atachment.ppt
- 1. Hospital Pharmacy Attachment By: SHIKUR YASIN SENEHIWOT ABEL YONAS ARAGEW 04/07/2022 1
- 2. Objective of attachment To be familiar for pharmaceutical care in hospital and to know available medication in practical setting. To established communication skills while providing information to clients 04/07/2022 2
- 3. Introduction A Hospital Pharmacy is a department within a hospital that prepares, compounds, stocks and dispenses medications for in and outpatients. Primarily focused on ensuring adequate supply of medications, Medical Supplies, Reagents and equipment to different units with very little or no involvement in direct patient care activities. TASH is the largest referral hospital in Ethiopia. It was established in 1964, and is now the main teaching center for both clinical and preclinical training of most disciplines. TASH has more than twelve pharmacies as a whole that all has dispensary, counseling and billing unit in each department like the internal medicine, pediatric, orthopedic, surgery, emergency, intensive care unit (ICU), gynecology, and others . 04/07/2022 3
- 4. Services rendered by hospital pharmacy Clinical pharmacy services includes dispensing and counseling, medication adherence medication therapy and ward pharmacy service, drug information service clinical pharmacokinetics service oncology pharmacy service, ICU pharmacy services etc…. 04/07/2022 4
- 5. OPD Pharmacy In OPD section there are three pharmacies main OPD pharmacy Endocrine Pharmacy and ART Pharmacy. 04/07/2022 5
- 6. OPD… Main Pharmacy This pharmacy is found on the 3rd floor of the Hospital It is the largest pharmacy of all OPD It provides comprehensive pharmacy service to outpatients The pharmacy follows the APTS system 04/07/2022 6
- 7. Cont….. Layout The pharmacy has Three main service windows The first window gives prescription evaluation service It evaluates the prescription It identify whether the patient take the medicine in cash or has Health insurance It verifies the patient whether the drug is available or stock out It print and bring prescription from the system to the patient. The second Windows are the cashiers window Provide cashier services It serves only those who buy the medications in cash 04/07/2022 7
- 8. Cont… The rest windows provide dispensing and counseling It dispenses medications to patients present with prescription Counsel the patient on the medication Record and register the prescriptions that are dispensed Among medication mostly dispensed medication we observed; Pironolactone Frusemide Atenolol Phenytoin Benzanthine penicillin powder Aspirin Lorazepam Regular insulin …… etc. Medication are shelfed in their pharmacological orders. 04/07/2022 8
- 9. Cont… Some limitations We have observed the following avoidable limitations on the pharmacy, The counseling time is too short Their medication wastes due to the dispensers open too many packs before finishing the opened first. There is language barrier between the patient and the counselor. Due to overload of the patients there is some time prescription mess. 04/07/2022 9
- 10. OPD…. Endocrine Pharmacy This pharmacy is the second largest of OPDs It mainly serves patients with Diabetes Mellitus Thyroid disease The pharmacy serves the patients with one window and two pharmacists The pharmacists involve in activities like: Dispensing medications and counselling Recording prescriptions and health insurance 04/07/2022 10
- 11. OPD…. Endocrine Pharmacy Most dispensed medications here are; Metformin Regular insulin NPH Levothyroxine Propylthiouracil(PTU) Metformin + Glibenclamide Atorvastatin As a limitation Due to high number of patients and only one window service, there is too short time for counselling of the patients 04/07/2022 11
- 12. OPD…ART pharmacy The ART pharmacy of TASH is found in front of the ART clinic and it is run by one pharmacist. It serves 50-60 patients per day The services delivered by this dispensing unit is to supply ARV medications and consult patients regarding their medications. The currently available drugs include the NRTIs - lamivudine, -zidovudine, -tenofovirand -abacavir; NNRTIs –efavirenz and -nevirapine The protease inhibitors Ritonavir, Lopenavir and Integrase inhibitor Dolutegravir in a fixed dose combination or monotherapy with different doses for children and adults 04/07/2022 12
- 13. ART….. Unlike other OPD Pharmacies the patient served in this pharmacy do not use internal code of the hospital rather they use National code which is denoted by MOH. Medications also have internal codes which is combined of number and 3 letters. TDF –Tenofovir ATZ-Atanavir 3TC-lamivudin AZT –Zidovudine ABC –Abacavir… etc. In addition to the ARTs other drugs are also dispensed here Clotrimoxazole Pyridoxine omiprazole 04/07/2022 13
- 14. Cont…. ART codes 1J(TDF +3TC +DTG) 4c(AZT +3TC + NVP) 4d(AZT +3TC +EFV) 4e(TDF + 3TC +EFV) 4f(AZT +3TC +LPV/r) etc… 04/07/2022 14
- 15. ART… Limitations The drugs are put on shelf just randomly neither accordingly to their pharmacological action nor Alphabetical. Most of the time there is no counsel to the patient at all thinking the patients are familiar to the medications; It is better to advise them even if they are familiar to it because even literates can not understand simply by reading leaflets. 04/07/2022 15
- 17. Drug Information Center Drug information center (DIC) is a unit designed for receiving, collecting, analyzing, and providing unbiased, accurate information about drugs and their use. It is found at third floor next to main OPD pharmacy. Drug information center accepts and answers queries, prepare drug alert, report ADR. 04/07/2022 17
- 18. DIC …. DIC involves in Creating variety of print and online educational resources for patients (e.g pamphlets) and health care professionals (e.g., in-service documents, newsletters) on topics such as optimal medication use, general health, or select clinical question DIC involves in educating health care professionals on safe and effective medication-use policies and processes, including development of resources to communicate this information. 04/07/2022 18
- 19. DIC….Limitations and comments It does not develop guideline for medicine use. It does not regularly publish information of medicine use via its website. Pharmacists are not avail themselves in working hours The center is weak in supporting clinical services with medication information 04/07/2022 19
- 20. Inpatient pharmacy There are around four inpatient pharmacies. we have seen A5 pharmacy, it is located at 5th floor on A- block, pediatric oncology pharmacy, adult oncology pharmacy and Gynecology pharmacy In A5 pharmacy, there are 3 staffs in which two of them are pharmacists and last one is cashier. They serve 100-150 customers per day. 04/07/2022 20
- 21. Inpatient….A5 pharmcy Most of the drugs found in this inpatient pharmacy are injectable There are both free and in cash service Common drugs at inpatient pharmacy include: anesthetic medication, anti-TB medication and Antibiotics. Medical supply is also dispensed such as IV cannula in different size (18,20,22),syringes with different sizes(5cc,10cc,20cc),IV set ,Urine catheter, urine bag 04/07/2022 21
- 22. Inpatient …. Limitations of A-5 pharmacy The number of pharmacists should be increased because the two pharmacists are not able to effectively serve the patients. Their inventory management is poor and lots of drugs are wasted by this bad practice Drugs with different kind of defects are not disposed rather they are on the shelf which is so risky 04/07/2022 22
- 24. Inpatient…Gynecology Pharmacy The pharmacy is found on the 6th floor in section A, it has one Pharmacist and no Cashier since all patients are getting the service for free. Sutures such as Surgical catgut, chromic catgut, synthetic absorbable, surgical needles suture also syringe are found. Drugs such as Neostigmine injection, Atropine Injection, Hydrocortisone sodium Succinate for injection, Tramadol, dopamine, Oxytocin(in refrigerator), Metoclopramide ampule, Misoprostol are some of them which are found in the Pharmacy. 04/07/2022 24
- 25. Gynecology Pharmacy strength Availability of important drugs Enough amount of import medical devices Availability of free drugs Implementation of I-Care system 04/07/2022 25
- 26. Gynecology Pharmacy limitations The drugs arranged nether Pharmacologically nor alphabetically. No counseling at all Pharmacists working there are most of the time spent there time by seeing movies 04/07/2022 26
- 27. Inpatient….Oncology pharmacy The pediatric oncology pharmacy is located at 7th floor The adult oncology is located at first floor of the oncology building. In black lion oncology pharmacies, most activities are providing chemotherapeutic agents and that are going to be administered by nurses. There are different chemotherapeutic agents like 5FU,cyclophosphamide,procarbazine,mercaptopurine,pac litaxel, etoposide, dacarbazine, in fridge vincristine,douxorubicin and beleomycin. 04/07/2022 27
- 28. Inpatient…Oncology pharmacy Oncology pharmacy play an important role in the delivery of care to patients with cancer. There are two oncology pharmacies which are located in different place. Adult oncology pharmacy and pediatric oncology 04/07/2022 28
- 29. Inpatient…..oncology Different anti-pain like morphine, tramadol, diclofenac and Anti-emetics like ondansetron and metoclopramide Drugs like bisacodylis also there for constipation 04/07/2022 29
- 30. Inpatient…..oncology limitations The reconstitution of the chemotherapeutic drugs should be done by pharmacists because there is high wastage of the chemotherapeutics drugs when a single vial is given for a single patient. The Counsel is little bit poor 04/07/2022 30
- 31. Counseling tip monograph Generic name-Metformin Brand name- none Price-0.6birr/tablet or 6birr/strip Dosage form –tablet Strength -500mg Mechanism of action-decrease hepatic glucose production, decrease intestinal absorption of glucose and improves insulin sensitivity by increasing peripheral glucose up take and utilization. 04/07/2022 31
- 32. Cont… Indications-for treatment of non-insulin dependent type II diabetes mellitus not controlled by diet and exercise alone. Off label use- use management of obesity, prediabetes, gestational diabetes . Dose and administration-Usual adult dose for diabetes type 2 Immediate-release-Initial dose: 500 mg orally twice/day Dose titration- Increase in 500 mg increments weekly Maintenance dose-2000 mg/day in divided doses Maximum dose- 2550 mg/day 04/07/2022 32
- 33. Cont… Common side effects – reduce levels of vitamin B12 in blood, Diabetic ketoacidosis and lactic acidosis (nausea or vomiting, uncontrolled rapid breathing or abdominal pain), Diarrhea, loss of appetite and altered taste, Liver function tests abnormality and Skin reactions such as : • erythema, • pruritus and • urticarial. 04/07/2022 33
- 34. Cont… Contra indication- Hypersensitivity to active substance, severe renal impairment, acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma, acute alcoholic intoxication or alcoholism, Patients with myocardial infarction or shock and Patients with breast feeding. 04/07/2022 34
- 35. Cont.. Pregnancy-category B- has no known fetal teratogenicity and no known fetal harm, although it crosses the placenta readily, and it is unbound in serum. Breast feeding- contraindicated because it is excreted into human breast milk. Instruction for use-It should be taken with meals to help reduce stomach or bowel side effects that may occur during the first few weeks of treatment. Do not crush, break, or chew it. 04/07/2022 35
- 36. Cont… Precaution- Avoid consuming large amounts of alcohol while on metformin, avoided drinking alcohol while taking metformin increases your risk of developing low blood sugar or even lactic acidosis, and avoid eating high-fiber foods after taking metformin 04/07/2022 36
- 37. Lessons learned and contribution during our stay We learned how dispensing is performed in outpatient and inpatient pharmacy. In inpatient pharmacy the drug is dispensed for only single dose. The majority of the medication that are found in inpatient pharmacy are in parenteral (injectable) form of administration. 04/07/2022 37
- 38. Cont… Counseling in inpatient pharmacy are not that much to the caregiver because the medications are administered by health professionals. In outpatient pharmacy, the majority of the patient are chronic patient. Because of this, the patient knows how to take the medication not needing that much counseling about how to use the medication. We also learned that how refill of medication for chronic patients is exercised, when there is scarcity of specific medication especially psychotropic medications. 04/07/2022 38
- 39. Cont.. In this practice we contribute the following: Assisting the pharmacists when there is workload Facilitating the handling of the patient to improve the satisfaction of the patient. 04/07/2022 39
- 40. Recommendation Enough pharmacists should be recruited because there is scarcity of on duty pharmacist in main OPD All essential medications and medical supplies should be available at all the time as much as possible to minimize the cost and the time of the patient The pharmacist should counsel the patient as much as possible. In the I- care system, the diagnosis of the patient case are not written to the pharmacy unit. This leads to difficulty to the evaluation of the appropriateness. So, the prescriber should write the diagnosis of the patient case. 04/07/2022 40
- 41. Reference 1 , (http://www.pharmatips.in/Articles/Hospital- Pharmacy/Define-Hospital-Pharmacy-Classifications-Of- Pharmacy.aspx). 2, (https://statements.eahp.eu/about/what-hospital- pharmacy.) 3, Drug-Information hand- Book-Lexicomp`s pdf 04/07/2022 41
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Editor's Notes
- #7: APTS (Auditable Pharmacy Transactions and Services)
- #9: Regular insulin is a short acting form of the synthetic hormone.
- #12: Regular insulin NPH(neutral protamine hagedorn) What is NPH insulin used for? An intermediate-acting insulin used in the treatment of diabetes mellitus. Administered once or twice daily