Community pharmacy course Topic 1 Introduction to community

Community pharmacy course Topic: 1 Introduction to community pharmacy ( definitions, practice, ethics, communication skills, and pharmacy design ) 1

• A pharmacy: is the health profession that links the health sciences with chemical sciences and it is charged with ensuring the safe and effective use of pharmaceutical drugs. . • • • Pharmacy practice includes: Compounding and dispensing Clinical services Reviewing medications for safety and efficacy Providing drug information • Pharmacist , therefore, are experts on drug therapy and are primary health professionals' who optimize medication use to provide patients with positive health outcomes 2

• Pharmacy Chemists Drug store • Pharma ( 1400 -1600 s), retail shop for medicines, sold tobacco, herbs • Pharmacists practice in a verity of areas including retail, hospitals, clinics, drug industry, …. . • Pharmacists can specialize in various areas of practice such as hematology, infectious diseases, drug information…. . 3

Pharmacy fields include: 1. Community pharmacy 2. Hospital pharmacy/ may have more complex clinical mediation management (drug interactions, effectiveness, compliance in hospital and home …. ) / include more specialized mediations/unit dose / complex process ( TPN) 3. Clinical pharmacy: direct patient care service/hospital &clinic 4. Compounding pharmacy: preparing drug in new form , manufacturer, mixing strength of drugs in hospital or community pharmacy/ found at community or hospital 4 pharmacy

5. Consultant pharmacy: focus more on medication regimen/ elderly people at homes. 6. Internet pharmacy/online services with lower costs / valid prescription youth & control drugs / 7. Veterinary pharmacy 8. Military pharmacy 9. Nuclear pharmacy: focus on preparing radioactive materials/need special training/ no direct interaction with patient 5

Future of pharmacy • Pharmacist become more integral within the health care system. • Paying attention toward the patient health, general wellness, counseling, and drugs related matter. • Medication therapy management (MTM): teaching clinical services that pharmacist can provide for patients/ to increase patient health outcome and decrease costs of health care system. • Ex: - Australia: Austrian government for conducting comprehensive home medicines reviews - UK: pharmacist additional training - USA: pharm D, 2 year residency for pharmacist 6

Community pharmacy • is a healthcare facility ( pharmacy, chain pharmacy, department) that emphasizes providing pharmaceutical services to a specific community. It dispenses medicine and typically involves a registered pharmacist. • Pharmacy automation: involves the mechanical processes of handling and distributing medications • A community pharmacist • Is responsible for dispensing and distributing medicine. • They work to legal and ethical guidelines to ensure the correct and safe supply of medical products even OTC to the general public. providing advice and information 7

• Some pharmacists will offer specialist health checks, such as blood pressure monitoring and diabetes screening. • Pharmacist cant form business partnership with physician • The prescribing and dispensing functions of physicians & pharmacists emphasize the differences in control each has over medications. • Pharmaceutical care • defined as: ‘the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patients quality of life’ 8

Drug information • Pre-packaged medicines contain written inserts giving detailed instructions for their use. • Pharmacists compete with other sources of advice and information such as doctors, the media and community. The open and wide availability of alternative sources of advice and information • Ensure the individual patient’s informational requirements are met, tailoring written information 9

Legislation ü Pharmacists practicing at the pharmacy are registered with a registering body. ü Process of community pharmacy practice is controlled by legislation. ü Legislation classifies medicines according to: o category of medicines that may be sold from other outlets (such as drugstores) not only pharmacies 10

o category of medicines that may be sold after being recommended by pharmacists o category of medicines that require a prescription o category of medicines that are controlled (e. g. , fentanyl, methadone). ü Pharmacy services must be available for 24 hours, 7 days a week. Rosters are issued for night-time service and for service on public holidays. 11

Actions of community pharmacists in society • Buying of medicines • Storage of medicines in appropriate conditions (temperature, humidity, cleanliness, stock monitoring) • Dispensing of medicines • Compounding and ensuring quality of compounded products • Patient medication review, advise patients on use of medicines and participate in adverse drug reaction reporting • Ensuring rational and safe use of medicines by patients 12

• Monitoring of self-care, responding to symptoms and identifying cases warranting referral • Point-of-care testing • Health promotion and promotion of healthy lifestyles (nutrition, physical activity, smoking cessation, sexual and reproductive health) • Participating in national health service schemes to provide social pharmacy services • Other responsibilities: nutritional supplements, special foods (e. g. gluten-free products, food for diabetic people), colostomy care and urinary incontinence devices, disability and mobility aids (e. g. wheelchairs, walking aids), oxygen supplies and ventilation equipment, veterinary medicines. 13

counseling and responsibilities of community pharmacist 1. Counseling : drug related problems, proper use of OTC and prescribed mediations, immunization schedule…. 2. Pharmaco-epidimology: post marketing phase of clinical trial of a drug, which concern with a new drug safety after marking. 3. May involve in the control of diseases, by making community a ware through counseling ( AIDS, TB, hepatitis…. ) 4. Encouraging patient to prevent them selves from various chronic diseases by using proven techniques of prevention (decrease risk of stroke by controlling BP) regular intake of prescribed medicine, quitting smoking, increase physical activity , lowering cholesterol intake 14

5. May involve in patient health education through the use of pamphlets and bulletins. 6. Provide counseling to pregnant ladies about material and child health, family planning, management of pregnancy, diet, guiding parents for the protection child against disease by proper immunization schedule. 7. May guide patients about nutrition intake according to the requirements of the patient and disease state. 8. Can make community aware about environmental health like food born disease, carcinogenic… 9. Provide counseling to the persons involved in alcoholism, smoking cessation, and drug abuse 15

Summary of the areas where a pharmacist can involve in public health through community pharmacy • • • • Drug and nutrition counseling Use of OTC and prescribed medicines Family planning Pregnancy and infant car Immunization Sexually transmitted disease counseling Toxic agents control Health and safety Control of accidental injures Prevention of smoking, alcoholism, and drug abuse Environmental protection Weight control program Poising and cancer detection 16

Code of ethics • Moral ‘’the conduct of individuals in any society is governed by the environment controls on the one land social customs and duties on the other” • Code of ethics = code of moral principles= science of moral • Governments restricts the practice of the pharmacy to who's qualified under regulatory requirement and grant them privileges necessarily denied to other. • In return, government expects the pharmacist to recognize his responsibilities and fulfill their professional obligations honorably and with due regard for the well being of the society. 17

Duties of pharmacists 1. pharmacist in relation to his job: • Pharmaceutical services: supply of commonly required medicines without delay, and involve emergency supplies at all times. • Conduct (management) of the pharmacy: arrangement in the pharmacy should be grade to avoid risk or error of accidental contamination preparation , dispensing or supply medicines. There should be a pharmacist in personal control of the pharmacy. 18

• Handling of prescriptions: prescription should be received by a pharmacist without any comment over it regarding the style or its therapeutics efficiency. Any question on the prescription should be answered with caution and care. Its not within the privilege of the pharmacist to add, omit, or substitute any ingredient or other the composition of a prescription should be taken. • Apprentice pharmacist: the apprentice trainee is given full facilities for their work, so that completion on their training they have acquired sufficient technique and skill to make themselves dependable pharmacists 19

Steps of dispensing a prescription in a community pharmacy: Receiving the prescription: At this stage, communication and interaction with the pharmacy staff take place Reading and checking of prescription -patient’s name and address -age of patient if under 12 years -name, dose and quantity of medicine -Date -prescriber’s name and address -signature of prescriber -legality and authenticity of document. Collection of medicine: care in selecting appropriate medicine, strength, and dosage form. 20

Label production: Details to be included on label: • patient’s name • date of dispensing • name of pharmacy • name of medicine • strength • dosage form • quantity dispensed • dose with clear instructions • cautionary labels. Rechecking Recheck that the prescription and the medicine prepared are consistent Handing over the medicine: The pharmacist explains to the patient when and how to take the medication. 21

Factors influencing health promotion activities in community pharmacies q. Positive factors §Environment within the pharmacy §Health promotion §Access to parts of the pharmacy §Communication skills of community pharmacy q. Negative factors §Lack of resource materials §Lack of space §Lack of privacy §In appropriate time management of the pharmacy 22

Communication with patient • Patient counseling is undertaken by pharmacists: • during dispensing, in disease management, in providing advice on self-care: advice on product selection and use, non-drug , referral and health assessment. • Pharmacist actions in communication with patients 1. Ensuring safe and correct use of medicines 2. Responding to symptoms 3. Discussing patient health-related and social problems that impact on health status 4. Empowering individuals to be active in health promotion and preservation. 23

• Communication process • Understanding needs of individual: (e. g. social problem associated with occurrence of acne may impact differently on individuals). • Professional Relationship building: friendliness and warmth, Provide reassurance, Preserve confidentiality. • Non-verbal communication and body language : Close conversational distance, Direct eye contact, forward leaning posture, Smiling, voice tone • Questioning and listening: Use effective questions by asking open questions to obtain information that is necessary, Ask only one question at a time, Encourage patient participation, Practice active listening. , • Responding and explaining: Place the most important points at the beginning of the communication session, Give specific instructions, Simplify complicated messages. Give care to Patient characteristics such as speech defect 24

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• Counseling in the community pharmacy setting 26

• Staff (personal): Training • important aspects of developing an efficient operating community pharmacy / proper training/ maintenance of employees. • Following criteria should be followed during the selection of the staff for community pharmacy: 1. Minimum standard of qualification 2. “over hiring” means superior people should not be hired for inferior jobs, this type of selection may result in an adverse effect on staff moral and efficiency 3. Developing a job description and specification for each position to avoid misunderstanding about the nature of duties 27

4. Promotion within a pharmacy staff may be appropriate 5. Availability file( a record of qualified peoples who applied for job) should be maintained in pharmacy. 6. Owner or manager of the pharmacy should design an application form to assist in the selection process, to serve a guide during interview, and permanent record of employee 7. All the employment polices and procedures must be consist with applicable laws 8. Compensation: retraining good employees is one of the most difficult problems faced by the community pharmacy manger/ compensation plan to encourages employee to work toward all goals and objectives of the pharmacy 28

( Discussion should be on the basis: goals, expected working hours, lunch brick, overtime safety rules, telephone usage, vacation policy…. ) v To increase productivity and reduce employee turnover v Sink or swim method of training is insufficient to pick up knowledge on the job. v there are effective simple training methods , a new employ is assigned to a capable experienced employee who explains and demonstrate the job. v Conference method can also be used. 29

2. Pharmacist in relation to his trade: • Price structure: fair/keeping with quality and quantity. • Fair trade practice: NO short prices, gifts, charging lower prices than fellow pharmacist, NO copy of labels, trademarks, and other signs and symbols of other contemporaries. • Purchase of drugs: purchase drug from genuine and reputable source. • Advertising and displays: (NO)misleading statements or guarantee of therapeutic efficacy or take a reference from medical team of hospital or a Dr which not already established, offering prizes, …. 30

3. Pharmacist in relation to medical profession • Limitation of professional activity: which is diagnosis diseases and prescribing medications/ in case of accidents or emergency a pharmacist may, however render first aid to patient. • Secret arrangement: NO pharmacist should enter into a secret arrangement or contract with a physician, to offer him any commissions or any advantage by recommending his drug store even his self to patients. • Communication with public: being a link between medical profession and people, a pharmacist always keep himself updated by regularly reading books, journals… should never disclose any information unless required the low. 31

Community pharmacy management 1. Selection of site space layout and design • During the selection of a site for new pharmacy following factors should be considered: a. A needy town or a city should be selected b. Site should be most suitable among those available pharmacies. c. Site should be convenient and accessible to the majority of consumers (center to population severed) d. Pharmacy site should be equipped with adequate free parking facility. e. If possible, site should be in neighborhood of a community shopping center for the convenience and accessibility of the consumers 32

2. Plan of an ideal retail and whole sale drug store • One of the main factors responsible for the success of a drug store is location and proper layout design • Objective of layout design: - To attract a large number of customers To increase the sale of store To reduce the selling expanses to the minimum To provide the customer satisfaction To have space for reserve for stock, office, and resting place for employees - To have a proper entrance for coming goods - To project a professional image and improve general appearance - To minimize the movement of customers with in the premises of the drug store 33

• Community pharmacies usually consist of: 1. A retail storefront with a dispensary area where medications are stored and dispensed. 2. A pharmacist on-duty at all times when opened 3. Pharmacy technicians while the pharmacist spends more time in communication with patients Owner of pharmacy must be a registered pharmacist (R. Ph) 34

1. Personnel present: managing pharmacist, pharmacists, technicians/ identifying training needs and providing appropriate training 2. Buildings : areas available for dispensing, storage of medicines, patient counseling. 3. Equipment: dispensing equipment, diagnostic equipment for point-of-care testing (e. g. blood pressure measurement, blood testing, urinalysis) 4. Documentation and information: registers to be kept at the pharmacy, IT-supported systems for documentation of pharmacist actions and for maintaining pharmacy patient profiles, drug information sources (books and electronic access). 35

• Dispensary area • Area should be spacious and designed in such a way as to promote communication between pharmacist and patient. • Space should be available for patient advice and counseling in privacy. • Consultation areas should provide for space to carry out point-of-care testing. • Adequate facilities for dispensing must be provided – cleanable floor and surfaces, adequate fixtures and fittings, clean refrigerator with appropriate temperature monitoring and control, clean sink, logical layout of stock and a normal workflow. 36

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The legal requirements for the establishment of retail drug store are: Ø General licenses: granted to persons who have the buildings for the business and the services of a qualified person to supervise the sale. • - Should be displayed in prominent place Should comply with provisions of drugs and cosmetics act and rules. Any change in qualified staff should be reported. Ø Restricted licenses: the license for restricted sale of drug - Drugs only are purchased from a licensed manufacture - Drugs should be sold in their original container 38

Importance of stocking for drug store • Drugs are stored in alphabetical order • It provides a channel for distribution of drugs • It provides space for storage of drugs or materials and supplies • Drugs are readily available for administration • Vaccine and antibiotic drugs are stored in refrigerator 39

Maintenance of various registers( records) in community pharmacy 1. Legal records: disposition of drugs, distribution of poison and hazardous substances 2. Patient record: patents drug history (type and amount)/ reducing drug problems and interactions 3. Financial records: loans, expenses, income…. 40

Using computer in community pharmacy Functions of computers in community pharmacy: 1. Systemic : preparation of prescription level, provide a receipt for patient, calculation of total prescription cost, order quantity…. 2. Managerial: daily sales reports, sales and financial analysis…. 3. Professional: storing of information on drug and other allergies of patients, drug-drug/food interactions, address of physician and phone number. 4. Clinical support: patient education file, pharmacists counseling activity, drug monitor. 5. Accounting and business management: record keeping/ analysis 41

References: 1. A Textbook of community pharmacy: new age international publishers, rakesh saini, 2012, chapter: introduction, chapters: introduction, 1 2. Lecture notes in pharmacy practice, Lilian M Azzopardi, 2010, part 1: chapters: 5, 6, 7, 8. 42