New to Inpatient Pharmacy
Introduction
Despite being stationed at the inpatient pharmacy for a year, I realized I have not spent much time explaining what an inpatient pharmacist actually does in their daily routine.
- This need for clarification became apparent when I began planning the briefing for incoming pharmacy students.
A common perception is that inpatient pharmacists are solely involved in the medication distribution system (e.g. unit-of-use, unit-of-dose, floor stock and emergency trolley). However, a reality check reveals that our roles extend far beyond distribution.
Our responsibilities include, but are not limited to:
- Clinical services
- Compounding extemporaneous preparations for pediatric patients.
- Providing medication counselling and issuing allergy cards for wards without a dedicated clinical pharmacist.
- Methadone dispensing.
- Responding to drug information queries
- Inventory management
- Updating the unit catalogue for wards and clinics.
- Ensuring sub-store stock levels are sufficient for daily operations and monitoring for expiry dates.
- Managing inventory control for direct issue items and special approval medicines.
- Updating the sub-unit master list.
Nonetheless, today's focus will be on the typical workflow of preparing medication for unit-of-use and unit-of-dose in a manual hospital setting.
Procedure: Daily Workflow
Managment of ward patient medication folders
- Arrange new prescription sheets (PS) to match the sequence of the ward patient list.
- Sort the prescriptions inside the folder to account for new admissions, bed changes, and discharges (including transfers to other wards, discharges home or cases of death).
Medication cart management
- Update the patient name label on the carts accordingly.
- Relocate medications within the cart if a patient has transferred beds.
- Remove medications if there is a change in drug management or if the patient has been discharged.
- Verify that all medications inside the cart belong to the assigned patient.
Medication supply process
- Ensure each prescription is within its 7-day validity period.
- Verify that all drugs are correctly dosed (including dilution instructions).
- Perform medication reconciliation to identify changes in clinical management, such as:
- IV to oral switch (oralisation) - e.g. thiamine, pantoprazole, antibiotics.
- Dosage adjustments - e.g. bisoprolol, amlodipine, frusemide, etc.
- Antibiotic review - changes in antibiotic choice based on C+S (culture and sensitivity) results and patient clinical response.
- Transcribe the medication order into the PhIS system to generate labels.
- Prepare the medication accurately.
Query the medication if there is any doubt.
Be vigilant for:
- Poor handwriting.
- Incorrect dosage.
- Missing doctor's countersignature.
- Mismatches between patient's name and IC number.
NOTE: When performing medication checks, consider the following clinical parameters: indication, patient age (appropriateness of dosage), pregnancy status, breastfeeding status, drug interactions, and renal or liver dysfunction.
Documentation: Local Practice
For certain medications, all transactions must be recorded inside a stock ledger (Bin Card KEW PS-3).
- Use a black or blue pen for "issue out".
- Use a red pen for C/F (Checked and Found) and "issue in".
- Any "issue in" should be preceded by a C/F verification of the physical quantity.
- Do not make any cancellations, obliterations, or alterations using crossing lines or correction fluid (Liquid Paper).
- Corrections should be made via a marginal note or footnote with a specified date.
- All entries must be signed and stamped with the pharmacist’s official stamp.
Summary
- Ensure all your clinical references are easily accessible via your mobile phone.
- Familiarize yourself with how medications are organized in your specific facility (e.g., by fast/slow-moving items or by drug category).
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