Hospital Training Report .pdf

1
Report of Hospital Training
At
250 Bedded General Hospital, Pabna
B. PHARM. PROFESSIONAL
THIS REPORT IS SUBMITTED IN TOTAL FULFILLMENT OF THE REQUIREMENT FOR THE COURSE ENTITLED
AS
“HOSPITAL TRAINING” AND PARTIAL FULFILLMENTS OF THE REQUIREMENTS FOR
THE DEGREE OF B. PHARM. PROFESSIONAL
Submitted By
Name: Mehedi Shah
ID: 161328
Registration No.: 1135110
Session: 2015-2016
Department of Pharmacy
Pabna University of Science and Technology
Pabna-6600
May, 2022

2 Department of Pharmacy,PUST
Pharmacy is the art, practice, or profession of preparing, preserving, compounding, and dispensing
medical drugs. B.Pharm.(Professional) course generally include subjects like: Pharmaceutics,
Toxicology, Physiology, Pharmacology, Pharmaceutical analysis, Physical pharmacy, Clinical
pharmacy, Hospital pharmacy, Medicinal chemistry etc.
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
patients, doctors, nurses and other healthcare professionals on their safe, effective and efficient use.
The report at hand is the outcome of an in-depth study of the training in hospital. The report is a
requirement for the partial fulfillment of B. Pharm. Professional degree, of Department of Pharmacy,
Pabna University of Science and Technology. The training period ran from the 25th May 2022 to 23th
June 2022. The primary goal of this training is to become familiar with the practical knowledge about
some hospital activities.
This training was a fantastic opportunity for learning and professional development for us as a pharmacy
student and will give us a wealth of information and practical knowledge. Regardless of class, income
level, age, gender, technical skill, or educational level, this training will equip us to deal with and manage
patients by educating them about the drug’s indication, safety, dosage, warnings, contradiction.
Hospital pharmacy training enhances university coursework by allowing students to put their knowledge
into practice in a real-world setting and to strengthen important professional skills. This training will
also help to identify the specific health problems and to come out with the possible solutions and
recommendations. It will also facilitate students to know about the present status of the hospital
pharmacy in Bangladesh and also to know the position of the healthcare system. The primary objective
of this training was:
 To be a part of the medication management system in hospitals, which encompasses the entire way in
which medicines are selected, procured, delivered, prescribed, administered and reviewed to optimize
the contribution that medicines make to produce desired outcomes.
 To enhance the safety and quality of all medicine related processes affecting patients of the hospital to
ensure the 7 “rights” are respected: right patient, right dose, right route, right time, right drug with the
right information and documentation.
PREFACE

INDEX
Contents Page no.
Chapter: 01 INTRODUCTION 1-17
1.1 Hospital 01-03
1.1.1 Functions of a Hospital 03-06
1.1.3 Hospital Pharmacy 01
1.1.4 Functions of Hospital Pharmacy Management Panel 01-03
1.1.5 Major Responsibilities of a Hospital Pharmacist: 04
1.1.6 Objectives of Hospital Training 05
1.1.7 Health Care Delivery System in Bangladesh 06
1.1.8 Minimum Standards for Hospital Pharmacy 07
1.1.9 Accommodation facilities 08-09
1.7.3 Practice of Hospital Pharmacy in Bangladesh: Current Perspective 09
1.7.4 Objective of Hospital pharmacy 10
1.7.5 Organizations of Hospital pharmacy 10
1.7.6 Duties & Responsibilities of Hospital pharmacy 11

1.7.7 Minimum Standard of Hospital Pharmacy 12
1.1.8 Practice of Hospital Pharmacy in Bangladesh: Current
Perspective
12 -13
Basic Terminology regarding Prescription Analysis 13-17
Chapter | 02 OVERVIEW OF HOSPITAL 19-62
2.1 History of 250 Bedded General Hospital, Pabna 20
2.2 Tasks of the Hospital 21
2.3 Infrastructure of the Hospital 22-
2.4 Departments and Wards 24
2.5 Approved Vehicles and Office Equipments 25
2.2. Medicine Department 26-39
2.2.1.2 A sub unit of Medicine department: Coronary Care Unit
(CCU):
32-34
2.2.1.3. A sub unit of Medicine department: Diarrhea Ward 34-35
2.3. Surgery Ward 39-45
2.4. Obstetrics and gynecology Ward 46-55
2.5 Pharmacy Department 56-62
Chapter | 03 PRESCRIPTION ANALYSIS
❖ Medicine Ward
❖ Surgery Ward
❖ Labor Ward
64-108

❖ Pediatric Ward
Chapter | 04 SWOT ANALYSIS
❖ Benefits
❖ Elements
❖ SWOT Analysis of Pabna Sadar Hospital
❖ Limitations
109-117
Chapter | 05 CONCLUSION 118-119
Chapter| 06 REFERENCES 120-121
List of figures
Figure No. Name of figure Page no.
1.1 Hospital Pharmacy 04
1.2 Pharmacist’s Role in Hospital. 05
1.3 Pharmacist’s role regarding Medication Use. 26
1.4 Structure of Public Healthcare system in Bangladesh. 08
1.5 A typical Prescription Structure. 14
1.6 Percentage of different types of Prescription Error. 15

1.7 Typical Drug Interactions. 17
2.1 Front view of Pabna General Hospital. 20
2.2 Flow Chart of Patient Service Procedure in Hospital. 21
2.4.1 Front view of Medicine Ward. 29
2.4.2 Flow chart of Medicine department working procedure. 30
2.4.3 Role of Pharmacist. 31
2.2.1.2 A Front view of Cardiac care Unit of Pabna general
hospital.
32
2.2.2 Causes of Diarrhea 35
2.2.3 Diarrhea causes and symptoms 36
2.3 Front view of Diarrhea Ward 38
2.3.1 Typical operation room 40
2.3.2 Physician carrying Surgery 40
2.3.3 Surgery Ward 41
2.3.4 Labor and Gynecology Ward 48
2.5.1 Pharmacy Department 58
2.5.2 Requisition Process 60
4.1 Elements of SWOT 111

List of Table
Table
no.
Title Page
no
2.1 Beds Per Wards. 22
2.2 Human Resources. 26
2.3 Drugs Commonly Used in the Treatment of Cardiac
Disease.
34
2.2.2.1 Common drugs used in diarrhea ward. 32
2.2.2.2 Common drugs used in surgery ward 35
2.2.2.3 Common drugs used in labor ward 40
2.2.2.4 Supplied drugs from Pharmacy department 43
2.2.2.5 Common drugs used in diarrhea department 45
2.2.2.6 Common drugs used in gynecology department 50
List of Abbreviation
Abbridged word Elaborated Form
CT Computed Tomography
OPD Out Patient Department
RBS Random Blood Sugar
EMO Emergency medical officer

ECG Electrocardiogram
BP Blood pressure
CBC Complete Blood Count
D/H Drug history
ORS Oral rehydration solution
Susp. Suspension
Syp. Syrup
Inj. Injection
Inf. Infusion
Tab. Tablet
Cap. Capsule
ESR Erythrocyte sedimentation rate
Amp. Ampule
COPD Chronic obstructive pulmonary disease
RTI Respiratory tract infection
IM Intramuscular
IV Intravenous
TSF Teaspoonful
TC Total count
DC Differential count
TFO Till fresh order
P/A View Poster anterior view
P/V/W/D Per vaginal water discharge
PVE Per vaginal examination
LAP Lower abdominal pain
Pg. Pregnancy
PROM Premature rupture of membrane

BT Blood transfusion
EOC Emergency obstetric care
USG Ultrasonography
CCU Coronary Care Unit
EPI Expanded Programme on Immunization
H/O History of
O/E On Examination
LMP Last Menstrual Period
EDD Expected Delivery Date
NPO Nothing per Oral
P/C Paracetamol
Stat Immediately
BD Twice a day
TDS Three Times a Day
QDS Four Times a Day
TSF Teaspoonful
SOS Save our Soul (when necessary)
Hb Hemoglobin

Chapter 01:
Introduction

| P a g e
1.1 Hospital
Hospital, an institution that is built, staffed, and equipped for the diagnosis of disease; for the treatment,
both medical and surgical, of the sick and the injured; and for their housing during this process. The
modern hospital also often serves as a center for investigation and for teaching. (1)
A hospital is a health care institution providing patient treatment with specialized medical and nursing
staff and medical equipment. The best-known type of hospital is the general hospital, which typically
has an emergency department to treat urgent health problems ranging from fire and accident victims to
a sudden illness. A district hospital typically is the major health care facility in its region, with many
beds for intensive care and additional beds for patients who need long-term care. (2)
1.1.1 Classifications of hospital are given bellow: -
1. According to service:
 General hospital: - District hospital, Thana hospital.
 Special hospital: - Medical college hospital, mental hospital, cancer hospital.
2. According to ownership:
 Government hospital: - Unforced hospital, public health hospital.
 Non-Government hospital: - Private hospital.
 Corporation hospital: - (Profitable, Non-profitable, Partnership hospital).
3. According to bed capacity:
 Fewer than 50 beds Thana label hospital.
 51 to 100 beds district label hospital.
 200 bed hospital Ex: - Khanpur hospital (Bangladesh)
 200 -300 bed hospital Ex: - Faridpur medical. (Bangladesh)
 400-500 beds hospital an over. Ex: - Dhaka medical college hospital. (Bangladesh)

1.1.2 Functions of a Hospital
1. Medical Care
A major function of a hospital is a place where doctors work together to treat and care for patients
(outpatient care, inpatient care).
2. Patient Support
Nurses, nutritionists, pharmacists and blood supply, diagnostic services, medical supplies are all part
of the patient support team at the hospital. Patient support is crucial function of the hospital.
3. Administrative
Administrative functions of hospital include following the hospital’s rules and directives when it
comes to finance, staff, housekeeping, materials and property, laundry, protection, transportation,
engineering, and board, as well as a lot of other things.
4. Teaching
Vocational, Undergraduate, Postgraduate, and Continuing education are all types of teaching are
some teaching functions of the hospital.
5. Research
Basic research, clinical research, health service research, and educational research are all types of
research are the some of the hospital function.
7. Employment
Inside hospital function, there are health professionals and other health care workers who work.
Suppliers and transportation services outside the hospital.
1.1.3 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 as well as
advising patients, doctors, nurses and other healthcare professionals on their safe, effective and efficient
use.

Figure 1.1: Hospital Pharmacy
1.1.4 Functions of Hospital Pharmacy Management Panel:
1. Ensure than all drugs are stored, dispensed correctly.
2. check the accuracy of the dose prepared.
3. keep proper records and preparation of bills.
4. Coordinate the overall pharmaceutical needs of the “patient care”.
5. Ensure that the established policies and procedures laid down are followed.
6. Maintain professional competence.
7. communicate with all pharmacy staff regarding new developments
8. coordinate the activities of the area
9. To maintain liaison between nurses.
10. Reviewing of drug administration in each patient.
11. provide instruction and assistance to junior Pharmacist.
12. Coordinate over all pharmaceutical services on the running unit level.

13. Identification of drugs bought into hospital by the patient.
14. Obtaining all medication history and communicating all information t the attending Physician.
15. Assist in the selection of drug products and their identities.
Figure 1.2: Pharmacist’s Role in Hospital.
1.1.5 Major Responsibilities of a Hospital Pharmacist:
Medicine Management:
A key role in a hospital pharmacist’s job is determining which form of medication best suits each patient.
Each decision must be made in a timely and efficient manner and requires significant input from doctors,
nurses and other healthcare professionals. Hospital pharmacists will often monitor the effects of the
medications they prescribe and counsel their patients on the effects of the drugs. (3)

Monitoring drug charts:
Drug charts provide a vital source of information and act as an efficient method of communication
between hospital pharmacists and other members of medical staff. Hospital pharmacists must monitor
these charts and ensure that the correct medication is being provided to each patient.
Keeping up to date information:
As with any healthcare job, hospital pharmacists are expected to remain up to date with all aspects of
medicine. This includes their usage and any new developments that may occur.
Beyond the ward:
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.
Figure 1.3: Pharmacist’s role regarding Medication Use.

1.1.6 Objectives of Hospital Training
Some objectives of hospital training are given below-
 Hospital training provides practical knowledge to the students.
 Hospital training is an observational oriented program in which a student is able to learn practically
form their theoretical knowledge.
 Hospital training helps to study closely the ground level problem regarding their job profile.
 Training removes the hesitation of the students regarding their working skills and personally
development.
 To promote awareness of health care among all sections of our country.
 To know the standard treatment pattern.
 To know the management procedure of disease.
 Communicating with Patients.
 Recognize the need to individualize drug dosage and fluid administration on the basis of weight, and
be able to calculate expediently nutritional and fluid and electrolyte requirements using standard
formulas.
 Providing Care to patients.
 Be able to diagnose and manage a variety of medical conditions.
 To know how pharmacy in a hospital is run.
 To promote the development of high-quality hospital services and community health care
 To promote a forum for the exchange of ideas and information among health and hospital planners,
academicians, administrators, various statutory bodies and the general public for the improvement
of Hospital and Health Care delivery Systems.
 To provide opportunities for training and research in all aspects of Hospital Services Health Care
Delivery System and Health Care Administration.
 To update the knowledge and skill of the Health & Hospital Administrators and other personnel
involved in the management of health care organization through continuous education and research.
 To provide Health Care Advocacy for the benefit of health system management and to endeavor to
become a national advisory body for union and state governments. (4)
 To publish text books and periodic monographs on current and futuristic trends in health and hospital
management.
 To conduct inter hospital/ Institution awards competition on various parameters to bring
competitiveness for improving healthcare quality & training.

1.1.7 Health Care Delivery System in Bangladesh
A health care system consists of all organizations; people and actions that promote restore or maintain
health. To ensure proper care, need to set up an effective healthcare delivery system. [13]
Figure 1.4: Structure of Public Healthcare system in Bangladesh.
.
Bangladesh health care systems are mentioned in the below:
1. In Ward Level:
 Community Clinic.
 Family Welfare Centre (FWC).

Services:
 Establishing referral linkage with higher facilities.
 Family planning.
 EPI (Expanded Programme on Immunization).
 Primary health care.
 Oral rehydration therapy.
 Sanitation.
2. In Union Level:
 Family welfare Centre (FWC),
 Community clinic,
 Union sub-Centre,  Rural dispensary.
Services:
 Maternal and neonatal health care services,
 Integrated Management of Childhood illness (IMCI),
 Registration of newly married women, pregnant women,
3. In Upazilla Level:
 Upazilla Health Complex (UHC)  TB Clinic.
Services:
 Comprehensive emergency obstetric care.
 Facilitate services of gynecology, anesthesia.
 General health problem treatment.
 Normal Delivery conduct.
 TB treatment.

 Maternal child care.
 EPI (Expanded Programme on Immunization).
4. In District Level:
 District hospital with nursing institute,
 General hospital,
 Medical college with nursing institute,
 Chest disease clinic, Services:
 All general healthcare,
 Operative care,
 Rehabilitation center,
 Co-ordination with all health care center,
 Training of health care personnel and Capacity building,
 Nursing education and service,
5. In Divisional Level:
 Medical College and Hospital, with Nursing Institute,
 General Hospital with Nursing Institute,
 Infectious Disease Hospital,
 Institute of Health Technology.
Services:
 Provide care of all complicated disease,
 Rehabilitation care,
 Training, research and development,
 Provide care of infectious and communicable disease,  Ensure nursing care.
6. In National level:
 Public health institute,
 Postgraduate medical institute and hospital with nursing institute,  Specialized health
institute.
Services:
 Facilitate opportunity of higher education,  Provide super specialty care.
Hospital pharmacy departments usually consist of:
 Inpatient and outpatient dispensaries.
 Manufacturing and compounding facilities.
 Drug information services.

 Quality use of Medicine services.
 Stewardship services.
 Clinical trial services.
1.1.8 Minimum Standards for Hospital Pharmacy
Standard 1: Administration
The pharmaceutical service shall be directed by a professionally competent, legally qualified
pharmacist. He or she must be on the same level within the institution's administrative structure as
directors of other clinical services. The director of pharmaceutical services is responsible for: [12]
 Setting the long- and short-range goals of the pharmacy based on developments and trends in health
care and institutional pharmacy practice and the specific needs of the institution.
 Developing a plan and schedule for achieving these goals.
 Supervising the implementation of the plan and the day-to-day activities associated with it.
 Determining if the goals and schedule are being met and instituting corrective actions where
necessary. The director of pharmaceutical services, in carrying out these tasks, shall employ an
adequate number of competent and qualified personnel.
Standard II: Facilities There shall be adequate space, equipment, and supplies for the
professional and administrative functions of the pharmacy. The pharmacy shall be located in
an area (or areas) that facilitate (s) the provision of services to patients. It must be integrated with the
facility's communication and transportation systems.
 Space and equipment, in an amount and type to provide secure, environmentally controlled storage
of drugs, shall be available.
 There shall be designated space and equipment suitable for the preparation of sterile products and
other drug compounding and packaging operations.
 The pharmacy should have a private area for pharmacist-patient consultations. The director of
pharmaceutical services should also have a private office or area.
 Current drug information resources must be available. These should include appropriate pharmacy
and medical journals and texts and drug literature search and retrieval resources. (5)
Standard III:
Drug Distribution and Control The pharmacy shall be responsible for the procurement,
distribution, and control of all drugs used within the institution. This responsibility extends

to drugs and related services provided to ambulatory patients. Policies and procedures
governing these functions shall be developed by the pharmacist with input from other
involved hospital staff (i.e., Nurses) and committees (pharmacy and therapeutics committee,
patient-care committee, etc.). In doing so, it is essential that the pharmacist routinely be
present in all patientcare areas, establish rapport with the personnel, and become familiar
with and contribute to medical and nursing procedures relating to drugs.
Standard IV:
Drug Information The pharmacy is responsible for providing the institution's staff and
patients with accurate, comprehensive information about drugs and their use and shall serve
as its center for drug information.
Standard V:
Assuring Rational Drug Therapy an important aspect of pharmaceutical services is that of
maximizing rational drug use. In this regard, the pharmacist, in concert with the medical staff,
must develop policies and procedures for assuring the quality of drug therapy.
1.1.9 Accommodation facilities
 There should be enough space for the administrative offices.
 Space for storage of common medicine, narcotic medicine, poisons.
 Space for pharmacy services: i.e., compounding and dispensing of prescription drugs.
 Space for education, research, library & information services.
 Space for preparation of sterile supply services. I.e., preparation space for sterile products
and materials.
1.1.10 Practice of Hospital Pharmacy in Bangladesh: Current
Perspective
The conventional role of pharmacist is to manufacture and supply medicinal products. WE
have DGDA as authority and Pharma industry of Bangladesh are doing a great job. Recently,
there is a significant change in the pharmacy curriculum in terms of professional training,
hospital training in the final year makes them competent to perform within other Healthcare
professionals. Though, pharmacists in Bangladesh haven’t got the suitable value in Hospitals.

Canada, US, Uk have large amounts of pharmacist working in hospitals helping other
healthcare professionals. A very small amount of A grade pharmacists are working in the
hospital sector because of not getting the right duty, right value, right healthcare associates.
Pharmacy is a vital profession in the multidisciplinary team for the provision of quality health
care. Improvements on health outcomes depends on the workforce levels and their quality,
accomplishment of quality treatment are difficult to achieve without a competent pharmacist.
The pharmacy profession is still lagging behind in developing countries as compared with
developed countries in a way that the pharmacy professionals have never been considered
valuable as a part of health care team. But, now-a-days many private hospitals are employing
A grade pharmacists and they are providing a effective Healthcare approach which ultimately
leads to quality treatment by reducing prescription error, drug-drug interactions, severe
adverse effects of medications. B. Pharm degree in Bangladesh is not that easy to pass,
students have to go through a lot of courses. (6)
Basic Terminology regarding Prescription Analysis
Prescription:
An instruction written by a medical practitioner that authorizes a patient to be issued with a
medicine or treatment. A prescription, often abbreviated ℞ or Rx, is a formal
communication from a physician or other registered health-care professional to a
pharmacist, authorizing them to dispense a specific prescription drug for a specific patient.
(7)

Figure 1.5: A typical Prescription Structure.
Prescription Error:
A prescription error is a failure in the treatment process that leads to, or has the potential to
lead to, harm to the patient. Medication errors can occur in deciding which medicine and
dosage regimen to use prescribing faults—irrational, inappropriate, and ineffective
prescribing, underprescribing, overprescribing); writing the prescription (prescription
errors); manufacturing the formulation (wrong strength, contaminants or adulterants, wrong
or misleading packaging); dispensing the formulation (wrong drug, wrong formulation,
wrong label); administering or taking the medicine (wrong dose, wrong route, wrong
frequency, wrong duration); monitoring therapy (failing to alter therapy when required,
erroneous alteration). (8)

Figure 1.6: Percentage of different types of Prescription Error.
Drug's Indication:
The indication outlines the condition that the medication can treat and, in some cases, the age
range for which it is recommended. For instance, Paracetamol has two main uses: one is as a
pain reliever and the other is as a fever reducer. Paracetamol can be used to treat fever and/or
pain. Furthermore, the indication can be more precise depending on the type of Paracetamol
chosen. Children's
Paracetamol, for instance, has indications for reducing fever or relieving pain. (9)
Contraindication:
It is a medical term used for a specific situation or factor that makes a procedure or
course of treatment inadvisable because it may be harmful to a person.
For example, having a severe allergic or anaphylactic reaction to a medication may
be a contraindication to receiving that medication again in the future. Likewise,
pregnancy is often listed as a contraindication to having certain medications or
procedures because of the potential harm they may cause to an unborn baby. (10)

Adverse drug reactions:
Unintended, harmful events attributed to the use of medicines – occur as a cause of and during
a significant proportion of unscheduled hospital admissions. A careful medication history
can assist a prescriber in understanding the patient's previous experiences with drug
treatment, particularly in identifying previous ADRs that may preclude re-exposure to the
drug. (11)
Drug-drug interactions:
When two or more drugs interact with one another, drug-drug interactions happen. There's a
chance that this drug-drug interaction will have an unanticipated side effect. For instance,
combining sedatives and antihistamines, which are both used to treat allergies, can impair
your judgment and make it dangerous to operate machinery or drive a car. (12) Common
Drug-drug interactions:
Angiotensin Converting Enzymes (ACE) inhibitors and Potassium Supplements: ACE
inhibitors increase the levels of potassium in the body. Thus, if potassium supplements are
coadministered with ACE inhibitors, there is a potential for elevated potassium levels in
blood (known as hyperkalemia) (13)
Digoxin and Amiodarone: Amiodarone may lead to increased levels of digoxin in the body
and potential toxicity.
Digoxin and Verapamil: Verapamil may decrease the clearance of digoxin, leading to
increased levels of digoxin in the body and potential toxicity. Intake of digoxin and
verapamil together may result in excessive slowing down of the heart. (14)
Theophylline and Quinolones: Quinolones inhibit the metabolism of theophylline, thereby
increasing its blood levels and leading to potential theophylline toxicity and increased
likelihood of seizures.
Warfarin and Macrolides: Macrolides reduce the metabolism and clearance of warfarin,
resulting in increased levels and effects of warfarin like bleeding
Warfarin and Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Warfarin is used as an
oral anticoagulant to prevent blood clot formation. NSAIDs interact with warfarin and can
result in serious gastrointestinal bleeding. (15)
Warfarin and Phenytoin: Phenytoin can lead to increased effects of warfarin while warfarin
can increase the blood levels of phenytoin. (16)

Figure 1
.
7: Typical Drug Interactions.

In 1919, a medical center named after the zamindar Smt. Hemangini Devi was set up near
Abdul Hamid Road in Pabna. The Sir Ashutosh Chowdhury Memorial Outdoor was later set
up at the same place in 1940. After the partition of the country, the medical center was shifted
to the then health department and converted into a 50 bedded hospital. In 1963, it was planned
to relocate the hospital to its present location at Shalgarhia with a view to upgrading it to a
100 bedded sadar Hospital, and in 1968 the old building with the existing infrastructure was
commissioned. Sadar Hospital was renamed as General Hospital in 1987. In 2001, the
government decided to increase the number of beds from 100 to 250. Administrative
approval was not received for a long time after the infrastructure was built. (17)
Figure 2.1: Front view of Pabna General Hospital.
2.1 History of 250 Bedded General Hospital, Pabna [30]

2.2 Tasks of the Hospital
o To make arrangements for the provision of improved medical services to the public in the
outdoor department, emergency department and indoor department. o Providing various
specialist treatments or services at the district level like orthopedics, cardiology, microbiology,
biochemistry, Urology, Neuro-Surgery, Nephrology, Plastic Surgery, Interventional Medicine
etc. o To provide quality pathological, radiological and imaging services. o To provide
improved services to the patients referred from the Upazilla Health Complex. o Accurate
data storage, exchange and utilization.
o Medical records of all patients are stored in the computer and health education is provided to
the incoming patients and visitors.
Figure 2.2: Flow Chart of Patient Service Procedure in Hospital.

2.3 Infrastructure of the Hospital
250 bedded general hospital, Pabna has three storied building (Old building is 2 storied and
new one is 3 storied building) with accommodation facilities, emergency, inpatient and
outpatient medical services, diagnostics and lab services, administrative facilities etc.
Ground Floor
Ground floor of the hospital consists of two main entrance, ticket counter, dispensing unit,
pharmacy department, store room, blood transfusion unit, emergency department, Eye and
ENT ward, radiology, pathology, surgery department, orthopedics surgery department, paying
ward (Male), RH Step, nursing supervisor unit, sample collection unit for corona, Food
supplying unit etc.
First Floor
It consists of a separate administrative unit, outdoor patient department (OPD), medicine
ward, obstetrics and gynecology department, children unit/pediatric ward, diarrhea ward,
paying ward (Female), Coronary Care Unit (CCU) etc.
Second Floor (On the new building)
It is situated only on the new building. There is no second floor on the old building. The
second floor has only the Anaesthesia unit and operation theatre (OT)

Figure 2.3: Outside view of the Hospital
2.4 Departments and Wards
250 bedded general hospital, Pabna is a district hospital which has all the facilities of
Emergency, Indoor (IPD) and Outdoor (OPD) Patient system. It is consisting of 3 mother
departments. They are:
1) Medicine Department
2) Surgery Department
3) Obstetrics and Gynecology Departments.
These departments consist of the following wards:
1) Medicine Department:
a) Cardiology
b) General Medicine (Male and Female)
c) Diarrhoea
2) Surgery Department:
a) General Surgery
b) Orthopedics
3) Obstetrics and Gynecology Departments:
a) Eclampsia
b) Post Delivery (Operative) Unit
c) Labor Unit
d) Children Unit
4) Diarrhea Ward
Besides these, the following departments are also available:
 ENT
 Eye
 Dental
 Radiology
 Pathology
 Blood Transfusion
 EPI
 Pharmacy
 Anaesthesia/OT

 Nursing Unit
Beds per Departments or Wards [
30]
Sl.
No.
Name of the Departments Number of Bed
01 Medicine (Male and Female) 72
02 Surgery 28
03 Gynae and Obs 40
04 Ortho-surgery 40
05 Children 38
06 Eye/ENT 16
07 Diarrhoea 16
Total 250
Table 2.1: Beds Per Wards.
Extra facilities of beds:
 Cabin: 08
 Pain ward: 15
 Pain ward: 01 (For Freedom Fighter)
 Isolation: 16 (Corona Unit)
 Coronary Care Unit (CCU): 08
2.5 Approved Vehicles and Office Equipments [30]
1. Vehicles: 2 ambulances
2. Office Equipments:
 Air Conditioner
 Photocopy Machine
 Computers (For each unit)
 Printers
 Refrigerators
 Generators

3. Miscellaneous issues:
 Use of government vehicle / ambulance for official poisoning.
2.6 Manpower or Human Resources [30]
1. Assistant Director: Dr. Omar Farooq Meer
2. Senior Consultant:
Medicine: Dr. Saleh Muhammad Ali (1004211)
Anaesthesia: Dr. Ataur Rahman (39348)
Surgery: Dr. Goutom Kumar Ghosh (42061)
Gynecology: Dr. Sabera Gulrukh (35170)
Eye: Dr. Md. Aminur Rashid Akanda
(41015) Cardiology: Dr. Md. Abdul Majid (39719)
3. Junior Consultant:
Anaesthesia: Dr. Ahammed Arif (33467)
Gynecology: Dr. Sabera Sultana Bishwas (124192)
Radiology: Dr. Md. Mofazzal Hossain (1007688)
Pathology: Dr. Md. Rashedul Haque (1006660)
Ortho-surgery: Dr. Zahedi Hasan (113116)
Children: Dr. Jannatul Ferdous (124019)
4. Residential Physician: Dr. Md. Nazmul Islam (125331)
5. Residential Surgeon: Dr. Sheuli Rani Shaha (124283)
6. Residential Medical Officer: Dr. Jannatul Ferdous (128015)
7. Pathologist: Dr. Md. Imran Hossain (131101)
8. Anaesthetist: i. Dr. Mohammad Faysal Jinnat (134056)
ii. Dr. Md. Hasanuzzaman (134520)
9. Medical Officer: I. Dr. Subarna Siddique (128235) II. Dr. Munmun
Mahmud (133662) iii. Dr. Raju Ahmed (123510)
10. Dental Surgeon: Dr. A H M Afzal Hossain (114915)
11. Other Officials, Nurses and Employees.

Summary of Manpower [30]
SL.
NO.
CLASS/POST/GRADE EXISTS
POST NO.
VACANT
POST NO.
TOTAL
POST
01 1st
grade
Deputy Director / Supervisor - 01 01
Assistant Director 01 - 01
Senior Consultant 10 - 10
Junior Consultant 10 02 12
RMO/RS/RP 04 - 04
Reg./MO/Asst. Reg./Anaes/Dental
Surgeon/MO(U)
35 Anaes.: 02 37
Nursing Superintendent/Asst.
Superintendent
Nursing 02 - 02
02 2nd
grade 01 03 04
03 3rd
grade 52 09 61
04 4th
grade 52 06 58
05 Nursing Supervisor 04 - 04
Senior Staff Nurse/ Staff Nurse/Asst. Nurse 180 - 180
Total 351 23 374
06 Outsourcing 33 - 33
Total 384 23 407
Table 2.2: Human Resource
MEDICINE DEPARTMENT
2.2.1 Basic Information
Medicine department is situated on the first floor of the building of 250 bedded general hospital,
Pabna. It consists of 3 different wards. They are:
1. General Medicine (Male and Female)
2. Diarrhoea
3. Coronary Care Unit (CCU) / Cardiac Unit

There are 72 beds are allocated medicine department and special 8 beds for CCU.
2.2.2 Manpower for medicine department
As 250 bedded general hospital, Pabna is currently operating on a temporary basis as an
outteaching hospital of Pabna Medical College (PMC), the assistant professors of the PMC
along with the senior and junior consultant, assistant registrar of general hospital are appointed
as the physicians for the purpose of treating patients.
The manpower for medicine unit is as follows:
Medicine Department, 250 bedded general hospital, Pabna:
Senior Consultant (General): Dr. Saleh Muhammad Ali (1004211)
Senior Consultant (Cardiology): Dr. Md. Abdul Majid (39719)
Assistant Registrar: Dr. Md. Nazmul Haque (130389) Medical Officer: Dr.
Farhana Hamid Tina(126006)
Medicine Department, Pabna Medical College (PMC):
Associate Professor (Forensic Medicine): Professor Dr. Kamal Osman
Assistant Professor: Dr. Md. Abdus Sattar Mia
Assistant Professor: Dr. Abu Md. Shafiqul Hasan
Assistant Professor: Dr. Md. Mahbubul Alam
(Community Medicine):
Nursing Officer:
Dr. Kh. Mehedi Ibn Mostafa
Senior Staff Nurse (SSN):
1.Jannatul Ferdous
2.Sima Khatun
3.Khadija Khatun
There are also some other staff like intern doctors, other medical professionals, employees etc.
2.2.3 General Medical Conditions or Problems of Patients
People or patients from all area of Pabna district come to medicine department, 250 bedded
general hospital, Pabna for different medical conditions or problems. Common medical
conditions or problems include:

o Asthma
o Respiratory Tract Infection (RTI)
o Poisoning
o Hepatitis
o Diabetes mellitus with various complications
o Urinary Tract Infection (UTI)
o Chronic Obstructive Pulmonary Diseases (COPD)
o Stroke
o Hypertension
o Angina and Myocardial Infarction (MI)
o Heart Attack
o Dengue
o Typhoid
o Vertigo
o Acalculous cholecystitis
o GERD
o Iatrogenic Cushing's syndrome
o Epigastric Pain
o Epistaxis
o Diarrhoea
o Constipation
o Weakness
2.2.4 Supplied Drugs in Medicine Department from Hospital
 Ceftriaxone Injection – 1 gm and 2 gm
 Cardinex (Enoxaparin Sodium) Injection – 60 mg
 Atropine Injection – 1 mL
 Cefixime Capsule – 200 mg
 Omeprazole Capsule – 20 mg
 Paracetamol Tablet – 500 mg
 Metronidazole Tablet – 400 mg

 B – Complex Tablet
 Lumona (Montelukast) Tablet – 10 mg
 Sedil (Diazepam) Tablet – 5 mg
 Kilmax (Cefuroxime) Tablet – 250 mg
 Lipicon (Atorvastatin) Tablet – 20 mg
 Histacin (Chlorpheniramine Maleate) Tablet
 Amlodipine 5 Tablet – 5 mg
2.2.5 Functions and Responsibilities of Medicine Department
 Serves patients with relief from the symptoms, pain and stress of a serious illness.
 Offers a full range of personalized care and educations for patient with various chronic
diseases.
 Provide multidisciplinary care and innovate treatments for common and complex heart
conditions.
 Treats immune disease by integrating patient care, basic and clinical research and
education of physician-pharmacists. (18)
Figure 2.4.1: Front view of Medicine Ward.
 Provide comprehensive and coordinated care for patients with digestive and liver
diseases.
 Offers extensive services for diabetes, osteoporosis and diseases of the pituitary, thyroid
and reproductive systems.

2.2.6 Patient Management System in Medicine Department
There is a common systematic procedure that is followed for the management of both general
and critical patients not only in medicine department, but also in all departments of 250 bedded
general hospital, Pabna. Beginning with taking the chief complains of patients, they go through
five distinct paths. They are:
Figure 2.4.2: Flow chart of Medicine department working procedure.
2.2.7 Roles of a Pharmacist in Medicine Department
There could be some vital roles for a graduate pharmacist in the medicine department along with
the physicians and nurses. By working shoulder to shoulder with the other healthcare provider
it’s easy to ensure a standard treatment for the patient. The roles of pharmacists are:

Figure 2.4.3: Role of Pharmacist.
2.2.1.2 A sub unit of Medicine department: Coronary Care Unit (CCU)
A coronary care unit (CCU) or cardiac intensive care unit (CICU) is a hospital ward
specialized in the care of patients with heart attacks, unstable angina, cardiac dysrhythmia
and (in practice) various other cardiac conditions that require continuous monitoring and
treatment.

Figure 2.2.1.2: A Front view of Cardiac care Unit of Pabna general hospital.
2.2.1.3 Coronary Care Unit (CCU) under Medicine Department
Patient conditions treated in this Special section of Medicine
1. Patient with abnormal ECG 6. Pulmonary embolism
2. Shortness of breath 7. Heart failure
3. Angina pectoris 8. Arrhythmias
4. Acute myocardial infraction 9. Dyspnea
5. Sudden cardiac arrest 10. Swelling
2.2.1.4 Role of pharmacist in CCU
 The pharmacists working in these areas can provide a wide range of services that can
expedite the arrival of medications and improve adherence to clinical practice guidelines
and patient outcomes. (19)
 In addition to processing medication orders and coordinating the arrival of medications,
these pharmacists can also assist with therapeutic drug monitoring (vancomycin,
aminoglycosides, and warfarin), medication dosing, renal dosing, and responding to
medical emergencies (stroke, code blue, therapeutic hypothermia, rapid sequence
intubation, etc).

 The Role of the Pharmacist in the Critical care pharmacists also play an active role on
hospital committees, in the education of staff, students, and resident. In patients with
heart failure take a number of high-risk drugs such as anti-thrombotic and antiarrhythmic
drugs, in addition to other drug types, including diuretics and cardio protective agents.
 Pharmacists should support the pharmacological management of these patients by
evaluating their clinical condition and laboratory data, due to the frequency of renal
failure.
 Furthermore, it is known that poor adherence to a drug regimen is one of the aggravating
factors for heart failure.
 It is necessary to conduct regular patient education to facilitate early hospital discharge
and to prevent the recurrence of heart failure
Prevention of cardiovascular disease
1. Lifestyle modification like quit smoking and less alcohol intake.
2. Weight lose
3. Get moving
4. Cutting the salt from the diet
5. Checking blood pressure regularly
6. Taking low fatty food
7. Vegetable enriched food intake
Table 2.3: Drugs Commonly Used in the Treatment of Cardiac Disease.
Classes of Drugs Pharmacology

1.Angiotensin Converting Enzyme
Inhibitor:
Eg: Ramipril, captopril, Lisinopril, etc.
inhibits ACE and formation
of angiotensin II and
block its effects
2.Angiotensin II Receptor Blocker:
Eg: losartan, valsartan, olmesartan, etc.
block the angiotensin II receptor and
inhibit the effects of angiotensin
3.Diuretics: Eg: thiazide, hydrochloro
thiazide, spironolactone, amiloride,
triameterine, etc.
works by decreasing blood volume and
cardiac output
4.Calcium channel blocker:
Eg: amlodipine, nifedipine,
nicardipine, etc.
block entry of calcium through calcium
channel. Drugs of choice in co-existing
asthma
5.Beta Blocker: Eg: atenolol,
metoprolol, carvedilol, bisoprolol,
propranolol, etc.
block beta-1 receptor on the heart. Block
beta-2 receptor on the kidney and inhibit
renin release which decreases cardiac
output
6.Alpha blocker: Eg:
prazosin, terazosin.
block alpha-1 receptor and causes
vasodilation
7. Nitrates causes vasodilation
8. Anti-hyperlipidemic drugs mainly
Atorvastatin
causes vasodilation
9. Warfarin anticoagulant
2.2.2 A sub unit of Medicine department: Diarrhea Ward
Diarrhea is loose or watery stool, which may occur multiple times a day. Diarrhea that starts
suddenly (acute) is a common harmless condition. Acute diarrhea typically only lasts a day or
two and goes away without treatment.
However, certain circumstances can signal a more serious problem, including:
Black, tarry stools
Diarrhea lasting more than two days
Diarrhea with high fever
Pus or blood in the stool
Severe abdominal pain
Signs of dehydration
The expert team of emergency care doctors, nurses, and technicians at 250 bedded

General Hospital, Pabna provide comprehensive and efficient care for diarrhea in the area.
Causes of Diarrhea
The main cause of acute diarrhea is viral gastroenteritis — an acute viral infection commonly
known as stomach flu. Contaminated food or water is the main cause of gastroenteritis.
Figure 2.2.2: Causes of Diarrhea
Norovirus is the most common virus affecting adults. In children, rotavirus is most common.
Other possible causes of diarrhea include parasitic and bacterial infections, lactose intolerance,
IBS, food poisoning, medications.
Diarrhea Symptoms

Signs and symptoms of diarrhea include:
Abdominal pain.
Bloating.
Nausea.
Abnormal bowel movement.
Loose, watery stools.
Diarrhea can lead to dehydration due to loss of fluids in the stool. Signs of diarrhea in case
of infant include:
• Fever of 102 degrees or higher
• Belly pain
• Blood or pus in their poop, or poop that’s black, white, or red
• Sluggishness
• Vomiting
People of all ages can get diarrhea. On average, adults In the United States have acute
diarrhea once a year. Young children have it an average of twice a year. People who visit
developing countries are at risk for traveler's diarrhea. It is caused by consuming
contaminated food or water.
Figure 2.2.3: Diarrhea causes and symptoms

Department of Pharmacy, PUST
2.2.2.1 Diagnosis of Diarrhea
Successful treatment depends on diagnosing the cause. Investigations may include:
♣ Medical history
♣ Physical examination
♣ Blood tests
♣ Laboratory analysis of stool sample
♣ Colonoscopy (the insertion of a slender instrument into the anus so that the doctor can look at
the bowel lining).
2.2.2.2 Treatment & Prevention of Diarrhea at 250 bedded General Hospital, Pabna
Diarrhea treatment depends on the underlying cause. For bacterial and parasitic infections, doctors
will prescribe anti-infective medicines, such as antibiotics. Preventing dehydration is the main focus
of viral diarrhea treatment. This means replacing electrolytes and drinking plenty of fluids. Over-
thecounter antidiarrheal medicines can successfully treat viral diarrhea in adults. However, these
medicines should not be used for bacterial diarrhea, parasitic diarrhea, or diarrhea in children.
Because spicy, greasy, and high-fiber foods can worsen your symptoms, eat bland foods, such as rice
and crackers, until your symptoms subside. The two best methods for preventing diarrhea are
sanitary food preparation and thorough handwashing.
Table 2.2.2.1: Common drugs used in diarrhea ward
Generic name Drug Class
Sulfa trim Anti-folate, Sulfa Antibiotic Combinations.
lopeamide Antidiarrheal
Antidiarrheal Glycopeptide Antibiotics, Firvanq
Flagyl
(metronidazole)
Nitro imidazole Antibiotics
Dificid Macrolide Antibiotics
Opium Opioids

Figure: Front view of Diarrhea Ward
2.2.2.3 Drawbacks of Medicine Department
 There was no any graduate pharmacist for standard treatment and counseling of patients.
 Drug-drug interactions, adverse drug reactions, drug allergy wasn’t monitored properly.
 Selection of drugs and dosage didn’t follow rational use of drugs (RUD).
 Patient history of previous medication and diseases wasn’t taken into consideration during the
management of critical patient.
 Polypharmacy and overprescribing were seen here.
 There was no proper treatment in the CCU due to lack of facilities.
2.2.2.4 Recommendations for Medicine Department
Inclusion of Pharmacist as multidisciplinary team member.
Drug-drug interactions, adverse drug reactions, drug allergy should be properly monitored.

Geriatrics ward should be separated.
Patient counseling and adherence.
Drugs in prescription should be written in generic name and proper dose calculation should be
maintained.
Overprescribing and polypharmacy should be avoided.
CCU should be decorated with enough facilities, equipments, manpower and medicines.
SURGERY DEPARTMENT
2.3.1 History of Surgery
Surgery is the branch of medicine that deals with the physical manipulation of a bodily structure to
diagnose, prevent, or cure an ailment. Ambroise Paré, a 16th-century French surgeon, stated that to
perform surgery is, "To eliminate that which is superfluous, restore that which has been dislocated,
separate that which has been united, join that which has been divided and repair the defects of nature."
Since humans first learned to make and handle tools, they have employed their talents to develop
surgical techniques, each time more sophisticated than the last; however, until the industrial
revolution, surgeons were incapable of overcoming the three principal obstacles which had plagued
the medical profession from its infancy — bleeding, pain and infection. Advances in these fields have
transformed surgery from a risky "art" into a scientific discipline capable of treating many diseases
and conditions. [37]
The first surgical techniques were developed to treat injuries and traumas. Early surgical procedures
were carried out by Sushruta, one of a number of individuals who has been called "the father of
surgery". A combination of archaeological and anthropological studies offer insight into early
techniques for suturing lacerations, amputating unsalvageable limbs, and draining and cauterizing
open wounds. Many examples exist: some Asian tribes used a mix of saltpeter and sulfur that was
placed onto wounds and lit on fire to cauterize wounds; the Dakota people used the quill of a feather
attached to an animal bladder to suck out purulent material; the discovery of needles from the Stone
Age seems to suggest they were used in the suturing of cuts (the Maasai used needles of acacia for the
same purpose); and tribes in India and South America developed an ingenious method of sealing minor
injuries by applying termites or scarabs who bit the edges of the wound and then twisted the insects'
neck, leaving their heads rigidly attached like staples. (20)

Figure 2.3.1: Typical operation room

Figure 2.3.2: Physician carrying Surgery
Figure 2.3.3: Surgery Ward
2.3.2 Basic Information
Surgery Department is one of the most organized and strategic departments in 250 bedded general
hospital, Pabna. It is situated in the ground floor of the old building of 250 bedded general hospital,
Pabna. There are 2 wards of Surgery Department such as General surgery and Orthopedics surgery.
General surgery department is a surgical specialty that focuses on abdominal contents including
esophagus, stomach, small intestine, large intestine, liver, pancreas, gallbladder, appendix and bile
ducts and often the thyroid gland etc whereas Orthopedics surgery department focuses on

musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat
musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and
congenital disorders.
2.3.2.1 Manpower of Surgery Unit
 General Surgery Department Members: Currently, the department is set up of 01 Associate
Professor, 01 Assistant Professor, 01 Senior Consultant, 01 Junior Consultant, 02 Assistant
Registrars, 01 Medical Officer, 07 Intern Doctors and some nurses.
Associate Professor: Dr. Md. Rayhanur Rahman Assistant Professor: Dr. Shamsul
Haque
Dr. Md. Abdus Sattar
Senior Consultant: Dr. Goutam Kumar Ghosh
Dr. A S M Kutub Uddin Junior Consultant:
Awal
Assistant Registrar: 1. Dr. Md. Hasanuzzaman Tutul
2. Dr. Md. Sajib Hossain Medical Officer: Dr. Subrata
Chandra Mondol
Nursing Officer:
In charge: Mst. Babli Khatun
Senior Staff Nurse (SSN): 1. Md. Nahid Hasan Jinnah
2. Mst. Ratna Khatun
3. Md. Nurunnabi
 Orthopedic Surgery Department Members: The department is consisting of 02 Assistant
Professors, 01 Junior Consultant, 01 Assistant Registrar and some nurses.
Assistant Professor: 1. Dr. Arun kanti Paul
2. Dr. Masudur Rahman
Prince
Junior Consultant: Dr. Jahedi Hasan
Assistant Registrar:
Nursing Officer:
Dr. Md. Abu Taleb

In charge: Md. Atiqur Rahman
1. Mst. Rojina Khatun
2.3.3 Patient Handling and Work Flow in Surgery Department
1) Emergency patients: Emergency unit for primary admission in the Hospital, for severe and
emergency surgery.
2) Casual patients: Admission in the surgery unit according to the day of the week. Surgery is
carried out according the admission day.
Outpatient consults with doctor about their problems, if surgery required for that disorders then doctor
consults to admit in hospital. Then the procedure is going like this:
Patient admission > Preoperative assessment > Surgery > Post-operative care > Recovery > Patient
release.
2.3.3.1 pre-operative assessment
 ECG
 Blood Test (CBC)
 Blood group (Rh grouping, cross matching)
 Cardiac (heart murmur, rhythm)
 Serum Creatinine
 X Ray
 Urine analysis (pregnancy test, UTI)
 Diabetes test (RBS)
 USG (Ultrasonogram)
Common surgeries carried out in Surgery Department
 Acute Appendicitis
 Acute Pancreatitis
 Acute Cholecystitis
 Cholelithiasis
 Inflammatory Bowel Disease
 Kidney stone treatment

 Intestinal Obstruction
 Hemorrhoid
 Hernia
 Abscess
 Nasal and sinus disorders
 Anal Fistula
 Anal Fissure
2.3.4 Commonly used Drugs in Surgery Department
Antibiotics:
• Ceftriaxone
• Cefuroxime
• Ciprofloxacin • Cefixime
• Flucloxacillin
• Metronidazole
• Azithromycin
• Amoxicillin
Anti-ulcerates:
• Omeprazole
• Esomeprazole
• Pantoprazole
Anti-emetic:
• Ondansetron
• Domperidon
Analgesic:
• NSAIDs
• Ketorolac Tromethamine
• Tramadol Hydrochloride
• Nalbuphine Hydrochloride
Anesthetic:

• Morphine
• Lidocaine
• Procaine
Infusion Saline:
• Hartmann's solution
• N/S
• 5% DA
• 5% DNS
2.3.4.1 Supplied Drugs in Surgery Department from Hospital
 Ceftriaxone Injection – 1 gm and 500 mg
 Hydrocortison – 100 mg
 Cefixime Capsule – 200 mg
 Flucoxacillin Capsule – 500 mg
 Omeprazole Capsule – 20 mg
 Paracetamol Tablet – 500 mg
 Metronidazole Tablet – 400 mg
 Vitamin B – Complex Tablet
 Montelucast Tablet – 10 mg
 Cefuroxime Tablet – 250 mg
 Azithromycin Tablet – 500 mg
2.3.5 Role of Pharmacist in surgery department Ensuring rational use of drug (RUD).
Monitoring drug-drug interaction and adverse drug reaction (multiple diseased patients).
Calculation of dose for total parenteral nutrition (TPN) for the post operative patients.
Providing drug related education among patients, doctors & nurses.
Consultation with the physician during selection of antibiotics.
2.3.6 Limitations of Surgery Department
 Absence of graduate ―A‖ grade pharmacists.  Use of upper generation antibiotics.
 Drug-drug interactions, adverse drug reactions, drug allergy wasn‘t monitored properly.
 Selection of drugs and dosage wasn’t followed rational use of drugs (RUD).

 History taking procedure wasn’t performed properly in orthopedics like previous medication
and diseases history, blood pressure and pulse measurement.
 Overprescribing and under prescribing can be seen here.
2.3.7 Recommendations for Surgery Department
 Pharmacists should be appointed to ensure quality treatment.
 Use of narrow spectrum antibiotics.
 Counseling the patient, nurses and other medical professionals.
 Rational use of drugs (RUD) must be followed during selection of drugs and dosage form, dose
and dosage regimen calculation.
 Proper monitoring of drug-drug interactions, adverse drug reactions, and drug allergy should
be done.
 Overprescribing and under prescribing should be avoided
Gynecology and Obstetrics Department
2.4.1 Introduction
The Department of Obstetrics and Gynecology caters to women of all age group. It deals with
diseases of female reproductive organs, family planning and care of women during pregnancy,
childbirth and postpartum. The department is committed to deliver quality and evidence based
clinical services to all patients coming under its domain after establishment of fully functional
department.
Gynecology and Obstetrics is a diverse, challenging and rewarding specialty. It combines medical and
surgical skills to address aspects of women's health during the entire life cycle. An obstetrician or
gynecologist has particular expertise in pregnancy, childbirth and disorders of the reproductive
system.
2.4.2 Gynecologist
Gynecologists are doctors who specialize in women‘s health, with a focus on the female reproductive
system. They deal with a wide range of issues, including obstetrics, or pregnancy and childbirth,

menstruation and fertility issues, sexually transmitted infections (STIs), hormone disorders, and
others.
There are some key points about gynecologists. They are:
 A gynecologist is a doctor who specializes in the health of the female organs.
 Many women start visiting a gynecologist from their early teens and continue to attend a well
woman clinic for general health issues too.
 Women are advised to visit a gynecologist annually for a checkup, and any time they have
symptoms that concern them.
 A gynecologist should be certified and registered with a professional body.
2.4.2.1 Types of Gynecologists [40]
There are several types of gynecologists such as:
 OB/GYN Specialists
Obstetrics and gynecology specialists are dedicated to the full spectrum of healthcare for women. They
take a personalized approach to your health, whether you need routine care, pregnancy care, or care
for conditions that require ongoing management and/or surgery.
 Gynecologic Oncology
Gynecologic oncologists are specialists in treating women with cancers that affect their reproductive
system. They understand the impact gynecologic cancer may have on your fertility, sexual function,
psychological health and your family. They draw upon the latest research findings and our ongoing
clinical trials to ensure cancer is found early, and create the most effective treatment plan for the stage
and type of cancer.
 Maternal Fetal Medicine
Maternal-fetal medicine specialists (also called perinatologists) follow your pregnancy closely while
focusing on personalized care based on your risk factors, lifestyle considerations, and specific health
needs.
 Minimally Invasive Gynecologic Surgery (MIGS)
Minimally invasive gynecologic surgery (MIGS) specialists use the latest non-surgical and minimally
invasive treatments for large, painful fibroids and ovarian cysts. Surgical alternatives include uterine
artery embolization and MRI-guided focused ultrasound. The specialists provide you with expert care
and a personalized treatment plan to return you to good health. (21)

 Reproductive Endocrinology and Infertility (REI)
Reproductive endocrinologists and infertility specialists provide a broad scope of compassionate care
to help individuals and couples become pregnant. Whether you experience fibroids, endometriosis,
polycystic ovarian syndrome, recurrent miscarriages or other hormonal problems, they can help
diagnose the cause, and choose from an array of treatments. They do their best to help you achieve a
successful pregnancy.
 Urogynecology
Urogynecologists and urologists are specially trained to treat pelvic floor disorders including
incontinence and dropped bladder (vaginal prolapse). The specialists undergo advanced training in
urology and gynecology, and are expertly equipped to treat women with pelvic floor problems,
including bladder leakage, pelvic organ prolapse (dropped bladder, vagina, uterus or rectum),
recurrent urinary tract infections, voiding difficulties and vaginal fistulas.
Figure 2.3.4: Labor and Gynecology Ward

2.4.2.2 Commonly Treated Conditions by Gynecologists Conditions commonly treated by
gynecologists include:
issues relating to pregnancy, fertility, menstruation, and menopause
family planning, including contraception, sterilization, and pregnancy termination
problems with tissues that support the pelvic organs, including ligaments and muscles
STIs
polycystic ovary syndrome
urinary and fecal incontinence
benign conditions of the reproductive tract, for example, ovarian cysts, fibroids, breast
disorders, vulvar and vaginal ulcers, and other non-cancerous changes
premalignant conditions, such as endometrial hyperplasia, and cervical dysplasia
cancers of the reproductive tract and the breasts, and pregnancy-related tumors
congenital abnormalities of the female reproductive tract
emergency care relating to gynecology
endometriosis, a chronic condition that affects the reproductive system
pelvic inflammatory diseases, including abscesses
sexuality, including health issues relating to same-sex and bisexual relationships
sexual dysfunction
thyroid disorders and other hormonal issues
domestic violence and sexual assault
osteoporosis
2.4.3 Obstetricians [41]
An obstetrician is a doctor who specializes in pregnancy, childbirth, and a woman's reproductive
system. Although other doctors can deliver babies, many women see an obstetrician, also called an
OB/GYN. An obstetrician can take care of you throughout your pregnancy, and give you follow-up
care such as annual Pap tests for years to come.
2.4.3.1 Activities of Obstetricians
During pregnancy an obstetrician will:
• Monitor health and developing babies' health, including doing routine ultrasounds,
measurements, and tests

• Check for health conditions that could cause problems during pregnancy or affect your babies'
health, such as high blood pressure, diabetes, infections, and genetic disorders
• Advise about diet, exercise, medications, and staying healthy
• Help you cope with morning sickness, back and leg pain, heartburn, and other common
pregnancy complaints
• Answer questions about pregnancy and growing baby
• Explain what will happen during labor and delivery An obstetrician will also:
• Deliver babies
• Monitor health while you recuperate
2.4.4 Difference between Obstetrics and Gynecology (23)
While OB/GYN is considered one specialty, it comprises two distinct fields.
 Obstetrics (the OB) involves care during pre-conception, pregnancy, childbirth, and
immediately after delivery.
 Gynecology (the GYN) involves care of all women's health issues.
 Physicians who focus on gynecology do not deliver babies or treat pregnant women. They
conduct cancer screenings; treat urinary tract issues, and more.
 Physicians who focus on obstetrics do not treat health issues outside pregnancy.
2.4.5 Objectives of Gynecology and Obstetrics Department
The main aim of gynecology and obstetrics department is to ensure and deliver proper care and
treatment to the women, pregnant women, child as infant as well as in delivery. Besides this, there are
several objectives such as:
Provide proper care in managing women’s health including pregnancy, labor and puerperium
and to ensure maternal and neonatal health and wellbeing and give proper advices.
Diagnose and manage patients with common obstetrical and gynecological problems.
Describe the basic concept of Counseling and counsel the women in the field of Obstetrics and
Gynecology.
Refer high risk cases appropriately.
Resuscitate new born babies and impart proper care.

Initiate & promote infant & young child feeding practices including exclusive breast feeding
Demonstrate appropriate attitude required to practice obstetrics and gynecology.
Demonstrate an understanding about the impact of socio-cultural beliefs and environmental
factors on women in pregnancy, labor and puerperium including their overall reproductive
health.
Counsel and motivate women about contraception and family planning, and women’s right.
Be acquainted with ongoing programme to reduce maternal mortality & morbidity.
Value the ethical issues in obstetrics and gynecology
Roles of pharmacists in Gynecology and Obstetrics Department
[44]
Pharmacists can provide a patient-centered approach to advising and treating the women about the
pregnancy, menopause, reproductive system health etc. The pharmacists can involve in several sector
of gynecology such as:
 Case-based learning: postnatal depression - Appropriate early recognition and timely treatment
of postnatal depression is essential if patients are to make a full recovery.
 Postnatal depression: recognition and diagnosis - Pharmacists are likely to encounter patients
affected by postnatal depression; therefore, the ability to identify signs of this under-recognised
disorder is essential for appropriate and prompt referral for help and support.
 Heavy menstrual bleeding: diagnosis and management options - Heavy menstrual bleeding has
a major impact on a woman‘s quality of life. This article covers the most recent guidance and
available treatment options.
 Treatment options for menopausal symptoms - Pharmacists and healthcare professionals can
provide a patient-centered approach to advising women about the menopause, and provide robust
information about the risks and benefits of menopause hormone treatment that will allow patients
to make an informed choice about how to relieve their symptoms.
 Preconception care: dietary and lifestyle advice - Engagement by women with a pharmacist or
healthcare professional for preconception advice and care ranges from 18% to 45%. Pharmacists
are uniquely placed to provide this advice when individuals present for new registration checks,
well woman consultations, contraceptive advice and reviews, as well as medicine use reviews.

Antidepressant use during breastfeeding - Recognizing the symptoms of postnatal depression,
which occurs in 10–15% women following childbirth, and selecting the most appropriate
antidepressant.
 Sub fertility: treatment options in women - The causes of sub fertility in women and the
pharmacological and surgical options available can be well described by a pharmacist.
 Pregnancy: use of medicines in managing complications - How physiological changes during
pregnancy are managed to minimize risk to the mother and fetus.
 Hormonal contraception: practice-based case studies - The wide range of hormonal
contraception available means that patients can present with a range of problems or concerns that
require advice or assessment
 Hormonal contraception: methods and patient eligibility - A wide range of hormonal
contraception is available, giving women greater choice in selecting a method appropriate for them.
2.4.7 Gynecology and Obstetrics Department in 250 bedded general hospital, Pabna
Gynecology and Obstetrics department is located on the first floor of the new building of 250
bedded general hospital, Pabna. It consists of 3 different wards. They are:
1. General Gynae (Pre and Post labor unit)
2. Eclampsia unit
3. Pediatrics/Children unit
There are 2 cabins, 40 beds are allocated for Gynecology and Obstetrics department. Post
labor/operative beds are separated from the others, but number of beds is not enough.
2.4.7.1 Manpower for Gynecology and Obstetrics department
 Gynecology & Obstetrics Department Members: Currently, the department is made up of 02
Assistant Professors, 01 Senior Consultant, 01 Junior Consultant, 02 Assistant Registrars, 01
Medical Officer and some nurses.
Assistant Professor: 1. Dr. Shaheen Ferdous Shanu
2. Dr. Nargis Sultana
Senior Consultant: Dr. Sabera Gulrukh
Junior Consultant: Dr. Sabera Sultana Biswas

Assistant Registrar: 1. Dr. Shamima Khatun
2. Dr. Sadia Shahrin
Medical Officer: Dr. Md. Jahidul Islam
Nursing Officer:
In charge: Mst. Rahima Khatun
Senior Staff Nurse (SSN):
1. Shimu Akter
2. Sabina Yasmin
3. Konika Das
 Pediatric Department Members: The pediatric department is consist of 02 Associate Professor,
03 Assistant Professor, 01 Junior Consultant, 01 Assistant Registrar, 01 Medical Officer and some
nurses.
Associate Professor: 1. Dr. Md. Belal Uddin
2. Dr. Nitish Kumar Kundu
Assistant Professor: 1. Dr. Md. Abdus Sattar
2. Dr. Md. Abul Fazal
3. Dr. Parimal Kumar Paul
Junior Consultant: Dr. Jannatul Ferdous
Assistant Registrar: Dr. GalibaTasnim
Medical Officer:
Nursing Officer:
Dr. Mahmudur Rashid
In charge: Doly Roy
Senior Staff Nurse (SSN): 1. Sabiha Mou
. 2.Dilruba Parvin

Commonly used drugs in Gynecology and Obstetrics Dept.:
• Ceftriaxone
• Cefixime
• Flucloxacillin
• Metronidazole
• Gentamycin
• Amoxicillin
• Hyosomide
• Omeprazole
• Esomeprazole
• Pantoprazole
• Ondansetron
• Tranexamic Acid (Xamic)
• Paloxi (Palonosetron)
• Nalepsin (Magnesium sulphate)
• Labetalol
• NSAIDs
• Ketorolac Tromethamine
• Tramadol Hydrochloride
• Nalbuphine Hydrochloride
• Lidocaine
• Procaine
• Vitamin B Complex
• APN infusion
• N/S infusion
• 5% DA infusion

• 5% DNS infusion
2.4.8.1 Supplied Drugs in Gynecology and Obstetrics Department from Hospital
Ceftriaxone Injection – 1 gm and 500 mg
Hyosomide injection – 20 mg
Amoxicillin Capsule – 500 mg
Flucoxacillin Capsule – 500 mg
Omeprazole Capsule – 20 mg
Paracetamol Tablet – 500 mg
Metronidazole Tablet – 400 mg
Vitamin B Complex Tablet
2.4.9 Inconveniences in Gynecology and Obstetrics Department
 Absence of registered pharmacists for proper care and treatment.
 Frequent use of upper generation antibiotics.
 NVD wasn’t done by expert or proper person and insufficient facilities of baby care.
 Overprescribing and polypharmacy was seen in cesarean patient.
 Drug-drug interactions, drug-food interaction, adverse drug reactions, drug allergy was not
monitored properly.
 Selection of drugs and dosage form didn’t follow rational use of drugs like pregnancy category.
 Patient history of previous medication and diseases wasn’t taken into consideration during the
management of pregnant mother.
2.4.10 Recommendations for Gynecology and Obstetrics Department
 Pharmacists should be appointed for the quality of treatment and proper management.
 Pregnancy category of drugs should be taken into consideration during prescribing.
 Use of narrow spectrum antibiotics.
 Drugs in prescription should be written in generic name and dose calculation should be done
accurately.
 Counseling the patients, nurses and other medical professionals.

 Collaboration is a must among the physicians, pharmacists and other health care professionals.
Pharmacy Department
2.5.1 Introduction
Hospital pharmacy departments are expected to optimize the preparation, dispensing, and
distribution of medications. So, it is necessary to have policies and regulations for handling
medication safely. The concept of a hospital pharmacy is either not clear or intentionally
overlooked in hospital management within teaching hospitals. Generally, hospital management
rents out space to private vendor, who runs its own private pharmacy. Hospital pharmacy plays
a pivotal role in patient care in a hospital. Hospital pharmacists serve as a link between
physicians and patients to promote better patient outcomes. But it is matter of great regret that
in Bangladesh, a developing country, people are totally unknown to the responsibilities of
hospital pharmacist, even they don‘t seek for recruit for hospital pharmacist in any hospital
except a few aristocrat hospitals. So, the seed of hospital pharmacy in Bangladesh is yet to be
germinated.
The hospital pharmacy is integrated with the dispensing section, manufacturing section, quality
assurance section, and clinical pharmacy services. The requirement of personnel for an
inpatient pharmacy depends on the nature and quantum of services provided by the department.
The requirement of hospital pharmacists in hospitals is based on workload and number of beds
in hospital. Generally, small hospitals require a minimum of three pharmacists, but this varies
with the number of beds in each hospital. The number of pharmacists required according to
beds in a hospital is listed in Table 01.
Bed Strength No. of Pharmacists Required
Up to 50 beds 3
Up to 100 beds 5
Up to 200 beds 8
Up to 300 beds 10
Up to 500 beds 15
Table 2.5.1: Number of pharmacists required according to beds in a hospital

2.5.2 Roles of Pharmacy Department in a Hospital [31]
Hospital pharmacy departments usually supply medication to both inpatients and outpatients. Due to
the demand for acute care in the home environment to ease pressure on hospital beds, pharmacy
departments sometimes supply medications for patients treated at home rather than in hospital e.g.,
Intravenous antibiotics and low molecular weight heparin following high risk surgery. In addition to
the supply of medications, hospital pharmacists have important clinical roles in the dispensary, on the
wards and sometimes in some outpatient.
 Ensuring the availability of the right medication, at the right time, in the right dose, for
inpatients, outpatients and patients when leaving the hospital
 Maintaining hospital formulary to procure medicines, vaccines and intravenous fluids and
storing them according to legal, regulatory and storage requirements
 Compounding specialized injections, infusion and oral mixtures
 Dispensing discharge prescription medicines and providing education and counselling to
patients
 Providing hospital pharmacy residency programs for early-career pharmacists
 Providing intern training programs and student placements for prospective pharmacists in
training
 Undertaking hospital-wide governance activities related to the use of medicines through quality
use of medicines and medication safety activities such as drug use evaluations and stewardship
programs for high-risk medicines, e.g., opioids, antimicrobials, anticoagulants Managing and
administering clinical trials and participate in research projects Providing medicines
information services to the entire hospital.
Five major themes emerged from various studies of changes in hospital pharmacy departments
over a long period: (24)
1. Hospitals have recognized universally that pharmacists must be in charge of drug product
acquisition, distribution, and control.
2. Hospital pharmacy departments have assumed a major role in patient safety.
3. Hospital pharmacy departments have assumed a major role in promoting rational drug
therapy.
4. Many hospital pharmacists have become patient care providers.

5. Hospital pharmacy departments have expanded their clinical activities to include patients in
ambulatory care clinics.
Thus, it can be said that, Pharmacy Department of 250 Bedded General Hospital, Pabna is a
so-called pharmacy department that only involves in dispensing or distributing of drugs only
for out-patients. There are no graduate pharmacists or other qualified pharmacists or medical
professionals for proper management, compounding and handling of pharmaceuticals and to
perform the actual or proper activities of pharmacy department.
Figure 2.5.1: Pharmacy Department
Pharmacy Department of 250 Bedded General Hospital, Pabna
Pharmacy Department of 250 Bedded General Hospital, Pabna is located at the ground floor of the old
building of room number 106. A diploma pharmacist named Md. Abdul Mojid is the in-charge of
pharmacy department of 250 Bedded General Hospital, Pabna. There is 4 other diploma pharmacists
are working with the in-charge pharmacist. There are also some others employees such as few nurses,
intern diploma pharmacists, ward boy, store keeper in the pharmacy department. Various kinds of
Drugs are supplied or distributed from pharmacy department only to Out Patient Department (OPD)
such as:

Supplied drugs from store room to In-Patient Department (IPD)
Different kinds of Drugs or medicines and other things are supplied or distributed from store room
only to In Patient Department (IPD) such as:
Table 2.5.2 : Drugs
supplied by Pharmacy
dept.
Besides the drugs or medicine, store room also contains:
 Cylinders of anesthetic and oxygen (only for OT)
Sl. No. Dosage Form Name of the Drug
01 Tablet Paracetamol
02 Tablet Histacin
03 Tablet Salbutamol
04 Tablet Hysomide
05 Tablet Metronidazole
06 Tablet B - Complex
07 Tablet Antacid
08 Tablet Etoricoxib
09 Tablet Calcium
10 Tablet Loratidine
11 Tablet Clonazepam
12 Tablet Montilucast
13 Tablet Azithromycin 500mg
14 Capsule Amoxicillin 250 mg
15 Capsule Amoxicillin 500 mg
16 Capsule Cefradine
17 Capsule Cefixime
18 Capsule Cefuroxime
19 Capsule Flucloxacillin
20 Capsule Omeprazole
21 Tablet Ranitidine
22 Tablet Atenolol
23 Injection Ceftriaxone 1 gm
24 Injection Ceftriaxone 500 mg
25 Injection Hydrocortisone 100 mg
26 Injection Omeprazole 40 mg
27 Injection Esomeprazole 40 mg

 Medical devices, equipments
 Chemical reagents (Antiseptics)
Drugs or medical products acquisition, distribution, and control in 250 bedded general hospital, Pabna
Nurses are responsible for hospital drug product acquisition, distribution, and control in the IPD and
pharmacists are responsible for hospital drug product acquisition, distribution, and control in the OPD.
Both the department follows about the same system of requisition, distribution and storage or control
of the drugs.
2.5.6.1 Requisition Process in 250 bedded general hospital, Pabna
Drugs or medicines in the pharmacy department for OPD and in other departments such as:
Medicine department (Male and Female), Diarrhoea ward, Paediatrics department,
Gynecology and Obstetrics department, Surgery department (Male and Female & child),
Orthopaedics department, OT, Eye & ENT department for in-patients are acqiured and stored
by a common process in 250 bedded general hospital, Pabna. The whole process is as follows:
Figure 2.5.2: Requisition Process.
Application by a
form and granted by
Assistant Director of
hospital
Application is sent to the
store keeper and shipment
of drugs from store room to
wards
Weekly or half
-monthly
requirement by the wards
Distribution of drugs to patient
and Calculation & store of the
remaining medicines.
Maintenance of
logbook and
Repetition of same
process.

Drug distribution Process in 250 bedded general hospital, Pabna
There are several methods that are used for the distribution of drugs and other medical devices
from the store room and pharmacy department of hospital to the necessary in-patient wards,
out-patient and specific areas. (24) The methods are:
Floor stock method
 Drug use for patient from the nurse’s stock.
 15 days indent is made to store.
 In stock out, emergency indent is made.
 Medicines for each patient packed separately as per prescription.
 Dispensed in one packet.  Chances of pilferage less.
 Suits computerization.
Patient specific drug order
 A drug not available in the stock.
 Prescription written in sent for emergency indent in patient name.
 Drug received given to the specific patient. (25)
2.5.6.3 Necessity of proper storage of drugs in store room and pharmacy department in the
hospital
Drugs are stored in a specially designed secure area or space of a building in order to:
Avoid contamination or deterioration
Avoid disfiguration of levels
Maintain integrity of packaging and so guarantee quality and potency of drugs during shell life
Prevent or reduce pilferage, theft or losses
Prevent infestation of pets and vermin
2.5.7 Limitations of Pharmacy department in 250 Bedded General Hospital, Pabna
Pharmacy Department of 250 Bedded General Hospital, Pabna has several limitations. They
are:
i. There were no graduate pharmacists are appointed in here and so proper counseling of
patient.
ii. It dispensed medication or drugs only to Out Patient Department (OPD). iii. Proper
drug storage condition was not maintained iv. They didn’t maintain collaboration with
the physicians or nurses.
v. IPD got their drugs without considering the proper labeling, quality of drugs.

2.5.8 Recommendations for Pharmacy department and Store room
The drawbacks of the Pharmacy Department of 250 Bedded General Hospital, Pabna can be
overcome through taking the following steps:
o Inclusion of graduate ―A‖ grade pharmacist is the prime step that should be taken.
o There should be a standard guideline for distributing or dispensing drugs. o Pharmacists must
maintain collaboration with the physicians, nurses or other health care providers.
o Proper drug storage condition should be maintained in both pharmacy department and store
room.
o Dispensing and distribution of drugs or medicines and other medical necessaries should be
done to both Out Patient Department (OPD) and In Patient Department (IPD) from pharmacy
department. o Drugs, packaging materials and cylinders of anesthetic and oxygen (only for
OT) should be properly labeled.
o Record keeping procedure of the distribution and dispensing of drugs should be properly
maintained.
Proper counseling of patient must be done here about the dosage frequency of the prescribed
drugs, adverse drug reaction, drug-drug or drug-food interaction, storage precautions,
management of side effects etc.

Chapter 03: Prescription Analysis

MEDICINE WARD (FEMALE)
PATIENT PROFILE 01
 Name: Shanta
 Age: 20 years
 Sex: female
 Address: Gopalpur
C/C
 SOB
 Chest Pain
O/E
 BP: 100/80 mmHg
 Pulse: 70 beat/min.
 Anemia: absent
Diagnosis
 CBC
 USG of W/A
 Urine R/E
Management
21.05.2022
 Diet: Normal
 Inf N/S 1L, Iv stat 25 d/min
 Tab Deleta (1+1+0)
 Tab Propanolol 10 (1+1+1)
 Cap. Dexilend (1+1+0)
 Tab Rivo 0.5 (0+0+1)
P/A
 Tab. Cefixim 400 (1+0+1)
P/A 31.05.22
Inj Algin 1 amp I/M stat
P/A 01.06.22
 Tab Algin (1+1+1)

PRESCRIPTION ANALYSIS
On examination, it was found that the patient had normal blood pressure as well as normal
pulse rate and absence of anemia.
Diagnosis of CBC and USG of W/A, Urine R/E was advised.
To manage these conditions physician took following measures:
No change on diet was accepted by the physician. Normal saline was administered
immediately to replace lost fluid and to prevent shock. Deleta (flupenthixol+melitacen) was
prescribed to treat anxiety which may arise due to SOB. Propranolol which is a beta blocker
was prescribed to prevent angina pectoris or tremor. Dexilend (dexlansoprazole) which is a
PPI was prescribed to block excess acid secretion. Rivo (clonazepam) was prescribed to
prevent any kind of seizure disorder. Cefixim (cefixime) was prescribed to treat possible
respiratory infection which may be causing SOB. Algin (tiemonium methylsulphate) is an
anticholinergic was prescribed to prevent any kind of muscle spasm.
No drug-drug or drug-food interactions were found.
Polypharmacy check: No incidence of polypharmacy was found within the prescription.
Prescription Errors: No incidence of administration, transcription and dispensing error.
Comment: As the patient was prescribed cefixime there might be a chance of allergic
conditions happening or improper bowel movement. So, this had to be considered by the
physician. Deleta is problematic for people undergoing therapy with MAOIs. Algin is
problematic to patients with glaucoma.

Attachment of Prescription No. 01

PATIENT PROFILE 02
 Name: Rashida
 Age: 45 years
 Sex: female
 Address: Shalgaria, Pabna.
C/C
 Abdominal pain.
 Constipation.
 Vertigo.
O/E
 BP: 100/60 mmHg.
Diagnosis:
 S. creatinine.
 RBS.
 CT Scan of brain.
 Abdomen X ray.
 Urine for ketone bodies.
Management
30.05.2022
 Diet: NPO TFO
 Inf N/S 1L, Iv stat 20 d/min
 Inj. Nalbun-20mg/2 mL 1 amp
I/M stat
 Inj. Emistat 8 1 amp I/V stat
 Inj. Omeprazole 40 I/V stat
 Supp. Glysup 2.3 gm 5 sticks P/R
stat
P/A 31.05.22
 Maxsulin R 100 S/C 30 min B/M

On examination, it was found that the patient had low blood pressure.
Diagnosis of RBS, CT scan of brain, Abdomen X-ray, Urine test for ketone bodies was
advised. To manage these conditions physician took following measures:
Nothing by mouth was advised till further order. Normal saline was administered immediately
to replace lost fluid and to prevent shock. Nalbun (nalbuphine HCL) is a opioid analgesic
which was administered immediately to treat abdominal pain. Emistat is a 5-HT3 receptor
antagonist was injected immediately to prevent nausea-vomiting. Omeprazole 40 was
administered immediately to block excess gastric acid secretion. Glysupp is a osmotic
purgative which was injected to treat constipation. Maxsulin R which is a medium acting
insulin was prescribed to lower blood glucose level.
Polypharmacy check: No incidence of polypharmacy was found.
Comment: As the patient was prescribed Nalbun, there might be a chance of hypersensitivity
reaction happening. Nalbun is also associated with side effects like hypotension as the patient
had low bp it might cause problem for the patient. So, this had to be considered by the
physician. Glysup is not usually recommended for diabetic patient. Ondansetron has a good
chance of causing headache. (26)

PATIENT PROFILE 03
 Name: Irin

 Age:26 years
 Sex: female
 Address: Gopalpur, Pabna
C/C
 SOB
 Cough
O/E
 BP: 150/90 mmHg
 Spo2: 94%
 Heart Rate: 86/min
Diagnostics
 CBC
 Echo 2D
 S. creatinine
 D-dimer
On Examination, it was found that the patient had high blood pressure but heart rate, Spo2
was normal
Diagnosis advised by the physician was CBC, Echo 2D, S. Creatinine, D-dimer.
Management:
30.05.22
 Diet: Normal
 O2 Inhalation stat 4-6 hourly
 Nebulization windel plus 6 hourly
 Inj. Lasix 2 amp iv stat
 Inj. Merotrax 500 mg 1 amp IV stat
& TDS
 Tab. Bizoran 5 mg+40 mg
 Tab. A-B1 (1+0+1)
 Tab. Monas 10 mg (0+0+1)
 Tab Esoprex 20 mg (0+0+1) P/A
28.05.22
 Tab. Tignior 10
 Tab. Carvista 6.25 mg
 Tab. Ramoril 2.5 mg

To manage the patient physician took following measure
The patient was admitted with SOB and severe cough. The doctor advised to continue normal
diet along with O2 inhalation. Dexilend (Dexlansopraqzole) which is a proton pump inhibitor
was prescribed to control the gastric acid secretion which might lead to esophagitis or GERD
if not controlled. Deleta(flupenthixol) which is an anxiolytic with Rivo (clonazepam) were
administered to treat seizure, anxiety and depression as the patient had SOB which might make
the patient anxious. To prevent any possibilities of myocardial infarction propranolol
(propranolol hydrochloride) was prescribed. Nasogastric tube was advised to use for carrying
food & medicine to the stomach. Cefixime which is a 3rd
generation cephalosporin was
prescribed to treat any kind of bacterial infection which might be the cause of chest pain. Algin
is a anticholinergic which was used to treat endocarditis or to prevent any kind of spasm.
No drug-drug or drug-food interactions were found in this prescription.
Comment: Caution should be taken before initiating furosemide for patients with hypovolemia
or dehydration, patients with an impaired renal function. Prolonged use of benzodiazepines
may result in dependence with withdrawal symptoms on cessation of use. Montelukast may
cause serious or life-threatening mental health changes. (26)

MEDICINE WARD (MALE)
PATIENT PROFILE 04

 Name: Nirob
 Age: 11 years
 Sex: Male
 Address: Ataykula, Pabna
 Bed no: 06
 Admission date: 29.05.2022
C/C
 Fever for 7 days
 Cough for 7 days
O/E:
 BP 110/80 mmHg
Management:
29.05.22
 Diet: Normal
 Tab. Monocast 10 mg (0+0+1)
 Tab. Renova 500 mg (1+1+1)
 Inj. Tyclav 1:2 1/2 vial
 Stat & 8 hourly
Tab.Clarin 500 mg (1+0+1)

On examination, the blood pressure of the patient was found normal. The patient was
admitted to hospital with fever and cough for 7 days.
To manage the patient physician took following measures:
Monocast(montelukast) which is a leukotriene receptor antagonist was used to treat seasonal
allergic rhinitis. Tyclav (amoxicillin+clavulanic acid) which is indicated as a broad-spectrum
penicillin & Clarin (clarithromycin) which falls under macrolides category was used
immediately to prevent/treat acute exacerbation of chronic bronchitis or mycobacterial
infection. As the patient was presented with fever so Renova (Paracetamol) which is a
antipyretic agent was used for the symptomatic management of fever.
Comment: Before initiating therapy with amoxicillin/clavulanic acid, careful enquiry should
be made concerning previous hypersensitivity reactions to penicillins, cephalosporins or other
betalactam agents. Serious and occasionally fatal hypersensitivity reactions (including
anaphylactoid and severe cutaneous adverse reactions) have been reported. These reactions
are more likely to occur in individuals with a history of penicillin hypersensitivity. If an
allergic reaction occurs, (amoxicillin+clavulanic acid) therapy must be discontinued and
appropriate alternative therapy should be instituted. (26)

PATIENT PROFILE 05

 Name: Abdul Kuddus
 Age: 65 years
 Sex: Male
 Address: Kamarbari, Pabna
 Date of Admission: 30.05.2022
C/C:
 Vomiting for several times
 Vertigo
 Weakness
O/E o BP: 90/50 mmHg.
Diagnosis:
 CBC
 S. Creatinine
 RBS
 PBF
Management:
25.12.20
o Diet: NPO, TFO o Inj. N/S (1L)
+5% o DNS (1L) I/V stat 20d/min
o Inj. Paloxi 0.075 amp 1
I/V stat & BD o Inj.
Omeprazole 40 1
vial I/V stat & BD
1.05.22
o BT 3 unit

On examination, it was found that the patient was hypotensive, which might potentially lead
to shock and ultimately coma.
CBC, S.creatinie, RBS, PBF test were advised by the physician for diagnosis as the patient was
very weak.
The patient was admitted with vertigo and weakness and NPO (nothing by mouth) was advised
by physician till further order. To manage the dehydration and save the patient from shock,
normal saline was administered as an intravenous infusion immediately at 20 drop/min rate two
times a day. Inj. Paloxi which is an antiemetic agent was given immediately by iv route to
control vomiting and it was prescribed two times a day. Omeprazole was injected immediately
to control the acid related dyspepsia or peptic ulcer events.
Comment: Paloxi is contraindicated in patients having Hypersensitivity to the active
substance. As palonosetron may increase large bowel transit time, patients with a history of
constipation or signs of subacute intestinal obstruction should be monitored following administration.

PATIENT PROFILE 06
 Name: Mohiuddin

 Age: 20 years
 Sex: Male
 Address: Bagha, Rajshahi
 Date of admission: 20.05.2022
C/C
 Poisoning (Bhang)  Restlessness.
Advice  Referred to mental hospital.
Prescription Analysis
The chief compliant of the patient was restlessness and it was said that he was poisoned with
Bhang.
Management:
30.05.22
 Diet: Normal
 Tab Risdon 2
 Tab Deprex
 Tab Cyclid 5
 Tab. Esocon 20 
Inf N/S 1L IV stat
15d/min.
 Tab Rivo 0.5

The patient was also referred to the mental hospital so he had some mental problem.
Normal Diet was no problem for the patient. Normal saline was infused due to poisoning as it
may cause fluid abnormality. Rivo(clonazepam) was prescribed to calm the patient and to
prevent epilepsy episodes. Risdon 2 was prescribed to manage psychotic disorders like acute
or chronic psychosis, mania, schizophrenia. Depres (flupenthixol) which is a anxiolytic was
prescribed to treat depression, anxiety, dysphoria. Cyclid (procyclidine HCL) was prescribed
to parkinsonism or drug induced extrapyramidal syndrome Procyclidine belongs to a class of
medication called anticholinergics that work by blocking a certain natural substance
(acetylcholine). Esocon (esomeprazole) was prescribed to treat any kind of heartburn which
may arises due to other medications administered.
Comment: Risdon may enhance the hypotensive effects of certain antihypertensive.
Neuroleptic malignant syndrome occurs rarely. Cyclid can sometimes cause addiction, so it
should be considered. (26)

SURGERY & ORTHOPEDICS WARD
PATIENT PROFILE 07
o Name: Asad
o Age: 45 years o Sex: Male o Address:
Ataykula, Pabna o Admission date:
23.05.2022
 C/C
Cell injury to mouth
 Hx
 RTA
 Diagnosis
 CT scan of head
 CBC
Management
22.05.2022
 Diet-NPO TFO
 Inj. Flucloxacillin 500 mg-1vial I/V
stat & 6 hourly.
 Inj. Ketorolac 30 mg- 1 amp I/M stat
& TDS
 Inj. Esomeprazole 40 mg- 1vial
I/V stat & BD
 Inj. Ceftriaxone 1g- 1vial I/V stat
& BD
 Inj Emistat 8mg 1amp iv stat &
BD
 Tab. p/c 500mg (1+1+1) * Inj. N/S
(1L) +5% DNS
(1L) I/V stat 20d/min

CBC and CT scan of Head was advised for diagnosis by the physician as the patient
The patient had a history of RTA.
The patient was presented with cell injury to mouth for which NPO was advised because he
had to undergo surgery afterwards. 5% DNS were injected as an intravenous infusion of a
carbohydrate source. It was injected immediately and two times a day. To relieve pain
Ketorolac inj which is a analgesic & P/C (Paracetamol+Caffeine) were injected. He was also
given Flucloxacillin & Ceftriaxone to treat any kind of possible infection on the injury site or
surgical prophylaxis. Emistat was injected to symptomatic relief of nausea & vomiting as well
as prevention of post-operative nausea, vomiting. Esomeprazole was prescribed to control the
gastric pH fluctuation which may arise due to antibiotic administration or surgery induced
nausea, vomiting.
No drug-drug interactions have been found in this prescription.
Comment: Flucloxacillin, Ceftriaxone should be given with caution to patients with a history
of allergy, especially to drugs. Before initiating therapy with flucloxacillin, ceftriaxone careful
enquiry should be made concerning previous hypersensitivity reactions to β-lactams. Ketorolac
is contraindicated in patients with previously demonstrated hypersensitivity to ketorolac. This
induce allergic reactions (severe anaphylactic-like reactions have been observed in such
patients). Such reactions have included asthma, rhinitis, angioedema or urticaria. (26)

PATIENT PROFILE 08
 Name: Anowar
 Age: 23 years
 Sex: Male
 Address: Arifpur, Pabna
 Admission date: 22.05.2022
C/C:
 Cut / Cell injury (Accidental)over left
wrist.
Management
22.05.2022
 Diet-Normal
 Inj. Flucloxacillin 500 mg-1vial I/V
stat & 6 hourly.
 Inj. Toradolin 30 mg- 1 amp I/M stat
& TDS
 Inj. Esomeprazole 40 mg- 1vial I/V
stat & BD
 Inj. Ceftriaxone 1g- 1vial I/V stat &
BD
 Inj. Vaxitet 1 amp

The patient was presented in the hospital with cell injury over left wrist by accident.
To manage the patient, physician took following measures:
Normal diet was advised and to relieve pain. Toradolin (ketorolac tromethamine) which is a
potent non-opioid analgesic was injected IM immediately. Flucloxacillin & Ceftriaxone which
is a penicillinase resistant penicillin was injected immediately for surgical prophylaxis and to
prevent any kind of bacterial infection on the wound. Vaxitet IG which is a toxoid vaccine was
injected to provide temporary passive immunity in the prevention and treatment of tetanus.
Esomeprazole was prescribed to prevent NSAID related ulceration or ulceration which may
arise due to antibiotic administration.
Comment: Most common side effects of flucloxacillin is nausea and diarrhea and it should be
taken on an empty stomach. Ceftriaxone should be Continued for the full time prescribed, even
if symptoms disappear after a few days. Stopping the medication too early may result in a return
of the infection. Toradolin can cause hypersensitive reactions, so physician should monitor the
patients for any kind of allergic reactions. (26)

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