Community internship


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Community internship

  1. 1. A Report On Community Pharmacy Internship at Medicament Pharmacy Submitted To Department of Pharmacy CiST college,New Baneshor Submitted By Iswor bdr.Gurung Ranjit Pandey +977-9849464685 CiST College, New Baneshor,ktm september, 2013
  2. 2. 1 CERTIFICATION This is to certify that Mr. Ranjit Pandey and Mr. Ishwor Bahadur Gurung have successfully completed the one week Community Pharmacy Internship at Medicament Pharmacy from Sep 2, 2013 to Sep 9, 2013. During their internship, they have been found to be actively participating in all the activities. Narad Parkas GR …………………….. …… Proprietor Medicament Pharmacy
  3. 3. 2 ACKNOWLEDGEMENT It is our great honor to complete community internship at Medicament Pharmacy, Kathmandu. We are very grateful towards Medicament Pharmacy for allowing us to complete our internship successfully. We would like to thanks our gratefulness to Phr Mr.Baburam Humagain for great support and guidance before going to community. We would like to express our heartfelt thanks to the owner of Medicament Pharmacy Mr Narad Parkas GR for such a kind co- operation and sheer encouragement throughout the training. Finally, we are really thankful to Mrs.Monika GR and the entire staffs of Medicament Pharmacy for the great support and co-operation throughout the training.
  4. 4. 3 ABSTRACT It is our great pleasure to be a trainee at Medicament Pharmacy. During our training, we have gained practical knowledge on drug procurement, arrangement, storage, dispensing and proper counseling techniques. Moreover, we learnt about the purchase policy, documentation, checking of expired medicines and storage of thermo labile drugs in refrigerator. In addition, we have learnt about various surgical items and their uses. On the top of all, this training helped a lot to make us feel the dire need of a pharmacist in community pharmacy. Thus, this training has indeed been very fruitful for us to achieve our goal to be a competent pharmacist and to uplift our profession. Background:
  5. 5. 4 Introduction Pharmacy is the health profession that links the health sciences with the chemical sciences and it is charged with ensuring the safe and effective use of pharmaceutical drugs. The scope of pharmacy practice includes more traditional roles such as compounding and dispensing medications, and it also includes more modern services related to health care, including clinical services, reviewing medications for safety and efficacy, and providing drug information. Pharmacists, therefore, are the experts on drug therapy and are the primary health professionals who optimize medication use to provide patients with positive health outcomes. A Community pharmacy is the place where most pharmacists practice the profession of pharmacy. It is the community pharmacy where the dichotomy of the profession exists—health professionals who are also retailers. Community pharmacies usually consist of a retail storefront with a dispensary where medications are stored and dispensed. The dispensary is subject to pharmacy legislation; with requirements for storage conditions, compulsory texts, equipment, etc., specified in legislation. Goals and objectives  To develop a concern for the patient's health and welfare and an appreciation for the impact of the community pharmacist in the health care system.  To foster the development of a responsible, professional attitude.  To develop professional judgment.  To develop proficiency in educating patients on health and medication-related matters.  To learn the value, importance and application of patient profiles.  To process prescriptions and acquire knowledge in the specialty of community pharmacy management.  To apply information gained in the didactic education component of the curriculum into clinical practice.  To provide a variety of exposures to pharmacy operation and to different practitioner philosophies and problem solving skills. Functions The functions of community pharmacy practice are:
  6. 6. 5 Patient Interaction: It includes securing correct information from patients concerning an accurate and complete drug history, advising the patient as to proper use and storage of prescription drugs and assisting in proper selection of over-the-counter medications. Moreover, current public-health information, e.g., information related to cancer, diabetes, heart, sexually transmitted diseases, etc. can be obtained. Also, the patient can be monitored through outcomes assessment. Dispensing of Prescriptions: It includes receiving, verification, checking for errors, drug selection, filling, recording, filing and delivery of prescription to the patient. Besides, contacting physicians, interpreting telephone and written orders, handling of patient records and understanding laws related to drug type, pricing strategies and completing all third party medical reimbursement are a part of it. Pharmacy Administration: Inventory control, ordering and returning merchandise, receiving and pricing drug products, stock arrangement and storage, management policies, bookkeeping, payroll, bills, employee policies, complaints, correspondence, pharmacy layout, traffic patterns, etc. are included in the pharmacy administration. Drug and Product Information: It includes identifying/evaluating information about both prescription and non-prescription drugs so that one can obtain the knowledge of general drug information, generic and trade names, common dosage forms, indications, side effects, interactions and patient counseling for the top 200 drugs dispensed.. Compounding: This includes bulk compounding, when appropriate. Non-Prescription Information: It includes age-specific over the counter medications, hospital and surgical supplies, diabetic para pharmaceuticals, cosmetics and other health-related items. Medicament Pharmacy (Community Pharmacy) We were posted for two weeks in Medicament Pharmacy for community internship. We visited there on daily basis for 8 days excluding Saturday from 11:00 a.m. to 5:00 p.m. looking after
  7. 7. 6 the activities inside the pharmacy and applying our theoretical knowledge which were in general practice. Medicament Pharmacy is situated in Budhanagar, Kathmandu which has been owned by Mr. Mr Narad Parkas GR .The working hour of this pharma is from 7:00 am to 9:00 pm. The doctors visiting this pharmacy are from different departments which are listed below: Dr names Arrangement of drugs There are four racks for the arrangement of drugs. Tablets and capsules are arranged in the racks according to their therapeutic categories. Drugs are classified as antacids, NSAIDS, antibiotics, antihypertensive, antidiabetic, etc. The liquid dosage forms like solution and syrups are kept in separate racks and topical dosage forms are arranged according to therapeutic category in separate rack. Various ophthalmic and otic preparations are also arranged separately. Thermo labile drugs like insulin are kept in the refrigerator. Similarly, inhalers, nasal sprays are kept separately and ayurvedic preparations are also kept separately. Various surgical items like syringe, needles, gloves, bandages, etc and orthopedic items like crutches, abdominal binder, ankle binder, etc are arranged in separate rack. Drugs available in the pharmacy There are approximately 500 to 700 brand drugs and 200 generic drugs. They are arranged in the racks according to their therapeutic categories. The drugs are categorized into over the counter (OTC) drugs and prescription drugs. The OTC drugs are: OTC Drugs Tab. Paracetamol 500mg Vitamin B complex caps Tablet digene Strepsils lozenges Oral rehydration solution Diclofenac gel Betadiene mouth wash Vitamin C tablet Vitamin E tablet Nitra gel toothpaste Glucose powder 100 mg/ 400 mg Moisturizer cream Common drugs being prescribed in the pharmacy  GI Drugs
  8. 8. Domperidone Esmoperazole Famotidine Metoclopramide Omeprazole Pantoprazole Ranitidine  Cardiovascular Drugs Amiloride Amlodipine Enalapril Frusemide Losartan Warfarin  Analgesics and Antipyretics Nimesulide Paracetamol Flunarizine Diclofenac Ibuprofen Naproxen Seropeptidase  Antidiabetics Glibenclamide Gliclazide Glimepiride Metformin, Glipizide. .  Antibacterials Azithromycin Amoxycillin Cefpodoxime Cephalexin Ciprofloxacin Doxycycline Metronidazole Minocycline Ofloxacin Penicillamine  Dermatological drugs Adapalene Beclomethasone Butenafine Clobetasone Fluconazole Hydroquinone Itraconazole Ketoconazole Salicylic acid Tretinoin  Nutritional Supplements Iron Calcium Protein Methylcobalamin Vitamin E Vitamin A  Antiallergic Cetrizine Ebastine
  9. 9. 1 Fexofenadine Levocetrizine Loratidine Promethazine  Eye/ear Drops Atropine Sulphate Chloramphenicol Cyclopentolate Cyclosporine Naphazoline Ofloxacin Polymixin Sodium Cromoglycate Timolol Tobramycin  Antihelminthic Drugs Albendazole Mebendazole Tinidazole Staffing in pharmacy The minimum number of staffs in this pharmacy is 7 in the morning and evening while there is only 2-3 in the day time when there is minimum flow of patients. Cash bills are prepared by the proprietor himself manually. Picking of the drugs are done according to the prescription and dispensing is done by all staffs available there with proper counseling. Those patients requiring special counseling like dry powder inhaler, nasal spray, pessaries, etc are given special directions and precautions for the assurance of drug compliance. Workflow in pharmacy Collecting of Prescription  Picking of Drugs  Dispensing of Drugs  Making of Bill Manually  Payment of Bill Fig: Workflow in Pharmacy Dispensing of drugs Drugs are dispensed to the patients according to the prescription. In case of high price, patients are allowed to get the medicines for certain period and for left out dose, they come to the pharmacy next time. As patients do not accept the brand substitution, only drugs prescribed by the physician are kept in the pharmacy.
  10. 10. 11 Refund of bills There is a provision of refunding as per the interest of the patients. For this, the patient has to bring the bill along with them and after calculating the amount to be refunded, cash payment is done. Inventory management Stocks of medicines are reordered from the supplier on daily basis. The suppliers come to the pharmacy and take the list of drug lacking in the pharmacy and supply the drug immediately if available. Inventory list helps to check the stock of medicine as well as the price of the medicine. In case of emergency, the proprietor call to the supplier for the inventory and the supplier supply those medicines immediately by sending his staff with the drug and bill. Shortage of drug in pharmacy is maintained by calling to the different suppliers. If the medicine is not available in the supplier then the patient is sent to another pharmacy or the patient is told to come on the next day. The frequency of visit of Marketing Representative to the pharmacy is less. They visit to the pharmacy rarely. Selection criteria of drugs in pharmacy There were no any standard techniques for the selection of drug in this pharmacy. The inventory of the drug was done the basis of drug generally being prescribed by the doctors visiting the pharmacy. List of suppliers: Daily sales record Number of sales bills and refunded bills are added daily. Then the total cash is obtained by subtracting refunded bills from sales bills. Poor patient fund service There is no provision of poor patient fund service to those who are unable to pay their medical expenses. The sample drugs available to the pharmacy are given to such patients. Other drugs are to be purchased by the patient himself/herself. Handling of expired and damaged drugs Drugs are sent back to the supplier after expiry date for Nepalese manufacturing company, but in case of international company the drug are not returned, they are just thrown. The problem related to expiry is rare due to limited stock in the pharmacy. So, there is less chance of expired drugs being dispensed. During our internship, we found some of the expired syringes which are sent back to the supplier for disposal. The pharmacy itself does not have any provision for disposal of expiry drugs.
  11. 11. 12 Suggestions  To arrange the drugs scientifically, it should be arranged in therapeutic order with proper storage condition.  To keep a pharmacist in the pharmacy for dispensing and counseling patients.  To make different cupboards for handling of narcotics and controlled drugs. Conclusion During our two weeks internship period in Medicament Pharmacy, we came to know that the role of pharmacist is very crucial in a community pharmacy. Still there is a room for the development of a role of pharmacist in clinical aspect as well. It may take time to establish our role in community setting but nothing is impossible for a willing heart. Throughout our training period, we were able to acquire knowledge on the system of drug procurement in community pharmacy, dispensing of drugs and counseling techniques of medical appliances. To be a trainee in Medicament Pharmacy was indeed an honor for us. Lastly, we wish Medicament Pharmacy good luck for their improvement in better patient care and achieve their goal very soon.