PRACTICE SCHOOL REPORT

Submitted to 
to 

RAJIV GANDHI PROUDHYOGIKI VISHWAVIDHYALAYA, BHOPAL M.P.) 

In partial fulfillment of requirement for

Award of degree of

achelor of Pharmacy
(Session- 2018-19)

Submitted by

STUDENT NAME: FAYZA KHAN

ENROLLMENT No.: 0137PY151014

LAKSHMI NARAIN COLLEGE OF PHARMACY, BHOPAL

(Approved by AICTE and PCI, and Recognized by Govt. of
Madhya Pradesh, affiliated to RGPV, NBA Accredited, Bhopal)
 

LAKSHMI NARAIN COLLEGE OF PHARMACY, BHOPAL

(Approved by AICTE and PCI, and Recognized by Govt. of
Madhya Pradesh, affiliated to RGPV, NBA Accredited, Bhopal)

CERTIFIC TE

This is to certify
certify that M
Mr./Ms.
r./Ms. FAYZ
FAYZA
A KHAN Enr
Enrollment
ollment No. 0137PY151014
0137PY151014 in the

 partial fulfillment
fulfillment of the requirement ffor
or the award of the Degree
Degree of Bachelor o
off Pharmacy

 by the R.G.P.V., Bhopal has satisfactorily completed 150 hours training in Sachin Mamta

Hospital in Pharmacy Department 16/02/2019 to 04/03/2019 in academic session 2018-

2019.

Ms. Sonal Gupta Dr. A. K. Singhai

Incharge Principal
(Practice School)
PY- 805

(SACHIN “MAMTA” HOSPITAL) 

2|Page 
 

CERTIFIC TE

This is to certify that Mr./Ms. FAYZA KHAN Enrollment No. 0137PY151014 in the

 partial fulfillment
fulfillment of the requirement ffor
or the award of the Degree
Degree of Bachelor o
off Pharmacy

 by the R.G.P.V., Bhopal has satisfactorily completed 150 hours training in Sachin Mamta

Hospital department Phar

Pharmacy
macy during
during 16/02/201
16/02/2019
9 to 04/03
04/03/2019
/2019 in ac
academic
ademic se
session
ssion

2018-2019.

Sign & Name (With Seal)

Authorized person

3|Page 
 

ACKNOWLEDGEMENT

This project consumed amount of work, research, & dedication. Still, implementation
would not have been possible if I did not have a support of many individuals &
organizations. Therefore I would like to extend our sincere gratitude to all of them.

It is pleasure to express my deep sense of gratitude of thankfulness to Dr. A. K. Singhai

principle, Lakshmi Narain College of Pharmacy, Bhopal. For his valuable guidance
felicitous advice during the course of my practice school training practical.
pr actical.

I wish to express my deep sense of gratitude to my incharge Ms. Sonal Gupta Asst.
Professor, Lakshmi Narain College of Pharmacy, Bhopal for her cooperation & valuable
guidance throughout my B.Pharma practice school training practical.

I am cordially grateful to my beloved parents, my family members & my friends who

always covered their shade of love & blessing & provide their valuable moral support
directly spirit & corporation.

Place : Bhopal
Fayza khan
Date : 08/04/2019

INTRODUCTION
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In order to widen my knowledge, to have new experiences in the field of health care, did
training at hospital pharmacy at SACHIN “Mamta” hospital. 

This training course is extended over a period of 150 hours, beginning on 16 February
2017 and ending on 04 March 2019. 
2019. 

Sachin “Mamta” Hospital (SMH) 

HIG-39 “A” Sonagiri choraha, BHEL, Bhopal 
Mob: 8109000135 

OBJECTIVES OF THE INTERNSHIP

Observing, comparing, analyzing and commenting on the management of different

I.
pathologies, clinical and paraclinical approaches.

Integrate fully the family medicine service (go to the extended clinic, the ward, the
II.
emergency room), participate in the activities of the other services.

III. Observation of procedures

IV.Rotations in family medicine, internal medicine, pediatrics, obstetrics and gynecology,

surgery, especially pediatric and adult emergencies.

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HOSPITAL PHARMACY

The practice of pharmacy within the hospital under the supervisio

supervision
n of a professiona
professionall
 pharmacist is known as hospit
hospital
al pharmacy
pharmacy..

FUNCTIONS OF HOSPITAL PHARMACY:

   Forecast of demand
   Selection of reliable suppliers
   Prescribing specifications
specifications of the required medicament
   Manufacturin
Manufacturing
g of sterile or non-sterile preparations
   Maintenance of manufacturing records Quality control of purchased or
manufactured products
   Distribution of medicaments
medicaments in the wards
   Dispensing of medicaments to out-patients
   Drug information source in hospitals
   Centre for drug utilization studies
   Implement recommendations
recommendations of the pharmacy and therapeutic committee
   Patient counseling
   Maintaining liaison between medical, nursing and the patient.

OBJECTIVES OF HOSPITAL PHARMACY

1. To professionalize the functioning of the pharmaceutical services in hospitals. 

2. to ensure availability of the required medication at an affordable cost at the required

time.

3. To plan, organize and implement the policies of the pharmacy.

4. To perform functions of management of material, purchase, sstorage

torage of essential items.

5. To maintain strict inventory of all items received and issued.

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6. To counsel the patient, medical staff, nurses and others involved in patient care on the

use of drugs, possible side effects, toxicity, adverse effects, drug interactions etc.

7. To serve as a source of information on drug utilization.

8. To manufacture drugs, large/ small volume parenterals which are critical for use in

patients.

9. To participate in and implement the decisions of the pharmacy and therapeutics

committee.

10. To organize and participate in research programmes, educational programmes.

programmes.

11. To provide training to various members of the patient team on various aspects of

drug action, administration and usage.

12. To engage in public health activities to improve the well-being of the population.

13. To interact, cooperate and coordinate with various other departments of the

hospital.

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PRESCRIPTION MONITORING 

The core of pharmacist

pharmacists’
s’ contribution to appropriate prescribing and medication use is

made whilst undertaking near-patient clinical pharmacy activities.

Checking and monitoring patients’ prescriptions on hospital wards is frequently the

starting point for this process and on most hospital wards the prescription card and

clinical observation charts (temperature, pulse rate, blood pressure, and so on) are

typically kept at the end of the patient’s bed. This allows the clinical pharmacist to

interact with the patient whilst reviewing the contents of the prescription.
pr escription.

The prescription is reviewed for medication dosing errors, appropriateness of

administration route, drug interactions, prescription ambiguities, inappropriate

prescribing and many other potential problems. Formal assessments of prescription

charts in hospitals have shown that there are wide variations in the quality of prescribing

and pharmacists are able to identify and resolve

r esolve many clinical problems. Patients can be

questioned on their medication histories, including allergies and intolerances, efficacy of

prescribed treatment, side-effects and adverse drug reactions (ADRs).

The routine presence of medical and nursing staff on the ward allows the pharmacist to

communicate easily with other members of the healthcare team who value the

prescription-monitorin
monitoring
g service that clinical pharmacists provide.19, 20 Patients’ notes

are also accessible, to enable the pharmacist both to check important information that

may affect their healthcare and to record details of any clinical pharmacy input made.

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MEDICATION ERRORS & ADVERSE DRUG REACTION

REPORTING 

Despite the important role of clinical pharmacy services, patients receiving drug therapy

may still experience unintended harm or injury as a result of medication errors or ffrom
rom

ADRs. Adverse events (from any cause) occur in around 10% of all hospital admissions

and medication errors account for one quarter of all the incidents that threaten patient

safety.

A study commissioned by the General Medical Council identified a mean prescribing

error rate of 8.9 per 100 medication orders. Contributing to the avoidance or resolution

of adverse medication events is an important part of any hospital pharmacist’s clinical

duties. This requires a multisystem approac

approach,
h, often incorporated into a hospital’s clinical

risk management strategy. Important lessons can be learned from analysis of

medication-related
medication-related incidents and from near-misses (that is, those that do not develop

sufficiently to result in patient harm or are detected prior to patient harm).

Even when the prescribed and administered treatment is correct and no errors have

occurred, a small proportion of patients can still suffer from ADRs. Clinical pharmacists
have an important role to play in the detection and management of ADRs and, more

recently, directly reporting ADRs to the Committee on Safety of Medicines via the Yellow

Card scheme. Their involvement can help to increase the number of ADR reports made,

particularly those involving serious reaction. 

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PATIENT EDUCAION & COUNSELLING, INCLUDING ACHIEVING

CONCORDANCE 
One of the key themes of the 2010 White Paper is empowering patients to take an a
active
ctive

role in managing their own care. This is also one of the themes of many of the NHS –

National Institute for Health Research collaborations for leadership in applied health

research and care that focus on translating research into practice. Helping patients to

understand their medicines and how to take them is a major feature of clinical

pharmacy. Patient compliance, defined as adherence to the regimen of treatment

recommended by the doctor, has been a concern of healthcare professionals for some

time. Adherence to treatment, particularly for long-term chronic conditions, can be poor

and tends to worsen as the number of medicines and complexity of treatment regimens

increase. NICE noted that between a third and half of all medicines prescribed for long-

term conditions are not taken as recommended and estimated that the cost of

admissions resulting from patients not taking medicines as recommended was between

£36 million and £196 million in 2006 –2007.

In recent years, use of the term ‘compliance’ in the context of medication has been

criticised because it implied that patients must simply follow the doctor’s orders, rather

than making properly informed decisions about their healthcare. The term ‘concordance’

has been proposed as a more appropriate description of the situation.

Concordance is a new approach to the prescribing and taking of medicines. It is an

agreement reached after negotiation between a patient and healthcare professional that

respects the beliefs and wishes of the patient in determining whether, when and how

medicines are taken.

This change in approach aims to optimise the benefits of treatment by helping patients

and clinicians collaborate in a therapeutic partnership. However, if patients are to make

informed choices, then the need for comprehensive patient education becomes more
pressing.

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Concordance with treatment is dependent on a complex interplay of beliefs, trust and

understanding, with non-adherence falling into two overlapping categories:

1.  intentional: the patient decides not to follow the treatment recommendat
recommendations
ions

2.  unintentional: the patient wants to follow the treatment recommendations, but

practical problems prevent the patient from doing so.

Many surveys have found that patients often know little about the medicines they are

taking. Several studies examining patient counselling and education have shown that

clinical pharmacists can help to improve patients’ knowledge of their treatment.  The

contribution made can also improve patient adherence to treatment. Improved

adherence should lead to improved outcomes and evidence has been collected to

demonstrate this.

In addition to providing face-to-face education and counselling on medicines, clinical

pharmacists can also help patients by contributing to the preparation of written material

and audiovisual demonstrations, or by using computer programs.

How patients take their medicines is a crucial component of whether the desired

outcomes will be achieved. Key to this is the health beliefs of individuals and the

relationship with their healthcare providers that are necessary in order to ensure this

happens. Society is moving away from a paternalistic approach to healthcare to a more

empowered one. Thus, whereas a course of treatment used to be accepted obediently

by patients, treatment is now negotiated and options, risks and benefits are discussed

and, where necessary, consent is obtained. Thus there is a greater need for information

and education of patients and/or carers in order for them to be able to make informed

decisions about their treatment. Indeed, the 2010 White Paper emphasised the

importance of patient involvement, and included the phrase ‘nothing about me, without

me’. 

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PHARMACOKINETICS & THERAPEUTIC DRUG LEVEL

MONITORING
Pharmacokinetics addresses the

absorption, distribution, metabolism

and excretion of drugs in patients. A

sound knowledge of the

pharmacokinetic profiles of different

drugs enables the pharmacist to assess

the dosing requirements for certain

drugs in patients in extremes of age and

in the presence of impairment of kidney

and liver function. Clinically important drug interactions and adverse reactions
r eactions can

sometimes be predicted. Dosing calculations of aminoglycoside antibiotics are us ually

made by employing pharmacokinetic principles.

A number of medicines in common use have a narrow therapeutic index; that is, the

difference between the lowest effective dose and a potentially toxic dose can be quite

small. In many cases it is nec

necessary
essary or desirable to
to undertake therapeutic drug leve
levell

monitoring (TDM) to ensure that patients can be treated safely. TDM services include the

measurement of drug levels in the patient’s blood and the application of clinical
pharmacokinetics to optimise drug therapy.

There is a wide range of medicines that fall into this category, but TDM services typically

include aminoglycoside antibiotics, anticonvulsants, immunosuppressants, digoxin,

lithium and theophylline. Monitoring drug levels in patients can also provide an

important indicator as to whether they are taking their medicine. Clinical pharmacy input

into TDM services can range from the provision of simple advice to other clinicians on

when to take samples and how to interpret results, to fully fledged services that may
include collection and laboratory analysis of the blood sample.

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PERSONALISED MEDICINE

The fact that not all patients respond to the

expected benefits of medicines and some have

disproportionately adverse effects from them is

leading to the development

d evelopment of personalised

medicines services. Good clinicians have always

tailored treatment to individual patients’ needs,

but this typically relied on trial and error.

Personalised medicine can start from using

biomarkers rather than clinical outcomes as surrogate markers of effectiveness and a

new specialty of pharmacogenetics that aims to assess phenotypic differences in

responding to and handling drugs that may account for a proportion of the variation in

patient response. A Parliamentary Office of Science and Technology review noted that:

Personalised medicine holds both promise and cause for concern. Selective treatment

may limit access to those most likely to benefit, whereas following a ‘one size fits all’

approach to medical research and development may have benefited the widest number

of potential patients. Nevertheless, explaining the environmental, genetic and other

biological sources of human variation will alter the way diseases are diagnosed, drugs are

developed, and the matching of therapeutic cells and tissues to patients.

However, economic considerations, regulation of biological tests and the speed of

clinical education and training will all influence the rate and degree to which

personalised medicine will be incorporated into drug development and clinical practice.

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THE ROLE OF PHARMACY TECHNICIANS IN CLINICAL

PHARMACY SERVICES
The role of pharmacy technicians is already well established in departmental activities

such as dispensing and aseptic services. However, the expansion of clinical pharmacy

services in hospital would not be possible without the additional support that can be

provided by hospital pharmacy technicians.

In a similar manner to the way in which w

ward
ard pharmacy services provided by pharmacists

evolved into clinical pharmacy, pharmacy technicians’ roles are becoming increasing
increasingly
ly

clinical in nature and can include

in clude a wide range of activities.

Current activities undertaken by pharmacy technicians, in collaboration with

pharmacists, include:

   medication supply
   checking medication in POD schemes
   patient counselling and education, including the provision of patient aids where
appropriate, as well as medication charts and monitored-dose systems to aid

compliance

   supporting patient self-medication

   medicines information

  discharge planning for patients, including communication with primary care



colleagues where appropriate

   involvement in clinical trials and good clinical practice governance

   preparation of medicines formularies and guidelines
   training and education
   liaison with clinical teams on medicines management and expenditure
   AMS.

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Whilst this last subject will be addressed under strategic medicines management,
management, it is

important to note that AMS was the first ever clinical pharmacy programme to receive

national, ring-fenced, governmental funding.

The importance of AMS is highlighted in national reports and is enshrined within statute

in the Health and Social Care Act 2008.

Guidance for compliance with criterion 9 states that healthcare providers ‘have and
adhere to policies, designed for the individual’s care and provider organisations that will

help to prevent and control infections’.

INFRASTRUCTURE

1.  Located in the ground floor or in the first floor.

2. Sufficient space for seating of patients.
3. Waiting room for out-patients. It should contain educative posters on
health, hygiene and offer literature for reading.
4. Suitable space  – routine
routine manufacturing of bulk preparations (stock
solutions, bulk powders and ointments etc.
5. Office of the chief
6. Packaging and labeling area
7. Cold storage area
8. Research wing
9. Pharmacy store room
10. Library
11. Radio isotope storage and dispensing area. 

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FLOW OF MATERIALS

Requisition or an indent

For supply of medicines and other items

Maintain inventory for received item

Distributes the medicine to out-patients (out-door

pharmacy) and in-patients (nursing stations)

FINANCES
1. Primary source-charges received from the patient

2. Charges received by the patients are either fully paid by himself or from third party.

3. Research work

4. Invested endowment funds

5. Other types of investment

6. Gifts, contributions towards general functional expenses

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ROLES AND RESPONSIBILITIES OF HOSPITAL PHARMACIST

INDOOR PHARMACISTS RESPONSIBILITIES

a) Central dispensing area:

1. To ensure that all drugs are stored and dispensed correctly.

2. To check the accuracy of the dosages

prepared.

3. Maintain proper records

4. Preparation of bills

5. Co-ordinate over all pharmaceutical needs of

the patient

6. Framed policies and procedures are followed

7. Maintain professional competence

8. Communicate with all pharmacy staffs

b) Patient care areas :

1. Maintain liaison with nurses

2. Reviewing of drug administration

3. Provide instruction and assistance to the junior pharmacist

c) Direct patient areas:

1.  Identification of drugs brought into the hospital

2.  Obtaining patients medication history

3.  Assist in the selection of drug products

4.  Monitor patients total drug therapy

5.  Counseling patients

6.  Participating in cardio-pulmonary emergencies

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d) General responsibilities:

1. Ensure that all drugs are handled properly

2. Participate in cardio-pulmonary emergencies

3. Provide education and training for pharmacists

OUTDOOR PHARMACIST RESONSIBILITIES:

a) Central dispensing area:

1. To ensure that all drugs are stored and dispensed correctly.

2. To check the accuracy of the dosages

prepared.

3. Maintain proper records

4. Preparation of bills

5. Keeps the pharmacy neat and tidy

manner

b) Patient care areas

1. Inspect periodically the medication

areas

2. Identify the drugs brought into the hospital

3. Monitoring of drugs

4. Counsel the patients

c) General responsibilities:

1. Ensure that all drugs are handled properly

2. Participate in cardio-pulmonary emergencies

3. Provide education and training for pharmacists

4. Co-ordinate overall pharmaceutical need of the outdoor services

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CONCLUSION

To do the practical training in a retail pharmacy is nothing but

b ut utilizing and implementing
whatever knowledge gained during course. Every student trainee should do systemic
training during practical training period. This proforma will beneficial to all institutes of
pharmacy for uniformity in project and training before sanctioning the apprentice

practical training.
In fact, I spent an excellent 150 hour internship, I learned a lot, Observed, Noted,
Identified, Discussed ... I am sure that this information will be useful to me throughout
my professional career.

While allowing me better apprehend and manage diseases, and thus serve my country. I
shall also transmit them to my successors.

I am satisfied with the internship, and my objectives are reached at 80%. And I thank
once again all those who have contributed to this success.

I hope that medicine in Haiti will have a much higher standard and that the population
will recognize the importance of this specialty, which is family medicine, and that
someday there will be subspecialties.