Pharmacy Internship Report (Apprentice, Community Pharmacist, Retail Pharmacist)


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Apprentice Pharmacist
Pharmacist Training
Community Pharmacy
Retail Pharmacy
Patient counselling

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Pharmacy Internship Report (Apprentice, Community Pharmacist, Retail Pharmacist)

  2. 2. 1 UNIVERSITYMODELPHARMACYJULY-AUGUST ACKNOWLEDGMENT To promote civic sense and shoulder the responsibilities with civil society, the University administration with special directives from Hon. Vice Chancellor Prof. Dr. Muhammad Akram Chaudhary, has termed it mandatory for each Pharm-D student to render community services to the society. These services aim to facilitate and guide the patients about the disease and its medication. Besides the services to the community this internship program have been designed to fulfill the current needs with regards to professionalism, marketability, employability, and entrepreneurship and to practice the practical aspects of pharmaceutical services at a community pharmacy. We, the students, are very thankful to Hon. Vice Chancellor Prof. Dr. Muhammad Akram Chaudhary for providing us with this valuable opportunity of internship by the University and within the University. No doubt, this step will encourage the professional activities of future Pharmacists.
  3. 3. 2 UNIVERSITYMODELPHARMACYJULY-AUGUST UNIVERSITY MODEL PHARMACY UNIVERSITY OF SARGODHA , UNIVERSITY ROAD , SARGODHA Pharmacy services in Pakistan have experienced both evolutionary and revolutionary changes since 1947. The pharmaceutical sector always remained regulated at different levels. The changes in legislation are also the contributing factor to uplifting of the pharmacy profession. The misuse and abuse of medicines remained a big issue at retail/ community level. Sale ofmedicines and this business remained in the hand of unqualified personnel for a long time. With time the pharmacists interest increased at community level and now the quality ofservices are improving but not up to the mark. While in comparison with the developed countries like U.K and U.S.A, where Community pharmacists are expanding patient care services and have enhanced their role as pharmaceutical care providers. The pharmacy profession in Pakistan is continuously evolving. Number of community pharmacies has been established in few cities of Pakistan like Care Pharmacy Faisalabad, Fazal Din Pharma plus Lahore etc. The aim of this review / report is to explore history for evolutionary and revolutionary changes in community pharmacy practice in Pakistan and to highlight the current scenario in Pakistan. A brief but comprehensive report has been provided in this review regarding the working of the visited pharmacy i.e. UNIVERSITY MODEL PHARMACY providing medicinal services to community on behalf of the UNIVERSITY OF SARGODHA, SARGODHA. University Model Pharmacy is one of the four departments of University Medical & Diagnostic Centre (UMDC) and it contains all available medicines at optimum conditions of storage. The University has an aim to provide each student of Pharm-D with the opportunityoftheinternshipatModelPharmacyinordertogetfamiliarwiththe applicationsofpharmacyatcommunitylevel.
  4. 4. 3 UNIVERSITYMODELPHARMACYJULY-AUGUST JULY-AUGUST 8.00 PM to 11.00 PM Dean Faculty of Pharmacy UOS. Subject Teacher Pharmacist (Pharmacists on training)
  5. 5. 4 UNIVERSITYMODELPHARMACYJULY-AUGUST (Session 2010-15) There are relatively a few studies articulating the situation with community pharmacy services in Pakistan. The Licensed premises in Pakistan include the medical stores, the retail pharmacies and also the Wholesale Distribution Setups. Among the total no. of pharmacists in Pakistan, 55 % join industrialsector, 15% works atpublic sector, 15% in sales marketing, 5 % in teaching and research, and 10 % in community pharmacies. About more than 1000-1500 students are passed out each year now (Public Sector Only) .The health care services at community pharmacies must undergo reforms to meet the international standards. Most of the personnel (dispensers) in pharmacies have minimum training. Even if the license is displayed in the pharmacy, the professional is seldom present. The dispensers working at retail outlets (so-called community pharmacies) are mostly untrained, non-qualified but haveexperience in years. Retail outlets indeveloping or low income countries sell Prescription Only Medicines without a Prescription on patient‘s demand. The doctors are receptive to the pharmacists expanded roles in Pakistan but their expectations do not match with their actual experiences. Community pharmacistisinabestpositiontoperformthesemainactivities:  Directpatientcare,  DUR (Drug Utilization Review),  Extemporaneouspreparations,  Respondtominorailments.
  6. 6. 5 UNIVERSITYMODELPHARMACYJULY-AUGUST (Estimated in year 2007-08 )   Hospitals 965  Dispensaries 4,916  Basic Health Units 4,872  MCH Centers 1,138  TB Centers 371  Firs Aid Points: 1,080 Federal Government Expenditure on Health (2007-08) Development Expenditure Rs. 14.272 billion Current Expenditure Rs. 3.791 billion Health Indicators Infant Mortality Rate (IMR) (per 1000 persons) 76.7 Maternal Mortality Rate (MMR) 350
  7. 7. 6 UNIVERSITYMODELPHARMACYJULY-AUGUST (per 100,000 live births) Under -5mortality rate (per 1000 persons) 101 Parasite Incidence of Malaria (per 1000 persons) 0.75 Incidence of TB (per 100,000 persons) 181 Fertility Rate (percentage) 4.1 (source: NIPS) Contraceptive prévalence rate % 30 (source: NIPS) Births attended by skilled persons % 19 Population growth rate 1.9 Total Population 159.06: million (source NIPS) Health Services Delivery (2006-07) Total Health Facilities 13,937 Hospitals 965 Dispensaries 4,916 Basic Health Units 4,872 Rural Health Centers 595 MCH Centers 1,138 TB Centers 371 First Aid Points: 1,080 Beds in hospitals & dispensaries 105,005 Population per bed 1,515 Population to health facility ratio 11,413
  8. 8. 7 UNIVERSITYMODELPHARMACYJULY-AUGUST Human Resources (Registered, 2007) Doctors 107,835 Doctors registered as specialists 19,623 Dentists 7446 Dental specialists 433 Nurses 43,646 Midwives 2,788 Lady Health Visitors 3,864 Lady Health Workers 95,000 Lady Health Supervisors 3,385 Population per doctor 1,475 Population per dentist 21,362 Population per nurse 3,644 (Punjab Province) Health Department across the province is divided into:  2,461 Basic Health Units (BHUs)  293 Rural Health Centers (RHCs)  88 Tehsil Headquarters Hospitals (THQs)  34 District Headquarter Hospitals (DHQs)  23 Teaching/ tertiary Care Hospitals
  10. 10. 9 UNIVERSITYMODELPHARMACYJULY-AUGUST UNIVERSITY ROAD A = Clerk Room B = Pharmacist Office C = Store Room D = Wash Room E = Stands F = Racks G = Fridge H = Dispensing Table J = Displays K = Seats
  11. 11. 10 UNIVERSITYMODELPHARMACYJULY-AUGUST L = Entrance Doors M=Entrance For Staff University Model Pharmacy University Of Sargodha, University Road, Sargodha. Dr. Nasir Haroon University Model Pharmacy is run and owned by the famous and well reputed public sector institution of Pakistan i.e. University of Sargodha,
  12. 12. 11 UNIVERSITYMODELPHARMACYJULY-AUGUST spread over a vast area of land like an oasis of calm and green at the midst of the bustling city. The University Road is one of the most populous roads in the city, providing a linkage to many towns, colonies as well as cantonment / defense area that’s why the pharmacy deals and facilitates a large number of patients. The University authorities established a well equipped Medical and Diagnostic center in 2010 which have four main departments: o Model Outdoor o Model Indoor o Model Laboratories & Radiology o University Model Pharmacy The major aim of all these establishments is to provide quality health care facilities to the community at reasonable and low cost and to serve the community both qualitatively and quantitatively. University Model Pharmacy ensures the No. 1 quality of the Products . It contains all medicines at optimum conditions of storage and at 05% less price as in Market , having separate section for intensive care and emergency medicine.
  13. 13. 12 UNIVERSITYMODELPHARMACYJULY-AUGUST 07.00 AM to 11.00 PM daily University Model Pharmacy has total 10 employees. These employees work in two different shifts i.e. morning and evening shifts. Each shift is supervised by a Pharmacist. The Pharmacist is qualified and efficient in his job. Sr. No Designation Count 1 Director UMDC 01 2 Pharmacist 01 3 Dealing Staff 04 (2+2) 4 Clerk 01 5 6 Sweepers Guards 02 02
  14. 14. 13 UNIVERSITYMODELPHARMACYJULY-AUGUST o Director : Prof. Dr. Zahoor ul Hassan Dogar M.B.B.S , M.Phil , PhD , Post Doc(Med. Biochemistry) o Pharmacist/Manager : Dr. Nasir Haroon Pharm- D (Doc. Of Pharmacy) o Dealing Staff : Waqas Zafar(Dispensing course) Hafiz Tayyab (Matric+Experience) Akmal Shehzad (Clinical Assistant Course) Kamran Aziz (Experience) 1. Fully Air Conditioned for optimum temperature control 2. 03 Refrigerators 3. Centrally controlled IT system
  15. 15. 14 UNIVERSITYMODELPHARMACYJULY-AUGUST 4. Medical Insruments like Stethoscope / Sphygmomano meter / Glucometer etc. The purchasing is made either direct from pharmaceutical company or by distriburtors. Most of the purchasing is made from authntic and licensed distributors and is supervised by Manager or Pharmacist. The distributors which supply drugs to University Model Pharmacy are :  Al-Aziz Distributors  Health Linkers Co.  Naeeli Shifa  UDL  IDL  Sameel Suleman Distributors. Racks of Pharmacy are made up of glass. Medicines in these racks are arranged company wise. Some of the medicines require specific conditions for storage i.e required to be stored at cool place / low temperature.
  16. 16. 15 UNIVERSITYMODELPHARMACYJULY-AUGUST Universitu Model Pharmacy ensures the proper storage of such medicines . For intance, specific injectibles , inhalers , insulines as well as the daily routine items like juices etc. have been placed in refrigerators for adequate storage and maintenance of quality. University Model Pharmacy and UMDC are providing a lot of services to patients / customers to facilitate them properly. Under the supervision of qualified Pharmacist Dr. Nasir , the staff members as well as the aprentice pharmacists (internee) are providing all medicinal and general services at their best. With special consideration by Hon. Vice Chancellor Prof. Dr. Muhammad Akram Chaudhary , it has been made mondatory for all Pharm-D students of UOS to get benefitted by the oppertunity of an unpaid internship / duty / experience at Model Pharmacy and facilitate the patients with their knowledge. This internship is unique in the sense that it has been provided by the University within the University .
  17. 17. 16 UNIVERSITYMODELPHARMACYJULY-AUGUST The aprentice pharmacists under the insructions of subject teacher Dr. Akhtar Rasul and Dr. Nasir Haroon (Pharmacist ) guide the patients about their medication and disease. While at pharmacy ,we used to chek the prescription , had a critical analysis of prescribed medicines , looked for any possible drug-drug or food drug interaction and guided the patints about proper usage , time of administration , storage and possible side effects of the prescribed drugs. The response from all the patients was encouraging one.The patients were satisfied to a greater extent and they appreciated this step of University administration to aid the patient in medicine usage. Hon. Vice Chancellor Prof. Dr. Muhammad Akram Chaudhary held a special meeting with apprentice pharmacists on 04 August 2013.Hon.Dean Prof. Dr. Sajid Bashir and Sir Alamgeer were also present in the meeting. He aadvised us to be honest and loyal to our profession and motivated us to give special consideration to practical aspects of Pharmacy. Meanwhile, he disclosed that UMDC is going to take a radical step very soon i.e. E-prescription. No doubt it will facilitate and improve the patient care and will be adavantageous to the chain of 3 Ps; The Physician , The Pharmacist and the Patient.
  18. 18. 17 UNIVERSITYMODELPHARMACYJULY-AUGUST University Model Pharmacy also provides necessary baby care products like baby shampoes , Lactogen , Cerelac , BF 101 ,Celia etc. It also has separate displays/racks for dental care products like tooth brushes , mouth washes , gargles and tooth pastes . A wide range of Dermal products like sun block creams , sun trap , skin care lotions or creams as well as ointments are available at Pharmacy.
  19. 19. 18 UNIVERSITYMODELPHARMACYJULY-AUGUST Basic literature about different commercial medicinal products is provided if available and can be had on demand. A comfortable sitting area is also provided to customers. Hopefully it will be available soon at the pharmacy. It’s a quality product of University Of Sargodha available at the pharmacy. It is registered from PSQCA and its quality check is maintained by senior quality control personnel. It is available at affordable price that’s why
  20. 20. 19 UNIVERSITYMODELPHARMACYJULY-AUGUST its demand is increasing day by day.Its present production is about 1 lac bottles per day. W While at pharmacy, the major task of an apprentice is to handle and deal with the prescriptions and after taking a brief history of patient , asking about any past therapy, family background ,socio-economic status and finally discussing the prescribed medication in a way to guide the patient properly regarding the use, intake/administration ,storage, frequency and time of medication. We also used to analyze the prescriptions critically in order to sort out any possible drug-drug or drug-food interaction under the supervision of Pharmacist Dr. Nasir Haroon. Most of the times, Dr. Nasir used to ask the questions about drug use and abuse especially he gave special consideration to antibiotics (class/generations/therapeutic uses) because these are the most prescribed drugs . Also he gave special attention to analgesics and CVS drugs.
  21. 21. 20 UNIVERSITYMODELPHARMACYJULY-AUGUST The Dealing Staff co-operated their best by providing all the basic information regarding dealing with patient and customer, receipt generation, billing and receiving cash. They provided us with the Information leaflets of different medicine .They also motivated the patients to take guidance from Pharmacists. Hon. Dean Faculty of Pharmacy Dr. Sajid Bashir paid special and frequent visits to the pharmacy to ensure the presence of students and also gave special advices/suggestions about the practice at pharmacy. Subject Teacher Dr. Akhtar Rasul kept a continuous eye on all activities of apprentices and guided us on regular basis and also used to check our duty registers/records and attendances. Hon. Vice Chancellor Prof. Dr. Muhammad Akram Chaudhary paid sudden visits, checked the status of services and also gave special instructions in this regard. He motivated us to take special interests in the latest applications as well as inventions in Pharmaceutical sciences and services. In short the experience at University Model Pharmacy was inspiring one, and made us able to
  22. 22. 21 UNIVERSITYMODELPHARMACYJULY-AUGUST understand the practical aspects of Pharmacy in an efficient way. Conclusion and Recommendations InPakistan,thepharmacyeducationas wellasthepharmacy professionisintransitionalstage.Thoughtherehadbeenevolutionary andrevolutionarychangesinthisfieldbutstilltheareaof pharmacy practicehasmanyloopholes.Oneofthemajorloopholesisinthe legislationofthesystem.Strictlegislativereformsandinspections shouldbeensuredtoprovidequalityservicesthroughpharmacies. Reimbursementsystemmustbedevelopedtopaytothepharmacists fortheprovisionofdirectpatientcareservices.Curriculumof Pharmacycoursebeupgradedagainandtrainingofthestudentsmust bemadecompulsory.Besidesthis,thereshouldbetheadditional trainingofthepharmaciststodevelopskills.Pharmacypracticecanbe bestdoneatcommunitypharmaciesasmostlythepatientsinminor ailmentsfirstgotothepharmacies.Andifthepatientconsultsadoctor thenagainthelasthealthcareproviderthatapatientseesisthe pharmacistatthecommunitypharmacy.Sothepharmacists areinan
  23. 23. 22 UNIVERSITYMODELPHARMACYJULY-AUGUST idealpositiontoprovidecognitiveservicestothepatientsat communitylevel. Thehealthcareservicesincommunitypharmacies,currently insignificant,mustundergoreformstomeetthechangingneeds ofmodernmedicinesusers.Althoughpharmacists'contributionsto healthcarearenotrecognizedyet,thereiseveryreasontobe optimistictowardmakingpatientcareincommunitypharmacysetting asuccess.Forthis,legislationmustbereformedtogiveidentitytothe pharmacistandeducationalsystemforpharmacistshastobeadapted.