Hospital Pharmacy I - Key Concepts and Processes

Pharmaceutical Care

  • Definition: Responsible provision of drug therapy to achieve definite therapeutic outcomes that improve patient's quality of life.
  • Therapeutic Outcomes:
    • Cure of disease
    • Elimination/reduction of symptoms
    • Arresting/slowing disease process
  • Patient-Oriented: Prevents Drug Related Problems (DRPs).
  • Integrated care with healthcare professionals
  • Continuous, systematic, and documented care
  • Optimizes patient's health and Quality of Life (QoL)
  • Emphasizes patient health education and promotion
  • Pharmacist's Role
    • Identifying potential and actual drug-related problems.
    • Resolving actual drug-related problems
    • Preventing potential drug-related problems.

Functions of Pharmacist/Pharmacy Assistants

  • Collection of patient data
  • Identification of problems
  • Establishing outcome goals through a therapeutic plan
  • Evaluating treatment alternatives, by monitoring and modifying therapeutic plan.
  • Individualising drug regimens
  • Monitoring outcomes

Role of Pharmacy Assistant

  • Identify patient problems and understand diseases
  • Prepare and dispense medications correctly to avoid DRPs (errors)
  • Educate patients on medication use and promote healthy lifestyles
  • Ensure proper completion of documents related to patients’ medication
  • Participate in quality improvement activities for medication safety

Dispensing

  • Definition: Supplying medicines based on a prescription with clear instructions and advice
  • Involves interpreting the prescriber's wishes and accurate preparation and labeling
  • Good dispensing practice ensures the right medicine of desired quality is delivered correctly to the right patient with appropriate instructions and packaging

Principles of Dispensing

  • Dispensing personnel (Pharmacist, Pharmacy Assistant, Nurse / Medical Assistant ,Doctor).
  • Patient.
  • Valid Prescription.
  • Medication.
  • Environment.
  • Communication Skills.

Dispensing Process

  • Screening
  • Preparation
  • Labeling
  • Checking
  • Dispensing

Screening

  • Receiving & Validating Prescriptions
    • Check patient & prescription details.
  • Understanding & Interpreting the Prescriptions
    • Check patient details, date, drug regimen, prescriber details & signature.
    • Dose, frequency, and duration
    • Drug interactions, allergies, medicine duplication.
  • Handling Queries
    • Contact prescriber and confirm.
  • Handling Out of Stock Situation
    • Contact prescriber and confirm alternatives.

Preparation

  • Filing
  • Extemporaneous Preparation / Compounding
    • Follow approved formulation and check calculations.

Labeling

  • Labels should be printed; if handwritten, be neat and legible.
  • Relevant information includes clinic/pharmacy name, patient’s name, medicine name, dosage form, directions for use, date of supply, expiry date
  • Special labels.

Checking

  • Check the prescription and the filled medicines by ensuring that:
    • Filled medicines match the prescription
    • Name of the patient is correctly written
    • Directions for use on the label matches the prescriber’s instructions
    • Date of expiry is available on label or packaging
  • Have a second person to double check before dispensing

Dispensing (Effective)

  • Check name and ID to confirm correct prescription items are received by the correct patient.
  • Give clear instructions and proper advice on how to take/use the dispensed medicines.
  • Ensure the patient understands transportation, storage conditions, and usage requirements.
  • Provide compliance aids (measuring spoon or syringe), if required

5 R's

  • Right Drug
  • Right Dose
  • Right Route
  • Right Time
  • Right Patient

Key Checks

  • Confirm correct patient by two identifiers: name & IC/MRN
  • Recognize brand and generic names
  • Confirm any abbreviations used by prescribers
  • Look alike Sound Alike (LASA) drugs
  • Certain drugs to be taken at a certain time of the day
  • Confirm correct dosage form supplied to patient as per prescribed

Dispensing for Elderly

  • Problems: Non-compliance, confusion, forgetfulness
  • Suggestions: Liquid preparations, easy-to-open containers, simple instructions, pill boxes

Dispensing for Children

  • Problems: Refusal to take medicine, vomiting, unable to swallow
  • Suggestions: Once or twice daily dosing, syrup (consider storage, shaking, content), suppository formulation, mixing with drinks/food

Medication Error

  • Preventable event that may cause or lead to inappropriate medication use or patient harm.