The general design and construction of a Hospital Pharmacy should consider its functionality. The location and size should accommodate anticipated personnel and inventory movement, work processes, and activities. Built-in storage and fixed equipment should be provided for storing documents, bulk supplies, dangerous drugs, psychotropic substances, portable medical gas cylinders, and refrigerated and cold-chain items. Drainage and sewerage systems should be present outside the premises.

Structural Design of Hospital Pharmacy

• 1) Wall: The walls should be of non-porous material and plastered on both sides. The indoor wall finishing should be of washable antifungal paint and the outdoor finishing should be of weatherproof paint. The walls for the cold room should be of a special building material and designed to prevent condensation.
• 2) Floor: The floor should be of concrete and smoothly plastered. The floor finishing should be of a non-slippery heavy-duty material to withstand heavy loads and traffic. The floor should be non-porous, damp-proof, and resistant to detergent. The floor-to-ceiling height should range from 15 -30 feet according to the functional area and handling equipment used.
• 3) Ceiling: The ceiling should be of fire-retardant, asbestos-free, and non-shedding materials or mineral fibers.
• 4) Roof: The roof should be pitched or sloped to prevent heavy rain damage.
• 5) Door: The doors should be of fire-retardant material. The doors should have two leaves and should be sufficiently wide to allow free and easy movement of supplies and handling equipment (such as forklifts and stackers). The exit doors should be purposefully located and fitted with luminous emergency exit signage.
• 6) Window: The windows should be available at the workstation, office, and staff areas, but not in storage areas.

Receiving Area

• 1) Loading and Unloading Area: This area should be adequately spaced and properly sheltered by taking care of the vehicle height.
• 2) Receiving Counter: It should have adequate waiting space and should be equipped with suitable office furniture and equipment.
• 3) Sorting and Unpacking Area: This area should be adequately spaced to enable sorting and checking of goods. The space should be sufficient for the utilization of the forklift.
• 4) Transit/Holding Area: The transit/holding area should be adequately spaced for storing:
  • i) Items requiring further clarification/investigation before receiving
  • ii) Transit items not requiring special storage conditions
  • iii) Pallets. 
• 5) Disposal Room: This room should store discarded items (like used boxes, wrappers, and plastic covers).

Storage Area

• 1) General Storage Requirement: The storage area should be provided with air – conditioning facilities for 24 hours. Its temperature should be effectively controlled between 160 -250°C. The electrical supply to refrigerators, freezers, cold rooms, and air conditioning facilities should be linked to the hospital emergency power supply. A computerized alarm system should be connected to the main electrical control system of the hospital to detect electrical failure of cold chain equipment. Adequate space should be provided for forklifts, stackers, and trolleys, and for accommodating IT facilities. The area should have sufficient numbers of pallets, shelves, and racks.
• 2) Drug Store: It should have adjustable, modular, heavy-duty open racks for storing packages of different sizes. It should have a sufficient storage area for bulk items. It should be equipped with heavy-duty plastic pallets for storing bulk items and larger cartons off the floor. These pallets should be designed to be used with forklifts to move around groups of larger items. The drug store should have a designated area with cautionary signage and a chemo-spill kit for cytotoxic drugs.
• 3) Dangerous Drugs/Psychotropic Substances Store: This area is meant for storing dangerous drugs/psychotropic substances, thus should be kept under lock and key in a special room/cabinet with an alarm system.
• 4) Cold Room/Pharmaceutical Refrigerator/Freezer Area: This area should be provided based on the functionality of the hospital. It should be present within the drug store for storing drugs that require low storage temperatures (like vaccines, antisera, and other biological products). Every cold room/pharmaceutical refrigerator/freezer should be equipped with a computerized temperature recorder system.
• 5) Intravenous (IV) Fluid Store: This area should be adequately spaced to accommodate hemodialysis peritoneal dialysis solution and intravenous solutions. The space should also be sufficient for using a forklift.
• 6) Surgical Store: This area is designed for storing bulk surgical/consumable/disposable items -ray films. It should have adjustable, modular, and heavy-duty open racks. It should be provided with adequate space to accommodate bulk items.
• 7) Non-Drug Bulk Store: This area is designed for storing dispensing bottles, containers, labels, and envelopes. It should have adjustable, modular, and heavy-duty open racks. It should be provided with adequate space to allow easy movements.

Store with Special Requirement

• 1) Inflammable Store: This area should be located at a minimum of 10 feet distance away from other adjacent buildings. It should be designed for storing inflammable items (ethanol, methanol, acetone, etc.) and should be equipped with firefighting equipment, smoke detectors, and exhaust fans for proper ventilation. The location and design of the inflammable store should provide maximum air circulation so that accumulation of fumes or gases can be avoided. Spark-proof switches should be present outside the room.
• 2) Corrosive Items Store: This area should be designed for the storage of corrosive items ( such as phenols and hypochlorite). It should be equipped with a special plumbing and drainage system and an eye wash station.
• 3) Medical Gas Store: This area should be designed for the storage of portable medical gas cylinders. The floor should be reinforced to bear the weight of heavy gas cylinders. Loading and unloading areas should be made present and sheltered well. The bay should be constructed to enable direct loading and unloading of goods. All electrical facilities should fulfill the requirements of the Fire Fighting and Rescue Departments and the Department of Environment. Proper ventilation should be maintained.
• 4) Quarantined Item Store: A designated area or cabinet should be provided and clearly labeled.
• 5) Non-Conformance/Condemned Item Store: A designated store/cabinet for expired, obsolete, or damaged items should be provided before disposal.

Issuing Area

• 1) Temporary Holding Area: Supply to various departments is carried out in this area. Indents from various departments should be processed and prepared for supply and kept here till collected. Designated secured areas should be provided close to the issuing area.
• 2) Issuing Counter: It should have an adequate waiting space, and should be equipped with appropriate office furniture and equipment. It should provide sufficient space for material handling equipment.

Administrative Area

• 1) Pharmacist In-Charge Office: This area is provided for the pharmacist in -charge to perform the administrative work. It should be located to allow supervision.
• 2) Pharmacist Work Station: This area is provided for the pharmacist. It should be half-glass paneled to allow supervision. Workstations and computer terminals should also be present here.
• 3) General Office: This area is provided for the assistant administrative officers and administrative assistants. Workstations with computer terminals should be present here.
• 4) Meeting/Discussion Room: This area should have sufficient space for discussion and routine administrative meetings.
• 5) Document Room: This area should have sufficient space for storing files and records.
• 6) Reception Counter and Customer Waiting Area: This area should be equipped with appropriate office furniture and equipment. The customer waiting area should have audio-visual facilities, a water dispenser, and a settee.

Ancillary Area

• 1) Personnel/Staff Rest Room: This room should be provided for staff rest, and should be equipped with staff lockers and domestic appliances such as a refrigerator, electric kettle, water dispenser, microwave oven, table, chairs, and sofa.
• 2) Wash Room: Separate washrooms for males and females with separate changing rooms, toilets, and shower facilities should be provided. A dedicated toilet for visitors should be made available.
• 3) Housekeeping/Utility Room: This room should have sufficient space for storing cleaning materials and equipment. It should have good ventilation for washing and drying of equipment.
• 4) Security Guard Post: This area should be located at the main entrance of the store. The room should be equipped with the necessary equipment for the convenience of the security guard.

Floor Space Requirements

Hospital Pharmacy floor area depends on the range of its operations, number of divisions, medicaments manufactured, number of patients served (out-patient pharmacy), number of indoor patients, strength of the pharmacy staff, etc. The floor space should be according to the norms laid down by the Drugs and Cosmetics Act (under Schedule M). The floor area should be a minimum of 250 sq m. The area requirements increase to 10 sq m per bed for 100 beds, 6 sq m per bed for 200 beds, and at least 5 sq m per bed for larger hospitals. Teaching institutes demand a greater area.

Staff Requirements

The hospital pharmacy comprises many departments as per the set-up of the hospital. In a small set-up, it has a dispensing department and a medical store; while in the big set-up, it has manufacturing, quality control, and clinical pharmacy departments also. The number of pharmacy staff members relies on the following factors:

• 1) Number of beds
• 2) Service-out-patients and in-patients
• 3) Whether the pharmacy is involved in manufacturing drugs or formulations
• 4) Whether the pharmacy is involved in stocking and dispensing of surgical and laboratory supplies.

A hospital pharmacy should appoint the following staff personnel:

• 1) One member as the Chief pharmacist or Director
• 2) At least 4 registered pharmacists in smaller hospitals so that one pharmacist handles 60 patients. Total patients involved (both in-patients and out-patients)
• 3) Sufficient number of assistants, attendants, and sweepers
• 4) Pharmacist-cum-clerk or clerks depending on the hospital size
• 5) A hospital pharmacy manufacturing drugs and formulations should have manufacturing chemists and analytical chemists supported by additional assistant pharmacists
• 6) For 50-bedded, 100-bedded, 200-bedded, 300-bedded, and 500-bedded hospitals, 3, 5, 8, 10, and 15, respectively pharmacists are needed. In big hospitals, one pharmacist is recommended for 133 patients.

Qualification

The Chief Pharmacist or Director should be a postgraduate degree holder in pharmacy (preferably in pharmacology or hospital pharmacy). The manufacturing chemist is required to have graduated in pharmacy and hold experience in manufacturing drugs and formulations for at least 18 months. The analytical chemist should be a postgraduate in pharmaceutical chemistry or analytical chemistry. Registered pharmacists and pharmacists – cum-clerk requires a diploma in pharmacy and registration in the state pharmacy council.

Reference

• Science Direct- Hospital Pharmacy
• Wikipedia- Hospital pharmacy

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