UNIVERSITY OF GONDAR

College of Medicine and Health Science

School of Pharmacy
Department of Clinical Pharmacy

Report on Hospital Pharmacy Internship

Prepared by: Addisu Afrassa

ID: GUR/03307/09

Submitted to: Coordinator Eden A. (BSc, MSc.)

Submission date: March 16/2021

Table of Contents
Acknowledgment ........................................................................................................................................... i
Acronyms and abbreviation .......................................................................................................................... ii
Abstract ........................................................................................................................................................ iii
Introduction ................................................................................................................................................... 1
Inpatient pharmacy.................................................................................................................................... 2
ART Pharmacy.............................................................................................................................................. 4
OP Pharmacy ............................................................................................................................................ 5
Gynecology Pharmacy .................................................................................................................................. 7
Conclusion ................................................................................................................................................ 8

2
Acknowledgment
Thanks to the Almighty God and I would like to extend my special thanks to School of Pharmacy,
University of Gondar for giving such internship to spend on training in Hospital Pharmacy. It is
my unique honor to complete Hospital practice at University of Gondar Comprehensive
Specialized Hospital, Gondar, Ethiopia. I am very grateful towards the Pharmacy for allowing me
to complete my practice successfully.

I would like to thanks my appreciativeness to Miss. Eden A. for her great deal of support and
instruction before going to hospital pharmacy, and thanks to Miss. Abebech for her daily assistance
to gain such type of knowledge.

I would like to express my heartfelt thanks to staffs all worked in hospital pharmacy at University
of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia for such kind of collaboration
and veritable inspiration throughout the training.

i
Acronyms and abbreviation

GURH-Gondar University Referral Hospital

FEFO-First Expire First Out

FIFO- First in First Out

OP-Out Patient

ART-Anti Retroviral Therapy

ii
Abstract
It is my great pleasure to be a trainee at University of Gondar Comprehensive Specialized Hospital,
Gondar, Ethiopia. During my training, I have gained practical knowledge on drug arrangement,
storage, dispensing and proper counseling techniques. Likewise, I learnt about the checking of
expire medicines and storage of thermo labile drugs in refrigerator. In addition, I have seen
different types of medical equipment and supplies and tried to observe their uses.

I spend most of the time in dispensing drugs and also medical equipment and counseling a patient
with appropriate information and checking prescriptions that already kept inside, about their
indication and dosage forms.

On the top of all, this training helped a lot to make me feel the dire need of pharmacist in hospital
pharmacy. Thus, this training has indeed been very fruitful for me to achieve my goal to be a
competent pharmacist and to be uplift my profession.

iii
Introduction
Pharmacy is the health profession that relate the health sciences with the chemical sciences and its
task on ensuring the safe and effective use of pharmaceutical products. Hospital is a medical
treatment facility capable of providing inpatient care. It should be appropriately staffed and
equipped to provide diagnostic and therapeutic services, as well as the necessary supporting
services required to perform its assigned mission and functions.

University of Gondar is one of the largest and most distinguished higher educational institutions
in Ethiopia, located in the heart of the historic Gondar City, found at 750 kilometers away from
Addis Ababa. After many transformations, in 2004 became the University of Gondar.
Pharmaceutical services are an essential component of hospital care. It has hospital pharmacy
services for the patients. Effective pharmaceutical services promote the safe, rational and cost-
effective use of drugs thus maximizing health gain and minimizing risk to patients. A well-
organized pharmaceutical service ensures the continuous availability of all pharmaceuticals that
are required for patient care. At the same time, an effective pharmaceutical service should be able
to respond to sudden increases in drug demand, ensuring that adequate supplies are available to
deal with any emergencies that arise. The hospital has a Drug and Therapeutics Committee (DTC)
which implements measures to promote the rational and cost-effective use of medicines.

The hospital pharmacy has the following components and functions:

Medicines Formulary listing all pharmaceuticals that can be used in the facility and is
reviewed and updated annually.
Outpatient, inpatient, emergency pharmacies a central medical store each directed by a
registered pharmacist.
Ensures that all types of drug transactions and patient-medication related information are
properly recorded and documented.
Standard Operating Procedures (SOPs) for all compounding procedures carried out.
Provides access to drug information to both health care providers and patients in order to
optimize drug use.
Policies and procedures for identifying and managing drug use problems, including:
monitoring adverse drug reactions, prescription monitoring and drug utilization monitoring.
Drug procurement policy approved by the DTC that describes methods of quantification,
prioritization, drug selection, supplier selection and ordering of pharmaceutical supplies
and is in line with national guidance.
Paper-based or computer-based inventory management system to reduce the frequency of
stock-outs, wastage, over supply and drug expiry.
Conducts a physical inventory of all pharmaceuticals in the store and each dispensing unit
at a minimum once a year.
Ensures proper and safe disposal of pharmaceutical wastes and expired drugs.

1
Inpatient pharmacy
Inpatient pharmacy is an area within a hospital, and where drugs are stored and dispensed to the
patients a licensed health care provider. It provides services to the wards, clinics, and other units
in the hospital through the unit dose supply system, “top-up” medicines stock, and ready supplies
system. Inpatient pharmacies are used for the dispensing and control of medications for patients
within the hospital. The patients treated by a health system pharmacist typically have more
complicated conditions than those in an ambulatory setting and take multiple medications.

Strength:

The pharmacy is centralized, with all of the pharmacy staff and equipment located on the
lower floors.
The working condition is safe and healthy to the customer and pharmacy staff to ensure
quality of service and inspire confidence on patients in the nature of pharmaceutical service
delivered.
The national essential drug list and the GURH essential drug list were available in
pharmacy units.
The pharmacy units as documentation system as the filled prescriptions were registered,
separated and documented by days, months and years and were kept for 2 years (for
ordinary prescription) and 5 years for NPS.
Inpatient pharmacy has dispensing unit, cashier services and they are with minimized
background noise, flooding, etc.,
The floor of the room is made of cement and the wall is painted.
It has toilet with water supply for washing hands or equipment and is maintained as free of
dust and dirt.
It is accessible to patients who are in hospitals, and have a banner for its indication to locate
the pharmacy.
The pharmacy rooms and shelves are cleaned regularly and the have refrigerator equipped
with a maximum/minimum thermometer and kept dispensing equipment clean that aids in
dispensing.
The pharmacy has such as surveillance cameras for security measures to monitor entry to
the pharmacy.
The pharmacy has a dispensing bench of adequate size having a smooth, impervious
working surface and I was so impressed with it.
The pharmacy has adequate shelves and lockable cabinet.
They Placed liquid products on the lower shelves and stored in cold storage in appropriate
temperature for products that require cold storage.
They follow the FEFO and FIFO procedures to minimize wastage due to
product expiry and prevent market failure due to wastage of their business.
They arranged the drugs in pharmaco-therapeutic category and putted in well ventilated,
dry and place protected from direct sunlight and heat.

2
 Inpatient pharmacy has adequate staffs/dispensers with legal document authorized to
dispense drugs and medical supplies to customers. They dispense drugs with great
approach and give close attention to the patient safely even under stress. They dispense
drugs to patients that come with prescriptions in appropriate interpretation of the
prescriber’s instructions by using their technical knowledge required to carry out these
instructions with accuracy and safety to the patient.

Weakness:

The dispensing room area is almost 12.6 m2, which is not in the recommended range.
The pharmacy has no a private counseling room, fire extinguisher and meeting area.
Many pharmacists did not participate in ward rotation with physicians.
They have no lockable cabinets for NPS drugs.
No available chairs for patient waiting area.
No cleanliness of dispensing aids and shelves are dirty.
The pharmacy did not have adequate space for maintaining and storing records.
The pharmacy has no documentation system for pharmacy professional's intervention, as
there was no document on adverse effects and drug interactions identified by pharmacy
professionals.

Recommendations:

Recommendation for hospital:

The standard for pharmacy units in hospitals requires that the inpatient pharmacy
dispensary should have at least 16 m2 area. Accordingly, the area of inpatient pharmacy
is not in the recommended range, so it should be reconstructed to fulfill the required
standard.
The availability of private counseling room is important, since the absence of
consultation area and privacy were reported to affect pharmacist-client interaction and
resulted in poor flow of information to patient.
GURH should review their policies to create conducive conditions for pharmacist to
participate in ward rotation.

Recommendation for school of pharmacy:

The hospital attachment should have enough time to practice as two days are just for
introducing the students to the pharmacy
The school head have no a procedure for routine evaluation of the performance of the
pharmacy students and program updates is not found. I recommended him to work with
efficiently by keeping students’ autonomy.

Recommendation for staff:

3
 Pharmacy staffs should provide better advice and counseling to the clients and they need
to work with other health care providers to promote pharmaceutical care at this hospital
like in ward rotations
Pharmacy professionals should also improve their patient assessment and documentation
system.

ART Pharmacy
Strength:

The pharmacy has tablet and capsule counting devices.

They have suitable range of dispensing container for pharmaceutical products.
Each dosage form of medicine is arranged in separate and distinct areas.
Sufficient empty space is demarcated one medicine or dosage form from
another.
It is secured for the patients to refill their medication in regard to psychological impacts.
The pharmacy work is under control by the technical leadership of registered pharmacists.
ART pharmacy has data clerk and documentation.
Pharmacy conducted medication history analysis for each patient.
The pharmacists have immediate access to comprehensive medication histories for each
patient's medical record.
They follow the FEFO and FIFO procedures to minimize wastage due to product expiry
and prevent market failure due to wastage of their business.

Weakness:

The pharmacy windows are always opened and the drugs are exposed to heat by sunlight.
There are no trees around the pharmacy to help provide shade and maintain good condition.
No safe available drug counter (dispensing tablet).
Long health facility waiting times during medication pick-up or laboratory services.
No available private counseling room.
No available water supply for washing hands or washing equipment
Appropriate air conditioner is not available.
Adherence support interventions should not be provided appropriately to people on ART.
ART call basis for the patient adherence to medication is not that much enough.
The staff do not arrive on time to work place and I was so tired for waiting them.

Recommendations

Recommendation to hospital:

4
 The hospital should fulfill the dispensing room for the storage and counseling area and
reassess the infrastructures.
Two primary entrances are required, a front entrance to serve as the main reception to the
pharmacy and for medication window pick-ups.
The hospital should implement good dispensing practice systems in relation to the services
and continuing professional development to professionals in order to improve the
satisfaction of patients.

Recommendation for school of pharmacy:

The hospital attachment should have enough time to practice as two days are just for
introducing the students to the pharmacy
The school head have no a procedure for routine evaluation of the performance of the
pharmacy students and program updates is not found. I recommended him to work with
efficiently by keeping students’ autonomy.

Recommendation to the staff:

The staff should treat clients equally without regarding geography and give appropriate
information about the storage of medicines and labeling instructions that were not provided
to them.
They should have to come on time.

OP Pharmacy
The Outpatient Pharmacy is comprised of all functional areas required to receive, process, fill,
store and distribute all manners of medications to the outpatient population in either the hospital
or satellite pharmacy.

Strength:

The OP Pharmacy is in an easily accessible area that is directly adjacent to the outpatient
clinics.
There is no noise with utilization of materials (e.g., flooring, ceilings and systems furniture)
that is acoustically absorbent and readily maintainable.
The working condition of OP pharmacy is safe and healthy to the customer and pharmacy
staff to ensure quality of service.
The height of the wall is enough and the dispensing room area is almost wide.
The floor of the room is made of cement and covered with ceramics and the wall is well
painted.
It accessible to patients, and have a banner for its indication to locate the pharmacy.
The pharmacy is checked, shelves are cleaned regularly and there is routine daily cleaning
of floors and working surface by a cleaner.

5
 They have refrigerator equipped with a maximum/minimum thermometer and kept
dispensing equipment clean that aids in dispensing.
The pharmacy has a dispensing bench of adequate size having a smooth, impervious
working surface and I was so impressed with it.
They Placed liquid products on the lower shelves and stored in cold storage in appropriate
temperature for products that require cold storage.

They arranged the drugs in pharmaco-therapeutic category and putted in well ventilated,
dry and place protected from direct sunlight and heat.
They follow the FEFO and FIFO procedures to minimize wastage due to product expiry
and prevent market failure due to wastage of their business.

The pharmacists dispense drugs with great approach and give close attention to the patient
safely even under stress.

Weakness:

There is no outpatient waiting environment designed to support calm and comfortable

seating arrangements.
Private counseling room is not available.
They have no good ventilation system and no water supply in the pharmacy.
The staffs do not take medication history.
Presence of poor hygiene capsule and tablet counter that leads to cross-contamination.
Lack of attitude to communicate with patients, they exhibit tiredness even to the students
who are practicing.
The staff do not arrive on time to work place.

Recommendations
Recommendation for hospital:

They should provide sufficient patient waiting chair.

The hospital administration should employ adequate worker for keeping good hygiene.
The institution should develop a system that allows content supervision of drug and
improve conditions that may affect stability of drug and decrease risk of the patients.

Recommendation for school of pharmacy:

The hospital attachment should have enough time to practice as two days are just for
introducing the students to the pharmacy
The school head have no a procedure for routine evaluation of the performance of the
pharmacy students and program updates is not found. I recommended him to work with
efficiently by keeping students’ autonomy.

6
Recommendation to staff:

The pharmacist should work more on the communication skill during counseling because
of its important in order to draw out relevant information from the patients as well as to
convey health advice.
Pharmacist can influence the physicians to prescribe accurately to avoid confusion error
when brand name is used.
Any prescription that is not readable is better too returned rather than guessing, because of
it can lead to major drug relate problem.
Pharmacist should ask recall feedback from patient to check if they understood dispensed
information.
They should come on time and be polite to the patient plus students who are practicing.

Gynecology Pharmacy
Strength:

It accessible to patients, and have a banner for its indication to locate the pharmacy.
They do not keep foods in the refrigerators rather in outside the pharmacy out of the
dispensing area.
They follow the FEFO and FIFO procedures to minimize wastage due to product expiry
and prevent market failure due to wastage of their business.
They have refrigerator equipped with a maximum/minimum thermometer and kept
dispensing equipment clean that aids in dispensing.

Weakness:

The pharmacy has no dispensing bench, lockable cabinet and shelves to arrange drugs
appropriately.
They do not arrange the drugs in pharmaco-therapeutic category and no well-ventilated,
not protected from direct sunlight.
The Pharmacy have small rooms for storing and dispensing drugs and is exposed to
background noise, flooding, etc.,
They do not have suitable range of dispensing container for pharmaceutical products with
separate sets for internal and external use.
There are not chairs in the pharmacy and there is a bed inside the pharmacy.

7
 Recommendations

Recommendation for hospital

The pharmacy must be reestablished with separate space storage and an adequate area
for dispensing medication.
They should provide sufficient dispensing table and patient waiting chair.
Drugs in this pharmacy should be replaced with safety stock to avoid stockout.
The institution should develop a system that allows content supervision of drug and
improve conditions that may affect stability of drug and decrease risk of the patients.
The pharmacy needs appropriate window to communicate with the patient.
Private counseling room is needed.

Recommendation for school of pharmacy

The hospital attachment should have enough time to practice as two days are just for
introducing the students to the pharmacy
The school head have no a procedure for routine evaluation of the performance of the
pharmacy students and program updates is not found. I recommended him to work with
efficiently by keeping students’ autonomy.
Make sure that the student receives the appropriate education and training so that they
can be qualified and competent employers.

Recommendation for staff

Pharmacist should arrange drugs and fluids separately and appropriately.

Any prescription that is not readable is better too returned because of it can lead to
major drug relate problem.
Hygiene and sanitations are important for dispensing environment cleaners must
maintain a clean environment and that requires a regular routine of cleaning shelves
and daily cleaning of floors and working surface.

Conclusion
During my eight days internship period in Hospital Pharmacy, I came to know that the place of
pharmacist is very significant in hospital pharmacy to promote Pharmaceutical care. Throughout
my training period, I was able to gather knowledge on the system of drug storage in hospital
pharmacy, dispensing of drugs and counseling approaches. To be a trainee in University of Gondar
Comprehensive Specialized Hospital was indeed an honor for me. After all, I wish all Pharmacy
staff good luck for their improvement in better patient care; customer satisfaction, and maintaining
their good approach to the clients.