HOSPITAL & COMMUNITY PHARMACY

By Kiran SharmaKIET School of Pharmacy

DefinitionCommunity pharmacyCommunity pharmacy means any place under the direct supervision of a pharmacist where the practice of pharmacy occurs or where prescription orders are compounded and dispensed other than a hospital pharmacy or a limited service pharmacy.

Hospital pharmacyHospital pharmacy is the organization or department of the hospital to manage the procurement, storage, preservation, packaging, sterilization, compounding, preparation, dispensing or distribution of  medicine in the hospital.

What is the scope of Community pharmacy ?

In processing prescriptions- The pharmacist verifies the legality, safety and appropriateness of the prescription order, checks the patient medication record before dispensing the prescription (when such records are kept in the pharmacy), ensures that the quantities of medication are dispensed accurately, and decides whether the medication should be handed to the patient, with appropriate counseling, by a pharmacist

Clinical pharmacy- The pharmacist seeks to collect and integrate information about the patient’s drug history, dosage regimen

Patient care- patient drug history, mode of administration, precautions, advices

Drug monitoring- as practice research projects, and schemes to analyze prescriptions for the monitoring of adverse drug reactions

Extemporaneous preparation- pharmacists engage in the small-scale manufacture of medicines, which must accord with good manufacturing and distribution practice guidelines.

Alternative medicines- In some countries, pharmacists supply traditional medicines and dispense homoeopathic prescriptions

Checking symptoms of minor aliments- pharmacist can supply a non-prescription medicine, with advice to consult a medical practitioner if the symptoms persist for more than a few days. Alternatively, the pharmacist may give advice without supplying medicine.

Health care professionals- provide the information as necessary to other health care professionals and to patients, and use it in promoting the rational use of drugs, by providing advice and explanations to physicians and to members of the public.

Counselor- the pharmacist provides an advisory as well as a supply service to residential homes for the elderly, and other long-term patients. In some countries, policies are being developed under which pharmacists will visit certain categories of house-bound patients to provide the counselling service that the patients would have received had they been able to visit the pharmacy

In prophylaxis and health promotion- The pharmacist can take part in health promotion campaigns, locally and nationally, on a wide range of health-related topics, and particularly on drug-related topics (e.g., rational use of drugs, alcohol abuse, tobacco use, discouragement of drug use during pregnancy, organic solvent abuse, poison prevention) or topics concerned with other health problems (diarrhoeal diseases, tuberculosis, leprosy, HIV-infection/AIDS) and family planning.

Role & responsibilities of community pharmacist 1.Dispensing prescriptions/ appropriate filling of prescriptions by Patient drug history. 2. Reviewing the prescription for correctly spell, label, interactions, right drugs etc.

Dispensing prescriptions/ Appropriate filling of prescriptionsReviewing the prescription for correctly spell, label, interactions, right drugs etc.

3. Rational use of drugs–As common as common sense?

“The irrational use of medicines is a major problem worldwide. WHO estimates that more than half of all medicines are prescribed, dispensed or sold inappropriately, and that half of all patients fail to take them correctly. The overuse, underuse or misuse of medicines results in wastage of scarce resources and widespread health hazards.”

Patients often come with the belief that there is "a pill for every ill“

 the prescribers' poor training workplace may impose pressures aggressive pharmaceutical marketing

Diarrhoea Here antibacterials are often over-prescribed. While there are many causes

for diarrhea, infective and non-infective, the fact remains that most of them are self-limiting and require only adequate rehydration.

In all doubtful cases, a stool examination should be done for ova, cyst, blood and hanging drop if cholera is suspected.

Stool culture can be done in the presence of severe and/or bloody diarrhoea, fever and systemic toxicity. 

Mixed infections" with bacteria and amoeba are never known to occur

4. Ensuring that different treatments are compatible – action 500 & coldarin increases B.P.

5. Special emphasis on pediatric and geriatric patients

6. Supervising the preparation of any medicines (not all are supplied ready made-up by the manufacturer)

7. Providing OTC (over the counter) Drugs8. Maintain records and register9. Interaction with doctors and nurses10. Proper diet regime – for children, hypertensive patients,

diabetic patients11. Knowledge about transmitted diseases- HIV,

tuberculosis, diphtheria

12. Quit-smoking medicines

Nicotine patchNicotine gumNicotine lozengeNicotine inhalerNicotine nasal sprayBupropion (Zyban)- a prescription medication classified as a type of antidepressant. A sustained-release form of bupropion is approved for smoking cessation

13. Women and infants care

Hygiene, Prophylaxis of diseases, Vaccination and immunizationProper child care, Proper child educationRight nutrition –•Slowly reduce the sugar & salt in your diet•Replace refined carbs with complex carbs such as oatmeal, brown rice•Check labels and opt for “sugar-free” or “no added sugar” products.•Don’t replace fat with carbs whole fat yogurt, with low-fat versions •Eat breakfast & regularly•Boost energy with quality protein  lower risk for obesity, osteoporosis, diabetesTake  "good fat” avoid (Trans fat—the “bad fats”)Monounsaturated fats are found in foods such as olive oil, avocados, nuts (like almonds, hazelnuts, and pecans), and seeds (such as pumpkin, sesame).Polyunsaturated fats include Omega-3 fatty acids, found in fatty fish such as salmon, herring, mackerel, anchovies, and sardines. Other sources include flaxseed and walnuts.•Take Vitamin D3, Ca & Mg

Vaccines Types1.Inactivated vaccine- Inactivated but previously virulent, micro-

organisms that have been destroyed with chemicals, heat, radiation, or antibiotics.

Examples are influenza, cholera, bubonic plague, polio, hepatitis A, and rabies.

2. Attenuated vaccine- Live, attenuated microorganisms-active viruses that have been cultivated under conditions that disable their virulent properties, or that use closely related but less dangerous organisms

Examples are yellow fever, measles, rubella, and mumps, and the bacterial disease typhoid. 

3. Toxoid vaccines are made from inactivated toxic compounds that cause illness

Ex-  tetanus and diphtheria

4. Protein subunit

Human respiratory syncytial virus (RSV) is a syncytial virus that causes respiratory tract infections.

14. Prevention and management of drug abuse, misuse and addictionMethamphetamine - stimulant drugAnabolic steroidsLysergic Acid Diethylamide (LSD)CocaineHeroinMarijuanaPrescription drugs

15. Alcohol use awareness programAlcohol advice and harm reduction servicesNeedle and syringe exchange for people with drug addictions* Supervised administration of methadone ( synthetic opioid. It is used medically as a pain medication and a maintenance therapy in people with opioid dependene)

and other substitutes

16. Clinical pharmacy/ patient care

17. Individualization of drug therapy

18. Monitoring of drug utilization and pharmacovigilance.

19. Nutrition counseling20. Health screening21. Family planning22. Documentation and

research

counseling and advising the public on the treatment of minor ailments;advising patients of any adverse side-effects of medicines or potential interactions with other medicines/treatments;preparing dosette and cassette boxes, usually for the elderly but also for those with memory/learning difficulties, where tablets are placed in compartments for specified days of the week;undertaking Medicine Use Reviews (MUR), an advanced service to help patients understand how their medicines work and why they have to take them;monitoring blood pressure, BMR and cholesterol levels;offering a diabetes screening service;arranging the delivery of prescription medicines to patients;managing, supervising and training pharmacy support staff;budgeting and financial management;keeping up to date with current pharmacy practice, new drugs and their uses.

Thanks