HOSPITAL TRAINING -I

A Project Report on Hospital Training-I Submitted

in partial fulfillment of requirements

For the Degree of

BACHELOR OF PHARMACY

By
Name: SANJEEV YADAV
Roll No.: 2004530500053

Supervisor
Mr. Pramod Kumar Biswal
Assistant Professor
Kunwar Haribansh Singh College of Pharmacy
Jaunpur

Principal
Dr. Anil Kumar Kharya
M.Pharm, Ph. D
Kunwar Haribansh Singh College of Pharmacy
Jaunpur

Dr. A.P.J ABDUL KALAM TECHNICAL UNIVERSITY

(Formely Uttar Pradesh Technical University)
NOVEMBER, 20222
 CERTIFICATE

This is to certify that the “Hospital Training- I” is carried out by SANJEEV YADAV
(Roll no. 2004530500053) to the Dr. A.P.J. Abdul Kalam Technical University, Lucknow
in partial fulfillment of the requirement or the award of degree of Bachelor of Pharmacy. It is
a record of candidate’s own independent bonafide work carried out by him in the academic
year, 2022-2023.

Supervisor Principal
Mr. Pramod Kumar Biswal Kunwar Haribansh Singh College of
Assistant Professor Pharmacy, Jaunpur

External Name & Signature:

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 1
 Acknowledgement
I would like to express my deepest appreciation to all those who provided me the possibility to complete
this report.
I am also thanks to Mr. Kunwar Haribansh Singh, Chairman, Mr. Ramesh Singh ,Vice Chairman, Mr.
Ajeet Singh M.D. of Kunwar Haribansh Singh College of Pharmacy, Jaunpur.
A special gratitude I give to Dr. Anil Kumar Kharya , Principal and Mr. Sanjeev Kumar Jha,
Registrar of Kunwar Haribansh Singh College of Pharmacy, Jaunpur for giving their appreciable
support in completion of this Hospital Training- I.
I am highly indebted to Mr. Pramod Kumar Biswal, M.Pharm, Associate Professor, K.H.B.S. College of
Pharmacy, Jaunpur for their guidance and constant supervision as well as for providing necessary information
regarding the report& also for their support in completing the report.

Furthermore I would also like to acknowledge with much appreciation the crucial role of the staff of Kunwar
Haribansh Singh College of Pharmacy, Jaunpur who gave the permission to use all required resources. I have
to appreciate the guidance given by other supervisor as well as the panels especially in our report presentation
that has improved our presentation skills thanks to their comment and advices.

I would like to express my special thanks of gratitude to my teachers Mr. Pramod Kumar Biswal, Dr.L. N.
Jaiswal, Mr. Firoj Alam , Mrs. Sharika Vishwakrma ,Mr. Virendra Kumar Baheliya , Mr. V.C. Saroj,
Mrs. Sadhana Singh, Mrs. Kaushikee Singh who gave me the golden opportunity to do this wonderful report
on the topic Hospital Training-I which also helped me in doing a lot of Research and I came to know about so
many new things I am really thankful to them.
Secondly I would also like to thank my parents and friends who helped me a lot in finalizing this report within
the limited time frame.
I have taken efforts in this report. However, it would not have been possible without the kind support and help of
many individuals and organizations. I would like to extend my sincere thanks to all of them.

Name: Sanjeev Yadav

B.Pharm, 3rd year (V sem)
Roll No. :-2004530500053

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 2

 INDEX

S. NO. PAGE NO.

TOPIC
1 Introduction 4
2 Function of Hospital 5
3 Classification of Hospital 5
4 Hospital Pharmacy 6
5 Objective of Hospital Pharmacy 6
6 Responsibilities of Hospital Pharmacist 7
7 Layout of Hospital 8
8 Data of Hospital Staffs 9
9 Facilities of Hospital 9
10 Out Patient Departments 10
11 Surgery 11
12 Stock & Dispending Block 12
13 Medication For In-Door Patient 13
14 Medication For Out-Door Patient 15
15 Nurses Station 16
16 Hospital Bed 17
17 First AID 17
18 Wound 19
19 Routes of Administration 23
20 Prescription 26
21 Patients Observation Charts 28
22 Simple Diagnostics 30
23 Summary 31
24 Conclusion 32
25 Reference 33

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 3

 1) INTRODUCTION

Fig. 1 COMMUNITY HEALTH CENTER MACHHALISHAHAR

COMMUNITY HEALTH CENTER MACHHALISHAHAR, JAUNPUR entity providing health care

services to people in certain area typical services covered are family practice, some clinics have expanded
greatly and can include internal medicines. The present Superintendent of hospital is Dr. VISHAL SINGH
YADAV and CMO of Jaunpur is Dr. Laxmi Singh We completed our 45 days Hospital Training 2022-23
under the supervision of Apprentice Master Mr. NIYAZ AHAMAD, Chief Pharmacist of
MACHHALISHAR.

What is Hospital

The word hospital derived from the Latin word “hospitium” which means a place where guests are received.
But today hospital is defined as an institutions of community health which is run successfully by health care
professionals such as registered medical practitioner, registered pharmacist, Nurse and other personnel’s in

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 4

 the well-established premises. Its function includes entire spectrum of medical care-prevention, diagnosis,
therapy, rehabilitation, treatment, education and research.

Function of Hospital

1. It improves the quality of care and general standard of medical services.

2. It provides medical cares such as prevention, diagnosis, therapy, rehabilitation, treatment, education
and research.
3. It lowers the incident of disease through early detection and treatment.
4. It stimulates the growth of medical science, Doctors and nurses receive their training in large
teaching hospitals.
5. It provides job opportunities for doctor, nurses & pharmacist and health personnel’s.
6. It provides teaching and training for doctor, nurses & pharmacist and health personnel’s.
7. It provides research work.
8. Large hospital co-operates with smaller hospitals, specialized hospitals co-operate with general
hospitals, private hospital co-operates with public hospitals.

Classification of Hospital

Hospitals are classified on the basis of clinical, non-clinical and medicinal system, size and cost.

1. Clinical hospital: This is also classified on the basis of diagnosis and treatments.
a) Medicine: Medicine for communicable disease and specialized medicine for psychiatric
disorder, tuberculosis, leprosy, asthma, cancer, epilepsy.
b) Surgery: Surgery performed such as cardiac surgery, kidney surgery, eye surgery, orthopedic
surgery, gynecological surgery (In case of women)
c) Maternity: This type of hospital deals with the delivery cases.
d) Pediatric: This type of hospital treating the disease of children’s including new born Childs.
2. Non-Clinical hospital: This is also classified on the basis of ownership of hospitals, which may be
of two type –
I. Public ownership: Public hospital may govern by following authority:
a) Central Government hospitals: This type of hospital runs by central government authority.
e.g. Railways Hospital, Defence Hospitals, Command Hospital Lucknow, AIIMs New Delhi
etc.
b) State Government hospital: These type hospitals are run by state government authority. e.g.
Civil Hospital Lucknow and other Civil Hospital, J.J. hospital Mumbai etc.
c) Local self-Government hospital: These types of hospital are run by municipalities or

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 5

 II. Private ownership hospital: These hospitals are run by the following organization:
a) Trusts hospitals: This type of hospital runs by trustees of the trust.
b) Religious bodies: These types of hospitals govern by the group of people belonging to
particular religion e.g. Jain hospitals and medical college, Christian Medical College and
Hospitals.
c) Limited companies: These type hospitals are governed by public limited companies, e.g.
Batra Hospital, Escart Heart Research Institute and Hospitals, New Delhi etc.
3. Medicinal system:
a) Allopathic hospitals: e.g. Ram Manohar Lohia Hospital etc.
b) Ayurvedic hospitals: e.g. Hospitals in Jammu, Triventarum.
c) Homeopathic hospitals: e.g. Nehru Homeopathic Hospital, New Delhi
d) Unani hospitals: e.g. Hamdard Dawakhana Delhi
e) Naturopathy hospitals: In Lucknow.
4. Size based hospitals: These types of hospital are classified on the basis of size or occupying
capacity of the beds.
a) Large hospitals: (Beds 1000 and above) e.g. J.J.group hospital Mumbai – 1400 beds.
b) Medium hospitals: (Beds between 500 – 1000) e.g. Bombay hospitals - 700beds.
c) Small hospitals: (Beds between 100 – 500) e.g. Beach candy hospital – 130beds.
d) Very Small hospital: (Beds less than 100)
5. On the basis of cost:
1) Elite hospitals: These are the symbols of high technology and advances in medical sciences.
They have deluxe room equipped with TV, telephone and refrigerator. Room rate may vary from
1000 to 10,000.

Hospital pharmacy

Practice of pharmacy in hospitals is known as Hospital Pharmacy.It is a department of hospital in which

procurement storage, compounding, dispensing, manufacturing, texting, packaging and distribution
of drugs.
A hospital pharmacy is controlled by professionally competent and qualified pharmacist.

Objective of Hospital Pharmacy

 To ensure the availability of right medication, at right time, in right dose at minimum possible cost.
 To professionalize the functioning of the pharmaceutical services.
 To act as counseling department for medical staff, nurse and patients.

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 6

  To act as data bank on drug utilization.

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 7

 Fig. 2 Organization of Hospital Pharmacy

Responsibilities of Hospital pharmacist:

There are various responsibilities of hospital pharmacist are given below:

 Counseling of patients.
 Communicate with prescribers.
 Dispensing of prescription.
 Ensure patients safety.
 Work with patients on general health,

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 8

  Managing of staffs.

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 9

  Educate health care provider colleagues
 Perform administrative tasks.
 Monitor drug interactions.
 Educate patients.
 Insurance and records.
 Manufacturing of proprietary medicine.

2) HOSPITAL LAYOUT

Fig. 3 Hospital layout of CHC MACHHALISHAHAR ,Jaunpur

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 10

 Data of hospital staffs

Sr. No. Staffs and there post No. of Workers

1. Chest physician 0
2. Physician 3
3. Child Care 1
4. specialist 0
5. Radiologist 0
6. Cardiac Specialist 0
7. Dermatologist 0
8. Anaesthetists 1
9. Surgeon 1
10. Ortho Surgeon 0
11. E.N.T. Surgeon 0
12. Eye Surgeon 2
13. Pathologist 1
14. Dentist 1
15. Physiotherapist 2
16. Chief Pharmacist 1
17. Pharmacist 1
18. X-Ray Technician 2
Lab Technician

Table 1: Data of hospital staffs

Facilities of hospital

 Out-Patient department
 Surgery
 Stock and dispensing room
 Nurses station
 Hospital bed

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 11

  Out-patient department

Fig. 4 Out-Patients waiting in seating area

An outpatient (or out-patient) is a patient who is hospitalized for less than 24 hours. Treatment provided in
this fashion is called ambulatory care. Sometimes surgery is performed without the need for a formal
hospital admission or an overnight stay. This is called outpatient surgery.

Outpatient surgery has many benefits, including reducing the amount of medication prescribed and using the
physician's or surgeon's time more efficiently. More procedures are now being performed in a surgeon's
office, termed office-based surgery, rather than in a hospital-based operating room.

Outpatient surgery is suited best for healthy patients undergoing minor or intermediate procedures (limited
urologic, ophthalmologic, or ear, nose, and throat procedures and procedures involving the extremities).

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 12

 Surgery

Fig. 5 Room for performing Surgery

Surgery is a technology consisting of a physical intervention on tissues, and muscle.

As a general rule, a procedure is considered surgical when it involves cutting of a patient's tissues or closure
of a previously sustained wound. Other procedures that do not necessarily fall under this rubric, such as
angioplasty or endoscopy, may be considered surgery if they involve "common" surgical procedure or
settings, such as use of a sterile environment, anesthesia, antiseptic conditions, typical surgical instruments,
and suturing or stapling. All forms of surgery are considered invasive procedures; so-called "noninvasive
surgery" usually refers to an excision that does not penetrate the structure being excised (e.g. laser ablation
of the cornea) or to a radio surgical procedure (e.g. irradiation of a tumor).

Types of surgery

Surgical procedures are commonly categorized by urgency, type of procedure, body system involved, degree
of invasiveness, and special instrumentation.

 Based on timing: Elective surgery is done to correct a non-life-threatening condition, and is carried
out at the patient's request, subject to the surgeon's and the surgical facilities availability. Emergency

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 13

 surgery is surgery which must be done promptly to save life, limb, or functional capacity. A semi-
elective surgery is one that must be done to avoid permanent disability or death, but can be
postponed for a short time.

 Based on purpose: Exploratory surgery is performed to aid or confirm a diagnosis. Therapeutic

surgery treats a previously diagnosed condition. Cosmetic surgery is done to improve the appearance
of an otherwise normal structure.
 By type of procedure: Amputation involves cutting off a body part, usually a limb or digit; castration
is also an example. Resection is the removal of all or part of an internal organ or part of the body.
Replantation involves reattaching a severed body part. Reconstructive surgery involves
reconstruction of an injured, mutilated, or deformed part of the body. Excision is the cutting out or
removal of an organ, tissue, or other body part from the patient. Transplant surgery is the
replacement of an organ or body part by insertion of another from different human (or animal) into
the patient. Removing an organ or body part from a live human or animal for use in transplant is also
a type of surgery.
 By body part: When surgery is performed on one organ system or structure, it may be classed by the
organ, organ system or tissue involved. Examples include cardiac surgery (performed on the heart),
gastrointestinal surgery (performed within the digestive tract and its accessory organs), and
orthopedic surgery (performed on bones and/or muscles).
 By degree of invasiveness of surgical procedures: Minimally-invasive surgery involves smaller outer
incision(s) to insert miniaturized instruments within a body cavity or structure, as in laparoscopic
surgery or angioplasty. By contrast, an open surgical procedure such as a laparotomy requires a large
incision to access the area of interest.

 By equipment used: Laser surgery involves use of a laser for cutting tissue instead of a scalpel or
similar surgical instruments. Microsurgery involves the use of an operating microscope for the
surgeon to see small structures. Robotic surgery makes use of a surgical robot, such as the Da Vinci
or the Zeus surgical systems, to control the instrumentation under the direction of the surgeon.

 Stock and
dispensing Stocking

The proper and efficient stocking of various material are done in a systematic way in order to easy the
dispensing of medication.

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 14

 Fig. 6 Dispensing Room

Medication for In-Door patients

Tranfusional fluids Parenteral products

Dextrose Solution Diclofenac Sodium
Ringer Lactose Solution Rantidine
Metrogel Deriphylline
P-10% Etofylline with theophylline
Mannitol Atropine sulphate
Ciproflaxine Nikethamide

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 15

 5% MgSO4
10% Dextrose Solution Dexona
Gentamycine
Perinorm
Dizapam
Avil
Paracetamal
Amikacin

Table 2 Medication for In-Door patients

Fig. 7 Inpatient Medication

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 16

 Medication for Out-Door patients

 Generally the medicines provided to the Out-Door patients are for 3 days only.
 The various medicines provided to Out-Door patients include
 Gel
 Paste
 Ointment
 Suppositories
 Capsules
 Tablets
 Parentrals
 Frequently used medication include
 Diclofenac Sodium
 Ranitidine
 Deriphylline
 Paracetamol

In-Patient

An in-patient (or in-patient), on the other hand, is "admitted" to the hospital and stays over night or for an
indeterminate time, usually several days or weeks, though in some extreme cases, such as with coma or
persistent vegetative state patients, stay in hospitals for years, sometimes until death. Treatment provided in
this fashion is called inpatient care. The admission to the hospital involves the production of an admission
note. The leaving of the hospital is officially termed discharge, and involves a corresponding discharge note.

Misdiagnosis is the leading cause of medical error in outpatient facilities. Ever since the National Institute of
Medicine’s groundbreaking 1999 report, “To Err is Human”, found up to 98,000 hospital patients die from
preventable medical errors in the U.S. each year, government and private sector efforts have focused on
inpatient safety.

While patient safety efforts have focused on inpatient hospital settings for more than a decade, medical
errors are even more likely to happen in a doctor’s office or outpatient clinic or center.

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 17

  Nurses station

Fig. 8 Nurses Station

A nurses station is an area of a health care facility (such as a hospital or nursing home), which nurses and
other health care staff sit behind when not working directly with patients and where they can perform some
of their duties.

Stored behind the table are materials for which access is limited to health care staff, such as patient files,
medicines, and certain types of equipment.

The nurse’s stations not only carry out administrative tasks, but also clinically associated functions that have
impact on the delivery of care to the patients. The key functions performed are:-
1. Secretarial work

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 18

 2. Chart processing and Management

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 19

 3. Monitoring of patients
4. Medication preparation

 Hospital bed

Fig. 9 Hospital Beds

A hospital bed or hospitalcot is a bed specially designed for hospitalized patients or others in need of some
form of health care. These beds have special features both for the comfort and well-being of the patient and
for the convenience of health care workers.

Common features include adjustable height for the entire bed, the head, and the feet, adjustable side rails,
and electronic buttons to operate both the bed and other nearby electronic devices.

Hospital beds and other similar types of beds are used not only in hospitals, but in other health care facilities
and settings, such as nursing homes, assisted living facilities, outpatient clinics, and in home health care.

While the term "hospital bed" can refer to the actual bed, the term "bed" is also used to describe the amount
of space in a health care facility, as the capacity for the number of patients at the facility is measured in
available "beds."

3) FIRST AID

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.

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 20

 It includes initial intervention in a serious condition prior to professional medical help being available, such

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 21

 as performing CPR while awaiting an ambulance, as well as the complete treatment of minor conditions,
such as applying a plaster to a cut.

First aid is generally performed by the layperson, with many people trained in providing basic levels of first
aid, and others willing to do so from acquired knowledge. Mental health first aid is an extension of the
concept of first aid to cover mental health.

There are many situations which may require first aid, and many countries have legislation, regulation, or
guidance which specifies a minimum level of first aid provision in certain circumstances.
This can include specific training or equipment to be available in the workplace (such as an automated
external defibrillator), the provision of specialist first aid cover at public gatherings, or mandatory first aid
training within schools.
First aid, however, does not necessarily require any particular equipment or prior knowledge, and can
involve improvisation with materials available at the time, often by untrained persons.

First aid can be performed on all animals, although this article relates to the care of human patients.

First aid box

It is the first emergency box available for providing medical treatment and relief the patients at the moment.
It consist of various necessary medication which are frequently used it.

First aid box contain:

 Sterilized gauze pads of different size.

 Adhesive tape

 Adhesive bandages

 Elastic bandages

 Splint

 Antiseptic wipes

 Antibiotic ointment

 Antiseptic solution

 Hydrocortisone cream

 Sharp scissor

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 22

  Safety pins

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 23

  Calamine lotion

 Thermometer

Aims Fig. 10 First

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.

Wound

A wound is a type of injury which happens relatively quickly in which skin is torn, cut, or punctured (an
open wound), or where blunt force trauma causes a contusion (a closed wound). In pathology, it specifically
refers to a sharp injury which damages the dermis of the skin.

Classification

1. Acute Wound: Acute wound is the result of tissue damaged by trauma. This may be deliberate, as in
surgical wounds of procedures, or be due to accidents caused by blunt force, projectiles, heat,

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 24

 electricity, chemicals or friction. An acute wound is by definition expected to progress through the phases
of normal healing, resulting in the closure of the wound.

2. Chronic Wound: Chronic wound fails to progress or respond to treatment over the normal expected
healing time frame (4 weeks) and becomes "stuck" in the inflammatory phase. Wound chronicity is
attributed to the presence of intrinsic and extrinsic factors including medications, poor nutrition, co-
morbidities or inappropriate dressing selection.

Type Colour Consistency Significance

Serous Clear, straw coloured Thin, watery Normal. An increase may be indicative
of infection
Haemoserous Clear, pink Thin, watery Normal

Sanguineous Red Thin, watery Trauma to blood vessels

Purulent Yellow, grey, green Thick Infection. Contains pyogenic organisms and
other inflammatory cells

Table 3: Wound Edges

Management

The overall treatment depends on the type, cause, and depth of the wound as well as whether or not other
structures beyond the skin (dermis) are involved. Treatment of recent lacerations involves examining,
cleaning, and closing the wound. Minor wounds, like bruises, will heal on their own, with skin discoloration
usually disappearing in 1–2 weeks. Abrasions, which are wounds with intact skin (non-penetration through
dermis to subcutaneous fat), usually require no active treatment except keeping the area clean, initially with
soap and water. Puncture wounds may be prone to infection depending on the depth of penetration. The
entry of puncture wound is left open to allow for bacteria or debris to be removed from inside.

Cleaning

Evidence to support the cleaning of wounds before closure is poor. For simple lacerations, cleaning can be
accomplished using a number of different solutions, including tap water and sterile saline solution. Infection
rates may be lower with the use of tap water in regions where water quality is high. Cleaning of a wound is
also known as wound toilet.

Closure

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 25

 If a person presents to a healthcare center within 6 hours of a laceration they are typically closed

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 26

 immediately after evaluating and cleaning the wound. After this point in time, however, there is a theoretical
concern of increased risks of infection if closed immediately. Thus some healthcare providers may delay
closure while others may be willing to immediately close up to 24 hours after the injury. A single study has
found that using clean non sterile gloves is equivalent to using sterile gloves during wound closure. If

closure of a wound is decided upon a number of techniques can be used. These include bandages, a
cyanoacrylate glue, staples, and sutures. Absorbable sutures have the benefit over non absorbable sutures of
not requiring removal. They are often preferred in children. Buffering the pH of lidocaine makes the
freezing less painful.

Adhesive glue and sutures have comparable cosmetic outcomes for minor lacerations <5 cm in adults and
children. The use of adhesive glue involves considerably less time for the doctor and less pain for the person
with the cut. The wound opens at a slightly higher rate but there is less redness. The risk for infections
(1.1%) is the same for both. Adhesive glue should not be used in areas of high tension or repetitive
movements, such as joints or the posterior trunk.

Dressings

In the case of clean surgical wounds, there is no evidence that the use of topical antibiotics reduces infection
rates in comparison with non-antibiotic ointment or no ointment at all. Antibiotic ointments can irritate the
skin, slow healing, and greatly increase the risk of developing contact dermatitis and antibiotic resistance.
Because of this, they should only be used when a person shows signs of infection and not as a preventative.

The effectiveness of dressings and creams containing silver to prevent infection or improve healing is not
currently supported by evidence.

Artificial respiration

Artificial respiration is the act of assisting or stimulating respiration, a metabolic process referring to the
overall exchange of gases in the body by pulmonary ventilation, external respiration, and internal
respiration. Assistance takes many forms, but generally entails providing air for a person who is not
breathing or is not making sufficient respiratory effort on his/her own (although it must be used on a patient
with a beating heart or as part of cardiopulmonary resuscitation to achieve the internal respiration). The first
method of CPR was developed in 1893.

Pulmonary action ventilation (and hence external parts of respiration) is achieved through manual
insufflation of the lungs either by the rescuer blowing into the patient's lungs, or by using a mechanical
device to do so. This method of insufflation has been proved more effective than methods which involve
mechanical manipulation of the patient's chest or arms, such as the Silvester method. It is also known as
Expired Air Resuscitation (EAR), Expired Air Ventilation (EAV), mouth-to-mouth resuscitation, rescue

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 27

 breathing or colloquially the kiss of life.

Artificial respiration is a part of most protocols for performing cardiopulmonary resuscitation (CPR) making
it an essential skill for first aid. In some situations, artificial respiration is also performed separately, for
instance in near-drowning and opiate overdoses. The performance of artificial respiration in its own is now

limited in most protocols to health professionals, whereas lay first aiders are advised to undertake full CPR
in any case where the patient is not breathing sufficiently.

Fig.11 Resuscition Process

Mechanical ventilation involves the use of a mechanical ventilator to move air in and out of the lungs when
an individual is unable to breathe on their own, for example during surgery with general anesthesia or when
an individual is in a coma.

Insufflations

Insufflation also known as 'rescue breaths' or ‘ventilations’ is the act of mechanically forcing air into a
patient's respiratory system. This can be achieved via a number of methods, which will depend on the
situation and equipment available. All methods require good airway management to perform, which ensures
that the method is effective. These methods include:

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 28

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 29
  Mouth to mouth - This involves the rescuer making a seal between his or her mouth and the patient's
mouth and 'blowing', to pass air into the patient's body
 Mouth to nose - In some instances, the rescuer may need or wish to form a seal with the patient's
nose. Typical reasons for this include maxillofacial injuries, performing the procedure in water or the
remains of vomit in the mouth

 Mouth to mouth and nose - Used on infants (usually up to around 1 year old), as this forms the most
effective seal
 Mouth to mask – Most organizations recommend the use of some sort of barrier between rescuer and
patient to reduce cross infection risk. One popular type is the 'pocket mask'. This may be able to
provide higher tidal volumes than a Bag Valve Mask.
 Bag Valve Mask (BVM) - This is a simple device manually operated by the rescuer, which involves
squeezing a bag to expel air into the patient.
 Mechanical resuscitator - An electric unit designed to breathe for the patient

4) ROUTE OF ADMINISTRATION

Fig. 12 Route of Administration

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 30

 Choice of route of administration

The options are limited by the available forms of any given drug. Still, there are advantages and
disadvantages to consider with any route of administration.

Oral

The oral route is generally the most convenient and carries the lowest cost. However, some drugs can cause
gastrointestinal tract irritation. For drugs that come in delayed release or time-release formulations, breaking
the tablets or capsules can lead to more rapid delivery of the drug than intended.

Topical

By delivering drugs almost directly to the site of action, the risk of systemic side effects is reduced.
However, skin irritation may result, and for some forms such as creams or lotions, the dosage is difficult to
control.

Sublingual

This method refers to the pharmacological route of administration by which drugs diffuse into the blood
through tissues under the tongue. Many drugs are designed for sublingual administration, including
cardiovascular drugs, steroids, barbiturates, opioid analgesics with poor gastrointestinal bioavailability,
enzymes and, increasingly, vitamins and minerals.

Inhalation

Inhaled medications can be absorbed quickly, and act both locally and systemically. Proper technique with
inhaler devices is necessary to achieve the correct dose. Some medications can have an unpleasant taste or
irritate the mouth.

Inhalation by smoking a substance is likely the most rapid way to deliver drugs to the brain, as the substance
travels directly to the brain without being diluted in the systemic circulation. The severity of dependence on
psychoactive drugs tends to increase with more rapid drug delivery.

Injection

The term injection encompasses intravenous (IV), intramuscular (IM), and subcutaneous (SC)
administration. Injections act rapidly, with onset of action in 15–30 seconds for IV, 10–20 minutes for IM,
and 15–30 minutes for SC. They also have essentially 100% bioavailability, and can be used for drugs that
are poorly absorbed or ineffective when given orally.

Some medications, such as certain antipsychotics, can be administered as long-acting intramuscular

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 31

 injections. Ongoing IV infusions can be used to deliver continuous medication or fluids.

Disadvantages of injections include potential pain or discomfort for the patient, and the requirement of
trained staff using aseptic techniques for administration.

However, in some cases patients are taught to self-inject, such as SC injection of insulin in patients with
insulin-dependent diabetes mellitus.

As the drug is delivered to the site of action extremely rapidly with IV injection, there is a risk of overdose if
the dose has been calculated incorrectly, and there is an increased risk of side effects if the drug is
administered too rapidly.

Uses

 Some routes can be used for topical as well as systemic purposes, depending on the circumstance.
For example, inhalation of asthma drugs is targeted at the airways (topical effect), whereas inhalation
of volatile anesthetics is targeted at the brain (systemic effect).

 On the other hand, identical drugs can produce different results depending on the route of
administration. For example, some drugs are not significantly absorbed into the bloodstream from
the gastrointestinal tract and their action after enteral administration is therefore different from that
after parenteral administration. This can be illustrated by the action of naloxone (Narcan), an
antagonist of opiates such as morphine.
 Naloxone counteracts opiate action in the central nervous system when given intravenously and is
therefore used in the treatment of opiate overdose. The same drug, when swallowed, acts exclusively
on the bowels; it is here used to treat constipation under opiate pain therapy and does not affect the
pain-reducing effect of the opiate.
 Enteral routes are generally the most convenient for the patient, as no punctures or sterile procedures
are necessary. Enteral medications are therefore often preferred in the treatment of chronic disease.
However, some drugs cannot be used enterally because their absorption in the digestive tract is low
or unpredictable. Transdermal administration is a comfortable alternative; there are, however, only a
few drug preparations that is suitable for transdermal administration.
 In acute situations, in emergency medicine and intensive care medicine, drugs are most often given
intravenously. This is the most reliable route, as in acutely ill patients the absorption of substances
from the tissues and from the digestive tract can often be unpredictable due to altered blood flow or
bowel motility.

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 32

 5) PRESCRIPTION
The word "prescription", from "pre-" ("before") and "script" ("writing,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 ℞. 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, "Vitellumunum,—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 a Prescription
A prescription should consist of the following seven parts:
a) Patients information block
b) Date of the Prescription
c) Superscription(Rx)
d) Inscription
e) Subscription
f) Signatura
g) Prescriber's block
a) Patients Information Block
In this part of prescription patient’s complete name, sex and address should be written to avoid medication
error and to take follow up.
b) Date of The Prescription

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 33

 This is necessary for the prevention of misuse of prescription, especially the once contain narcotics

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 34

 c) 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”.

d) Inscription

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

 Name of ingredients.
 Dosage form.
 Strength and quantities of the medicament.
e) 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.
f) Signatura
Instruction for the patient. They may be include:
i) The dose if the preparation is for internal dose.
ii) The time of administration.
iii) The method of administrations and application
iv) Thediluents (e.g. water)
g) Prescribers Block
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

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 35

 Fig. 13 Prescription

6) PATIENT OBSERVATION CHARTS

Monitoring and documenting physiological observations is a key component of recognition and response
systems. An observation and response chart is a document that allows the recording of patient observations,
and specifies the actions to be taken in response to deterioration from the norm. The purpose of these charts

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 36

 is to support accurate and timely recognition of clinical deterioration, and prompt action when deterioration
is observed.

Observation and response charts should:

 be designed according to human factors principles
 have the capacity to record the core physiological observations specified in Element 1-6 of the
National Consensus Statement (respiratory rate, oxygen saturation, heart rate, blood pressure,
temperature and level of consciousness)
 Specify the physiological parameters and other factors that trigger an escalation of care.

Fig: 14: Patient observation chart

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 37

 7) SIMPLE DIAGNOSTIC REPORT: Collection of the diagnostic data is the Hospital Statistics
Regulation ("Krankenhausstatistik-Verordnung" - KHStatV) always in the current version of the reporting
year.
It applies in connection with the Federal Statistics Law ("Bundesstatistikgesetz (BStatG)"). Basis for the
collection of diagnostic data are the details of § 3 No. 14 KHStatV.
The obligation to give information arises from § 6 KHStatV in connection with § 15 BStatG. The results of
the diagnosis statistics are compiled annually and published in the subject-matter series ("Fachserie")
Hospital statistics - diagnostic data of the hospital patients.

Fig. 15: Sample diagnostic report

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 38

 7) SUMMARY

Hospital training- I (2022-23) was done from Community Health Center Machhalishahar Jaunpur
under the supervision of apprentice master Mr. Niyaz Ahamad training was commenced from
20/08/2022 up to date 08 /10/2022 that is for period of 45 days.

In that period I did various things which was in our course curriculum and which is of immense important as
per pharmacy point of view.

Mine training included First aid which include wound dressing, artificial respiration and other first aid
measures, different routes of injections ( Intramuscular, Intravenous, Intradermal, Subcutaneous, etc. )
study of patient observation chart, prescription handling and dispensing, simple diagnostic report ,patient
counseling. Of all the things prescription handling and dispensing was of prime concern and I spent a major
period of time in dispensing department.

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 39

 8) CONCLUSION

There is great importance of Hospital Training in today’s society. As the life style of people is getting more
dependent on machines and technology people are getting more prone and susceptible to various diseases
and at that time health care professionals such as doctor, pharmacist, nurses, etc. come into action in the
diagnosis, treatment, cure of diseases.

In Hospital Training I learnt about first aid include various things such as wound dressing, artificial
respiration, blood pressure measurement, etc. The first aid treatment varies according to the type of injury
like burn, shock, bone fracture, wound, etc.

There I got training of administration of injections via various routes and precautions that must be taken
while administration of injection. The another most important part is patient counseling in this pharmacist
interacts with patient and exchange of words take place in the betterment of health of patient.

Prescription handling and dispensing is the main role of pharmacist in health society. Our major field in
Hospital Training was this only and for that purpose I spent two weeks under the supervision of Mr. Niyaz
Ahamad.

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 40

 9) REFERENCES
1. Patil D.J, ‘‘A text book of Hospital and Clinical Pharmacy’’, 2nd edition 2008, Published by
NiraliPrakashan.
2. Yadav A.V, Yadav B.A, ‘‘A text book of Hospital and Clinical Pharmacy’’, Published by
NiraliPrakashan.
3. Paradkar A.R, Chunawala S.A, ‘‘A text book of Hospital and Clinical Pharmacy’’, 21st edition 2005,
Published by NiraliPrakashan.
4. Jain N.K, Gupta G.D, ‘‘Modern Dispensing and Hospital Pharmacy’’, 2nd reprint 2012, Published by
Pharmamed Press.
5. PratibhaNand, Roop K.K, ‘‘A text book of Hospital and Clinical Pharmacy’’, 15th edition 2014-15,
Published by Birla Publication Private Limited.
6. Tripathi, K.D. ‘Essential of Medical pharmacology’ 6th edition 2003, jaypee brother’s medical
publishers (p) ltd, page no. 03-10.
7. http://www.merckmanuals.com/home/drugs/administration-and-kinetics-ofdrugs/drug-administration
8. Nand P, Khar RK, (2005), “A Text book of Hospital and Clinical Pharmacy”, 15th edition, Volume I,
Published by Birla Publication (P) Ltd., Page- 11-19, 24-34.
9. https://en.wikipedia.org/wiki/intractive_patient_care

KUNWAR HARIBASH SINGH COLLEGE OF PHARMACY 41