The procedure for preferential provision of medicines. The state of drug supply to the population of the Russian Federation

03.04.2019

Federal Service for Surveillance in Healthcare and social development from 2005 to the present time monitors and controls implementation drug supply certain categories of citizens. Based on the available analytical material and certain experience in this area, proposals were formulated to improve drug provision in the Russian Federation.

When forming the proposals, we proceeded from the fact that the main objective social policy of the Russian state - to make medical and, in particular, pharmaceutical care of higher quality and more accessible to all segments of the population. It should be borne in mind that medical care accounts for 95% of all medical appointments, in connection with which it should be considered as part of the treatment process. The improvement of the drug supply system, in our opinion, presupposes the use of all the best that is available in the existing system.

At the same time, when developing a new concept of drug provision, it is necessary to remember that there are categories of citizens who cannot be obliged to pay extra for the necessary drugs for various reasons(WWII invalids - for political reasons, rural residents - due to the low level of material support, patients in need of expensive therapy, etc.).

The history of the issue of preferential drug provision of the population in the Russian Federation and the tasks of today

The problem of preferential drug provision became acute in the early 90s - during the formation of market relations. This was facilitated by a complex of unfavorable socio-economic factors: the deteriorating state of health of the population, a decrease in life expectancy, an increase in socially significant diseases, as well as a lack of funding, which led to an increase in debt to pharmacy organizations for dispensing drugs on free and preferential prescriptions to decreed groups of the population.

The lack of funds had a negative impact on the activities of pharmacy organizations, the reform of which took place in a very difficult environment.

The Government of the Russian Federation approved the Resolution of July 30, 1994 No. 890 "On state support for the development of the medical industry and improving the provision of the population and healthcare institutions medicines", In accordance with which certain groups of the population and persons with certain diseases, drugs on prescription were to be dispensed free of charge or for preferential terms(with 50% discount). The enactment of such a decree was due to the restructuring of economic relations in the sphere of drug circulation, an increase in prices for them, which made drugs inaccessible to the population with low level income.

It should be emphasized that the benefits provided by the Government of the Russian Federation were not supported by the corresponding amounts of funding. This led to a huge budget debt to pharmacies for dispensed drugs, and ultimately to a decrease in quality. drug assistance.

So, in 1995, the duration of non-payments to Moscow pharmacies for dispensed drugs reached 5 months. An unacceptable situation has developed in which pharmacies, having begun to lend to the budget, themselves found themselves without working capital. At the same time level preferential leave Drugs in the total turnover of pharmacies increased from year to year: if in 1993 it was 24.5%, in 1994 it was 30.4%, then in 1995 it was already 40%.

At the same time, the lack of a system of control over the issuance of preferential prescriptions further exacerbated the situation. The current situation demanded a radical change in the concept of preferential dispensing of drugs.

Conducting an experiment - first with the involvement of pharmacies in South, Central and Zelenogradsky administrative districts Moscow, as well as two insurance companies "Max" and "Rosno" - was sanctioned by the order of the Mayor of Moscow dated 20.10.1995 No. 551-RM.

Since April 1996, the experiment involved pharmacy and treatment-and-prophylactic institutions of all districts of the city. In the three districts in which the experiment was carried out, the payment of preferential prescriptions was carried out more clearly and in a timely manner, and prescriptions (especially for expensive drugs) from the neighboring districts "flowed" there.

The main goal of the planned experiment was to develop a more efficient system for managing the drug dispensing process on preferential terms, which would provide the ability to control the use of budget funds allocated for this.

During the experiment, the following were approved:

- a list of pharmacy organizations entitled to dispense drugs on preferential prescriptions;

- a list of medical and prophylactic institutions that have the right to issue preferential prescriptions;

- list of drugs and products medical purpose(Medical device), dispensed by prescriptions of doctors free of charge or at a discount;

- the procedure for the examination of accounts and registers for dispensed drugs.

To increase the efficiency of control and obtain objective and comprehensive information, it was proposed to supplement the form of the prescription form (form No. 148-1 / u-88) with information including the series and number of the insurance compulsory medical insurance policy, diagnosis code and population category code.

In order to maximize the targeting of the provision of preferential drug provision together with the Committee social protection the population, the Health Committee, the Moscow City MHI Fund and the insurance companies "Max" and "Rosno", and work was carried out on the automated formation and maintenance of the Register of Moscow residents in a reliable state. This made it possible to organize personal accounting of 3.5 million people belonging to privileged groups of the population or suffering from certain diseases, in the outpatient treatment of which drugs and medical devices are dispensed by prescription free of charge or with a 50% discount, as well as to carry out personal accounting of the provision of preferential drug assistance outpatients on the basis of an individual plastic card health insurance- unified information carrier and means of identification of these persons.

Since 1996, 468 pharmacy organizations have participated in the experiment (86% of the total number of pharmacies in the city). All of them were equipped with computers (560 personal computers) and software provided by the insurance companies Max and Rosno. They also trained the pharmacy staff to work on computers. The database already in 1996 amounted to 22.9 million electronic copies of prescription benefits.

An analysis of the data of the automated system for registering preferential prescriptions was carried out. The largest costs were found for one cancer patient - 313.1 thousand rubles. For one patient cardiovascular disease spent an average of 60.2 thousand rubles, for a patient with diabetes - 51.6 thousand rubles. and on the patient bronchial asthma- 50 thousand rubles. ( rice. one).

Experiment Results:

1. The volume of prescriptions for more expensive drugs has increased, incl. more efficient.

2. average cost one recipe increased by 15%.

3. The actual financing of preferential dispensing of drugs increased in 1996 by 11% compared to 1995 with inflation of 23%.

4. The share of preferential dispensing of drugs in the total turnover of pharmacy organizations in 1996 reached 42.9%. Compared to 1995, it increased by only 1.8%, while the increase in the share of preferential drug dispensing in 1994 compared to 1993 was 5.9%, and in 1995 compared to 1994. year - 9.7%. Besides, comparative analysis the dynamics of accounts of pharmacy organizations showed that in December 1995 the basic growth rate of turnover on preferential prescriptions in relation to January was 519%, and in 1996 the same indicator decreased to 161%, that is, more than 3 times.

Thus, thanks to the automated system of expert control over the procedure for preferential dispensing of drugs, it was possible to obtain positive results, namely: to exclude fake prescriptions from circulation, to identify cases of unreasonable discharge of an overestimated amount of drugs.

In 1998, against the background of the crisis, the experiment in Moscow was gradually curtailed, although here the attitude towards preferential drug provision was special both on the part of the city government and on the part of health authorities: the allocation of financial resources, effective administration, correct drafting applications by doctors, pharmacies were organized at medical and prophylactic institutions (LPI), and much more, and the work of chief specialists was informal.

However, this was not the case in all regions. Despite the resolutions adopted by the Government of the Russian Federation on granting certain categories of the population the right to free drug provision, the obligations of the state were not fulfilled in full due to the lack of financial resources. The state was forced to recognize it as necessary to equalize the conditions for ensuring the availability and quality of medical care for all segments of the population.

The analysis of the socio-economic and medical-demographic situation made it possible to establish that the bulk of the population turned out to be close to the poverty line or was below it, the population was declining annually by 400-800 thousand people ( rice. 2), the proportion of people over working age has significantly increased, the mortality rate has exceeded the birth rate.

The analysis of the causes of death showed that the main ones are diseases of the circulatory system, neoplasms and accidents (poisoning and injuries). At the same time, the age of persons dying from diseases of the circulatory system has decreased.

The increase in the incidence averaged 12.5%, the most high rate- 28.5% - referred to diseases of the circulatory system. Diseases of the circulatory system, trauma and poisoning, malignant neoplasms are the main reasons for the disability of Russians and an increase in the number of people eligible for social assistance.

Front the Russian state and society has enormous tasks to create conditions that ensure an increase in the birth rate, an increase in life expectancy, and a reduction in premature mortality.

IN last years as a result of the excess of the revenues of the state budget over the expenditure indicators of the country's socio-economic development, improved. This allowed to increase the cost of implementing measures social support, incl. to provide assistance to 16.3 million people in need of preferential drug assistance.

In connection with the definition of reforms in the health sector as a priority direction of the state's social policy, a real opportunity has emerged to improve drug provision for certain categories of citizens.

In the constituent entities of the Russian Federation, they paid attention to preferential drug provision only in 2005, with the start of the implementation of the program of additional drug provision after the release Federal law dated August 22, 2004 No. 122-FZ "On Amendments to legislative acts Of the Russian Federation and the recognition as invalid of some legislative acts of the Russian Federation in connection with the adoption of the Federal Laws "On Amendments and Additions to the Federal Law" On General Principles of Organization of Legislative (Representative) and Executive Bodies of State Power of Subjects of the Russian Federation "and" On General Principles of Organization local self-government in the Russian Federation ””. This legislative act provided for a system of more equitable state support for citizens in need of social protection, including drug provision for socially vulnerable categories of the population.

The main principles of the system of additional drug supply (DLO) were determined: personalization of the accounting of drug supply provided within the framework of a single list of drugs with a single price level, formed by international non-proprietary names (INN), on the basis of guaranteed supply, elimination of the existing disproportion in drug supply in the territory RF.

In the course of the study, it was found that until 2005 the social guarantees associated with the provision of the necessary medicinal assistance to citizens, due to the lack of financial resources, were of a declarative nature.

The degree of satisfaction of the need for necessary drug assistance in different subjects ranged from 30 to 100%. Territorial programs of state guarantees of free drug assistance were not fully implemented due to a lack of financial resources.

As a result, significant disparities in the per capita rates of reimbursement of the cost of drug care have emerged: these indicators in different regions differed by 4 times.

Analysis of the main socio-economic indicators characterizing the state of drug supply preferential categories population, conducted in the constituent entities of the Russian Federation ( tab. 1,2,3,4).

For example, in the subjects of the Northwestern Federal District specific gravity beneficiaries averaged 11.8% and ranged from 1.6 to 17.2%. Maximum per capita income the inhabitants of the Nenets autonomous region... The minimum values of this indicator fell on the population of the Leningrad Region, which indicated different possibilities of the population to acquire, if necessary, drugs at your own expense.

Of particular concern was the problem of organizing drug provision for certain categories of citizens living in rural areas.

As shown by the study of the Siberian region, in cities the level of satisfaction of the need for essential drugs was 71.5%, and in rural areas - only 28.5% (i.e. 2.5 times lower).

The level of financial provision of the necessary medical assistance for certain diseases in rural areas also turned out to be 1.4 times lower than in urban areas.

There were significant differences in the pricing mechanism for drugs. Thus, in the Republic of Mordovia, a 30% mark-up was applied to the prices for drugs, and in the Republic of Tatarstan and the Nizhny Novgorod region - a 15% markup.

The DLO model specifies the following functions:

- development of a system of targeted social support for the population;

- implementation of the transition to new order financing measures for social support of privileged categories of the population;

- implementation of measures to improve the availability and quality of medical and pharmaceutical care.

The technology for implementing the DLO program consists of several areas:

1. Organization of personalized accounting of the DLO subject.

2. Formation of the list of drugs.

3. Formation of reference databases.

4. The choice of a pharmaceutical organization that provides the supply of drugs.

5. Formation of contractual relations with DLO subjects.

6. Formation of applications.

7. Organization of supplies.

8. Organization of dispensing drugs in pharmacies.

9. Organization of information interaction and inventory management systems.

10. Organization of reporting on dispensed drugs.

11. Organization of financing of the provided drug supply.

12. Monitoring the implementation of the DLO program.

13. Control over the implementation of the Federal Law of August 22, 2004 No. 122-FZ in terms of additional drug provision (DLO).

Results of the implementation of the program for the provision of essential drugs (ONLS) for the period 2005-2007. (as of 31.12.2007) ( rice. 3):

- for the period 2005 - 2007 drugs were dispensed to patients on 356,250,396 prescriptions for the amount of 164 billion rubles;

- the program gave an impetus to the modernization of healthcare in general;

- vital drugs have become more accessible;

- there was a decrease in mortality;

- there was an improvement in the quality of life of patients for a number of nosologies;

- there was a decrease in the load on the hospital segment of the healthcare system;

- the domestic pharmaceutical industry has become much more active;

- the program had a major impact on pharmaceutical market generally.

To confirm that vital drugs have become more accessible, we present data on the total volume of the insulin market and the volume of the new generation insulin market, as well as on the dynamics of treatment costs. multiple sclerosis and hemophilia ( rice. 4,5,6).

However, despite the growth of funds allocated for the DLO-ONLS program, there were many complaints against it both from patients and from the authorities and legislators. During its implementation, the program has undergone several changes, but the most significant modernization took place in 2008:

- 7 high-cost nosologies - diseases requiring expensive therapy were allocated to a separate group;

- since 2008, in accordance with Federal Law No. 230-FZ of 18.10.2007 "On Amendments to Certain Legislative Acts of the Russian Federation in Connection with Improving the Delimitation of Powers" categories of citizens when providing state social assistance and the organization of drug supply.

In addition, the activities related to the modernization of the program in 2008 include:

- introduction of standardization methods medical care, which will increase the predictability of medical care costs, optimize drug provision and consolidate guarantees of the availability of high-quality medical care for citizens of the Russian Federation;

- improvement of control and supervisory activities.

At the same time, the modernization involved not only the transfer of financial capabilities, but also the transfer of responsibility for drug provision in the constituent entities of the Russian Federation ( rice. 7).

The provision of medicines for certain categories of citizens in 2008 was divided into two parts:

- centralized procurement - for 7 high-cost nosologies;

- regional purchases.

The scheme of drug supply has changed: the powers for drug supply were delegated to the constituent entity of the Russian Federation, while the amount of funds did not decrease, but increased (Federal Law No. 230-FZ of 18.10.2007). Procurements (both centralized and regional) in accordance with Federal Law No. 94-FZ of July 21, 2005 “On Placing Orders for the Supply of Goods, Performing Works, and Rendering Services for State and Municipal Needs” were carried out by the auction method.

It was assumed that the new configuration of the ONLS program would allow:

- to fix the border of the rights and responsibilities of the Federal Center and regional authorities in terms of organizing and monitoring the implementation of the ONLS program;

- to increase the transparency and predictability of management decisions related to the implementation of the program;

- to increase the resource of control over the provision of state social assistance to citizens.

The transfer of powers to the constituent entities of the Russian Federation played a certain role in stabilizing drug supply, and the share of deferred supply decreased significantly.

The subjects of the Russian Federation began to pay more attention to the administration of the program. At the same time, problems in the implementation of the ONLS program remain, these are:

1) a decrease in the level of financing of drug provision for privileged categories of citizens at the expense of the budgets of the constituent entities of the Russian Federation (in accordance with the RF Government No. 890, targeted programs);

2) the problem of the quality of determining the need (drawing up an application) for drugs, as well as the quality and efficiency of the auction procedures in the framework of purchases made by the constituent entities of the Russian Federation;

3) problems associated with inventory management, financial flows, drug prescription;

4) problems of information interaction between the participants in the implementation of the ONLS program;

5) problems of centralized procurement:

* a large number of additional applications from the constituent entities of the Russian Federation after the auction and the signing of government contracts, the lack of a clear mechanism for determining the needs of the constituent entities of the Russian Federation for expensive drugs;

* lack of epidemic calculations (the expected number of patients for each nosology);

* Incorrect maintenance of the patient register by the constituent entities of the Russian Federation;

* lag in the preparation of documentation for the acceptance of drugs within the framework of supplies for high-cost nosologies (especially at the beginning of 2008);

* insufficiently developed legal and regulatory framework;

* the presence of significant residues of drugs arising from an incorrect determination of the need;

* problems with limited shelf life of drugs, etc.

All this indicates the need for further improvement of drug supply.

Currently, drug provision of citizens:

- in outpatient within the framework of ONLS is a measure of social support;

- in a hospital setting refers to medical care.

Sources of medical financing, incl. medicinal, help:

- budgets of various levels (regional, municipal);

- compulsory medical insurance funds;

— personal funds citizens.

The main directions of the currently developed drug policy in the Russian Federation are:

- on an outpatient basis: transfer of drug assistance from the category of measures of state social support to the category of medical assistance within the framework of the compulsory health insurance system;

- Replacement of the procedure for public procurement of drugs for reimbursement of the cost of drugs dispensed to citizens in pharmacies as prescribed by a doctor.

To predict and control costs within the system of drug provision for patients on an outpatient basis, it is proposed:

- Selection of essential drugs, taking into account pharmacoeconomic features, creation of a list of essential drugs provided to the population under the compulsory health insurance program.

- Rational use of drugs within the framework of approved standards, development of standards for the provision of medical care that establish the most effective therapeutic regimens.

- State regulation of pricing, determination of the amount of reimbursement by the state to individuals or pharmacies for the cost of drugs sold by them.

- Choice of co-payment mechanism.

It should be noted that the Ministry of Health and Social Development currently pays Special attention development of standards. After the standards are approved, it will be possible to start developing a new list of drugs, based on the data of pharmacoeconomics and evidence-based medicine.

Particular attention should be paid to pricing issues.

There are several options for changing pricing. At the same time, it is important to emphasize that practice has shown the need to return to a regulated approach to pricing. To calculate the reference prices, of course, you will first have to register the prices for drugs, and then make the necessary calculations.

At the level of the Ministry of Health and Social Development, three principal mechanisms of state regulation of prices are considered:

- Establishment of differentiated prices during negotiations with drug manufacturers, depending on costs, therapeutic and economic effects the use of drugs.

- Comparison of the prices of new drugs with the cost of similar drugs in other countries or on the domestic market, determining the price depending on the comparative effectiveness.

- Limiting the reimbursement price by dividing drugs into groups according to the principle of clinical interchangeability and setting the total reimbursement price for all drugs in the group.

Roszdravnadzor offers the following options for calculating the reference price, agreed with the Federal Tariff Service (FTS):

- The calculation is made according to the arithmetic mean, while only drugs below remain for reimbursement average size.

- The calculation is based on the normalized average, while only drugs below the average remain, while calculating the average, drugs with the lowest and highest prices are not taken into account.

- The calculation is based on the normalized average (only drugs remain below the average value, when calculating the average, drugs that differ by more than 30% from the average value are not taken into account).

There are other methods for calculating the reference price.

The calculation of the reference price should be simple and understandable to everyone: pharmacists, distributors, manufacturers, and other market participants.

Authors: N.V. YURGEL, Head Federal Service on supervision in the field of health care and social development, Doctor of Medical Sciences, Professor, Honored Doctor of the Russian Federation, E.A. TELNOVA, Deputy. Head of the Federal Service for Surveillance in Healthcare and Social Development, Doctor of Philosophy

Drug provision is one of the most important components of providing medical care to the population and includes, as already mentioned, a pharmaceutical activity management system, production, quality control, wholesale and retail sale and use of drugs (Starodubov V.I., 1999).

The documents regulating this sector of health care are the Constitution of the Russian Federation, "Fundamentals of Legislation of the Russian Federation on the Protection of Citizens' Health", the Law "On Health Insurance of Citizens of the Russian Federation", as well as other legislative and regulatory acts.

The state policy of providing the population with medicines is aimed at providing them to consumers in a sufficient range and volumes for affordable prices and is carried out through the development of the pharmaceutical services market (Starodubov V.I., 1999).

The main ways of state regulation in the field of drug provision are (Medik V.A., Yuryev V.K., 2003):

state registration of medicines;

licensing of activities in the field of drug circulation;

attestation and certification of specialists involved in the circulation of medicines;

state control of production, manufacture, quality, efficiency, safety of medicines;

state regulation of prices for medicines.

The economic mechanism of drug supply, which has now formed on the basis of the current legislative and regulatory framework, is characterized by a combination of market principles of the functioning of pharmaceutical organizations with measures of state regulation aimed at implementing social protection of the population.

The Ministry of Health and Social Development of the Russian Federation, as a federal executive body in the field of health protection, provides pharmaceuticals to federal healthcare institutions and, within the framework of targeted federal programs for socially significant diseases, to healthcare institutions at the regional level.

In the constituent entities of the Russian Federation, drug provision is carried out at the expense of local budgets, territorial compulsory medical insurance funds and the population. Ensuring the availability and adequacy of drug assistance to the population with a constant increase in the share of spending on medicines in health budgets and a decrease in the population's ability to pay requires adoption additional measures aimed at improving the mechanisms of state regulation of drug provision; provision of state support for domestic drug manufacturers; improving the organization of drug supply and pharmaceutical management.

The pharmaceutical market of the Russian Federation has a number of features that make it different from the markets of other goods. These features include a wide range of drugs, a long development cycle, high science intensity, dependence of the need for drugs on epidemics, natural disasters, and other extreme situations.

The introduction of market mechanisms into pharmaceutical activities contributed to the saturation Russian market a wide range of medicines; Currently registered and authorized to medical use 13.5 thousand drugs, which is 2.4 times higher than the level of 1992.The assortment of drugs is represented by 98 pharmacotherapeutic groups, 70% of which are consumed in 4 groups: analgesic, antipyretic and anti-inflammatory drugs (28%), vitamins (18 %), cardiovascular drugs (13%) and antibacterial agents, including antibiotics, sulfa and anti-tuberculosis drugs (12%).

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Topic 1: Theoretical basis healthcare and pharmacy

1 . 1 What powers in the field of drug circulation are vested in the Government of the Russian Federation and the executive authorities of the constituent entities of the Russian Federation

Government of the Russian Federation:

1) ensure the implementation in the Russian Federation of a unified state policy in the field of providing the population of the Russian Federation with medicines;

2) develops and implements federal programs providing the population of the Russian Federation with medicines and the development of the medical industry;

3) establishes the procedure for social protection of citizens of the Russian Federation, preferential or free provision of certain categories of citizens of the Russian Federation with medicines;

4) approves the Regulation on the activities of the federal body for quality control of medicines.

Executive authorities of the constituent entities of the Russian Federation in the field of drug circulation:

1) develop and implement regional programs for providing the population of the constituent entities of the Russian Federation with medicines;

2) carry out an examination of the environmental safety of the production of medicines in the territories of the constituent entities of the Russian Federation;

3) conduct an examination of the sanitary and epidemiological safety of the production of medicines in the territories of the constituent entities of the Russian Federation

1.2 Role and influence The World Organization Healthcare and the International Pharmaceutical Federation to improve drug supply for the population of the Russian Federation

In order to improve the provision of medical care, it is necessary to adopt, as a matter of priority, federal laws on state, municipal and private health care. This will ensure the implementation of state policy in the field of health care at a modern level. To implement a unified state policy in the field of health care, the structure of industry management should be modernized.

The main tasks of the healthcare organization at the federal level should be considered:

· Determination of the strategy for the development of health care in the country;

· Development and implementation of federal targeted health programs;

· Development of a legislative and regulatory framework for health care;

· Coordination of the activities of public authorities to address health issues;

· Development of mechanisms for the activity of the control and licensing system in the field of drug circulation.

At the level of the constituent entity of the Russian Federation, the main tasks of the healthcare organization should be:

· Development of health care, taking into account regional characteristics;

· Development and implementation of territorial target health programs and programs of state guarantees for the provision of citizens with free medical care on the territory of the constituent entities of the Russian Federation.

The main direction of improving the organization of health care is to ensure its integrity through unified approaches to planning, regulation, standardization, licensing and certification. Wherein positive influence should be provided by the compulsory health insurance system as the basis for financing health care within the framework of state guarantees.

The planning will be based on federal health development programs that implement the goals and objectives of state policy on certain period and including:

· Federal target programs for health care development;

· Programs of state guarantees to provide citizens of the Russian Federation with free medical care.

These federal programs must be approved simultaneously with the allocation of appropriate financial resources for their implementation.

The healthcare programs of the constituent entities of the Russian Federation include programs of state guarantees for the provision of free medical care to citizens, in which the following should be determined:

· Indicators of health status to be achieved as a result of improving the health care system;

· The amount of financing from the health care budget and compulsory health insurance, ensuring the implementation of state guarantees;

· general principles financing and performance of health care institutions;

· Measures to improve the efficiency of health care institutions;

· The main directions of preventive activities.

In the constituent entities of the Russian Federation, standards for outpatient and inpatient treatment costs must be approved. On the basis of these standards and indicators of morbidity, the structure of medical care for the population is determined.

The health care programs of the constituent entities of the Russian Federation serve as the basis for the formation of municipal programs containing indicators of the volume of activities of health care institutions and their funding at the municipal levels.

Executive authorities at all levels control the implementation of relevant programs, which will increase the efficiency of the healthcare organization.

In the context of insufficient financing of health care, duplication of work of medical institutions in the public sector, especially departmental health care institutions, should be eliminated. Involvement of departmental medical institutions for the implementation of the program of state guarantees, which will make it possible to effectively use financial and material resources, to implement the principle of equal treatment of the state to all citizens regardless of their place of work, to reduce the financial burden on the budgets of departments. Separate departmental healthcare institutions should be transferred to the ownership of the constituent entities of the Russian Federation or to municipal ownership.

1.3 Improvement of drug supply, guarantees in the field of drug assistance to the population

The state policy of providing the population with medicines and medical products is aimed at providing them to consumers in a sufficient quality assortment and volume at affordable prices.

The implementation of this policy should be carried out through the development of the market for pharmaceutical services.

In order to ensure safe use drugs and medical devices, it is necessary to improve the existing control and authorization system of examination, standardization and state control both at the federal level and at the level of the constituent entities of the Russian Federation.

The main direction of the implementation of the state policy in the field of drug assistance to citizens should be drug, including preferential, provision of the population in the provision of medical care within the framework of state guarantee programs.

At the stage of outpatient treatment:

Formation within the framework of state and municipal orders of lists of medicines and medical products for preferential provision citizens;

· Formation, within the framework of state and municipal orders, of lists and volumes of medicines and medical products for the treatment of socially significant diseases.

At the stage of inpatient treatment - free drug provision within the types, volumes and conditions for the provision of medical care provided for in the programs of state guarantees.

In order to effectively spend public funds allocated for the preferential provision of medicines and medical products to citizens, it is planned to develop and introduce a system for accounting and control of these funds, to create conditions that ensure citizens' interest in the rational use of benefits for drug provision.

In the field of wholesale purchasing and retail sale of medicines, the following should be done:

To carry out these purchases and sales on competitive basis and ensure transparency in the selection of wholesale suppliers of medicines;

· Ensure the safety, efficacy and quality of medicines through selection, standardization and control over compliance with standards;

· To ensure the availability of a wide range of medicines in retail, in a stationary network - under government guarantee programs.

In order to ensure the availability and adequacy of drug assistance to the population, it is necessary:

· Improve the mechanisms of state regulation of drug provision;

· To provide government support domestic drug manufacturers;

· To improve the organization of the provision of medicines and the management of pharmaceutical activities.

The International Pharmaceutical Federation was founded in 1912 and currently unites over 500,000 pharmaceutical practitioners and scientists. The peculiarity of membership in the federation is that both national pharmaceutical associations and each participant in the sphere of drug circulation can take part in its work. The main goal of the Federation is to spread knowledge and develop practical pharmacy and pharmaceutical science. The Federation represents the interests of practicing pharmacists and scientists and has two councils: the Board of pharmaceutical practice and the Board of pharmaceutical sciences. The first one has 10 sections, each of which deals with separate areas of practical pharmacy: for example, pharmaceutical information or industrial pharmacy, etc. Within the framework of the second Council, there are specialized groups in particular on bioequivalence / bioavailability and pharmaceutical biotechnology.

1.4 Situational tasks for topic 1

The task... Give a description of the pharmacy: form of ownership, organizational legal status; List the documents required for the licensing procedure for these pharmacies.

Pharmacy No. 127 is open government bodies health care in combination with a medical and sanitary part. The charter has been approved, there is a seal, stamps, its own current account. A license was obtained for the corresponding species pharmaceutical activities

Ownership - state

By legal status (organizational and legal forms) - State Unitary Enterprise

A unitary enterprise shall not have the right to create another unitary enterprise as a legal entity by transferring to it a part of its property (subsidiary enterprise).

A unitary enterprise may, on its own behalf, acquire and exercise property and personal non-property rights, bear obligations, be a plaintiff and defendant in court. A commercial organization not endowed with ownership of the property assigned to it by the owner. The property of a unitary enterprise is indivisible and cannot be distributed by contributions (shares, shares), including among the employees of the enterprise. State unitary enterprises can be created by federal bodies of state power on the basis of federal state property, or formed by bodies of state power of the constituent entities of the Russian Federation on the basis of state property of these constituent entities of the Russian Federation. The firm name of a unitary enterprise must contain an indication of the owner of its property.

Licensing of medical activities is regulated by the Federal Law of 08.08.2001, No. 128-FZ "On licensing of certain types of activities", the Regulation on the licensing of medical activities, approved by the Government of the Russian Federation of 22.012007, No. 30, as well as regulatory documents Ministry of Health and Social Development of Russia and Roszdravnadzor.

In accordance with paragraph 1 of Article 9 of the Federal Law "On Licensing Certain Types of Activities", in order to obtain a license, the license applicant shall send or submit to the appropriate licensing authority an application for a license, which specifies:

1. Full and (if any) abbreviated name, including the company name, and the organizational and legal form of the legal entity, its location, addresses of the places of implementation of the licensed type of activity that the applicant intends to carry out, the state registration number of the record of creation legal entity and the data of the document confirming the fact of entering information about the legal entity in the unified state register legal entities, - for a legal entity;

2. taxpayer identification number and data of the document on the registration of the license applicant with the tax authority;

3. a licensed type of activity in accordance with paragraph 1 of Article 17 of this Federal Law, which the license applicant intends to carry out.

Attached to the license application are:

1. Copies of constituent documents (with the presentation of originals if the copies are not certified true to a notary) - for a legal entity;

2.a document confirming the payment state duty for granting a license;

3. Copies of documents, the list of which is determined by the regulation on licensing a specific type of activity and which indicate that the license applicant has the ability to fulfill licensing requirements and conditions, including documents, the presence of which in the implementation of the licensed type of activity is provided for by federal laws.

The licensing body is not entitled to require the license applicant to submit documents not provided for by this Federal Law.

The application for the grant of a license and the documents attached to it, on the day of receipt by the licensing authority, are accepted according to the inventory, a copy of which with a note on the date of acceptance said statements and documents are sent (handed) to the license applicant. Certificate of changes (if there were changes).

Memorandum of Association (if more than two founders)

Certificate of registration with the Inspectorate of the Ministry of Taxes and Duties

Lease agreement (certificate of ownership)

Employee qualification documents:

Diplomas of pharmaceutical education and certificates of specialists (two pharmacists);

Diploma of higher pharmaceutical education, certificate of a specialist, work experience in the specialty for at least three years (one pharmacist) (Improvement at least 1 time in 5 years of qualifications of employees engaged in pharmaceutical activities).

The original of the sanitary and epidemiological conclusion of the Regional SES.

The original of the conclusion of the State Fire Service.

Agreement with a security company.

Topic 2. Pharmacy as a retail link of the pharmacy system

2. 1 Draw a characteristic organizational structure of a production-type pharmacy

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2.2 Situational tasks for topic number 2

On the basis of situational tasks, give a general description of the pharmacy: legal status, activities, type of pharmacy and other characteristics.

Pharmacy No. 5 of the system of a state unitary enterprise, has its own charter, a current account registered with the tax authorities. Received a license, has the right to carry out retail trade in medicines and medical products, to engage in the production of medicines according to prescriptions and intra-pharmaceutical preparations. Specializes in the manufacture of children's lek. forms.

The pharmacy is located in a residential area and serves 15.0 thousand people. Works in two shifts, without a lunch break. Not on duty. There are two pharmacies within a radius of 600 m.

The following customers are attached to the service: Children's Hospital No. 1 with 300 beds, 2 kindergartens, 3 schools, 2 children's polyclinics (100,000 calls). The total number of leks. drugs dispensed according to prescriptions and requirements - 300 thousand,% of ready-made standards is 87%, incl. intra-pharmacy preparation - 13%.

Pharmacy No. 5 is located in a separate room specially designed for it, adjacent to a residential building. Has a sign indicating the parent organization, name, operating mode. The emblem is missing. The total area of the pharmacy is 280 sq. meters. The shopping area covers an area of 60 sq. meters, the manager's office - 15 sq. meters, washing room - 5 sq. meters, distillation - 10 sq. meters, the total area for the storage of pharmaceutical goods is 150 sq. meters, staff room - 8 sq. meters, bathroom - 2.5 sq. meters.

The pharmacy is in sufficient volume and fully equipped with everything necessary equipment... The pharmacy has the necessary literature at all workplaces of specialists. The pharmacy has a room for storing drugs and strongly active ingredients... A license from the UBNON authorities for technical strengthening was obtained.

According to the organizational and legal basis, Pharmacy No. 5 is a unitary state enterprise. Only state and municipal enterprises can be created in the form of unitary enterprises.

A unitary enterprise may, on its own behalf, acquire and exercise property and personal non-property rights, bear obligations, be a plaintiff and defendant in court. unitary enterprises are not entitled to carry out activities not provided for by the charter, that is, there is a special legal capacity. A unitary enterprise must have a round seal containing its full corporate name in Russian and an indication of the location of the unitary enterprise. The seal of a unitary enterprise may also contain its corporate name in the languages of the peoples of the Russian Federation and (or) a foreign language.

A unitary enterprise has the right to have stamps and letterheads with its own company name, its own emblem, as well as a trademark registered in accordance with the established procedure and other means of individualization. The only one constituent document the unitary enterprise is the charter.

Algorithm for solving situational tasks

Stage 1. Determine the classification of pharmacies by product range: specialized - specializes in the manufacture of children's dosage forms

Stage 2. Determine the classification of the pharmacy depending on the mode of operation - not on duty (work in 2 shifts without a lunch break)

Stage 3. Determine the classification of the pharmacy depending on the territorial location - located in a residential area

Stage 4. Define the classification of the pharmacy according to the characteristics of buyers: 15 thousand population, a children's hospital with 300 beds, 2 kindergartens, 3 schools, 2 children's polyclinics (100,000 visits).

Stage 5. Give a description of the attached small retail network - the small retail chain does not have

Stage 6. Give the classification of the pharmacy by the nature of production activities: is production, because specializes in the manufacture of children's dosage forms.

Stage 7. Draw a possible organizational structure, highlight the departments.

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Stage 8. According to the developed structure. Plan the staff.

I on an outpatient basis.

Intra-pharmacy stock 39 thous.

The hospital has 300 beds.

II by stationary recipe

Job title

Standard for 1 unit

Number of units per calculation

Pharmacist for receiving requests

Defect

Pharmacist - analyst

Pharmacist Deputy head of department

Total pharmacists

Pharmacist for preparation

For writing labels

Total pharmacists

Packer

Nurse

0t 500 - 1000 beds

no more than 500 beds

0.35 for each should. Pharmacist and pharmacist

Stage 9. Determine the load on one pharmacy

The pharmacy is located in a residential area and serves 15 thousand people. There are 2 more pharmacies within a radius of 600 meters. The standard for the load on one pharmacy in urban areas is 10.2 thousand people. After calculating, we can conclude that the load does not meet the standards.

Stage 10. Give an opinion on the correspondence of the pharmacy in terms of the parameters of the areas and the composition of the premises.

Guided by the standards of areas, orders of the Ministry of Health of the Russian Federation, we will analyze:

The total area of the pharmacy is 270 sq. m. (standard> 138 sq. m.)

Trading floor 70 sq. m. (> 32 sq. m.)

Head's office 12 sq.m. (> 8 sq. M)

Washing room 5 sq. m. (> 5 sq. m)

Distillation 8 sq. m. (> 5 sq. m.)

Total storage area

pharmaceutical goods 160 sq. m (> 34 sq. m.)

Staff room 12 sq. m. (> 8 sq. m.)

Bathroom 3 sq. m. (> 2 sq. m.)

A room for storing narcotic, poisonous and potent medicines has been equipped.

From the above, it can be concluded that the pharmacy meets the standards. But in terms of the composition of the premises, since the pharmacy is a production one (manufacturing of children's dosage forms), it is necessary to do:

Assistant room (> 10 sq. M.)

Aseptic cooking room (> 8 sq. M.)

Sterilization room (> 10 sq. M.)

Stage 11. What organizations check the pharmacy?

Fire inspection

Federal Service for Surveillance in Healthcare and Social Development for the sale of unregistered medical devices

Expertise pharmacy organization for compliance with licensing requirements and conditions

District SES

Executive authorities for the storage and sale of narcotic, poisonous and potent medicines

Tax authorities

Stage 12. Calculate the staff of pharmacists.

Total drugs dispensed from the pharmacy - 300 thousand.

1.1 calculate the FPP:

FPP = total number of recipes x% FPP / 100%

FPP = 300 x 87/100 = 261 (thousand units)

1.2 the number of intra-pharmaceutical preparations

VAZ = total ready-made standards x% VAZ

VAZ = 87 x 13/100 = 11.31 (thousand units)

1.3 number of custom-made drugs

Ind = total number of recipes - number of FPP

Ind = 300 - 261 = 39 (thousand units)

1.4 total number of recipes by prescription production department

39 + 11.31 = 50.31 (thousand units)

H = volume of work / standard workload for the position

H = 300/25 = 12 - pharmacists - analysts

H = 300/25 = 12 - pharmacist - receiving recipes, quality control, dispensing

3. Give an estimate of the location of the network of pharmacies in the region:

Note: according to guidelines VNIIR No. 97/111 of 1997, the standard for the number of residents per pharmacy is 8.5 thousand people; incl. in cities - 10.2 thousand people, in rural areas - 6.2 thousand people.

So, let's calculate:

In urban areas

800 thousand people / 90 pharmacies = 8.88 thousand people (9 thousand)

In the countryside

40 thousand us. / 8 pharmacies = 5 thousand us.

Conclusion: in urban areas, according to the standards, there should be 10.2 thousand of the population per pharmacy, but in our country, there are 9 thousand of the population per one pharmacy, so further opening of pharmacies in this area is not advisable. In rural areas, one pharmacy, according to the standards, should account for 6.2 thousand of the population, in our country, 5 thousand of the population, therefore, further opening of pharmacies in this rural area is not advisable and not profitable.

Topic 3: Organization of the work of the pharmacy for the receipt of prescriptions and dispensing of drugs. Pharmaceutical prescription expertise

3. 1 What is a comprehensive recipe analysis?

When accepting prescriptions and dispensing medicines, pharmacy workers should be guided by the order of the Ministry of Health of the Russian Federation No. 328 of 23.08.99. "On the rational prescription of medicines, the rules for writing prescriptions for them and the procedure for their dispensing pharmacies(organizations ".

When taking prescriptions and dispensing medicines, it is advisable to follow the following algorithm of actions:

1. Verification of the compliance of the form of the prescription form of the medicinal prescription. Any prescription, regardless of the order of payment for the medicine and the nature of the action of the medicines included in it, must contain the following mandatory and additional details.

The required details include:

· - a stamp of the healthcare facility, indicating the name of the healthcare facility, its address and telephone number;

· - date of issue of the prescription;

· - FULL NAME. the patient and his age;

· - FULL NAME. a doctor;

· - name and quantity of drugs;

· - detailed way the use of drugs;

· - signature and seal of the doctor.

· Additional prescription details depend on the composition of the medicinal product and the form of the prescription form. Prescriptions are written out on forms printed by typographic method according to the forms established by the Ministry of Health of Russia.

1. Checking the eligibility of the person who wrote the prescription. Prescription of medicines is carried out by the physician who is directly managing the patient. In the provision of emergency and emergency medical care, medicines are prescribed by a doctor of the ambulance team or a department doctor. emergency care outpatient clinic. In some cases, medicines can be prescribed by a specialist with an average medical education(dentist, paramedic, midwife).

2. Prescriptions are written clearly and legibly, in ink or ballpoint pen with mandatory filling all the columns provided in the form are certified by the signature and personal seal of the doctor, corrections in the prescription are not allowed.

3. Checking the correctness of the prescription and the method of using drugs. The composition of the medicinal product, the designation of the dosage form and the doctor's appeal to the pharmaceutical worker about the manufacture and dispensing of the medicinal product are prescribed for Latin... The names of narcotic drugs, psychotropic and poisonous substances, as well as medicines of list A are written at the beginning of the prescription. The way of using the medicinal product is written in Russian, indicating the dose, frequency, time of their use in relation to food intake. If an emergency dispensing of a medicinal product is required, the cito or statum designations are placed at the top of the prescription form. Only allowed adopted by the rules abbreviations of designations.

4. Checking the compatibility of the ingredients in the recipe. In a recipe requiring individual production, the compatibility of the ingredients that make up the medicinal product is checked. In cases where it is necessary to change the composition or amount of active substances, replace one dosage form with another, etc. necessary this question check with the prescribing doctor.

5. Checking the highest single and daily doses of drugs, taking into account the patient's age. When evaluating a drug prescription, a pharmacy worker must check the highest single and daily doses (WFD and VVD) of drugs, taking into account the patient's age. When dispensing narcotic, psychotropic and poisonous substances, he must be guided by clause 3.9 of Order No. 785 of December 14, 2005 of the Ministry of Health and “Requirements for the release of narcotic drugs and psychotropic substances; medicines subject to quantitative accounting; anabolic steroids ".

6. Checking the compliance of the amount of prescribed drugs with the order of the Ministry of Health of the Russian Federation dated 12.02.2007 No. 110. Upon receipt of the extemporaneous prescription at the pharmacy pharmaceutical worker is obliged to dispense the drug, which is on the PCU, in half of the highest one-time, in the event that the doctor did not comply with the established rules for issuing a prescription or exceeded the highest single dose. In some cases, an excess is provided. established norms, which is possible if there is a doctor's instruction on the prescription "On special purpose", Certified by the signature and seal of the doctor, as well as the seal" For prescriptions ". For incurable oncological and hematological patients, the number of drugs prescribed in one prescription can also be doubled against the established norms.

The Ministry of Health and Social Development of the Russian Federation is established following dates action of recipes.

Prescriptions written on a special prescription form on narcotic drug and a psychotropic substance, valid - 5 days from the date of discharge, on prescription form No. 148-1 / y-88 - 10 days.

· The prescription written on the prescription form No. 148-1 / y-88 is valid - 10 days, 1 month. The validity period is indicated by strikethrough.

· The prescription written on the prescription form No. 107-1 / y is valid for 10 days, 2 months, 1 year. The validity period is indicated by strikethrough.

· Prescriptions for all other medicines are valid - 2 months from the date of discharge.

· Prescriptions written out on prescription forms of the form No. 148-1 / y - 04 (l) and No. 148-1 / u-06 (l) are valid - 1 month from the date of discharge, with the exception of medicines that are on the subject-quantitative accounting.

Recipes for derivatives of barbituric acid, ephedrine in pure form, pseudoephedrine in pure form, ephedrine and pseudoephedrine mixed with other substances, anabolic steroids, clozapine, tianeptine for the treatment of patients with lingering and chronic diseases can be discharged for a course of treatment up to 1 month.

In this case, the prescription must have an inscription - "For special purposes", which is signed by the doctor and the seal of the medical institution "For prescriptions". Prescriptions that do not meet the above requirements remain in the pharmacy, are canceled with the stamp "Prescription invalid" and are registered in special journal.

8. Recipe taxation. The correct recipe is then taxed. In pharmacies with an equipped workstation, this process takes place with the help of various software. If the prescription is executed incorrectly, then it is registered in the "Journal of Incorrectly Prescribed Prescriptions", previously canceled with the "Prescription invalid" stamp.

9. Registration of the recipe.

10. Registration of the signature, if necessary.

11. Issuance of a receipt.

12. Payment for the prescription.

All these stages are carried out in a complex, since registration, payment and issuance of a receipt go as components of one process.

3. 2 Bring the pharmaceutical expertise of recipes

Stage 1... Determine the eligibility of the person who wrote the prescription: is the doctor authorized to prescribe the medicinal products contained in the prescription, is it not authorized or prohibited to prescribe the medicinal products contained in the prescription for outpatients - on the prescription forms of private practitioners in the upper left corner, their address, license number should be indicated in a typographic way or with a stamp, date of issue, validity period and name of the organization that issued it.

Stage 2... Determine the compliance of the form of the prescription form with the requirements of the regulations: corresponds, does not correspond.

On one prescription form, no more than 3 simple and no more than 2 medicines of lists A and B are written out

Stage 3.

3.1 Medical facility stamp: available, absent. in the upper left corner, a stamp of a medical and prophylactic institution should be affixed with an indication of its name, address and telephone number.

3.3 Name of the patient, age: available, absent

In the columns "Full name of the patient" and "Age", the full surname, name, patronymic of the patient, his age (number of full years) are indicated

3.4 Full name of the doctor: available, absent.

In the column "Full name of the doctor", the full surname, name, patronymic of the doctor are indicated

3.6. Method of application in Russian, except for indications such as "Internal", "Known": available and meets the requirements, absent or does not meet the requirements.

The method of application is indicated in Russian or Russian and national languages. It is forbidden to be limited to general indications: "Internal", "known", etc.

3.7. Signature and personal seal of the doctor: available, missing in whole or in part.

The prescription is signed by the doctor and certified by his personal seal

Stage 4

4.1 Print "For recipes": not required or available; required but not available; not available

4.2 The round stamp of the healthcare facility: not required or available, required but not available; Present

Stage 5... Determine the validity of the prescription: the validity period has not expired and the prescription is valid 5 days, 10 days, 2 months, 1 year; the prescription has expired.

Prescription validity 10 days from the date of prescription up to 1 year

Stage 6.

Stage 7.

Stage 8.

Stage 1... Determine the eligibility of the person who wrote the prescription: whether the doctor is authorized to prescribe the medicinal products contained in the prescription, is not authorized or prohibited to prescribe the medicinal products contained in the prescription to outpatients.

On the prescription forms of private practitioners in the upper left corner, their address, license number, date of issue, validity period and the name of the issuing organization must be indicated in the upper left corner by typographic method or stamp. and analogue form

Stage 2... Determine the compliance of the form of the prescription form with the requirements of the regulations: corresponds, does not correspond - On one prescription form, no more than 3 simple and no more than 2 drugs of lists A and B are written out

Stage 3. Determine the availability of the main requisites of the recipe.

3.1 The stamp of the healthcare facility: available, absent - in the upper left corner, the stamp of the healthcare facility must be affixed with the indication of its name, address and telephone number.

3.2 Prescription date: available, not available.

3.3 Name of the patient, age: available, absent - In the columns "Full name of the patient" and "Age", the patient's surname, name, patronymic, his age (number of full years) are indicated.

3.4 Full name of the doctor: available, not available - the doctor's signature and personal seal must be present

3.5 The names of ingredients in Latin and their quantities are available, the names of ingredients are in Russian or their quantities are absent - Columns "Rp" indicate: Russian Federation, its dosage. The recipe is written out legibly, clearly, in ink, ballpoint pen, corrections are prohibited.

3.6 Method of application in Russian, except for indications such as "Internal", "Known": available and meets the requirements, absent or does not meet the requirements. The method of application is indicated in Russian or Russian and national languages. It is forbidden to be limited to general indications: "Internal", "known", etc.

3.7 Signature and personal seal of the doctor: available, missing in whole or in part. The prescription is signed by the doctor and certified by his personal seal

Stage 4... Determine the presence of additional prescription details.

4.1 Print "For recipes": not required or available; required but not available;

4.2 The round stamp of the healthcare facility: not required or available, required but not available;

4.3 Number, recipe series: not required or available, required but not available;

4.4 Amb. Number patient card or address: not required or available, required but not available;

4.5 Signature of the head physician: not required or available, required but not available;

Stage 5... Determine the validity of the prescription: the validity period has not expired and the prescription is valid 5 days, 10 days, 2 months, 1 year; prescription expired - 2 months or 1 year

Stage 6. Determine the compliance of the recipe with the established procedure for the release of medicinal product.

6.1 Compliance with the prescribed amounts of drugs prescribed in the recipe to the limit norms one-time vacation: Complies or the norm is not established; does not match, i.e. the rate is too high.

6.2 Possibility of dispensing a medicinal product according to a nonresident prescription: it is possible or not a nonresident prescription, it is not possible or there is no medical facility stamp.

6.3 Possibility of dispensing a medicinal product by prescription from a veterinary healthcare facility: possible or a prescription from a non-veterinary healthcare facility, not possible.

Stage 7. Formulate a conclusion about the compliance of the received recipe with the requirements of the regulations: corresponds, i.e. the recipe is valid; does not match, i.e. the recipe is not valid. Describe the measures to provide the patient with medicinal product, if the prescription does not meet the requirements of the regulations.

The received recipe does not match. A recipe that does not meet at least one of the listed requirements or contains incompatible medicinal substances is considered invalid. In this case, the pharmacy employee must contact the doctor or other health workers who wrote the prescription, clarify the name of the drug, its dosage, pharmacological compatibility, and then release the medicine to the patient. All incorrectly written prescriptions remain in the pharmacy, are canceled with the stamp "Prescription is invalid", are registered in a special journal, information about them is transmitted to the head of the relevant medical institution for taking action against employees who violate the rules for prescribing prescriptions.

Stage 8. Determine the shelf life in the pharmacy of the prescription for which the medicine was dispensed: not stored and returned to the patient.

pharmaceutical pharmacy drug prescription

3. 3 For the main parameters included in the pharmaceutical expertise, fill out the table for each medicinal product

Drug name	LS groups	Form prescription blank	Add. seal	Add. Signature	Expiry date Recipe	Stay in the pharmacy	The term is stored.	Subject to PKU	Rate otp. on the prescription	Limit. in the right to discharge
Atropine sulfate	M-choline blocker, List A			Doctor's signature		Remains and is stored in a safe		subject to
Bromized	Strong-acting Sleeping pill		The stamp of the healthcare facility, the personal seal of the doctor, the stamp of the healthcare facility "For prescriptions"	Doctor's signature		Remains and is stored in a safe		subject to
Buprenorphine (tabl)	List II narcotic Opioid narcotic analgesics					Remains and is stored in a safe		subject to		It is forbidden to write out prescriptions for drug addicts by private practitioners.
Ephedrine g / x pore.	Strong Adreno- and sympathomimetics (alpha, beta)		The stamp of the healthcare facility, the personal seal of the doctor, the stamp of the healthcare facility "For prescriptions"	Doctor's signature		Remains and is stored in a safe	1 year; on drugs sold on preferential terms - 5 years	subject to
Tramal 5% -2ml	Strong Opioid non-narcotic analgesics		The stamp of the healthcare facility, the personal seal of the doctor, the stamp of the healthcare facility "For prescriptions"	Doctor's signature		Remains and is stored in a safe	1 year; on drugs sold on preferential terms - 5 years	subject to
Dikain (rr)	Local anesthetics		The stamp of the healthcare facility, the personal seal of the doctor, the stamp of the healthcare facility "For prescriptions"	Doctor's signature		Remains and is stored in a safe		subject to
Corinfar (dragee)	Calcium channel blockers		Medical facility stamp, doctor's stamp	Doctor's signature				Is not subject to
Clonidine 75mkg No. 50	Strong Alpha adrenergic agonists		The stamp of the healthcare facility, the personal seal of the doctor, the stamp of the healthcare facility "For prescriptions"	Doctor's signature		Remains and is stored in a safe	1 year; on drugs sold on preferential terms - 5 years	subject to
Calypsol 10 ml	Psychotropic List II Anesthetic drugs	special prescription form for a narcotic drug	Round stamp of healthcare facility, stamp of doctor, stamp of healthcare facility			Remains and is stored in a safe		subject to		it is forbidden to write out prescriptions for lek. Wed-va, used only in health care facilities, It is forbidden to write out prescriptions I for drug addicts, private practitioners.
Pilocarpine g / chl (solution)	m-choline mimetics		The stamp of the healthcare facility, the personal seal of the doctor, the stamp of the healthcare facility "For prescriptions"	Doctor's signature		Remains and is stored in a safe		Is not subject to
Reladorm (tabl)	Sleeping pills in combinations		The stamp of the healthcare facility, the personal seal of the doctor, the stamp of the healthcare facility "For prescriptions"	Doctor's signature		Remains and is stored in a safe		Is not subject to
Sedalgin (tabl)			Medical facility stamp, doctor's stamp	Doctor's signature		Not stored	Not stored	Is not subject to
Silver nitrate gr	Antiseptics and disinfectants		The stamp of the healthcare facility, the personal seal of the doctor, the stamp of the healthcare facility "For prescriptions"	Doctor's signature		Remains and is stored in a safe		Is not subject to
Sombrevin (amp)	Narcotic drug Anesthetic drugs	special prescription form for a narcotic drug	Round stamp of healthcare facility, stamp of doctor, stamp of healthcare facility	Doctor, Ch. medical facility doctor or his deputy.		Remains and is stored in a safe		subject to		it is forbidden to write prescriptions on lek. Wed-va, used only in health care facilities, It is forbidden to write out prescriptions I for drug addicts, private practitioners.
Ethanol	Antiseptics and disinfectants		The stamp of the healthcare facility, the personal seal of the doctor, the stamp of the healthcare facility "For prescriptions"	Doctor's signature		Remains and is stored in a safe		subject to	in pure form - 100 gr.
Phenazepam (tabl)	Anxiolytics		The stamp of the healthcare facility, the personal seal of the doctor, the stamp of the healthcare facility "For prescriptions"	Doctor's signature		Remains and is stored in a safe		Is not subject to
Nosepam 10 mg No. 20	Strong Anxiolytics		The stamp of the healthcare facility, the personal seal of the doctor, the stamp of the healthcare facility "For prescriptions"	Doctor, Ch. medical facility doctor or his deputy.		Remains and is stored in a safe	1 year; on drugs sold on preferential terms - 5 years	subject to
Cyclobarbital (tabl)	Strong Sleeping pills		The stamp of the healthcare facility, the personal seal of the doctor, the stamp of the healthcare facility "For prescriptions"	Doctor's signature		Remains and is stored in a safe	1 year; on drugs sold on preferential terms - 5 years	subject to
Ergotamine tartrate	precursor list IV Uterotonics	special prescription form for a narcotic drug	Round stamp of healthcare facility, stamp of doctor, stamp of healthcare facility	Doctor, Ch. medical facility doctor or his deputy		Remains and is stored in a safe		subject to
Ethylmorphine g / chl. (Solution)	Narcotic substance in list II Anti-cough drugs	special prescription form for a narcotic drug	Round stamp of healthcare facility, stamp of doctor, stamp of healthcare facility	Doctor, Ch. medical facility doctor or his deputy		Remains and is stored in a safe		subject to		It is forbidden to write out prescriptions I for drug addicts by private practitioners.

Topic 4. Features pharmacy production medicines. Rational organization and certification of workplaces

4. 1 List the regulatory documents on the organization in detail- quantitative accounting in the pharmacy

· Subject-quantitative accounting of medicines is kept in the book of quantitative accounting of pharmaceutical stocks, form 8-MZ, the pages of which must be numbered and certified by the signature of the chief accountant.

· For each name, packaging, dosage form, dosage of medicines subject to quantitative accounting, a separate page opens.

The basis for daily recording the medicines received at the pharmacy are the accounts of the suppliers, and the invoices (requirements), acts or other documents issued.

On the basis of invoices (requirements for dispensed medicinal products subject to quantitative accounting, a list of the sample of consumed medicinal products subject to quantitative accounting is compiled, form 1-MZ, in which records are kept for each name separately. The sheet is signed by the head of the pharmacy or his deputy. ”The total number of the specified material assets released per day, according to the sample per day, is transferred to the book f.8-MZ.

When medicines are received at the pharmacy, the head of the pharmacy, or a person authorized to do so, checks the compliance of their quantity and quality with the data specified in the documents, the correctness of prices per unit of the specified material values (according to the current price lists), after which he makes the following inscription on the supplier's account Contents: "Prices have been checked, material values have been accepted by me (signature)."

· If a shortage, surplus, damage and breakage of material assets is detected, the commission created on behalf of the head of the institution accepts the received material assets in accordance with the instructions on the procedure for accepting products and goods in terms of quantity and quality in accordance with the established procedure.

The head of the pharmacy records the received and verified accounts of suppliers in the register of accounts received at the pharmacy, form 6-MZ, after which he transfers them to the accounting department of the institution for payment.

· When filling out the book f.6-MZ, column 6 indicates the cost of medicines by weight, i.e. the cost of dry and liquid medicines, which require certain processing in the pharmacy (mixing, packing, etc.) before being dispensed to the departments (offices) of the institution.

Medicines subject to quantitative accounting must be discharged from the pharmacy on separate invoices (requirements) with a stamp, seal of the institution and approved by the head of the institution, they must indicate the numbers of case histories, surnames, names and patronymics of patients for whom the medicines were prescribed ...

· Each invoice (requirement) for the dispensing of medicines to departments (offices) is taxed by the head of the pharmacy or a person authorized to do so to determine the value of the released material assets. Valuables are tagged at retail (list) prices for each dosage form up to a whole penny according to the rules for applying the price list of retail prices for medicines and pharmaceutical goods No. 0-25, and the amount as a whole is displayed according to the invoice (requirement). The cost of each name of medicinal products and their total amount is indicated in the copy of the invoice (requirement) of the pharmacy.

Taxed waybills (requirements) are recorded daily in numerical order in the book of taxed waybills (requirements) f.7-MZ, the pages of which must be numbered and on the last page certified by the signature of the chief accountant, while the numbers of waybills (requirements) for medicines, subject to quantitative accounting are underlined.

· At the end of the month in the book f.7-MZ, the total amount for each group of released material assets listed in paragraph 1 of the instruction is calculated, and the total amount for the month, which is entered in numbers and in words.

· The total amounts from the book of the specified form for each group of medicines dispensed by the pharmacy for the month are included in the pharmacy's report on the receipt and consumption of medicines, dressings and medical products in monetary (total) terms.

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1.3 Improvement of drug supply, guarantees in the field of drug assistance to the population

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