A

Report on

HOSPITAL TRAINING-I

For partial fulfillment of the

requirement for the

degree of

BACHELOR OF PHARMACY

By

HARSHIT GOYAL

Submitted to

KRISHN KUMAR AGRAWAL

(Assistant Professor)

FACULTY OF PHARMACY
RAJA BALWANT SINGH ENGINEERING TECHNICAL CAMPUS BICHPURI AGRA

to the

DR. A. P. J. ABDUL KALAM TECHNICAL UNIVERSITY, LUCKNOW

 ACKNOWLEDGEMENT

The training opportunity I had with S.N.M.C., Agra was a great chance for learning
and professional development therefore I consider myself as a very lucky
individual as I was provided with an opportunity to be a part of it. I am also
grateful for having a chance to meet so many wonderful people and professionals
who led me though this training period.

I am using this opportunity to express my deepest gratitude and special thanks to

R.B.S.E.T.C, Bichpuri(Agra) who is spite of being extra ordinary busy with their
duties give us an opportunity so that we could learn something so important.

I express my deepest thanks to Doctors of S.N.M.C, Agra for taking part in useful
decision and giving necessary advisors and guidance and arranged all facilities to
make life easier I choose this moment to acknowledge his contribution gratefully.

It is my radiant sentiment to place on record my best regards deepest sense of

gratitude to Mr chief pharmacist for their careful and precious guidance which are
extremely valuable for my study both theoretically and practically I perceive as this
opportunity as a big milestone in my career development I will strive to use gain
skills and knowledge in the best possible way and I will continue to work on their
improvement

Thanking You

HARSHIT GOYAL

B.Pharm 5th Semester

Roll.No. 1900040500025
 HOSPITAL TRAINING CERTIFICATE

Place Xerox copy of your hospital training certificate/appendix here

 TABLE OF CONTENT

Sr. Topic Page

No. Number
1. Objective

2. Introduction

3. First aid
4. Different routes of injection
5. Study of patient observation charts
6. Prescriptions
7. Dispensing
8. Simple Diagnostic Reports

9. Conclusion
 HOSPITAL PHARMACY

The practice of pharmacy within the hospital under the supervision of a professional pharmacist
is known as hospital pharmacy

FUNCTIONS OF HOSPITAL PHARMACY:

• Forecast of demand. Selection of reliable suppliers

• Prescribing specifications of the required medicament • Manufacturing of sterile or non-sterile

preparations

• Maintenance of manufacturing records Quality control of purchased ormanufactured products

Distribution of medicaments in the wards Dispensing of medicaments to out-patients

• Drug information source in hospitals • Centre for drug utilization studies.Implement

recommendations

of the pharmacy and therapeutic committee Patient counseling • Maintaining liaison between
medical, nursing and the patient.
 OBJECTIVES OF HOSPITAL PHARMACY

The vision of the hospital training is to study the organisation of various departments the
working and development of the organisation the present status of the hospital and future
prospects of the organisation to promote civic sense and soldier the responsibilities with full
potential by being a ultimate Health Care professional and a responsible pharmacist.

1. To professionalize functioning of the pharmaceutical services in hospitals.

2. To ensure availability of the required medication at an affordable cost at the required

time.

3. To plan, organize and implement the policies of the pharmacy.

4. To perform functions of management of material, purchase, storage of essential items.

5. To maintain strict inventory of all items received and issued.

 FIRSTAIDS

First aid is the assistance given to any person suffering a sudden illness or injury. with care
provided to preserve life, prevent the condition from worsening. and/or promote recovery.

The key aims of first aid can be summarized in three key points, sometimes known as the three
P's

*.Preserve life: the overriding aim of all medical care, including first aid, is to save lives and
minimize the threat of death

*.Prevent further harm: also Sometimes called prevent the condition from worsening, or
danger of further injury, this covers both external factors, such as moving a patient away from
any cause of harm, and applying first aid techniques to prevent, worsening of the condition,
such as applying pressure to stop a bleed becoming dangerous.
*Promote recovery: first aid also involves trying to start the recovery process from the illness or
injury, and in some cases might involve completing a treatment, such as in the case of applying
a plaster to a small wound.

*Key Skills: In case of tongue fallen backwards, blocking the airway, it is necessary to
hyperextend the head and pull up the chin, so that the tongue lifts and clears the airway.
Certain skills are considered essential to the provision of first aid and are taught ubiquitously.
Particularly the "ABC's of first aid, which focus on critical life-saving intervention, must be
rendered before treatment of less serious injuries.

The airway can also become blocked through a foreign object becoming lodged in the pharynx
or larynx, commonly called choking. The first aider will be taught to deal with this through a
combination of "back slaps' and 'abdominal thrusts.

Once the airway has been opened, the first aider would assess to see if the patient is breathing.
If there is no breathing, or the patient is not breathing normally, such as artificial breathing, the
first aider would undertake what is probably the most recognized first aidprocedure
cardiopulmonary resuscitation or CPR, which involves breathing for the patient, and manually
massaging the heart to promote blood flow around the body.
Promoting recovery::The first aider is also likely to be trained in dealing with injuries such as
cuts, grazes or bone fracture. They may be able to deal with the situation in its entirety (a small
adhesive bandage on a paper cut), or may be required to maintain the condition of something
like a broken bone, until the next stage of definitive e are (usually an ambulance) arrives.

Conditions that often require first aid:

Medical emergency

Altitude sickness, which can begin in susceptible people at altitudes as low as 5.000 feet, can
cause potentially fatal welling of the brain or lungs.

Anaphylaxis, a life-threatening condition in which the airway can become constricted and the
patient may go into shock. The reaction can because by a systemic allergic reaction to allergens
such as insect bites or peanuts. Anaphylaxis is initially treated with injection of epinephrine.

Battle field first aid This protocol refers to treating shrapnel, gunshot wounds, burns, bone
fractures, etc. as seen either in the traditional battlefield setting or in an area subject to damage
by large-scale weaponry, such as a bomb blast.

Bone fracture, a break in a bone initially treated by stabilizing the fracture with asplint.

Burns, which can result in damage to tissues and loss of body fluids through the burn site....

Cardiac Arrest, which will lead to death unless CPR preferably combined with an AFD, is started
within minutes. There is often no time to wait for the emergency services to arrive as 92
percent of people suffering a sudden cardiac arrest die before reaching hospital according to
the American Heart Association.

Choking, blockage of the airway which can quickly result in death due to lack of oxygen if the
patient's trachea is not cleared, for example by the Hamlich maneuver.

Heart attack, or inadequate blood flow to the blood vessels supplying the heart muscle.

Heat stroke, also known as sunstroke or hyperthermia, which tends tooccur during heavy
exercise in high humidity, or with inadequate water, though it may occur spontaneously in
some chronically ill persons. Sunstroke, especially when the victim has been unconscious, often
causes major damage to body systems such as brain, kidney, liver, gastric tract.
Unconsciousness for more than two hours usually leads to permanent disability. Emergency
treatment involves mapid cooling of the patient
Hair Tourniquet, a condition where a hair or other thread becomes tied around a toe or finger
tightly enough to cut off blood flow.

Heavy bleeding, treated by applying pressure (manually and later with a pressure bandage) to
the wound site and elevating the limb if possible.

Hyperglycemia (diabetic coma) and Hypoglycemia (insulin shock). *Hypothermia or Exposure,

occurs when a person's core body temperature falls below 33.7 °C (92.6°F). First aid for a mildly
hypothermic patient includes re-warming, which can be achieved by wrapping the affected
person in a blanket, and providing wam drinks, such as soup, and high energy food, such as
chocolate. However, re-warming a > severely hypothermic person could resulting a fatal
arrhythmia, an irregular heart 69 rhythm. *Insect and animal bites and stings.

Joint dislocation

Poisoning, which can occur by injection, inhalation, absorption, or ingestion

 Routes of administration

1: Parental routes of administration

An injection is an inanion method of putting fluid into the body, usually with a syringe and a hollow
needle which is pierced through the skin to a sufficient depth for the material to be administered into
the body.
Intradermal injection

lntradermal injection upection of small amounts of material into the coram or substance of the
skin done in diagnostic procedures and in administration of regional anesthetics, as well as in
treatment procedures in certain allergy tests, the allergen is injected
Intramuscular injection

Intrare injection into the substance of a muck, usually the muck of the upper arm thigh or
buttock. Intramuscular injections are given when the substance is to be absorbed quickly. They
should be given with extreme care, especially in the buttock, because the scutic nerve may be
injured or a large blood vessel may be entered if the injection is not made correctly in the
upper, outer quadrant of the buttock.

Subcutaneous injection

Injection mode into the subcutaneous tissues .Although only fluid medication are injected,
occasionally solid materials such as steroid hormones may be injected in smell, skrwty absorbed
> pellets to prolong their effect. Subcutaneous injections may be ➜ given whenever there is
subcutaneous tissue, usually in the outer arm or thigh upper.

Intravenous injection

Intravenous is a term that means "the intravenous medication administration occurs when a
needle is injected and a vein and medication is administered through that needle. The needle is
usually placed in a sein near the chow, the wrist, or on the back of the hand. Different ses can
be used if necessary.
List of Injections

Various injection and vaccines are med in department of pharmacy, some of them are

Vaccines

Anti rabies vaccines (ARV)

Anti-snake venom (ASV)

Injections

Antbiotics (Gentamycin 80g. Ampicillin 500mg. Monoceff 500mg, Ciprofloxacin 500mg,

Stails Desthasone Sodium Phosphate Injection dug Benedejection)

 Study of patient observation charts

The core of pharmacists' contribution to appropriate prescribing and medication use is made
whilst undertaking near-patient clinical pharmacy activities.Checking and monitoring patients'
prescriptions on hospital wards is frequently the starting point for this process and on most
hospital wards the prescription card and clinical observation charts (temperature, pulse rate,
blood pressure, and so on) are typically kept at the end of the patient's bed. This allows the
clinical pharmacist to interact with the patient whilst reviewing the contents of the
prescription.The prescription is reviewed for medication dosing errors, appropriateness of
administration route, drug interactions, prescription ambiguities, inappropriate prescribing and
many other potential problems. Formal assessments of prescription charts in hospitals have
shown that there are wide variations in the quality of prescribing and pharmacists are able to
identify and resolve many clinical problems.

Patients can be questioned on their medication histories, including allergies and intolerances,
efficacy of prescribed treatment, side-effects and adverse drug reactions (ADRs).The routine
presence of medical and nursing staff on the ward allows the pharmacist to communicate easily
with other members of the healthcare team who value the prescription-monitoring service that
clinical pharmacists provide. 19, 20 Patients' notes are also accessible, to enable the pharmacist
both to check important information that may affect their healthcare and to record details of
any clinical pharmacy input made.
 PRESCRIPTION:

The word "prescription", from "pre" (before") and "script" Cwriting. written), refers to the fact
that the prescription is an order that must be written down before a compound drug can be
prepared. A prescription is a health-care program implemented by a physician or other
qualified health care practitioner in the form of instructions that govern the plan of care for an
individual patient. The term often refers to a health care provider's written authorization for a
patient to purchase a prescription drug from a pharmacist.

PROCEDURE IN WRITING A PRESCRIPTION:

The first step is to write the name of the patient, the date, and the sign R. Then the title of each
ingredient should be written in Latin and in the genitive case, except when only a certain
number of an ingredient is to be used the ingredient should be in the accusative case, as for
example, Vitellum unum,-one Yolk-of-egg Next the quantity of each ingredient sufficient for one
dose should be mentally determined, and multiplied by the number of doses which the mixture,
etc, is to contain, and the result set down in signs and Roman numerals opposite the
designation of each article. Directions to the pharmacist and for the patient being added, and
the prescriber's name or initials being affixed, the prescription is completed. Frequently, the
ingredients and their quantities for but one dose, in pill, powder, suppository, etc., are named,
with instructions to make a certain number after the formula prescribed. When an unusually
large dose of any poisonous drug is prescribed, it is customary to underline the quantity, so as
to call the attention of the compounder to the fact that the large dose is ordered intentionally

PARTS OF PRESCRIPTION:

A prescription should consist of the following seven parts:

-Patients information block

-Date of the Prescription

-Superscription(Rx)

-Inscription

-Subscription
-Signatura

PATIENTS INFORMATION BLOCK: In this part of prescription patients complete name, sex and
address should be written to avoid medication error and to take follow up

DATE OF THE PRESCRIPTION: This is necessary for the prevention of misuse of prescription,
especially the once contain narcotics and controlled drugs. The pharmacist should advise the
patient to visit the doctor again.

SUPERSCRIPTION (Rx): This symbol is written before writing the subscription part. This symbol
originated in medieval manuscripts as an abbreviation of the Latin verb recipe, meaning "take
thou".

INSCRIPTION: This is the main part of the prescription. It contains

-Name of ingredients.

-Dosage form.

-Strength and quantities of the medicament.

SUBSCRIPTION: It is instruction for the pharmacist. It may include instruction regarding the
flavour of the product, compounding, labeling, and quantity to be dispensed, i.e. for one week
etc.

SIGNATURA: Instruction for the patient. They may be include:

-The dose if the preparation is for internal dose.

-The time of administration.

-The method of administration and application.

-The diluents(e.g. water)

PRESCRIBERS BLOCK: It include name, address, contact number, registration number and
signature of RMP.

HANDLING OF PRESCRIPTION: Following procedure should be followed by pharmacist while

handling the prescription for compound and dispensing.

-Receiving.

-Reading & checking.

-Collecting the materials.

-Weighing the materials.

-Compounding.

-Labeling & Packaging.

 DRUGS DISPENSING

Drugs dispensing is often portrayed as merely being the process of giving a drug product to a
patient in the hospital.

Dispensing procedure

- Ensure that the prescription has the name and signature of the prescriber and the stamp of
the health centre. Ensure that the prescription is dated and has the name of the patient.
-If the prescription has not been written in a known (local health centre. the prescriber of the
centre should endorse it. Avoid dispensing without a prescription or from an unauthorized
prescriber. Check the name of the prescribed drug against that of the container. Check the
expiration date on the container.

- Calculate the total cost of the drug to be dispensed on the basis of the prescription where
applicable. Inform the patient about the cost of the drug. Issue a receipt for all payments.

Dispensing prescriptions on part-payment

Where a patient does not have enough money to pay for all the drugs as prescribed, the
dispenser is faced with a difficult situation. Consider the following scenario to resolve this
situation:

(a.) Cotrimoxazole 400/80 mg tab2 bd x 5 days

(b.) Chloroquine 150 mg tab 4 stat, then 2 tab bd x 277Either dispense

All the 20 tablets of cotrimoxazole of the 10 tablets of chloroquine as prescribed and insist that
the patient completes the dose dispensed.In case a patient is uruble to pay for all the
prescribed drugs, go to the prescriber and ask which of the two drugs should bedispensed first.
Do not dispense a few tablets of cotrimoxazole and a few tablets of chloroquineas the patient
will not come back to complete the prescription ifhe feels better.When the temporary relief
passes, the cotrimoxazole or chloroquine may not Beeffective again in that particular condition.

Guiding principles in dispensing on cash basis

Dispense drugs only on payment. Do not give free drugs to any person in the community, no
matter what theperson's social standing. Issue receipts for drugs sold.Display a price list of
drugs for transparency and accountability, and to help patients crosscheck.
 Diagnostic Report

A diagnostic report is the set of information that is typically provided by diagnostic service
when investigations are complete. The information includes a mix of atomic result, text report,
images and codes. The diagnostic report resources suitable for the following kinds of diagnostic
reports; "laboratory (clinical chemistry, hematology, microbiology etc.)
"pathology/histopathology" image investigation (x-ray CT, MRI etc.) " other diagnostics-
cardiology
 CONCLUSION

The project Hospital Training is the working in a hospital. The process takes care of
all the requirements of an average hospital and is capable to provide easy and
effective storage of information related to patients that come up to the hospital. It
generates test reports, provide prescription details including various tests, diet
advice, and medicines prescribed to patient and doctor. It also provides injection
detail and billing facility on the basis of patient's status whether it is an indoor or
outdoor patient. The system also provides the facility of backup as per the
requirement. Patients who are non-local language speakers or come from migrant
populations or ethnic minority groups often are not able to communicate
effectively with their clinicians to receive complete information about their care.
At the same time, clinical staff is often not able to understand the patients' needs
or to elicit other relevant information from the patient. Professional interpreter
services should be made available whenever necessary to ensure good
communication between non-local language speakers and clinical staff. The task
force brings together practitioners, managers, scientists and community
representatives with specific expertise and competence in policy-relevant
knowledge in the field.