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