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Distribution of drugs to wards then to in-patient , must be according to -
:one of the following system
"a- Unit dose system "U.D.S
"b- Complete floor stock system 'C.F.S.S -
:Dispensed drugs should be - -
"a- properly packaged e.g "plastic container or sealable bags
b. Clearly labeled e.g ." patients name ,drug name , drug potency, type of
."dosage form , dose & frequency , date & word name
Other duties of in- patient pharmacy
.A. supply of disinfectant , chemical and pesticides to all departments
B. Supply of surgical equipment & disposable surgical equipment
together with anesthetic & and anesthesia equipment to operation theater
& emergency clinic also supplying medical equipment of stethoscope ,
.sphygmomanometer
.C. Supplying laboratory chemical & blood bank requirement
D. Supply of drug & equipment to intensive care unit (I.C.U) e.g
.Analgesic e.g (morphine , pethedine. etc) .1
.Antihypertensive e.g ( propranolol , digoxin ) .2
.Bronchodilator e.g (salbutamol , aminophyline ) .3
Corticosteroid (paranteral ) .4
.Antitoxin & antidotes .5
Adrenaline paranteral .6
2
.Preparation , manufacturing & prepacking of the drug. 3
Manufacturing wide variety of items in common use at hospital e.g
gentian violet -
.iodine solution-
nasal drug -
.ear drops-
.sulphur ointment -
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.e-Drug combination
f- Dose to ( pregnant ,lactating women ,elderly ,premature babies
g-Restriction of drug during pregnancy & lactating e.g tetracycline-
.i-Antidote to toxic drug or suicidal administration of drug or over dose
.k-Incompatibilities of drug
.l- long term effect of drug to chronic patients
.Supplying emergency packs to paramedics. 6
e.g.There are boxes which contain drug & tools necessary for
:paramedics
.I -. Ampulance
.II - helicopter ambulance
:They includes
a- I.v solutin e.g (normal saline drip ,glucose drip)
."b-Adrenaline "I. M
c-Morphine . paranteral
d-Anesthetic e.g local or i.v e.g thiopental na
.e-Oxygen cylinder & masks
"f-Nebulizer for "asthma emergencies
.g-Antihistamine injection
h-Cardiovascular drug
i-Sedative cns stimulant
.J-Antidote ,bandage ,first aid..etc
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.Participating ( taking part) in hospital committee 7
.I.V additives departments .8
.Clinical pharmacy services .9
Administration & Organization of pharmacy .10
.department
: This involve organization of the pharmacy department such as
.Distribution of duties and shift work .1
:Recording prescription and keeping both .2
a- Prescription
.b- The record
Recording narcotic & control drugs prescription , then keeping the .3
:following
.a- copy of narcotic and control drug prescription
.b- keeping of the narcotic & control drug record
.c - empty container of the drug all in safe cabin
.keeping statistic of drug dispenced through the year.4
Checking the maintenance of refrigerators & air conditioner in the .5
.pharmacy
.keeping contact with other department & taken part in committees.6
.keeping adequate supply & storing them properly.7
((.Note: Role of pharmacy department include 1-10 as above
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Pharmacy Site , Area
The pharmacy site should be located in an area which is convenient for
:providing service to many department of the hospital, it should be
.A. Easily accessible to all department
.B. It should not be in the crowded area
C .Should provide free movement of medication carts in and out of the
.pharmacy
The inpatient pharmacy department serves as storage , manufacturing
.,dispensing of medicines to the discharge patients and to in patients
Now a days there is new concept of satellite pharmacy or sub pharmacy
.to be near to the patient
:The pharmacy is formed of the following components
A. Compounding and dispensing area
This area is the nearest to the patient or it could be called as dispensing
.window where the delivery of medication to the patients is done
In early pharmacy times the compounding of drugs was also done in this
area but in modern times the compounding is not done , the dosage form
.is readily available , this area has to be kept neat and clean all time
B. Active storage room
This is the area where the medication are stored which are needed on
daily bases and are fast running. This area is freely accessible to the
pharmacy technician working on dispensing . In this area the stock has
.to be checked on daily bases as the stock is kept to a limited
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C. Manufacturing room
In this area the manufacturing of some medications used in the hospital
is done such as ointments, some of the material are repacked in this area
such as castor oil . This area is also called as the lab which is under
the pharmacist and he is responsible for all the preparation being carried
.out here
D. Nonsterile Mixing and filling area
This is also a part of the lab which is separated from the sterile area, in
this area the preparation which does not require much sterilization or
aseptic area are packed here, this area has to be separate from the oral
.liquids
E. Prepacking area
This is the area used to pre packing either for unit single dose or
.separating to small volume
F. I.V admixture room
This is very sterile area and also aseptic on where the reconstitution of
the injection is done , the person has to be very active conscious and
knowledgeable to work in this area as most of the important medication
are diluted here so the knowledge of the diluents and mixing technique
.and keeping himself sterile is important
G. Labeling and inspection room
after the dilution is done the labeling is also very important and it is
done by the pharmacist who is in charge after the preparation are kept in
the prepared area before going to the storage area .It is adjacent to the
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filling area to facilitate the transfer of unlabeled drugs to the labeling
.area
H. Quarantine storage
new products manufactured in the pharmacy are subjected quarantine
.until appropriate chemical and bacterial testing is done
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Pharmacy Equipments And Instruments
Adequate pharmaceutical and administrative facilities shall be provided
;for the pharmacy department , including
The necessary equipment for the compounding ,dispensing and .1
.manufacturing of pharmaceutical and parental preparations
Book keeping supplies and related materials for proper administration .2
.of the department
An adequate library and filing equipment to make information .3
concerning drugs readily available to both pharmacist and the
.physicians
Special locked storage space to meet the legal requirement for storage .4
.of narcotics ,alcohol and other prescribed drugs
.A refrigerator for the storage of thermo bile products.5
Adequate floor space for all pharmacy operations and storage of the .6
. products in a satisfactory location with proper lighting and ventilation
:The equipment are segregated into tow groups fixed and movable
Fixed: it is defined as those equipment which requires installation and
become attached to the building . example cabinets ,counters ,sinks ,
.etc
Movable; it is defined as that equipment which is capable of being
moved and is not intended to be permanently affixed to the building
..example carts ,desk balance ,mixer etc
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Role of pharmacy technician in pharmaceutical services
Duties in the central hospital
:Preparation of prescription under pharmacist supervision .(1
-:Involves
a. The ability to read prescriptions
.b. Identifying different dosage form & different strength of drugs
.c. Compounding f drug in the pharmacy
.d. Writing the correct directions for use on each drug
.e. The ability to identifying drug incompatibility and contraindication
:I.V admixture or IV additives (2
:Involves
The ability to follow procedure of I.V additives, mixed under sterile
:condition to prepare
.a .Total paranteral nutrition (TPN)
.b.Cytotoxic &and cancer treating
.c. Antibiotic & antiviral drug
It is mainly prepare specific drugs and strength (potency) to patient
which need special treatment i.e weaker or much stronger drug, or
.prepare nutrition or vitamins, salt etc
All these preparation are not available as ready products (items) on
.pharmacy shelves
Preparation of medication for in- patient according to the unit (3
.dose system(U.D.S)
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It is process followed in modern hospital to supply drugs daily to each
.patient individually( one by one) giving only 24 hours drugs supply
:Prepacking of medication(4
Prepare packages which contain a standard of doses ( tablet, capsule,
ampoules etc.)in (bottles or plastic bags ) & writing standard direction
. for use on them
Prepacking of medication is done during hours of no rush (i.e not
crowded and few patients) in preparation (to get ready) for the rush
.hours( when highest number of patients come to the pharmacy)
:Arrangement of medication in the pharmacy(5
:Medication can be arranged in the pharmacy according to
A) Alphabet sequence (usually using the generic name but trade name
can be used.)
B) According to dosage form (tablet, capsule ,ointment, cream,
paranteral ,syrup ..etc)
:C. According to use
This means that drug will be grouped (put together) as the action they
used for e,g
.Antipyretic & analgecic.1
.Antibiotic ,anti fungal & antiviral .2
.Antihypertensive drug.3
.Anti diabetic drug .4
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This is done both in out patient & in oupatient pharmacy. Also we must
but drug with short expiry date in front of the shelves& new drug behind
.them
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Daily or weekly checks on expiry date in the pharmacy is best -
practice , because drug must be returned to drug store, before six month
:or at least pharmacy department must write to the stores a list of
.A. Name of items near expiry
.B. Quantities of each item
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:Prescription polices
:Is agreement on a system to be followed and understood by
.Doctors, specialist and consultants .1
.Pharmacy department staff .2
:They agree on
.A. Quantity of medication dispensed
.B. Quality and type of drugs prescribed by specialist and consultants
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Chronic cases: These are long term patients , suffering from (2
hypertension, heart disease , diabetes etc, where large quantities of drugs
are needed to treat ( help) them as long as they suffer from these disease.
But the treatment is given every month or every 2-3 month with special
) repeat) or refill prescription
:Quantities supplied by drug store .3
The quantity of each drug order by the pharmacy from drug store , May
.not be supplied as orderd by the pharmacy
:Many factors control that
A. Availability of that items (drug) i.e may be not available ( out of
.stock) or the quantity available in the store is small
B. Financial limitation specially if the item is not an essential
.therapeutic drug e.g effervescent vitamin tablets etc
C. Time of change of new supplier or drug company i.e the same generic
name but different trade name ,where the new supply is not ready or
.being tested for quality in the laboratory
B. Quality and type f drug prescribed by specialists and consultants
:only
To organized and limit highly specialized and expensive drugs it is
always agreed to make a list of these drugs and a list of consultants who
.are allowed to prescribe them
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Refill system
This is a system for chronic patient who keeps taking the same
medication for long time or as longer as he or she is a live e,g
diabetes patients , asthmatic , hypertensive , sickle cell anemia patients
.etc
They usually get (take ) their supply of long term drugs ,dispensed by
the out patient pharmacy . the pharmacy must use the computer to
.keep records of these patients
If there was no computer , the pharmacist should keep a ( card system)
i.e cards with special file or box for these chronic patients and their
.refills
In either cases computer or card system , there must be the essential
information listed e,g
Patients name (1
Age (2
Sex (3
.Diagnosis (.4
Drug to be refilled and how frequent (every 1,2,or 3 month) (5
Date to be refilled (last date dispensed) (6
.Doctors name and telephone number (.7
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Prescription of narcotic and controlled drug
:These prescription should dealt with very carefully , starting with
.Reading them & checking every (item ,date ,doctor signature .etc.1
.Despensing them ( make sure of the patient name).2
Recording them ( in special record for them ).3
Keeping them ( storing them).4
Narcotic drug prescription are usually 1-4 copies, each of them in a
different colored ,but always red colors is used to mark these
prescription , in out patient pharmacy , but on special sheets (also 3-
4) copies of different colors for in- patients in the UDS
Checking each item in the prescription is important to avoid any
mistakes or old prescription or not an authorized doctors has prescribed
.it..etc
Narcotic drug & control drug prescription should be recorded as soon as
the items (drug) prepared into the special record book. This record
should be kept in the special safe(strong and locked with a key that only
.the pharmacist keeps), with the narcotic and controlled drugs
It must be remembered to include a copy of the narcotic or controlled
.drugs ,prescription with the record in that safe for 3 years or more
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:Inspectors from
The hospital itself.1
The ministry of Health.2
The ministry of interior. 3
.Can come any time and check every thing in the safe
It must be learnt very well and practiced that even broken ampouls ,
bottles or not completely use ampouls or does must be reported , in case
of accidents with narcotic a committee is formed immediately ( which
.includes the the pharmacist) to investigate and report the accident
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.Drugs available in nursing station (nursing unit)
There are certain drugs which are kept in nursing station of each
ward, as spare to be used if needed by patients specially when
A) The pharmacy is closed
.B) These drug are not apart of drug prescribed to the patient
Usually the nurse will have to ask the doctor before dispensing any of
these drug (may be by phone ) or some times the doctors must come and
.administer some of these drugs , himself to the patients
List usually varies from ward to another, also the dosage form may
vary too. e.g
Analgesic: specially in surgical wards when the patients may need (1
extra dose of analgesic after waking after operation or women after
. delivery gynecology and obstetric ward etc
Drug may be
a) Paracetamol
b) Acetylsalicylic acid
c) Indomethacin
d) Diclofenac sodium
Some times narcotic analgesic are kept and used when needed ,under
.doctors supervision
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.Cough mixture: such as cough suppressant ,expectorants.2
Bronchodilater : inhaler or nubilizer e.g salbutamol.3
Anti-emetic drugs: they stop nausea and vomiting specially in .4
.surgical wards
Antihistamine: to stop allergic reactions developing against drugs .5
.used locally in hospital
Hypnotics : sometimes patients are tense & anxious and can not .6
. sleep specially before major operation
Other drugs : vary from a ward to another & doctor .7
.(recommendation
These drug must be always observed and followed e,g
- Expiry date of thee drug
Storage instruction eg (storage refrigerated)-
.Storage in wards narcotics safe-
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All the above example are primary form of dosage forms, which helped
. the development of unit dose
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D) Regular meeting of the committee as well as regular meeting of the
pharmacy department staff are necessary ,to study methods of improving
.the system
Stages of U.D.S
:U.D.S usuall pass through three main stages as follows
.Stages A. patient & doctors
.B. in-patient sheets to in-patients pharmacy
.C. Nurse & patients
A. patient & doctors
after examining the (hospitalized patients) , the doctor shall prescribed
.suitable medication on ( hospital sheets speially for U.D.S)
: This sheet must be showing
: Day & date .1
this is important to find the day or date at which a specific drug was
given to the patient, and to follow up the patient progress, and when to
.stop treatment
Some patient may spend the ( weekend)at home and U.D.S must be
prepared to give them their medicines for that period before they go
.home
:Word name and code.2
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So that wrong drugs or doses can be checked e.g specific drug for
.women only , or in pediatric (children) words , doses must be checked
: Patients( name ,sex ,age hospital number & nationality.3
sex is necessary to be identified in case of certain drugs like
.hormones for example
Age is important to decide the dose for children, infant, adult or old age
.(geriatric)
: Diagnosis.4
to classify the patient according to that disease ,and to check the right
drug is prescribed to the right illness (disease ). Very important in case of
multiple illness , to check drug interaction .etc
:Medicines prescribed.5
A)Generic name of drugs is best used, but some trade name of
.drugs may be used, as well
.B)Dosage form e.g( tabs ,caps, inj(iv, im, sc, drip)
. C)Potency this is very important to decide the dose of that drug
.NOTE
Some times drug are available in the pharmacy at higher or lower
.potency than a single dose
.That dose must be adapted (altered ) to the correct dose prescribed
. D)Frequency & rout of administration
Frequency : number of time of drug must be taken. It should be specify
the relation to food i.e before or after or during meals if the drug is
.taken orally
Name &signature of prescribe doctor 6
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:This is important to check & discuss with the doctors
"IF There was "an incompatibility or drug interaction etc .1
IF That doctor is allowed to prescribe that drug , because there are .2
.drug which are only to be prescribed by consultant
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e. Prepare a label ( by the computer or by hand ) with clean &
.correct direction for use
f. After the final check , the pharmacist must be sign his (name ,date,
.hour)
:Advantage of (U.D.S)
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all medication despised to the patient are " checked& reviewed " by .1
.the pharmacist
."Involve the co- operation of " pharmacist , doctor , nurse & patient .2
.Allows (gives ) full control of drug stocks .3
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Disadvantages of (C.F.S.S)*
:Errors may happen frequently (many times) on similar drug name -1
" a-Type of drugs e.g."paracetamol& Propranolo
b-Time of administration of drugs
:There error are mainly due to-
a- Exhaustion of nurse
b- Overlap of drug dispensation with other duties
No review of drug or no "four checks" Point before dispensation-2
Drug deterioration (break down) , after opening large packs& keeping -3
.them for long time
No proper storage facilities (equipment)-4
" Nurse must spend long times to "read sheet , dispense &help patient -5
.to administer each dose
patient recovery can be followed up, and ( 4 .Not possible to followed up accurately (4
selection of best effective type of drug for the
disease
U.D.S will give the nurse more time to spend (5 (5 Takes a lot of nurse time, & may cause (5
on patient care confusin to nurses other duties
less waste of drug, since only unite does are (6 More waste of drug ,because large stock must (6
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dispensed Be kept in nurse station, which may decay
A lot of paper work & equipment e.g. "computer (7 No need for much paper work or computer (7
more contact & exchange of opinion among (9 Very little or no contact or exchange of opinion (9
(doctors ,pharmacists & nurses ) among (doctors, pharmacists &nurses), no
committee (U.D.S)
Accurate & effective follow up of patient (10 No real follow up of drug of administration (10
Administration of medication ,by (return)of "no action of expected" (no return)
Unadministation drug to the pharmacy, also
.Action can be taken to correct case
Several checks of each unit does by different(111 One check only by the nurse (11
pharmacist
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IV Additive) )
There are sterile "I.V " liquid given to patients or replacement to oral
." nutrition " eating& drink
.Specially prepared according to patient's need , under sterile condition
:These aqueous solution may be prepared to (come patients) & contain
.protein -1
.carbohy drate -2
.lipids -3
.vitamins -4
minerals -5
water -6
All these according to variation in patient's need , are give (I.V as -
.a drip)
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:Antibiotics (2
These are prepared in the (I.V additives) Unit in pharmacy department, -
.under sterile condition
: Some of advantages of preparing antibiotic this may are -
The needed concentration (potency) of antibiotic are not available (1
: in ready preparation
.a- higher concentration are needed (sever infection)
.b-Low concentration are needed (infant & children)
. Maintain stable or steady plasma level of antibiotic (2
Control plasma level of antibiotic that will reduce ( liver or kidney -3
.damage)
.Avoid oral drug interaction -4
:Cytotoxic (3
Treatment of (cancer , leukemia & other malignant disease) is -
necessary to be given by infusion to avoid serious side effect of high
.toxic drug , usually used for this case
Real accurate control of plasma levels of cytotoxic drug is necessary -
to give (maximum response)& in the same time to avoid the serious side
effect
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: Of these drug
.Methotrexate-1
.Cyclophosphamide-2
.Actinomycin-3
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Committees
. Pharmacy Quality Control Committee (1
Infection Control (2
.committee
.The pharmacy & Therapeutic committee(3
.Antibiotics Committee (4
: Committee member -
"Chair man "head pharmacist -1
Out patient pharmacy manager. "member'- 2
"In- patient pharmacy manager. 'member-3
."Clinical pharmacist "member -4
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This is an internal committee within the pharmacy department itself
,which will hold monthly meeting , to provide (give) & maintain (keep)
., highest quality service possible to patients
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Checking the Rota (on call) of staff ,and that no gaps (shortage of -5
.staff ) of service will happen
Drugs prepared (manufactured) in pharmacy department should of " -6
" high quality sterility packaging & labeling
After each meeting ,a circular letter, must be given to all staff about -
quality control committees decision (what were the new decision ) to
.follow them
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