Hospital Pharmacy Service

1. Presented By:
Sushil Kumar Mahato
Department of Pharmacy
Nepal Mediciti Hospital
Pharmacy Service at Nepal
Mediciti Hospital

2. Head :Commercial and
supply chain
Pharmacy Incharge
IP Pharmacy
24 hours
IP Pharmacy In-charge
Pharmacist/Pharmacy
Assistant
Pharmacy Dispensary
7am-7pm
Pharmacy Dispensary
Incharge
Pharmacist/Pharmacy
Assistant
OT Pharmacy
7am-7pm
OT Pharmacy Incharge
Pharmacist/Pharmacy
Assistant
Clinical Pharmacist

3. Routine Responsibilities
• Indenting for required medicines,
surgicals,disposables to medical store.
• Proper arrangement and storage of medicines
as per Storage instructions.
• Dispensing of medicines to In-Patients and
Outpatients as per physician Prescription.
• Daily scroll posting and cash handover to IP
billing.
• To co-ordinate and co-operate with other
departments of a hospital.

4. Routine Responsibilities
• To plan, organize and implement pharmacy policy
procedures in keeping with established policies of
the hospitals.
• To implement decisions of the Drug and
therapeutics committee.
• Proper arrangement of medicines in Pharmacy
including the special storage of LASA, High Risk
medicines and Narcotics drugs.
• Return of Near Expiry and damaged medicines to
medical store.

5. Pharmacy Service at Nepal
Mediciti Hospital
• AIMS:
 Nepal Mediciti pharmacy focus on providing care
to the patient of hospital and nearby community.
 Team with the mission to provide the healthcare
products(Medicines and surgicals/disposables) at
reasonable price with proper counselling from
the experienced professionals.
 Focus on consistent quality standards through
proper management, better infrastructure and
partnership with professionals who are highly
capable, dedicated towards their work and service

6. What we do?
• Pharmacy is a health profession and aims to ensure
the safe and effective use of pharmaceutical drugs.
• Dispensing of medicines to In-patients and Out
Patients.
• Pharmacy practice also includes more modern
services related to health care, including clinical
services, reviewing medications for safety and
efficacy, and providing drug information
• Delivery of medication at every nursing station,
• 24 hours open service for 7 days,

7. What we do?
• Fully computerized system for such as;
• Inventory management
• Billing
• Narcotic record
• Expiry/return goods management
• Drug Formulary Preparation with approval from DTC
committee.
• Separate chamber for LASA – for error minimizing
• HRM labeling for minimizing risk of incident,
• Different coloring in product for expiry alert and for identifying
narcotics drugs,
• Stock verification in terms of quantity/price and expiry
datePatient counseling on disease, drugs and life
styles modifications for both OPD and IPD patients.

8. Pharmacy Services
In Patient Pharmacy:
Located in Second floor
Opens 24 Hours, 7 days a week
Call #1233,1232,1234
Out Patient Pharmacy:
Located in Arcade (Beside Mabel Mart)
Opens 12 Hours, (7am-7pm)
Call #1291,1292,1293,1294,1295,1300
OT Pharmacy:
Located in Third floor
Opens from 7AM to 7:30PM
Call #1325
Medical Store:
Located in first floor (T3 Block)
Opens from 9AM to 6PM
Call #1083

9. Prescription Copied by Nurse
In-Patient Medication order through
Sukraa
Indent Received by Pharmacy
through Sukraa
Issue of indent and Filling of Order by
Pharmacist
Medicine Supply through Pneumatic
or Housekeeping Staff
Flow-Chart for In-Patients

10. Discharge Medicine Supply for In-Patients
Discharge Medicines Prescribed by
Doctors
Prescription copied by Nurse and
Indent to Pharmacy
Indent issued/Filling of Prescriptions
Medicine supplied to Wards
Counselling done by Nursing

11. Discharge Medications
• Discharge Medicines of In-Patients are being
indented through system and delivered to Nursing
station via Pneumatic whereas for onco day care
Patients discharge medicines are being dispensed
from OP Pharmacy.
• Charges of medicines for IP-patients is directly
added to Patient Final Invoice.

12. Flow-chart for Out-Patient dispensing and OTC
medicines
Prescriptions written by Physican/ Request for
OTC drug
Received by Pharmacist/Check for clarity and
accuracy of prescription.
Filling of
Prescription/Selection/Labelling/pricing
Patient Counselling
Payment through Cash or card or as per credit
plan

13. Work Process for IP Pharmacy

14. Medicine Return Process
For IP-Patients
Return Request sent by Nurse through sukraa
Return Request received by
Pharmacist
Physical Verification of medication
and quantity by pharmacist
Return Request accepted through
system
Charges deducted as acceptance
done
Finally Department clearance at
time of discharge
For OP Patients
Return Request by Patient with medicines and
original invoive with 30 days of Purchase
Received by Pharmacist
Cross Check of Medication and
Invoice
Medicine Return Slip generated
through sukraa
Get patient Signature in Returned
slip
Cash Refund

15. Work-Flow for OT Pharmacy
Dispensing of medicines/surgicals to OT
Pharmacy receives charge sheet of used items.
Pharmacy receives the unused items physically.
Pharmacist verify and Charge the items as per charge
sheet
Receiving Indents/Lists of items from OT Nursing Department
Receiving Planned OT schedule for next day (Evening 5pm-6pm)

16. Work Process for IP Pharmacy

17. Work Process for Pharmacy
Dispensary

18. Work Process for Pharmacy
Dispensary

19. Handling of Prescriptions
• Patients name and registration number, patients demographics.
• Written clearly and legibly (Prefer CAPITAL LETTERS) and
that the same are dated, timed, named and legibly signed.
• Drug name (generic name), dosage form, route of administration,
frequency and duration of administration.
• Prone Abbreviations for drug names should not be accepted.
• Doctors are authorized to use only those drugs listed in the
Hospital Formulary.

20. Safe Dispensing of medications
(Out patient)
• Drugs shall be dispensed only by the authorized person
registered with Nepal pharmacy council.
• Drugs shall be dispensed only of valid prescription from
those authorized by the hospital.
• In case of non clarity in the prescription (including mistakes
of dose of drug/duration/ timings/ spellings), the duty
pharmacist contacts the prescriber for clarifications before
dispensing.

21. Safe Dispensing of
medications (Out patient)
• Ensure the correct drug and dose form for the specific
patient.
• Drug ordered shall be billed with correct name, strength,
dose form and quantity, quality, MRP, batch no, EXP date &
check items with bill before dispatch.
• Patient and family are being educated & counseled about
drug-drug and food-drug interactions, if any and on the
effective use of their medications.

22. Safe Dispensing of medications
(Inpatients)
• Name of patient shall be confirmed before issuing
medicines.
• Prescriptions/Indent shall be read and check carefully.
• High-risk medication orders are verified & Double Check
prior to dispensing
• Stat doses and discharge medications will be given first
priority for dispensing.

23. Safe Dispensing of
medications (Inpatients)
• The following details shall be labeled on all cut
tablets/capsules strip or loose
• tablets dispensed for inpatient:
• Name of the medicine,
• Strength and dosage form of medicine,
• Quantity of medicine,
• Expiry date

24. Storage of Medication
• Medications are stored in the pharmacy in designated areas
which are sufficient to ensure proper sanitation,
temperature, light, ventilation, moisture control.
• Drugs shall be stored in the area accessible to only
designated and authorized persons.
• Emergency and life saving medications are replenished in a
timely manner when used and are available all the time.

25. Storage Temperature of medicines
• Proper storage of medication ensures efficacy,
stability and safety
• Store frozen : Minus -- 200c
• Cold : 20c - 8*c
• Cool : 8*c - 25*c
• Room temperature : 15*c - 30*c

26. Expiry System
• Expiry date will be checked at the beginning of every month.
• All such drugs, which will be likely to be expired within 3 months, will
be removed from the shelves.
• Returned to the medical Store.
• All accumulated drug are returned back to the suppliers/manufactures
for credit or replacement.

27. Use of Narcotic and psychotropic
drugs.
• The hospital has a policy to treat the Narcotics and
Psychotropic drugs with extra precaution to prevent any
misuse.
• Appropriate license is obtained and renewed every year
before procuring Narcotic drugs.
• All Narcotics and Psychotropic Drugs shall be stored under
Secured double door Locks both in pharmacy and in nursing
stations under the supervision of a nominated person.
• Every prescription for narcotic drug contains prescribers
name, date, reg. no. along with the name & doses of drug.
• Necessary entry in the stock register is made which include
the name of doctor, name of the drug, batch no, date of
issue, patient name, issued quantity,, issued by, dispensed
by, remaining stock balance.
• Physical and computer stock—reviewed daily.

28. Narcotic Drugs Storage
All stock should be kept in double lock & Key
system. Key of the locked compartment shall be
available with senior pharmacists nominated
for handling narcotic.

29. Narcotics List
S.No. Name of Drug
1 Morphine
2 Pethidine
3 Fentanyl
4 Codeine
5 Dextropropoxyphene
6 Methadone
7 Tramadol
8 Alprazolam
9 Buprenorphine
10 Chlordiazepoxide
11 Clobazam
12 Clonazepam
13 Diazepam
14 Flurazepam
15 Gluthethiamide
16 Lorazepam
17 Midazolam
18 Nitrazepam

30. High Risk Medications List
S.NO. NAME OF PRODUCT BRAND NAME
1 Vecuronium GLANVEC, NEOVEC
2 Rocuronium ROCSUR
3 Tenecteplase ELAXIM,METALYSE
4 Alteplase ACTILYSE
5 Enoxaparin CUTENA,XYNOVA
6 Heparin NUPARIN, HEPLOCK,HEP25
7 Fondaparinux VIRINUX
8 Dabigatrin etexilate PRADAXA
9 Cardiplegia CARDIPLEGIN,PLEGIOCARD
10 Potassium Chloride KCL,POTCL
11 Misoprostol tab MISOPROST,MISTOL
12 Sodium Bicarbonate inj SODIUM BICARBONATE,UBICARB

31. Storage of Medication
• High Risk Medication
• High Alert Medications will be identified by special
labels. (Should labelled as Pink colour)
• HAM should be stored in special storage location.

32. Refrigeration System:
Cold Chain Drugs
• Items requiring refrigeration will be stored appropriately.
• Refrigerators shall be maintained at the require
temperatures (i.e. 20c to 80c)
• Record through continuous temperature charting in each
shift.
• All refrigerated medicines are dispensed with ice packs.

33. Look Alike Sound Alike Drugs(LASA)
• Sound alike and look alike medications are
identified and stored separately.
2 MACOX PLUS
tab
MACOX PLUS 600
tab
Rifampicin 450mg +
Isoniazid 300mg VS
Rifampicin 600mg +
Isoniazide 300mg
3 AMLOSUN
5mg tab
EMSOLONE 5mg
tab
Amlodipine Vs
Prednisolone
4 MEROBAX
500mg Inj
MEROBAX 1gm
Inj
Same Generic
(Meropenem)
5 ALLEGRA
120mg tab
ALLEGRA 180mg
tab
Same generic
(Fexofenadine)
6 ACECLO tab ACECLO SR tab Same Generic
(Aceclofenac)
7 DIVAA tab DIVAA OD tab Same Generic
(Divalproex Sodium)
8 HIMOX cap HICLOX cap Amoxicillin VS
Amoxicillin +
Cloxacillin

34. Counselling Points
• What are the generic and brand names of the medication?
• How often should I take it?
• What time of day should I take it?
• Should I take it on an empty stomach or with meals?
• Where should I store the medication?
• What should I do if I miss a dose?
• How long should I expect to take the medication?
• What side effects should I expect?
• Will the medication interfere with driving, working or other
activities?
• Does the medication interact with any foods, alcohol, other
medications (including over-the-counter medications),

35. Counselling Points
• Inform your doctor if you are pregnant or breast
feeding
• Do not discontinue medicines without the advice of
your doctor
• Find out if any food is to be avoided when taking a
particular medicine
• If you have any doubts about the medication
prescribed to you, clear it with your doctor

36. Abbreviations
• AMP: AMPULE
• B.I.D: TWICE A DAY
• CAP.: CAPSULE
• G OR GM: GRAM
• H.: HOUR
• H.S: AT BEDTIME
• IM: INTRAMUSCULAR
• IV: INTRAVENOUS
• MG: MILLIGRAM
• ML: MILLILITER
• Q.I.D: FOUR TIMES A DAY

37. Abbreviations
• OD: ONCE A DAY.
• STAT: IMMEDIATELY
• SOS: As & When required.
• SUBQ, SQ, SC, SUBCUT: SUBCUTANEOUS
• SUSP.: SUSPENSION
• T.I.D.: THREE TIMES A DAY
• TAB: TABLET
• TBSP.: TABLESPOON (15
ML)
• TSP.: TEASPOON (5 ML)

38. Thank you!