INDUSTRIAL TRAINING REPORT

Submitted to the

H.K. COLLEGE OF PHARMACY

For the Training undertaken at

SAIFEE HOSPITAL

By

GHANCHI SUFIYAN

Third Year B.Pharm.

Roll No. 16

INDUSTRIAL TRAINING REPORT

Submitted to the

H.K. COLLEGE OF PHARMACY

For the Training undertaken at

SAIFEE HOSPITAL

By

DHRUV ABHISHEK

Third Year B.Pharm.

Roll No. 12

INDUSTRIAL TRAINING REPORT

Submitted to the

H.K. COLLEGE OF PHARMACY

For the Training undertaken at

SAIFEE HOSPITAL

By

PARAB MAHADEV

Third Year B.Pharm.

Roll No.45

STATEMENT BY THE STUDENT

I, Mr. Ghanchi Sufiyan, third year student of H.K. College of Pharmacy, hereby state that I have completed the

industrial training of four weeks at SAIFEE HOSPITAL from 30th May 2016 to 29th June 2016 as required by

University of Mumbai for the Academic Year 2015-2016. The industrial training report submitted to the college is

true to the best of my knowledge.

Name of the student: Ghanchi Sufiyan

Signature:

Date:

Checked by

Dr. Anagha Raut/ Dr. Iram Nazish

STATEMENT BY THE STUDENT

I, Mr. Dhruv Abhishek, third year student of H.K. College of Pharmacy, hereby state that I have completed the

industrial training of four weeks at SAIFEE HOSPITAL from 30th May 2016 to 29th June 2016 as required by

University of Mumbai for the Academic Year 2015-2016. The industrial training report submitted to the college is

true to the best of my knowledge.

Name of the student: Dhruv Abhishek

Signature:

Date:

Checked by

Dr. Anagha Raut/ Dr. Iram Nazish

STATEMENT BY THE STUDENT

I, Mr.Parab Mahadev, third year student of H.K. College of Pharmacy, hereby state that I have completed the

industrial training of four weeks at SAIFEE HOSPITAL from 30th May 2016 to 29th June 2016 as required by

University of Mumbai for the Academic Year 2015-2016. The industrial training report submitted to the college is

true to the best of my knowledge.

Name of the student: Parab Mahadev

Signature:

Date:

Checked by

Dr. Anagha Raut/ Dr. Iram Nazish

ACKNOWLEDGMENT

I consider it a great privilege and honour to have had the opportunity to undergo the industrial training work in

Saifee Hospital. Hence, I would like to offer my heartiest thanks to Sachin R. Mayenkar, Sr. Manager (HRD).

I am greatly indebted to Mrs. Zarine Khety (H.O.D.), Prof. Dr. Anagha Raut and Dr. Iram Nazish for enabling us

to have the chance of industrial training and arranging such a nice arrangement.

I convey my heartiest thanks to Mrs. Shweta Verma (Administrative Officer), Mrs. Sarika Jadhav (Assistant

Manager), Mrs. Rageshree Bodad (Senior Executive Pharmacist), Mrs. Jyotsana Shede (Senior Pharmacist), Mr.

Saif Shaikh (Counselor), Mr. Abbas Dorajiwala (Assistant) for their most valuable suggestions, constant

encouragement, and affectionate guidance during the period of this training.

I owe deep gratitude to the chemist Mrs. Gauri Parab, Mrs. Shakil Farooqui, Mr. Abdul Shaikh and Mrs. Rashmi

Gadekar for their support and guide to carry out the tasks assigned to us while we are in the training. At last, I am

greatly thankful to all my seniors and colleagues in OPL for extending their constant cooperation which went a

long way towards the completion of this Training and Report.

TABLE OF CONTENTS

SR. NO. CONTENTS Page No.1. Introduction 1-22. Hospital Pharmacy 33. Out Patient and In Patient Pharmacy Department 44. Prescription and Its Handling 5-75. Storage of Drugs in Pharmacy 8-96. Look Alike Sound Alike (LASA) 10-117. Bar-coding 128. First Expiry First Out (FEFO) 139. Inventory Control and Stock Checking 14-1610. Central Sterile Service Department (CSSD) 17-2311. Seminars 2412. Project 2513. Conclusion 26

INTRODUCTIONThe Saifee Hospital is a hospital built in the Charni Road region of Mumbai, India. Syedna Mohammad

Burhanuddin dedicated the hospital to the memory of his revered father, Syedna Taher Saifuddin.

The old Saifee Hospital was functioning since 1948, thereafter, the Saifee Hospital Trust decided to build a new

hospital on the existing premises. Construction commenced in 2001 and the Hospital and was commissioned 4TH

June 2005 in the presence of the erstwhile Honorable Prime minister of India, Manmohan Singh.

It is a 250 bedded multi-specialty tertiary care hospital providing medical, surgical, diagnostic and therapeutic

services. The specialties range from simple Day-care procedures to complex Cardiac surgery and acute care

emergency medicine.

There are 37 beds Critical Care Units, 4 beds High Dependency Unit for critical patients, 9 State of the art

Operating Theatre suites with International Infection Control Protocols.

The Hospital is based on the unique philosophy to extend world class Preventive, Curative and Holistic care to

individuals from every strata of society in a safe, ethical and affordable manner with : 

 • World Class Infrastructure

    • Highly skilled medical professionals

    • State of the art medical equipment

The vision of the Hospital is based on the precept of two important criteria namely:-

  • Quality of Care

    • Safety of patients

FEATURES

Medical, Surgical, Diagnostic and Therapeutic care services are all provided under one roof.

The specialties range from simple Day-care procedures to complex Cardiac surgery and acute care

emergency medicine.

37 beds Critical Care Units, 4 beds High Dependency and 9 State of the art Operating Theatre suites with

International Infection Control Protocols.

The ROYAL SUITE 52 offers exclusive facilities with ultimate comfort and luxury.

The Department of Imaging is equipped with 1.5 Tesla MRI with TIM technology which performs a

whole body scan in 8 seconds and CT scanner with 40 slice capability.

Physiotherapy, Rehabilitation and Wellness Centre for treatment of sports injuries with PRIMUS which is

the first equipment of its kind in India.

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The physiotherapy department is a state of the art department fully equipped for treatment of

Neurological, Cardiac, Pulmonary, Pediatric and Ortho Rehabilitation patients along with Antenatal and

Postnatal Training.

Alternative medicine treatments like Yoga, Homeopathy, Steam, Sauna, Ayurveda and Ayurvedic

massage therapy.

Gymnasium offers Health fitness assessment, body composition analysis and personal fitness training

with modern equipments.

OPD and Daycare Services are manned by a team of highly qualified, efficient and committed

Consultants and Paramedical staff.

Health Check-Up packages are dedicated to adding years to your life through early detection of diseases

and identification of unhealthy life style practices.

Cardiac Rehabilitation Program helps develop healthier lifestyles and recover from heart diseases.

RECENT DEVELOPMENTS

Inauguration of a state of the art Minimal Invasive Surgery Theatre “Aqeeq” which has India's first full

HD (1920x1080) Integration System, the Arcadis Orbic 3D which can be equipped with Navilink 3D1, the

direct 3D navigation interface.

An isolation unit for high dose radioactive iodine treatment for thyroid cancer patients.

Specialized Clinic for Female Uro Genital Problems.

Saifee Hospital is now associated with a home healthcare company that focuses on post-hospitalization

care.

2

Hospital pharmacy

Pharmacies within hospitals differ considerably from community pharmacies. Some pharmacists in hospital

pharmacies may have more complex clinical medication management issues whereas pharmacists in community

pharmacies often have more complex business and customer relations issues.

Because of the complexity of medications including specific indications, effectiveness of treatment regimens,

safety of medications (i.e., drug interactions) and patient compliance issues (in the hospital and at home) many

pharmacists practicing in hospitals gain more education and training after pharmacy school through a pharmacy

practice residency and sometimes followed by another residency in a specific area. Those pharmacists are often

referred to as clinical pharmacists and they often specialize in various disciplines of pharmacy. For example, there

are pharmacists who specialize in hematology/oncology, HIV/AIDS, infectious disease, critical care, emergency

medicine, toxicology, nuclear pharmacy, pain management, psychiatry, anti-coagulation clinics, herbal medicine,

neurology/epilepsy management, pediatrics, neonatal pharmacists and more.

Hospital pharmacies can often be found within the premises of the hospital. Hospital pharmacies usually stock a

larger range of medications, including more specialized medications, than would be feasible in the community

setting. Most hospital medications are unit-dose, or a single dose of medicine. Hospital pharmacists and trained

pharmacy technicians compound sterile products for patients including total parenteral nutrition (TPN), and other

medications given intravenously. This is a complex process that requires adequate training of personnel, quality

assurance of products, and adequate facilities. Several hospital pharmacies have decided to outsource high risk

preparations and some other compounding functions to companies who specialize in compounding. The high cost

of medications and drug-related technology, combined with the potential impact of medications and pharmacy

services on patient-care outcomes and patient safety, make it imperative that hospital pharmacies perform at the

highest level possible.

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OUT PATIENT AND INPATIENT PHARMACY DEPARTMENT

An outpatient pharmacy is a pharmacy which fills prescriptions for patients affiliated with the pharmacy's parent

medical institution, typically a hospital or clinic. Usually, these facilities will only fill prescriptions related to

medical treatment at the parent facility or one of its outpatient clinics, which fills prescriptions for anyone.

Hospitals usually offer outpatient pharmacy services as a convenience to their patients, and sometimes to staff as

well.

Inpatient pharmacies departments were the dispensing of the medicines to the patients admitted in the hospital for

more than 24 hours. The order comes to the IPD and the dispensing is done according to the need of the patient in

the ward. For inpatient dispensing floor stock and ward stock system is arranged, also satellite pharmacy is

developed for easy and fast dispensing of medication.

The rules about who may get prescriptions filled at an outpatient pharmacy vary, depending on the pharmacy's

policies. Usually, people who are hospitalized may fill their prescriptions there, along with people who have just

been discharged with prescriptions which need to be filled. In addition, the pharmacy handles prescriptions from

people in outpatient therapy, and many also fill prescriptions for the staff of the hospital.

As with other types of pharmacies, an outpatient pharmacy can usually handle written prescriptions as well as

prescriptions which are phoned in. Due to the need to compound complex drugs in a hospital facility, these

pharmacies may also be able to offer specialty drugs and preparations to their patients, rather than having to

special-order them.

There are several advantages for patients who use an outpatient pharmacy as opposed to a regular pharmacy. The

first is that the pharmacy is on the same site where they receive medical treatment, so they do not need to make an

extra trip to the pharmacy to pick up prescriptions. The second is that the pharmacy staff is usually very

knowledgeable about the patient's condition, and the staff can quickly catch potential drug conflicts and other

issues which may arise. The pharmacy may also offer discounts on prescriptions. Hospital staffs may also take

advantage of outpatient pharmacy services, picking up the prescriptions they need at work. Pharmacy services

may also be a part of employee benefits, with employees receiving prescriptions at reduced cost as part of their

health plans. Employees who choose to fill prescriptions elsewhere may certainly do so, but they may be obliged

to pay full cost for the drugs .In addition to an outpatient pharmacy, some hospitals also have

an inpatient pharmacy, which specifically fills prescriptions for people who are hospitalized. The inpatient

pharmacy is often in a different area of the hospital than the outpatient one, and it may only be open to authorized

personnel, with doctors and nurses picking up prescriptions for their patients. This pharmacy also synchronizes its

records with the outpatient pharmacy to ensure that the patient's data is always up to date.

4

PRESCRIPTION AND ITS HANDLING

A prescription is a health-care program implemented by a physician or other qualified health care practitioner in

the form of instructions that govern the plan of care for an individual patient. The term often refers to a health

care provider's written authorization for a patient to purchase a prescription drug from a pharmacist.

Prescriptions may be entered into an electronic medical record system and transmitted electronically to a

pharmacy. Alternatively, a prescription may be handwritten on preprinted prescription forms that have been

assembled into pads, or printed onto similar forms using a computer printer. In some cases, a prescription may be

transmitted from the physician to the pharmacist orally by telephone; this practice may increase the risk of

medical error. The content of a prescription includes the name and address of the prescribing provider and any

other legal requirement such as a registration number (e.g. DEA Number in the United States). Unique for each

prescription is the name of the patient. Each prescription is dated and some jurisdictions may place a time limit on

the prescription. In the past, prescriptions contained instructions for the pharmacist to use for compounding the

pharmaceutical product but most prescriptions now specify pharmaceutical products that were manufactured and

require little or no preparation by the pharmacist. Prescriptions also contain directions for the patient to follow

when taking the drug. These directions are printed on the label of the pharmaceutical product.

'℞' is a symbol meaning "prescription". It is sometimes transliterated as "Rx" or just "Rx". This symbol originated

in medieval manuscripts as an abbreviation of the Late Latin verb recipe, the imperative form of recipere, "to

take" or "take thus". Literally, the Latin word recipe means simply "Take...!" and medieval prescriptions

invariably began with the command to "take" certain materials and compound them in specified ways.

Folk theories about the origin of the symbol '℞' note its similarity to the Eye of Horus, or to the ancient symbol

for Zeus or Jupiter, (♃), gods whose protection may have been sought in medical contexts.

The word "prescription", from "pre-" ("before") and "script" ("writing, written"), refers to the fact that the

prescription is an order that must be written down before a compound drug can be prepared. Those within the

industry will often call prescriptions simply "scripts".

A prescription should include:

* Name, address, telephone of prescriber

* Date

* Generic name of the drug, strength

* Dosage form, total amount

* Label: instructions, warnings

5

* Name, address, age of patient

* Signature or initials of prescriber

HANDLING OF PRESCRIPTION:

1. Receiving

When a pharmacy first receives a prescription, they must check that the prescription is valid and that the prescriber

has prescribed within their remit. 

2. Reading

Patient’s name and address In many cases only the patient’s name was given, or perhaps the patient’s position in

life, for example, Lady Smythe’s cook, Mrs. Jones’ baby. The address was not compulsory in some categories of

medicines. The sign is an abbreviation of ‘recipe’, which in Latin means ‘take thou’.Ingredients The medicinal

ingredients are listed with a quantity in weight, volume, percentage or proportion. M ft Misce fiat – mix and make.

Directions from the prescriber indicating the form in which he requires the prescription to be dispensed, for

example, a mixture, an ointment, a pill etc. The illustrated example states “Fiat Mist” meaning make a mixture.

Dosage The dosage is in Latin. It reads ‘One tablespoonful three times a day after food’. To this day, Latin

abbreviations are used. Among the more common are: om omne mane every morning bd bis die twice a day tds ter

die sumendus to be taken three times a day qh quartis horis every four hours hs hora somni at bedtime n nocte at

night ud ut dictum as directed ac ante cibos before food pc post cibos after food ex aq ex aqua with water sos si

opus sit when necessary prn pro re nata as occasion arises Mitte Means send. It is the amount to be dispensed as a

number, weight or volume. The amount on this prescription is eight fluid ounces. Signature The doctor’s

verification of an authentic prescription. Date Most important if the prescription is for a Dangerous or Controlled

Drug as a time limit of thirteen weeks is imposed for the presentation of the prescription to the pharmacist. For

Prescription Only Medicines (POM) the time is twenty-six weeks. Doctor’s name and address Both are essential

for certain categories of prescribed medicines. Repeats If the doctor wished, he could state a number of times that

the prescription could be repeated. RECORDS It is a recommendation that a copy of all dispensed private

prescriptions should be entered into a dedicated record book (Prescription Book). It became a legal requirement

for certain categories of prescribed medicines. If the medicine is a Controlled Drug (previously a Dangerous Drug)

then an entry has to be made in a dedicated register. The prescription would be endorsed with the pharmacist’s

stamp and the code for the record entry in the prescription book.

6

3. Dispensing

A pharmacist must take reasonable steps to ensure that the dispensing of a medicine in accordance with a

prescription or order is consistent with the safety of the person named in that prescription or order.

Guidelines

In dispensing a prescription, a pharmacist has to exercise an independent judgment to ensure the medicine is safe

and appropriate for the patient, as well as that it conforms to the prescriber’s requirements. If there is any doubt,

the prescriber is to be contacted.

In conforming to the above principle, dose, frequency and route of administration, duration of treatment, the

presence or absence of other medicines, the patient’s illness, medication history, and other relevant circumstances

need to be taken into account.

4. Patient counseling

Patient counseling is providing medication information orally or in written form to the patients or their

representatives on directions of use, advice on side effects, precautions, storage, diet and life style modifications.

Labels were stick on tablet strip containing counseling tips.

The communication process between Pharmacist and patients serves two primary functions:

1. It establishes an ongoing relationship between the Pharmacist and the patient.

2. It provides the exchange of information necessary to assess a patient’s health condition,

Implement treatment of medical problems, and evaluate the effects of treatment on a

Patient’s quality of life.

Communication during dispensing

- Purpose of medication

- How medication works

- Dose and duration of therapy

- Goals of therapy

- How effectiveness will be monitored

- Adverse effects and how to deal with them

- Drug specific issues

7

STORAGE OF DRUGS IN PHARMACY

ARRANGEMENT OF DRUGS ON SHELVES:

The following guidelines are for arranging drugs.

• Shelves should be made of steel or treated wood.

• Shelves should be strong and robust.

• Drugs are arranged in alphabetical order of generic names.

• Each dosage form of drug is arranged in separate and distinct areas.

• Sufficient empty space should demarcate one drug or dosage form from another.

Most recently received drugs are placed behind old stock on the shelf except where new drugs have shorter

expiration dates.

It is important to ensure the following rules in the dispensary and the store attached to the dispensary:

• Keep the environment clean.

• Always put lids properly on tins.

• Put drugs in a dry place protected from light and heat.

• Store liquids on a pallet on the floor or on the lowest shelf.

The store must be cleaned daily and mopped at least once a day.

STORAGE OF DRUGS IN BINS:

The bins uses for storage of drugs are made up of materials such as plastics.

• Standardization: The medication storage format was simplified and standardized for all areas in an effort to

enhance consistency and efficiency. This standardization allows individual health care workers to learn how

medications are organized in one area and to use that knowledge to find medications when working in different

areas. This is particularly important for those who regularly work in several areas, for example, on one or more

patient care units.

• Clustering: Medications have been “clustered” into logical groups (i.e., injectable, oral, and topical medications)

in an effort to minimize choice and simplify searching for a specific medication. For example, a nurse who is

looking for a tablet of acetaminophen can easily eliminate all injectable and topical medications from his/her

search.

8

• Use of color: Colored bins have been used to provide visual redundancy, which helps in distinguishing among

the clustered medication groups. For example, red, yellow, and green bins are used to store injectable, oral, and

topical medications, respectively. Medication Bins.

• Minimize: To reduce the opportunity for confusion, the number of medications and concentrations of the same

medication stored in one bin has been minimized. When multiple medications or concentrations of the same

medication have to be stored in the same storage bin, a labeled divider is used. The divider label includes the

name of the medication, the dosage form, the strength and the package size, and the number of items in each

section. (Additional information on labeling will be provided in the subsequent article.)

• Separate: Narcotic storage bins were redesigned to separate narcotics according to the duration of action, i.e.,

short-acting and long-acting. Further differentiation was provided by adding a label to the applicable storage bins

stating “LONG ACTING”, similar to that applied to the narcotic package itself.

STORAGE OF DRUGS IN REFRGIRATOR:

Certain drugs are meant to be stored at cold temperatures such as from 2-8 degree Celsius. Therefore the

pharmacy should contain a refrigerator for storage of drugs that requires storage temperature between 2-8 degree

Celsius. It includes certain Insulin’s (such as Human mixtard inj, Insugen inj., Wosulin inj. Etc), Insulin flexpens

(Actrapid, HM-Penfill, Insulatard flexpen, Novamix flexpen),Vaccines (such as Biopolio B1/3, Hibpro Inj.,

Influvac Inj),Chemotherapy Products (such as Cap. .Aprecap 125, Neukine inj, Endoxan Inj), Other drugs (such

as Basugine inj, Dalcinex inj, Foracot respules, Neovac inj.), High Risk Medications (such as Dilzem Vial,

Artacil Ampoule, Kabiroc Vial).

STORAGE OF HIGH RISK DRUGS

High risk medicines are those medicines that have a high risk of causing significant patient harm or death when

used in error. Although errors may or may not be more common than with other medicines, the consequences of

errors with these medicines can be more devastating. To assist in preventing errors, SA Health’s High Risk

Medicines safety initiative has put together a set of safety tips for specific high risk medicines.

Special safeguards to minimize opportunities for errors are integral to patient safety. Examples of high-alert

medications include heparin, warfarin, insulin, chemotherapy, potassium chloride for injection concentrate,

opioids, neuromuscular blocking agents, antithrombotic agents, and adrenergic agonists.

They should be stored separately and dispense with care. In order to prevent any errors or confusion it should be

labeled with red stickers and a list of drugs included in high risk medication should be stick beside their bins.

9

LOOK ALIKE SOUND ALIKE (LASA):

Look Alike Sound Alike (LASA) medications involve medications that are visually similar in physical

appearance or packaging and names of medications that have spelling similarities and/or similar phonetics.

As more medicines and new brands are being marketed in addition to the thousands already available, many of

these medication names may look or sound alike. Confusing medication names and similar product packaging

may lead to potentially harmful medication errors. The increasing potential for LASA medication errors was also

highlighted in the Joint Commission’s Sentinel Event Alert.

Healthcare organizations need to institute risk management strategies to minimize adverse events with LASA

medications and enhance patient safety. To aid in this effort, a Guide on Handling of Look Alike Sound Alike

Medications is published by the Ministry of Health.

Common Risk Factors

Common risk factors associated with LASA medications includes:

Illegible handwriting

Incomplete knowledge of drug names

Newly available products

Similar packaging or labeling

Similar strengths, dosage forms, frequency of administration

Similar clinical use

Strategies to avoid with look alike sound alike medications:

1. Procurement

(a) Minimizes the availability of multiple medicines strengths.

(b) Whenever possible, avoid purchase of medicines with similar packaging and appearance. As new

products or packages are introduced, compare them with existing packaging.

2. Storage

During storage look alike and sound alike medications are highlighted using color stickers, yellow for

sound alike (such as Anovate cream and Betnovate cream) and green stickers for look alike (such as B-Protein

and D-Protein).

Prescribing

Prescription should clearly specify name of medication, dosage form, dose and complete direction for use.

Communicate clearly. Take your time in pronouncing the drug name whenever an oral order has to be made. Ask

that the recipient of the oral communication repeat the medication name and dose. Verbal orders should be

limited to emergency situations only.

Dispensing/ Supply

10

(a) Identify medicines based on its name and strength and not by its appearance or location.

(b) READ medication labels carefully at all dispensing stages and perform triangle check. Triangle check

is to check actual medicines against the medicines’ labels and against the prescription.

(c)Double checking should be conducted during the dispensing and supply process.

Administration

Read medication labels carefully during the administration process and perform triangle check. Triangle

check is to check actual medicines against the medication labels and against the prescription.

Monitoring

All facilities need to identify medications that look alike or sound alike in its organization. The LASA list

needs to be reviewed and update periodically at least once a year.

Information

All relevant personnel have access to LASA list.

Staffs are informed on new medication listed in LASA in the hospital.

Patient Education

(a) Inform patients on changes in medication appearances.

(b) Educate patients and their caregivers to alert healthcare providers whenever a medication appears to

vary from what is usually taken or administered.

(c) Encourage patients and their caregivers to learn the names of their medications.

9. Evaluation

Evaluate medication errors related to LASA medications.

BARCODING:

11

A printed symbol made up of black and white bars; the most common type of machine-readable code that

provides a method for data input into an automated system.

Bar Coded Medication Process (BCMP); term that describes the hospital’s overall medication use process using

bar codes to improve medication use accuracy and safety.

Bar-coding is done to most of all the products in the OPD & IPD. It helps to maintain the record of purchase and

sale. The system of bar-coding the products helps in recognition of the in house products while refund or

exchange of the product.

We were told to stick barcodes on the pack of medicines, which help us to handle the products review the brand

names of the marketed products.

It also helped us to know the cost price, expiry date, strengths of various medications and the batch number.

It is necessary to do bar-coding as it gives idea about the stock balance in the store and also helps in inventory

control programmers.

Bar code prevents the medication errors due to scanning of product by the pharmacist.

Which help to double check the medication while dispensing along with the strength of drug.

Bar coding can be done simultaneously while entering the name of the product in the computerized system.

When the bar codes are stuck on the products it help the new pharmacist or an intern to know the packaging of

various medicinal products.

This knowledge of the packaging helps the pharmacist to identify the product easily.

It also help in fast dispensing during emergency and / or rush in OPD and IPD.

FEFO (FIRST EXPIRY FIRST OUT):

12

First Expired, First Out, often abbreviated by the acronym FEFO means "first expired, first out".

This term is used in logistics and inventory management to describe a way of dealing with perishable products, or

with a specified expiry date. The product with the deadline for the next intake will be the first to be served or

removed from stock.

FEFO is mostly followed in all MEDICINE departments.

Due to FEFO inventory can be well controlled for the near expiry products in the store.

While following the FEFO the purchase department can maintain the stock at appropriate level.

It helps to maintain the budget of the purchase pharmacy department.

Help to check the stock according to the expiry.

It helps to maintain the flow of dispensing the old products first.

Also makes the pharmacist alert to see the expiry while dispensing the bulk product.

It must be followed by all the retail and hospital pharmacies.

If FEFO is not been followed then the inventory is affected.

Most on the non running products in the store get expired in the shelves.

It may also affect the budget if the pharmacy department.

Separate individuals must be allotted to follow FEFO.

Monthly evaluation of the products should be done accordingly and stock should be maintained.

It reduces the rate of expiry product dispensing.

It will help the new pharmacist and interns to know about the locations of many of the products in the pharmacy

while following the FEFO.

This will help the pharmacist to easy and fast dispensing.

FEFO also help in short listing the less running products in the store.

INVENTORY CONTROL AND STOCK CHECKING:

13

Inventory control is important in any commercial environment, but even more so when it comes to maintaining

inventory in a pharmaceutical setting because public health is involved. Anyone with pharmacy technician

training can appreciate the importance of having enough medical stock in both retail and hospital pharmacies at

all times in order to be able to successfully fill the prescriptions that customers may need immediately.

Successfully dispensing prescriptions may seem like a simple task, but if you’ve ever observed the operation of a

hospital or community pharmacy, you’ll understand the need for an efficient inventory control structure.

Inventory control objectives

The main goal of an effective inventory control system is to successfully fulfill customer demand at the lowest

cost, while keeping a lot of factors in mind, including seasonal variation, changing patterns in usage as well as

theft prevention. Here are some goals to keep in mind when controlling inventory:

Minimize inventory investment

Maintain an optimal level of customer service

Maintain a balance of supply and demand

Minimize costs

Manage and maintain a current inventory control system

Because traffic in a pharmacy is never easy to predict or control, these objectives may sometimes be challenging

to accomplish, however, pharmacy technician courses can definitely provide a better understanding in reaching

these goals.

Contradictory demands of inventory control

Inventory control demands in a pharmacy can sometimes be a little tricky because of conflicting priorities. Some

common objectives include:

Keeping a wide variety of stock while also maintaining a large supply that moves quickly

Increasing inventory turnover without affecting service

Maintaining minimal stock without affecting service

Making larger purchases to get lower prices without overstocking on inventory that doesn’t sell

Maintaining a large inventory without getting stuck with expired or dated products

While controlling inventory may appear to be a somewhat straightforward task, pharmaceutical inventory

management requires many considerations to be met, demanding consistency and dedication.

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Inventory control methods:

Various methods are available when controlling inventory in a pharmacy. Here is a list of the methods and short

descriptions differentiating each one:

The open-to-buy budget method provides an allotted amount of funds, within a specific timeframe, for

purchasing pharmaceutical inventory

The short-list method identifies all of the products that are low in stock and need to be replenished, and

provides this information to the individual in charge of placing inventory orders

The minimum and maximum method is used to find out how much to order of each item as well as when is

best to order, while providing a limited dollar allowance

The stock card method is used to trace when items are brought into storage and taken out

Each of these methods are useful in controlling inventory on their own, however when implementing an efficient

inventory management system it is preferable to use a combination of all available methods to establish a

customized system that best meets the needs of a specific pharmaceutical environment.

Inventory control was done by ABC (Always Better Control) analysis and VED (Very Essential Desirable)

analysis.

Stock checking is also done according to the ABC class of products.

While stock checking FEFO also can be followed:

The ABC analysis includes:

In materials management, the ABC analysis (or Selective Inventory Control) is an inventory categorization

technique. ABC analysis divides an inventory into three categories- "A items" with very tight control and accurate

records, "B items" with less tightly controlled and good records, and "C items" with the simplest controls possible

and minimal records.

The ABC analysis provides a mechanism for identifying items that will have a significant impact on overall

inventory cost, while also providing a mechanism for identifying different categories of stock that will require

different management and controls.

The ABC analysis suggests that inventories of an organization are not of equal value. Thus, the inventory is

grouped into three categories (A, B, and C) in order of their estimated importance.

'A' items are very important for an organization. Because of the high value of these 'A' items, frequent value

analysis is required. In addition to that, an organization needs to choose an appropriate order pattern (e.g. ‘Just-

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in- time’) to avoid excess capacity. 'B' items are important, but of course less important than 'A' items and more

important than 'C' items. Therefore 'B' items are intergroup items. 'C' items are marginally important.

Examples of ABC class are

‘A’ items – 20% of the items accounts for 70% of the annual consumption value of the items. ‘B’ items - 30% of the items accounts for 25% of the annual consumption value of the items. ‘C’ items - 50% of the items accounts for 5% of the annual consumption value of the items.

Another recommended breakdown of ABC classes:

1. "A" approximately 10% of items or 66.6% of value2. "B" approximately 20% of items or 23.3% of value3. "C" approximately 70% of items or 10.1% of value

VEN ANALYSIS:

VED Analysis attempts to classify the items used into three broad categories, namely Vital, Essential, and

Desirable. The analysis classifies items on the basis of their criticality for the industry or company.

Vital: Vital category items are those items without which the production activities or any other activity of the

company, would come to a halt, or at least be drastically affected.

Essential: Essential items are those items whose stock – out cost is very high for the company.

 Desirable: Desirable items are those items whose stock-out or shortage causes only a minor disruption for a

short duration in the production schedule. The cost incurred is very nominal.

ABC-VED matrix analysis

The ABC-VED matrix was formulated by cross-tabulating the ABC and VED analysis. From the resultant

combination, three categories were classified (I, II and III). Category I was constituted by items belonging to AV,

AE, AD, BV and CV subcategories. The BE, CE and BD subcategories constituted category II, and the remaining

items in the CD subcategory constituted category III. In these subcategories, the first alphabet denotes its place in

the ABC analysis, while the second alphabet stands for its place in the VED analysis.

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CSSD (CENTRAL STERILE SERVICE DEPARTMENT)

The central sterile services department (CSSD), also called sterile processing department (SPD), sterile

processing, central supply department (CSD), or central supply, is an integrated place in hospitals and

other health care facilities that performs sterilization and other actions on medical devices, equipment and

consumables; for subsequent use by health workers in the operating theatre of the hospital and also for

other aseptic procedures, e.g. catheterization, wound stitching and bandaging in a medical,

surgical, maternity or pediatric ward.

Sterilization (or sterilization) is a term referring to any process that eliminates (removes) or kills (deactivates)

all forms of life and other biological agents (such as priors, as well as viruses which some do not consider to

be alive but are biological pathogens nonetheless), including transmissible agents (such

as fungi, bacteria, viruses, priors, spore forms, unicellular eukaryotic organisms such as Plasmodium, etc.) present

in a specified region, such as a surface, a volume of fluid, medication, or in a compound such as biological culture

media. Sterilization can be achieved with one or more of the following: heat, chemicals, irradiation, high pressure,

and filtration. Sterilization is distinct from disinfection, sanitization, and pasteurization in that sterilization kills,

deactivates, or eliminates all forms of life and other biological agents.

EQUIPMENTS

CLEANING AREA

High capacity passes through washer disinfector at 80- 90 degree Celsius having various shapes and sizes.

Cold and hot water streams.

Detergent solution.

Steam when available.

Hot air oven for drying instrument.

Wall fixture for drying.

STERILIZATION AREA

Autoclaves using dry heat, most heat.

Ethylene oxide sterilizers.

Testing material to check effectiveness of sterilization.

STORAGE AND DISTRIBUTION

Cup boards, selves, tables, chairs, racks.

Trolleys, instrument trays, wire baskets and containers.

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OTHER EQUIPMENTS:

Cleaning and decontaminating devices

Hot air oven for drying and heat sterilization

Testing apparatus foe emergency sterilization.

Others: trolley, work surface, telephones etc.

Material: chemicals for washing and cleaning

Steam boiler.

QUALITY CONTROL:

Indicator tapes

Bacteriological indicator.

Personnel training.

Regular maintenance.

Infection control committee.

COLD STERILIZATION

ETO STERILIZATION:

Ethylene Oxide (EtO) sterilization is mainly used to sterilize medical and pharmaceutical products that cannot support conventional high temperature steam sterilization - such as devices that incorporate electronic components, plastic packaging or plastic containers.EtO gas infiltrates packages as well as products themselves to kill micro organisms that are left during production or packaging processes. This gas, mixed with air at a ratio of at least 3% EtO gas, forms an explosive mixture. Pure EtO gas boiling point is 10.73 ºC at atmospheric pressure. Most of the time, it is mixed with Nitrogen or CO2. This explosive condition requires Intrinsic Safe material (ATEX) zoning, for security of people as well as security of the process itself.

Safety of personnel is an important issue due to the harmful effect of EtO on humans. Polluted areas need to be alarmed using gas detectors set up at different locations to monitor any leak. Visual and audio alarm systems need to be provided. The system must inform any operator when a sterilization cell contains EtO.

When this toxic gas is removed from the room it needs to be treated using thermal burners, scrubbers or oxidation for environmental protection or be transported to an alternate facility for treatment.

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AUTOCLAVE:

An autoclave is a pressure chamber used to carry out industrial processes requiring elevated temperature and

pressure different from ambient air pressure. Autoclaves are used in medical applications to perform sterilization

and in the chemical industry to cure coatings and vulcanize rubber and for hydrothermal synthesis. They are also

used in industrial applications, specially regarding composites, see autoclave.

Many autoclaves are used to sterilize equipment and supplies by subjecting them to high pressure saturated steam

at 121 °C (249 °F) for around 15–20 minutes depending on the size of the load and the contents. The autoclave

was invented by Charles Chamber land in 1879, although a precursor known as the steam digester was created

by Denis Papin in 1679. The name comes from Greek auto-, ultimately meaning self and Latin clavis meaning

key, thus a self-locking device.

DEAREATION

It is very important to ensure that all of the trapped air is removed from the autoclave before activation, as trapped

air is a very poor medium for achieving sterility. Steam at 134 °C can achieve in three minutes the same sterility

that hot air at 160 °C can take two hours to achieve. Methods of achieving air removal include:

Downward displacement (or gravity-type): As steam enters the chamber, it fills the upper areas first as it is less

dense than air. This compresses the air to the bottom, forcing it out through a drain which often contains a

temperature-sensing device. Only when air evacuation is complete does the discharge stop. Flow is usually

controlled by a steam trap or a solenoid valve, but bleed holes are sometimes used, often in conjunction with a

solenoid valve. As the steam and air mix it is also possible to force out the mixture from locations in the chamber

other than the bottom.

Steam pulsing: air dilution by using a series of steam pulses, in which the chamber is alternately pressurized and

then depressurized to near atmospheric pressure.

Vacuum pumps: a vacuum pump sucks air or air/steam mixtures from the chamber.

 Super atmospheric cycles: achieved with a vacuum pump. It starts with a vacuum followed by a steam pulse

followed by a vacuum followed by a steam pulse. The number of pulses depends on the particular autoclave and

cycle chosen.

Sub atmospheric cycles: similar to the Superatmospheric cycles, but chamber pressure never exceeds

atmospheric pressure until they pressurize up to the sterilizing temperature.

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PLASMA STERILIZATION:

Plasma is a form of matter in which many of the electron s wander around freely among the nuclei of the atom s.

Plasma has been called the fourth state of matter, the other three being solid , liquid , and gas .

Principle:

The plasma technology, adopted by HUMANMEDITEK, resembles the technology 

described above. The following summarizes the structure of technology.

As shown in the figure, hydrogen peroxide remained after sterilization is absorbed 

into the plasma generator with two electrodes. Then, plasma is generated between 

the electrodes, which are applied with high voltage, and the light similar to neon light is emitted. In addition,

hydrogen peroxide steam, entered into the plasma generator, is degraded into oxygen and water with high-voltage

energy and ejected. based on the principle of air purifier.

Why Plasma sterilization?

• The process is usually at room temperature and hence poses no dangers associated with high temperatures

(unlike autoclaves).

• Doesn’t involve any chemicals and hence is non-toxic (unlike EtOH)

• Time of treatment is fast and of the order of 1 min or less.

Before Sterilization- After Plasma Treatment

• Is versatile and can sterilize almost any material and any shape with nooks and crannies.

WORKING:

Plasma sterilization uses a triphasic technique. Plasma is basically ionized gas. When you apply an electric field

to a gas, it gets ionized into electrons and ions. The plasma we generate in our lab is named Dielectric Barrier

Discharge. When the plasma is turned on, it generates a whole lot of particles- UV photons, electrons, ions and

neutral particles. The electrons and ions just swim around. It’s the UV photons and radicals that do all the hard

work. Most of the research in plasma sterilization pertains to volume discharge. Triphasic behavior was observed

in these experiments. The process involves UV irradiation, photo-desorption and chemical etching. The spores are

basically made up of simple atoms like C, O, N, H and the like. The radicals react with these atoms to form

simple compounds like CO2, which can subsequently be flushed out. When the organism loses such atoms that

are intrinsic to its survival, it dies.

A few points to be noted:

• We have performed tests wherein we have exposed a solution of yeast spores to plasma for different times of

exposure.

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• As can be seen above, after 24 hours of incubation, almost all the spores on the yeast layered plate are killed.

While results like these require definite validation by way of microscopic examination and other standard tests.

AUTOCLAVE IN PHARMACY:

A medical autoclave is a device that uses steam to sterilize equipment and other objects. This means that

all bacteria, viruses, fungi, and spores are inactivated. However, prions, such as those associated with Creutzfeldt-

Jakob disease, may not be destroyed by autoclaving at the typical 134 °C for three minutes or 121 °C for 15

minutes. Although that a wide range species of archaea, including Geogemma barosii, can survive at temperatures

above 121 °C, no archaea are known to be infectious or pose a health risk to humans; in fact their biochemistry is

so vastly different from our own and their multiplication rate is far too slow for microbiologists to worry about

them.

Autoclaves are found in many medical settings, laboratories, and other places that need to ensure the sterility of

an object. Many procedures today employ single-use items rather than sterilizable, reusable items. This first

happened with hypodermic needles, but today many surgical instruments (such as forceps, needle holders,

and scalpel handles) are commonly single-use rather than reusable items (see waste autoclave). Autoclaves are of

particular importance in poorer countries due to the much greater amount of equipment that is re-used. Providing

stove-top or solar autoclaves to rural medical centres has been the subject of several proposed medical aid

missions.

Because damp heat is used, heat-labile products (such as some plastics) cannot be sterilized this way or they will

melt. Paper and other products that may be damaged by steam must also be sterilized another way. In all

autoclaves, items should always be separated to allow the steam to penetrate the load evenly.

Autoclaving is often used to sterilize medical waste prior to disposal in the standard municipal solid waste stream.

This application has become more common as an alternative to incineration due to environmental and health

concerns raised because of the combustion by-products emitted by incinerators, especially from the small units

which were commonly operated at individual hospitals. Incineration or a similar thermal oxidation process is still

generally mandated for pathological waste and other very toxic and/or infectious medical waste.

In dentistry, autoclaves provide sterilization of dental instruments according to health technical memorandum 01-

05 (HTM01-05). According to HTM01-05, instruments can be kept, once sterilized using a vacuum autoclave for

up to 12 months using sealed pouches.

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BIOLOGICAL INDICATORS:

In biology, an incubator is a device used to grow and maintain microbiological cultures or cell cultures. The

incubator maintains optimal temperature, humidity and other conditions such as the carbon dioxide (CO2)

and oxygen content of the atmosphere inside. Incubators are essential for a lot of experimental work in cell

biology, microbiology and  molecular biology and are used to culture both bacterial as well as eukaryotic cells.

The simplest incubators are insulated boxes with an adjustable heater, typically going up to 60 to 65 °C (140 to

150 °F), though some can go slightly higher (generally to no more than 100 °C). The most commonly used

temperature both for bacteria such as the frequently used E. coli as well as for mammalian cells is approximately

37 °C, as these organisms grow well under such conditions. For other organisms used in biological experiments,

such as the budding yeast Saccharomyces cerevisiae, a growth temperature of 30 °C is optimal.

More elaborate incubators can also include the ability to lower the temperature (via refrigeration), or the ability to

control humidity or CO2 levels. This is important in the cultivation of mammalian cells, where the

relative humidity is typically >80% to prevent evaporation and a slightly acidic pH is achieved by maintaining a

CO2 level of 5%.

It is mandatory to validate the effectiveness of waste sterilization monthly for every autoclave using Geobacillus

stearothermophilus indicator vials.

1. Monitoring is to be done monthly.

a. For labs using Common Biology autoclaves, a rotation schedule to do the testing has been established.

2. Self-contained biological indicator vials (SCBI) containing Geobacillus stearothermophilus and medium with a

pH indicator to detect growth are available for Common Biology autoclaves.

b. Storage 15-30oC. Do not refrigerate/freeze or expose to direct sunlight or UV light to the indicator.

3. A typical load for waste disposal is to be one 24” x 30” autoclave bag. The bag should be no more than half

full. The bag should be tied loosely, leaving the top open a few inches to allow steam to circulate within the bag.

4. Exposure: Tie a long string to the biological indicator vial & insert it into the middle of the load to be sterilized

(the string will allow easy removal after autoclaving). Don’t forget to label the vial with date, autoclave & cycle

used.

5. Autoclave the load for a minimum of 75 minutes sterilization time.

6. Activation: At the end of your cycle, remove the biological indicator vial from the load & ‘activate’

a. Each SCBI contains a spore disc and culture medium contained in a crushable glass ampoule.

b. Seal the cap by pressing down firmly until the medium ampoule is crushed.

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c. Inspect to make sure spore disc is completely saturated with medium. If not, hold the vial vertically and tap

gently on hard surface to make disc go into medium.

7. Incubation: Place the autoclaved biological indicator(s), plus an activated, non-autoclaved, control vial of

biological indicator in a vertical position in an incubator at 55-60oC for 48 hours.

a. For convenience, a hybridization oven set at 56oC that contains a rack for holding the vials for incubation. The

oven is labeled ‘For Biological Indicator Testing’ and is located on the floor under the far end of the bench on the

right hand side of the room.

8. Monitoring: Examine the biological indicators daily during their 48 hour incubation & record your

observations.

a. If sterilization has worked, the medium will remain purple after 48 hours.

b. If sterilization has failed, the medium will turn yellow due to acid released during bacterial growth and

turbidity will also be visible. Tubes with bacterial growth should be removed as soon as they are detected and

disposed in the autoclave waste. (Yellow indicator can change color if left to long – in control tubes, growth

should be obvious after 24 hours incubation).

9. Recording: Your results will be added to cumulative log sheets that will be posted on the relevant autoclave(s).

Items you need to record in the on-line form include:

a. Date

b. Name of Operator

c. Autoclave – e.g. N5 Right or Left.

d. Cycle [type – gravity vs. liquid] & Temperature

e. Cycle Time

f. Type of load (e.g. Petri dishes)

g. Biological Indicator Used

h. Biological Indicator Expiry Date & Lot i.e. [Written on vial]

i. Results (Pass/Fail) for Autoclaved Indicator & Control Indicator. Pass = sterilized (medium remained purple);

Fail = not sterilized (medium turned yellow & cells grew – the control should always fail, if not, the indicator lot

has problems)

10. Disposal: Used vials of biological indicators should be disposed of in your lab’s biological waste for

autoclaving.

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SEMINARSDuring the internship period seminars were organized for the improvement of our knowledge. Seminars were

organized by Mrs. Zarine Khety which is H.O.D. of Saifee Hospital.

Each intern was told to take any one drug molecule and have to specify and elaborate its,

Its Generic Name

Uses

Adverse Drug Reactions (ADR)

Mechanism Of Action (M.O.A.)

Name of other brands available in India with same generic name drug

Drug- drug interactions

Drug- food interactions

Pharmacodynamics

Pharmacokinetics

Dosage to be given

Onset of action

Duration of action

Dose to be given

Indications and contraindications

Tips for patients

Precautions

Storage conditions

This helps interns as well other staff members to understand drug molecule effects as well as its uses towards

patients. The patient counseling tips given during seminars helps dispensing pharmacist.

An advantage of seminars was indirectly to patient as the pharmacist can give more valuable tips to patients about

their medications.

Seminars last for weeks giving every interns equal opportunity. Seminars cover up drugs molecules such as

Amoxicillin and Potassium Clavulanate, Fentanyl Citrate, Cefuroxime Axitle and Isoniazide .etc.

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PROJECTInterns were divided in the groups and each group was given a project for better understanding of professionalism

in pharmacy.

Out of witch the topic given to us was “To Study the Prescriptions Containing and Their Interactions (NSAID’s

And PPI’s).

Initially we started with the collection of prescription from the hospital. Simultaneously we studied the topic

“NSAIDs and PPIs”.

Then we listed the drugs of both the categories, and accordingly we found the brands of those in the hospital

store.

The collected prescriptions were then observed and studied for the interactions of the molecules in them.

Due to this project we came across the interactions in the prescription which forced us to find the reasons.

Hence we were flooded with the enough knowledge and we found the suggestions to the prescribers as well as

patients.

It helped us to know the working pattern in the hospital.

We made a format so as to present the project in the proper manner.

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CONCLUSIONIn the one month training we came across various events in the hospital pharmacy department.

Out of which the major ones are hospital management and inventory of the medicine.

Initially we were given the task to renovate the labeling system of the bins in which the tablets and cupules were

placed according to the alphabetical manner.

We also handled the prescriptions in the OPD which made us more confident to dispense medicines to the

patients.

We came across many mistakes which forced us to improve the dispensing of medicine more alertly.

Stock checking is one more task completed by us, due to whom we were engaged in the hospital management

studies, and hence we were in contact with other departments in the hospital other than pharmacy.

We were also told to audit the nursing station on various floors in the hospital for the betterment of the pharmacy

as well as the patient health.

It was a great and good experience to know the hospital pharmacy so closely and that too in one of the top

hospital in the Mumbai.

It all goes to the teaching staff engaged in our internship program and I heartily thanks to all of them.

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