pharmacy internship report (apprentice, community pharmacist, retail pharmacist)
DESCRIPTION
Apprentice Pharmacist Pharmacist Training Community Pharmacy Retail Pharmacy Patient counsellingTRANSCRIPT
INTERNSHIP REPORT AT
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ACKNOWLEDGMENTTo promote civic sense and shoulder the responsibilities
with civil society, the University administration with special directives from Hon. Vice Chancellor Prof. Dr.
Muhammad Akram Chaudhary, has termed it mandatory for each Pharm-D student to render community services to the society. These services aim to facilitate and guide
the patients about the disease and its medication. Besides the services to the community this internship
program have been designed to fulfill the current needs with regards to professionalism, marketability,
employability, and entrepreneurship and to practice the practical aspects of pharmaceutical services at a
community pharmacy. We, the students, are very thankful to Hon. Vice Chancellor Prof. Dr. Muhammad Akram Chaudhary for providing us with this valuable
opportunity of internship by the University and within the University. No doubt, this step will encourage the
professional activities of future Pharmacists.
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ABSTRACT
Pharmacy services in Pakistan have experienced both evolutionary and revolutionary changes since 1947. The pharmaceutical sector always remained regulated at different levels. The changes in legislation are also the contributing factor to uplifting of the pharmacy profession. The misuse and abuse of medicines remained a big issue at retail/ community level. Sale of medicines and this business remained in the hand of unqualified personnel for a long time. With time the pharmacists interest increased at community level and now the quality of services are improving but not up to the mark. While in comparison with the developed countries like U.K and U.S.A, where Community pharmacists are expanding patient care services and have enhanced their role as pharmaceutical care providers. The pharmacy profession in Pakistan is continuously evolving. Number of community pharmacies has been established in few cities of Pakistan like Care Pharmacy Faisalabad, Fazal Din Pharma plus Lahore etc. The aim of this review / report is to explore history for evolutionary and revolutionary changes in community pharmacy practice in Pakistan and to highlight the current scenario in Pakistan. A brief but comprehensive report has been provided in this review regarding the working of the visited pharmacy i.e. UNIVERSITY MODEL PHARMACY providing medicinal services to community on behalf of the UNIVERSITY OF SARGODHA, SARGODHA. University Model Pharmacy is one of the four departments of University Medical & Diagnostic Centre (UMDC) and it contains all available medicines at optimum conditions of storage. The University has an aim to provide each student of Pharm-D with the opportunity of the internship at Model Pharmacy in order to get familiar with the applications of pharmacy at community level.
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INTERNSHIP DETAILSInternship Month:
JULY-AUGUST
Internship Timings:
8.00 PM to 11.00 PM
SUPERVISION
Prof. Dr. Sajid BashirDean Faculty of Pharmacy UOS.
Dr. Akhtar RasulSubject Teacher
Dr. Nasir HaroonPharmacist
APPRENTICE PHARMACISTS(Pharmacists on training)
1. Muavia Sarwar (Roll No. 12)2. Shoaib Nawaz (Roll No. 91)3. Aurangzeb (Roll No. 83)4. Imran Ali (Roll No. 60)
(Session 2010-15)
COMMUNITY PHARMACY IN PAKISTAN
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There are relatively a few studies articulating the situation with community pharmacy services in Pakistan. The Licensed premises in Pakistan include the medical stores, the retail pharmacies and also the Wholesale Distribution Setups. Among the total no. of pharmacists in Pakistan, 55 % join industrial sector, 15% works at public sector, 15% in sales marketing, 5 % in teaching and research, and 10 % in community pharmacies. About more than 1000-1500 students are passed out each year now (Public Sector Only) .The health care services at community pharmacies must undergo reforms to meet the international standards. Most of the personnel (dispensers) in pharmacies have minimum training. Even if the license is displayed in the pharmacy, the professional is seldom present. The dispensers working at retail outlets (so-called community pharmacies) are mostly untrained, non-qualified but have experience in years. Retail outlets in developing or low income countries sell Prescription Only Medicines without a Prescription on patient‘s demand. The doctors are receptive to the pharmacists expanded roles in Pakistan but their expectations do not match with their actual experiences. Community pharmacist is in a best position to perform these main activities:
Direct patient care , DUR (Drug Utilization Review), Extemporaneous preparations , Respond to minor ailments.
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HEALTH FACTS
(Estimated in year 2007-08 )
Hospitals
965
Dispensaries
4,916
Basic Health Units
4,872
MCH Centers
1,138
TB Centers
371
Firs Aid Points:
1,080
Federal Government Expenditure on Health (2007-08)
Development Expenditure Rs. 14.272 billionCurrent Expenditure Rs. 3.791 billion
Health Indicators
Infant Mortality Rate (IMR)(per 1000 persons)
76.7
Maternal Mortality Rate (MMR)
(per 100,000 live births)
350
Under -5mortality rate 101
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(per 1000 persons)Parasite Incidence of Malaria
(per 1000 persons)0.75
Incidence of TB (per 100,000 persons)
181
Fertility Rate (percentage) 4.1 (source: NIPS)Contraceptive prévalence rate
%30 (source: NIPS)
Births attended by skilled persons %
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Population growth rate 1.9Total Population 159.06: million
(source NIPS)
Health Services Delivery (2006-07)
Total Health Facilities 13,937Hospitals 965
Dispensaries 4,916Basic Health Units 4,872
Rural Health Centers 595MCH Centers 1,138
TB Centers 371First Aid Points: 1,080
Beds in hospitals & dispensaries
105,005
Population per bed 1,515Population to health facility
ratio11,413
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Human Resources (Registered, 2007)
Doctors 107,835Doctors registered as specialists 19,623
Dentists 7446Dental specialists 433
Nurses 43,646Midwives 2,788
Lady Health Visitors 3,864Lady Health Workers 95,000
Lady Health Supervisors 3,385Population per doctor 1,475Population per dentist 21,362Population per nurse 3,644
Latest Health Facts
(Punjab Province)
Health Department across the province is divided into:
2,461 Basic Health Units (BHUs) 293 Rural Health Centers (RHCs) 88 Tehsil Headquarters Hospitals (THQs) 34 District Headquarter Hospitals (DHQs) 23 Teaching/ tertiary Care Hospitals
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LAYOUT DESIGN
PARKING/ CORRIDOOR
UNIVERSITY ROAD
H
F
G
K
E
LLL
J
D C B A
L
M
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KEYS
A = Clerk Room
B = Pharmacist Office
C = Store Room
D = Wash Room
E = Stands
F = Racks
G = Fridge
H = Dispensing Table
J = Displays
K = Seats
L = Entrance Doors
M=Entrance For Staff
PHARMACY DETAILS
Name
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University Model Pharmacy
Location
University Of Sargodha, University Road, Sargodha.
Pharmacist /Manager
Dr. Nasir Haroon
Site Plan
University Model Pharmacy is run and owned by the famous and well reputed public sector institution of Pakistan i.e. University of Sargodha,
spread over a vast area of land like an oasis of calm and green at the midst of the bustling city. The University Road is one of the most
populous roads in the city, providing a linkage to many towns, colonies as well as cantonment / defense area that’s why the pharmacy deals
and facilitates a large number of patients.
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Aim & Specifications Of UMP
The University authorities established a well equipped Medical and Diagnostic center in 2010 which have four main departments:
o Model Outdooro Model Indooro Model Laboratories & Radiologyo University Model Pharmacy
The major aim of all these establishments is to provide quality health care facilities to the community at reasonable and low cost and to serve the community both qualitatively and quantitatively.University Model Pharmacy ensures the No. 1 quality of the Products .It contains all medicines at optimum conditions of storage and at 05% less price as in Market , having separate section for intensive care and emergency medicine.
Pharmacy Timings
07.00 AM to 11.00 PM daily
Staff Details
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University Model Pharmacy has total 10 employees. These employees work in two different shifts i.e. morning and
evening shifts. Each shift is supervised by a Pharmacist. The Pharmacist is qualified and efficient in his job.
Sr. No Designation Count1 Director UMDC 012 Pharmacist 013 Dealing Staff 04 (2+2)4 Clerk 015
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Sweepers
Guards
02
02
Qualification And Experience Of Staff
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o Director :Prof. Dr. Zahoor ul Hassan DogarM.B.B.S , M.Phil , PhD , Post Doc(Med. Biochemistry)
o Pharmacist/Manager :Dr. Nasir HaroonPharm- D (Doc. Of Pharmacy)
o Dealing Staff :
Waqas Zafar(Dispensing course)Hafiz Tayyab (Matric+Experience)Akmal Shehzad (Clinical Assistant Course)Kamran Aziz (Experience)
Facilities / Equipments
1. Fully Air Conditioned for optimum temperature control2. 03 Refrigerators3. Centrally controlled IT system4. Medical Insruments like Stethoscope / Sphygmomano meter
/ Glucometer etc.
Purchasing Of Medicine
The purchasing is made either direct from pharmaceutical company or by distriburtors. Most of the purchasing is made
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from authntic and licensed distributors and is supervised by Manager or Pharmacist.The distributors which supply drugs to University Model Pharmacy are :
Al-Aziz Distributors Health Linkers Co. Naeeli Shifa UDL IDL Sameel Suleman Distributors.
Racking
Racks of Pharmacy are made up of glass. Medicines in these racks are arranged company wise.
Refrigerators
Some of the medicines require specific conditions for storage i.e required to be stored at cool place / low temperature. Universitu Model Pharmacy ensures the proper storage of such medicines . For intance, specific injectibles , inhalers , insulines as well as the daily routine items like juices etc. have been placed in refrigerators for adequate storage and maintenance of quality.
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Services
University Model Pharmacy and UMDC are providing a lot of services to patients / customers to facilitate them properly. Under the supervision of qualified Pharmacist Dr. Nasir , the
staff members as well as the aprentice pharmacists (internee) are providing all medicinal and general services at their best.
Patient Councelling:
With special consideration by Hon. Vice Chancellor Prof. Dr. Muhammad Akram Chaudhary , it has been made mondatory for all Pharm-D students of UOS to get benefitted by the oppertunity of an unpaid internship / duty / experience at Model Pharmacy and facilitate the patients with their knowledge. This internship is unique in the sense that it has been provided by the University within the University .The aprentice pharmacists under the insructions of subject teacher Dr. Akhtar Rasul and Dr. Nasir Haroon (Pharmacist ) guide the patients about their medication and disease.While at pharmacy ,we used to chek the prescription , had a critical analysis of prescribed medicines , looked for any possible drug-drug or food drug interaction and guided the patints about proper usage , time of administration , storage and possible side effects of the prescribed drugs.
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The response from all the patients was encouraging one.The patients were satisfied to a greater extent and they appreciated this step of University administration to aid the patient in medicine usage.
E- Prescription
Hon. Vice Chancellor Prof. Dr. Muhammad Akram Chaudhary held a special meeting with apprentice pharmacists on 04 August 2013.Hon.Dean Prof. Dr. Sajid Bashir and Sir Alamgeer were also present in the meeting. He aadvised us to be honest and loyal to our profession and motivated us to give special consideration to practical aspects of Pharmacy. Meanwhile, he disclosed that UMDC is going to take a radical step very soon i.e. E-prescription.No doubt it will facilitate and improve the patient care and will be adavantageous to the chain of 3 Ps; The Physician , The Pharmacist and the Patient.
Baby products
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University Model Pharmacy also provides necessary baby care products like baby shampoes , Lactogen , Cerelac , BF 101 ,Celia
etc.
Dental Products
It also has separate displays/racks for dental care products like tooth brushes , mouth washes , gargles and tooth pastes .
Dermal Products
A wide range of Dermal products like sun block creams , sun trap , skin care lotions or creams as well as ointments are
available at Pharmacy.
Literature
Basic literature about different commercial medicinal products is provided if available and can be had on demand.
Waiting Area
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A comfortable sitting area is also provided to customers.
Extemporaneous dispensing
Hopefully it will be available soon at the pharmacy.
Khush Aab Water
It’s a quality product of University Of Sargodha available at the pharmacy. It is registered from PSQCA and its quality check is maintained by senior quality control personnel. It is available at affordable price that’s why its demand is increasing day by day.Its present production is about 1 lac bottles per day.
WORKING AT PHARMACYW
While at pharmacy, the major task of an apprentice is to
handle and deal with the prescriptions and after taking a
brief history of patient , asking about any past therapy,
family background ,socio-economic status and finally
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discussing the prescribed medication in a way to guide the
patient properly regarding the use,
intake/administration ,storage, frequency and time of
medication. We also used to analyze the prescriptions
critically in order to sort out any possible drug-drug or drug-
food interaction under the supervision of Pharmacist Dr.
Nasir Haroon. Most of the times, Dr. Nasir used to ask the
questions about drug use and abuse especially he gave
special consideration to antibiotics
(class/generations/therapeutic uses) because these are the
most prescribed drugs . Also he gave special attention to
analgesics and CVS drugs.
The Dealing Staff co-operated their best by providing all the basic information regarding dealing with patient and customer, receipt generation, billing and receiving cash. They provided us with the
Information leaflets of different medicine .They also motivated the patients to take guidance from Pharmacists.
Hon. Dean Faculty of Pharmacy Dr. Sajid Bashir paid special
and frequent visits to the pharmacy to ensure the presence
of students and also gave special advices/suggestions about
the practice at pharmacy.
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Subject Teacher Dr. Akhtar Rasul kept a continuous eye on
all activities of apprentices and guided us on regular basis
and also used to check our duty registers/records and
attendances.
Hon. Vice Chancellor Prof. Dr. Muhammad Akram
Chaudhary paid sudden visits, checked the status of services
and also gave special instructions in this regard. He
motivated us to take special interests in the latest
applications as well as inventions in Pharmaceutical sciences
and services. In short the experience at University Model
Pharmacy was inspiring one, and made us able to
understand the practical aspects of Pharmacy in an efficient
way.
Conclusion and Recommendations
In Pakistan, the pharmacy education as well as the pharmacy profession is in transitional stage. Though there had been evolutionary
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and revolutionary changes in this field but still the area of pharmacy practice has many loopholes. One of the major loopholes is in the legislation of the system. Strict legislative reforms and inspections should be ensured to provide quality services through pharmacies. Reimbursement system must be developed to pay to the pharmacists for the provision of direct patient care services. Curriculum of Pharmacy course be upgraded again and training of the students must be made compulsory. Besides this, there should be the additional training of the pharmacists to develop skills. Pharmacy practice can be best done at community pharmacies as mostly the patients in minor ailments first go to the pharmacies. And if the patient consults a doctor then again the last health care provider that a patient sees is the pharmacist at the community pharmacy. So the pharmacists are in an ideal position to provide cognitive services to the patients at community level.
The healthcare services in community pharmacies, currently insignificant, must undergo reforms to meet the changing needs of modern medicines users. Although pharmacists' contributions to health care are not recognized yet, there is every reason to be optimistic toward making patient care in community pharmacy setting a success. For this, legislation must be reformed to give identity to the pharmacist and educational system for pharmacists has to be adapted.
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