Hospital and Community Pharmacy

1. Hospital & Community Pharmacy
By- Dileep Kumar Pandey
[B.Pharma] Institute of Pharmacy,
Bundelkhand University, Jhansi U.P.

2. Content-
SN Topics
1. Definition of Hospital & Community pharmacy
2. Scope of Hospital & Community pharmacy
3. Roles & Responsibilities of Community pharmacist
4. Code of ethics
5. Pharmacy Management
6. Prescription, Types & Parts of Prescription
7. Handling the Prescription
8. Inventory control in Community pharmacy
9. Various methods of Inventory Control

3. Definition, Scope of Hospital
Community Pharmacy

4. Hospital Pharmacy-
Hospital Pharmacy
is a branch of pharmacy, which deals with the
patient care and medication and promotes health
wellness and disease inhibition.
The pharmacist works in management with the
doctors for the patient healthcare.
Clinical pharmacists have wide education in the
biomedical, pharmaceutical, and clinical
sciences.

6. Community Pharmacy-
A Community
pharmacy is a pharmacy, that deals directly with
people in the local area.
It has responsibilities including compounding,
counseling, checking and dispensing of
prescription drugs to the patients with care,
accuracy & legality.

8. Scope of Hospital & Community
Pharmacy-
Though the text is same of hospital
and community pharmacy but in actual practice
both differs a lot.
Community pharmacy deals with Mass health in
general whereas hospital pharmacy is a limited
scope and deals with in-patient as well as out-
patient only but does not include the mass which
are out of the scope of a hospital or tertiary
healthcare unit.
Cont..

9. Community pharmacy includes various pharmacy
services providing to a community in many terms
such as through a medical or community
pharmacy or setting up drug distribution centre,
Jan aushadhi Kendra's, pharmacy vaccinisation
programs, drug education programs, providing
free drugs on doctors prescription, conducting
health check ups in community, providing
healthcare campaigning through corporate social
responsibility forum of a pharma company. But,
hospital pharmacy is up to providing services to
in patients and out patients only. Cont..

10. There are very broad scope of hospital & community
pharmacy, some of them are following-
Drug Information and their actions.
Drug Selection or Patients Counciling.
Drug Evaluation or monitoring.
Drug Utilization and Distribution.
Disease State Management.
Medication Therapy Management.
Formal Education and Training Programs.

11. Roles and Responsibilities of
Community Pharmacist

12. Role of Community Pharmacist-
 Community Pharmacists work at the front line
of healthcare in cities, towns and villages.
They work from their own pharmacies, or Out
of local healthcare centres and doctor’s
surgeries.
 Some community pharmacists own their own
businesses and enjoy the challenges of
management and having responsibility for
staff, stock and premises that this brings.
Cont..

13.  Community pharmacists are also taking on
more of the clinical roles that have traditionally
been undertaken by doctors, such as the
management and monitoring of long term
conditions for example asthma and diabetes,
as well as delivering flu vaccinations, and
conducting medicines reviews.
◆There are many other important roles of a
Community Pharmacist, Some of them are
following-

14. Clinical Pharmacy & Patient’s
care-
The pharmacist seeks to collect and
integrate information about the patient's drug
history, dosage regimen, mode of administration,
precautions, advices, etc.
Drug monitoring-
As practice research
projects, and schemes to analyze prescriptions
for the monitoring of adverse drug reactions.

15. In Processing Prescriptions-
The
Pharmacist verifies the legaity & appropriateness
of the prescription order and checks the patient
medication record before dispensing the
prescription (when such records are kept in the
pharmacy), ensures that quantities of medication
are dispensed accurately and decides whether
the medication should be handed to patient with
appropriate counseling by a pharmacist.

16. Alternative medicines-
Some countries
pharmacists supply traditional medicines and
dispense homoeopathic prescriptions.
Extemporaneous Preparation-
Pharmacists angage in the small scale manufacture
of medicines, which must accord with good
manufacturing and distribution practice guidelines.

17. Health care professionals-
Provide
the information as necessary to other healthcare
professionals & 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.

18. Responsibilities of a Community
Pharmacist-
 Community pharmacists are the health
professionals most accessible to the public.
They supply medicines in accordance with a
prescription or, when legally permitted, sell
them without a prescription. They maintain
links with other health professionals in
primary health care.

19. The important Responsibilities of a Community
pharmacist are following-
Collaborate with Physicians to
receive Prescriptions-
In today’s age,
many prescriptions are sent digitally straight to
a patient’s pharmacy of choice.
It is the
responsibility of the community pharmacist to
develope and maintain relationships with local
physicians.

20. Fill Patient Prescriptions and
Instruct customers for How to
use Medications-
Community pharmacists
fill prescriptions for customers.
They often delegate tasks like pill counting to
interns or pharmacy technicians.
Their main focus is educating patients on how
to use medications and efficiently answering
their questions.

21. Advise Customers on Minor
ailments and general health
topics-
Many people go to their local
community pharmacist for advice on what to
take for minor ailments, such as colds, as well
as how to treat minor abrasions.
They recommend non-prescription medication
when possible, and refer customers to a
physician when necessary.

22. Administer Flu Shots and Other
Minor Vaccinations-
You don’t have to go
to your primary care physician to get a flu shot.
Community pharmacists administer thousands
of flu shots around the globe each flu season.
These are some most important
responsibilities of a community pharmacist.

23. Code of Ethics-
 The Code of ethics is the science, in which
we study about the Code of Moral Principles.
 The Code of Ethics sets out the principles,
that we must follow as a pharmacist or
pharmacy technician.
 The Code is the Society’s core guidance on
the conduct, practice and professional
performance expected of you. Cont..

24. The code of pharmaceutical ethics is
formulated by Pharmacy Council of India for
the guidance of Indian pharmacist.
The code of pharmaceutical ethics helps to
guide the pharmacist as to how he should
conduct himself as follow:-
Pharmacist in relation to his job.
Pharmacist in relation to his trade.
Pharmacist in relation to his profession.
Pharmacist in relation to medical
profession.

25. Pharmacist in relation to his job-
1. Pharmaceutical Services.
2. Conduct of the Pharmacy.
3. Handling of prescription.
4. Handling of drugs.
5. Apprentice Pharmacy.

26. Pharmacist in relation to his trade-
1. Price Structure.
2. Fair trade practice.
3. Purchase of drugs.
4. Hawking of drugs.
5. Advertising and Display.

27. Pharmacist in relation to his
profession-
1. Professional Vigilance.
2. Law abiding profession.
3. Decorum and Propriety.
4. Relationship with professional
organisation.

28. Pharmacist in relation to Medical
profession-
1. Liaison with public.
2. Clandestine Arrangement.
3. Limitation of professional
activities.

29. A Pharmacist should have to-
A pharmacist should have to respects the
autonomy and dignity of each patient.
A pharmacist should have to promote the right
of self-determination and recognizes individual
self-worth by encouraging patients to participate
in decisions about their health.
A pharmacist should have to communicate with
patients in terms that are understandable. Cont..

30. A pharmacist should have to make the care of
patients and it should be his first concern.
A pharmacist should have to encourage
patients to participate in decisions about their
care.
 A pharmacist should have to show respect to
all medical professionals.
A pharmacist should have to be honest and
trust-worthy and take responsibility for his
working practices and have to develope his
professional knowledge and competence.

31. Pharmacist’s Oath
I promise to devote myself to a lifetime of service to others through the
profession of pharmacy. In fulfilling this vow:-
 I will consider the welfare of humanity and relief of suffering my primary concerns.
 I will apply my knowledge, experience, and skills to the best of my ability to assure
optimal outcomes for my patients.
 I will respect and protect all personal and health information entrusted to me.
 I will accept the lifelong obligation to improve my professional knowledge and
competence.
 I will hold myself and my colleagues to the highest principles of our profession's
moral, ethical and legal conduct.
 I will embrace and advocate changes that improve patient care.
 I will utilize my knowledge, skills, experiences, and values to prepare the next
generation of pharmacists.
I take these vows voluntarily with the full realization of the responsibility with which
I am entrusted by the public.

32. Pharmacy Management

33. Selection of site for Hospital Pharmacy-
 In hospital premises so that patients and staff can easily
approach it.
 In multi storied building, on the ground floor especially
the dispensing unit.
 Manufacturing room should be adjacent to the pharmacy.
 Outpatient pharmacy should give pleasant appearance
and must have enough space for seating of patients who
have to wait for medicines.
 Medical stores should be adjacent to the pharmacy itself
or should be directly connected to pharmacy.

34. Selection of site for Community Pharmacy-
 A needy town or city should be selected. The site must
be most suitable one available in the city.
 Site of the pharmacy should be at the centre of the
population to be served to ensure accessibility and
convenience.
 If possible the site should be in the neighborhood of
community shopping centre for convenience and
accessibility of the customers.
 An island type of location in which the pharmacy is in
the main traffic artery with adequate parking facility
can be opted.
Selection of site for Community Pharmacy-

35. What is layout and its importance?
Layout is an arrangenment or a plan,
espicially the schematic arrangement of
parts or areas.
It plays significant role in the
development of the customers perception
which have a positive impact on its sale
potential.

37. Objectives of an ideal layout design-
To project a professional image and improve general
appearance to attract a large number of customers.
To provide customer satisfaction.
To increase the sales of the store and to reduce the
selling expenses to the minimum.
To have adequate space for reserve stock, office and
resting space and to have proper entrance for the
newly arrived goods.
To minimize the movement of the customers in the
premises of the pharmacy.
Objectives of an ideal layout design-

38. An ideal layout of Hospital Pharmacy

39. An ideal layout of Community Pharmacy

40. Staff / Personnel
Criteria for staff selection-
The qualification of the employee should not
fall below the minimum standard or else the
reputation of the pharmacy may get
compromised.
'Over hiring' i.e., superior people in inferior
jobs, should be avoided as this will lead to an
adverse effect on staff morale and efficiency.
Cont..

41. Selection process-
Job description- The details of job, its relation
to other job, working hours, pay scale, etc.
Job specification- The qualification needed
for the job.
Job recruitment- Depends upon the number
of vacant posts.
Selection of personnel- tests, interviews, etc.
Orientation and training of staff.

42. Coding of drugs
Process of assigning code for easy
identification of a material.
Essential for good store keeping.
Ambiguity in description is avoided.
Length of description minimized.
Codes ensure of items lying in the floor.
Item easily identified when it is known by
more than one name.

43. Stored in alphabetical order.
Provides a channel for distribution of
drugs.
Drugs readily available in the pharmacy.
Enables correct storage of drugs e.g.,
antibiotics and vaccines in refrigerator.
Stocking of drugs

44. • Legal requirements for a Hospital
or Community Pharmacy-
General license-
Granted to person who have the premise for the
business and who engage the services of a
qualified person to supervise the sale of the
drugs.
The license for the retail sale of drugs other than
the ones mentioned in the Schedule C,C1 and X
are issued in form 20.
For drugs specified in Schedule C and C1 in form
21 and Schedule X drugs in form 20F.

45. Condition for general license-
Should be displayed in a prominent place open
to the public.
The license should comply with the Drug and
Cosmetics rule there under in force.
Any change in the qualified staff should be
reported to the licensing authority within one
month.
Precaution prescribed by the licensing
authority for the storage of schedule C and C1
drugs should be observed.

46. Use of Computers and Drug
information services-
Maintenance of register-
1. Legal records- Required by law regarding
the acquisition and disposition of drugs.
2. Patient’s records- Regarding the patient
utilization of the drugs.
3. Financial records- Regarding the past and
present financial status of the company.

47. Legal records
According to federal and state law.
Adequate and up to date records should be
maintained according to Drugs and
cosmetics act 1940, Rules 1945 and the
Poison Act 1919.
Maintain adequate record related to
acquisition and disposition of certain drugs.
Records of distribution of poisonous and
hazardous substances.

48. Patients drug history and all details.
Information on all kinds ok information
about kinds and amount of drugs taken by
average patients.
Source of information on insurance claims
and income tax deduction of patients.
Patient’s records

49. For making sound decision regarding future
needs inventory requirements, etc.
For evaluation of past operations, planning of
present activities, forecasting needs, and
controlling the activities.
Analyzing revenues and expenses.
Measuring return on investment.
Help ensure profitable operations.
Financial records

50. Prescription

51. What is Prescription?
Prescription is an order
written by a physician,
dentist or any other
medical practitioner to
the pharmacist to
compound & dispense a
specific medication for
individual patient.

52.  Prescription is actually a direct link
between physician, pharmacist &
patient.
 Prescription is accompanied by direction
for pharmacist and for patient.
 The prescriptions are generally written
in the English language but Latin words
or abbreviations are frequently used in
order to save time.
Cont..

53. Types of Prescription-
There are two types of prescription-
(i) Precompounded Prescription- Prescription
for already prepared drug (by
pharmaceutical companies).Example- Cap.
Ciprofloxacin (500 mg) etc.
(ii) Compounded Prescription- The pharmacists
prepare the medication according to the
drugs and dosages directed by the
physician.

54. Pre-Compounded Prescription Compounded Prescription

55. PARTS OF A PRESCRIPTION-
1. Date
2. Name, Age, Sex and Address of the
Patient
3. Superscription
4. Inscription
5. Subscription
6. Signa or signature
7. Renewal instruction
8. Signature of Physician

56. It helps a pharmacist to find out the date
of prescribing and date of prescription for
filling the prescription.
The prescription which prescribe narcotic
or other habit forming drug, must bear the
date, so as to avoid the misuse of
prescription if it is presented by the patient,
a number of times for dispensing.
Date-

57. Name, age, sex and address of the patient
must be written in the prescription because
it serves to identify the prescription.
In case, if any of this information is missing
in the prescription, the same may be
included by the pharmacist after proper
enquiry from the patient.
Also used in dose calculation of children.
Name, Age, Sex & Address
of the Patient-

58. It is represented by Rx symbol and it is
a Latin word which means You take.
In older days, the symbol was
considered to be originated from the
Sign of Jupiter, God of healing.
This symbol was employed by the
ancient in requesting god for the quick
recovery of the patient.
Superscription-

59. This is the main part of the prescription, contains the
names and quantities of the prescribed ingredients. It
also contain manner in which medicine should be taken.
The name of each ingredient is written on a separate line
along with its quantity.
Now a days, the majority of the drugs are prescribed
which are already in a suitable formulation. The
pharmacist is required to dispense the readymade form
of drugs, so compounding of prescription is almost
eliminated.
Inscription-

60. Subscription is also a main part of the
prescription and it contains the
prescriber's directions to the pharmacist.
It includes-
 Type of dosage form to be prepared.
 Number of doses form to be dispensed.
Subscription-

61. This consists of the direction to be given to
the patient regarding the administration of
drug. It is usually written as 'Sig' on the
prescription.
The instructions given in the prescription are
required to be transferred to the container in
which the medicament is to be dispensed, so
that the patient can follow it.
Sidnatura or Signa-
Cont..

62. The instruction may include-
1. The quantity to be taken or amount to be
used.
2. The frequency and timing of administration
or application.
3. The route of administration.
4. The special instruction such as dilution
direction.

63. The prescriber indicate on every
prescription order, whether it may be
renewed and if so, how many times.
It is very important part in the prescription
containing the narcotic and habit forming
drugs to prevent its misuse.
Renewal instruction-

64. Prescription must be signed with
Prescriber's own hand.
Address and Registration number
should be written in case of
dangerous drugs.
Signature of Physician-

65. Receiving the Prescription
Reading and Checking of Prescription
Compounding of Prescription
Pricing of Prescription
Delivering the Prescription
Handling of Prescription

66. Pharmacist should himself receive the
Prescription.
While receiving a prescription,
a pharmacist should not change his facial
expression which gives an impression to the
patient that he is surprised or confused after
seeing the prescription.
• Receiving the Prescription-

67. • Reading & Checking of Prescription-
After receiving a prescription, it should be read
completely and carefully from top to bottom
and the Prescription should be checked for any
incompatibility, and always check it that it is
written in proper format.
A prescription should always be screened
behind the counter. In case of any doubt
regarding the prescription ingredients or
directions, the pharmacist should consult the
other pharmacist or prescriber.

68. • Compounding of Prescription-
Compounding should be carried out in a neat
and clean place.
Only one prescription should be compounded
at one time.
It includes-
1. Collecting and weighing the material
2. Packaging
3. Filling and Labeling

69. • Collecting and weighing the
material-
For compounding the prescription, all the
materials required for it, should be collected
on the left hand side of the balance.
After weighing the material, it should be
shifted to right hand side of the balance.
This gives a check of ingredients which
have been weighed.

70. • Packaging-
For packaging following containers are used-
 Round vials Oval bottles
 Wide mouth bottles
 Colored bottles
 Dropper bottles
 Collapsible tubes
 Paper wrappers

71. • Filling and Labelling-
 The compounded medicament should be
filled in suitable containers depending on
its quantity and use.
 The filled container should be suitably
labeled and the label should be affixed on
smooth surface of bottle.
 White plain paper of good quality should
be used for labeling the container.

72.  While compounding, the label of every
stock bottle should be read at least three
times in order to avoid any error-
1. When taken from the shelf or drawer.
2. When the contents removed for
weighing and measuring.
3. When the containers are returned back
to its proper place.
Cont..

73. • Pricing of Prescription-
The prescription should be priced
immediately after receiving it and
informed the patient about it.
This should be done before starting
the compounding to avoid any
dispute.

74. • Delivering the Prescription-
While delivering the prescription to the
patient, the pharmacist should explain
the mode of administration, direction for
use, and storage.

75. Now-a-days, the majority of the drugs are
available in the market as readymade
formulation manufacturing by different
pharmaceutical companies. The drugs
should be prescribed by its official name
and not by its proprietary or trade name.
There are certain advantages and
disadvantages of prescribing the drugs by
its proprietary name, which are following-
Modern methods of Prescribing-

76. Advantages-
 It's easy to remember proprietary because
they are very catchy.
 It is easy to communicate with the patient.
 The continuity can be maintained by
prescribing the same proprietary name
every time.
 It is cheaper to prescribe the drugs by its
official name.

77. Disadvantages-
 The bioavailability of drugs change with
the change of adjutants used in drugs
formulation manufacture by different
manufactures, so only those proprietary
drugs can be prescribed which have a
better bioavailability.
 It becomes difficult for a pharmacist to
dispense the substitute of the drug which
is available in the stock.

78. Inventory Control in
Community Pharmacy

79. What is Inventory?
Inventory means all the
materials, parts, supplies,
expense tools and inprocess
or finished products
recorded on the books by an
organisatiion and kept in its
stocks, warehouses or plant
for some period of time.

81. OBJECTIVES OF INVENTORY-
 Discuss why inventory control is important for
pharmacies.
 Become familiar with some of the more common
purchasing concepts and some of the methods
for controlling inventory.
 Discuss purchasing policies and their value
within the pharmacy.
 Having a working knowledge of some of the
most common receiving and storage policies.

82. Characteristics of Inventory-
The concept of inventory and its relation with
performance can be well explained by following
statement-
Inventories serves as cushions to absorb shocks.
Inventory for any organisation is a necessary evil.
Inventory provides production economies.
Marketing, production, finance & purchasing
decisions directly influence the level of inventory.

83. Costs in Inventory-
Inventory costs may vary from 28 to 32% of
the total cost. Apart from material costs,
several other costs involved in inventory.
These are given as are also below-
1. Ordering Costs
2. Holding/Carrying Costs
3. Stock Out Costs

84. • Ordering Costs-
 Stationary
 Clerical and processing, salaries/rentals.
 Postage.
 Processing of bills.
 Staff work in Expedition/ Receiving
inspection and documentation.

85. • Holding/Carrying Costs-
 Storage space (rent/depreciation)
 Property tax on warehousing.
 Insurance.
 Deterioration/Obsolescence.
 Material handling & maintenance, equipment.
 Stock taking, security and documentation.
 Capital blocked (interest/opportunity cost)
 Quality control.

86. • Stock Out Costs-
 Loss of business/profit/market/advise.
 Additional expenditure due to urgency of
purchases-
a) Telegraph/telephone charges.
b) Purchase at premium.
c) Air transport charges.
 Loss of labor hours.

87. Inventory control' or 'Stock control' is the
activity of checking stock of the community
pharmacy.
Inventory Management System is a technique
which helps to determine how much stock to
hold, when to place order and how many
quantity to order for smooth operation of a
community pharmacy.

88. Inventory Control is a scientific method of finding
out how much stock should be maintained in order
to meet the production demands and be able to
provide right type of material at right time, in right
quantities and at competitive prices.
A successfully implemented inventory control
program takes into account such things as
purchasing goods commensurate with demand,
seasonal variation, changing usage patterns and
monitoring for pilferage.
Cont..

89. Objectives of inventory control-
 Minimization of procurement costs and carrying
costs.
 Protection aganist fluctuations in demand & output.
 Better use of men, machines and materials.
 Control of stock volume and stock distribution.
 Balance of supply and demand.
 Determination of the right level of customer
service.

90. Importance of Inventory Control-
 Provides and maintains good customer service.
 Provides protection aganist the uncertainities of
demand and supply.
 Enables smooth flow of goods through the production
process.
 Various production can be performed economically &
independently.
 It can allow temporary variations in operating rates.
 Ensure a reasonable utilisation of equipment & labour.

91. Functions of Inventory Control-
1. To permit operations.
2. To meet anticipated demand.
3. To protect against stock-outs.
4. To take advantage of order cycles.
5. To help hedge against price increases.
6. To smoothen production requirements.
7. To take advantage of quantity discounts.

92. ABC method of inventory control is also called
as "Always Better Control" method. It is based
on the concept "Thick on the best and thin on
the rest".
This method classifies Inventory according to
annual value of consumption of the items-
ABC Analysis/Method-
Cont..
Methods of Inventory Control-

93. (A) Very Important.
(B) Mod. Important.
(C)Least Important.
 [A] items- 15% of the items are of the highest
value and their inventory accounts for 70% of
the total.
 [B] items- 20% of the items are of the
intermediate value and their inventory accounts
for 20% of the total.
 [C] items- 65%(remaining) of the items are
lowest value and their inventory accounts for
the relatively small balance, i.e., 10%. Cont..

94. Advantages-
 It ensures better control over costly items.
 It helps in maintaining the stock in a better
approach.
 It helps in reducing the storage costs.
 It helps in developing scientific method of
controlling inventories.
Disadvantages-
 B and C categories can often get neglected
and pile in huge stocks or susceptible to loss
and slackness in record control.

95. VED stands for- Vital, Essential and Desirable.
1. Vital- Medicines, whose non-availbility or
shortage can not be tolerated.
2. Essential- Medicines, whose non-availbility
or shortage can be tolerated for 3-4 days.
3. Desirable- Medicines, whose non-availbility
can be tolerated for a long period.
VED Analysis/Method-

96. Economic Order Quantity (EOQ) technique
helps you identify the most economical way
to replenish your inventory by showing you
the best order quantity.
EOQ = mathematical device for arriving at
the purchase quantity of an item that will
minimize the cost.
total cost = holding costs + ordering costs
EOQ Technique/Method-

97. The Lead Time is the interval between
placing an order and having it ready for
dispensing.
When calculating lead times in a pharmacy,
you must consider the amount oftime to
stock the shelves, compound, or mix.
Lead Time-

98. Safety stock is the extra units of inventory carried as
protection against possible stock-outs.
The safety stock must be carried when the pharmacy
is not sure about either the demand for the drug or
the lead time or both.
In the case where the demand is uncertain, safety
stock is the difference between the maximum usage
and the average usage multiplied by the lead time.
Safety stock-

99. For example- assume that a pharmacy is faced
with an uncertain usage of Lisinopril. Lead time
is constant at two days. Normal daily usage is 7
bottles but it can go as high as 10.
The store would compute the safety stock as
follows-
Maximum daily usage= 10 bottles
Average daily usage= 7 bottles
Excess= 3 bottles
Lead time x 2 days
= Safety Stock 6 bottles.
Cont..