MAIN PHARMACY

PHARMACISTS

•          All Pharmacists are expected to be at their duty post on or before 8am and close by 4pm.

•          All Pharmacists must be polite, kind, considerate and show empathy to all Patients at all times.

•          The attention of the most senior Pharmacist must be drawn to any error in the prescription and the needed remedial action and documentation should be done by such officer.

•          The counselling Pharmacist should not be distracted while performing this important duty.

•          The counselling pharmacist should match each drug with the right prescription and also ensure they are handing out the drug to the right Patient.

•          The Pharmacist should ensure each drug to be dispensed is properly labelled with the name of the Patient, name of the drug, dosage regimen, and date of dispensing

•          The fridge in the counselling room is under the direct control, and supervision, of the counselling Pharmacist between 8am & 4pm on weekdays, while on weekends it is under the supervision of the Pharmacist on call.

•          At the end of each working day the

Pharmacists must ensure that the backup stock is returned to the impress store.

•          The impress store is under the supervision of the HOD, the Chief Pharmacist, and the supervising Pharmacist for SOPP; while on weekends, it is under the supervision of the Pharmacist on call

•          A proper handing over is extremely important. All Pharmacists on call must always hand over to the in-coming Pharmacist at the end of all call duty; no Pharmacist is allowed to leave without handing over to another Pharmacist.

 

PHARMACY TECHNICIANS

•          It is expected that all Technicians will resume work on or before 8am and close at 4pm the same day.

•          When on afternoon duty they are expected to resume at 2pm and close at 8pm the same day. While on call, they are expected to resume at 7pm and close at 8am the next day.

•          All Technicians are expected to assist in the pre-packing of the drugs to be used in the ante-natal clinic.

•          Dispensing of ante-natal drugs to pregnant women should be handled solely by Pharmacy Technicians.

•          When necessary, Technicians can be deployed to any section or outlet of the Pharmacy to work. Also, they could be called upon to assist in the dispensing of drugs during times of heavy Patient traffic.

 

PRODUCT REQUSITION

i.          The Intern Pharmacist will make an order through the requisition form and also sign as the requisitioning Officer.

ii.         The Pharmacist -in-charge checks through the list of products required and makes necessary adjustments; where applicable.

iii.        The Pharmacist-in-charge will sign as the approving Officer.

iv.        The Pharmacy Assistant takes the requisition form to the main drug store for supply, after which he/she signs as the receiving Officer (that is the person who delivers the drugs to the paediatrics pharmacy)

v.         Upon delivery of the product, the product count/amount is checked, and also the expiry date, to ensure that the date is not near, in order to make sure that the product is safe and effective.

vi.       When a wrong drug is supplied, or the correct drug in the wrong quantity, or a particular drug is omitted; then the Pharmacist relates the problem to the Issuing officer in the main drug store for correction.

vii.       A list of out-of-stock drugs on each clinic day is communicated to the Pharmacist - in charge of the drug store.

viii.      The available drug stock is then displayed and ready to be sold after charting into the stock balance register.

ix.        The requisition booklet is kept for future use and other cases.

 

2.        DISPENSING

I.          Greet the client with a smile.

ii.         Receive the e-MR card in a dignified manner.

iii.        Read through the prescription properly, checking the drug names, strength, dose, quantity and duration. The prescription is also checked for any errors.

iv.        Check the legality and legibility of the prescription.

v.         If the prescription is illegible and raises any doubt, confirm with the prescribing doctor.

vi.       After that, check for the availability of the drug and ensure that the product is the one indicated in the prescription order.

vii.       Ensure that the product is in good condition and that the expiration date is still far.

viii.      Give the client the chance to choose what is affordable and most cost-effective.

ix.        Proceed to billing of the available drugs.

x.         Check the product in the presence of the client and explain the instruction for drug administration to the patient/guardian

xi.        Give relevant information regarding drug storage, administration, and interactions to the client.

xii.       Clients are not expected to wait beyond 1 5 minutes from the time of presentation of payment receipts, to the collection of medicines. Any anticipated delays should be communicated to the Patient.

 

3.        DRUG STORAGE

I.          After initially checking the drugs delivered all products should be transferred to their respective areas.

ii.         Store the drugs in an organized and orderly manner, with the label bearing the name of drugs in front.

 iii.       First —Expire-First-Out (FEFO) will be the basis of disposing drugs.

iv.        Avoid direct contact from the sun or the walls to avoid moisture accumulation.

v.         Expired goods should be marked "Expired" to prevent use.

vi.        Expired goods/drugs should be withdrawn from the shelves and recorded in the expired drugs book register and handed over to the necessary officers in charge of this.

vii.       Store drugs at stipulated temperature, and areas protected from excessive light, dust, and humidity.

viii.      The temperature should be checked by the Pharmacist daily and recorded in the monitoring sheet.

 

4.        PRODUCT COMPLIANT

I.          Upon receiving the compliant, the attention of the Pharmacist in charge is called.

ii.         Ask the complainer for the official receipt to ensure that the product was brought from the pharmacy.

iii.        The Pharmacist will ask for details regarding the compliant, a full interview should continue therefrom.

iv.        The Pharmacist calls for the prescription for that particular patient, referring to the details on the receipt.

v.         Check the batch number, expiration date and condition of the medicine.

vi.        Make a proper documentation of the complaint.

vii.       If the compliant is justified, the following will be done:

•          Replace the drug, or credit the money to  patient.

•          Institute proper action to prevent re-occurrence.

•          Inform the suppliers of the drug.

•          If the patient demands a refund, he/she should be advised to forward a written request to the Medical Director

viii.      If the complaint is not justified advice the customer about the findings.

ix.        Submit a report to the hospital authority.

 

5.        DISPOSAL OF EXPIRED, DAMAGED,

RETURNED OR REJECTED PRODUCTS.

i.                    The Pharmacist/intern/Pharmacy Assistants are assigned to specific shelves to check expiration dates periodically.

ii.        Near-expired drugs; that are 3 months to expiration, are removed from the shelves.

iii.        Checking expiration dates of all drugs shall be done every month and shall be recorded.

iv.        Drugs with near expiration dates are gathered and taken to the main drug store for the Pharmacist-in-charge of the store to call the attention of the suppliers to return the near-expired, damaged, returned, and rejected drugs so that the products will be pulled-out.

v.         When the supplier cannot accept the expired/near expired drugs, the pharmacy must dispose the products in an environmentally conscious way OR, hand the drug products to the Environmental Health unit of the hospital.

 

ACCIDENT AND EMERGENCY

A. FUNCTIONS

I.          Timely filling of Emergency prescriptions

ii.         Ensuring availability of emergency medicines in the Unit

iii.        Ensuring proper storage of emergency medicines

iv.        Ensuring proper documentation of all dispensed medicines and financial transactions

 

B. DRUG REQUISITION

I.          Drugs are requested from the impress drug store to the unit by the Intern Pharmacist and approved by the pharmacist-in-Charge.

ii.         Where the drug is not available in the impress drug store, it is requested from other units such as the in-Patient pharmacy or paediatric pharmacy; if available, and documented in the requisition book.

iii.        Requested drugs are properly stored in the appropriate shelves in the unit and documented as received items in the appropriate registers.

 

C. DRUG DISPENSING

I.          Doctors, Nurses or Attendants may present prescriptions and/or treatment sheets of Patients presenting in emergency situations to the pharmacy unit. Prescriptions may also be sent via e-MR

ii.         If urgent, drugs are dispensed immediately without payment and documented as 'taken' or 'given' on the treatment sheet.

iii.        When the patient's condition becomes stable, his/her caregiver is asked to pay for drugs dispensed, and subsequent drugs.

iv.       Drugs are dispensed to all Patients who cannot afford it (for whatever reason), in the first 48hours without any payment, via the analog (or offline) pharmacy; with the inscription 'NYP' (Not Yet Paid).

v.         Where a Patient has paid more than the required amount, the credit balance is domiciled in the wallet on the Patient's e-MR for future use.

vi.        Where a Patient has paid less than the amount stipulated, the patient is asked to 'pay more' of the outstanding amount.

vii.       If a Patient has paid for a drug which is no longer available in the pharmacy, the inscription 'TCA' (To Come Again) is written on that particular drug and the information passed to the Director of Pharmaceutical services.

viii.      Where a particular drug is not available now, and will not be available in the pharmacy in the near future, the inscription 'O/S' (Out of Stock) is written on that particular drug, and the patient advised to purchase the drug from outside the hospital.

 

 D. EXPIRED DRUGS

The check for expired drugs should be done at the end of every month. All expired drugs are retrieved and returned to the impress drug store for onward disposal; according to the hospital's guidelines for disposal of medical waste.

IN-PATIENT PHARMACY

1.        The treatment sheet containing the prescription of drugs/items from different wards is brought to the pharmacy by the ward Attendant attached to each ward.

2.        The prescription is scrutinized for possible drug interactions, or prescription errors, by the Pharmacist in-charge.

3.        The Prescription bill is generated by e-MR using the prevailing price list available at the material time.

4.        The patient's relative then proceeds to the cashier for payment.

5.        After confirmation, the drugs/consumables are put into the basket brought to the Pharmacy by the ward Attendant.

6.        The Attendant checks the drugs supplied to know if the items are complete, in the presence of the pharmacist, before taking them to the ward.

 

 THEATRE PHARMACY

1.        A list of items needed for the week is written in the Nurses' requisition book every Monday. These are supplied by the Pharmacist, after proper scrutiny. Emergency items can also be requested for by the Nurses during the week, as the need arises.

2.        Two each, of anaesthetic (GA/SPINAL) packs and drug packs, are prepared for use each day by the Pharmacist; and kept in the Anaesthetist's fridge and lockers respectively.

3.        These packs are refilled at the end of each work day ensuring that all items used are properly accounted for.

4.        Receipts are detached from Patient's notes, which show evidence of payment for theatre consumable fees, before the patient is admitted into the theatre for each procedure.

5.        A list of all items used per procedure, by every Patient, is recorded in the Patients' consumable register.

6.        The Pharmacist in-charge must ensure that the controlled drugs record book is duly filled and signed by an Anaesthetist.

7.        Ensure there is a witness, and such witness shall confirm use by signing.

8.        Write down any complaints or drug reactions.

9.        The Pharmacist should restock controlled drugs when stock level is low, from the Pharmacist in-charge in the main pharmacy.

10.      A controlled drug requisition register, duly signed by the pharmacist in-charge of the theatre is used for the above purpose.

11.      Send the empty packs of used controlled drugs alongside the requisition book to the Pharmacist in-charge for re-supply.

12.      A poison/controlled drug box/locker is provided for safe keeping of these drugs in the theatre pharmacy.

13.      Always check expiry dates of injections and consumables before dispensing.

14.      Ensure all cupboards, refrigerators and drawers are properly locked at the end of each day.

15.      Consumables not included in the theatre requisition list are supplied only in the case of emergency, after being duly documented e.g.

Redivac drain, Mesh, central line Catheter etc.

16.      Ensure cold chain for thermo labile drugs is maintained.

17.      All drugs in lockers and cabinets must be properly labelled for easy identification

18.     First Expiry-First Out, will be the basis for disposing Injectables and consumables.

19.      Expired drugs and consumables should be withdrawn from the fridge and l  ockers and recorded in the expired drug register.

20.     All drugs with expired dates are taken to the main drug store for the Pharmacist in-charge to discard appropriately.

21.     All drugs and consumables should be stored at stipulated temperature areas, protected from excessive light, dust and humidity.

 

PHARMACY STORE

1.       The Pharmacy store usually opens at 8am and is closed at 7pm.

2.       All drugs and Consumables are received by the Pharmacist in the store after being checked for expiration date, content, name of product; to ensure it is in line with the specification on the award letter and LPO.

3.       Their invoices and waybills are endorsed by Pharmacist (store Pharmacist) after which the Auditor is called by the supplier to verify the quantity supplied in accordance with the award as well.

4.      Received goods are transferred to their respective shelves according to their sub-classes and those that need refrigeration are refrigerated.

5.      All products within the drug store are kept under specific required temperatures for each product; properly categorized into sub-classes such as: Tablets and Capsules, Syrups, Injections and Consumables.

6.       Combined Requisition and Issuing Note (CRIN) are sent from various hospital pharmacy outlets, and their requisition lists are issued by the store officers

7.        Products are issued on First to Expire, First Out (FEFO) basis.

8.        Drugs are then taken to the various units by the Intern Pharmacist or Pharmacy Assistant attached to impress store.