The document summarizes the pharmacy services at Tikur Anbessa Specialized Hospital (TASH) in Ethiopia. It describes the various inpatient and outpatient pharmacies including the main OPD pharmacy, endocrine pharmacy, ART pharmacy, drug information center, A5 pharmacy, oncology pharmacies, and gynecology pharmacy. It provides details on the services offered, most commonly dispensed medications, limitations, and lessons learned during the pharmacy attachment. Recommendations are provided to improve pharmacy services like increasing pharmacist staffing and ensuring adequate medication availability.

1. Hospital Pharmacy Attachment
By:
SHIKUR YASIN
SENEHIWOT ABEL
YONAS ARAGEW
04/07/2022 1

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
04/07/2022 2

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
04/07/2022 13

14. Cont….
 ART codes
 1J(TDF +3TC +DTG)
4c(AZT +3TC + NVP)
4d(AZT +3TC +EFV)
4e(TDF + 3TC +EFV)
4f(AZT +3TC +LPV/r)
etc…
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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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16. Cont….
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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
04/07/2022 21

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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23. Inpatient….
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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
04/07/2022 25

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.
04/07/2022 27

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
04/07/2022 28

29. Inpatient…..oncology
 Different anti-pain like morphine, tramadol, diclofenac
and Anti-emetics like ondansetron and metoclopramide
 Drugs like bisacodylis also there for constipation
04/07/2022 29

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
04/07/2022 32

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.
04/07/2022 33

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.
04/07/2022 34

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.
04/07/2022 35

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
04/07/2022 36

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.
04/07/2022 37

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.
04/07/2022 38

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.
04/07/2022 39

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.
04/07/2022 40

41. Reference
1 , (http://www.pharmatips.in/Articles/Hospital-
Pharmacy/Define-Hospital-Pharmacy-Classifications-Of-
Pharmacy.aspx).
2, (https://statements.eahp.eu/about/what-hospital-
pharmacy.)
3, Drug-Information hand- Book-Lexicomp`s pdf
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