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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5717_Библиотеки_им_академика_М_И_Перельмана.pdf
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Educational and Training Programs in Hospital
program, in which expert is internal staff member and may be good in their job but may
not have advanced expertise, required to train others. Outside professionals have the
knowledge and experience in a particular area and so they can give in-depth knowledge
in that particular area to the participant, which can be beneficial for the hospital set up.
External training programs are organized outside the hospital work environment for
a particular period. Learning material is provided to the participant to give complete
theoretical knowledge in this program. In this program, lectures are conducted by an
external expert with the inclusion of relevant case studies, audio-visuals, role play, etc.
The involvement of cost is a major limitation in external training programs. The cost
to conduct the programs is comparatively quite high, which is due to rental place of
training, cost to arrange the facilities, travel expenses, study material cost, remuneration
paid to experts to provide the training. Following are some additional examples of
external training programs.
Introduction to new advancement/ change in technology/equipment: Everyconcerned
staffmembermustgettraining for theupgradationofknowledge to providebetter
patientcareservices.Forexample,knowledgeofnewinstrumentsaswellasdrugsis
amustfortreatmentofapatient.
Mock drills:Practicaltrainingtodealwiththe critical situations suchasfire,bomb
threats,mass casualties,etc. is given to a staff member.Thus, thereis requirement
ofexpertpersonandfinancialmechanisminhospitalsetuptoconductsuchtypeof
trainingprogram.
Services to Nursing Homes
Residential care services are provided in nursing homes to elderly/disabled people.
Sometimes, short-term rehabilitative services like stays after operative surgery, illness,
or injury are also provided. Physical therapy, occupational therapy, or speech-language
therapy along with housekeeping service, are included in such types of services.
The practice nurses, posted in the surgeries, wear a uniform of dark blue colour and
check the requirements needed in surgery. They either work alone or in association with
the general practitioners. They also provide health education, and take care of patients
suffering from chronic diseases such as asthma, diabetes, high blood pressure. They
also provide other services such as vaccinations, immunizations, dressings, etc.
The nurses also deliver advice on contraceptives use, and assist the doctors and
others in the preparation of smears and other procedures in the hospital.
CODE OF ETHICS FOR COMMUNITY PHARMACIST
The Code of Ethics for Community Pharmacists are the standard ethics that are expected
to follow by community pharmacist. These are:
1. Pharmacistshouldrespecttheprofessionalrelationshipwithpatientwithhonesty
andintegrity. Pharmacists arecommitted to patient welfareand thus help the
patientingettingmaximumimprovementinhealthconditionfromtheprescribed
medications.
2. Pharmacistshouldconsidertheindividualneeds,anddignityofthepatientinan
empathetic,andconfidentialmanner.
Pharmacistshouldhelpthepatientsintheexpressionofneedsandvalues.These
shouldbedulyconsideredbythepharmacist.
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Textbook of Pharmacy Practice
3.Pharmacist should respect the independency and self-respectof patient.For
this,encouragethepatientstobe participant in thedecision-makingmedication
therapyfortheirhealth.
4. Pharmacistshouldperformhisdutieswithhonestyandintegrity.
Pharmacistmust perform hisduties withthe faith ofethics. Heshould place
concernforthewell-beingforthepatientandprovidebestcareintheprevailing
circumstances.
5. Pharmacistshouldworkwithaprofessionalattitude.Hehasprimeresponsibilities
tokeepupdatedknowledgeofnewmedicationsanddevicesaswellastomake
availabilityofadvancedtechnologyforpatientcare.
6. Pharmacistshoulddueregardtoethicsandpotentialofotherhealthprofessionals.He
shouldreferthepatientfortheexpertopiniontootherhealthprofessional,ifrequired.
7. Pharmacistshouldfulfilltheindividual,community,andsocialdesires.itisalsothe
responsibilityofthepharmacisttostretchtheirdutiesforthebenefitsofcommunity
andsociety.Forthis,heshouldactafterproperidentificationofduties.
8. Pharmacistshouldbeunbiasedondistributionofhealthcareresources.Hemustdo
thefairandequitableindistributionofhealthcareresources.
ROLE OF PHARMACISTS TOWARDS COMMUNITY HEALTH EDUCATION
The following are the prime roles of pharmacists for community health education:
1. Handling of prescriptions: Afterreceivingtheprescription,pharmacistshouldverify
itslegality,correctness,dosage,interactionbetweencurrentlyprescribedmedication,
overdosage,pharmacokinetic/pharmacodynamic interaction, contraindication
beforedispensingprescribedmedicationtothepatient.
2. Service related to patient care: The pharmacistshouldcollect andintegratethe
patientinformationrelatedtodrughistory,andthenexplainabouttheproposed
dosageregimenandmethodofdrugadministration.Hecanalsoadviceonvarious
precautions,whicharetobetakenduringdrugtherapy.
3. Monitoring of drug utilization: Thepharmacistcanmonitorthedrugutilization
andevaluatetheADRsassociatedwithprescriptiondrugs.
4. Small-scale manufacture of medicines: Pharmacistscanmanufacturethemedicines
asperGMPguidelines.
5. Traditional and alternative medicines: Pharmacist may beinvolved in the
dispensingoftraditionalandhomeopathicmedications,ifprescribedbyphysician.
6. Responding to minor ailments: Pharmacist can give non-prescription drug, if the
enquiryismadeaboutthesymptomswhicharerelatedtominorailmentssuchasbody
pain,acidity,simplefever,seasonalcough,cold,etc.withasuggestiontoconsultamedical
practitioner.Pharmacistcanrefertheenquirytopractitioner,ifrelatedtotherapy.
7. Communication of information to healthcare professionals: Thepharmacistshould
compiletheinformationonallnewlyintroducedmedicinesandcommunicatetoother
healthcareprofessionalsaswellastothepatientsforpromotingtherationaluseofdrugs.
8. Health promotion: Pharmacistshouldparticipateinthevariouslocalandnational
healthpromotion programssuch asnational programof leprosy, HIV/AIDS
tuberculosis,etc. and drug-related topicssuch as alcohol abuse, rational use of
drugs,druguseduringpregnancy,managementofpoisoning,etc.Itisbeneficial
fordevelopinganimageofpharmacyprofession.
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Educational and Training Programs in Hospital
9. Home service: Pharmacistshouldinvolveinprovidingthehealthcareservicesat
homefordisabled,elderly,andchronicpatientsincludingsupplyofmedicine.
10.Agricultural and veterinary practice: This practiceincludes theinvolvement of
pharmacistsinprovidingofveterinarianmedicinesandmedicatedanimalfeed.
ROLE OF PHARMACIST IN INTERDEPARTMENTAL COMMUNICATION
Pharmacy departments should facilitate the inter-department by communicating with
physician and nursing unit whenever:
• Medicationorderisreceivedbythephysician.
• Thereisconcernofpatient’sage.
• Medication,administeredbythefirsttimetothepatientsbythenursingstaff.
Before dispensing the prescription, pharmacists should always verify the physician
order and the medication history and should consult the doctors if any doubt regarding
the dose or possible drug interactions. For example, if the patient is allergic to penicillin
and ampicillin is prescribed by the doctor. In this case, pharmacist can have discussion
with doctor about the possible allergic reaction.
The physicians always write the patient’s age and diagnosis in the prescription, which
is taken into consideration by the pharmacist while dispensing the medications. This
is important to inform to avoid the complications, whenever there is a need to reduce
the dosage of medications in younger patients as such patients cannot metabolize adult
doses quickly. To avoid any untoward events, the pharmacist must check the prescription
for the correctness in the prescribed dose related to patient age and weight.
EXERCISE
Multiple ChoiCe Questions
Tick mark the appropriate choice
1. What is the objective of training for pharmacist?
(a) To provide optimal drug therapy
(b) To counsel the patient on various disease conditions
(c) To provide education for promotion of the general health of the public
(d) To provide information on immunization to prevent disease
(e) All of the above
2. What is the benefit of training program in hospital?
(a) Improved patient care (c) Minimised supervision
(b) Reduced errors (d) All of the above
short Questions
4. Give the importance of training programs in hospitals.
5. Discuss the code of ethics for pharmacist, which must be followed.
long Questions
6. Discuss the role of pharmacists towards community health education.
7. Discuss the internal and external training programs, conducted in hospital. Give their merits
and demerits.
Answer to MCQs
1. (e) 2. (d)
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Chapter
Prescribed Medication Order
and Communication Skills
INTRODUCTION
Doctor recommends the medicines to the patient either through a medication order
in a patient medical register or through prescription to take prescribed drugs from
pharmacy. In each type of setting, whether prescription or medication order, it is
essential to interpret carefully for correct delivery of medication. The dosage form of
medication must be administered appropriately for patient safety. It is important to
transcribe the order into written form to record in patient register if given verbally.
It is required for legal purposes. Therefore, the expertise to interpret the components
of the prescription is a necessary skill for any health professionals, dealing with
medications.
Just to remind here that many drugs which have similar-sounding or look-alike names,
create confusion sometimes in reading the prescription. It becomes much like playing
a puzzle game. For dispensing and delivery of correct medication as per medical order
or prescription, the pharmacist is solely responsible.
WHAT DOES A PRESCRIPTION INDICATE?
Prescription is a written instruction, often abbreviated as ‘R’ or ‘Rx’ given by
healthcare (e.g. physician) for pharmacist to dispense the desired specific therapeutic
dosage to specific patient. It is a written instruction for a specific condition for
particular reason issued by a registered medical practitioner. The rules about who
may prescribe the medication vary from state to state, so the regulation of the
state of practice dictate the legalities of prescription writing. As a legal value of
document, the prescription suggests the desired medication for particular condition
along with the directions for its use as per need of the patient in terms of safety and
effectiveness. Component included in the prescription, which are necessary for its
legality, are illustrated in Fig. 15.1. There are five major components—superscription,
inscription, signa (Sig), subscription and signature of a prescription issued by the
healthcare professional. Line A of Fig. 15.1 indicates name of the physician or group
of physicians, the address, and phone number. Line B consists of patient’s name,
address, date, sex, and the age if the patient is a child. It is essential to mention
the date on the prescription because prescriptions must be filled within 12 months
from the specified date except with controlled substances or narcotic drugs. Hence,
15
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Prescribed Medication Order and Communication Skills
refilling of prescriptions is dependent on the date of issue. Line C specify the
term superscription or the symbol ‘R’, meaning “recipe” or “take thou,” derived
from Latin word. The inscription, which indicates the name of the medication, its
strength, and quantity of drug to be dispensed, appears on line D. Ingredients may
appear in this line if the medication is compounded or prepared. Line E designate
the term “Sig,” or signa, which gives the directions for taking the medication. The
subscription, line F, informs the pharmacist about the dosage form, as well as how
to take the medication. The physician’s signature appears on line G, and the number
of allowed refills on line H. Finally, if the prescription has inclusion of controlled
medication (e.g. narcotic drug), the physician must provide his/her registration
number along with the signature.
Prescriptions may be issued as written document or given verbally except with
controlled medications, which require a signature of registered practitioner, but the legal
implications are the same for both types of prescription. Means of communicating a
prescription must provide identification of the patient, who collect the medication and
the quantity of medicine to be delivered. It is the duty of the pharmacist to follow the
communication via prescription and deliver the drugs as per prescription. When the
orders are issued verbally, it is essential to reconfirm with the healthcare professional
to double-check the drug, the amount, and the directions to avert errors. If there is
suspected error in the prescription or medication order, pharmacist must clarify from
the prescriber or rectify before the dispensing or delivery of medication to patient.
Further communication with the prescriber, who has prescribed these drugs, is required
for clarification.
Abbreviations are shortened version' of words or phrases, often convenient to use
in the writing of prescriptions. It is advised to use only commonly used standard
abbreviations. Always keep in mind that a prescription is a legal document that could
appear in a court, if case is filed. Under these circumstances, “local” or non-standard or
self-framed abbreviations might be an area of concern for possible wrong interpretation.
To understand and interpret the orders correctly by the pharmacist, the healthcare
professional should use the good handwriting and standard abbreviations to write the
presciption. Some of the commonly standard abbreviations, are presented in Table 15.1.
Fig. 15.1: Example of prescription
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Textbook of Pharmacy Practice
Table 15.1: Standard abbreviation
Abbreviation Terminology Abbreviation Terminology
Aa Area affected BW Weight of body
ac (anti cibum) Before meals C Centigrade
ABW Actual wt. of body c or c With
ad (auris dexter) Right ear cap Capsule
am (ante meridiem) Morning, before noon cr, crm Cream
amp Ampule d Day
APAP Acetaminophen d/c Discontinue
Aq Water disp Dispense
as (auris sinistra) Left ear div Divide
ASA Aspirin DOB Date of birth
ATC Around the clock DS Double strength
au Each ear dtd Give as such doses
bid (bis in die) Twice a day DW Distilled water
biw Twice a week D5NS Dextrose 5% in normal saline
BMI Body mass index D5½NS Dextrose 5% in ½ normal
saline (0.45% NaCl)
BSA Body surface area D5W Dextrose 5% in water
EC Enteric coated OTC Over-the-counter
elix Elixir ou oculus uterque
emp As directed oz Ounce
F Fahrenheit p or per By
fl or fld Fluid pc After meals
ft. Make PCN Penicillin
g or Gm Gram pm Afternoon or evening
gr Grain po By mouth
gtt, gtts Drop, drops post After
h, hr, or° Hour PPM Parts per million
HCTZ Hydrochlorothiazide pr Rectally
hs At bedtime pre-op Before surgery
IBW Ideal body weight prn As needed
ID Intradermal pulv Powder
IM Intramuscular q Every
inj Injection qd Every day
IU International units qid Four times a day
IUD Intrauterine device qod Every other day
IV Intravenous qs Sufficient quantity
(Contd.)
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Prescribed Medication Order and Communication Skills
Table 15.1: Standard abbreviation (Contd.)
Abbreviation Terminology Abbreviation Terminology
IVP Intravenous push qs ad A sufficient qty to make
IVPB Intravenous piggy back s or s Without
jt or j-tube Jejunostomy tube sc, sq, subq Subcutaneous
KVO Keep vein open Sig. Write on label
L Liter SL Sublingual
LE Lower extremities sol. Solution
LR Lactated Ringer’s injection ss One half
M
2
or m
2
Square meter stat. Immediately
mcg or μg Microgram supp. Suppository
MDI Metered dose inhaler susp. Suspension
mEq Milliequivalent syr. Syrup
mg Milligram tab Tablet
min Minute tal. dos. Such dose
ml or mL Milliliter tbsp. Tablespoon
MOM Milk of magnesia tid Three times a day
MR May repeat tiw Three times a week
MRX_ May repeat _ times top Topically
NGT Nasogastric tube tsp. Teaspoon
No. or no. Number U or u Unit(s)
noct. Night ud or utdict As directed
non rep. Do not repeat UE Upper extremities
NPO Nothing by mouth ung. Ointment
NS Normal saline Half-strength
Normal saline (0.45%NaCl)
vag. Vaginally
NTG Nitroglycerin w/ With
od Right eye wa While awake
oint. Ointment w/o Without
os Left eye x Times
WHAT IS A MEDICATION ORDER?
Medication order provides the same information as indicated on a prescription issued
to the patient, but former is issued in an inpatient or physician’s office environment
(Fig. 15.2). This comprises patient’s name and a secondary information such as the
patient’s DOB, hospital ID number, the patient’s room/bed number; date and time of
the order; the drug name, dose, route, frequency, and duration of administration. Like
prescription, it also consists of prescriber’s name along with signature. An exception
with the medication order is that the order is written for either the number of doses
or for the specific length of time, in which the medicines are to be taken. With the
medication order, the healthcare professional is suggested, what drug or drugs should
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Textbook of Pharmacy Practice
be administered, along with the strength of the medication, and the frequency. In an
inpatient setting, order is a means of providing drugs at correct frequency to avoid
the dispensing error. Six parts of medication order include: Date, patient name, name
of medications, dose or medication strength/form, route of administration, time, and
frequency of administration. The name may appear on the patient record. At the end,
medication order must be signed by prescribing healthcare professional. Medication
orders if verbally communicated, must be transcribed into written form signed by
prescriber. Registration number should also be mentioned. These things may be required
for legal purposes, if any case is filed.
Evaluations and Legal Requirements
After receiving the prescription, it is evaluated to:
1. Analyzethevariouscomponentsofaprescriptionormedicationorder.
2. Confirmtheprescriber’sregistrationnumber,mentionedinorderorprescription.
3. Clarifyabbreviationsandsymbols,ifusedinprescriptionormedicationorder.
4. Developamethodofdispensingafterinterpretationofprescriptionormedication
orders.
5. Recognizethecomponents,whicharementionedonamedicationlabel.
6. Predictthepatient’spercentadherencetoaprescribedregimen.
Under Section 65(10) of the Drugs and Cosmetics Rules, 1945, "prescription" should
have the following components:
a. Writtendocumentissuedbyregisteredmedicalpractitioner(prescriber),whichis
dulysignedwithusualsignaturewithdate;
b. Thenameandaddressofthepatientforwhosemedicationorderorprescriptionis
given,orthenameandaddressoftheowneroftheanimalifthedrugismeantfor
veterinaryuse;
c. Thetotalamountofthemedicinetobesuppliedandthedosetobetaken.
d. Routeofadministrationifapplicable.
e. Directionforuse.
Patient’s Name:
Age:
Medical Record No.:
Room No.:
DATE MEDICATION ORDERS TRANS BY
Diagnosis
Weight
Height
Sensitivity/Drug Allergies:
1/12/22 0900 Lasix 80 mg po bid.
Digoxin 0.125 mg po qid
Slow-K 10 mEq po bid
A physician MD
MEDICAL RECORDS COPY PHYSICIAN’S ORDERS T-5
B-Clin Notes E-Lab G-X-Ra X-Diagnostic M-surgery T-Orders W-Nursing Y-Misc
Fig. 15.2: Examples of medication order
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Prescribed Medication Order and Communication Skills
For all medical therapies done through telemedicine or web-interface format,
prescriptions must satisfy the above requirements; it must be signed by a registered
medical practitioner. Without these requirements, prescription will be considered invalid
in terms of legalities.
What are Communication Skills?
Communication skill is defined as ability of transmission of information by using
verbal and non-verbal words, phrases, voice tones, facial expressions, gestures, and
body language. Listening, speaking, observing and empathizing are involved in the
communication skills.
In generalized sense, verbal communicationisthecapabilityoforalcommunication
withwords, in whichyou andothers speak out loudly.Clarity ofspeech isa basic
requisiteintheprocessofverbalcommunication.
Some of examples of verbal communication include:
• Presentingyourideasorprocessesinaparticulargathering,usingparticularstyle.
• Presentingthefinalprojectreporttorelevantstakeholders.
• Introducingyourparticularbrandtoanexternalclient.
• Givingreal-timefeedbackontheirpresentationtoyourteammate.
• Clarificationfrommanagerorhigherpersonbyaskingfollow-upquestions.
• Complimentingajuniorpersononhisexcellentperformance.
Non-verbal communicationistheabilitytoexpressideasand conceptsthroughthe
useofnon-verbalplatformlikebodylanguage,gestures,facialexpressionsandtoneof
voice,andalsouseofpictures,icons,andsymbols.Itisalsocalledmanuallanguage,
andconsistsofprocessofsendingandreceivingmessageswithoutusingwords,either
spokenorwritten.Non-verbalcommunicationrequiresbackgroundknowledgessuch
asawarenessfortypeofaudience,personalpresentationandbodylanguage.
Effective communication isrequiredfor developing good physician–patient and
physician–pharmacistrelationships; essentialfor exchanging ideas, thoughts,
opinions,knowledge, concept and transmission ofpurposeful information with
clarity.Presentationofideasordeliveryofmessagebythesenderisbestpossibleway
forbetterunderstandingofthereceiverwitheffectivecommunication.Boththesender
andreceiverofinformationhavethefeelingofsatisfactionbyeffectivecommunication.
Effectivecommunication isgoodapproachfortransmissionofinformation.In other
words,itisnothingbutthepresentationofideasbythesenderinabestpossibleway
forunderstandingofthereceiver.
Importance of Communication Skills in Healthcare System
Communication skills are required in the following ways:
• Helpfulinexplainingdiagnosis,analysisofreportsandtreatmentstrategy.
• Involvedinguidingthepatientinthedecision-makingabouttherapy.
• Helpfulincommunicatingwithhealthcaretakerorrelatives.
• Deliveryofpurposefulinformationtootherstaffmembersofhospital.
• Helpfulinbreakingunfavorablenews,whichcanleadtonegativeconsequencesfor
patients,families,andphysicians.
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Textbook of Pharmacy Practice
• Gettinginformedconsent/clarificationforaninvasiveprocedureorobtainingconsent
forapostmortemprocedure.
• Handlingwithdisturbedpatientsorrelatives.
• Helpfulingivingdirectionstopatientsondischarge.
• Givingadviceonlifestylemanagement,healthsafetyorrelevantriskfactors.
COMMUNICATIONS WITH PATIENTS, PRESCRIBERS AND PHARMACISTS
Communication is a fundamental aspect of good pharmacy practice—in community
pharmacies and in other health care settings. The communication skill of pharmacists
and other pharmacy staff is an important aspect of, for example, dispensing, healthcare,
and counselling services offered to patients. Through skilled communication, patients’
needs can be assessed and accordingly, information, education, and advice can be
given, regarding rational use of medicine. In addition, effective inter-professional
communication with other healthcare professionals is central to health outcomes of
patient treatments.
Communication with prescribers. Pharmacistshouldcommunicateinanimpressive
mannerwithphysicians andotherprescribersforsafeandeffectiveuseofdrug.He
shouldalsoproviderecentclinicalupdatestoassistthemintheirevaluationofpatients’
therapies.
Pharmacist should communicate/help the physicians and other prescribers to select
medications not only to meet patients’ requirements but also at the same time covered
under medical insurance policy for reimbursement purpose.
By skilled communication, pharmacists should identify the drug therapy problems
that patients may be experiencing. The categories of drug therapy related problems
may include:
a. Untreatedorundiagnosedindication.
b. Need for additional therapy.Itis consideredwhen preventive drug therapy is
essentialtodecreasetheriskofdevelopingnewcondition.
c. Adherencetomedications.Itmaybeduetolackofunderstandingtheinstructions,
forgetfulness,inabilitytoswalloworself-administerthedrugappropriately,etc.
d. Dosingissues(dosetoolowanddosetoohigh).Highdosemayleadtotoxicity,and
lowdosedoesnotproducethedesiredresponse.
e. Unnecessarydrugtherapy.Itisconsideredwhenthereisnovalidmedicalindication
forthegivendrugtherapyatthistime,ormultipledrugproductsareusedfora
conditionthatcanbetreatedwithsingledrugtherapy,etc.
f.Adversedrugreactions.Theseareconsideredwhen:
• Thedrugcausesanundesirablereactionthatisnotdose-related.
• The druginteraction causesan undesirable reactionthat doesnot depend on
doseofdrug.
• Thedrugcausesanallergicreaction.
• Thedrugiscontraindicatedincertainconditionsduetoriskfactors.
• Thedosageregimenadministeredorchangedtoorapidly.
Pharmacist should inform to the prescriber about the safety and clinical effectiveness
of new medications, recently introduced in the market.