Scope of Services
Overview of Services
The Department of Pharmacy provides systems-based services including drug and disease state information, drug preparation and distribution, and dosage monitoring services for all patients. All physician orders/prescriptions for medications are reviewed by a clinical pharmacist for appropriateness of therapy and entered into a pharmacy database. This database provides clinical screening, drug preparation lists, drug production reports, and other drug use information.
A central distribution area and several satellite work areas including outpatient pharmacies support the delivery of product-related and clinical services to patients and health care providers of UMMC. General pharmacy services include:
- Anticoagulation Clinic
- Central Pharmacy
- Greenebaum Cancer Center Pharmacy
- Gudelsky Pharmacy
- IV Preparation Lab
- Investigational Drug Service Pharmacy
- Nuclear Pharmacy
- Operating Room Pharmacy
- Shock Trauma Pharmacy
- University Pharmacy - Redwood Building
- UMMC Outpatient Pharmacy
- Women and Children's Pharmacy
Clinical pharmacy specialists and clinical pharmacists provide direct patient care throughout the institution. Many of these practitioners are active, integral members of medical service teams and assist the team by providing services including:
- drug selection
- pharmacokinetic assessment and drug dosing
- drug information
- patient medication counseling and education
- other patient-focused services to optimize drug therapy outcomes
All pharmacists provide patient and health care provider education; participate in Adverse Drug Reaction (ADR) and Medication Error programs; and participate in investigational drug research, drug and therapeutic policy development and implementation, and other cost and quality enhancement programs and projects. Pharmacists' interventions are recorded and often documented in the medical record.
Types and Ages of Patients Served
The ages, sexual distribution, medical requirements, disease states, and general conditions of patients served by the Department of Pharmacy Services are the same as those of the general patient population served by UMMC.
Scope and Complexity of Patient Care Needs
With technical and management support, clinical pharmacists/specialists:
- document the resolution or prevention of nearly 22,000 drug-related problems
- provide about 3.7 million inpatient doses and about 290,000 outpatient prescriptions
- prepare about 455,000 sterile admixtures
- manage about 200 research studies every year
Patient-focused activities are provided from admission to discharge and continue on an outpatient basis through ambulatory care services.
Strategies to Assess and Meet Patient Care Needs
The department's vision is to be standard setting in its provision of direct patient care and to continuously develop methods that improve this practice.
- assess patient care requirements by patient interview
- collaborate with physicians and other health care providers
- provide clinical assessment of the medication-related problems
- provide physical assessment, if necessary
- assess, recommend and monitor the medication regimen
- review the medical record for additional patient information
Patient Care Providers
Direct patient care or pharmaceutical care is provided by all employees of the Department of Pharmacy Services. Listed below are the components that make up the Pharmaceutical Care Team:
- Director of Pharmacy Services
- Clinical Pharmacy Manager
- Pharmacy Operations Managers and Process Coordinators
- Clinical Pharmacists and Clinical Specialists
- Pharmacy Technicians
- Pharmacy Residents and Students
- Inventory Control Specialists
- Administrative Assistants
- Technology Support Personnel
- School of Pharmacy Faculty members
Pharmaceutical care includes, but is not limited to, appropriate, accurate, and timely dispensing of medications to patients. Regulations set by the Maryland State Board of Pharmacy and Federal Government govern these practices. Professional and ethical practice are maintained at all times through adherence to the department's, institution's, and profession's code of professional conduct.
Pharmacy work areas are staffed by:
- clinical pharmacists/specialists
- pharmacy operation managers
- inventory control specialists
Staffing requirements are determined by known daily patterns of physician order generation and times when therapeutic decision making occurs (e.g. pharmacist rounds with the medical teams). Sudden changes in staffing requirements are accommodated by:
- temporary hiring of supplemental staff
- shifting staff and work among work areas
A staffing model is prepared annually to outline workload data, staffing patterns, and fiscal year budget information. Performance is tracked bi-weekly and discussed monthly in combination with quality, human resource, and financial data.
The Department of Pharmacy Services maintains nationally recognized one-year residency programs in General Pharmacy Practice, Critical Care Pharmacy Practice, and Transplant Pharmacy Practice.
The General Pharmacy Practice and Critical Care Pharmacy Practice residencies are nationally accredited by the American Society of Health Systems Pharmacists (ASHP). Pharmacy residents are fully licensed practitioners and are trained by clinical pharmacy specialists and clinical pharmacists to provide proficient and compassionate direct patient care, to conduct research projects associated with the UMMC medication use process, and to educate patients, other health care providers, and students.
Click here for a full description of the department's residency program. Pharmacy students and residents may work with various medical service teams and patient populations. These interactions occur under the supervision and direction of clinical pharmacists/specialists who are residency preceptors and appointed clinical faculty members at the Maryland School of Pharmacy.
The department provides documents to orient health care providers and UMMC staff on pharmacy services including:
- UMMC Formulary - published annually and distributed to all house staff and patient care areas
- P&T Highlights - departmental newsletter published monthly
The Internet site you are currently visiting is used to communicate new and revised therapeutic policies and other important medication information to the hospital staff.
Hospital orientation is provided to staff in addition to annual training, ongoing professional development, and appropriate competency validation.
Extent to Which Care Meets Patient Care Needs
Patient care quality measures are reported to the Process Improvement Steering Committee (PISC). Among these are medication error and ADR trends, results of focused medication use evaluations, and results of drug-use and process improvement projects.
This department complies with the UMMC Hospital Policy Manual and all federal, state, and regulatory standards to guide practice. Additional patient care standards and clinical guidelines used are published in the UMMC Formulary.
Other standards of care used by the department include:
- Therapeutic Guidelines for Medication Use developed and approved by the UMMC Therapeutics Committee
- IV Push Guidelines Manual
- Adult IV Medication Administration Guidelines
- Medication Protocols or Algorithms
- Critical Pathways
- Investigational Drug Protocols approved by the Institutional Review Board (IRB)
The Pharmacy Leadership Team determines the short and long term departmental goals, which are consistent with and focus on fulfillment of the department's and institution's mission and vision.
The surgical pharmacists provide pharmaceutical care to general adult surgery patients. Services provided include assistance with drug selection, pharmacokinetic dosing and monitoring, patient and team education, and drug information. Consultations are also provided to the SICU teams on issues of critical care management.
The pharmacists working with the Adult Medicine- Infectious Disease provide inpatient and outpatient services. Specialized pharmacists function as team members on the inpatient HIV Service, providing patient specific and health care provider education and drug information on the pharmacotherapy of HIV and related diseases. They also assist in the coordination of home parenteral therapy. Pharmacists working at the Evelyn Jordan Center clinic review and update patient profiles, provide prescription counseling for patient education and adherence, as well as pharmacotherapeutic information to the health care team.
Pharmacists working in the Anticoagulation Clinic monitor outpatients on warfarin therapy. Patients are interviewed for signs and symptoms of bleeding or thromboembolic complications. Their INRs are measured and their warfarin dosages are adjusted accordingly. Pharmacists also check patients' blood pressures. Education and compliance, including referral to Dupont's Indigent Patient Program, are strongly emphasized. Appropriate over-the-counter medications are recommended as needed.
The pharmacists on this service attend rounds in the PCU/CCU where they assist with drug information, drug selection and dosing, pharmacokinetics, and adverse drug reaction reporting. In addition, pharmacists participate in discharge planning, such as simplification of medication regimens, with an emphasis on patient compliance, cost-effectiveness, and patient education.
Critical Care Medicine
This specialized service works with critical care physicians and other professionals in designing and implementing drug therapy in the Shock Trauma Center and the Medical Intensive Care Unit. The pharmacists provide information on pharmacodynamics, drug selection and administration, toxicities, and cost effective treatment options. A comprehensive pharmacokinetic service is provided for aminoglycoside and vancomycin dosing as well as other drugs upon request. In addition, the service is involved in development of multiple drug and disease state protocols, research and educational programs.
Greenebaum Cancer Center: Oncology Clinical and Research
This specialized service provides consultations in the areas of antineoplastic drug therapy to include pharmacology, pharmacokinetics, drug administration, toxicities, compatibilities, and related supportive care management. A variety of references on these topics are also available. In addition, therapeutic monitoring including pharmacokinetics is provided for patients.
Intravenous Admixture Services
This comprehensive service prepares about 1500 doses a day which range from simple premixed bags to complex intravenous admixtures. All total parenteral nutrition bags are compounded here using automated technology. Technicians and pharmacists on this service assist in aseptic technique training of new staff members in the department.
Investigational Drug Service
The Investigational Drug Service is responsible for the development, distribution, and accounting procedures for all investigational drugs at UMMC. Assistance is also provided for protocol development, preparation of drug information materials, IND submission, randomization and blinding, and post-marketing surveillance studies.
The Pharmacy Leadership Team strives to create and maintain a pharmacy practice environment conducive to the provision of proficient, compassionate and standard setting direct patient care. This group consists of the Director of Pharmacy Services, the Manager of Clinical Services, Operations Managers, and Process Coordinators.
Maryland Poison Center
The Maryland Poison Center (MPC) is an emergency telephone service which provides health professionals and the general public with immediate, up to date information on exposures to toxic substances on a 24 hour per day basis. A division of the University of Maryland School of Pharmacy, the MPC is the official poison center for the state of Maryland. The center is staffed by specialists in poison information. Public and professional education programs are also available.
The medicine pharmacists work with physicians and other health care professionals to provide pharmaceutical care services to adult medicine patients. Services provided include assistance with drug selection and dosing, cost-effective treatment options, drug information, patient counseling, team education, pharmacokinetic dosing and monitoring, renal dosing, and adverse drug reaction reporting.
Pharmaceutical services are provided to the neonatal, pediatric, mother/baby, and labor & delivery inpatient teams in critical and non-critical areas. The pediatric clinical pharmacists provide patient specific and general pharmacotherapeutic information. This includes drug information, pharmacokinetics, and other drug-related problems. Assistance is also provided for questions related to Total Parenteral Nutrition.
The pharmacists working with the Abdominal Transplant Teams provide pharmaceutical care services through immunosuppression initiation and adjustment, drug information, dosage recommendations, pharmacokinetic dosing, drug selection, and adverse drug reaction reporting. Medications used by this team are complicated and costly. Medication profile review helps to decrease unnecessary waste of drugs and preparation times.
Kidney and Pancreas
The pharmacists working with the Kidney/Pancreas Transplant Team provide pharmaceutical care services through immunosuppression adjustment, drug information, dosage recommendations, pharmacokinetic dosing, drug selection, and adverse drug reaction reporting. Medications used by this team are complicated and costly. Medication profile review helps to decrease unnecessary waste of drugs and preparation times.
Pharmaceutical care services are provided for both inpatients and outpatients. These services include dosing and monitoring of immunosuppressive agents, assistance with drug selection, drug interaction monitoring, patient education, and drug information. This service also provides assistance with protocol development and inservice education per request.
Medication Use Evaluation Program
The Medication Use Evaluation Program (MUE) is a planned and ongoing process to monitor and evaluate the use of drugs at UMMC. The aim of the program is to help assure appropriate, safe and effective use of drugs. The program involves monitoring of drug usage patterns, adverse drug reactions, formal drug and disease state oriented reviews utilizing approved criteria, collection and analysis of data on drugs recently evaluated by the Therapeutics Committee, and outcomes research. Results and activities are reported to the Pharmacy and Therapeutics Committee.
Medication Use Process Programs
Adverse Drug Event Advisory Council
The ADE Advisory Council functions as a multidisciplinary consulting body to the Therapeutics Committee. The Council is charged with analyzing data collected from the ADR Surveillance Program and the Medication Error Surveillance Program, collaborating on prevention projects, initiating quality improvement programs, and making recommendations for action.
Adverse Drug Reaction Surveillance Program
The definition of an adverse drug reaction (ADR) at UMMC is, "a detrimental response to a drug that is unintended or unexpected and occurs at doses used for prophylaxis, diagnosis or therapy." The ADR Surveillance Program, through the implementation of the ADR Hotline, has been developed to concurrently monitor for ADRs.
Three key features of the program include: routine feedback to healthcare providers concerning ADRs, compliance with The Joint Commission requirements, and prevention of known or suspected drug intolerances. Physicians, nurses, and other health professionals are able to report a possible ADR by calling the ADR Hotline. The hotline is operational 24 hours a day. All documented or suspected allergic and other significant reactions may be reported through the hotline. There is no paper work involved. All calls are strictly confidential. The data collected is analyzed for trends that could signify areas where ADR prevention can occur. Serious reactions are reported to the FDA MedWatch program.
Medication Error Surveillance Program
The definition of a medication error at UMMC is, "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in control of the health care provider, patient, or consumer." The Department of Pharmacy Services, in collaboration with the Department of Risk Management collects and analyzes medication errors at UMMC. The purpose of this program is to identify and correct system breakdowns believed to be causing errors. All medication errors should be reported to Pharmacy by filling out a Medication Error Report form.
ISMP Medication Safety Alert
The Institute for Safe Medication Practices (ISMP) is a nonprofit organization dedicated to educating the global healthcare community about methods to prevent adverse drug events. ISMP publishes its recommendations along with actual events reported to the USP Medication Error Reporting Program, operated in cooperation with ISMP. ISMP has given the Department of Pharmacy permission to reproduce the ISMP Medication Safety Alert in Therapeutic Perspectives for the medical system staff. This bi-weekly publication brings potentially life-saving information about medication and device errors and adverse drug reactions. The ISMP Medication Safety Alerts can be found each month as an insert in Therapeutic Perspectives.
Medication Use Process Manual (Formulary)
The Medication Use Process Manual (Formulary) is an electronic publication of the Department of Pharmacy in collaboration with the Medical Staff. It includes complete product descriptions of the formulary items available for use at UMMC.
P&T Highlights is the official newsletter of the Pharmacy and Therapeutics (P&T) Committee, published monthly by the Department of Pharmacy Services. P&T Highlights provides a summary of the P&T Committee activities. Each edition provides information on formulary changes, medication guidelines for use, new and revised drug policies, and drug shortages. This publication is distributed to all physicians at the University of Maryland Medical Center (UMMC), as well as nurse managers, pharmacists, and hospital administrators.
Pharmacy and Therapeutics Committee
The Therapeutics Committee is a standing committee of the medical staff responsible for assuring that the medications and therapeutic agents used at UMMC are of the highest quality. The Department of Pharmacy provides administrative support for the Pharmacy and Therapeutics Committee including: setting monthly agendas, formulary reviews for requested medications, monitoring non-formulary drug use, medication use evaluations, adverse drug and medication error surveillance, pharmacoeconomic analyses, preparation of guidelines for use, dissemination of information from the Committee, and publication of P&T Highlights. Other administrative duties are performed as requested.
For patient inquiries or to make an appointment, call 1-800-492-5538.