HOSPITAL TRAINING REPORT II (BP707P)

Submitted for partial fulfilment of award of

The Degree of

BACHELOR OF PHARMACY

By

Nitish Goel
(Roll No. - 1910340500031)

B. PHARM.
Fourth Year
Seventh Semester

Session: 2022-23

DEPARTMENT OF PHARMACY
MEERUT INSTITUTE OF TECHNOLOGY
MEERUT
 CERTIFICATE OF TRAINING COMPLETION

This is to certify that Mr. Nitish Goel, student of

B. Pharm. Fourth Year (Seventh Semester) has completed Hospital Training II, as
prescribed by Dr. A.P.J. Abdul Kalam Technical University (Dr. AKTU) as a part of the
curriculum in Evaluation Scheme and Syllabus Guidelines and Pharmacy Council of
India (PCI).

Prof. (Dr.) Neeraj Kant Sharma

Principal
Department of Pharmacy
Meerut Institute of Technology (MIT)
Meerut, Uttar Pradesh, India
 DECLARATION

I certify that the contents in the training report has been compiled and
completed by myself. I have followed the guidelines provided by the Institute in
writing the report. I have conformed to the norms and guidelines as recommended by
the Institute.

Mr. Nitish Goel

Roll No.: 1910340500031

B.Pharm . IVth Year (VIIth Semester)
MIT, Meerut
 CONTENTS
Page
Certificate of Training Completion I
Hospital Training Certificate Ii
Declaration Iii
Acknowledgment Iv

1. OBJECTIVES OF HOSPITAL TRAINING 1

2. ABOUT THE HOSPITAL 2
3. INTRODUCTION 3-4
4. FIRST AID, MEDICATION AND 5-15
ARTIFICIAL RESPIRATION
5. HANDLING OF PRESCRIPTION 15-19
6. DISPENSING 20-21
7. STUDY OF PATIENT OBSERVATIONAND 22
RESPONSE CHART
8. SIMPLE DIGNOSTIC REPORT 23
9. ROUTES OF INJECTION 24-28
10. CONCLUSION 29
 OBJECTIVES OF HOSPITAL TRAINING

 Hospital training is an observational oriented procedure in which a

person is able to learn practically from their theoretically knowledge.
 Hospital training helps to study closely the ground level problems
regarding their job profile.
 Hospital training provides practical knowledge to the students.
 Hospital training promotes an environment in which student are
induced to adapt themselves quickly to changed circumstances.
 Hospital training puts the students in real life situations.
 Hospital training removes the hesitation of the students regarding their
working skills and personality development.

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 SIROHI HOSPITAL AND MATERNITY CENTRE

Sirohi Hospital is a recognized name in patient care. They are one of the well- known
Hospital in Meerut. A hospital devoted to excellence in health care. Backed with a
vision to offer the best in patient care and equipped with technologically advanced
healthcare facilities, they are one of the upcoming names in the healthcare industry.
This hospital is easily accessible by various means of transport. A team of well-trained
medical staff, non-medical staff and experienced clinical technicians work round-the-
clock to offer various services that include OPD Services from 09:00 AM to
12:00PM and 6.00 PM to 8.00 PM and 24 hours Ambulance Services also. Their
professional services make them a sought Hospital in Meerut. A team of doctors on
board, including specialists are equipped with the knowledge and expertise for
handling various types of medical cases.

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 INTRODUCTION

A Hospital is a health-care institution providing patient treatment with specialized

medical and nursing staff and medical equipment. The best-known type of hospital is
the General hospital, which typically has an emergency department to treat urgent
health problems ranging from fire and accident victims to a heart attack. A district
hospital typically is the major health care facility in its region, with a large number of
beds for intensive care and additional beds for patients who need long-term care.
Specialized hospitals include trauma centers, rehabilitation hospitals, children's
hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical
needs such as psychiatric treatment (see psychiatric hospital) and certain disease
categories. Specialized hospitals can help reduce health care costs compared to
general hospitals. Hospitals are classified as general, specialty, or government
depending on the sources of income received.

A teaching hospital combines assistance to people with teaching to medical students

and nurses.

A medical facility smaller than a hospital is generally called a clinic. Hospitals have a
range of departments (e.g. surgery and urgent care) and specialist units such as
cardiology. Some hospitals have outpatient departments and some have chronic
treatment units. Common support units include a pharmacy, pathology, and radiology.

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Hospitals are usually funded by the public sector, health organizations (for profit or
nonprofit), health insurance companies, or charities, including direct charitable
donations. Historically, hospitals were often founded and funded by religious orders,
or by charitable individuals and leaders.

Currently, hospitals are largely staffed by professional physicians, surgeons, nurses,

and allied health practitioners, whereas in the past, this work was usually performed
by the members of founding religious orders or by volunteers. However, there are
various Catholic religious orders, such as the Alexians and the Bon Secours Sisters
that still focus on hospital ministry in the late 1990s, as well as several other Christian
denominations, including the Methodists and Lutherans, which run hospitals. [4] In
accordance with the original meaning of the word, hospitals were originally "places of
hospitality", and this meaning is still preserved in the names of some institutions such
as the Royal Hospital Chelsea, established in 1681 as a retirement and nursing home
for veteran soldiers. Some of the Training parts are as Follows:-

 FIRST AID (wound dressing, artificial respiration)

 HANDLING OF PRESCRIPTION
 DISPENSING
 STUDY OF PATIENT OBSERVATION CHART
 SIMPLE DIGNOSTIC
 DIFFERENT ROUTES OF INJECTION

HOSPITAL TRAINING Page 4

 FIRST AID
First aid is basic knowledge about how to help people who are suddenly sick
(illnesses) or hurt (injuries or body damage). For example, first aid is used at
accidents to help an injured person until he receives medical treatment (help by
doctors, nurses or ambulances). First aid is also used to help people who suddenly
become sick, until help arrives or they can be taken to medical care. A person does
not need a lot of equipment to give first aid. A package of things useful to give first
aid is called a first aid kit. Lives can be savd even without a first aid kit. First aid can
be done just about anywhere. In places far from hospitals, first aid may be the only
help possible until the person can be taken to a hospital or clinic. Emergency medical
dispatchers are trained in first aid, so that if there is an emergency, they can give the
caller some information on what to do until the ambulance arrives. This can include
the "CAB" listed below.

Goals of first aid

First aid skills are kept simple on purpose so that people can remember and use them
in an emergency to save at least one life. One set of goals of first aid is called the
"Three P's":
Preserve life – stop the person from dying
Prevent further injury – stop the person from being injured even more. If possible,
an injured person should not be moved. First aid can include how to safely move
injured people or move them anyway with less harm if there is no choice.
Promote recovery – try to help the person heal his injuries Another set of goals for
keeping a badly hurt person alive is sometimes called “CAB”

First aid kit

A first aid kit is a collection of supplies and equipment for use in giving first aid, and
can be put together for the purpose by an individual or organization or purchased
complete. There is a wide variation in the contents of first aid kits based on the
knowledge and experience of those putting it together, the differing first aid
requirements of the area where it may be used and variations in legislation or
regulation in a given area. The international standard for first aid kits is that they
should be identified with the ISO graphical symbol for first aid (from ISO 7010)
which is an equal white cross on a green background, although many kits do not

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comply with this standard, either because they are put together by an individual or
they predate the standards.

Format
First aid kits can be assembled in almost any type of container, and this will depend
on whether they are commercially produced or assembled by an individual. Standard
kits often come in durable plastic boxes, fabric pouches or in wall mounted cabinets.
The type of container will vary depending on purpose, and they range in size from
wallet sized through to large rucksacks.
It is recommended that all kits are in a clean, waterproof container to keep the
contents safe and aseptic.
Kits should also be checked regularly and restocked if any items are damaged or are
expired out of date.

Contents
Commercially available first aid kits available via normal retail routes have
traditionally been intended for treatment of minor injuries only. Typical contents
include adhesive bandages, regular strength pain medication, gauze and low grade
disinfectant. Specialized first aid kits are available for various regions, vehicles or
activities, which may focus on specific risks or concerns related to the activity. For
example, first aid kits sold through marine supply stores for use in watercraft may
contain seasickness remedies

The common kits mostly found in the homes may contain:

Alcohol, Band-aids,
Cotton Balls, Cotton Swabs,
Iodine, Bandage,
Hydrogen Peroxide Stethoscope
Sphygmomanometer (blood pressure cuff),Thermometer

Medication
Medication can be a controversial addition to a first aid kit, especially if it is for use
on members of the public. It is, however, common for personal or family first aid kits
to contain certain medications. Dependent on scope of practice, the main types of
medicine are life saving medications, which may be commonly found in first aid kits

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used by paid or assigned first aiders for members of the public or employees,
painkillers, which are often found in personal kits, but may also be found in public
provision and lastly symptomatic relief medicines, which are generally only found in
personal kits.
Aspirin primarily used for central medical chest pain as an anti-platelet.
Paracetamol (also known as Acetaminophen) is one of the most common pain killing
medication
Ibuprofen, Naproxen or other NSAIDs can be used as part of
treating sprains ,strains, and painkillers.
Codeine which is both a painkiller and anti-diarrheal Symptomatic relief.
Loperamide especially Anti-diarrhoea medication.
Hydrogen peroxide is often included in home first aid kits, but is a poor choice for
disinfecting wounds it kills cells and delays healing.
Alcohol pads sometimes included for disinfecting instruments or unbroken skin.
Burn gel A water based gel that acts as a cooling agent and often includes a mild
anaesthetic such as lidocaine and, sometimes, an antiseptic such as tea tree oil.
Calamine lotion for skin inflammations.
Avil,dexona is use for Medicine Reaction.

Fig- First Aid Kit

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 Wound Dressing
Cleaning the Wound
1) Know when the wound needs immediate medical attention:- Although most
minor wounds can be bandaged with a Band-Aid and most moderate skin wounds
with dressings and medical tape, some are too serious for home care. For example,
skin wounds that also involve seriously broken bones need immediate medical
attention, as do major injuries to blood vessels that won't stop gushing blood.[1]
Wounds to the arms and legs that cause numbness or loss of sensation below the
injury may indicate nerve damage, which is also an indication to seek medical car

2) Control the bleeding:- Before you clean and bandage a wound, try to get any
bleeding under control. Using a clean, dry bandage (or any clean absorbent cloth),
apply very gentle pressure over the wound to control the bleeding. In most cases, the
pressure on the wound will promote blood clotting and the bleeding should stop
within 20 minutes, although it may continue to ooze a little for up to 45 minutes. The
bandage or cloth will also help prevent bacteria from entering the wound and causing
infection. In severe cases, a tourniquet can be made by using a neck tie or long piece
of cloth to tie a tight knot just above the wound.

If significant bleeding continues even after you apply pressure for 15-20
minutes, the wound may need immediate medical attention. Continue applying
pressure and get to a doctor's office, emergency room, or urgent care center.

3) Remove any visible debris:- If there are large pieces of dirt, glass, or other objects
embedded in the wound, try to remove them with a clean set of tweezers. Rinsing the
tweezers in rubbing alcohol first will help to prevent the transfer of bacteria and other
microbes.

4) Remove or cut clothing away from the wound:-To get better access to the wound
once the bleeding is under control, remove any clothing and jewelry from the general
area of the injury. This should be done so that if the wounded area swells, the tight
clothing or jewelry won't affect blood flow.

For example, if you're dealing with a bleeding hand wound, remove the wrist watch
above the wound. In terms of clothing, if you can't remove it from around the wound,
then consider cutting it away with blunt-nosed safety scissors (ideally). For example,

HOSPITAL TRAINING Page 8

if you're dealing with a thigh injury, remove the pants or cut them away from the
wound before trying to clean and bandage it.

5 Rinse the wound thoroughly: - In the best case scenario, wash out the wound
thoroughly with saline solution for at least a few minutes until it looks free of dirt and
debris. Saline solution is ideal because it decreases the bacterial load by rinsing it
away and is typically sterile when bought packaged.
If you don't have access to saline solution, then use clean drinking water or tap water,
but make sure you let it run over the wound for a few minutes. Squeezing it out of a
water bottle works well for this, or hold the wound under the tap if possible.
Don't use hot water; Instead use lukewarm or cool water.

6) Clean the wound with a washcloth or other soft cloth:-Using very gentle
pressure, pat the wound with a clean cloth to make sure that it is completely clean
after you've flushed it out with saline solution or regular running water. Do not push
too hard or scrub too vigorously, but make sure you’ve removed any remaining
debris. Keep in mind that gentle scrubbing may cause a bit more bleeding to occur, so
reapply pressure to the wound after the cleaning.

Apply an antibacterial cream to the wound at this stage prior to bandaging, if

available. Antibacterial creams or ointments.

Bandaging the Wound

1) Find an appropriate bandage:-Pick out a sanitized (still in its wrapper) and

appropriately sized bandage for the wound. If it's a smaller cut, then a bandage with
self adhesive (such as a Band-Aid) is likely best for the job. However, if it's a larger
cut not appropriate for a Band-Aid, the you'll need to use a larger piece of dressing.
You may have to fold or cut the dressing so it just covers the wound.

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Be careful not to touch the underside of the dressing (the side that will lay against the
wound) in order to reduce the risk of infection.

If you don't have an adhesive bandage and plan on taping the dressing in place, leave
a little extra material on the edges so the tape doesn't stick
directly to the wound.

If you don’t have actual dressings and bandages available, you can improvise using
any clean cloth or piece of clothing.

2) Secure the dressing and cover it: - Use non stretch, water resistant medical tape
to attach the dressing to the skin on all sides. Make sure the tape contacts healthy,
uninjured skin.
Avoid using industrial tape like duct tape or electrician's tape, which may tear the skin
when you remove it.
Once the dressing is taped over the wound, completely cover the dressing with a clean
elastic wrap or stretchy bandage for further protection. Make sure that you don't wrap
the bandage too tightly and cut off circulation to the wound or any part of the
wounded person's body.

3) Change the dressing daily:- Replacing the old dressing with a fresh one each day
keeps the wound clean and promotes healing. If the outer elastic wrap bandage
remains clean and dry, then you can reuse it.

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.

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The first method of CPR was developed in 1893.Expired Air Ventilation(EAV), mout
h•to•mouth resuscitation, rescue 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 firstaid.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.

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.

Insufflation
Also known as 'rescue breaths' or 'ventilations', is the act of mechanically forcing air i
nto 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: -

Mouth to Mouth Resuscitation

1) Stretch out victim on his back and kneel close to his side. Loosen any tight clothing
around his neck or chest.
2) Remove foreign objects if present from victim's mouth and throat by finger
sweeping. If the patient seems to have water or mucus in his throat or chest, tilt him
upside down or on his side to permit such fluid to run out the mouth.

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3) Lift up chin and tilt head back as far as possible. If the head is not tilted, the tongue
may block the throat. The tilting procedure should provide an open airway by moving
the tongue away from the back of the throat. (Sometimes the victim will resume
breathing as soon as this has been done.)

4) Begin the resuscitation immediately. Pinch the nostrils together with the thumb and
index finger of the hand that is pressing on the victim's forehead. This prevents the
loss of air through the nose during resuscitation.
5) Inhale deeply.
6) Place your mouth tightly around the victim's mouth (over mouth and nose of small
children) and blow into the air passage. Volume is important deep breaths should be
used for adults; less for children; for infants, gentle puffs (emptying the cheeks)
should be sufficient. You should start at a high rate and then provide at least one
breath every 5 seconds for adults and every 3 seconds for small children. Continue
this maneuver so long as there is any pulse or heartbeat.

7. Watch the victim's chest. When you see it rise, stop blowing, raise your mouth, turn
your head to the side and listen for exhalation

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8. If patient is revived, keep him warm and do not move him until
the doctor arrives, or at least for one half hour.

Mouth to Nose Method

1) Maintain the backward head tilt position (as with the mouth to mouth
method) with the hand on the forehead. Use the other hand to close the mouth.
(Sometimes the victim's jaw is clenched shut as often happens in the case of
drowning.
2) Open your mouth widely, take a deep breath, seal your mouth tightly around the
victim's nose and blow into the victim's nose.
3) On the exhalation phase, open the victim's mouth (if possible) to allow air escape.

When administering mouth to nose ventilation to small children or infants, do not

make the backward head tilt as extensive as that for adults or large children.

The objective of these procedures is to obtain a rise and fall of the chest. If this is not
occurring, something is wrong. The first aider must quickly reassess the situation.
Check again for foreign matter in the mouth or throat; establish and maintain an open
airway; and continue the blowing efforts until the victim breathes on his own or a
physician pronounces him dead.

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If the victim's stomach is bulging, air may have been blown into the stomach. This
can happen when the air passage is obstructed or the inflation pressure is excessive.
Although this is not a dangerous condition, it may make lung ventilation more
difficult and increase the likelihood of vomiting.

Chest pressure arm lift (Silvestre) Method:-

Expose chest and find breast bone. Put the heal of one hand on breast bone and other
hand on top.
Compress the chest 15 minutes.

Back pressure arm lift (Holger-Nielsen) Method:-

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 HANDLING OF PRESCRIPTION

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.

Prescriptions may be entered into an electronic medical record system and transmitted
electronically to a pharmacy. Alternatively, a prescription may be handwritten on
preprinted prescription forms that have been assembled into pads, or printed onto
similar forms using acomputer printer. In some cases, a prescription may be
transmitted from the physician to the pharmacist orally by telephone; this practice
may increase the risk of medical error. The content of a prescription includes the
name and address of the prescribing provider and any other legal requirement such as
a registration number (e.g. DEA Number in the United States). Unique for each
prescription is the name of the patient. Each prescription is dated and some
jurisdictions may place a time limit on the prescription. In the past, prescriptions
contained instructions for the pharmacist to use for compounding the pharmaceutical
product but most prescriptions now specify pharmaceutical products that were
manufactured and require little or no preparation by the pharmacist. Prescriptions also
contain directions for the patient to follow when taking the drug. These directions are
printed on the label of the pharmaceutical product.

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

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compound drug can be prepared. Those within the industry will often call
prescriptions simply "scripts".

'℞' is a symbol meaning "prescription". It is sometimes transliterated as "Rx" or just

"Rx". This symbol originated in medieval manuscripts as an abbreviation of the Late
Latin verb recipe, the imperative form of recipe, "to take" or "take thus". Literally, the
Latin word recipe means simply "Take...!" and medieval prescriptions invariably
began with the command to "take" certain materials and compound them in specified
ways.

Contents
In some countries, drug companies use direct-to-prescriber advertising in an effort to
convince prescribers to dispense as written with brand-name products rather than
generic drugs. Many brand name drugs have cheaper generic drug substitutes that are
therapeutically and biochemically equivalent. Prescriptions will also contain
instructions on whether the prescriber will allow the pharmacist to substitute a generic
version of the drug. This instruction is communicated in a number of ways. In some
jurisdictions, the preprinted prescription contains two signature lines: one line has
"dispense as written" printed underneath; the other line has "substitution permitted"
underneath. Some have a preprinted box "dispense as written" for the prescriber to
check off (but this is easily checked off by anyone with access to the prescription).
Other jurisdictions the protocol is for the prescriber to handwrite one of the following
phrases: "dispense as written", "DAW", "brand necessary", "do not substitute", "no
substitution", "medically necessary", "do not interchange". In other jurisdictions they
may use completely.

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Different languages, never mind a different formula of words. In some jurisdictions, it
may be a legal requirement to include the age of child on the prescription. For
pediatric prescriptions some advice the inclusion of the age of the child if the patient
is less than twelve and the age and months if less than five. (In general, including the
age on the prescription is helpful.) Adding the weight of the child is also helpful.
Prescriptions often have a "label" box. When checked, the pharmacist is instructed to
label the medication. When not checked, the patient only receives instructions for
taking the medication and no information about the prescription itself. Some
prescribers further inform the patient and pharmacist by providing the indication for
the medication; i.e. what is being treated. This assists the pharmacist in checking for
errors as many common medications can be used for multiple medical conditions.
Some prescriptions will specify whether and how many "repeats" or "refills" are
allowed; that is whether the patient may obtain more of the same medication without
getting a new prescription from the medical practitioner. Regulations may restrict
some types of drugs from being refilled. In group practices, the preprinted portion of
the prescription may contain multiple prescribers' names. Prescribers typically circle
themselves to indicate who is prescribing or there may be a checkbox next to their
name.

Who can write prescriptions (that may legally be filled with prescription-only
items)?
National or local (i.e. state or provincial) legislation governs who can write a
prescription. In the United States, physicians (either M.D., D.O., or D.P.M) have the
broadest prescriptive authority. All 50 states and the District of Columbia allow
licensed certified Physician Associates (PAs) prescription authority (with some states,
limitations exist to controlled substances). All 50 states allow registered certified
nurse practitioners and other advanced practice registered nurses (such as certified
nurse-midwives) prescription power (with some states including limitations to
controlled substances). Many other healthcare professions also have prescriptive
authority related to their area of practice. Veterinarians and dentists have prescribing
power in all 50 states and the District of Columbia. Clinical pharmacists are allowed
to prescribe in some states through the use of a drug formulary or collaboration
agreements. Florida pharmacists can write prescriptions for a limited set of drugs. In
all states, optometrists prescribe medications to treat certain eye diseases, and also

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issue spectacle and contact lens prescriptions for corrective eyewear. Several states
have passed RxP legislation, allowing clinical psychologists (PhDs or PsyDs) who are
registered as medical psychologists and have also undergone specialized training in
script-writing to prescribe drugs to treat emotional and mental disorders.
Chiropractors may have the ability to write a prescription, depending on scope of
practice laws in a jurisdiction.

LEGIBILITY
Prescriptions, when handwritten, are notorious for being often illegible. In the US,
illegible handwriting is at least indirectly responsible for the deaths of 7,000 people
annually, according to a July 2006 report from the National Academies of Science's
Institute of Medicine (IOM).Historically, physicians used Latin words and
abbreviations to convey the entire prescription to the pharmacist. Today, many of the
abbreviations are still widely used and must be understood to interpret prescriptions.
At other times, even though some of the individual letters are illegible, the position of
the legible letters and length of the word is sufficient to distinguish.

The medication based on the knowledge of the pharmacist. When in doubt,

pharmacists call the medical practitioner. Some jurisdictions have legislated legible
prescriptions (e.g. Florida). Some have advocated the elimination of handwritten
prescriptions altogether and computer printed prescriptions are becoming increasingly
common in some places.

Conventions for avoiding ambiguity

Over the years, prescribers have developed many conventions for prescription-
writing, with the goal of avoiding ambiguities or misinterpretation.
These include:
 Careful use of decimal points to avoid ambiguity:
 Avoiding unnecessary decimal points: a prescription will be written as 5 mL instead
of 5.0 mL to avoid possible misinterpretation of 5.0 as 50.
 Always using zero prefix decimals: e.g. 0.5 instead of .5 to avoid misinterpretation
of .5 as 5.
 Avoiding trailing zeros on decimals: e.g. 0.5 instead of .50 or 0.50 to avoid
misinterpretation of .50 as 50.

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 "mL" is used instead of "cc" or "cm³" even though they are technically equivalent to
avoid misinterpretation of 'c' as '0' or the common medical abbreviation for "with"
(the Latin "cum"), which is written as a 'c' with a bar above the letter. Further, cc
could be misinterpreted as "c.c.", which is a rarely used abbreviation for "take with
meals" (the Latin "cum ciao")
 Directions written out in full in English (although some common Latin
abbreviations are listed below).
 Quantities given directly or implied by the frequency and duration of the directions.
 Where the directions are "as needed", the quantity should always be specified.
 Where possible, usage directions should specify times (7 am, 3 pm, 11 pm) rather
than simply frequency (three times a day) and especially relationship to meals for
orally consumed medication.
 The use of permanent ink.
 Avoiding units such as "teaspoons" or "tablespoons."
 Writing out numbers as words and numerals ("dispense #30 (thirty)") as in a bank
draft or cheque.
 The use of the degree symbol (°), which is commonly used as an abbreviation for
hours (e.g., "q 2-4°" for every 2 – 4 hours), should not be used, since it can be
confused with a '0'. Further, the use of the degree symbol for primary, secondary, and
tertiary (1°, 2°, and 3°) is discouraged, since the former could be confused with
quantities (i.e. 10, 20 and 30, respectively).
 The use of apothecary/avoirdupois units and symbols of measure -- pints (O),
ounces (℥), drams (ℨ), scruples (℈), grains (gr), and minims (♏) -- is discouraged
given the potential for confusion. For example, the abbreviation for a grain ("gr") can
be confused with the gram, abbreviated g, and the symbol for minims (♏), which
looks almost identical to an 'm', can be confused with micrograms or meters. Also, the
symbols for ounce (℥) and dram (ℨ) can easily be confused with the numeral '3', and
the symbol for pint (O) can be easily read as a '0'. Given the potential for errors,
metric equivalents should always be used.

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 DISPENSING
Remote dispensing is used in health care environments to describe the use of
automated systems to dispense (package and label) prescription medications without
an on-site pharmacist. This practice is most common in long-term care facilities and
correctional institutions that do not find it practical to operate a full-service in-house
pharmacy.[citation needed] Remote dispensing can also be used to describe the
pharmacist controlled remote prescription dispensing units which connect patients to a
remotely located pharmacist over video interface to receive counseling and
medication dispensing. Because these units are pharmacist controlled, the units can be
located outside of typical healthcare settings such as employer sites, universities and
remote locations, thus offering pharmacy services where they have previously never
existed before.

A typical remote-dispensing system

A typical remote-dispensing system is monitored remotely by a central pharmacy and
includes secure, automated medication dispensing hardware that is capable of
producing patient-specific packages of medications on demand. The secure
medication dispensing unit is placed on-site at the care facility or non-healthcare
locations (such as Universities, workplaces and retail locations) and filled with
pharmacist-checked medication canisters. [Citation needed] When patient medications
are needed, the orders are submitted to a pharmacist at the central pharmacy, the
pharmacist reviews the orders and, when approved, the medications are subsequently
dispensed from the on-site dispensing unit at the remote care facility. Medications
come out of the dispensing machine printed with the patient‘s name, medication
name, and other relevant information. If the medication stock in a canister is low, the
central pharmacy is alerted to fill a canister from their bulk stock. New canisters are
filled, checked by the pharmacist, security sealed, and delivered to the remote care
facility.

Perceived Advantages
In theory, access to dispensing services 24 hours a day in locations previously unable
to support full pharmacy operations. Advocates for remote dispensing additionally
claim that the service provides focused, uninterrupted and personalized time with a

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pharmacist as the system manages the physical dispensing process while the
pharmacist simply oversees it. Certain prescription dispensing units can carry over
2000 different medications [citation needed] tailored to the prescribing habits of local
healthcare providers? Furthermore, remote dispensing terminal manufacturers state
that this technology can facilitate patient continuity of care between prescriber and
pharmacist. [Citation needed]

Disadvantages
While some may purport that travel time to pharmacies is reduced, this point has
been negated by an Ontarian study published in the journal Healthcare Policy as over
90% of Ontarians live within a 5 km radius of a pharmacy. [1] Remote dispensing
also places a physical barrier between the patient and pharmacist, limiting the
pharmacist's ability to detect a patient's nonverbal cues. A patient with alcohol on his
or her breath would go undetected via remote dispensing, increasing the risk for
dangerous interactions with drugs such as tranquilizers, sleeping pills, narcotics, and
Warfarin to name a few. This problem may be amplified through telecommunication
service disruptions, which were reported in previous studies examining the utility of
remote dispensing technology

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STUDY OF PATIENT OBSERVATION AND RESPONSE CHART
In medicine, monitoring is the observation of a disease, condition or one or several
medical parameters over time. It can be performed by continuously measuring certain
parameters by using a medical monitor (for example, by continuously measuring vital
signs by a bedside monitor), and/or by repeatedly performing medical tests (such as
blood glucose monitoring with glucose meter in people with diabetes mellitus).
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 action to be taken
in response to deterioration from the norm. The purpose of these charts is to support
accurate and timely recognition of clinical deterioration, and prompt action when
deterioration is observed. The way in which observation charts are designed and used
can contribute to both the poor recording of observations and failure to interpret them
correctly.
Observation and response charts should:
 Be designed according to human factor principle.
 Have the capacity to record the core physiological observations specified in element
of the National Consensus Statement (respiratory rate, oxygen saturation, heartrate,
blood pressure, temperature and level of consciousness).
 Specify the physiological parameters and other factors that trigger an escalation of
care.
 Specify the actions require when care is escalated.

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 SIMPLE DIGNOSTICS REPORTS
Many mental health professionals use the manual to determine and help communicate
a patient's diagnosis after an evaluation; hospitals, clinics, and insurance companies in
the US also generally require a DSM diagnosis for all patients treated. The DSM can
be used clinically in this way, and also to categorize patients using diagnostic criteria
for research purposes. Studies done on specific disorders often recruit patients whose
symptoms match the criteria listed in the DSM for that disorder. An international
survey of psychiatrists in 66 countries comparing use of the ICD-10 and found the
former was more often used for clinical diagnosis while the latter was more valued for
research A diagnostic test is a procedure performed to confirm, or determine the
presence of disease in an individual suspected of having the disease, usually following
the report of symptoms, or based on the results of other medical tests. This includes
posthumous diagnosis. Such tests include.
 Utilizing nuclear medicine techniques to examine a patient having a lymphoma.
 Measuring the blood sugar in a person suspected of having diabetes mellitus, after
periods of increased urination.
 Taking a complete blood count of an individual experiencing a high fever, to check
for a bacterial infection.
The Diagnostic Report resource is a suitable for the following kinds of diagnostic
reports:
 Laboratory (Clinical Chemistry, Hematology, Microbiology etc.
 Pathology / Histopathology / related disciplines.
 Imagine Investigations (X-Ray, CT scan, MRI etc.)
 Other diagnostics – Cardiology, Gastroenterology etc. The Diagnostic Report
resource is not intended to support cumulative result presentation (tabular presentation
of past and present result in the resource). The Diagnostic Report resource does not
yet provide full support for detailed structured reports of sequencing; this is planned
for a future release.

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 ROUTES OF INJECTION
Administration by injection (Parenteral administration) includes the Intravenous,
Subcutaneous, Intramuscular And Intrathecal Routes.
Intravenous (IV)
Drugs may be given into a peripheral vein over 1 to 2 minutes or longer by infusion.
Rapid injections are used to treat epileptic seizures, acute asthma, or cardiac
arrhythmias.

Advantages:
1. Rapid - A quick response is possible. Plasma concentration can be precisely
controlled using IV infusion administration.
2. Total dose - The whole dose is delivered to the blood stream. That is the
bioavailability is generally considered to 100% after IV administration.
3. Larger doses may be given by IV infusion over an extended time. Poorly
soluble drugs may be given in a larger volume over an extended time period.
4. Veins relatively insensitive - to irritation by irritant drugs at higher
concentration in dosage forms.

Disadvantages:
1. Suitable vein - It may be difficult to find a suitable vein. There may be some
tissue damage at the site of injection.
2. Maybe toxic - Because of the rapid response, toxicity can be a problem with
rapid drug administrations. For drugs where this is a particular problem the
dose should be given as an infusion, monitoring for toxicity.

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 3. Requires trained personnel - Trained personnel are required to give
intravenous injections.
4. Expensive - Sterility, pyrogen testing and larger volume of solvent means
greater cost for preparation, transport and storage.

Intramuscular (IM)
Z tracking Procedure

• Pull skin taut

• Keeping skin taut with heel of hand insert needle at a 90% angle
• Aspirate plunger over 5-10 seconds noting any blood
• If clear inject 1ml every 10 seconds
• Wait 10 seconds before removing needle (Beyea & Nicoll 1995)
• Keep skin taut until needle removed
• Don’t massage the site
• Check patient and site (30 minutes)

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Advantages:
1. Larger volume than SC can be given by IM. They may be easier to administer
than IV injections.
2. A depot or sustained release effect is possible with IM injections, e.g. procaine
penicillin.

Disadvantages:
1. Trained personnel required for injections. The site of injection will influence
the absorption, generally the deltoid muscle provides faster and more complete
absorption.
2. Absorption can be rapid from aqueous solution. Absorption is sometimes
erratic, especially for poorly soluble drugs, e.g. diazepam, phenytoin. The
solvent maybe absorbed faster than the drug causing precipitation of the drug
at the site of injection.
3. Irritiating drug may be painful.

Subcutaneous (SC)
This involves administration of the drug by injection just under the skin. Commonly
used for insulin injection.

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Advantages:
1. Can be given by patient, e.g. in the case of insulin.
2. Absorption can be fast from aqueous solution but slower with depot
formulations. Absorption is usually complete.
3. Improved by massage or heat. Vasoconstrictor may be added to reduce the
absorption of a local anesthetic agent.

Disadvantages:
1. Can be painful. Finding suitable sites for repeat injection can be a problem.
2. Irritant drugs can cause local tissue damage.
3. Maximum of 2 ml injection thus often small doses limit use.

Needle Size
There are several factors which need to be considered in choosing the size of a needle
to use for an injection or “shot”. They include such
issues as:
• the type and viscosity of the medication
• the size and age of the patient
• the mobility status of the patient
• the desired absorption rate for the medication

In general for IM (intramuscular) injections you would use a 21 to 23 gauge needle 1

to 1.5 inches long for an adult. In a child you use a 1 inch long, 25 to 27 gauge
needle. In obese patients, 1.5 to 2 inch needles may be necessary.

For SQ (subcutaneous) injections you would typically use a 25 to 27 gauge needle

3/8 to 5/8 inches long for

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Adults and children alike. Some newer medications such as Byetta for diabetes
recommends using 30 or 31 gauge 1/3 inch needles which are ultra fine.

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 CONCLUSION

During training procedures I have got lot of knowledge about flowing-

 Stated project a training regarding each and every first aid procedures. It
includes checking the symptoms and treating at small scale in first aids and
later transferringfor surgical procedures.
 I got known regarding artificial respiration process and wound dressing.
 Sites of injection which includes knowledge of syringes, routes of
injections. Routesof injections such as I.V., I.M., I.D., Subcutaneous etc.
 In Prescription reading, its parts and the abbreviations used are studied by
me in thisproject it’s truly a scandalous matter for pharmacists study.
 Later the dispensing procedure is stated therefore which was practiced by me
allaround the training at regular intervals.
 I also learn about patient observation chart and how to fill it, use it.
 In Simple diagnostic reports that are easy to study in case of pathological
reports but abit of difficulty arises in reading radiological reports.
 Therefore I have got a marvelous experience by this training.

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