College of medicine and health science
School of pharmacy
Hospital pharmacy practice report
Name Habtamu Semagn
Id no_ 03577/09
Submitted to: Hospital pharmacy assistant
Date of submission:26/06/2013 E.C
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Table of content page
1, Introduction -------------------------------------------------------------3
1.1, Hospital pharmacy ----------------------------------------------------3
1.1,2 Role of hospital pharmacy in the health service ----------------3
1.1,3 Mission of hospital pharmacist -------------------------------------3
2, Main body --------------------------------------------------------------------4
2.1, Hospital pharmacy department ---------------------------------------4
2.1,2 Dispensing environment -----------------------------------------------4
2.1,3, Emergency pharmacy -------------------------------------------------5
2.1,4 Inpatient pharmacy ----------------------------------------------------6
2.1,5 Compounding pharmacy ----------------------------------------------7
2.1,6 ART pharmacy -----------------------------------------------------------8
3. Recommendation ------------------------------------------------------------9
3.1, Conclusion ------------------------------------------------------------------9
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Hospital pharmacy practice
1, INTRODUCTION:
Pharmacy service is an essential component of health care delivery in hospitals. It
contributes to improved treatment outcomes through ensuring availability and rational
use of quality, safe and effective medicines.
1.1, Hospital pharmacy
Hospital pharmacy is the health care service, which comprises the art, practice, and
profession of choosing, preparing, storing, compounding, and dispensing medicines and
medical devices, advising healthcare professionals and patients on their safe, effective
and efficient use.
Hospital pharmacy is a specialized field of pharmacy which forms an integrated part of
patient health care in a health facility.
1.1,2, Role of hospital pharmacy in health care services
Hospital pharmacists are responsible for monitoring the supply of all medicines
used in the hospital and are in charge of purchasing, manufacturing, dispensing
and quality testing their medication stock along with help from pharmacy
assistants and pharmacy technicians.
1.1,3, Missions of the hospital pharmacist
To be part of the medication management in hospitals, which encompasses the
entire way in which medicines are selected, procured, delivered, prescribed,
administered and reviewed to optimise the contribution that medicines make to
producing informed and desired outcomes.
To enhance the safety and quality of all medicine related processes affecting
patients of the hospital.
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To ensure the 7 “rights” are respected: right patient, right dose, right route,
right time, right drug with the right information and documentation.
2, Major component of hospital pharmacy
2.1, Hospital pharmacy departments
Hospital pharmacy departments are embedded in hospital sites and are an integral part of
patient care in hospitals.
Hospital pharmacy departments usually consist of:
Inpatient and outpatient pharmacies
Manufacturing and compounding facilities
Drug information services
Quality use of Medicine services
Emergency pharmacy
Clinical trial services.
2.1,2, DISPENSING ENVIRONMENT
Premises and facilities
The premises on which a dispensing service is provided would reflect the quality of
service and inspire confidence on patients in the nature of pharmaceutical service
delivered.
The walls, floors, windows, ceiling, and all other parts of the premises should be
as per the requirement set by the regulatory body.
Rooms (with minimum area specified) are required for dispensing, storing and
compounding medicines.
Toilet with water supply and drainage system is also a requirement.
All parts of the premises should be maintained in an orderly and tidy condition.
Pharmaceutical products should be protected from the adverse effect of light,
freezing or other temperature extremes and humidity.
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In our practical session of inpatient, ART, emergency pharmacy and compounding
area in Gondar university hospital, we were observe such strength and weakness as
per standard set up listed above.
2.1,3 Emergency pharmacy
Emergency medicine pharmacy practice focuses on rapid assessment of available
patient data to optimize pharmacotherapy, improve patient safety, increase efficiency and
cost‐effectiveness of care, facilitate medication stewardship, and educate patients and
health care provider.
Strength
Its position is found the area where no sunlight.
Is accessible to all emergency pharmacy user.
It’s wall is same what smooth, washable and light color.
Adequate electric sockets are available.
Shelves have adequate height.
Medications are stored in desirable condition: insulin and vaccine stored in cold
place (in refrigerator) and the remaining tablet, capsule are put in room
Temperature (150c-25oc).
Cartons are found 10 cm above floor.
Weakness
Electric wires are not well secured.
Both narcotic and anti psychotic drugs are not locked well.
Not have good counselling area.
Ceiling seams to leak water during summer season.
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No toilet with water supply and drainage system.
There is communication barrier in between pharmacist and customer due to
narrowed window.
On the Shelves no indicator as which medication found at which place or It does
not follow common medicine arrangement technique.
Intervention
Upon dispensing in emergency pharmacy, one customer (care giver) was coming with
morphine (tablet) prescribed paper, but the prescription paper did describe nothing how it
has to be taken? At that time I told to the care giver to ask the prescriber and come back
with full instructed prescription paper.
2.1,4 Inpatient pharmacy
Inpatient pharmacies are used for the dispensing and control of medications for patients
within the hospital. All hospitals have an inpatient pharmacy, but a security best practice
is to not have signage directing individuals to the pharmacy area to discourage theft from
outsiders.
The strength and weakness of inpatient pharmacy of Gondar university hospital stated as
follows according to my observation.
Strength
The room is well ventilated and protected from direct sun light.
Room is nearby inpatient ward.
Shelves have appropriate height and clean with light color.
Wall is approximately 3 meter height and clean enough.
Bottles are stored at the bottom of shelves.
Most pharmaceuticals in this pharmacy are stored in recommended site.
There is appropriate lighting.
The shelves found 30cm away from the wall.
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Medicines are arranged on shelves made of steel and treated wood.
The shelves are strong and robust.
Weakness
Stock cartons are available at the floor, like normal saline
No tablets and capsules counting devices
No cold storage facility
Sufficient professional waiting chairs are not present.
Intervention
Upon dispensing in inpatient pharmacy, one customer was coming with omeprazole
20mg BID PO prescribed paper, which is ordered to be taken morning at one hour before
breakfast. At the same time the patient take rifampicin as the care giver told me. Those
two drugs are severely interacted. Due to this difficulty prescription, I was intervene
omeprazole has to be taken 2:00:2:30 morning after rifampicin. This decision was done
after deep discussion with care giver.
2.1,5 Compounding pharmacy
Drug compounding is often regarded as the process of combining, mixing, or altering
ingredients to create a medication tailored to the needs of an individual
patient. Compounding includes the combining of two or more drugs. Compounded drugs
can serve an important medical need for patients, but they do not have the same safety,
quality, and effectiveness assurances as approved drugs.
Strength
o The room is clean, safe, well ventilate.
o Good sanitation and sanitary agents are available.
o Every ingredients are stored in dry, clean locked cabinet.
o There is water distillation system.
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Weakness
o There is shortage of excipients for compounding.
o Sun light get the room afternoon.
2.1,6 ART pharmacy
Antiretroviral treatment (also known as antiretroviral therapy or ART) are the drugs that
treat HIV. Taking ART means that people living with HIV can live long and healthy
lives.
Strength
Well ventilate, clean, lighty color wall.
Ceiling is well done for protection of rodent and any adherence of insect.
Shelves have appropriate height to access medication easily.
Weakness
Not have good Counseling area (Semi-private area, Separate private
area).
High number of professional pharmacy is required.
The dispensing area or room is very narrowed.
Most ART drugs are near to expired.
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Recommendation to pharmacy manager
I would like to recommend to pharmacy manager to add pharmacy professionals in
Gondar university hospital to provide good dispensing practice. As my observation there
is shortage of pharmacist professionals that leads them to make a lot of mistake while
dispensing and they will not have enough time to counsel patient.
Recommendation to pharmacy staff
Staff workers should provide good pharmaceutical service with appropriate professional
ethics even if they will not have enough time to get rest.
Conclusion
Generally Pharmacy practice improves clinical knowledge and skill to provide good
dispensing and satisfy patients with sufficient counselling.
Questions that we were asked at dispensing area
1, verify normal saline, ringer lactate and 5 % dextrose difference?
Answer
Those parenteral fluids are differ by their content
0.9% Normal saline contains 9gm NaCl in each 1000ml of water
It is used as fluid replacement, as a vehicle for compatible parenteral medication. But not
used at a time of hypernatremia coma associated with diabetic ketoacidosis.it also used to
replace dehydration, hypovolemia, sepsis, hemorrhage.
Ringer lactate
Used as Fluid replacement for metabolic acidosis because it contains lactated sodium
which release bicarbonate after metabolism.
It contains lactated sodium, potassium chloride, calcium chloride.it is a fluid of choice for
trauma burn.
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5 % dextrose contains 5g dextrose in each 1000ml water. Not used for diabetic patient.
It is used as fluid replacement, as nutritional replacement.
0.45% normal saline is hypotonic solution used to treat hypernatremia and coma
associated with diabetic ketoacidosis. Decrease electrolyte and cause to hemolysis.
2, what is the antidote of opoide over dose?
Naloxone is the antidotes of opoid over dose.
3, what is the advantages of lidocane with adrenaline combination?
Advantage
Since adrenaline is vasoconstrictor, it reduce bleeding during surgical procedure.
Adrenaline increase durations of lidocane.
Adrenaline also used to reduce toxicity of lidocane.
Reference
Manual for Medicines Good Dispensing Practice Ethiopia
By asking emergency ,inpatient ,ART pharmacist
Pharmacy Practice 2nd edition
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