FORE WORDS
I would like to express my gratitude to
all those who gave me the possibility to complete this field. I thank the
school of Pharmacy and pharmaceutical sciences of St. John’s University of
Tanzania for description, arrangements and supervision of the field. I am bound
to the Dean of school Pharmacy and Pharmaceutical sciences Dr. J R Mhando
and associate
dean Dr.
Sanga,also Mr
B.Makala for their stimulating support throughout the field.
I am deeplly indepted to the course instructor
of PH211 Dr R.MBWASI whose suggestions, Description, explanations, lecture
and encouragement help me in all time of
the field and in writing this report.
I thank my colleagues or fellow B.
Pharm two students, especially Mr Juma Daniel, Mashaka. k.Mashaka
and Thobias Masashua whom we were togather at UPENDO PHARMACY
&UPENDO HEALTH CENTRE.
I thank the staff members of UPENDO PHARMACY
& UPENDO HEALTH CENTRE starting with Dr G.MIRAMBO, the Director General
and pharmacist
of UPENDO
PHARMACY &HEALTH CENTRE and all other staff.
Lastly I thank the Loans Board for their financial support throughout
the field practice.
TABLE OF CONTENTS
²
Fore worlds…………………………………i
² Introduction…………………………………………..1
²
General description of the
facility……………2
² Roles of community pharmacy………………..2-4
² Good dispensing practice………………………..4-6
² Roles of community pharmacist………………6-9
² Legal and ethical obligations………………….9-11
² Evidence based pharmacotherapy…………11-13
² Discussion………………………………………………14-15
² Conclusion………………………………………………..16
² Refference…………………………………………………17
INTRODUCTION
In developing countries like Tanzania most of
the people when they fall sick they first visit pharmacies (a place where medicinal drugs are prepared or
sold.)seeking for quick medical care or advice. Pharmacies are
important drug outlets for provision of medicines, drug information and counseling
as well as referral to health facilities.
pharmacists are the first people in most cases
to be consulted by patients seeking medical advice. Increasingly their roles are
growing, moving from simply compounding and dispensing medicines and
expanding to drug development, pharmaceutical manufacturing, patient care
and participation in a multidisciplinary team of health workers..
Aim
The
aim of the practical field was to observe the practical aspects of pharmacy
practice and have a better understanding of the roles of pharmacy in the
community, the roles of community pharmacists in their day to day practice,
guidelines and tools that are used by pharmacists in their every day practice,
legal and ethical obligations of pharmacists and evidence based pharmacotherapy
Method
Observation
of all activities from morning to
evening was made and sometimes practically done some activities under
directions from the phamacist ,pharmacist techinician and Nurses who was there every day at all times and sometimes
questions were asked to the phamacist where clarification was required as well as
patients where certain information needed to be gathered from the patient.
GENERAL DISCRIPTION OF FACILITY
UPENDO Pharmacy & HEALTH
CENTRE where
I did my PH211 field practice is a privately owned, full time service pharmacy
located MADUKAN street in Dodoma
town. UPENDO PHARMACY has two rooms and a toilet inside. One room
is used for dispensing, counseling as well as patient or customer care and the
other room is used for storing prescription and non prescription drugs, heath
equipments, other pharmaceuticals and cosmetics ,there is refrigerator. Drugs in store are categorized in a standard of pharmacy items,
for instance grouped into Refrigerated, Drug safe, Oral, Injectable,
Topical, Infusion, Inhalational and Non Drugs.
ROLES OF COMMUNITY PHARMACY
Community
pharmacies are easily accessible health care facilities in Tanzania located
where people live, shop and work. Most of the population in urban areas and
even those living in the most deprived areas around the Town can get to a
pharmacy easily. Community pharmacy is consequently a socially inclusive
healthcare service providing a convenient and less formal environment for those
who cannot easily access or do not choose to access other kinds of health
service. Most pharmacies now have a private consultation area specifically
for confidential or sensitive discussions.
Therefore community pharmacy plays quite a number of
roles to the communities which are:-
1.Centre of Drug information
Correct, current and reliable information about drugs are obtained
easily in community pharmacy because there is where drug professionals such as
pharmacists work and drug reference books are obtained.
Observation; A number of
patients came to UPENDO PHARMACY seeking for
information about various drugs. I remember a woman came to the pharmacy asking
for information about the side effects of family planning pills. In UPENDO PHARMACY this
service was provided freely.
2.Centre for public health information
Nutritional information, healthy lifestyles, family
information, drug storage information, drug use information, information about
various diseases and many other information are obtained in the community
pharmacy.
Observation;At Upendo pharmacy we were providing leaflets which were having different
information about pharmaceutical product available in place.
3.Centre
for care and treatment
Community pharmacies are indeed the most accessible health care and
treatment facilities to the public than any other since they are located where
people live, shop, work and in the heart of most deprived societies. They
operate for a long time when other health care professionals are unavailable. Observation;This makes community pharmacies like at UPENDO PHARMACY most
opted by the people for care and treatment.
4.Stock of medical and health
care goods
Upendo pharmacy has a stock of medicines and other
health care goods such as gloves, Syringe and others. Medicines are on the
shelf as well as inside the store room and the large number of drugs are those
in essential drug list. Obsevation;In this sense community pharmacies like UPENDO PHARMACY are
a reserve medical store of drugs for the public.
5.Dispensing outlets
Community pharmacy is one of the places where drug professionals like
pharmacists work and is where medicines are dispensed after prescription has
been written by physicians.
Observation: UPENDO PHARMACY is an easily accessible dispensing outlet located at madukani street in Dodoma
town which serves quite a big number of patients
GOOD
DISPENSING PRACTICE (GDP).
Good dispensing practice is that part of
duality assurance which ensures that products are constantly dispensed and
controlled to the quality standards appropriate to their intended use as
required by governing regulations. Good dispensing practice is clearly shown by
examining the six quality determinants namely, decision, inputs, procedures,
outputs, systems and records.
Decision
Good
dispensing practice starts from when the owner of pharmacy was planning to start
the facility. Sound decisions are to be made on the location, design of the
pharmacy as well as goods that will be sold at the pharmacy apart from drugs
that will comply to the rules and regulations regarding pharmacy practice. UPENDO PHARMACY is located in Dodoma town nearby general
hospital. There are two
rooms and a toilet which is in used. One room for dispensing as well as counseling
and the other room is used to store drugs.
Inputs
After considering all factors that make
good decision has been considered, then input follows. Input includes the
employment of pharmacy experts, installing the pharmacy with modern latest
equipments and lastly good materials and products are to be brought. In Upendo pharmacy there are lab techinicians and nurses.
I saw just a certificate of a pharmacist hanged at the wall he was visited the pharmacy at least twice per day.
Upendo pharmacy is well installed with equipments.
The
process and procedures
Customer care in any place where people get any kind of service is very
important. The nurse and pharmaceutical
techinicians & assistant was
quite good in taking care of patients by talking to them politely. As part of
hygiene procedures, the workers was cleaning the pharmacy every time when required,
the store room once a week. They observed the correct dispensing procedures such as
reading the prescription, understanding, filling the prescription and finally
dispensing right drugs to the right patient.
Outputs
The
output always reflects the entire process from decision, input and the process.
One day I stood outside the pharmacy and a patient came out of the pharmacy and
I asked him “are you satisfied with the service you got from Upendo pharmacy”? He said
yes. I saw read the prescription and medicines dispensed were the right
medicines in a correct dose with clear instructions on how to use them and they
were for the right patient. He was not given the leaflet of that drug.
Satisfaction for any service is very Important.
Systems
The
systems include procurement system, inventory system, cleaning system, patient
handling system, workers training system and financial management system. Upendo pharmacy & health centre
accountant and the owner procure medicines from the Medical stores department.
Drugs brought to pharmacy were not expired, they are of good quality that are
safe for human use. The owner and accountant of Upendo pharmacy are very
strict about money so financial management is their first priority.
Records
Upendo pharmacy do keep patient drug use records and their business
records of sold medicines and daily remaining medicines both in the store as
well as on shelf.
ROLES OF COMMUNITY PHARMACISTS
Community pharmacists as part of health care team are the most accessible
health professionals to the general public and in many parts of the world,
pharmacists are increasingly being recognized as a source of professional
health services. They supply medicines in accordance with a prescription or
when legally permitted, sell them without a prescription. Pharmacists have
become increasingly involved in patient care, advice on variety of healthcare
issues, drug information provision, supporting promotional health campaigns and
they have expanded their traditional role of compounding or extemporaneous
preparation and small scale manufacture of medicines.
Community pharmacists work in a retail environment and may also be involved in the management of the business. This may include marketing, finance, accounting, personnel management and stock control. Every chemist shop or community pharmacy in Tanzania must be under "the direct supervision" of a pharmacist. Strict legal and ethical obligations are in place to ensure the control and safe use of medicines within the community.
Community pharmacists work in a retail environment and may also be involved in the management of the business. This may include marketing, finance, accounting, personnel management and stock control. Every chemist shop or community pharmacy in Tanzania must be under "the direct supervision" of a pharmacist. Strict legal and ethical obligations are in place to ensure the control and safe use of medicines within the community.
Patient
interaction and advice
The
workers(pharmaceutical techinician & nurses)whom were
there at Upendo pharmacy & Health
centre were doing all the activities that a Pharmacist can paform,
Pharmacy technician and Pharmacy assistant they are doing
their jobs even in the absence of the phamacist.
The workers was securing correct
information from patients concerning an accurate and complete drug history,
advising the patient as to proper use and storage of prescription drugs and
assisting in proper selection of over-the-counter medications. There were
able to monitor a larger number of a patients who
came into the pharmacy.
Dispensing Prescriptions
Receiving, verification, checking for
errors, drug selection, filling, recording, filing and delivery of prescription
to the patient was done by the pharmaceutical techinician & nurses in
assistant with the pharmacist.
Pharmacy Administration
Part
of Pharmacist roles in community pharmacy includes inventory control, ordering
and returning merchandise, receiving and pricing drug products, stock
arrangement and storage, management policies, bookkeeping, payroll, bills,
employee policies, complaints, correspondence, pharmacy layout, traffic
patterns. Contrary at Upendo phamarcy & health centre
the Director General are professionally the Pharmacists.
Drug and Product Information
Learning has no end. The pharmaceutical
techinician & nurses in
the absence of patients, they were
identifying and evaluating information and knowledge of general drug
information, generic and trade names, common dosage forms, indications, side
effects, interactions from the leaflets obtained inside the packs of various
prescription and non-prescription drugs and there were
using this for patient counseling,
advice and educating as the Pharmacist.
Compounding
Traditional role of Pharmacists is compounding prescription requiring
compounding. In the Pharmacy where I was doing field practice I did not observe
any kind of compounding being done there. When I asked why it was not done, The pharmaceutical
techinician said, she never received any compounding case
and also most of dosage forms are
already available in any concentration or volume widely used.
Responding to symptoms of
minor disorders
A
large number of patients come to upendo
pharmacy seeking for advice and sometimes treatment on a variety of symptoms
they express. If symptoms relate to a self limiting minor ailments, the the workers
who was there as pharmacist supplied a non prescription medicine with more
advice to consult a physician if symptoms persist. They
rarely gave patients advice without medicine unless patient just
came seeking advice only.
LEGAL AND ETHICAL OBLIGATIONS
Pharmacists are health professionals
who assist the individual patients in making the best use of medications. The
legal and ethical obligations are intended to state publicly the principles
that form the fundamental basis of the role and responsibilities of the
pharmacists. The legal and ethical based on the moral obligation, are
established to guide pharmacists in relationship with the patients, health
professionals and the society.
Pharmacist respects the covenantal relationship between the patient and
the pharmacist
A pharmacist in his oath promised to help patients achieve optimum
benefits from their medications, to be committed to their welfare and maintain their
trust. The workers(techinicians & nurses) who was there doing pharmacists duties
actually tried to abide to the pharmacists promise even though sometimes
business interests overcome the patient benefits and their welfare.
Pharmacist promotes the good of every patient in a caring, compassionate
and confidential manner
A pharmacist always places concern for
the well-being of the patient at the center of professional practice. I
observed the workers(techinicians & nurses)
always considering the needs stated by the patients as well as those defined by
health science professionals. There were
dedicated to protect the dignity of the patients and serving with a caring
attitude and a compassionate spirit as well as keeping patients
confidentiality.
Pharmacist
respects the autonomy and dignity of each patient
A pharmacist is expected to promote the
right of self-determination and recognize individual self-worth by encouraging
patients to participate in decisions about their health. The workers(techinicians &
nurses) whom were doing
the pharmacists duties was communicating with patients in terms that are
understandable and concordance dispense was done. All
times were respecting the personal
and cultural differences among patient coming to the pharmacy.
Pharmacist acts with honesty and integrity in
professional relationships
A pharmacist has a duty to tell patients
the truth and to act with conviction of conscience. The workers(techinicians &
nurses) whom were
there as a pharmacist was avoiding any
discriminatory practices, behavior or work conditions that impair professional
judgment, and actions that compromise dedication to the best interests of
patients.
Pharmacist
maintains professional competence
A pharmacist has a duty to maintain
knowledge and abilities as new medications, devices, and technologies become
available and as health information advance.
Pharmacist
respects the values and abilities of colleagues and other health professionals
When appropriate, The workers(techinicians &
nurses) whom were
there doing pharmacists duties was consulting colleagues from neighboring
pharmacies or other health professionals. By doing that their
acknowledges that colleagues and other health professionals may differ in their
knowledge, beliefs and values
Pharmacist
serves individual, community, and societal need
The primary obligation of a pharmacist is
to individual patients. However, the obligations of a pharmacist may at times
extend beyond the individual to the community and society.
EVIDENCE BASED
PHARMACOTHERAPY
This is
the practice of pharmacy in which the pharmacist makes decisions, taking
into account the best available current research evidence, their expertise, and
the needs and preferences of the patient and this is achieved through having
enough drug information and indeed registered ones. Know drug use monitoring
and evaluation and lastly pharmacoeconomics.
Drug information
Numerous resources of medicines
information are available, including reference books, drug compendia, national
medicines lists, essential medicines and treatment guidelines, drug
formularies, drug bulletins, medical journals, drug information centres,
computerized information and the pharmaceutical industry. UPENDO pharmacy they have all kind of drug information source as mentioned above
,which makes the pharmacy to be agood place for leaning.
Drug registration
Tanzania Foods and Drug Authority has been
making sure that drugs imported to Tanzania and manufactured in Tanzania are
registered after passing specific tests in order to be sure of their safety and
efficacy. Upendo pharmacy & health centre dispenses all registered drugs.
Pharmacoeconomics
There are four main criteria to be
considered in the selection and use of a medicine and these are efficacy, safety, quality and economic
evaluation. “Value for money” is one of the underlying principles of
pharmacoeconomic analysis. Health economics is about making decisions on the
most efficient use of limited resources for health care. Pharmacists as well as
patients must constantly decide which of several courses of action to follow in
order to use their limited budgets to the greatest possible benefit. Upendo pharmacy & health
centre many patient opted for the cheapest drug
though where the drug was manufactured mattered a lot.
DISCUSSION
Through the three weeks field
practice at UPENDO Pharmacy & HEALTH CENTRE I have identified a high level of
involvement of community pharmacists in treatment of prevalent diseases. This
may raise some legal/ethical questions as to functions of the pharmacist in
health care delivery. In Tanzania, the existing pharmacy laws are yet to
incorporate this aspect of pharmacy practice. However, WHO recognizes the key
role of pharmacists in public health and the use of medicines. It emphasizes
their responsibility to provide informed objective advice on medicines and
their use, to promote the concept of pharmaceutical care, and actively
participate in illness prevention and health promotion.
During my field,I
observed that
Community pharmacies are very frequently the first visited health care system
by the Dodoma residents often before going to Hospital to see the physician.
There is a high frequency of contacts with low barriers to access to the
pharmacy: no appointments, no long waiting time, convenient opening hours, and
they are located within the community. Regular contacts offer access to a wide
range of people, namely, healthy persons, those showing symptoms, patients
undergoing treatment, relatives and other care givers and actually people from
all social strata. It would be necessary to pursue relevant policies to enhance
the utilization of the untapped potentials of community pharmacists.
In order to improve the knowledge
base of practicing pharmacists, continuing education programmes for
pharmaceutical professionals with emphasis on public health promotion and
disease prevention is recommended. Additionally the legal framework of
community pharmacy practice should be reviewed to restrict non pharmaceutical
professionals to work and dispense in community pharmacies. Awareness should be
created amongst the public about the role of pharmacist, so that they will know
what to expect from pharmacy services.
Whether
counseling patient, communicating with physician, or interfacing with
associates, pharmacists use their interpersonal communication skills daily.
Effective communication by pharmacists is essential to improve the use of
medications by patients and ensure optimal therapeutic outcomes. Pharmacists
can improve patient adherence to drug therapy through appropriate strategies,
including patient counseling and education.
In my field work I leaned a lot at Upendo phamarcy
and Upendo health centre ,among of things which I leaned at upendo phamarcy are
stock taking (which were done monthly),stock location methords ,at upendo
common used were FEFO (First expiry First out)& FIFO(First in first
out),Patient care,procurement and financial management , good dispensing
practice and many more things.
CONCLUSION
Community pharmacies in Tanzania are
very important as they are easily accessible to the entire population and they
operate for long time when other health care professionals are unavailable. The
main responsibilities of a community pharmacy include compounding, counseling
and dispensing of drugs on prescription to the patients with care, accuracy and
legality.But main functions nower days are counseling and dispensing of drugs on
prescription to the patients with care, accuracy and legality. Appropriate
procurement and financial management, storage, dispensing and documentation of
medicines are within the purview of its professional responsibilities. It is an
important branch of the pharmacy profession and involves a qualified and
pertinent pharmacist, pharmacy technicians and pharmacy assistants. Being
closely in contact with general people, the community pharmaceutical
professionals should have the required education, skills and competence to
deliver the professional service to the community.
REFERENCE
1. World Health Organization. The role of the
pharmacist in the health care system. Report of a WHO consultative group, New Delhi,
India, 13-16 December 1988. Geneva: World Health organization 1994
2.
Canadian Pharmacists Association. Pharmacists and primary health care.
2004. Available from http://www.pharmacists.ca/content/about
3. British national formulary 61 March 2011.
