Foundation in Pharmacy Practice

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Foundation in Pharmacy PracticeBen J Whalley, Kate E Fletcher, Sam E Weston, Rachel L Howard and Clare F Rawlinson

Foundation in Pharmacy Practice

Foundation in Pharmacy Practice

Ben J Whalley

BPharm (Hons), MRPharmS, PhD

Lecturer in Clinical Pharmacy, Reading School of Pharmacy, University of Reading, UK

Kate E Fletcher

MRPharmS, Dip Clin Pharm, PhD

Teacher Practitioner, Reading School of Pharmacy, University of Reading, UK Lead Pharmacist for Specialist Surgery, Royal Berkshire NHS Foundation Trust, Reading, UK

Sam E Weston


Teacher Practitioner, Reading School of Pharmacy, University of Reading, UK

Rachel L Howard

MRPharmS, Dip Clin Pharm, PhD

Lecturer in Pharmacy Practice, Reading School of Pharmacy, University of Reading, UK

Clare F Rawlinson

MPharm, MRPharmS, PhD

Lecturer in Pharmacy Practice, Reading School of Pharmacy, University of Reading, UK



Published by the Pharmaceutical Press An imprint of RPS Publishing1 Lambeth High Street, London SE1 7JN, UK 100 South Atkinson Road, Suite 200, Greyslake, IL 60030-7820, USA Pharmaceutical Press 2008 is a trade mark of RPS Publishing RPS Publishing is the publishing organisation of the Royal Pharmaceutical Society of Great Britain First published 2008 Typeset by J&L Composition Ltd, Filey, North Yorkshire Printed in Great Britain by Cambridge University Press, Cambridge ISBN 978 0 85369 747 3 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, without the prior written permission of the copyright holder. The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made. The rights of Ben J Whalley, Kate E Fletcher, Sam E Weston, Rachel L Howard and Clare F Rawlinson to be identified as the authors of this work has been asserted by them in accordance with the Copyright, Designs and Patents Act, 1988. A catalogue record for this book is available from the British Library.

The authors dedicate this book to Dr R T Gladwell, Director of Teaching and Learning, Reading School of Pharmacy (20052007)


Foreword ix About the authors x Acknowledgements xii


What is Pharmacy Practice?Ben J Whalley

1 9


Structure and function of the NHS in EnglandRachel L Howard


An overview of community pharmacy the role of the community pharmacist: past, present and futureSam E Weston

23 33 43 55


An overview of hospital pharmacyKate E Fletcher


An overview of industrial sector pharmacyClare F Rawlinson


Introduction to medicines managementRachel L Howard


Structure and function of the Royal Pharmaceutical Society of Great BritainKate E Fletcher

71 77 85 97


Essential communication skills for pharmacistsKate E Fletcher


Prescriptions types and legal requirementsSam E Weston


Understanding and interpreting prescriptionsSam E Weston


viii 11

Contents Packaging of medicinesSam E Weston

109 117 125 135 151 169


Labelling of medicinesSam E Weston


Extemporaneous dispensing: a beginners guideSam E Weston and Kate E Fletcher


Compliance, adherence and concordanceRachel L Howard


Sale and supply of medicines: risk and advice provisionRachel L Howard


Major routes of drug administrationKate E Fletcher

Glossary of terms commonly used in Pharmacy Practice Index 201



Many Schools of Pharmacy now introduce Pharmacy Practice at the start of the course to show students how Practice draws on clinical and scientific knowledge and to instil a professional attitude from the very beginning. More practically, students often take vacation and Saturday jobs in a pharmacy to supplement their income as well as to gain experience and they need the basics behind them to do so. Introducing Practice at such an early stage means it is necessary to start at a fundamental level. Until now there has not been a suitable textbook to help the students or their teachers. The authors, all members of the Pharmacy Practice team at Reading, have experience of the Practice of pharmacy in all its guises: from managing and owning a community pharmacy and a locum agency, ethics committee membership, PCT experience, and specialist clinical pharmacy, right through to preregistration tutelage in both the hospital and community sectors. They have already brought their experience to bear in devising a fresh approach to a new course, in a new School of Pharmacy. The introductory module proved so popular with students that this textbook, including all the new material the team had written, was suggested. The scope of the book covers the structure of the NHS and RPSGB; the varied and changing

roles of the pharmacist in different sectors (including industry); an introduction to medicines management, law, ethics, confidentiality and duty of care; essential communication skills; major routes of drug administration; a very useful section on dispensing: practicalities, labelling, legal issues relating to different types of prescriptions and a beginners guide (with handy tips) to extemporaneous dispensing and routes of administration; and a glossary of commonly used Pharmacy Practice terms. Foundation in Pharmacy Practice is not only a textbook but it is also a teaching and learning resource, providing checklists, hints and tips. Teachers of Pharmacy Practice will find it useful for developing undergraduate courses, and preregistration pharmacists will find it a valuable resource and revision guide, as will pharmacists returning to practice after a break, or those moving sector, from hospital to community pharmacy for example. Most importantly, it will help the new undergraduate pharmacy student to discover and find their way around the profession they have chosen.

Elizabeth M Williamson, MRPharmS Professor of Pharmacy and Director of Practice April 2008


About the authors

Ben J WhalleyDr Whalley is a lecturer at the Reading School of Pharmacy. In May 2006 he received an award for outstanding contributions to teaching and learning support from the University of Reading for his part in formulating and delivering the new Pharmacy Practice course, and in particular the development of novel teaching methods, including lecture podcasting and extensive use of the virtual learning environment. He is a qualified and registered pharmacist (1992), and obtained his PhD (Neuroscience) from the School of Pharmacy, University of London in 2003. He continues to practise in the community sector as a registered pharmacist, has worked as a practice-based pharmacist for Bromley Primary Care Trust and has appeared as a scientific adviser in a number of television programmes. He also acts as Receiving Editor for the European Journal of Neuroscience and is an Expert Pharmacist Member of the Thames Valley Multi-Centre NHS Research Ethics Committee and an Associate of the Institute of Health Sciences.

pharmacists for the past 7 years and has been a pre-registration pharmacist tutor for the past 3 years, tutoring individual trainees and taking part in delivery of the Thames Valley Regional Programme for Pre-Registration Pharmacists. She joined the Department of Pharmacy Practice at the Reading School of Pharmacy in November 2005, where she is involved in developing MPharm course content, lectures on a variety of clinical and non-clinical subjects and supervises practical sessions.

Sam E WestonSam Weston currently convenes Year 2 of the Pharmacy Practice course of the School of Pharmacy at the University of Reading, and has played a part in creating and delivering the new undergraduate MPharm course since January 2006. She is a qualified and registered pharmacist (1998), and is currently reading for her PhD at Reading School of Pharmacy, investigating the potential use of cannabis in the treatment of epilepsy. She has an MBA (Open University) and also runs a locum pharmacy agency, whilst continuing to work as a locum pharmacist in the community, hospital and prison sectors.

Kate E FletcherSince qualifying as a pharmacist in 1995, Kate Fletcher has worked in hospital pharmacy, specialising in general surgery, neurosurgery, neuro-intensive care and geratology. She has worked at the Royal Berkshire NHS Foundation Trust in Reading for 4 years, and is currently Lead Pharmacist for Specialist Surgery. She has been involved with teaching nurses, doctors and

Rachel L HowardRachel Howard has worked as a clinical pharmacist for 10 years in both hospital and general practice, with particular experience in cardiology, care of the elderly and medical admissions.


About the authorsSince 2000 she has conducted research into the underlying causes of medication-related admissions to hospital and how these events can be avoided. This formed the basis for her PhD, awarded by the University of Nottingham in 2006. Dr Howard has contributed chapters to two books on patient safety, focusing on medicines management in primary care and the exploration of medication-related morbidity. She has worked with leading academics in the field of patient safety, helping to develop a draft design specification for electronic prescribing for NHS prescribing systems and to test an IT-based pharmacist-led intervention to reduce potentially hazardous prescribing in primary care. In 2006 she took up the position of Lecturer in Pharmacy Practice at the University of Reading School of Pharmacy.


Clare F RawlinsonDr Rawlinson is a qualified and registered pharmacist (2002) who obtained her PhD in Drug Delivery at the Institute of Pharmaceutical Innovation, University of Bradford (2006). Her experience spans industrial, hospital and community sectors of pharmacy and she previously held a Developmental Lectureship in Pharmaceutics at the University of Bradford. She has recently developed the Law and Ethics module of the Pharmacy Practice course at Reading School of Pharmacy, where her other roles include pre-registration placement tutor and Industrial Pharmacists Group representative. She is a committee member of the Analytical Science Network, which provides support for early career analytical scientists working in all sectors of industry, and which is affiliated with the Analytical Division of the Royal Society of Chemistry. Dr Rawlinson is also a reviewer for the International Journal of Pharmaceutics.


The writing of any textbook is not conceived or conducted by the authors in glorious isolation. We would therefore like to thank all of the people who have freely given advice, support and time to this endeavour. Moreover, we would also like to thank some particular individuals, without whose efforts this process would have been much harder, if not impossible: Professor E Williamson for her support and advice throughout the writing of this book, and Kevin Flint, David Allen and Daniel Grant for their help with photographs, figures and information sources. Also, many thanks to staff and patients at the Royal Berkshire NHS Foundation Trust for agreeing to have their photographs taken, in particular Mr W G V

Woodley, Claire-Louise Cartwright, Jennifer Cockerell, Dr Chloe Dallimore, Tania Jones, Adella Mutero, Sawsan Turkie, Amanda Wheeler and Jonathan Yazbek. We would also like to thank Dr Claudia Vincenzi and Dr Riddhi Shukla for their contributions about careers in industrial pharmacy. Finally, we should not forget that large parts of the Pharmacy Practice courses that we teach are influenced significantly by the students we are privileged to teach. Their enthusiasm for, commitment to and engagement with our courses provide constant inspiration and motivation in our work, which we hope is reflected in this book.


1What is Pharmacy Practice?Ben J Whalley

Introduction . . . . . . . . . . . . . . . . . . . . . . . 1 Pharmacy Practice: definitions . . . . . . . . . . 1 More than a definition . . . . . . . . . . . . . . . 2

Summary . . . . . . . . . . . . . . . . . . . . . . . . 7 References. . . . . . . . . . . . . . . . . . . . . . . . 7

IntroductionThe principal aim of this book is to provide an essential reference on Pharmacy Practice for Pharmacy Masters (MPharm) students, particularly those just embarking on their study of Pharmacy at undergraduate level. As such, it provides an overview of the major topics in Pharmacy Practice encountered by such students, in a practical, clear and succinct manner. As a text aimed at new Pharmacy students, it is not intended as an exhaustive reference text for each topic covered; rather, it should be considered as a starting point for further study, facilitated by regular signposting and referencing to the many excellent advanced texts available. Students are strongly encouraged to pursue such directions as required, and as their overall level of understanding and ability develops. The rapidly changing nature of the profession and the unfamiliar terminology and acronyms that are widely used often present barriers to students beginning their study of Pharmacy Practice. This book provides a glossary of common terms used in the discipline, which can be used either as the book is read as a whole, or as a companion text during the study of other texts on Pharmacy Practice.

This book also provides a practical guide to extemporaneous dispensing, including hints and tips for successful dispensing. This guide is to be used in conjunction with formal pharmaceutical texts such as: British Pharmacopoeia (BP) British National Formulary (BNF; published every 6 months) Martindale: The Complete Drug Reference Pharmaceutical Codex Medicines, Ethics and Practice Guide for Pharmacists and Pharmacy Technicians (MEP; published annually).

Pharmacy Practice: definitionsAs a first step in undertaking the study of Pharmacy Practice, it is vital to understand what the term means. What is Pharmacy Practice? Which specific subject areas does it encompass? How does it relate and link to other relevant disciplines that comprise the undergraduate Pharmacy degree? Considering and answering these important questions will provide an overview of the subject, a prerequisite for its successful study and practice.



Chapter 1

What is Pharmacy Practice?Public health (Chapter 2 )As health professionals, pharmacists are concerned not just with the treatment of existing disease states, but also with their prevention and the promotion of healthier lifestyles. Consequently, the area of public health concerns the prevention rather than the treatment of disease, often via the surveillance of specific disease states and the promotion of healthy behaviours shown to reduce the incidence and/or severity of suc...


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