Hospital & Community Pharmacy

1. Pharmacy Practice
By Dr. ABDRHMAN GAMIL
Associate Professor of Pharmaceutics
Al-Neelain University - Khartoum

2. Contents
 Hospital pharmacy
 Community pharmacy
 Essential list of drugs
 Good manufacturing practice
 Good storage practices
 Over the counter

3. Institutional Pharmacy
Hospital Pharmacy

4. Definition
 Practice of pharmacy in a hospital setting including it organizational related facilities
or services.
 It is that department or division of the hospital wherein the procurement, storage,
compounding, manufacturing, packaging, controlling, assaying, dispensing,
distribution and monitoring of medicines through the drug therapy management for
hospitalized and ambulatory patients are performed by a legally qualified,
professionally competent pharmacist.
 It includes responsibility for the safe and appropriate use of drugs.
Rational selection, monitoring, dosing and overall control of the
therapy program

5. Uniqueness of
hospital pharmacy

6. Functions of hospital pharmacy
To provide and evaluate service in support of medical care
pursuant to the objectives and policies of the hospital.
To implement for departmental services the philosophy,
objectives, policies and standards of the hospital.
To provide and implement a plan with clear responsibilities
and duties of the personnel.
To participate in all functions of all other departments and
services of the hospital.

7. Functions of hospital pharmacy
To estimate the requirements for the department and to recommend
and implement policies and procedures to maintain adequate
competent staff.
To provide methods by which personnel can work with other groups
to interpreting the objectives of the hospital to the patient and
community.
To develop and maintain an effective system for clinical and
administrative records and reports.
To estimate needs for facilities, supplies and equipment and to
implement a system for evaluation, control and maintenance.

8. Functions of hospital pharmacy
Research activities.
Continuous education for the staff.
Educational program for the students.
To adhere to the safety program of the hospital.
Comprehensive pharmaceutical service of high quality coordinated to
meet the needs of diagnostic and therapeutic department as well as
nursing service to provide better patient care.

9. Routine contacts of hospital pharmacist
 Physician specialists ( PTC), clinical round, all matters related to drug therapy)
 Nursing professionals.
 Microbiologists.
 Biochemists.
 Physicists and radiologist
 Clinical pharmacologist
 Medical sociologist
 Medical dietetics
 Engineering
 Administrative staff

10. Group practice
 There is a need for a number of hospital pharmacists of variety of clinical
pharmacy specialists to assist in the rational selection and use of drug
therapy.
 This will strengthen the professional role of the hospital pharmacist and
give them entry to the group of professionals who make up the health care
team.

11. Organizational Structure
 The head department reports to the hospital administrator.
 Formulates and implements administrative and professional polices of the
pharmacy subject to the approval of the administrator.
 Professional and clinical policies which have direct relationship to the
medical staff, are formulated and developed through the pharmacy and
therapeutics committee and are subject to administrative approval.
Comprehensive job description and responsibilities in
pharmacy activities and in clinical functions

12. Hospital Administrator
Department of Pharmacy Director
Executive and administrative operations
Professional and clinical services Research and support servicesEducational and technical services
Nuclear pharmacy division
Unit dose dispensing division
Ambulatory &home care
I.V admixture division
Sterile products division
Drug administration division
Clinical pharmacy division
Research division
Assay & QC division
Kinetic & bioavailability lab
Manufacturing & packaging
Purchasing&inventory control
Dept services division
Investigation division
Drug information division
Education& training division
Professional development
Residency training program
Computerized operations

13.  Determine the level and scope of pharmacy
services.
Planning and monitoring the budget.
Developing the policy and procedures manual.
Pharmacist Responsibilities – DirectorGENERAL

14. Pharmacist Responsibilities – Central Pharmacist
1. Ensures that established policies and procedures are followed.
2. Check for accuracy of doses prepared, IV or unit dose.
3. Proper drug control, investigational drugs, laws are followed.
4. Good techniques are used in compounding
5. Proper record keeping and billing
 Patient medication records.
 Extemporaneous compounding records.
 IV admixture records.
 Investigational drug records.
 Monthly workload reports.
6. Maintain professional competence; drug stability & incompatibilities and drug information.
7. Ensures that personnel are well trained on policies and procedures.
8. Coordinate and evaluate the personnel activities.
9. Keep the dispensing area neat, clean and orderly organized.
10. Coordinate with the patient-care area.
DispensingArea

15. 1. Supervision of drug administration:
 Review and interprets each unit-dose and IV admixture medication order to ensure that it is entered
accurately into the system.
 Review each patient´s drug administration form ( missed doses, review drug charges)
 Confirm that administered doses are noted correctly in patient chart.( sign)
 Ensures that records for controlled drugs are correctly kept.
 Ensures that proper drug administration techniques are used.
 Acts as liaison between the pharmacist and nursing and medical staff.
 Communicate with nurses and physicians concerning medication problems.
 Periodically inspects the medication area on the nursing units to ensure that adequate levels of floor
stock are maintained.
 Ensures that drugs are procured from the dispensing area as required.
 Coordinate all pharmacy services on the nursing units level.
 Ensures that the area is neat, orderly and appropriate security levels are maintained.
Pharmacist Responsibilities – Central PharmacistPatient-careArea

16. 2. Direct Patient care:
 Identify drugs brought by the patient.
 Obtain patient medication histories.
 Assist in drug-product selection
 Assist physician in selecting dosage regimens and schedules, then assigns administration times.
 Monitors patient total therapy ( effectiveness, side effects, toxicity, allergic reactions, drug
interaction, therapeutic outcome)
 Patient counseling.
 Participate in cardiopulmonary emergencies.
3. General responsibilities:
 Education to personnel staff, students, medical and nursing students.
 Provides drug information to the health care personnel.
Pharmacist Responsibilities – Central PharmacistPatient-careArea

17. Pharmacist Responsibilities – Ambulatory PharmacistDispensingArea
1. Ensures that established policies and procedures are followed.
2. Checks for the accuracy of supportive personnel.
3. Ensures that proper techniques are used in compounding.
4. Adequate record keeping ( patient medication records,
investigational drug records, outpatient billing, reports and
prescription files)
5. Maintain professional COMPETENCE.
6. Training for the new personnel.
7. Coordinate the activities of the area.
8. Keep the area neat, clean and orderly organized.

18. Pharmacist Responsibilities – Ambulatory PharmacistPatientcareArea
1. Inspect the medication area at the nursing unit to ensure an adequate supply of
stock and proper storage.
2. Identifies drugs brought by the patient into the clinic.
3. Obtain patient medication records and provided to the physician.
4. Assist in drug-product and entity selection.
5. Assist the physician in dosage regimen and schedules.
6. Monitors patient total therapy ( effectiveness, side effects, toxicity, allergic
reactions, drug interaction, therapeutic outcome)
7. Patient counseling
8. Prepare medications for intravenous administration.
9. Provides medications for patient home care.

19. Pharmacist Responsibilities – Ambulatory PharmacistGeneral
Responsibilities1. Provide drug information to staff , nursing and medical staff.
2. Coordinate activities and needs within the area,
3. Provide adequate control and proper handling following the laws.
4. Maintain professional competence.
5. Participate in cardiopulmonary emergencies.
6. Provides education on service to staff, nursing and medical students.

20. Pharmacy staff
 Director of the pharmacy.
 7 – 12 pharmacists to each 300 beds hospital.
 5- 15 technicians, helpers, clerical staff.
 Full-time secretary.
Administrative aids:
 Functional organization charts.
 Operation manual
 Job description.
 Policy and procedures manual

21. Facilities
 The space varies according to the hospital size.
Example; hospital of 200 beds requires:
 Office for chief pharmacist.
 Separate area for inpatient and unit-dose dispensing.
 Outpatient services.
 Compounding area.
 Sterile admixture area.
 Store room.
 Departmental computer.
 Space for drug information service.
 Controlled medicines.
 Clinical pharmacy services.

22. Pharmacy & Therapeutics Committee
The American society of health system pharmacists
state that “ the multiplicity of drugs available and the
complexities surrounding their safe and effective use
make it necessary for hospital to have organized,
sound program for maximizing rational use of drug”.
The pharmacy and therapeutic committee, or
equivalent, is the organizational keystone for this
program“ Health system pharmacists”.

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 Pharmacy and Therapeutic Committee:-
 Objectives:-
 1- Developing and implementing professional policies on drug
selection, procurement, evaluation, safe use and drug
information.
 2- Assisting in the formulation of educational programs
designed to meet the needs of the staff for drug related
practices.
 The formulary and therapeutic committee is the authoritative
body who formulates the drug list circulating in that facility, and
regulates the intervention concerning drug. The P&TC should
have a regulatory power and activity.
 The committee should be launched by the first post in the
organization. His first deputy, normally, is the chairman of the
committee. The committee should be permanent and the order
should point to the members and functions and activities
regulating its work.

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 Members: -
 Chairman – usually a physician representing the headquarter.
 Secretary – pharmacist; senior or drug information centre or pharmacologist.
 Head of main clinical department.
 Hospital pharmacist.
 Authoritative physician and specialist.
 Invited specialists to participate in certain issues, also nurses when needed with
no voting privileges.
 -Decisions should be made by vote.
 -Members should not have any business relationship with pharmaceutical
distributors or manufactures.
 - Members should not be more than ten.
 - One at least should attend continuing course in clinical pharmacology.

25. Pharmacy & Therapeutic Committee
Subcommittees
 Subcommittee on Antineoplastic Agents.
 Subcommittee on Anti-infective Agents.
 Subcommittee on GIT Agents.
 Subcommittee on Cardiovascular Agents.
 Subcommittee on CNS Agents.
 Subcommittee on Endocrinology Agents.
 etc.

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 Functions of Formulary & Therapeutic Committee: -
 1- Developing criteria for evaluation of drugs to be included in the drug hospital
list, preparing and maintaining the formulary list.
 2- Developing policies and procedures for selection, procurement and use of
drugs..
 3- Criteria for additions and deletions from the formulary list.
 4- Conducting monitoring and evaluation programs for use of drugs,
management and dispensing practices.
 5- Maintain an emergency drug list, approve standard ward stock list.
 6- Standardizing prescribing practices through preparation of treatment
guidelines.
 7- Provide unbiased drug information through the development of a formulary
manual.
 8- Coordinate drug supply for special ongoing programs.
 9- Review the leveling of drugs utilization.
 10- Conduct training programs.
 11- Represent the facility to drug companies’ representatives.
 12- Describe the inpatient and outpatient drug schemes.
 13- Coordinate drug reimbursement with the health insurance program.

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 Policies to be developed: -
 Policies empower the committee to implement decisions.
 Firstly, polices developed should be approved by the chair administrator.
 To request medical staff compliance.
 To organize its work and activities.
 the criteria of formulary drug selections.
 The addition and deletion procedures.
 Meetings; on call and periodical meetings.
 The use of generic names.
 Prescribing requirement and ideal prescription.
 Substitution policy. Generically equivalent or therapeutically alternatives.
 Non-.formulary drugs, allowed or not, reimbursed or not.
 Rules governing the formulary and revising period.
 Drug use evaluation and investigational regulations.
 Drug promotion and company representative guidelines.

28. Formulary System
 Increasing number of drugs being marketed.
 High competitive marketing practices
 Increasing influence of biased advertising literature.
 Increasing complexities untoward of the newer more
potent drugs.

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 Hospital drug formulary: “ Hospital level selection”
 The key factor for the optimum therapeutic benefit of the public sector expenditure is
the rational selection of drugs.
 At the hospital level this may involve forming a hospital therapeutic and formulary
committee. The result of such selection is developing a hospital formulary list which
differs from that of the national level in being restrictive to be used within that given
hospital .The hospital formulary becomes the basis of developing a hospital formulary
manual which is a concise reference book containing the basic drug information
facilitating the rationality of prescribing, dispensing, patient and staff education to
rationalize drug use.

30. • The Formulary : A continually revised compilation of pharmaceuticals plus
ancillary information that reflects the current clinical judgement of the medical
staff.
• The formulary System: is a method whereby the medical staff of an institution
working through the P&T committee, evaluates, appraises and selects from
among the numerous available drug entities and drug products those that are
considered most useful in patient care.
 Only those selected are routinely available from the pharmacy
It is a control for drug cost and use.
It describes the procurement, prescribing, dispensing and administration of drugs
in their nonproprietary or proprietary names.

31. Principles in utilizing Formulary system
1. Appointment of pharmacy and therapeutic committee.
2. Medical staff on recommendation of P&T should be sponsored of the formulary.
3. written procedures governing polices from the P&T committee.
4. Drugs in generic names and prescribers should comply.
5. Limited number sustain the patient care and give financial benefits.
6. Polices governing purchasing, prescribing , dispensing and administration.
7. Formulary system should be available to all medical staff.
8. Quantity and quality are the pharmacist responsibility.

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Formulating the list:-
1-Classification method:
Therapeutic and pharmacological actions, anatomical, chemical classification or
alphabetical arrangement could be chosen..
2-Data collection: Concerning annual morbidity report and the statistical information
available.
3-Drug information available, e.g. essential list of drugs.
4- Drug consumption.
5- Analyze the data:
6- Arranging orderly the prevalent diseases.
7-Define the drug of choice for each disease. The dosage pattern.
8-Calculate the quantity of each drug required.

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9-Setting priorities according to ABC / VEN. ( Vital, Essential ,Non-essential)
10-Conduct drug class reviews and draft the formulary:
11-Classify the drugs obtained.
12- Implement the formulary either class by class or totally.
After finishing selection, drafting the formulary and widely disseminated, the deleted
drugs could be eliminated and the new drugs could be added.
13-Reviewing the formulary periodically and cautiously. Evaluation and monitoring of
drugs by group facilitates the improvement.
14-Endorsement by the chief of the organization.

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Methods to promote formulary adherence:-
16- Take action on non-formulary drugs available
17- Provide easy access to the formulary list.
18- Involve the medical staff in preparing the list and committee decisions.
19- Provide lists for therapeutic substitution when a prescribed drug is out of stock.
20- Design a request form for the use and addition of the drugs out of the list.
21-Prohibiting the distribution of drug samples of non-formulary drugs.
22- Filing the committee activities.
23- Shortly disseminate and develop the hospital drug manual.
24- The list should be open for additions and deletions

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Results required from the formulary: -
 The formulary should be designed to maximize the use of resources. Limited to conserve resource, as
there is no way to stock all drug in the national formulary. Therefore the number of drugs is limited.
 Formulary in generic names, rationalize the practice, concentrate on drug of choice for prevalent
diseases, assures the balance of safety, toxicity, effectiveness and cost of a chosen drug and avoids
duplication of unnecessary alternatives.
 A formulary classified in therapeutic groups allow formulary manual development to provide unbiased
information resulting in improved prescribing, dispensing and appropriate use of drugs .
 Provide good quality drugs and eliminate unsafe and ineffective drug and newly introduced drugs of
questionable efficacy drugs.
 Decrease the inpatient hospital stay .
 Leveling the list by medical occupation position, allow improved prescribing and restriction and limitation
of use of certain drugs to certain specialties and certain wards and professional level verify the patient
safety and health.
 Excluded approved products may be supplied to meet exceptional needs.
 The formulary should provide an important objective of selection in establishing a drug supply system
that satisfies the health needs of certain community and respond positively to the exceptional
circumstances.( Taylor & Harding-2001 ) .

36. Inventory management
 Generally assigned to senior pharmacy technician.
 Every hospital pharmacy should maintain sufficient inventory without shortage.
 Purchasing
 Ordering
 Receiving and storage.
 Daily monitoring
 Special handling of certain substances.

37. Purchasing
The specifications and standards for all requirements should be
established by the pharmacist and approved by the FTC.
Competitive bidding is the professional practice.
o Manufacturer .
o Whole seller
o Prime vendor
IV solutions may have special supply procedures.
 Contracts
The goal is to obtain high quality at the lowest cost.

38. ordering
 Ordering may be according to
the stock using a software
computer program.
 Using a bar-cod scanner

39. Receiving and storage
 Once the order received it should be checked against the invoice.
 Any discrepancies should be noted and solved.
 Then the inventory control technician can make the entry to the
records.
 The stock is then stored in shelves or refrigerator according to the
storage conditions stated.
Food material should not be kept aside

40. Daily monitoring
 Storage conditions. Checked and documented.
 Storage area; clean and dust-free.
 Out-of-stocks.
 Checking expiration date of the rotating inventory as FEFO.
 Checking the unit dose cart.
 Checking the nurse stock.
 Software computer program and out-of-stock reports.
 Checking and Monitoring the narcotics and control drugs.
 Checking for drug recalls.

41. Hospital Medication Order ( Prescription) and order Entry.
 Medication order is a format that differs from the
common prescription.
 Could be delivered to the pharmacy via nurse,
personal, computer system, pneumatic tube or
fax.
 All medication orders entered into the computer
by the hospital pharmacist.
Types of medication orders:
• Admitting order.
• Stat order
• Daily and continuation order.
• Standing order.
• Discharge order.

42. Admitting order
• Written by the physician upon patient admission and it contains:
- Name and demographic data.
- Medications taken before.
- Diagnosis.
- Request for laboratory investigations.
- Radiological examination.
- Instructions for the nursing staff.
- Medication order including dose, dose intervals and administration.
- Dietary requirements.
- Allergies.
- Home med and bedside medications.

43. Stat order ( Emergency order)
• An order being sent electronically to the pharmacy.
• It should have the priority in dispensing.
• Delivered to the patient by the pharmacy technician.

44. Daily and continuation order
 Written by the physician in daily or at least weekly basis

45. Standing order
 The same set of medications for each patient who receives a
similar treatment or surgery.
 Physician may sign this preprinted order and may add or
delete some items.
 Postoperative orders are good example.

46. Discharge order
 Order including all medications, doses and instructions to
take-home.
 May continue for one week or maximum one month until
follow-up visit.

47. Computerized Prescriber Order Entry CPOE
Benefits
- Immediate access to patient medical records.
- Streamlined work-flow process.
- Enhance coordination of patient care.
- Clear communication with other health care professionals.
- End result improves patient care and safety.
Drawbacks:
- High initial cost.
- Need time for training.
- Resistance from the prescribers to embrace changes.

48. CPOE – cont.
For the pharmacy:
- Efficient medication order completion.
- Simplification of inventory ordering and posting of patient charges.
- Improvement of medication safety
- Safeguard medication filling and dispensing.
- Error checking functions, duplication, incorrect doses
- Reduce medication errors.

49. Inpatient Distribution Systems
1- A complete floor-stock System.
2- Individual prescription medication for each patient.
3- Combination of 1 & 2.
4- Unit-dose dispensing system.

50. Floor-stock
 Floor-stock is an inventory of frequently prescribed drugs including narcotics,
that is stored on the patient care unit rather than delivered by a unit dose cart.
 May be free or charge.
 Predetermined list kept on each nursing unit.
 Topping-up by the pharmacy and record the consumption and cost.
 For more expensive drug the charge may be via bar-code, removable label or
pre-stamped pharmacy requisition form.

52. Individual Patient Medications
 All medications dispensed by the pharmacy, kept in the nurse
cabinet and administered to each patient in doses as instructed by
the physician.
 Control through pharmacy prepackaged form.

53. Mixed system
 Floor-stock is carried out and the charges were included in the nursing and
other services charges.
 Individual patient drugs kept in the nursing cabinet and charges are recorded
in the pharmacy upon dispensing.
 Control and follow-up of storage conditions are the pharmacy responsibility.

54. Unit Dose Distribution System
 It is the standard practice in developed hospitals
 12 – 72 hours supply prepacked for each patient-care unit.
 Then administered by the nurse to the patient.
 Inpatient distribution system is composed of:
- Unit dose.
- IV admixture.
- TPN services.
The pharmacist maintain the inventory of the floor stock drugs and narcotic sent to
each unit.

55. Unit dose –cont.
 Definition:
An amount of a drug prepackaged for a single administration. That is to
say an amount of a medication in a particular dosage form that is
ready for administration to a particular patient at a particular time.

56. Unit dose cont.
 General information on the label:
- Generic or brand name of the drug
- Strength of the dose.
- Bar code of the product
- Manufacturer name and lot number.
- Expiration date.

57. Unit dose cont.
 Unit dose cart:
 A movable cart that contains removable
cassette drawers that house medications.
 Each cassette drawer is labeled with specific
patient, patient bar code and room number.
 Medications are generally for 24 hours -
exchange in the morning by pharmacy.

58. Unit dose –cont.
 Benefits:
 Streamlined work flow.
 Decreased medication errors.
 Increased medication security.
 Reduced medication wastage.
 increased cost effectiveness.

59. Unit dose –cont.
 Repackaging medication into unit dose
1- heat-sealed ziplock bags.
2- adhesive sealed bottles.
3- blister pack.
4- heat- sealed strips.
5- Plastic or glass cups.
6- heat-sealed aluminum cups.
7- plastic syringes for liquids labelled for oral use only.

60. Unit dose cont.
 Processing medication order:
 Using a Cart Fill List preparing patient-specific unit dose label containing:
- Patient name
- Medication name, strength, dose, frequency od dose, route and time of
administration and bar code.
A printout of all patient profiles in the hospital results in daily cart fill list.
- Labels are then printed for each patient before beginning the fill process.
- Floor stock is not dispensed. Controlled drug are dispensed separately.
- Each hospital have specific time for administration using military time.

61.  Processing medication order:
 Filling he medication unit dose order at a designated station usually rhe
inpatient pharmacy
 Doses for each patient are placed in his cassette drawer in the cart..

62. Robotic dispensing system

63. Intravenous admixture service
 Prepared by trained pharmacist in clean room sterile and
germ-free.
 In a horizontal laminar airflow.
 Total parenteral nutrition are prepared by a team and using
automated compounding device because of wide range of
ingredients.
 The device should be calibrated daily.

64. TPN preparation device.

65. Narcotics
• Locked cabinet or safe.
• Date, time of administration, patient, physician and
nurse names, dose are verified.
• Reconcile nursing administration record and patient
chart at each nursing shift.
• Witnessed and signed.
• Software provides more control.

67. Medication Administration Record MAR
 Specific-patient record filled by the nurse.
 It includes medication order number, name of all drugs administered,
doses, route, times, and start and stop dates and any instructions given.
 eMAR had been developed using bar code technology.

69. Benefits of eMAR
Fulfilling the 5 – rights:
1- right patient.
2- right drug.
3- right dose.
4- right route.
5- right time.
Minimize medication errors.
Meeting documentation guidelines of authorities and accreditation
standards.

70. Community
Pharmacy
( Retail Pharmacy )
Unit 2

71. Role of Community Pharmacy
 Dispensing medications safely, accurately
and in accordance with the laws upon receipt
of valid medication order from a licensed
prescribers.

72. Compounding
Preparation and delivery of medication to non-traditional
nursing home, personal care home, prisons.
Blood pressure check.
Blood glucose and cholesterol tests.

73. Community Pharmacy Facility
 perfect location and spacious.
 Front area:
 OTC
 Medical supplies
 Dietary supplements
 Commercial commodities.
 Back area:
 Prescription medications.
 Access to personnel only and locked when the pharmacist is not
there.
 A counter separates these two areas.
 Storage area and area for prescription pickup and cashier.

74. Community Pharmacy personnel
 Licensed Pharmacist
Pharmacy Technician
 Cashier.

75. Prescription
 Definition:
An order of medication for a patient, issued by a physician or a qualified
practitioner for a valid medical condition often in a preprinted form and then
filled by a pharmacist.
 Prescriber information:
- Name
- Address
- Telephone, Fax, e mail,
- Number of Provider Identifier. NPI
 Date of issuing prescription.

76. Prescription
 patient information:
- Full Name
- Address and telephone.
- Age or birth day.
- Health care insurance number.

Rx : latin word recipre meaning to take.
 Inscription:
- List of medications, generic name, strength and dose and amount.
 Subscription:
Instructions for the pharmacist for dispensing, substitution and refill.

77. Prescription
 Signa :
- Directions for the patient to follow.
 Physcian signature

78. Prescription Common Abbreviations
Category abb Meaning category abb Meaning
Amount cc ml Time ac Before meales
g Gram am morning
gr Grain bid Twice a day
gtt drop pc After meals
mg milligram pm afternoon
mL millilitre prn As needed
qs Sufficient quantity q6h Every 6 hours
tbsp Table spoonful qid Four times a day
tsp teaspoonful tid Three times a day
Dosage cap capsule Site au Each ear
MDI Metered-dose inhal ou Each eye
sol solution po Oral
supp supposotries pr Per rectum
susp suspension sl subligual
tab tablet top topical
ung ointment vag vaginal

79. Types of Prescriptions
 Written prescription.
 e-Precsription.
Telephone / Fax
Prescription not yet due
Transfer In
Refill Request
Partial Fill
Emergency Fills
Transfers Out
Controlled substances

80. Processing a Prescription
1. Patient drop off the prescription, check the authentication.
2. check patient information.
3. Enter or scan the prescription, check insurance and calculate the cost.
4. Generate the medication information sheet and the container label.
5. Check and review the drug utilization review and drug interaction and
warning screen.
6. Select the medications and verify the bar code.
7. Quantities of prescribed medication and double check for the controlled
medicines.
8. Packages the medications in an appropriate container.
9. Fix the computer generated label.

81. Processing a Prescription
10. The pharmacist make the final check taking the original prescription,
medication information sheet, stock drug bottle, medication container label and
medication container.
11. Pharmacist initial the label and the prescription.
12. Bag the prescription and medication information sheet.
13. Return the stock drug bottle and mark it as open.
14. Deliver to cash area and pharmacist counseling. Verify the name of patient
before patient picking.
15. Cash payment or credit card or cheque. Signature of the patient in case
required by the insurance provider.

82. The Business of Community Pharmacy
 Nonprescription sales.
- OTC
- Dietary supplements.
- Medical supplies.
 Computer & automation.
 Cash management
 Inventory management.
- Purchasing
- Receiving and posting
- Out of stock medication.
- Drug return and credits
- Controlled medications
 Business calculations.
 Audits

83. Compounding

84. Essential Medicines

85. Definition
 Essential medicines are those drugs that
satisfy the health care needs of the majority
of the population, they should therefore be
available at all times in adequate amounts
and in appropriate dosage forms at a price
the community can afford.

86.  Concept of Essential Medicines
 They are selected with due regard to public health relevance, evidence on efficacy
and safety, and comparative cost-effectiveness. Essential medicines are intended to
be available within the context of functioning health systems at all times in adequate
amounts, in the appropriate dosage forms, with assured quality and adequate
information, and at a price the individual and the community can afford. The
implementation of the concept of essential medicines is important exactly which
medicines are regarded as a national responsibility. Careful selection of a limited
range of essential medicines results in a higher quality of care, better management of
medicines and a more cost-effective use of available health resources. The essential
medicine list contains limited cost-effective and safe medicines, while the open
pharmaceutical market is flooded with large number of medicines many of which are
of doubtful value. The model list of WHO serves as a guide for the development of
national and institutional essential medicine list. The concept of essential medicines
has been worldwide accepted as a powerful tool to promote health equity and its
impact is remarkable as the essential medicines are proved to be one of the most
cost-effective elements in health care.

87. Selection of essential medicines
Basis of selection.
Methodology for selection
Selection committee.
Selection in generic names.
Classification of drug list.
WHO list of essential medicines.

88. WHO Model of Essential Medicines –
2015 , 19th edition
1. Anaesthetics.
2. Pain & palliative care.
3. Antiallergics and anaphylactic shock.
4. Antidotes & substances used in Poisoning.
5. Anticonvulsants / antiepileptics.
6. Anti-infective.
7. Antimigraine.
8. Antineoplastics and immunosuppresives.
9. Antiparkinsonism.
10.Medicines affecting the blood.

89. 11. Blood products of human origin and plasma substituents.
12. Cardiovascular.
13. Dermatological.
14. Diagnostics.
15. Disinfectants and antiseptics.
16. Diuretics.
17. GIT.
18. Hormones & endocrines.
19. Immunological
20. Muscle relaxants and cholinesterase inhibitors.

90. 21. Opthalmological preparations.
22. Oxytocics and antioxytocics.
23. Peritoneal dialysis.
24. Mental & behavior disorder.
25. Respiratory tract.
26. Water, electrolyte and acid-base disturbance.
27. Vitamins & minerals.
28. ENT.
29. Specific medicines for neonatal care.
30. Medicines for diseases of joints.

91. WHO list of Essential Medicines
 who list essential drugs.pdf

92. Rational use of medicines
 The rational use of Medicines (RUM) is defined as “Patients receive
medications appropriate to their clinical needs, in doses that meet their own
individual requirements, for an adequate period of time, and at the lowest cost
to them and their community. Irrational use occurs when one or more of these
conditions are not met. The use of too many medicines per patients;
inappropriate use of antimicrobials, often in inadequate dosage, for non-
bacterial infections; over use of injections; and prescriptions not in
accordance with STG; are few common types of irrational use of medicines.
 The inappropriate use of medicines is widespread. It is costly and extremely
harmful both to the individual and the population as a whole mainly in
childhood infection and in chronic diseases like hypertension, diabetes,
epilepsy, and mental disorder. Increased incidence of adverse drug events
and resistance is another serious issue.