1 week The first day,we reached to klinik kesihatan kajang at 11am which located at Bandar Tecnology,Jalan Semenyih,Kajang.

We introduced to Pn.Nur Kamalah binti Daud,Pegawai Farmasi Kajang(Head of KKKajang Pharmacy).Later,we introduced ourselves to Miss.Nazirah our traineer.She gave us lot of information about our duties that we going to do here.She have explain us about the clinic and our responsibility as a pharmasict assistant during the practical period.Our lunch break at 1.00-2.00pm.Our pharmacist give us a small briefing about tha arrangement of drug in the pharmacy.The drug are divided into diffrent groups:TB drugs Antibiotics Gastro-intestinal drug Comman fast moving drugs Respiratory system Types of syrup Anti-hypertensive drugs Anti-Diabetic drugs External application Slow moving drugs List A drugs FARMASI WORK FLOW Receiving prescription Screening prescription Clarify problems Filling the prescription and double check against the prescription Label the drugs Full supply / monthly supply Check the label and prescription

Call the patient Indentify patient detail Dispense Kaunselling Sign the prescription and recheck

The most commanly used drugs Pain and Fever Paracetamol Mefenemic Acid Diclofenac Sodium Cough Bromhexine Diphenhyramine Promethazine Antibiotics Amoxycillin Cloxacillin Bacampicilin Cephalexine Gastric Ranitidine Mixt magnesium trisilicate High blood pressure Amlodipine

Perindrprill Enalaprill Atenalol Hydrochlorothiazide Diabetes Metformin Glibenclamide Gliclazide 2 week Filling the prescription This week my duty was filling the prescription.First day,any faced some difficulties to regonise doctors hanwritting.Before filling the prescription we need to screening the prescription,for the patient detail,patient age,dignosis,drug name,drug dose and also drug duration.We also need to know the prescription whether it expired or not.If the duration for the medication supply is finished,it consider expired prescription.There are two type of prescription,where doctors prescription and senior nurse prescription.Senior nurse can only prescribe:Obimin (pregnancy vitamin) 1/1 od Multivitamin Syrup 10ml od Albendazole syrup 10ml or 5ml stat Syrup Paracetamol 3.5ml tds (not more than 5ml) List A drugs These are the drugs which need to record during the filling.We have to record the patient name,registration number and the amount of drug supply.These List A drug can only supply maximum for 2 month.These are the drug mostly expensive and dangerous need the countersign by Head of Doctors Department Pn.Nik Rosilawati before dispensed. Poison Drugs These poison drugs such as phenobarbitone can only filled by pharmacist.The

are there drug need to record in poison drug book,and get the other pharmacist to double check before place for label process.These poison drugs is placed in locked cabinet to prevent from any accidental changes in medication. During the filling process we have learn about the generic name and trade name for the drugs.There are also slow moving drugs and fast moving drugs. Fast moving drugs Perindroprill-Conversyl Glibenclamide-Daonil Gliclazide-Damicron Diphenhydramine syrup-Syrup Benadryl Paracetamol Tab-PCM Clorpheniramine-Piriton Slow moving Drugs Amiloride-Moduretic Potassium Chloride-Slow K Frusimide-lasix Prochlorperazine-stemetil 3 week Packaging Packaging work flow Indentify the packaging item Check from the Store record card for first out and second out items Check the date of manufacturing and expiration date Issused out the items Permission from senior Pharmacy assistant Fill the pre packaging work paper

My second week start with preparing and packaging.The oinment and creams such as Methylsalicylate oinment,aqueous cream.hydrocort cream are available in bulk container should packed in small oinment containers.The are diffrent expiration date for every packaging items.The Methlysalicylate oinment will expired in 6 month for the day the container open.Each container will consist 15mg of medicament.The container should labelled appropriaetly.The drug used for external application should cleary label"EXTERNAL USE ONLY" and "DO NOT EAT".There is also syrup packaging which should clearly labelled"SHAKE BEFORE USE". LMS 6month Betamatasone 6month Vaselin 3month Sodium silver Dinitrate 3month Solution Gargle Thymol gargle 15ml (3month) Syrup Mixture magnesuim Trisilicate 90ml(6month) Mouth wash Chlorhexidine mouth wash 30ml(3month) Preparation Of Solution

Erythromycine Syrup These Erythromycin is available as as reconstitution powder which have to prepare before dispensed.These erythromycin powder is easily soluble in distiiled water.First,dissolve the powder ingredient in small amount of distilled water.Shake the bottle vigrously to ensure the powder drug evenly diffused thoughout the liquid.Then,add more vehicle to produce final volume and transfer into bottle.Later,store in cool place in temperature 2-8C. 30ml (7 Days)

Tablets The tablet which availabe in blister packaging should be prepack in envolope for monthly supply.The tablet in blister and strips will follow the expiration date of the manufacturer.But,tablet in bulk container expires in one year from the day the medicines container opened .In the other case, such as glyceral trinitrate will expired in 30 days from the day the container opened. Tablet Counting Machine 4 week 5S PROGRAM This week i started to do 5S project which was given by our pharmacist.5S is a goverment project to standardise all the goverment clinic pharmacies.It's advantage for us to have earlier exposure of these concept.5S concept describes how to organize a work space for efficiency and effectiveness.There are 5 primary phase of 5S. Seiri-Separating.Discard and store the tools,meterials,stock which currently not in use.These leads to fewer hazards and less clutter to interfere with productive work Seiton-Sorting.Arrange the tools and meterials as it respective area which can eliminates extra motion.The arrangement of tools and equipment in an order could promote an effective workplace. Seiso-Shine.These refes the need to keep the workplace clean and neat.At the end of each shift,the work area is cleaned up and everything is return to its place.Maintaining the cleanliness should be the part of daily routine. Seiketsu-Standardizing.This refer to standardized work practise.These is more

to the systemic cleanliness. Shitsuke-Sustaining.Once the above 4S is established,they become the new way to operate.Maintain the new system and do not allow agradual decline back to the old ways of operating. PHOTOS 6 week LABELLING This week, my duty was labelling.Before I start to label, I have been taught the calculation for dose,duration, insulin calculation and the drug used before and after.During labelling, I was learned lot of information about the drug . Example:Acethylsalicylate 300mg (Aspirin) Prescription: Aspirin 150mg bd 4/12 Calculation:300mg/150mg x 30 days (monthly supply) Use Treat pain and reduse inflammation.Managment of rheumatic disorder like Rheumatoid arthiritis. Taken orally,since it irritate the stomach should be taken after food Should inform doctor if u planning for any surgery.Aspirin will increase the blood flow. Side effect: Aspirin causes nausea,vomiting,drowsiness and heart burn. The drug,Hydrochorthiazide should take in morning.These is because,HCTZ is a hypertensive which is moduretic group could increase the normal urine level.So,the patient will more comfortable to take this medicine in the morning.In the other case,Lovastatin in a cholestrol drug should only take at night.These is because,the cholestrol in human body will settle down at night and the drug can easily react.

Label 7 week INSULIN

These week, we have studied about the insulin available in KK Kajang.There are three type of insulin:Humulin R (Regular human insulin injection (rDNA origin) ) is a short acting insulin that has relatively short duration of activity as compared with other insulins Humulin N (human NPH insulin injection (rDNA origin) )is an intermediateacting insulin with slower onset of action and longer duration of activity than Humulin R. Humulin 70/30 (70% human insulin isophane suspension,30% human insulin injection (rDNA origin) ) is a mixture insulin.It is an intermediate acting insulin combined with the onset of action of humulin. INSULIN CALCULATION Example:Prescription:Mixtard 70/30 24u om/22uon bd 3/12 24unit+22unit x 30days /300unit =4.6 =5 vial of humulin 70/30 (monthly supply) Syrup Calculation Example: Prescription:Syr.PCM 110mg bd 5/7 110mg/125mg x 5ml =4.4 ml for 2 times a day In some cases we need to know the patient age and the body weight.These is to prevent the overdose for the patient. Calculation:Patient weight x 15mg/125mg x 5ml 8 week PRESCRIPTION ERROR During the labelling duties, I have taught to regonise error in prescription.The person who are labelled is responsible for countercheck the prescription for any error.We also need to double check for any wrong medication prescribe,

wrong dose or wrong duration.If we had any confusion on the prescription,immediatly we need to clarify from our pharmacist.Sometimes,the prescription is send back to the doctors who prescribe to double check if the error is not confirmed.Sometimes,we feel very hard to regonise doctors handwritting for the dose such as od,bd, on and om.If the prescription does not have the doctors signature it also consider as a prescription error. Importance:The strenght of the medication a.Metformin 500mg,Gliclazide 80mg,Glibenclamide 5mg The duration for the medication can supply maximum b.Amoxycillin can give maximum 1 week The type of humulin prescribe c.R,N,70/30 and the unit The dose of the medication d.For chilren below 9 years cannot take amoxycillin more than 250mg tds The drug interaction e.Perindroprill and enalaprill cannot prescribe togather f.Metformin and glibenclamide cannot prescribe togather with glucovance 9 week Integrated Drug Dispensing System Integrated Drug Dispensing System (SPUB) DEFINITION : SPUB is a referral drug dispensing service that facilitate the patients to obtain their next partial supply refill of medications in any Ministry of Health (MOH) facilities listed in MOH SPUB directory.

OBJECTIVES :

1.

To bring medication supply service closer to home.

2. To supply medication through standardised supply system through out MOH facilities. 3. To facilitate access for long term therapy and promote compliance.

SCOPE : This service is provided for patients receiving prescriptions for long term therapy from MOH healthcare facilities throughout the country.

WHAT DO YOU NEED TO DO ? Get your prescription after seeing your doctor Get the first supply of your medications from the outpatient pharmacy

Consult the pharmacy staff on appropriate hospital/health clinic to get your next partial supply refill of medication Make sure that your prescription has been stamped with the SPUB referral stamp before you leave the pharmacy counter CHECKLIST FOR NEXT SUPPLY : Appointment date of next supply Bring your prescription that has been stamped with SPUB Go to the hospital/health clinic that you have been referred to

SPUB IS FOR YOUR CONVENIENCE Closer to home Save time and travelling costs Uninterrupted medication supply FURTHER INFORMATION Please consult our pharmacy staff in any MOH hospitals/health clinics within your vicinity for further information. 10 week Program put and go pharmacy

Programme put and go pharmacy is introduce to reduce the time taken for the patient who coming every month to take their medicine.These programme also give the patient convinent time to take their medicine.But ther is only selected patient can register to this programme and it according to the terms and condition:Contain chronic drugs 5 or more The duration must 3 month and above Follow the appoinment date accurately More importants for OKU patients Work flow for Put and go pharmacy Understand the Programme put and go pharmacy Receive the prescription from doctor Registeration for put and go programme Received the put and go patient appoinment book write the full patient details in the prescription The pharmacist will record the prescription The appoinment date will given to the patient Pharmacist will prepare the medication and labelled Patient appoinment date Come to the appoinment counter Patient appoinment book Drug is dispensed These is very easy method to patient take thier medicine.I have a duty to fill the prescription and labelled the prescription.The prepared prescription will palced in the drower according to their appoinment.Every prescription will filled before one week for the appoinment.So,it also can reduce the pharmacist workload and prevent from medication error. 11 week Store managment

This week my duty was at store.First day in store we was learn about the store arrangement.Klinik kesihatan Kajang consist three different stores.First tore is the prescription record store.These prescription are place in box according to their date of the prescription dispensed.The dispensed prescription will divided into,chonic prescription,outpatient prescription,nurse prescription and also dental prescription.These will be easier to refer the prescription again if needed in future.The second store, is to stocking the syrups,types of injection,ear drops,eye drops,suppositories,pessaries.There also have the empty container for packing the medicament.The types of injection is placed in locked cabinet to prevent any accidental breakage.The suppository,pessary and types of drops is place in rak.The store temperature is 27C.The third store is to stocking the tablet form of drug and others.The other is represent the glucose,oral dehyration salt,and empty syringe.These store arrangement is according to the pharmacological system.The drug divided into endocrine drug,cardiovascular drugs,antibiotics,vitamin and more.Each store have different arragement with different drugs.The arragement of drug in store should not exceed 50cm from top.In store management we have learn about the FIFO system and indent system.The FIFO system is means the drug first out and the drug first in.These is according to the drug expiration date.The drug early expired date will used first and must placed infront of new drug during arrange the drugs.We also learn about the tagging system.We need to check the drug every week whether the drug going to finish or the drug near to expired or the drug is finish or the drug is expired.I have duty to check the drugs and the record have to send to the pharmacist to place the order if needed.If our store have more drugs that near to expired,my pharmasict will inform to PKD to share the drug with other Clinics which need the drugs.So,they can use the drugs before it expired.Then,the clinik will replace the drugs after they get the new drugs.From these process they can prevent the wastage of drug.Other than that we also learn about indent system.Indent is the recording sysyem for the drugs.Each drug have a card named bin card where we need to record the drug issused in and the drug issused out.Each drug that issused in must record the manufacturing date,expired date,batch number.We also have a range to drugs issused out such as the drug glibenclamide can issused minimum is 1 box and the maximum is 2 box only.During my duty on store,we also asked to do the 5S project.In 5S project,we had to do the new store layout,new masterlist of drugs and we have decorate the store. 12 week Drug Disposal and Return Drugs. This week I still remain in store,this time I lear abot the drug disposal and retun drug process.The drug swhich have been expired, should be disposed properly.the drugs in blister and strips packagind I need to peel out the

tablets.Then, the tablets is put into the plastic bag and water is pour into the plastic bag to let the drugs dissolve.Later,the drug in thrown into drug dispose bin.For the syrups,i need to open the bottle and pour the medicament into the sink and flash out properly.The bottel should thrown in recycle bin.Moreover I also learn about the return drug process.Return drug means,the drug return by the patient when they not used.These process and reduse the drug expenses. Receving the drugs Checking the expired date Discard the expired drugs Checking the drugs in good condition Recording the drugs in Replaced the drugs Placed infront for first out. 13 week This week my duty was filling the prescription and labelling the prescription.I feel very easy to filling the prescription because I have learn before.This time I have learn to label the chronic drugs.I have giude by my pharmasict and she double check tne drug I have labelled.After that,I also learn about discharge pateint drugs and HIV pateint drugs system.These Discharge pateint drug is where yhe patient continue the drug at our clinic.The drugs will received from the hospital where they have been admit.The hospital will send the medicine for 3 month in a plastic bag.They have written the name and registration number of the patient above the plastic bag.To fiiling these type of prescription we need to:Refer discharge patient list Check the name and registration number Find the patient plastic bag Confirm the drugs prescribe Record the drug out Supply for 1 month These process is same to filling the HIV patient drugs.These drugs will be

double check by our pharmasict before labelling.These week I have to issuse out the medicine from store and inform my pharmacist to placing the order for the drugs.In store,I have learn about APPL and LP drug.APPl is a goverment budget drug which the order of this drug can only sent to PKD hulu langat.From the PKD,they will sent the reqiured amount of drugs.If the drug is no enough for our pharmasict,we need to send our stock requesed to other clinics with the permission of PKD.When, we receiving the drugs,we need to check the drug and issused in the drugs.We also need to replace the drug if we have borrow the drug from other clinics. 14 week Dispensing This week my duty was dispensing.During I dispensing the medicine a pharmasict will guide me to explain the drug information to the patient.From these,I also have a chance to learn more about the drugs.I also have learn about 5R process which is very impotant during dispensing. Ask for the counter number check the prescription number Check the prescription Right patient Right dose Right route monthly supply g.Give the next appoinmet to take medicine h.Reconfirm the doctors appoinment i.Return the prescription to patient Full supply Sign the prescription as dispenser Placed in dispensed prescription box Record the total drug dispensed As a dispenser I need to double check each drug against the prescription and

the label of the drugs.I also need to calculate the dose for syrup if I dispensed to babies and children to avoid overdose.There are some special instruction that i should gave to patient.Foe example,dispensing suppository:The PCM suppository need to used for babies who having high fever.If the baby have taken parecetamol syrup they cannot give these PCM suppository.These both drug cannot use togather because can lead to overdose.The person who inserting the suppository must make sure their hand is clean and insert in rectal.The baby should not have more movement after inserting these drug so it is advisible to use at night.