# Hospital Pharmacy Organisation > Hospital pharmacy organisation notes for Pharmacy: Pharmacy and Therapeutics Committee, formulary, unit dose versus floor stock systems, IV admixtures and TDM for PCI exams. - Canonical URL: https://prepelephant.com/topics/allied/pharmacy/hospital-pharmacy-organisation - Exam / course: Allied Health · Subject: Pharmacy - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Hospital Pharmacy Organisation", PrepElephant, https://prepelephant.com/topics/allied/pharmacy/hospital-pharmacy-organisation ## Direct answer Formulary, indent, unit dose: hospital pharmacy runs on systems the retail counter never needs. Its organisation places the pharmacy under the medical superintendent, headed by a chief pharmacist, and puts its policies in the hands of the Pharmacy and Therapeutics Committee (PTC) — physicians, the pharmacist as secretary, nursing and administration — which owns the hospital formulary, reviews adverse drug reactions and audits drug use. Daily work divides into procurement through indents and the central drug store, distribution by floor-stock or unit-dose systems, sterile services such as IV admixtures, and clinical services from therapeutic drug monitoring to ADR reporting; controlled drugs travel with their own double-lock registers on every ward. ## What you must remember - Structure: medical superintendent at the top, chief/deputy/assistant pharmacists and technicians below; the pharmacy is a clinical department, not a store room. - Pharmacy and Therapeutics Committee: policy body for the formulary, additions and deletions of drugs, ADR and medication-error review, and drug-use evaluation; the pharmacist traditionally serves as its secretary. - Hospital formulary: the committee-approved list of drugs the hospital stocks, with prescribing information — the instrument that rationalises therapy and controls cost. - Procurement and stores: indent-based requisitions, competitive purchasing, goods receipt note on arrival, quarantine until verified, ABC/VED inventory control, cold-chain monitoring at 2-8 °C. - Distribution systems: floor (ward) stock — bulk issue to wards, nurse-controlled, fast but prone to errors and losses; unit dose dispensing — a 24-hour supply in ready-to-give single doses, consistently associated with fewer medication errors at higher setup cost; individual prescription issue for outpatients and named inpatients. - Sterile products unit: intravenous admixtures and total parenteral nutrition prepared under laminar airflow, cytotoxics in biological safety cabinets by specially trained staff. - Clinical services: therapeutic drug monitoring for narrow-index drugs (phenytoin, digoxin, lithium, theophylline, aminoglycosides, methotrexate), ADR monitoring centre reporting to the PvPI, drug information service, medication reconciliation at admission and discharge, and patient counselling. - Controlled drugs on wards: double-locked cupboard, shift-wise narcotic counts, dedicated registers, and documentation of every dose wasted or discarded. - Documentation loop: indent, GRN, bin card, consumption records, narcotic register — the audit trail inspectors and PTC reviews read. ## Floor stock versus unit dose, reasoned Follow one order under each system to see the trade. Under floor stock, the ward keeps running supplies — a tray of analgesics, a box of common antibiotics — and the nurse selects and administers. The order travels fast, night demands are met instantly, and the pharmacy's workload is batched; but the selecting mind is the busiest person on the ward, transcription and selection errors survive unseen, stock discrepancies accumulate, and no one can prove which tablet a given patient actually received. Under unit dose dispensing, the pharmacy profiles the patient's medications and delivers each 24 hours as individually packaged, labelled, ready-to-administer doses in a patient-specific cassette. The pharmacist's review happens before the first dose, the nurse administers rather than selects, returns are minimised, and charging is exact — at the cost of pharmacy infrastructure, packaging equipment and a bigger technical staff. Indian hospital reality runs a hybrid: floor stock for emergencies and standard infusions, unit dose or blistered named-patient supply where the pharmacy is strong. The examinable sentence is the reasoning, not the geography: unit dose moves the checking function upstream to the pharmacist, which is why studies credit it with lower medication-error rates. Then the ward-level details complete the answer — emergency cupboards with break-glass access and audit, and the narcotic cupboard whose keys change hands against a signed count every shift. ## Where students misread the department The first error is writing the formulary off as "the pharmacy's price list". It is the PTC's therapeutic policy — the committee (not the pharmacist alone) decides additions and deletions on efficacy, safety and cost grounds, and the pharmacist executes and advises as secretary. The second error is ignoring the clinical tier: a hospital pharmacy answer without TDM, ADR reporting, drug information and counselling reads as stores management, which is a different subject. Third, the sterile-services blind spot: IV admixture belongs in the pharmacy, not the ward sluice, because only there are the laminar-flow hood, aseptic training and compatibility references assembled together — ward-prepared mixes are the classic source of incompatibility and contamination events. And a favourite viva: name the TDM drugs. Any four of phenytoin, digoxin, lithium, theophylline, aminoglycosides and methotrexate, with a phrase on narrow therapeutic index, is the expected answer. ## Frequently asked questions ### What is the Pharmacy and Therapeutics Committee and who serves on it? The multidisciplinary body that frames drug policy — formulary management, ADR and error review, drug-use evaluation — with physicians, nursing and administrative representation and the pharmacist as secretary. ### Compare floor stock and unit dose distribution. Floor stock issues bulk medicines to wards for nurse selection — quick but error-prone; unit dose supplies each patient's 24-hour medication as labelled single doses checked in the pharmacy — slower to establish but consistently associated with fewer medication errors and tighter accountability. ### What is a hospital formulary and why does it matter? The PTC-approved list of medicines stocked with prescribing guidance; it rationalises prescribing, simplifies stocking, controls cost and standardises therapy across the hospital. ### Name four drugs monitored by therapeutic drug monitoring and why. Phenytoin, digoxin, lithium and aminoglycosides — narrow therapeutic indices where underdosing fails and overdosing toxifies, so plasma levels guide dosing. ### Why are IV admixtures prepared in the pharmacy? The pharmacy provides laminar airflow asepsis, trained staff and compatibility references in one place, reducing the contamination and incompatibility risks of ward-side preparation.