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:

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.
For psychotropic drugs, separate prescription registers must be maintained for each drug.
  • 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

Here are a few final tips to ensure you are fully prepared for your inpatient pharmacy rotation:



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