CHAPTER ONE

1.0 INTRODUCTION

The Students Industrial Work Experience Scheme (SIWES) is part of the University of

Jos academic program which is aimed at developing the student by exposing them to the

practical aspects of the theoretical knowledge gained in the classroom. It enables the student

appreciate more of higher academic work and this points to its relevance as an important

academic programme designed for teaching, learning, industry and work. It serves as a bridge

between the theoretical knowledge acquired and practical knowledge required in the labour

market. It is an important avenue that helps to prepare the students to join the working

population.

1.1 HISTORY AND BACKGROUND OF SIWES

The Student Industrial Work Experience Scheme (SIWES) was established by the

Industrial Trust Fund (ITF) under decree 47 of 1971 as amended in 1990; the scheme has been in

operation since then (James-Rugu, 2013). The policy statement No.1 of the fund published in

1973 inserted a clause dealing with the practical skills, to solve the problem of inadequate

practical skills preparatory for employment in industries by Nigerian graduates of tertiary

institutions. The scheme was a skill training oriented programme designed to expose and prepare

students on works they would be engaged in after graduation.

ITF, as a Federal parastatal, was charged with the responsibility of promoting and

encouraging the acquisition of skills in industry and commerce with a view to generating

indigenous trained man power sufficient to meet the needs of the economy. Participation in

SIWES has become a necessary condition for the award of Degree and Diploma Certificates in

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specific disciplines in most institutions of higher learning in the country, in accordance to the

Education policy of the government.

The Students Industrial Work Experience Scheme (SIWES) is a skill training program

designed to expose and prepare students of Universities, Polytechnics Colleges of Technology,

and Colleges of Education for the Industrial Work situation they are likely to meet after

graduation. The scheme also afford students the opportunity of exposing and getting familiar

with the needed experience in handling equipment and machinery that are not available in their

institution.

There was a growing concern before the establishment of the scheme among industrialists

that graduates of higher institutions lacked practical background knowledge, preparatory for

employment in industries. The employers were of the opinion that the theoretical education

going on in higher institutions was not responsive to the needs of the employers of labour. It is

against this background that the rationale for initiating and designing the scheme by the fund

during its formative years (1973/1974) as introduced to acquaint students with the skills of

handling employers equipment and effectively taken over by the industrial training fund (ITF) in

July 1985 with the funding solely borne by the Federal government.(Adali I. A 2017)

1.2 AIMS AND OBJECTIVES OF SIWES

The aims of the Students Industrial Work Experience Scheme (SIWES) is; to expose

Students to machines and equipment, professional work methods and ways of safe-guarding the

work areas and workers in the industries and other organizations (James-Rugu, 2013).

The objectives of the Students Industrial Work Experience Scheme (SIWES) are to:

a) Provide students with an opportunity to apply their knowledge in real work situation

thereby bridging the gap between theory and practical.

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 b) Expose students to work methods and techniques in handling equipment and machinery

that may not be available in the universities.

c) Prepare students for the industrial work situation they are likely to meet after graduation.

d) Provide an avenue for students in institutions of higher learning to acquire industrial

skills and experience in their course of study, which is restricted to engineering and

technology, environmental studies and other courses that may be approved.

e) Make the transition from school to the world of work easier, and enhance students’

contacts for later job placement.

f) Enlist and strengthen employers’ involvement in the entire educational process and

prepare students for employment in industry and commerce (James-Rugu, 2013).

1.3 CONTRIBUTION TO THE ECONOMY

i. Improves the quality of skilled manpower

ii. Establishing closer ties between institutions and industries

iii. Increasing the output of the Nigerian Labour force

1.4 RELEVANCE OF SIWES TO PHARMACY

The relevance of SIWES to pharmacy profession cannot be over-emphasized because it

helps to preparing the Pharmacy students for the challenges of the future.

It helps in the general practical assessment of the student regarding the knowledge

acquired during the first four years of study.

It also helps to boost the students morale built- in confidence in the students.

It can also make student to be more committed to their studies knowing what is expected

of them in the labour market.

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 Challenges of internship will be greatly reduced as the students are already exposed to

what they will later be doing in the future.

1.5 THE HOSPITAL PHARMACY (PLATEAU STATE SPECIALIST HOSPITAL)

The hospital pharmacy aim is that which gives relevant, intelligent and crucial

therapeutic information on all aspects of the drugs, both to physicians, nurses, laboratory

scientists and the patients themselves. This integral role involves the recommendation of drug

types to be procured by the hospital, proper management and maintenance of pharmaceuticals in

the hospital, recommendation of drug types for administration to patients, administration routes,

and dosages depending on the individual assessments. Hospital pharmacists find a great

relevance in drug therapy problems and therefore they are the epicentre of ‘pharmaceutical care.

Other roles of the hospital pharmacists include drug dispensing, quality assurance tests,

compounding of medications, regulating the purchase of medicaments in the hospital.

1.5.1 SUMMARY OF ACTIVITIES CARRIED OUT AT PLATEAU STATE

SPECIALIST HOSPITAL

1. Renewed knowledge on some medical conditions

2. Dispensing of drugs to patients in the antenatal care unit

3. Basic knowledge on the compounding of medications for paediatric use

4. Filling of various ledgers for daily drug supplies and distribution.

5. Analysis of prescriptions which involves screening, filling and interpretation.

6. Counselling of patients on proper drug usage.

1.6 COMMUNITY PHARMACY (KUNOOK PHARMACY)

The community serves as the closest and most accessible health service provider. The

community setting usually consists of a retail storefront with a dispensary where medications are

4
stored and dispensed. The dispensary is subject to pharmacy legislation; with requirement for

storage conditions, compulsory text and equipment specified in the legislation. A community

pharmacy is expected to have a registered pharmacist on duty at all times when open and the

outlet must be registered with the appropriate body/bodies concerned.

1.6.1 SUMMARY OF ACTIVITIES CARRIED OUT AT KUNOOK PHARMACY

The following are some of the basic activities carried out in the community pharmacy

(Kunook pharmacy). They are:

1. Learning of brand names, strength and the dosage forms in which particular drugs can be

available.

2. Standard arrangement of drugs in a community pharmacy.

3. Analysis of prescriptions which involves screening, filling and interpretation.

4. Clerking and counselling of patients.

5. Dispensing of drugs (Over The Counter (OTC) and Prescription-Only Medicines (POM)

6. Measurement of blood pressure using sphygmomanometer, Body weight using the scale

balance

7. Performing simple tests such as blood glucose test, pregnancy test, malaria test and rapid HIV

test, Hepatitis B test

8. Wound dressing

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 CHAPTER TWO

2.0 HOSPITAL PHARMACY EXPERIENCE.

2.1 BRIEF HISTORY OF PLATEAU STATE SPECIALIST HOSPITAL

The Plateau State Specialist Hospital (PSSH) formerly known as Plateau Hospital was

established by the British expatriate tin miners in 1935 to care essentially for the health care

needs of its workers who settled in and around Jos. It was then known as European Hospital. The

services of the hospital were later extended to some highly placed Nigerians like the Emirs,

Chiefs and Top Government officials. Its capacity was 25 beds spaces which occupied mainly

the present maternity/gynaecology ward.

The name was changed to Plateau Hospital in 1958 during the pre-independence period

when the expatriates were beginning to leave the country in view of Nigeria’s political

independence. Following the country's independence in 1960 coupled with mass departure of the

colonial masters from the country, the services of the hospital were later extended to senior civil

servants as it assumed the status of an Amenity Hospital. Its services were improved upon by the

building of an output complex. The administration of health in 1977 when the hospitals

management board was first established was followed by structural and administrative changes

leading to the building of additional wards with a hundred and twenty bed spaces, modem central

blood bank, twin Theatre, pathology department, staff canteen and mortuary. Also constructed

was a senior staff quarters in addition to the various modern hospital equipment. In 1981, the

hospital was elevated to the status of a general hospital following the upgrading of the Murtala

Mohammed Hospital to a teaching hospital due to the need for a secondary health centre in the

state capital.

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 On 7th March 1995, a sole administrator was appointed for the hospital by the then

military administrator, Col. Mohammed Mana for the purpose of upgrading its standard. This

resulted in major structural improvement and the renovation of existing structures. The hospital

is one the health institutions of the state, approved by the Nigerian medical laboratory Science

Technology for internship program for doctors, pharmacists and medical laboratory scientist

respectively.

The hospital also witnessed a major land mark in 1997 when it was approved by the post

graduate medical college of Nigeria for the training of resident doctors in general medical

practice, a program that is going on successfully and attested to the success at the latest re-

accreditation exercise in January 2006.

A major achievement recorded was the upgrading of the hospital in year 2000 to a

specialist hospital status in response to the increasing need for the provision of specialized

services in the state apex hospital services as a referral centre for the general and cottage

hospitals within the state following its separation from the Plateau State Hospital Management

Board and the subsequent passage of the bill granting its autonomy by the State House of

Assembly. This led to a number of administrative changes and restructuring of its operations.

The Hospital is now headed by a Chief Medical Director.

One of the most recent land marks is the commissioning of the Plateau State Human

Virology Research Centre (PLASVlREC) in March 2004 for research purposes.

2.2 PHARMACY DEPARTMENT OF PLATEAU STATE SPECIALIST HOSPITAL

The Plateau State Specialist Hospital has a pharmacy department that deals with the

provision of medication for patients i.e. it provides services and is concerned with meeting the

drug and pharmaceutical needs of the various units and wards in the hospital for onward

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dispensing to patients and other basic needs of the hospital. The department is also charged with

the responsibility of procuring the necessary drugs to be used on a routine basis for the Hospital

and also the training of students on industrial training, students on ward rounds, intern

pharmacists and other senior pharmacists who will be needing clinical pharmaceutical guidelines

and briefings

2.3 THE DUTIES/ROLES OF A HOSPITAL PHARMACY DEPARTMENT

1. Provision of essential drug list and the hospital's drug formulary.

2. Sourcing and procurement of genuine drugs and standard healthcare products at good and

effective prices to meet the patient's need

3. Storage, distribution and stock control of drugs.

4. Filling and screening of prescriptions and patients counselling to ensure appropriate drug

use.

5. Dissemination of drug information to other health professionals.

6. Production of extemporaneous preparations like mixtures, syrups and solutions.

7. Effective administration by the head of the department to maintain high standards.

8. Drug monitoring by going on ward rounds with the medical team.

2.4 THE PHARMACY UNITS IN PLATEAU STATE SPECIALIST HOSPITAL

The pharmacy operates on a decentralized system and the various units are as follows:

 The Central/ Administrative office.

 The General Out-Patient Department (GOPD)

 The In-Patient and Paediatric Department (IPD)

 The Amenity Department where National Health Insurance Scheme patients (NHIS)

are attended to.

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 The Casualty pharmacy

 The Antiretroviral (Heart to Heart) pharmacy

 The Store.

The ranking of positions in each of the pharmacy units are as follows:

 The Unit head (the pharmacist).

 An intern pharmacist.

 A pharmacy technician.

 And other members of staff.

We were posted round the different department built to run on a two weeks rotation

format.

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2.5 ORGANIZATIONAL STRUCTURE OF THE HOSPITAL PHARMACY

DEPARTMENT

THE HEAD OF DEPARTMENT ( THE CHIEF PHARMACIST )

THE PRINCIPAL PHARMACIST

THE SENIOR PHARMACIST

THE CORPER PHARMACIST

THE INTERN PHARMACIST

THE PHARMACY TECHNICIAN

THE I.T PHARMACIST STUDENT

THE PHARMACY ATTENDANTS

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2.6 BASIC EXERIENCES IN THE DIFFERENT PHARMACY UNITS

2.6.1 OBSTETRICS AND GYNAECOLOGY UNIT

This department covers the following sections:

 Ante-natal

 Post natal

 Gynae-emergency

 Family planning

 Special Baby Care Unit (SBCU)

 Maternity ward

 Labour room

This department is concerned with the whole process of antenatal, perinatal and postnatal

care to prospective mothers and mothers. It is also concerned with the provision of healthcare to

women with gynaecological problems and emergencies. The pharmacy unit in this department is

useful for the supply and accurate administration of drugs that are labour which includes,

dispensing of antenatal routine drugs, discharge drugs and take home drugs according to

prescriptions. They also recommend antipyretics for babies who were just immunized. intended

for the care of a mother and the child before, during and after. In this unit, I was involved in the

dispensing of routine drugs to pregnant women, billing of receipts for payment for drugs

according to prescription, counting and packaging of drugs to be dispensed to patients,

arrangement of drugs in the shelves for easy operations, preparing injections to be administered

to women in the Gynae-emergency unit, measurement of blood pressure, pulse rate for the

discharge of patients – women who had just been delivered of babies, counselling of patients on

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proper drug use. I also had discussions with the pharmacist in charge on the safety of drugs in

pregnancy. Some of the drugs safe in pregnancy are:

1. Ferrous sulphate, Folic acid tablets which are given to pregnant women on

antenatal basis according to the time of their next contact with the physician

2. S.P Sulphadoxine and Pyrimethamine which is given routinely to prevent malaria

(but as much as possible should be avoided in the first trimester. In cases where

the individual is down with malaria already and perhaps in the 2" trimester of

pregnancy, anti-malarias containing dihydroartemisinin and piperaquine sulphate

(Artequick®) are safe.

3. Methyldopa, amoxicillin, paracetamol, chlorpheniramine and some other drugs

are safe for use in pregnancy and are dispensed accordingly as the prescription

orders are sent.

2.6.2 GENERAL OUT PATIENT DEPARTMENT

This department supplies the whole hospital including in patients and outpatients. The

drugs dispensed include both over the counter drugs and prescription only medicines. In this unit,

drugs are billed and the patient pays the full bill to the cashier, returns with the receipt and the

drugs will be fully dispensed. In this unit, I was involved in procuring drugs that are out of stock

in the department from the store. I was also involved in dispensing drugs to general out patients

and in patients in wards and had some interactive session with pharmacy technicians and the

pharmacist in charge.

2.6.3 AMENITY UNIT

In this department, the drugs dispensed (both' prescription only' medicines and over the

counter drugs) are mainly to patients registered under NHIS (National Health Insurance

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Scheme). The NHIS package is insured with an operation of 90% discount where the patients

pay just 10% thus NHIS is an insurance scheme introduced by the Federal Government. It has a

separate operational plan unlike the other departments. In this section, drugs are billed and the

patient pays 10% of the total bill to the cashier, returns with the receipt and the drugs will be

fully dispensed. In this unit, I was involved in procuring drugs that are out of stock in the

department from the store. I was also involved in dispensing drugs to NHIS patients and also had

some interactive sessions with the pharmacist in charge.

2.6.4 IN-PATIENTS / PAEDIATRICS DEPARTMENT

In this department, drugs are dispensed to patients in the ward (patients on admission)

and also Paediatrics, including paediatrics infected with HIV. I was involved in screening and

issuing of drugs based on prescription orders, teachings on compounding of drugs and discussion

with the pharmacist on some clinical conditions and the reasons for various drug prescriptions.

2.6.5 THE ANTIRETROVIRAL (HEART TO HEART) PHARMACY

In this department, drugs are dispensed to HIV/AIDS Patients only. Drugs here include

protease inhibitors, reverse nucleoside transcriptase inhibitors, Integrase inhibitors, Entry

inhibitors and Antiviral drugs. In this unit I was involved in drug dispensing.

2.6.6 STORE

This is where drugs in the hospital are being kept for future use. I was involved in stock
check.
2.7 ACTIVITIES ENGAGED IN AT THE HOSPITAL.

2.7.1 FILLING PRESCRIPTIONS

Prescriptions are written orders from a Physician, a dental surgeon or a Veterinary

surgeon stating the medication required for the patient ( animal in the case of veterinary

prescriptions) whose name is on it (the prescription).the prescriber is not limited to the

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mentioned class of people, a nurse in charge of a ward can order for medications too within

his/her jurisdiction .Prescription rights vary from country to country ,many countries have

separate regulations for prescribing certain drugs regarded as poisons.

Parts of a prescription include;

1. Patient’s name

2. Patient’s age

3. Patient’s sex

4. Medication required

5. Quantity of the medication required

6. Name of the prescriber

7. Signature of the prescriber

8. Address of the institution (Hospital) where the prescription was made.

2.7.2. INTERPRETING PRESCRIPTIONS

On honouring a prescription, the drugs or medicines are dispensed by the pharmacists or

under their supervisions. As a student I had to ensure that the pharmacists sees every drug I am

set to dispense this is to reduce mistakes which may be harmful to the patients. It takes

experience and knowledge to master the art of dispensing accurately. In table 0.2 there are Latin

terms commonly found on prescriptions and their meanings.

Table 0.1

TERMS MEANING

TDS OR TID Three times daily (8 hourly)

BD Twice daily (12 hourly)

NOCTE At night

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QDS OR QID Four times daily (6 hourly)

The first step In effectively dispensing a prescription order is understanding it , only by

understanding a prescription can a pharmacist say whether or not the prescription satisfies all

requirements to be dispensed .when it comes to dispensing mediations, ethical issues might arise

that is why it is so important that prescriptions are handled by professionals and not just

anybody.

2.7.3. COMPOUNDING OF DRUGS

2.7.3.1 INTRODUCTION

Compounding is the act of constituting a solid dosage form into a liquid dosage form for

extemporaneous use. It involves the use of various excipients alongside the active ingredients in

a suitable liquid medium for different reasons. Compounding is very essential to paediatric and

as such, solid dosage forms (e.g., tablets and capsules) have to be formulated into suspension for

easy dosage administration and compliance.

2.7.3.2 PRINCIPLE OF COMPOUNDING

Patient’s age and body weight are major consideration and are important because the

doses of most drugs are expressed in mg/kg. I.e. quantity of drug per kg per body weight. Most

drugs come with a dose range for adults only, without children doses hence age and body weight

is used to obtain prescribed doses of drugs in children.

Aims of compounding:

Some major aims of compounding include:

1. To mask the bitter taste of some drugs. This is achieved by using a vehicle with pleasant

taste and flavour.

2. To minimize problems associated with swallowing

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 3. To increase the rate of absorption

4. To ensure patient compliance

2.7.3.3 CALCULATION INVOLVED IN COMPOUNDING

Compounding employs simple calculations used to determine the number of tablets

required and the volume of liquid (water or syrup) to be used in constituting the drug. This could

be done in different ways based on the prescription. Two methods commonly used are ratio and

proportion, and compounding formula.

EXAMPLE

Furosemide 12mg BD x 2/52

Calculation:

Using the compounding formula:

Total number of 40mg Furosemide tablets required =

Where; Dose = 12mg; Frequency = 2 (BD) Strength = 40mg; Duration = 14days

NB, we shall compound for 15days in case of spillage and to prevent shortage

= 9 tablets

Total volume of vehicle to be used = Dose × Frequency × Duration

Where; Dose = 2.5ml; Frequency = 2; Duration = 15days

Suitable vehicle=water (and Vitamin C syrup as an antioxidant): half volume is water; half

volume is syrup. Thus, if we are to compound such that 12mg will be contained in 5ml, then

Total volume = 2.5ml × 2 × 15days = 75ml

Hence 75ml of water is used

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2.7.3.4 VEHICLES USED IN COMPOUNDING

When compounding tablets into suspension, the choice of vehicle to be used is very

important because choice of an incompatible vehicle may lead to deterioration or inactiveness of

the drug. For the right choice of vehicles to be used in compounding, reference is made to

official books (monograms) that provide information on the compatibility of drugs with different

vehicles. Some examples of drugs and the vehicles used in compounding them are:

Isoniazid water

Diazepam water

Phenobarbitone water

Methyldopa water

Acetazolamide water

Rifampicin Syrup

Pyrazinamide syrup

Ethambutol syrup

Quinine Syrup

Fluconazole syrup

2.7.3.5 COMPOUNDING PROCEDURE

Compounding is done in the hospital using the simple compounding tools, mortar and

pestle. The tablets are first triturated (and sieved in the case of coated tablets), then the vehicle is

added gradually while triturating until a fine suspension or solution is formed. The resulting

suspension is then transferred into a clean dry dispensing bottle and appropriately labelled.

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2.7.3.6 LABELING

This is a very important stage in compounding because it provides the patient with

direction and information about the medication; the name, dose, dosing frequency and duration

of therapy of a given medication. Thus, it affects compliance.

A good label must include:

1. Name of medicament

2. Strength of the preparation

3. Instruction to the patient

4. Auxiliary label

5. Pharmacist’s name and signature

2.7.4 USE OF A TABLET BREAKER

In the In-Patient Department, cases were also handled were the dose of drugs to be

administered varies from the strength available. E.g. Celecoxib (a selective COX-2 inhibitor) is

prescribed as 100mg b.d, and the drug is available as 200mg. Before the drug is dispensed to the

patient, the required number of tablets to be dispensed according to the duration of drug intake, is

calculated and by the use of a sterile manual tablet breaker, one tablet is then divided into two

equal halves and the patient takes one half b.d. as prescribed.

2.7.5 PHARMACEUTCAL CARE WARD ROUNDS

Pharmaceutical care is the responsive provision of drug therapy for the purpose of

achieving definite outcomes that improves the patient's quality of Life. The outcomes include;

1. Care of the disease

2. Elimination or reduction of patient's symptoms

3. Arresting or slowing of the disease process

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 4. Preventing of disease

The clinical pharmacist must therefore work closely with the doctor and patient in order to

gain a correct understanding of the relevance and impact of the various medications for the

patient's pathology. This was achieved during by hospital experience and we saw patients in the

various wards with different clinical conditions of which we understood and asked questions.

Due to the requirements of care process, the pharmacist is required to have a good knowledge

of clinical pharmacy to enable them practice as clinical pharmacists. Ward round is encompassed

in pharmaceutical care so as to asses patients response to their medication.

2.7.6. KEEPING RECORDS

Records are a detailed or accurate representation of past events. it is important to keep

records especially because of referencing in the future. Many pharmacies keep records using

automated machine systems and softwares the pharmacy in plateau state specialist hospital also

keeps digital records of all their served prescriptions sometimes a prescription for a passed date

may be needed, when this happens it can easily be obtained from the record room.

Keeping records in the pharmacy has also aided researchers at all levels.

2.7.7 PRESENTATIONS AND CLINICAL MEETINGS.

At the hospital there are usually organized clinical meetings and presentations by the

team of clinicians. The presentations may be given by students on clinical rotations, companies’

representatives or the clinicians themselves. A presentation is a very Good Avenue to learn many

new skills and get updated information. During the course of my stay at the hospital, I did some

research and presentations too though to smaller group comprising of just the pharmacists and

my fellow colleagues (students) I also had the honours bringing forth knowledge from my search

and putting it forth to my colleagues.

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2.8 SKILLS LEARNT IN THE HOSPITAL.

The training in the hospital was to expose me to both clinical and social skills that will make

me self-reliant and adequate enough to solve challenges which may present to me in future.

i. Social skills.

This includes skills like tidiness, punctuality, respect I will work with, honesty and diligence.

These skills are very important in the industries were value is created, although often a times,

these skills are overlooked they have proven over the years to be some of the very qualities that

employers look out for. In Plateau state specialist hospital, we are charged to come in as early as

8:00 am and not leave until its 2:00 pm, the challenge here is to test our punctuality and how

truthful we can be. Leaving before closing is highly discouraged.

ii. Clinical skills

These are skills required by a professional to function properly within his/her sphere. For

pharmacists, it is that skill that tends to bring together all other knowledge and skill previously

acquired to solve a clinical problem at hand. Clinical skills include critical thinking skills,

conversational skills, and the ability to make rapid and accurate deductions from the data

obtained or the analytical skills.

iii. Therapeutic skills

In the hospital, this helps the pharmacist suggest pharmaceutical alternatives to

prescribers also to discourage polypharmacy. It is the ability to make the right choice drug for a

particular patient from several possible choices. The bulk of therapeutic skills were learnt

through clinical presentation

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 CHAPTER THREE

3.0 COMMUNITY PHARMACY EXPERIENCE

3.1 BRIEF HISTORY OF KUNOOK PHARMACY JOS

Kunook pharmacy was established February 7th,2014 located at Eltof Plaza after Farin

gada roundabout with the aim of meeting the drug needs of the public. The establishment has a

vision of becoming the best and credible provider of pharmaceutical services and supplier of all

forms of pharmaceutical products as well as medical equipment in the world. From the time of

its establishment, Kunook Pharmacy has continued to grow and develop till date. It is owned and

established by Pharm.(Mrs) Denkat Abok and also managed by her as the superintendent

pharmacist.

3.2 ORIENTATION TO KUNOOK PHARMACY

On my first day at work, the Superintendent Pharmacist of Kunook Pharmacy, during our

orientation, placed us on working hour shifts of morning and afternoon shifts. The total number

of students on industrial training at the pharmacy was four (4) so we were split into the two

shifts. The morning shift begins at 8:00am and ends at 1:00pm while the afternoon shifts starts at

1:00pm and ends at 5:00pm from Mondays to Fridays. A register of attendance was maintained

on my logbook where I indicated and signed against my name, the time I resumed work for that

day and the time I ended work. We were also introduced to all the staff of Kunook Pharmacy, to

the different sections of the community pharmacy which includes the retail area, the payment

section, the pharmacist’s cubicle, and the store.

After the orientation, we were all to familiarize ourselves with all the drugs and

equipment in the premises which we began by compiling a list of all the products sold indicating

their trade names, non-proprietary names, active constituents, therapeutic classes. Subsequently,

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as we watched the pharmacist and the sales personnel dispense drugs, we became familiar with

the cost prices of these drugs

3.3 ARRANGEMENT OF DRUGS ON THE SHELF

There are two categories of drugs found in every standard community pharmacy. They

are:

Over The Counter (OTC) drugs: these are well known and frequently dispensed drugs in

the community pharmacy which can easily be self-administered. Some examples are,

Paracetamol, antacids, multivitamins, chlorpheniramine maleate (Piriton ®), fesolate, folic acid,

etc.

Prescription Only Medicines (POM): these are drugs that are dispensed only on the presentation

of a properly filed prescription or on recommendation by the pharmacist because to be effective,

their administration must be guided by a qualified and knowledgeable healthcare practitioner.

Some drug classes like this include Antibiotics, Poisons and drugs acting on the Nervous system.

Etc.

Poisons: these are under the POM, they are drugs which are dispensed strictly on the basis of a

presentation of a prescription because they are kept in the poison cupboard. They include:

Antipsychotics, Antidepressants and Drugs that induce uterine contraction.

3.4 INTERPRETATION AND SCREENING OF PRESCRIPTIONS

The ability of the selling dispenser to interpret prescriptions is the first step in the

dispensing of drugs. Before filing a prescription, the prescription is usually screened by checking

details on it like:

1. Date on which the prescription was written

2. Prescriber’s data (Name, Signature, Qualification)

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 3. Patient’s information (Name, gender, age, address)

4. Name, form, strength of drug and dosage regimen

5. Route of administration

6. Name of the hospital written boldly at the top of the sheet

Prescription interpretation ensures rational drug use, correct doses and the required amount

dispensed.

Taking note of certain Latin abbreviations used enables one to effectively explain the

frequency, duration and time of administration to customers. They include

O.D once daily

B.D/b.i.d two times daily (12hourly)

T.D.S/t.i.d – three times daily (8hourly)

Q.D.S four times daily (6hourly)

Nocte at night

GUTT drops (eye/ear)

Symbols that denote the duration of administration of the drugs were also encountered. Examples

include:

x/7 meaning the drug should be taken for x days

y/52 meaning the drug should be taken for y weeks

z/12 meaning the drug should be taken for z months

The strength of drugs prescribed was noted because this together with the frequency and

duration of administration enables me to calculate the quantity and cost of drug to be dispensed

to the patient. For example, from the prescription below:

i) Syrup Multivite, 5ml b.d

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 Syrup paracetamol, 10ml t.d.s

One bottle of Multivitamin syrup and one bottle of Paracetamol syrup are dispensed to the

patient

ii) tabs Multivite O.D 2/52

tabs paracetamol 1g t.d.s 5/7

Calculation:

For Multivite, tablets sufficient for a 2 weeks duration will be dispensed:

Daily dose = 1 tablet, then for 2 weeks (14 days), it will be 14tablets to be dispensed

For Paracetamol, tablets sufficient for a 5 days duration will be dispensed:

One tablet(dose) of Paracetamol = 500mg, then using the 1g format, one dose = 2 tablets for 1

day, 2 t.d.s=2×3 = 6tablets. Then, for 5 days; 6×5 = 30tablets will be dispensed

3.5 DISPENSING OF DRUGS

This involves dispensing the OTC drugs, POMs from valid hospital prescriptions and

drugs recommended by the pharmacists on duty. In all cases, the drugs are given to the

customers who take them to the cashier for invoicing and payment. The patients then bring the

drugs for any special instruction on how to take them and the explanation of the dose.

Without explaining the dosage of drugs issued out to customers, dispensing is not

complete. for instance, an adult who purchases Loratidine 10mg is told to take once daily and

those who purchased Ampiclox 500mg are told to take 1 cap every six hours (for times daily).

This indicates that every drug strength is peculiar to the potency and efficacy of the active

ingredient in the drug to achieve therapeutic concentrations in the body.

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3.5.1 DISPOSAL OF POISONS

These are regarded in this context, as substances either as semi-finished products or

contained in other products which are subject to misuse and abuse.

Pharmacy Law and Ethics seeks to define what the pharmacy profession entails. Ethics can

simply be defined as a moral obligation placed on another person by a group of persons to

perform certain acts. Some of the areas covered by the pharmacy law and ethics in Nigeria

include:

1. Registration of Pharmacists

1. Registration of community pharmacy premises

2. Disposal of Poisons (Poison and Pharmacy Act, Cap. 535 of 1990)

3. Duty to patients

There are strict rules guiding the dispensing of poisons as stipulated by the Poisons and

Pharmacy Act Cap. 535 of 1990. Some of them that applied to the community pharmacy and

were seen practiced include:

1. Poisons are kept in the poisons cupboard under lock and key accessible only to a

pharmacist.

2. Before a poison is dispensed (usually in drug form), the information is appropriately

entered into the Disposal of Poisons book (Form K) and signed by the patient collecting it

and the pharmacist dispensing it.

3. After the dispensing of poisons, the original prescription is retained by the community

pharmacist for evidence and documentation according to the Poison and Pharmacy Act

Cap 535 of 1990.

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3.6 CLINICAL PRESENTATIONS

Clinical presentations were also conducted during the community training. The Pharmacist in

charge occasionally gave us clinical topics to research on and we had appointed days to make

presentations of our research findings too. Some of the conditions presented include:

 Peptic ulcer disease

 Headache

 Cold and catarrh

Also, certain clinical conditions were raised by the pharmacist and a general discussion

begins

3.7 VALUE ADDED SERVICES

Here, I was taught by the superintendent pharmacist on the techniques and procedures to

be carried out in diagnosis of patients to make certain rational decisions. They include:

Blood pressure measurement

This can be done either by using a manual or digital sphygmomanometer. However, I was

taught using the manual sphygmomanometer. The procedures are as follows:

1. The patient is made to sit uprightly and relax with the fore arm placed 900 to the chest.

2. The pressure cuff of the sphygmomanometer is tied round the arm just above the cubital

fossa such that the tube connecting the cuff to the bulb is directly placed on the brachial

artery

3. Sufficient pressure is built with the stethoscope placed on the vessel by pumping the

rubber knob till about 200mmHg or more and the ear piece in the ear facing forward

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 4. The pressure is then released bit by bit, the Korotkoff sound heard is the systolic blood

pressure which indicate opening at the heart valves and as the sound diminishes, the

diastole is measure which indicates closure of the heart valves

Three (3) more readings can be taken and the average value is the patient’s blood pressure

Normal range = Systolic pressure = 110-130(mmHg)

Diastolic pressure 75-90 (mmHg)
Blood pressure above these ranges may not indicate that a patient is hypertensive as

certain other factors like walking and not at rest can make a white coat elevated reading

Pregnancy test

A pregnancy test strip is used in this test and a sample of urine is tested for the presence

of human Chorionic Gonadotropin (hCG) which is present in the female urine from the 3 rd/4th

day of pregnancy. The procedure is as follows:

1. A urine sample is collected

2. A two-third portion of the test strip is inserted vertically in the urine sample for at least

15seconds

3. The strip is then removed and placed on a flat horizontal surface and left to lay for at least

2-5minutes.

4. The appearance of two distinct lines (control and test) gives a positive result, the

appearance of only one distinct colour i.e. the control gives a negative result and the

appearance of the test line only or no appearance at all gives an invalid result

Malaria test

This test is carried out to detect and confirm the presence of Plasmodium spp that causes

malaria. It is carried out using the malaria test kit, the blood of the subject is the sample, and a

special solvent called a buffer is used. The principle is based on adsorption chromatography, that

27
the antigen causing malaria present in the blood has a definite Rf value which when reaches by

capillary action, it indicates this using a line on the test kit. The procedures involved are as

follows:

1. The subject is to sit down, and the malaria test kit is opened and a cotton swab made

ready

2. Massage the tip of the thumb to attract blood to the area, the wipe thoroughly with a

cotton swab

3. Using the sterile lancet, prick gently, the cleaned area of the thumb to cause a small blood

ooze, the first ooze is wiped out and using a capillary tube, the subsequent ooze is

collected

4. This is then placed in the sample port in the test kit and 2 drops of the buffer is placed in

the buffer port. This is then left to stand for about 5minutes

5. The appearance of two distinct lines (control and test) gives a positive result, the

appearance of only one distinct colour i.e. the control gives a negative result and the

appearance of the test line only or no appearance at all gives an invalid result

Wound dressing

This is the act of cleaning and managing skin abrasions and lesions were blood/fluid

discharge is observed flowing profusely or not. I was taught on dressing wounds/injuries using

the procedure below:

1. Ask the patient to sit/help the patient to sit in a position so as to reduce to a considerable

level, the extent, amount and frequency of the bleeding

2. Using a first aid kit, a protective disposable pair of hand gloves is worn on both hands

before handling the patient. Any tool used must be cleaned with Methylated spirit

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 3. Cotton wool held with a pair of scissors is moistened in Hydrogen peroxide and used to

clean the wound. Any torn skin portion hanging is also severed out gently using a pair of

scissors

If the patient is in a very grievous discomfort, Procaine powder (local anaesthetic) can be applied

on and around the area

4. Then using a pad of cotton wool, Methylated spirit (antiseptic) is applied on the area

5. Then the area is covered if it is a new/fresh wound using a roll of Crepe bandage and

plaster depending on the size of the injury. Old wounds may be left open for air to have

access and dry it or covered slightly by a loosely woven bandage only.

6. For open wounds, Lincomycin HCl monohydrate 500mg t.d.s is given, if the wound is

ruptured and swollen, Ampiclox 500mg q.d.s is given

3.8 STOCK TAKING AND REQUISITION

Stock taking involves monitoring and proper documentation of all the drugs stocks in the

pharmacy, similar to hospital stock taking. The stock cards contain information like date of

purchase, expiry date, and quantity sold. Stock check is a regular procedure carried out at

Kunook Pharmacy. This procedure is important as it helps to know drugs that are out of stock,

near expiry date, quantity of drugs in the pharmacy, total cost of drugs (worth) in the pharmacy.

If a particular drug is out of stock, requisition is made by ordering from wholesale

marketers. On requisition, the price placed on the products is dependent on the mark up- this is

the prices of drug product multiplied by a cerin factor- which could be in percentages, decimals

or whole numbers

If a particular drug has reached its expiry date, according to the Poisons and Pharmacy

Act Cap 535, 1990, the drug is packed and kept in a room/place not within the reach of

29
dispensable drugs, and when NAFDAC comes for inspection, these expired drugs and products

are handed over to them.

3.9 PATIENT COUNSELING

1. In the course of dispensing drugs, I was able to counsel patients who had some problems.

I noticed that some patients buy drugs for particular ailment because they had noticed a

friend using the same drug for that ailment. Most of the patients needed counselling. A

few out of the numerous counseling I gave includes:

1. Patients counselled on proper use of drugs especially those affected by the presence or

absence of food. Customer using Amoxicillin capsules (500mg) were advised to take the

drugs at least 30 minutes before or 1 hour after meals because food reduces its

absorption.

2. Customers were advised not to use antacids together with other drugs because they

disrupt the absorption of most drugs. They were advised to allow about 30 minutes to 1

hour interval between the administration of antacids and other drugs, example

antibiotics/antacids and anti-malarial/antacids.

3. Pregnant women and breastfeeding mothers were advised not to use tetracycline and or

members of the amino glycosides. In fact, antibiotics in general without proper advice

and direction from the physician. They were also cautioned on the use of such drugs in

young children.

4. Patients, who were prescribed artemisinin derivatives like artesunate, were advised not to

take vitamin C, because vitamin C contains ascorbic acid, which possesses anti –oxidant

activity and may tend to mop the free radicals which are utilized in the mechanism of

action of Artesunate.

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5. Patients on NSAIDS were advised to take the drugs after meals to prevent gastric

ulceration. Also, those who have ulcer and mild pains together were advised to stay off

NSAIDS, but they can use paracetamol or drug that contain NSAIDS alongside

prostaglandin e.g. Arthrotec (Misoprostol +Diclofenac).

6. Patients were advised to follow timing especially when using antibiotic to ensure

therapeutic effects is achieved.

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 CHAPTER FOUR

RESULTS

From the various industrial training experiences in our Plateau Specialist Hospital and

Kunook Pharmacy, an outstanding case "Uncomplicated Malaria" in which I was involved was

chosen and further studies to elucidate on it was carried out. This chapter focuses on

Uncomplicated Malaria, its clinical knowledge and my encounter with this case.

4.0 UNCOMPLICATED MALARIA

4.1 INTRODUCTION

Malaria is a mosquito-born infectious disease that affects humans and other animals. It is

caused by a single-celled microorganisms of the plasmodium genus, commonly spread by an

effected female anopheles mosquito. The insect bites during the search for a blood meal,

introduces the parasites from the saliva via the proboscis into the victim's blood. The parasites

travel to the liver where they undergo a series of reproduction.

4.2 ETIOLOGY

Malaria is caused by plasmodium parasites,

spread by an insect vector (mosquito) which is transmitted during a bite.

Common species known for malaria infection are:

 P. Falciparum

 P. vivax

 P. Malariae

 P. ovale

 P. knowlesi

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4.3 EPIDEMIOLOGY

The disease is widespread in the tropical and subtropical regions. This includes much of

sub-Saharan Africa, Asia and Latin America. In 2018 there were 228 million cases of malaria

infection worldwide resulting in an estimated 405,000 deaths. Approximately 93% of the case

and 94% of deaths occurred in Africa. Malaria is commonly associated with poverty and has a

negative effect on economic development.

In Africa, it is estimated to result in losses of $12 billion a year due to increased

healthcare cost, lost ability to work, and negative effect on tourism. In US, about 1700 people are

diagnosed with malaria each year, most of whom are travellers returning from endemic area.

Malaria is a risk for majority of Nigeria population with an estimated 100 million cases with over

300,000 deaths per year, children under 5 years of age are the most vulnerable group.

4.4 PERSONS AT HIGHER RISK OF MALARIA INFECTION

In malaria-endemic areas, it has been shown that some particular groups of the populations are at

considerably higher risk of contracting the disease, and developing severe malaria than others.

Infants, Children under 5 years of age, Pregnant women, HIV/AIDS patients, Malnourished,

Travelers (non-immune) from areas without malaria to malaria endemic areas

4.5 TRANSMISSION OF MALARIA

Means of Malaria Transmission includes:

1. Bite of Anopheles mosquito (common means of transmission)

2. Unusual means of transmission:Congenital malaria (mother to baby at birth), Blood

transfusion, Sharing intravenous needles

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4.6 SIGNS AND SYMPTOMS

Signs and symptoms typically start within 10 -25 days after being bitten by an infected

mosquito, depending on exposure.

Signs and symptoms of uncomplicated Malaria includes:

 Fever

 Chills

 Headaches

 Abdominal discomfort

 Nausea and Vomiting

 Anorexia

 Fatigue and general body ache.

There is no evidence of vital organ dysfunction, Infected individuals can also be asymptomatic.

4.6.1 COMPLICATIONS

When uncomplicated malaria is not treated at the early stage of the infection, continuous

destructions of the red blood cells, and in some cases, with additional interactions of the

infection with other parasitic infections and with nutritional deficiencies, could result in severe

symptoms.

These severe symptoms may include: Abnormal behaviour, Impairment of consciousness,

Seizures, Coma, Severe anaemia, Haemoglobinuria, Pulmonary oedema/ acute respiratory

distress syndrome(ARDS),Abnormalities in blood coagulation,Low blood pressure caused by

cardiovascular collapse and shock, Hypoglycaemia, Metabolic acidosis

4.7 DIAGNOSIS OF UNCOMPLICATED MALARIA

1. Clinical diagnosis:

34
Based on signs and symptoms, Very low specificity; unreliable; inaccurate

2. Parasitological diagnosis:

 Light microscopy (blood smears)

 Rapid diagnostic tests (RDTs)

4.8 MANAGEMENT

 Prompt and accurate diagnosis of suspected cases

 Prompt use of appropriate anti-malarial drugs for malaria positive cases.

 Adjunct treatment for fever, anaemia or rehydration when necessary

 Monitor clinical and parasitological improvement

 Assess for signs of complicated/severe malaria

 Cure – parasite clear and or absence of clinical symptoms

 Instructions for future prevention of malaria

The following drugs are used to manage uncomplicated Malaria

 Artemesinin-based combination treatments, (e.g, artemether-lumefantrine,artesunate-

amodiaquine).

 Chloroquine

 Doxycycline

 Mefloquine

 Quinine

4.8.1 PREVENTIVE MEASURES

1. Preventing mosquito bites through the use of pre-treated mosquito net.

2. The use of insecticide.

3. Draining stagnant water.

35
 4. People traveling to an area where mosquito is common are advised to take

medication for prophylaxis before embarking on the journey.

4.9 CASE PRESENTATION

4.9.1 PATIENTS DEMOGRAPHIC INFORMATION( Taken on 11th June,2021)

 Name: L.J

 Sex: Female

 Age: 16years

 Weight: 44kg

 Occupation: student

 Tribe:Tarok

 Marital status: single

 Hospital number: 518***

4.9.2 PATIENTS SUBJECTIVE DATA

 Patient complaint: Fever and chills, nausea and vomiting, fatigue and headaches,Loss of

appetite

 Family history: Third born of 5 children

 Medical history:Malaria experienced in Last 6 months

 Social history:

 Smoke: no

 Alcohol: no

 Marital status: single

4.9.3 PATIENTS OBJECTIVE DATA

 Temperature: 40.2°C

36
  PCV: 37%

 Blood pressure: 130/90mmHg

 Hb: 10.4g/dL

 Pulse rate: 90bpm

4.9.4 LABORATORY DIAGNOSIS

 Widal : -ve

 HPV : -ve

 MP: +++

4.9.5 PRESCRIBED MEDICATIONS

 I.M. Metoclopramide 10mg/2ml stat.

 I.M. Arteether 150mg/2ml o.d × 3/7

 Tabs. Paracetamol 1g tds 5/7

 Tabs. Vit.B complex ii tabs tds 6/7

 Tabs. Artemeter +Lumefantrine 80mg +480mg b.d 3/7

4.9.6 INTERVENTION

To achieve a complete elimination of the plasmodium parasites from the body, oral

artemeter and lumefantrine combination should be taken after the three days of arteether

injection regimen.

I encourage the patient on appropriate intake of medicines as prescribed by the doctor.

4.9.7 MONITORING/FOLLOW UP

On a call to the patient, most of the subjective signs have subsided, only a complaint of

abdominal disturbance and drowsiness which are side effects of Artemeter/Lumefantrine , were

reported.

37
4.9.8 CONCLUSION

There is a complete recovery from the ailment after treatment.

38
 CHAPTER FIVE

SUMMARY

5.1 NEW KNOWLEDGE LEARNT

Being a period of attachment to an entirely new environment, the SIWES program

provided an exciting opportunity for learning about many clinically relevant topics. Some of

these were entirely new while some were elucidations of previously encountered ones.

In the community pharmacy, new experiences from interaction with the community pharmacist,

the customers/patients, other sales personnel and sales representatives of various indigenous and

foreign based pharmaceutical companies was a notable point of gathering relevant information

that previous were only abstract and unrealistic. The community pharmacy experience afforded

us the opportunity to bring to practical terms, the art of drug dispensing, counselling of patients

and storage of drugs. We were also trained in performing some simple clinically relevant

procedures like measurement of blood pressure, rapid diagnostic tests for malaria, hepatitis,

pregnancy, wound dressing. We also engaged in intelligent discussions and interactions with

some real-life experiences of clinical conditions and we made researches on topics given after

which we made presentations and were further educated on such clinical conditions and their

drug managements. I particularly learnt on the drug management of poisoning.

At the Hospital, I had a lot of novel experiences and some of them included the art of

compounding of medicament(s) for administration to paediatric patients, how to clerk a patient

and obtain relevant data that will help in the diagnosis and management of the diseases

condition(s) he/she has. At the Female ward we encountered cases such as Ectopic pregnancy,

diabetic foot. At the male ward, cases such as Peripheral oedema were encountered. Again at the

Paediatric ward, we encountered special cases which needed special medical attention like

39
neonatal tetanus, convulsions and I learnt about the drug therapies indicated therein. We were

also taught on the screening of prescriptions and drug dispensing.

5.2 CHALLENGES AND PROBLEMS ENCOUNTERED

1. Patients insistence on brand name drugs even after being educated on the equivalence of

drugs given that they have the same active ingredients. Sometimes the patients simply

base their choice on fame and appearance and would refuse to take into cognizance the

efficacy of the drug.

2. Problems of transportation to and from the centre of internship experience

3. Prescriptions with brand names posed a peculiar challenge during the initial periods of

hospital experience

4. Unreadable handwriting of some prescribers which makes it hard to understand what has

been written.

5. Language problem; most of the patients that came to the pharmacy only understand

Hausa language or their dialect and this posed a challenge in communicating with them.

6. Location of drugs on the shelves especially in the community pharmacy

7. Inadequacy of drug knowledge when required to give patient relevant information

However, in all these challenges, the pharmacist(s) were always there to help me us out and

further educate us on how to handle these challenges

5.3 POSSIBLE SOLUTIONS

1. Brand names of drugs should also be taught in schools so that students find it easier to fit

impeccably into the SIWES program.

2. Students should be paid during, and not after the SIWES program to ease the challenges

of transportation.

40
 3. Prescribers should be mandated if need be, by a legal binding, prohibiting the writing of

prescriptions with brand names.

4. Development of effective communication skills will go a long away in tackling the

problem of antagonistic patients.

5. The Pharmacists should maintain a good communication relationship with the physicians

and other prescribers so as to understand necessary protocols

6. The student can take time to study the shelf arrangement of drugs again and again to be

conversant with it.

5.4 PROBLEMS THAT AFFECT THE SCHEME

1. Poor funding: this places a heavy burden on the students as they have to transport

themselves to places of attachment and sometimes pay for accommodation in new

environments. This affects overall performance in the scheme.

2. The lack of regular supervision by the SIWES and departmental staff.

3. Lack of seriousness on the part of the students

4. There exists a level of communication lacunae between the SIWES directorate and the

various departments that enrol their students for the scheme. This has led to instances of

clashes between the SIWES program and some departmental academic calendars.

5. Non-challant attitude of some employers: some employers fail to offer the needed level

of exposure and practical knowledge to the SIWES students due to lack of commitment

and fear of possible future competition

6. Non-cooperation of some organizations and companies as regards accepting students for

the program.

41
5.5 RECOMMENDATIONS

The SIWES scheme is such a crucial program in the training of workforce for Nigeria

that it must be vibrant, virile and veritable in providing the needed skills that form the basic

objectives of the scheme. I hereby recommend that;

1. All establishments that receive SIWES students should have expert professionals

specifically assigned to train SIWES students more thoroughly.

2. Regular supervision of the SIWES students can immensely increase the value of this

program in the eyes of the students

3. Code of conduct as SIWES students should be encouraged

4. Establishments should be mandated to give SIWES students some form of financial

assistance as a way of motivating them to work harder and achieve excellence in the

scheme.

5. Academic courses within the semester of industrial attachment should be discontinued in

other to avoid clashes and permit smooth running of the scheme

6. The government should provide a constitutional framework that would compel

establishments to accept a certain number of students yearly for the SIWES program

The SIWES program is a very essential part of the students training and should be deliberately

and diligently handled with the fear of the Lord that we all enjoy the benefits of the scheme.

5.6 CONCLUSION

Overall, the scheme is useful and important; the extent to which this scheme affects the

lives of student is enormous. It was a worthy course spending six months training with actual

real life situations. I feel more adequate and confident to take up challenges, SIWES is relevant.

42
 REFERENCES

www.medicalnewstoday.com

Clinical Guidelines diagnosis and treatment manual,2016 edition

https/emedicine.medscape.com/article/malaria

University Health Service Medical Journal

www.mayoclinic.org.uncomplicatedmalaria

2021. [online] Available at: <https://www.plateaustate.gov.ng/others/plateau-state-specialist-

hospital> [Accessed 10 December 2021].

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6532584/

Artemisinin‐based combination therapies for uncomplicated malaria Timothy ME Davis, Harin

A Karunajeewa, Kenneth F Ilett Medical Journal of Australia 182 (4), 181-185, 2005

Patient file

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