honey. goods;

• - information work.

Types of pharmacies

• Depending on the profile and structure of health facilities, hospital pharmacies can be:

• 1. Pharmacies of general hospitals;

• 2. Pharmacies of specialized hospitals (tuberculosis, infectious diseases, neuropsychiatric);

• 3. Pharmacy clinics;

• 4. Pharmacies of sanatoriums.

• Pharmacies that serve health care facilities can be budgetary (funding of these pharmacies is carried out at the expense of budgetary funds) and self-supporting. Self-supporting pharmacies - operate as a legal entity, carry out wholesale and retail sales of medicines and medical devices, and also manufacture extemporaneous drugs.

• Pharmacies are opened to serve one health facility (hospital pharmacy) or several health facilities (interhospital pharmacy). Such pharmacies should be located in a separate room or in a medical facility with a separate entrance.

• The purchase of drugs and medical devices is carried out from distributors, pharmacy warehouses on the basis of contracts with a license by participating in tenders (if there are at least 3 suppliers, with a purchase of at least 30 thousand hryvnias).

• The range of purchased drugs is regulated by the state.

• Responsibilities of an authorized person

• regulated by the order of the Ministry of Health of Ukraine No. 584 dated 12.16.03.

• Input control is carried out by an authorized person (head nurse, pharmacist or pharmacist of the pharmacy of the health facility, approved by order of the head of the health facility, their data is reported to the territorial state inspections).

Boundary standards for the storage of narcotic, psychotropic drugs and precursors in the structural divisions of healthcare facilities

• Pharmacy of health care facilities - a two-week requirement;

• Department of health care facilities - a three-day requirement;

• Posts (offices) of healthcare facilities - a two-day requirement;

• Reception department of a hospital for the provision of emergency medical care for vital signs in the evening and at night - a five-day reserve;

• Outpatient clinics, FAPs - a weekly need.

• The procedure for prescribing drugs and medical devices and PKU in the structural divisions of health facilities.

• Medicines for the needs of health care facilities are prescribed separately for each department. The requirement-order is made out with a stamp, a round seal of the medical facility, the signature of the head or his deputy from the medical unit. The requirement-order indicates the names, dosage, forms of release and the total number of drugs (in 3 copies).

Requirements-orders for drugs that are subject to PKU, drugs for anesthesia are issued on separate forms for each group of drugs (4 copies). They must indicate the name of the department or offices, the appointment of drugs (for injection, internal, etc.). Narcotic, psychotropic drugs, precursors of list No. 1 are prescribed in Latin and the amount is indicated in words.

• For narcotic drugs, in addition to the above, there should be: the number of the medical history, the full name of the patient, the name and dosage of these drugs, as well as their purpose. To receive drugs, a power of attorney is issued (valid for 10 calendar days).

• PKU in health care facilities are subject to:

• 1. Narcotic drugs.

• 2. Psychotropic drugs.

• 3. Precursors of list No. 1.

• 4. Poisonous drugs (atropine and its salts - powder, tetracaine, trihexyphenidyl, peripheral muscle relaxants).

• 5. Strong drugs (butorphanol, diphenhydramine (solid forms), clonidine (substance and liquid forms), methandienone, retabolil, promethazine).

• 6. Combined drugs (solid forms) that contain tramadol, ephedrine, pseudoephedrine.

• Budget pharmacies purchase medicines within the limits allocated from the state budget for the treatment of inpatients. Self-supporting pharmacies have the ability to form stocks in significant volumes, which allows the pharmacy to quickly respond to requests from healthcare facilities.

Characteristics of pharmacies that provide drug supply to healthcare facilities

• Small health facilities, especially those located in rural areas, are provided with medicines and medical devices through territorial pharmacies.

• Large health facilities are provided with drugs through a network of interhospital and hospital pharmacies.

• An interhospital pharmacy is organized to provide two or more health facilities with a total number of beds of at least 500, as well as in settlements where the total number of beds in all health facilities is from 100 to 500.

• A hospital pharmacy is organized to provide one health facility with 500 or more beds, as well as in a locality where there is only one hospital with at least 100 beds.

• Pharmacies should have a number of additional premises to serve health care facilities, namely:

• - service room for medical personnel (information room);

• - a room for picking orders;

• - billet concentrates and semi-finished products;

• - room for storing clean dishes;

• - material for poisonous and narcotic preparations;

• - material for storage of thermolabile substances;

• - material for the storage of medical products and others;

• - unpacking.

Interhospital pharmacy staff:

• 1. Administrative staff (pharmacy manager, pharmacist, chief accountant, safety engineer, economist);

• 2. Pharmaceutical staff (pharmacists, pharmacists);

• 3. Support staff (packers, nurses);

• 4. Service personnel (premises repair worker, driver).

Responsibilities of a pharmacist

• To perform functions regarding the organization of drug supply for inpatients in health facilities that are attached to pharmacies, the position of a pharmacist (but not more than two persons) is introduced, which is directly subordinate to the head physician or his deputy.

• Responsibilities of the pharmacist:

• - Acceptance and verification of orders from the departments of healthcare facilities;

• - acceptance of completed orders from the pharmacy and timely transfer of drugs and medical devices to the appropriate departments;

• - constant communication with doctors, informing them about medicines;

• - control over compliance with the established rules for the storage of medicines in the departments and offices of healthcare facilities.

Position of clinical pharmacist

• introduced into the staff of health care facilities at the rate of 1 clinical pharmacist per 300 hospital beds, but not more than 2 people per hospital.

• Functions:

• - participation in the choice of the method of pharmacotherapy for a particular patient, determining its cost and end time;

• - interpretation of the doctor's instructions regarding drugs in connection with previously prescribed drugs, the patient's diagnosis and medical history, his condition, laboratory test results and hereditary diseases;

• informing doctors about changes in legal documents that regulate pharmaceutical activities;

• advising medical personnel on possible adverse reactions, dosage, optimal medical form, method and time of use of the drug;

• - advising the patient on the use of drugs prescribed to him, the need to comply with a certain diet and medication regimen;

• The clinical pharmacist must have:

• the main methods of clinical, laboratory and instrumental examination of patients;

• the main directions and principles of medical therapy;

• methods for assessing the clinical efficacy of drugs of the main pharmacological groups;

• systemic knowledge of clinical pharmacology, drug compatibility in complex therapy;

• methodology for predicting and preventing the facts of the risk of side effects of drugs.

The main activities of the clinical pharmacist

• pharmaceutical care in the departments of healthcare facilities, hospital pharmacies;

• issues of rational procurement and use of drugs on the basis of clinical and pharmaceutical management and pharmacoeconomic studies, improvement of drug supply for health facilities;

• quality control of pharmacotherapy by evaluating prescription lists;

• clinical and clinical laboratory work;

• organizational and methodological work.

Hospital pharmacy abroad

• The main functions of the hospital pharmacy are the purchase, distribution and control over the use of drugs. In addition, the pharmacy is engaged in:

• - providing medicines for special programs of drug therapy;

• - providing drugs to polyclinics, houses for the maintenance of the elderly, and other medical institutions;

• - collection and provision of information about drugs;

• - holding seminars for the medical staff of the hospital on pharmacy issues;

• - conducting clinical trials of drugs in order to determine their effectiveness;

• - provision of information about drugs;

• - work on the compilation of equally effective, inexpensive drugs that are recommended for use in the hospital;

• - periodic monitoring of the use of medicines in the hospital.

Typical hospital pharmacy models:

• 1. Pharmacy - a warehouse dispenses ready-made drugs on the orders of doctors.

• 2. Clinical pharmacy - together with doctors, develops a list of drugs necessary for the operation of the hospital and takes part in the introduction of new drugs and determining their effectiveness.

• 3. Pharmacy of a specialized type performs the functions of the first two.

Drug distribution systems.

• Traditional system is that:

• - in accordance with the doctor's order, which was received, the pharmacy dispenses the drug for several days to the hospital, where it is stored in the drug cabinet;

• - nurses form a set of individual doses from the reserve;

• - at the end of the stock, the nurse writes out a new order.

• The second system provides for the issuance of ready-made medicines dosed by a doctor from a pharmacy, when a container with a drug is issued for only one patient. It is also possible to use the two-container method: one container is in the hospital, the other in the pharmacy. An empty container is replaced with a full one from the pharmacy every day.

• The main types of documents of a hospital pharmacy are orders for medicines from doctors and documents for dispensing medicines.

"Pharmaceutical Review", 2005, N 12

HOSPITAL PHARMACIES:

WITHOUT STATUS, EMPLOYEES AND MONEY

On the wave of widespread reforms in Russia, the system of medical care is also gradually being modernized. State hospitals organize paid beds and departments, private medical institutions are actively developing. Paid services are not the only factor that unites them. Most of these health facilities have pharmacies that provide the treatment process with the necessary medicines.

INTERMEDIATE POSITION

Hospital pharmacies differ significantly from conventional green cross facilities, both in function and in the nature of their activities. The task of HCI pharmacies is to meet the needs of the medical process in pharmaceutical goods and services. Therefore, certain tasks are set for pharmacies at hospitals: to provide medicines for the treatment process both in the provision of free medical care and paid services, to provide medical personnel with professional information about medicines, and to organize pharmaceutical supervision in the hospital.

Sounds nice. In reality, however, the picture that emerges is extremely ugly. Hospital pharmacies are in distress. And there are several reasons for this: limited funding and rising prices for drugs, shortcomings in the organization of the drug supply system for hospitals and in controlling the use of financial resources.

The root of all problems of health care facilities lies in the legal framework. Pharmacy LPU operates on the basis of a license for pharmaceutical activity. However, the current definition of pharmaceutical activity does not correspond to the functions performed by hospital pharmacies. The Federal Law "On Medicines" defines pharmaceutical activity as "an activity carried out by wholesalers and pharmacies in the field of medicines circulation, including wholesale and retail trade in medicines, the manufacture of medicines." According to Anna Soloninina, vice-rector of the Perm SFA, head. cafe Management and Economics of Pharmacy of the Faculty of Additional Professional Education, Ph.D., for the activities of pharmacy units in health care facilities, the definition of "pharmaceutical service" is more suitable, as "a set of pharmaceutical services provided by pharmacy units in the organization of drug supply to health facilities."

Regulatory documents regulating the activities of pharmacies, in particular OST 91500.05.0005-2002 "Rules for the wholesale trade of medicines. Basic provisions" and OST 91500.05.0007-2003 "Rules for the dispensing (sale) of medicines in pharmacy organizations. Basic provisions", also do not reflect modern requirements for the organization of the activities of pharmacies serving healthcare facilities. As A. Soloninina notes, by the nature of their activities, hospital pharmacies occupy an intermediate position between wholesale and retail trade enterprises, since, on the one hand, they do not sell drugs for cash, and on the other, they carry out, in most cases, production activities related to the manufacture drugs, which is typical for retail pharmacies.

To summarize, it can be noted that in the existing legal documents, the issues of drug provision of hospitals in the CHI system are not regulated in any way. They do not define the status, tasks and functions of hospital pharmacies, do not develop industry standards for activities, lack regulatory documents on licensing, etc.

PROBLEMS OF CORRECT ORGANIZATION

The lack of proper legal regulation leads to a trail of other troubles of hospital pharmacies. Low wages lead to a shortage of employees and an increase in the burden on working professionals. Weak funding makes it impossible to repair and replace obsolete equipment. Therefore, it is meaningless to talk about the compliance of hospital pharmacies with international production quality standards.

The pharmacy establishment that exists on the territory of the health facility, first of all, provides drugs to patients who are being treated here. But not everything is smooth here either. Studies conducted by specialists from the Perm Pharmaceutical Academy revealed that far from all hospitals have a pharmaceutical specialist and adequate drug formularies on staff, which leads to the use of drugs with unproven clinical efficacy, but high cost. The current practice of determining the need, standard stocks, purchases, storage, use of drugs does not always correspond to reality. The results of these studies can be extended to any region of Russia - the situation in hospital pharmacies is the same everywhere.

Today, probably, the vast majority of medical facilities provide certain paid medical services. This is a natural phenomenon in market conditions and additional income for budgetary institutions. However, everything again rests on the organization of the process. The need for drugs for paid services, as a rule, is not clearly defined. Therefore, purchases are chaotic and are made as needed. When a drug is not available, it is bought urgently at any pharmacy for cash, regardless of its cost, which affects the cost of medical services. Often used drugs purchased at the expense of the budget and compulsory medical insurance, but not always there is a refund of their cost if they were used for paid medical services. In practice, there is no separate storage, accounting for the purchase and expenditure of drugs purchased for the provision of free drug care and for the provision of paid medical services.

NO PHARMACY - DIFFICULT, THERE IS - MORE DIFFICULT

Analyzing the situation with pharmacies at healthcare facilities, we can conclude that there are two types of problems: when there is a pharmacy at healthcare facilities and when there is none. In the case when it is not available, people without pharmaceutical education are engaged in drug provision. As a result of their incompetence, certified drugs of proper quality are not always purchased. The storage conditions of medicines in medical facilities are called into question, outside the pharmacy they do not always meet the standards. Often, patients themselves acquire the drugs they need (again, the question of their quality and effectiveness arises). As a result, there is a significant weakening of internal pharmaceutical control over the circulation of drugs in health facilities (there is no accounting for the issuance of drugs to patients, control over the rationality of purchases).

The problems are, of course, serious. But the paradox is much more serious and larger than the problem when there is a pharmacy at a medical facility. First of all, this is the mentioned range of legal problems. Often, pharmacies in hospitals are organized as departments, and the head acts as the head of the department. Pharmacies do not work around the clock, which creates difficulties due to the unavailability of drugs in emergency situations. Due to problems with premises and equipment, the manufacture of drugs for injection and infusion in hospital pharmacies is problematic. Not everywhere is a personalized record of the release of drugs to patients. Another problem that can seriously complicate the life of hospital pharmacies is that pharmaceutical services are not included in the list of paid medical services.

The question arises how to solve all these problems. The main role in this is assigned to the state, which should finally determine the legal framework for hospital pharmacies. But reforms must also take place in the health facilities themselves. Among them are measures to rationalize the use of drugs and financial resources for drug provision:

Implementation of a formulary system in each health facility, which will allow using the safest and most cost-effective drugs in the treatment process, more accurately determine the need for the necessary drugs and plan their purchases;

Introduction of a two-level management and control system: at the level of the MHIF and HCI;

Introduction of a system for recording the consumption of drugs in health facilities, including for paid medical services, as well as monitoring the rationality of their purchase and use;

Centralization of storage of medicines in health facilities based on pharmacy units, ensuring their round-the-clock availability;

A fundamental change in the practice of purchasing medicines (on a competitive basis, planning purchases taking into account the necessary standard for the need for inventory in terms of assortment and quantity, introducing a system of single-use packages);

Introduction of subject-quantitative accounting of all drugs and personalized accounting of their release.

INSIDE VIEW

An employee of pharmacy N 744 at the Dolgoprudny Central City Hospital, who wished to remain anonymous:

We had a good pharmacy, but now everything has changed. There are no personnel, two people work (someone is on vacation, someone is in the hospital, the manager quit). For a long time there was no repair. The pharmacy serves the whole hospital: maternity hospital, traumatology, infectious diseases department, cardiology and other departments - load.

Previously, there were three municipal pharmacies in the city, they were reorganized into closed joint-stock companies. Now it's a pharmacy chain. The central pharmacy, which also sold narcotic drugs, closed at some point. And then all the burdens of supplying numerous surrounding units fell on our hospital pharmacy. But we only have a license to serve 466 beds. However, there are many patients in the city who require the same narcotic drugs. After a lock was put on the central pharmacy, an ambulance had to visit patients (this was the case with cancer patients) and inject them with the necessary narcotic drugs at home. At some point, the central pharmacy did open, but did not receive a drug license. In addition, the production department was removed from it. Now there is no industrial pharmacy in the city at all. Then the central pharmacy did get a license for drugs, but the volume of its current work cannot be compared with what it was before.

Funding, in principle, has always been decent. But in the summer there are problems. Therefore, at the end of August there is a debt for two months. We work with suppliers on a tender held by the regional Ministry of Health, but, unfortunately, suppliers with really low prices are not always selected.

Svetlana Rybitskaya, pharmacy at the Mytishchi City Clinical Hospital:

Our biggest problem is funding. It has become especially bad since 2005: volumes have decreased, permanent debt. Perhaps this is due to the fact that there are more seriously ill patients, so they need more expensive medicines. Maybe the problem is in combined treatment, when several drugs are needed at once, and before they managed with one. Or patients start their sores, come to the doctor only as a last resort, and the treatment of such diseases is more expensive. Then do not forget that we have an oncological hospital and drugs of a certain assortment. I am glad that suppliers understand our position and always deliver the order on time.

Almost all employees in the pharmacy are of retirement age, there are no young people. You have to work in teams.

The work is very stressful, monotonous and monotonous, not the same as in a regular pharmacy. But you have to work everywhere.

Tatyana Bychkova, pharmacy at the Moscow Regional Oncological Hospital, Balashikha:

Our difficulties are the same as everyone else's, as they have been for several years: a small salary. Therefore, there is no one to work. According to the staffing table, our pharmacy should have 18 employees, and only seven work. We don't have movers, a pharmacist. You have to deal with everything yourself.

Antonina Grushina, pharmacy at the Moscow Regional Psychiatric Hospital N 5:

Since we are a closed pharmacy at a psychiatric hospital, we dispense drugs only for the hospital department. The direction of the hospital dictates its specifics - drugs for the treatment of depression, mental illness. The hospital is budgetary, so funding is small. How much money will be allocated to us, we will buy so many drugs. You always have to wait for money before placing an order. Young people do not want to come here to work because of low wages. In order to somehow change the situation, it is necessary, first of all, to change the regulatory framework. In other pharmacies, everything changes: time, attitude, style of work, but here everything is the same as before, we still work according to the Soviet regulatory framework.

S. GRACHEVA

The Association assists in the provision of services in the sale of timber: at competitive prices on an ongoing basis. Timber products of excellent quality.

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MANUAL FOR THE DESIGN OF HEALTH CARE INSTITUTIONS (K SNIP 2-08-02-89) - SECTION V - AMBULANCE AND EMERGENCY MEDICAL STATION ... Relevant in 2018

HOSPITAL PHARMACIES

1. The main tasks facing hospital pharmacies are the preparation, control and dispensing of medicines to departments of medical and preventive institutions.

For rational design, hospital pharmacies are divided into 5 groups according to the number of beds served: up to 200, 400, 600, 800 and 1000 beds.

<*>It is introduced in the presence of an infectious diseases department in a medical and preventive institution. Provision separate outdoor entrance through vestibule.

<**>For the manufacture of eye drops and dosage forms for newborns.

<***>It is allowed to place non-combustible substances in the basement, when the necessary storage conditions are created.

<****>When storing more than 100 kg - a separate building.

7. The doors of the premises for the storage of poisonous and narcotic medicines must be upholstered with iron; storage is carried out in safes; The building is provided with a security and light-sound alarm system.

8. In accordance with the course of the production process, the prescription room should be located adjacent to the service room (information room). The service room must be brought closer to the forwarding room.

The number of sections in the walk-through cabinet for storing completed orders in the forwarding room should correspond to the number of functional units of the medical institution.

9. The assistant must be brought closer to the analytical and, expediently, to the distillation. In the immediate vicinity of the assistant, it is desirable to place a coctorium. To the assistant should be as close as possible to the washing room, the storage room for clean dishes.

10. The blank (with a lock) should have a direct relationship with the packaging, as close as possible to the analytical one.

11. Between the premises of the aseptic complex, in accordance with the stages of the technological process, a consistent direct relationship should be provided: washing of the aseptic complex - sterilization dishes - assistant - aseptic (for the manufacture of injectable dosage forms) - assistant aseptic (for the manufacture of eye drops and dosage forms for newborns) - packing with a lock - seaming - sterilizing dosage forms - control and marking.

12. The premises of the assistant - aseptic, filling, sealing, sterilizing dosage forms, control - marking can be connected in series with each other by transfer windows or through a door. Seaming should be directly adjacent to the filling and have a transfer device that provides aseptic conditions.

13. All premises for the manufacture of dosage forms and washing facilities must be provided with distilled water. The distillation room should be directly adjacent to the assistant room, the assistant room should be aseptic or as close as possible to them.

A pharmacy organization is an organization, a structural subdivision of a medical organization, engaged in the retail trade in medicines, storage, manufacture and dispensing of medicinal products for medical use.

Any pharmacy organization must have a license, only specialists should work in a pharmacy organization. Management can be carried out by a pharmacist who has a certificate in the specialty of a pharmacist-organizer and work experience of 3 years.

By the nature of their activities, pharmacies are divided into 2 groups:

1 Carrying out the sale of finished medicinal products by prescription, without a prescription to health care institutions - pharmacy, pharmacy kiosk

2 Carrying out all functions, as well as manufacturing and selling, pharmacies with a production department and with the right to manufacture

Classification.

By form of ownership:

State

Municipal

By organizational and legal form:

AO-open and closed

ALC (additional liability company)

Unitary enterprises

By organizational type:

Types of pharmacies:

Pharmacy of finished dosage forms

Manufacturing pharmacy

Production facility with the right to manufacture aseptic molds

sick leave

Interhospital

Pharmacy healthcare institutions

homeopathic

Central, district, city

Pharmacy

pharmacy kiosk

pharmacy store

Served contingent:

Serving the population and healthcare facilities

hospital pharmacy

Interhospital

Health facility pharmacy

Central District Pharmacy

Departmental pharmacies

By the nature of the product range:

Universal

Specialized

Profile

By the presence of a production function:

Production

non-production

By mode of operation:

normal mode

On duty pharmacies

24/7

Pharmacy Functions

1 Production-manufacturing, packaging, water production, quality control

2 Logistics - inventory management

3 Marketing - sale to the population, health care facilities, vacation free of charge or preferential

4 Information and consulting

5 Financial function

6 Marketing research of the pharmaceutical market in order to determine the assortment and pricing policy of the enterprise

7 Control

8 Medical

9 Training

4. Organizational structure of pharmacies. Premises and equipment of pharmaceutical organizations. Qualification groups of positions of pharmacy workers.

They take into account the service area, functions, scope of work, composition of consumers, number of staff, pharmacy area, etc.

Large pharmacies have five departments:

Inventory department: applications, storage, vacation

Prescription and production: receipt of recipes, harvesting, packaging, quality control

OTC Department

Department of finished dosage forms

Department of free preferential leave

Pharmacy premises and equipment.

All rooms must be located in the building and combined into one block. Entrance and exit through the premises of other organizations is allowed. Ramps are required. On the premises of pharmacy organizations there should not be institutions that are not listed in the license. A pharmacy organization must have central water supply, heating, ventilation and fire alarm systems. The pharmacy must have a sign (type of organization, legal form, form of ownership, company name, location, working hours, addresses and telephone numbers of nearby pharmacies)

The premises of the pharmacy are divided into:

1. Production: premises for acceptance and unpacking of goods; shopping room; premises for the preparation of non-sterile medicines; premises for the preparation of medicines in aseptic conditions; control and marking

   Administrative and economic: workplace of the manager, accountant, dressing room, staff room, archive

   Sanitary and amenity premises: a lavatory with a lock, storage space for inventory, showers

Qualification groups of positions.

Established by Order No. 526

MEDICAL PHARMACEUTICAL STAFF OF THE 1ST LEVEL (nurse)

Special medical pharmaceutical staff (junior pharmacist, senior pharmacist, head of the pharmacy)

Doctors and pharmacists (pharmacist-intern, pharmacist trainee, pharmacist-technologist, pharmacist-analyst, senior pharmacist)

Heads of structural divisions (head of structural division, head)

5. STRUCTURAL UNITS OF THE PHARMACY ORGANIZATION FOR RECEIVING RECIPES, MANUFACTURING MEDICINES, CONTROL OF THEIR QUALITY AND DISPENSING. TECHNOLOGY OF RELEASE OF PRECISION MEDICINES. PHARMACEUTICAL EXAMINATION OF THE RECIPE.

In a pharmacy organization, two types of dispensing of goods are possible - prescription and over-the-counter. To receive prescriptions for finished and extemporaneous dosage forms, manufacture medicines, control their quality, dispense prescription and non-prescription goods in pharmacies, the following structural units are distinguished:

Department of finished dosage forms, the main functions of which are the receipt of prescriptions and the release of finished drugs according to them

Prescription and production department, whose functions include taking prescriptions for extemporaneous forms, manufacturing, dispensing drugs and controlling their quality, and dispensing.

OTC department, organized for the sale of drugs without a doctor's prescription, as well as other pharmacy products

The technology for dispensing prescription drugs includes the following procedures:

Pharmaceutical prescription expertise

Taxation of prescriptions, placing an order for manufacturing, registration and control of manufactured medicines

Dispensing medication after payment

A prescription (FZ No. 61) is a written prescription of a medicinal product in the prescribed form, issued by a medical or veterinary worker who has the right to do so for the purpose of dispensing a medicinal product or its manufacture and dispensing.

Pharmaceutical examination of the prescription - assessment of the compliance of the prescriptions received by the pharmacy with the current regulations on the rules for prescribing and dispensing drugs for them. It is carried out in the following stages:

1 Definition of legal capacity

2 Compliance with the form of the form

3 Availability of basic details: stamp of the medical institution, date of discharge, last name and age of the patient, last name of the doctor, name of the drug, quantity, method of administration, signature and personal seal of the doctor

4 Additional details: the seal of the health facility for prescriptions, the round seal of the health facility, the series and number of the prescription, the number of the patient's medical record, the patient's address, the signature of the head doctor of the health facility

5 Expiry date of the prescription

6 Compliance with the order of dispensing: maximum allowable dispensing rates, compatibility of ingredients, compliance of doses with the age of the patient, dispensing according to a foreign prescription, dispensing according to a veterinary prescription

Taxation of a prescription is the determination of the cost of a medicinal product, which consists of the cost of ingredients, water, dishes and the tariff for manufacturing. The tariff includes electricity, rent of the premises in which they cook, utilities, wages of workers.

Prescription registration:

1 Receipt method

2 Journal method

3 Token form

4 Check Form

They take a prescription, check the last name, receipt or token number, visually check the appearance of the medicine