HOSPITAL TRAINING

A REPORT OF THE ONE MONTHS HOSPITAL TRAINING ON

‘HOSPITAL PHARMCY’s

In association with

AGRAWAL HOSPITAL,AHMEDNAGAR

Submitted to
Savitribai Phule Pune University

Submitted by
RAMESHWAR ASHOK SHINDE
( T.Y. B. PHARMACY)
(A.Y – 2022-23)

Shri Jain Vidya Prasarak Mandal’s

RASIKLAL M.DHARIWAL INSTITUTE OF PHARMACEUTICAL
EDUCATION AND RESEARCH -CHINCHWAD PUNE 411019
ACKNOWLEDGEMENT
This project consumed amount of work, research,& dedication. Still,
implementation would not have been possible if I did not have a support
of many individuals & organizations. Therefore I would like to extend our
sincere gratitude to all of them.
It is pleasure to express my deep sense of gratitude of thankfulness to
Dr. Sanjay Walode.
Principle Rasiklal M Dhariwal Institute of pharmaceutical Education &
Research chinchwad pune. For his valuable guidance felicitous advice
during the course of my pharmacy Training.
I wish to express my deep sense of gratitude to my incharge Dr. Sameer
Lakade.
Professor, RMD Colleage Pune for His co-operation & valuable guidance
throughout my Hospital Pharmacy Training .
I am cordially grateful to my beloved parents, my family members & my
friends who always covered their shade of love & blessing & provide
their valuable moral support directly spirit & corporation.

Place :- Pune Rameshwar Shinde

Date :-
 INTRODUCTION

In order to widen my knowledge, to have new experiences in the field of

health care,did training at hospital pharmacy at Ahmednagar “Agrawal”
Hospital This training course is extended over a period 8 th feb 2022 to 8th
mar 2022.

Agrawal Hospital Opp. Hotel Oberoi

Savedi Ahmednagar 414003
Ph 2429899/2421661
OBJECTIVES OF THE INTERNSHIP

1. Observing, comparing, analyzing and commenting on the

management of different pathologies, clinical and paraclinical
approaches.
II. Integrate fully the family medicine service (go to the extended clinic,
the ward, the emergency room), participate in the activities of the other
services.
III. Observation of procedures
IV. Rotations in family medicine, internal medicine, pediatrics, obstetrics
and gynecology, surgery, especially pediatric and adult emergencies.
 HOSPITAL PHARMACY

The practice of pharmacy within the hospital under the supervision of a

professional pharmacist is known as hospital pharmacy.

FUNCTIONS OF HOSPITAL PHARMACY:

⚫ Forecast of demand
⚫ Selection of reliable suppliers
• Prescribing specifications of the required medicament Manufacturing of
sterile or non-sterile preparations
• Maintenance of manufacturing records Quality control of purchased or
manufactured products
⚫ Distribution of medicaments in the wards
⚫ Dispensing of medicaments to out-patients
⚫ Drug information source in hospitals
⚫ Centre for drug utilization studies
⚫ Implement recommendations of the pharmacy and therapeutic
committee
⚫ Patient counseling

• Maintaining liaison between medical, nursing and the patient.

OBJECTIVES OF HOSPITAL PHARMACY

1)To professionalize the functioning of the pharmaceutical services in
hospitals.
2)To ensure availability of the required medication at an affordable cost
at the required time.
3)To plan, organize and implement the policies of the pharmacy.
4)To perform functions of management of material, purchase, storage of
essential items.
5)To maintain strict inventory of all items received and issued.
6)To counsel the patient, medical staff, nurses and others involved in
patient care on the use of drugs, possible side effects, toxicity, adverse
effects, drug interactions etc.
7)To serve as a source of information on drug utilization.
8)To manufacture drugs, large/ small volume parenterals which are
critical for use inpatients.
9)To participate in and implement the decisions of the pharmacy and
therapeutics committee.
10)To organize and participate in research programmes, educational
programmes.
11)To provide training to various members of the patient team on various
aspects of drug action, administration and usage.
12)To engage in public health activities to improve the well-being of the
population.
13)To interact, cooperate and coordinate with various other departments
of the hospital.
 PRESCRIPTION MONITORING

The core of ‘pharmacists' contribution to appropriate prescribing and

medication use is made whilst undertaking near-patient clinical
pharmacy activities. Checking and monitoring ‘patients' prescriptions on
hospital wards is frequently the starting point for this process and on
most hospital wards the prescription card and clinical observation charts
(temperature, pulse rate, blood pressure, and so on) are typically kept at
the end of the patient's bed. This allows the clinical pharmacist to
interact with the patient whilst reviewing the contents of the prescription.
The prescription is reviewed for medication dosing errors,
appropriateness of administration route, drug interactions, prescription
ambiguities, inappropriate prescribing and many other potential
problems. Formal assessments of prescription charts in hospitals have
shown that there are wide variations in the quality of prescribing and
pharmacists are able to identify and resolve many clinical problems.
Patients can be questioned on their medication histories, including
allergies and intolerances, efficacy of prescribed treatment, side-effects
and adverse drug reactions (ADRs). The routine presence of medical
and nursing staff on the ward allows the pharmacist to communicate
easily with other members of the healthcare team who value the
prescription-monitoring service that clinical pharmacists provide. 19, 20
Patients notes are also accessible, to enable the pharmacist both to
check important information that may affect their healthcare and to
record details of any clinical pharmacy input made.
MEDICATION ERRORS & ADVERSE DRUG REACTION REPORTING

Despite the important role of clinical pharmacy services, patients

receiving drug therapy may still experience unintended harm or injury as
a result of medication errors or from ADRs. Adverse events (from any
cause) occur in around 10% of all hospital admissions and medication
errors account for one quarter of all the incidents that threaten patient
safety.

A study commissioned by the General Medical Council identified a mean

prescribing error rate of 8.9 per 100 medication orders. Contributing to
the avoidance or resolution of adverse medication events is an important
part of any hospital pharmacist's clinical duties. This requires a
multisystem approach, often incorporated into a hospital's clinical risk
management strategy. Important lessons can be learned from analysis
of medication-related incidents and from near-misses (that is, those that
do not develop sufficiently to result in patient harm or are detected prior
to patient harm).

Even when the prescribed and administered treatment is correct and no

errors have occurred, a small proportion of patients can still suffer from
ADRs. Clinical pharmacists have an important role to play in the
detection and management of ADRs and, more recently, directly
reporting ADRs to the Committee on Safety of Medicines via the Yellow
Card scheme. Their involvement can help to increase the number of
ADR reports made, particularly those involving serious reaction.
PATIENT EDUCAION & COUNSELLING, INCLUDING ACHIEVING
CONCORDANCE

One of the key themes of the 2010 White Paper is empowering patients
to take an active role in managing their own care. This is also one of the
themes of many of the NHS National Institute for Health Research
collaborations for leadership in applied health research and care that
focus on translating research into practice. Helping patients to
understand their medicines and how to take them is a major feature of
clinical pharmacy. Patient compliance, defined as adherence to the
regimen of treatment recommended by the doctor, has been a concern
of healthcare professionals for some time. Adherence to treatment,
particularly for long-term chronic conditions, can be poor and tends to
worsen as the number of medicines and complexity of treatment
regimens increase. NICE noted that between a third and half of all
medicines prescribed for long term conditions are not taken as
recommended and estimated that the cost of admissions resulting from
patients not taking medicines as recommended was between £36 million
and £196 million in 2006-2007.

In recent years, use of the term 'compliance' in the context of medication

has been criticised because it implied that patients must simply follow
the doctor's orders, rather than making properly informed decisions
about their healthcare. The term 'concordance' has been proposed as a
more appropriate description of the situation.
Concordance is a new approach to the prescribing and taking of
medicines. It is an agreement reached after negotiation between a
patient and healthcare professional that respects the beliefs and wishes
of the patient in determining whether, when and how medicines are
taken.
This change in approach aims to optimise the benefits of treatment by
helping patients and clinicians collaborate in a therapeutic partnership.
However, if patients are to make informed choices, then the need for
comprehensive patient education becomes more pressing.
Concordance with treatment is dependent on a complex interplay of
beliefs, trust and understanding, with non-adherence falling into two
overlapping categories:
1.Intentional: the patient decides not to follow the treatment
recommendations
2.Unintentional:The patient wants to follow the treatment
recommendations, but practical problems prevent the patient from doing
so. Many surveys have found that patients often know little about the
medicines they are taking. Several studies examining patient counselling
and education have shown that clinical pharmacists can help to improve
patients' knowledge of their treatment. The contribution made can also
improve patient adherence to treatment. Improved adherence should
lead to improved outcomes and evidence has been collected to
demonstrate this.
In addition to providing face-to-face education and counselling on
medicines, clinical pharmacists can also help patients by contributing to
the preparation of written material and audiovisual demonstrations, or by
using computer programs.
How patients take their medicines is a crucial component of whether the
desired outcomes will be achieved. Key to this is the health beliefs of
individuals and the relationship with their healthcare providers that are
necessary in order to ensure this happens. Society is moving away from
a paternalistic approach to healthcare to a more empowered one. Thus,
whereas a course of treatment used to be accepted obediently by
patients, treatment is now negotiated and options, risks and benefits are
discussed and, where necessary, consent is obtained. Thus there is a
greater need for information and education of patients and/or carers in
order for them to be able to make informed decisions about their
treatment. Indeed, the 2010 White Paper emphasised the importance of
patient involvement, and included the phrase 'nothing about me, without
me.
PHARMACOKINETICS & THERAPEUTIC DRUG LEVEL

Pharmacokinetics addresses the absorption, distribution, metabolism

and excretion of drugs in patients. A sound knowledge of the
pharmacokinetic profiles of different drugs enables the pharmacist to
assess the dosing requirements for certain drugs in patients in extremes
of age and in the presence of impairment of kidney and liver function.
Clinically important drug interactions and adverse reactions can
sometimes be predicted. Dosing calculations of aminoglycoside
antibiotics are usually made by employing pharmacokinetic principles. A
number of medicines in common use have a narrow therapeutic index;
that is, the difference between the lowest effective dose and a potentially
toxic dose can be quite small. In many cases it is necessary or desirable
to undertake therapeutic drug level monitoring (TDM) to ensure that
patients can be treated safely. TDM services include the measurement
of drug levels in the patient's blood and the application of clinical
pharmacokinetics to optimise drug therapy. There is a wide range of
medicines that fall into this category, but TDM services typically include
aminoglycoside antibiotics, anticonvulsants, immunosuppressants,
digoxin, lithium and theophylline. Monitoring drug levels in patients can
also provide an important indicator as to whether they are taking their
medicine. Clinical pharmacy input into TDM services can range from the
provision of simple advice to other clinicians on when to take samples
and how to interpret results, to fully fledged services that may include
collection and laboratory analysis of the blood sample.
PERSONALISED MEDICINE

The fact that not all patients respond to the expected benefits of
medicines and some have disproportionately adverse effects from them
is leading to the development of personalised medicines services. Good
clinicians have always tailored treatment to individual patients' needs,
but this typically relied on trial and error. Personalised medicine can start
from using biomarkers rather than clinical outcomes as surrogate
markers of effectiveness and a new specialty of pharmacogenetics that
aims to assess phenotypic differences in responding to and handling
drugs that may account for a proportion of the variation in patient
response. A Parliamentary Office of Science and Technology review
noted that:

Personalised medicine holds both promise and cause for concern.

Selective treatment may limit access to those most likely to benefit,
whereas following a 'one size fits all' approach to medical research and
development may have benefited the widest number of potential
patients. Nevertheless, explaining the environmental, genetic and other
biological sources of human variation will alter the way diseases are
diagnosed, drugs are developed, and the matching of therapeutic cells
and tissues to patients.

However, economic considerations, regulation of biological tests and the

speed of clinical education and training will all influence the rate and
degree to which personalized medicine will be incorporated into drug
development and clinical practice.
THE ROLE OF PHARMACY TECHNICIANS IN CLINICAL PHARMACY
SERVICES

The role of pharmacy technicians is already well established in

departmental activities such as dispensing and aseptic services.
However, the expansion of clinical pharmacy services in hospital would
not be possible without the additional support that can be provided by
hospital pharmacy technicians. In a similar manner to the way in which
ward pharmacy services provided by pharmacists evolved into clinical
pharmacy, pharmacy technicians' roles are becoming increasingly
clinical in nature and can include a wide range of activities. Current
activities undertaken by pharmacy technicians, in collaboration with
pharmacists, include:
⚫ medication supply
⚫ checking medication in POD schemes
⚫ patient counselling and education, including the provision of patient
aids where appropriate, as well as medication charts and monitored-
dose systems to aid compliance
⚫ supporting patient self-medication
⚫ medicines information discharge planning for patients, including
communication with primary care colleagues where appropriate
⚫ involvement in clinical trials and good clinical practice governance
⚫ preparation of medicines formularies and guidelines
⚫ training and education
⚫ liaison with clinical teams on medicines management and expenditure
⚫AMS.
Whilst this last subject will be addressed under strategic medicines
management, it is important to note that AMS was the first ever clinical
pharmacy programme to receive national, ring-fenced, governmental
funding. The importance of AMS is highlighted in national reports and is
enshrined within statute in the Health and Social Care Act 2008.
Guidance for compliance with criterion 9 states that healthcare providers
'have and adhere to policies, designed for the individual's care and
provider organisations that will help to prevent and control infections'.
 INFRASTRUCTURE

1. Located in the ground floor or in the first floor.

2. Sufficient space for seating of patients.
3. Waiting room for out-patients. It should contain educative posters on
health, hygiene and offer literature for reading.
4. Suitable space routine manufacturing of bulk preparations (stock
solutions, bulk powders and ointments etc.
5. Office of the chief
6. Packaging and labeling area
7. Cold storage area
8. Research wing
9. Pharmacy store room
10. Library
11. Radio isotope storage and dispensing area.
 FINANCES

1. Primary source-charges received from the patient.

2. Charges received by the patients are either fully paid by himself or

from third party.

3. Research work.

4. Invested endowment funds.

5. Other types of investment.

6. Gifts, contributions towards general functional expenses.

ROLES AND RESPONSIBILITIES OF HOSPITAL PHARMACIST

 Pharmacists' Responsibilities.

 Dispense Prescriptions.

 Communicate With Prescribers.

 Ensure Patients' Safety.

 Counsel Patients.

 Work With Patients on General Health.

 Deal With Insurance Companies.

 Manage Staff.

A) Central dispensing area:

1. To ensure that all drugs are stored and dispensed correctly.

2. To check the accuracy of the dosages prepared.

3. Maintain proper records

4. Preparation of bills

5. Co-ordinate over all pharmaceutical needs of the patient

 6.Framed policies and procedures are followed

7.Maintain professional competence8. Communicate with all

pharmacy staffs.

B) Patient care areas:

1. Maintain liaison with nurses

2. Reviewing of drug administration

3. Provide instruction and assistance to the junior pharmacist

C) Direct patient areas:

1. Identification of drugs brought into the hospital

2. Obtaining patients medication history

3. Assist in the selection of drug products

4. Monitor patients total drug therapy

5. Counseling patients

6. Participating in cardio-pulmonary emergencies

D) General responsibilities:

1. Ensure that all drugs are handled properly

2. Participate in cardio-pulmonary emergencies 3. Provide education and

training for pharmacists
OUTDOOR PHARMACIST RESONSIBILITIES:

A) Central dispensing area:

1. To ensure that all drugs are stored and dispensed correctly.

2. To check the accuracy of the dosages prepared.

3. Maintain proper records

4. Preparation of bills

5. Keeps the pharmacy neat and tidy manner

B) Patient care areas

1. Inspect periodically the medication areas

2. Identify the drugs brought into the hospital

3. Monitoring of drugs

4. Counsel the patients

C) General responsibilities:

1. Ensure that all drugs are handled properly

2. Participate in cardio-pulmonary emergencies

3. Provide education and training for pharmacists

4. Co-ordinate overall pharmaceutical need of the outdoor services

 CONCLUSION

To do the practical training in a retail pharmacy is nothing but utilizing

and implementing whatever knowledge gained during course. Every
student trainee should do systemic training during practical training
period. This proforma will beneficial to all institutes of pharmacy for
uniformity in project and training before sanctioning the apprentice
practical training.
In fact, I spent an excellent 2 Months internship, I learned a lot,
Observed, Noted, Identified, Discussed... I am sure that this information
will be useful to me throughout my professional career.
While allowing me better apprehend and manage diseases, and thus
serve my country. I shall also transmit them to my successors.
I am satisfied with the internship, and my objectives are reached at 80%.
And I thank once again all those who have contributed to this success.
I hope that medicine in Haiti will have a much higher standard and that
the population will recognize the importance of this specialty, which is
family medicine, and that someday there will be subspecialties.