REPUBLIC OF CAMEROON REPUBLIQUE DU CAMEROUN

Peace -Work- Fatherland Paix –Travail- Patrie

MINISTRY OF HIGHER EDUCATION MINISTERE DE L’ENSEIGNEMENT
MINISTERE DE L’EMPLOIET DE FORMATION SUPERIEURE
PROFESSIONELE MINISTRY OF EMPLOYMENT AND
VOCATIONAL TRAINING

BIAKA UNIVERSITY INSTITUTION OF BUEA (BUIB)

P.O BOX 77
BOKOKO, BUEA

MOTTO: KNOWLEDGE AND SERVICE TO HUMANITY

“The Audacity to be different”

SPECIALTY: PHARMACY TECHNOLOGY

CLINICAL REPORT CARRIED OUT AT REGIONAL

HOSPITAL LIMBE FROM YHE 25TH OF MAY TO THE 2ND OF
OF JULY 2021
A

A Report submitted to Biaka University Institude of Buea (B.U.I.B) in

partial fulfillment for the requirement of the award of a diploma in

pharmacy technology

Presented by

KAMGA YAMENI MEGANE

HS20PTO25

JULY 2021
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DEDICATION
this work is dedicated to God almighty for his abundant grace. Blessings and
inspiration to my parents for their love, care, support and sponsorship and also
to Biaka University for the knowledge and opportunity given to me
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ACKNOWLEDGEMENT
I feel a deep sense of gratitude to the various person who helped in the
realization of this report. Thanks to the supervisor and director of regional
hospital Limbe who gave me the permission to carry out any clinical practice at
the hospital. To all my family members who provided financial and moral
support throughout the process. And above all thanks goes to God almighty for
giving me the strength and knowledge.
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TABLE OF CONTENTS

Table of Contents
DEDICATION .............................................................................................................................................. ii

ACKNOWLEDGEMENT ............................................................................................................................... iii

TABLE OF CONTENTS ................................................................................................................................ iv

LIST OF ABBREVIATION ........................................................................................................................... vii

CHAPTER 1

GENERAL INTRODUCTION ......................................................................................................................... 2

1.1 INTRODUCTION AND INTERNSHIP OBJECTIVES ........................................................................ 2

1.2 Introduction .................................................................................................................................... 2
1.3 Internship Objectives ................................................................................................................... 2
1.4 Definition of terms ...................................................................................................................... 3
1.5 DESCRIPTION OF PLACEMENT SITE ........................................................................................... 4
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CHAPTER TWO

2.1 PHARMACY PRACTICE ................................................................................................................ 5

2.1.1 CENTRAL RESPONSIBILITY ....................................................................................................... 5

2.1.2 Sterile products areas and responsibilities ................................................................................... 7

2.1.3 DECENTRAL RESPONDIBILITIES ..................................................................................................... 7

2.2 Nursing Practice ...................................................................................................................................... 8

2.2.1 Basic equipment’s used in the nursing department ..................................................................... 8

2.2.2 Patient Reception, Vital Signs And History Taking ........................................................................ 8

2.2.3 Setting Up Patient Medication Tray .............................................................................................. 9

2.2.4 Drug Administration Using Different Routes ................................................................................ 9

2.2.5 Admission And Discharge Of Patients......................................................................................... 10

2.2.6 Cleaning The Ward And Other Unite .......................................................................................... 10

2.3 LABORATORY PRACTICE ........................................................................................................................ 11

2.3.1 Equipment’s Used In The Laboratory ......................................................................................... 11

2.3.2 Different Procedures Carried Out In The Laboratory ................................................................. 11

2.3.3 How Machine Is Operated In The Laboratory ............................................................................. 12

2.3.4 Preparation Of Stock Solution .................................................................................................... 13

2.3.5 Laboratory Safety Guidelines ...................................................................................................... 14

2.3.6 Minor Laboratory Examinations ................................................................................................. 14

2.3.7 Cleaning The Laboratory ............................................................................................................. 15

CHAPTER THREE
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3.0 CONCLUSION................................................................................................................................... 16

3.1 Recommendation............................................................................................................................ 16
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LIST OF ABBREVIATION
- FIFO: First-in first-out
- FEFO: First expired, first out
- DEA: Drug enforcement administration
- OUDD: One-unit dose dispenses
- PRN: Pro re natal
- FP: Family Planning
- ANC: Antenatal Care
- MP: Malaria parasite
- WIDAL: typhoid test
- FBS: fasting blood sugar
- ac: before meals
- ac hs: before meals and at bed time
- AD: right ear
- Ad lib: freely as much desired
- aa: of each
- AAA: apply to affected part
- ad: up to you
- nocte: at bed time
- cap: capsule
- til: dilute
- dis: dispense
- dics: discontinue treatment
- A.S.: left ear
- A.U.: both ears
- ATC: round the clock
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CHAPTER 1

GENERAL INTRODUCTION

1.1 INTRODUCTION AND INTERNSHIP OBJECTIVES

1.2 Introduction
An internship is a period of work experience offered by the institute for a limited
period of time.as a mandatory part of the HND pharmacy program, all the
students of biaka university institute have to undergo a one month two weeks
long internship program with an objective of gaining practical knowledge about
the whole of pharmaceutical studies. The internship furnishes the student with an
exposure into the practical word. This study is conducted in one of leading,
innovative and modernized hospital in the south west region that is in the
regional hospital limber (RHL). It known for providing value services to its
patients. Being a Biaka student I am delighted to spend my 4weeks internship
program at RHL because it is well – established healthy work place. Internship is
an intergyral platform for anyone to again experience in an actual work place.
Internship is a good opportunity for student to learn, to gain experience and make
preparation (men learn through experience), we encounter many difficult and
obstacles and are expected to be able to complete the cleaning the process. This
practice help make control, develop and improve my attitude and behavior in
dealing with different kinds of people and situation. I also grabbed the
opportunity to apply theories and knowledge I have in real life setting.

1.3 Internship Objectives

The primary objective for going on an internship is to be able to work as an
accurate and efficient technician. But the internship was divided in three
separate phase, with each phase having specific objective relative to the
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domain. These phases are nursing orientations, laboratory orientations and

hospital pharmacy.
a. Objectives for nursing
- To Identify basic nursing equipment
- To Observe and appreciate patient reception, vital signs and history
taking
- To Observe and acquire skills in setting up patient medication tray
- To Appreciate the different nursing position in relevance to their
condition
- To Observe and assist in admitting and discharging patients
- To assist in cleaning the various wards/units.

b. Objectives for laboratory

- To identify lab equipment
- Observe the different procedures carried out in the lab
- Observe how machines are operated in the lab
- To be able to prepare stock solutions
- To assist in performing minute lab examinations
- To assist in cleaning the lab

c. Objectives for hospital pharmacy

 Central responsibilities
 To understanding inventory requirement/ordering
 To prepare unit dose prepackaging and labeling per legal requirements
 To know how to handle control substances
 Sterile product area responsibilities
 Know how to clean the pharmacy
 Know how to prepare sterile products using aseptic techniques
 Know how to perform and apply pharmaceutical calculations
 Decentral responsibilities
 To deliver patients medications to wards
 Assist in locating missing medications
 Document patient allergy information
 Understand how to fill patient’s drug administration chart.
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1.4 Definition of terms

 There are some terms that were used in the clinic that need some
clarifications so that it may be better understood by the readers.
 Vital signs: these indicators of the body’s ability to maintain
homeostasis. They are considered vital because they measure the body
vital functions and provide necessary information about the patient’s
physical well-being
 Diagnosis: it is the identification of the nature of an illness or other
problem by examination of symptom.
 Pharmacy: A shop or hospital dispensary where medicinal drugs are
prepared or sold
 Inventory: It is the quantity of material at hand
 Symptoms: A physical or mental feature which is regarded as indicating
a condition of a disease, particularly such a feature that is apparent to the
patient.
 Drug: It is a chemical substance that is used for the treatment, diagnosis
and prevention of a disease.
 Hospital: an institution providing medical and surgical treatment and
nursing care for sick or injured people.
 Patient: A person receiving or registered to receive medical treatment
 Stock card: A document that tracks purchases, sales, returns, and other
drawings. It tracks the unit price and inventory counts
 Request book: It’s a form used in the pharmacy to request for drugs
when finished or when they are almost finish
 Empathy: the ability to stand in another`s shoes or what it is like for that
person in that situation
 Dispensing: It is the provision of drugs or medicines as set out properly
on a lawful prescription
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1.5 DESCRIPTION OF PLACEMENT SITE

Regional hospital is located at mile one. At the hospital entrance is a mighty
gate and inside to the right is a statue carved representing a doctor and a
nurse, at the center is the hospital canteen. To the left is the laboratory unit
and deep inside is the outpatient’s department, minor theater, pharmacy, the
imagine center, intensive care unit, major theater. To the right is the male
medical word, female medical ward, children’s ward, maternity, male and
female surgical ward and the mortuary. The hospital pharmacy is divided into
the drug store where drugs are stored and the dispensary
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CHAPTER TWO

2.1 PHARMACY PRACTICE

2.1.1 CENTRAL RESPONSIBILITY

 Understanding inventory requirements/ordering
A pharmacy’s inventory represents its single largest of item present at a time.
Inventory and ordering is done so as to ensure enough materials is available
both at the level of the warehouse and the dispensary, to keep custody and
issue of materials and record stock movement. This help to ensure proper
management, marketing and maintenance of all the pharmaceutical
departments. Inventory is done with the help of documents in the pharmacy
department.
 At the level of the store room or warehouse the documents include:
 Store room/warehouse drug control book: It contain
parameter’s such as;
- Name and quantity of drugs supplied from the suppliers
- Date of supply and date received
- Expiry date of drugs supplied
 Store room/warehouse stock card: it contains parameter such
as
- Request indicator
- Security stock
- Average monthly consumption
- Name and form of drug
- Expiry date of drug
- Quantity of drugs delivered (to dispensary or other hospital
units)
- Name and signature of receiver
 Dispensary drug control book: it contains parameter such as
- Quantity of drugs received from store room
- Date and signature of receiver
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- Expiry date of product received

 Dispensary stock cards: the dispensary stock cards have same
parameter as the stock card but is filled differently. it has
parameter such as
- Request indicator
- Average monthly consumption
- Security stock
- Quantity of drugs leaving the dispensary (to outpatient,
inpatient for sale)
- Expiry of date of products received
- Date of receipt and date of delivery
- Daily sales book or dispensing book
- In this book all the products leaving the pharmacy
dispensary are entered. it contains the date of delivery, the
name of the person collecting the product, the quantity of
the product and the unit price
 Ordering:
Ordering in regional hospital limbe is done using documents such
as requesting form where the name and quantity of product
required are writing. the average monthly values guides ordering.
The pharmacy at this medical center, orders for its product
different companies or accredited suppliers such as;
- 3-N PHARMA
- PARATEEK
The requisition form is sent to these companies via mail
or phone call. The companies then arrange the product
and deliver them to the pharmacy.
 Unit dose prepackaging and labelling per legal requirements
the client presents his prescription containing the medication and dosage to be
taken. As per legal requirements the prescription has to contain the prescriber
name, signature and stamp before the medication can be dispensed. The dose
required is the gotten and labelled according to the doctor prescriptions (that is
one tablet two times daily, 5mls two times daily).
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 Proper handling of control substances

Controlled substances are drugs or chemicals whose manufacture,
possession, or use is regulated by a government such as illicitly used drugs
such as diazepam, tramadol, ketamine. These drugs are to be used solely for
patient care hence are given out von prescription which is legal (signed and
stamped) the s items are kept in very secure areas in the pharmacy so that
they cannot spill or get broken. This is because some of them is spilled
especially those in the powder form could induce sleep and cause other
disorders if inhaled in a large amount

2.1.2 Sterile products areas and responsibilities

 Cleaner of the pharmacy and others departments
In regional hospital limbe, the pharmacy and store are properly cleaned
before the workers begin work in the morning. I therefore had to come to
the hospital. very early so was to clean. The shelves are well cleaned and
the medications and stock card arranged in order then the floor too is
mopped with water and omo and camel water (eau de javel). The windows
are opened for proper ventilation
 Performing general pharmaceutical calculation
This involves calculating individual drug does and accurately converting
between unit of measurements. The goal of this is to ensure that does of
medication are appropriately for every individual patient. in one of such
cases I came an=bout a patient with a prescription as:
Azithromycin 1g
1 x 3days
The pharmacy at the moment had just the strength of 250mg. to
dispense this medication, I had to convert from gram to milligram
Knowing that 1g = 1000mg
Xg = 250mg
This implies that the patient will received 4 tablet daily instead of 1. So for 3
days he will require 3 x 4 tablets which will give a total of 12 tablet.
2.1.3 DECENTRAL RESPONDIBILITIES
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 Delivery of medication to ward

In regional hospital limbe medications are delivered to ward for
patients who are admitted. The medications are entered in the
pharmacy drug chart and dispensing book and then taken to nursing
station. The nurses then take them to the ward administer them and fill
the patient’s drugs drug administration chart
 allocating missing medication
since all medication entering and leaving the pharmacy are registered in
varies documents missing medication were easily traced and stored out
mostly while updating the stock card the missing medication were
traced

2.2 Nursing Practice

2.2.1 Basic equipment’s used in the nursing department

Nurses mostly use diagnostic equipment’s. the equipment’s are used for
monitoring vital signs and drug administration.
 For Vital Signs Monitoring Equipment’s Used Include:
- Stethoscopes
- Blood pressure machine
- Thermometer
- Stop watch
 For Drug Administration Equipment’s Used Include:
- Drug medication trays
- Waste disposal tray (kidney dish)
- Scissors
- Tourniquets
- Syringes

2.2.2 Patient Reception, Vital Signs And History Taking

In regional hospital limbe, patients are received at the out patient’s
department (OPD). The patients are received by the nurses at the
outpatient who welcome the patient in a calm manner and begging to clerk
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the patients. The nurses here collected the patient’s demographics (name,
sex, status, address and telephone number) and in the course of this tries
to develop a good rapport with the patient so as to make them
physiologically prepared and stable. The information gutting is writing
down in the patient’s hospital book.
He further proceeds to the vital signs monitoring were the patients weight,
temperature, blood pressure, pulse and respiratory measured and also
written in the patient’s hospital book. For admitted patients, the vital signs
are monitor every day and writing down on a vital sign chart.
 History taken: is done at the out – patient or in- patient for
emergency cases. The patient’s medical history, family and social
history information is taken and written in the patient’s file and
allergy information is noted and written in the patient’s hospital.
book or allergy form.
To ensure patient’s comfort and efficiency throughout the whole process,
all these are done in a clean, well ventilated environment and when the
patient is good physiological state. Patients with difficulty or in pain could
be asked to lie. The patient is the sent for consultation after this.

2.2.3 Setting Up Patient Medication Tray

The patient’s medication tray contains medications to be administered at a
particular point in time. It also contains sterile syringes, skin antiseptic
(alcohol,), swaps(cotton), plaster, cannula (needle for intravenous
medication), and container for disposal of needle and drip set for newly
admitted patients. The medications are placed such that they cannot spill
or break and first to be administered is placed in front while the
subsequent ones to be administered follow. The trays are carried gradually
to the patient’s ward where the medication are to be administered.

2.2.4 Drug Administration Using Different Routes

I was opportune to participle [ate administer some drugs to patients such
as ceftriaxone, anlagen and ampicillin through intravenous route, tramadol
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and vitamin k through subcutaneous route and artemether, and

dexamethasone through intramuscular route.

2.2.5 Admission And Discharge Of Patients

In regional hospital, patients are administering into the general or private
ward depending on the patient’s choice and into the male ward or female
ward depending on the patient’s sex. There is also pediatric ward for
children. And the maternity for women who put to birth.
For a patient to be admitted, he or she must present his hospital book
showing admit into ward written by the doctor or he or she must be from
the emergency unit. The patient is taken to the ward where his or her
medication are to be given, his or her drip is set and he or she left tom lie
on the bed were the patient will be monitor from time to time. A file is
created were the patient information is written. This information includes
the patient name, sex age, address, phone number, ward date of admission.
The file will also contain the patient’s drug administration chart, vital sign
chard, laboratory form, hospital book and continuation sheet for writing
during rounds
When the patient must have recovered, the doctor will indicate in this file
that he should be discharge and relay him on oral medications to take
home. The patients bill is calculated which will include all medication used
from the hospital, bed fee, Nursing care and accessories. The bill sheet is
prepared and handed to the patient which will be later put in the file after
payment and the patient takes home his hospital book and receipt. The
nurses fill the exist forms or discharge registers and death registers in case
of death

2.2.6 Cleaning The Ward And Other Unite

In regional hospital limbe, the wards and units are cleaned very early in the
morning. The floor is cleaned with water, omo and diluted cancel water (la
Croix), the windows are opened for ventilation. In units like the theater
after cleaning in the morning, after surgery they are clean again. Also if a
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patient urinates on the floor in the wards it is cleaned up immediately to

prevent infections and germs from spreading.

2.3 LABORATORY PRACTICE

2.3.1 Equipment’s Used In The Laboratory

The various equipment use’s used in regional hospital lime include:
- Test tube; used for sample collection
- Glass slide and cover slid; used as the backing on which test samples
are taken and placed on the microscope
- Petri dish: used for the preparation of culture media and the culture
of organisms they are in.
- Micropipette; used for aspiration and addition of reagent.
- Syringes; for sample collection
- Tourniquet; used during intravenous injection and cannulations to
cause an artificial venous stasis by applying pressure through the
rubber tube which lead to encouragement of the veins.
- Incubator; used to keep sample at a particular temperature
- Spectrophotometer; used to determine quantities of biochemical
elements.
- Microscope; used for visualizing minute structure including
microbes.
- Centrifuge; used to separate particles dispersed in liquid according
to their molecular mass
- Bunsen burner; source of fire and heat

2.3.2 Different Procedures Carried Out In The Laboratory

The different clinical procedures carried out at regional hospital limbe
include;
 Urinalysis; this is a laboratory examination of urine for various cells
and chemicals such as red blood cells, white blood cells, infections or
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excessive protein. Urinalysis break down the components of urine to

check for the presence of drugs, blood, protein, urea, glucose and
other substance.
 Full blood count (FBC); this test determines general health, number
of red blood cells, white blood cells in a given volume of blood. It can
screen for disorder such as anemia or infections, as well as
nutritional status and toxic exposure. The reading varies with sex,
age and physiological state.
 Serological test; these are laboratory procedures carried out on a
sample of red blood serum. The purpose of the test is to detect the
serum antibodies that appear specially in association with certain
disease. The various types of serological test include; complement
fixation test, flocculation test, wedel reaction and syphilis test.
 Immunologic blood test; any group of diagnostic analysis of blood
that are capable of detecting abnormalities of the immune system.
This test includes HIV, Hepatitis B, C and chlamydia. Most of the test
are performed with an enzyme linked immunosorbent assay.
 Stool analysis; this is a laboratory examination of stool for cells and
microbes and also chemical substances.
 Prothrombin time; this test measure how long it takes for blood to
clot, it measures the presence and the activity of the five different
blood clotting factors. Est screens for bleeding abnormalities
 Lipid panel; this is a group of test used to evaluate cardiac risk. It
includes cholesterol and triglyceride level
 Other clinical test includes c- reactive protein, pregnancy test etc.

2.3.3 How Machine Is Operated In The Laboratory

 The Centrifuge: the centrifuge works by spinning mixtures around
a central axis at high speed and thus creates a strong centripetal
force causing the denser materials to move to the bottom of the
centrifuge tube more rapidly. The particles separate according to
their sizes, shapes, density, viscosity of the medium and rotor speed.
The specimens are placed inside on opposite sides so that their
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weight is balanced, it is then turned on to spin for about 5minute

after which the specimen is separated into its various components
 The Microscope; the microscope is an instrument used to view
objects that cannot be seen with the necked eye. The spacemen for
example stool sample is placed on the microscope slide and covered
with the cover slide. The slide slid is then placed on the microscope
stage and fastened with the stage clip. The objective lens is used to
move the slid upward. The slide is moved to the center and viewed
through the eyepiece. The focus knop is moved till the image comes
into focus and the light intensity is adjusted. The sample slide is
moved around until an appropriate field of what is wanted appear.
After observing, the stage is lowered and the slide is removed.
 the full Blood count machine: it is also known as the hematology
analyzer. The machine is switch on and it send a small tube down
where the blood sample will be placed. For each sample, the patient’s
name and age range is indicated. The machine then collects the
sample and produces the results of the blood components (RBC,
WHC, platelets, and Hemoglobin)
 Spectrophotometer; a spectrophotometer is used to determine the
amount of analyst present in a sample, by measuring the degree of
absorption and emission of radiation in a preselected spectrum. The
sample solution is placed in it and it measures the intensity of light
absorbed after it passes through the sample solution

2.3.4 Preparation Of Stock Solution

A stock solution is a concentrated solution that is diluted to some lower
concentration for actual use. Stock solutions are used to save preparatory
time, conserve materials, reduce storage space and improve accuracy with
which lower concentration solution are prepared. As an example, to
prepare 50ml of 0.1M solution from 2.0M solution, the volume stock
solution required is calculated. So to make the solution, 25ml of the initial
solution is collected and since the required volume is 50ml, 25ml is poured
into a 50ml volumetric flask. A solvent is added to the 50ml line.
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2.3.5 Laboratory Safety Guidelines

- Laboratory jacket, and closed toe shoes should be worn at all times
when working in the lab
- No eating and playing in the lab
- Containers of chemicals should always be closed
- Warning signs should be posted on hazardous materials.
- Reagents containers should be labelled and well placed
- Reagent should be combined in their appropriate order, such as
adding acid to water
- Wash exposed areas of the skin when about leaving the lab

2.3.6 Minor Laboratory Examinations

 Urinalysis
Urine sample is collected in a clean urine container. For macroscopy, the
color of the urine is examined, normal color is amber or yellow. A urine
strip is dipped into the urine, the colors indicate the presence and
concentration of component in urine like glucose, ketone, bilirubin, urea
and ascorbic acid. It also shows the PH and specific gravity of the urine. For
microscopy, the urine is centrifuge and the sediment is collected and
viewed under the microscope. The sample is analyzed for bacteria cell,
epithelia cell and pus cell.
 stool analysis
The stool sample is collected in a clean sterile container. For macroscopy,
the stool color is checked, the odor (offensive or non –offensive), and the
texture (formed, semi formed and watery, bloody or mucoid). For the
microscopic examination, a drop of normal saline or iodine is placed on a
clean dry slide then the stool sample is added to mixed and mixed to have a
uniformed texture. It is then covered with the cover slid and viewed under
the microscope. The sample is analyzing for blood cell cells, micro-
organisms such as E. histolitical, helminth egg and cyst of amoebic
organism
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2.3.7 Cleaning The Laboratory

The laboratory is cleaned in the morning before work and after work. The
surface is cleaned with ware and an antiseptic solution to kill micro –
organism that might have settled on it. The floor is cleaned with water,
omo and diluted camel water (eau de javel)
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CHAPTER THREE

3.0 CONCLUSION
The training would not have gone successfully without some little
challenges.
Firstly, I had difficulties mastering the pieces of drugs at the pharmacy
since there were no price tags on the drugs, I therefore had to refer to the
price list from time to time making the dispensing process slow.
Secondly, it was difficult performing nursing and lab procedures
confidently as it is not my field so I was a little bit tensed. Also I was
opportune to meet up with all my objectives since the activities were really
performed at regional hospital limbe.
Lastly the internship duration was really too short for me to have a good
mastery of what is required

3.1 Recommendation
Based on the challenges faced, I will like that next time I pray before I go
their next time a hand typed and printed list of price list of the price should
be printed, and hopefully next time our internship program won’t be rather
4weeks but 6weeks do that we will at least have enough time to spend in
the various department and be able to master the concept well.