Community pharmacy course

Topic: 1
Introduction to community
pharmacy
( definitions, practice, ethics, communication
skills, and pharmacy design )

1
• A pharmacy: is the health profession that links the
health sciences with chemical sciences and it is charged
with ensuring the safe and effective use of
pharmaceutical drugs..

• Pharmacy practice includes:

• Compounding and dispensing
• Clinical services
• Reviewing medications for safety and efficacy
• Providing drug information
• Pharmacist ,therefore, are experts on drug therapy
and are primary health professionals' who optimize
medication use to provide patients with positive
health outcomes
2
• Pharmacy Chemists Drug store
• Pharma ( 1400-1600s), retail shop for
medicines, sold tobacco, herbs
• Pharmacists practice in a verity of areas
including retail, hospitals, clinics, drug
industry, …..
• Pharmacists can specialize in various areas of
practice such as hematology, infectious
diseases, drug information…..

3
Pharmacy fields include:
1. Community pharmacy

2. Hospital pharmacy/ may have more complex clinical

mediation management (drug interactions, effectiveness, compliance in hospital and home ….)
/ include more specialized mediations/unit dose /
complex process ( TPN)

3. Clinical pharmacy: direct patient care service/hospital

&clinic

4. Compounding pharmacy: preparing drug in new form

,manufacturer, mixing strength of drugs in hospital or
community pharmacy/ found at community or hospital
pharmacy 4
5. Consultant pharmacy: focus more on medication
regimen/ elderly people at homes.

6. Internet pharmacy/online services with lower costs

/ valid prescription youth & control drugs /

7. Veterinary pharmacy

8. Military pharmacy

9. Nuclear pharmacy: focus on preparing radioactive

materials/need special training/ no direct
interaction with patient
5
Future of pharmacy
• Pharmacist become more integral within the health
care system.
• Paying attention toward the patient health, general
wellness, counseling, and drugs related matter.
• Medication therapy management (MTM): teaching
clinical services that pharmacist can provide for
patients/ to increase patient health outcome and
decrease costs of health care system.
• Ex:
- Australia: Austrian government for conducting comprehensive home
medicines reviews
- UK: pharmacist additional training
- USA: pharm D, 2 year residency for pharmacist 6
 Community pharmacy
• is a healthcare facility ( pharmacy, chain pharmacy,
department) that emphasizes providing
pharmaceutical services to a specific community. It
dispenses medicine and typically involves a
registered pharmacist.
• Pharmacy automation: involves the mechanical
processes of handling and distributing medications
• A community pharmacist
• Is responsible for dispensing and distributing medicine.
• They work to legal and ethical guidelines to ensure the
correct and safe supply of medical products even OTC
to the general public. providing advice and information
7
• Some pharmacists will offer specialist health checks, such
as blood pressure monitoring and diabetes screening.

• Pharmacist cant form business partnership with physician

• The prescribing and dispensing functions of physicians &

pharmacists emphasize the differences in control each
has over medications.
• Pharmaceutical care Pharmaceutical care
• defined as:
‘the responsible provision of drug therapy for the
purpose of achieving definite outcomes that
improve a patients quality of life’
8
 Drug information
• Pre-packaged medicines contain written inserts
giving detailed instructions for their use.

• Pharmacists compete with other sources of advice

and information such as doctors, the media and
community.
The open and wide availability of alternative sources of advice and information

• Ensure the individual patient’s informational

requirements are met, tailoring written information

9
 Legislation
Pharmacists practicing at the pharmacy are
registered with a registering body.
Process of community pharmacy practice is
controlled by legislation.
Legislation classifies medicines according to:
o category of medicines that may be sold from
other outlets (such as drugstores) not only
pharmacies

10
o category of medicines that may be sold after
being recommended by pharmacists
o category of medicines that require a
prescription
o category of medicines that are controlled (e.g.,
fentanyl, methadone).

Pharmacy services must be available for 24

hours, 7 days a week. Rosters are issued for
night-time service and for service on public
holidays.

11
 Actions of community pharmacists
in society
• Buying of medicines
• Storage of medicines in appropriate conditions
(temperature, humidity, cleanliness, stock monitoring)
• Dispensing of medicines
• Compounding and ensuring quality of compounded
products
• Patient medication review, advise patients on use of
medicines and participate in adverse drug reaction
reporting
• Ensuring rational and safe use of medicines by
patients
12
• Monitoring of self-care, responding to symptoms and
identifying cases warranting referral
• Point-of-care testing
• Health promotion and promotion of healthy lifestyles
(nutrition, physical activity, smoking cessation, sexual
and reproductive health)
• Participating in national health service schemes to
provide social pharmacy services
• Other responsibilities: nutritional supplements, special
foods (e.g. gluten-free products, food for diabetic people), colostomy
care and urinary incontinence devices, disability and
mobility aids (e.g. wheelchairs, walking aids), oxygen supplies
and ventilation equipment, veterinary medicines.
13
counseling and responsibilities of community
pharmacist
1. Counseling : drug related problems, proper use of OTC
and prescribed mediations, immunization schedule….
2. Pharmaco-epidimology: post marketing phase of
clinical trial of a drug, which concern with a new drug
safety after marking.
3. May involve in the control of diseases, by making
community a ware through counseling ( AIDS,TB, hepatitis….)
4. Encouraging patient to prevent them selves from
various chronic diseases by using proven techniques of
prevention (decrease risk of stroke by controlling BP) regular
intake of prescribed medicine, quitting smoking,
increase physical activity , lowering cholesterol intake

14
5. May involve in patient health education through the
use of pamphlets and bulletins.

6. Provide counseling to pregnant ladies about material

and child health, family planning, management of
pregnancy, diet, guiding parents for the protection
child against disease by proper immunization
schedule.

7. May guide patients about nutrition intake according

to the requirements of the patient and disease state .

8. Can make community aware about environmental

health like food born disease, carcinogenic…

9. Provide counseling to the persons involved in

alcoholism, smoking cessation, and drug abuse 15
Summary of the areas where a pharmacist
can involve in public health through
community pharmacy
• Drug and nutrition counseling
• Use of OTC and prescribed medicines
• Family planning
• Pregnancy and infant car
• Immunization
• Sexually transmitted disease counseling
• Toxic agents control
• Health and safety
• Control of accidental injures
• Prevention of smoking, alcoholism, and drug abuse
• Environmental protection
• Weight control program
• Poising and cancer detection
16
 Code of ethics
• Moral ‘’the conduct of individuals in any society is
governed by the environment controls on the one
land and social customs and duties on the other”
• Code of ethics = code of moral principles= science of
moral
• Governments restricts the practice of the pharmacy
to who's qualified under regulatory requirement and
grant them privileges necessarily denied to other.
• In return, government expects the pharmacist to
recognize his responsibilities and fulfill their
professional obligations honorably and with due
regard for the well being of the society.
17
 Duties of pharmacists
1. pharmacist in relation to his job:
• Pharmaceutical services: supply of commonly
required medicines without delay, and involve
emergency supplies at all times.
• Conduct (management) of the pharmacy:
arrangement in the pharmacy should be grade
to avoid risk or error of accidental
contamination preparation ,dispensing or
supply medicines . There should be a
pharmacist in personal control of the pharmacy.
18
• Handling of prescriptions: prescription should be
received by a pharmacist without any comment over it
regarding the style or its therapeutics efficiency. Any
question on the prescription should be answered with
caution and care. Its not within the privilege of the
pharmacist to add, omit, or substitute any ingredient or
other the composition of a prescription should be taken.

• Apprentice pharmacist: the apprentice trainee is given

full facilities for their work, so that completion on their
training they have acquired sufficient technique and skill
to make themselves dependable pharmacists

19
Steps of dispensing a prescription in a
community pharmacy:
Receiving the prescription: At this stage,
communication and interaction with the pharmacy
staff take place
Reading and checking of prescription
-patient’s name and address
-age of patient if under 12 years
-name, dose and quantity of medicine
-Date
-prescriber’s name and address
-signature of prescriber
-legality and authenticity of document.

Collection of medicine: care in selecting appropriate

medicine, strength, and dosage form.
20
Label production: Details to be included on label:
• patient’s name
• date of dispensing
• name of pharmacy
• name of medicine
• strength
• dosage form
• quantity dispensed
• dose with clear instructions
• cautionary labels.
Rechecking Recheck that the prescription and the
medicine prepared are consistent
Handing over the medicine: The pharmacist
explains to the patient when and how to take the
medication.

21
Factors influencing health promotion
activities in community pharmacies
Positive factors
Environment within the pharmacy
Health promotion
Access to parts of the pharmacy
Communication skills of community pharmacy

Negative factors
Lack of resource materials
Lack of space
Lack of privacy
In appropriate time management of the pharmacy
22
 Communication with patient
• Patient counseling is undertaken by pharmacists:
• during dispensing, in disease management, in providing
advice on self-care: advice on product selection and use,
non-drug , referral and health assessment.

• Pharmacist actions in communication with patients

1. Ensuring safe and correct use of medicines
2. Responding to symptoms
3. Discussing patient health-related and social problems
that impact on health status
4. Empowering individuals to be active in health
promotion and preservation.
23
• Communication process

• Understanding needs of individual: (e.g. social problem

associated with occurrence of acne may impact differently on individuals).
• Professional Relationship building: friendliness and warmth,
Provide reassurance, Preserve confidentiality.
• Non-verbal communication and body language : Close
conversational distance, Direct eye contact, forward leaning posture, Smiling,
voice tone
• Questioning and listening: Use effective questions by asking open
questions to obtain information that is necessary, Ask only one question at a
time, Encourage patient participation, Practice active listening.,
• Responding and explaining: Place the most important points at
the beginning of the communication session, Give specific instructions,
Simplify complicated messages. Give care to Patient characteristics such as
speech defect
24
25
• Counseling in the community pharmacy
setting

26
• Staff (personal): Training
• important aspects of developing an efficient
operating community pharmacy / proper training/
maintenance of employees.

• Following criteria should be followed during the

selection of the staff for community pharmacy:
1. Minimum standard of qualification
2. “over hiring” means superior people should not be
hired for inferior jobs, this type of selection may
result in an adverse effect on staff moral and
efficiency
3. Developing a job description and specification for
each position to avoid misunderstanding about the
nature of duties
27
4. Promotion within a pharmacy staff may be
appropriate
5. Availability file( a record of qualified peoples who
applied for job) should be maintained in pharmacy.
6. Owner or manager of the pharmacy should design
an application form to assist in the selection
process, to serve a guide during interview, and
permanent record of employee
7. All the employment polices and procedures must be
consist with applicable laws
8. Compensation: retraining good employees is one of
the most difficult problems faced by the community
pharmacy manger/ compensation plan to
encourages employee to work toward all goals and
objectives of the pharmacy

28
( Discussion should be on the basis: goals, expected
working hours, lunch brick, overtime safety
rules, telephone usage, vacation policy….)

To increase productivity and reduce employee

turnover
Sink or swim method of training is insufficient to pick
up knowledge on the job.
there are effective simple training methods , a new
employ is assigned to a capable experienced
employee who explains and demonstrate the job.
Conference method can also be used.

29
2. Pharmacist in relation to his trade:
• Price structure: fair/keeping with quality and
quantity.
• Fair trade practice: NO short prices, gifts, charging
lower prices than fellow pharmacist, NO copy of
labels, trademarks, and other signs and symbols of
other contemporaries.
• Purchase of drugs: purchase drug from genuine and
reputable source.
• Advertising and displays: (NO)misleading statements
or guarantee of therapeutic efficacy or take a
reference from medical team of hospital or a Dr
which not already established, offering prizes, ….
30
3. Pharmacist in relation to medical profession
• Limitation of professional activity: which is diagnosis
diseases and prescribing medications/ in case of accidents
or emergency a pharmacist may, however render first aid
to patient.
• Secret arrangement: NO pharmacist should enter into a
secret arrangement or contract with a physician, to offer
him any commissions or any advantage by recommending
his drug store even his self to patients.
• Communication with public: being a link between medical
profession and people, a pharmacist always keep himself
updated by regularly reading books, journals… should
never disclose any information unless required the low.
31
 Community pharmacy management
1. Selection of site space layout and design
• During the selection of a site for new pharmacy
following factors should be considered:
a. A needy town or a city should be selected
b. Site should be most suitable among those available
pharmacies.
c. Site should be convenient and accessible to the
majority of consumers (center to population severed)
d. Pharmacy site should be equipped with adequate free
parking facility.
e. If possible, site should be in neighborhood of a
community shopping center for the convenience and
accessibility of the consumers 32
2. Plan of an ideal retail and whole sale drug store
• One of the main factors responsible for the success of a
drug store is location and proper layout design

• Objective of layout design:

- To attract a large number of customers
- To increase the sale of store
- To reduce the selling expanses to the minimum
- To provide the customer satisfaction
- To have space for reserve for stock, office, and resting place for
employees
- To have a proper entrance for coming goods
- To project a professional image and improve general appearance
- To minimize the movement of customers with in the premises of
the drug store
33
• Community pharmacies usually consist of:
1. A retail storefront with a dispensary area where
medications are stored and dispensed.
2. A pharmacist on-duty at all times when opened
3. Pharmacy technicians while the pharmacist spends more
time in communication with patients

Owner of pharmacy must be

a registered pharmacist
(R.Ph)

34
1. Personnel present: managing pharmacist,
pharmacists, technicians/ identifying training needs
and providing appropriate training
2. Buildings : areas available for dispensing, storage of
medicines, patient counseling.
3. Equipment: dispensing equipment, diagnostic
equipment for point-of-care testing (e.g. blood pressure
measurement, blood testing, urinalysis)
4. Documentation and information: registers to be
kept at the pharmacy, IT-supported systems for
documentation of pharmacist actions and for
maintaining pharmacy patient profiles, drug
information sources (books and electronic access).

35
• Dispensary area
• Area should be spacious and designed in such a way as
to promote communication between pharmacist and
patient.
• Space should be available for patient advice and
counseling in privacy.
• Consultation areas should provide for space to carry
out point-of-care testing.
• Adequate facilities for dispensing must be provided –
cleanable floor and surfaces, adequate fixtures and
fittings, clean refrigerator with appropriate
temperature monitoring and control, clean sink, logical
layout of stock and a normal workflow.
36
37
• The legal requirements for the establishment
of retail drug store are:
 General licenses: granted to persons who
have the buildings for the business and the
services of a qualified person to supervise
the sale.
- Should be displayed in prominent place
- Should comply with provisions of drugs and cosmetics act and rules.
- Any change in qualified staff should be reported.

 Restricted licenses: the license for restricted

sale of drug
- Drugs only are purchased from a licensed manufacture

- Drugs should be sold in their original container

38
Importance of stocking for drug store
• Drugs are stored in alphabetical order
• It provides a channel for distribution of drugs
• It provides space for storage of drugs or
materials and supplies
• Drugs are readily available for administration
• Vaccine and antibiotic drugs are stored in
refrigerator

39
Maintenance of various registers( records)
in community pharmacy
1. Legal records: disposition of drugs, distribution
of poison and hazardous substances
2. Patient record: patents drug history (type and
amount)/ reducing drug problems and
interactions
3. Financial records: loans, expenses, income….

40
Using computer in community pharmacy
Functions of computers in community pharmacy:
1. Systemic : preparation of prescription level, provide a
receipt for patient, calculation of total prescription cost,
order quantity….
2. Managerial: daily sales reports, sales and financial
analysis….
3. Professional: storing of information on drug and other
allergies of patients, drug-drug/food interactions, address
of physician and phone number.
4. Clinical support: patient education file, pharmacists
counseling activity, drug monitor.
5. Accounting and business management: record keeping/
analysis

41
 References:

1.A Textbook of community pharmacy: new age

international publishers, rakesh saini, 2012,
chapter: introduction, chapters: introduction, 1

2.Lecture notes in pharmacy practice, Lilian M

Azzopardi, 2010, part1: chapters: 5,6,7,8.

42