Course Outcomes b.

Lead workplace communication

➢ Identify actual institutional pharmacy issues and c. Develop and practice negotiation skills
trends with significant implications to pharmacy d. Solve problems related to work activities
practice e. Use mathematical concepts and techniques
➢ Describe the roles of the pharmacists in f. Use relevant technologies
institutional pharmacies
• Common Competencies
Introduction a. Maintain an effective relationship with
Institutional Pharmacies clients/customers
- Refer to pharmacies of institutions, b. Update industry knowledge and practice
organizations, and/or corporations that provide through continuing professional
a range of pharmaceutical services, given development
exclusively to the employees and/or their c. Perform workplace security and safety
qualified dependents (RA 10918) practices
d. Perform computer operations
Industrial Pharmacists Association Philippines (IPAP) e. Use pharmaceutical calculation techniques
- Mission: and terminologies
To promote continuous learning in our
professional career in order to provide quality • Core Competencies
healthcare service to our associates and be fully a. Practice good housekeeping
committed to socioeconomic activities b. Monitor supply/inventory of
- Vision: pharmaceutical products
An excellent pharmaceutical health care service c. Handle and control pharmaceutical
that meets that challenges of the corporate products
world d. Arrange and display pharmaceutical
products
Pharmacy Services NC III: Pharmacy Assistant e. Dispense pharmaceutical products
• Pharmacy Staff (RA 10928) f. Perform good laboratory practices
- (nn) Pharmacy assistants refer to persons who g. Perform health promotion, education and
assist the pharmacists in different aspects of vigilance
pharmacy operation based on established h. Demonstrate product knowledge on
standard operating procedures and processes, medicines
with a minimum degree of independence or i. Adhere to good manufacturing practices
decision making and may have supervised (GMP)
interaction with patients
NC III – BASIC COMPETENCIES
TR Summary
Pharmacy Services NC III Competency Map (Pharmacy Service NC III)
Unit of Elements Performance BASIC COMPETENCIES
Competency Criteria Lead small teams
Basic 6 19 68 Lead workplace communication
Competencies Develop and practice negotiation skills
Common 5 17 57 Solve problems related to work activities
Use mathematical concepts and techniques
Competencies
Use relevant technologies
Core 9 27 101
Competencies • Lead Small Teams
Total 20 63 226 ➢ Management vs Leadership
o Management – doing this right
o Leadership – Doing the right things

• Basic Competencies • Lead Workplace Communication

a. Lead small teams
 ➢ The capacity of a given medium to convey
information and promote learning (Lowest
to highest)

•Flyers, bulletins, generalized computer reports

Impersonal
static media

• Solve Problems Related to Work Activities

•Memos, letters, tailored computer reports ➢ Case 1:
Personal
static media A memo dated January 1, 2019 released
from the office of the Operation Manager
was received on January 2, 2019 at 800
•Telephone
Interactive a.m. instructing all staff in the Pharmacy
media
that at the start of the business hour on
January 5, no one is allowed to dispense an
•Face-to-face antimicrobial without a prescription.
Physical
presence
o How will the memo be communicated?
o How will you explain to the front liner
who asks why when they have been
dispensing antimicrobials for the past
➢ Media Selection Framework 10 years since the pharmacy opened?
o One of the pharmacy staff is not aware
of the memo
o All are aware of the memo, yet one of
the staffs did not follow.
o On February 1, a notice of violation for
dispensing Antimicrobial was received
from the FDA.

• Develop and Practice Negotiation Skills

- It is a dialogue intended to resolve disputes, to
produce an agreement upon courses of action,
to bargain for individual or collective advantage, • Use Mathematical Concepts and Techniques
or to craft outcomes to satisfy various interests. ➢ Use pharmaceutical calculation techniques
➢ Common Barriers to Successful and terminologies
Negotiations
o Viewing negotiations as a
confrontation
o Trying to “win” at all costs
- It’s a solution that should benefit both
parties not a win-lose confrontation - How
o Being emotional many tablets
- It’s important to maintain control of
o Not trying to understand the other Paracetamol
person’s perspective will you
o Blaming the other person dispense to
the patient?
➢ 5 Basic Bargaining Styles - If each
o Competitor: win-lose tablet is P4
o Problem Solvers: win-win (selling price)
o Compromisers: each win and lose a bit and the patient is 72 years old, how
o Accommodation: lose-win much is the total cost of the dispensed
o Conflict Avoiders: lose-lose medicines?
 - If the patient gives you P100 how much
change should you give the patient?
- If there are 500 tablets in the shelves
how many tablets are remaining in your
stocks?
o The label of a dry powder for oral
suspension states that when 112 mL of
water is added to the powder, 150 mL
of a suspension containing 125 mg of
ampicillin per 5 mL is prepared. How
many milliliters of purified water should
be used to prepare, in each 5 mL of
product, the correct dose of ampicillin
for a 70 lbs child based on the 6 mg/kg
dosing?
• Use Relevant Technologies
➢ Perform computer operations
➢ Basic Excel or Word
NC III – COMMON COMPETENCIES
Competency Map (Pharmacy Service NC III)
COMMON COMPETENCIES
Maintain an effective relationship with
client/customers
Update industry knowledge and practice through
continuing professional development
Perform workplace security and safety practices
• Maintain an effective relationship with
client/customers: Development of your
professional self
➢ What is a Professional?
- Professionals have a body of knowledge,
scope of practice, agreed upon values, oath
or code and accountability to our society
for our profession and our professional
behavior.
➢ What is Professionalism?
- Describes a certain type of behavior in the
workplace
- Based on our values and understanding of
our professional roles
- Evidenced in our behavior
➢ How Professionalism judged?
- Against a set of expectations or standards
- From our own personal values set and
understanding of what “professionalism”
means
- May be situational in nature
- Strongly influenced by culture
“Professionalism is in the eye of the beholder…”
➢ Professionalism is determined by:
o Our image
o Our communication
o Our competence
o Our demeanor
➢ From the Client’s perspective:
o Trustworthy
o Competent
o Empathetic
o Respectful
o Caring
➢ Unprofessional Behavior – Clients
o Non-therapeutic relationships
o Inappropriate communication
o Inappropriate self-disclosure
o Exploitation – money, gifts
o Breaches of confidentiality
➢ From the Co-Worker’s perspective
o Trustworthy
o Competent
o Supportive
o Respectful
o Accountable
➢ Unprofessional Behavior – Coworkers
o Inappropriate relationships
o Disengagement – texting,
inappropriate use of internet, phoning
o Provision of misleading information
o Disrespect
“Always do your best. What you plant now,
you will harvest later.”
• Og Mandino
• Perform workplace security and safety
practices:
Personal Safety
➢ Safety from physical harm
o Substances
o Supplies (chemicals, poisons, etc.)
o Equipment
o Improper body mechanics
➢ Employee responsibilities
o Maintain a safe work place
 o Apply principles of proper body • requires paying attention to important details
mechanics such as:
o Wear appropriate PPE (Personal o layout of workplace
Protection Equipment) when indicated
o aisle marking
o Follow proper procedures in handling
pharmaceutical agents that may pose o adequacy of storage facilities
a hazard to the practitioner o maintenance
o Know and apply the policies and
procedures in case of emergency Store layout
Large stores: cross aisles
➢ Environmental Safety - reduces travel time (cross aisle every 10-20 m.)
o Clean work place
o Proper ventilation
o Proper lighting
o Adequate set-up and layout of work
place
o Proper functioning equipment

Safety Practices
➢ Patients trust pharmacy personnel to:
- Provide accurate and competent service
- Safe and effective medications
- Dispense according to prescriber’s
pacing depends on frequency of picking
directions
Slow moving products- long aisle
Fast moving products- short aisle
➢ Pharmacist must ensure:
o Right drug
o Right patient
o Right dose
o Right route
o Right time
o Right attitude

➢ Practitioner must be familiar with:

o Common side effects
o Contraindications
Specifications: (from top to bottom)
o Drug or food reactions with
Top shelf- light bulky goods
medications
Second shelf- Normal bulk, frequent access
o Generic drug that may be substituted
Third shelf- Small goods
“Beware of dispensing errors!!”
Fourth shelf- heavy goods, frequent access
NC III CORE: PRACTICE GOODHOUSEKEEPING
Fifth shelf- Heavy bulk goods, liquids
Housekeeping
Height
• not just cleanliness
2.7 meters max for ladder picking
• basic part of incident & fire prevention 1.7 meters max for floor picking
• includes:
o keeping work areas neat & orderly Width
o maintaining halls & floors free of slip & 1.20 meters min. aisle
trip hazards 1.50 meters two-way aisle
1.75 meters two-way trolley aisle
o removing of waste materials & fire
hazards Standard Operating Procedure: Cleaning and
Housekeeping (Sample)

Cleaning of shelves
1. Use a clean cloth
2. Transfer contents to an empty tray/table (if
any).
3. Wipe with cloth to remove dust
4. Use water for rigid stains/smudges
5. Once complete: Place medicines appropriately
back onto the shelves
6. Place cloth in area allocated for cleaning
materials
7. Repeat cleaning every 2 weeks or before if
requires as per location and usage.
8. Cleaning register- shall be kept to keep records
of cleaning done
9. After cleaning: Pharmacist shall check whether
all medications are kept at their labelled
locations.
Cleaning of refrigerator
1. Turn off before starting cleaning
2. Quickly transfer all products into an empty
carton (thermocol box, if available)
a. Take care that no medicines come in
contact with the floor.
b. With alternate refrigerator- transfer
medicines there until cleaning is
complete
3. Once emptied, clean from the inside and
outside with a clean wet cloth to remove any
dirt and stains.
a. Use mild soap/detergent if needed
4. Close the ref door & switch on
5. After ½ hour, check temperature if attained in
the ref in different zones, using a thermometer.
6. Quickly place back all products (in specified
locations, in a neat manner)
7. Quickly close the door & fill cleaning register
and temp log sheet
8. Defrost the ref from time to time (a sched shall
be fixed for this)
9. The ref should be cleaned ONCE A MONTH,
preferably after working hours on a non-busy
day/ low customer flow
Cleaning of floor
1. Clean the floor at the specified/allotted times
2. Use clean mop
3. Use clean bucket, clean water, and
disinfectant/phenol.
4. Carefully clean all areas and corners. Rub out
any marks/smudges that don’t go easily
5. Refill bucket if necessary.
6. At end, inspect & ensure that all areas are clean
7. Throw out dirty water in the sink, clean mop
and bucket, and keep it back in allocated place
(for easy finding)
8. Maintain registers to keep records of cleaning
done
9. Repeat every day, and when needed.
a. Frequency may have to be increased
(x2/day) in the rainy season (mucky
floors)
Cleaning of Chemical Spill
1. Wear gloves and mask & place tissue
paper/sponge on the spill and absorb the spill.
2. Put the absorbent paper/sponge in a black
waste bag for disposal.
3. Pour sodium hypochlorite solution on the spill
for 10 minutes and wipe off with wet mop
4. Then wet mop the area with disinfectant &
water solution
Disposal of Expired Drugs
Responsibility- Pharmacist
Record- Expiry Drug Register
1. Expired goods shall be stored in separate
shelf/cupboard marked “EXPIRED GOODS NOT
FOR SALE” to prevent misuse.
2. Due importance shall be given to the expiry
date of medicines.
a. Periodic checking for expiry date shall
be carried out.
 3. Expired drugs shall be segregated and returned
to Central Medical Store (CMS) & the expiry
drug register shall be updated.

Pest Control Guidelines

Responsibility- Pharmacist
1. The storage areas shall always be maintained
neat & tidy at all times. Procedures shall be laid
down for daily & periodic cleaning.
a. Record- none
2. Storage areas shall be regularly checked for
Techniques
signs of pests, water damage, and
1. Routine cleaning- necessary to maintain a
deterioration due to climatic conditions
standard of cleanliness
a. Record- Pest control register
2. Schedules & procedures should be consistent
and posted
BASIC PRINCIPLES
Cleaning Disinfection 3. Use a starting point- reference to ensure that
Removal of gross Destruction/ all surfaces have been reached
contamination, elimination of a 4. Least soiled to most soiled- cleaning
organic material and specific species of progression
debris infections a. high to low- debris that fall on the floor
microorganism will be cleaned last
Uses mechanical
5. Use of PPE
means (sweeping, dry Physical (heat) or
cleaning, wet cleaning- chemical (disinfectant) 6. FDA & related regulations
water + detergent) means; may also be a 7. Good Storage Practices
combination of 8. Clearing of fire exits
GOAL: Minimize methods 9. Risk management
organic material so a. Special training for Pas in Onco
disinfection can be GOAL: Removal, pharmacies- Onco product medicine
effective. deactivation or killing
spillage
of pathogenic
microorganisms MONITOR SUPPLY/ INVENTORY OF PHARMACEUTICAL
PRODUCTS
Cleaning Solutions Drug Management Cycle
Appropriate agents for use: 1. Use
• 0.5% sodium hypochlorite solution 2. Selection
3. Procurement
• Benzalkonium chloride
4. Distribution
Take note of procedures and precautions (what not to
Drug Selection – one of the most cost-effective areas for
mix)
intervention
Essential Drugs – those that are deemed to satisfy the
Cleaning Methods
health care needs of the majority of the population
Wet mopping
- Should be available in the appropriate dosage
Dusting (dry & wet)
forms and strengths at all times
Essential Drugs List
- Optimal treatment choices to satisfy the health
care needs of a given population
- Used for one or more health facilities or for the
public sector as a whole
- Can be considered a supply list
Formulary List
- List of drug products approved for use in a
specific health care setting
- May be a national formulary list, a provincial
list, a hospital list, or a list reimbursed by a
health insurance
- Synonymous with essential drugs list
DRUG PROCUREMENT
Procurement
- process of acquiring supplies from private and
public suppliers or through purchases from
manufacturers, distributors, or agencies such as
UNICEF, WHO, or bilateral aid programs
Effective Procurement
- Procure the right drugs in the right quantities
- Obtain the lowest possible purchase price
- Ensure drugs procured meet recognized
standards of quality
- Arrange timely delivery to avoid shortages and
stockouts
THE PROCUREMENT CYCLE
1. Determine quantities needed
2. Reconcile needs and funds
3. Choose procurement method
4. Locate and select suppliers
5. Specify contract terms
6. Monitor order status
7. Receive and check drugs
8. Make payment
9. Distribute drugs
10. Collect consumption info
11. Review drug selections
CONSUMPTION METHOD
1. List of drugs to be quantified
2. Consumption data
3. Arrange monthly consumption
4. Drug quantification
Inventory Management of Medicines
- Aims to protect the quality and integrity of
products and services
- Provide uninterrupted production, sales, and/or
customer-service levels at the minimum cost
- PAs should ensure that fast selling medicines
will not be OOS
STOCK RECORDS AND STANDARD REPORTS
Stock Records
- Core records of inventory management
- Source of info for forecasting and reordering
- Manual or computerized
COMMONLY USED MANUAL STOCK RECORDS
o Ledger system
▪ Records are kept on ledger
sheets in a bound/ loose leaf
book
o Bin cards
▪ File cards are physically kept
with the stock
SUPPLY SYSTEMS
- Computerization (barcoding) is desirable if local
situation can afford and support automation
Advantages:
o Efficient for perpetual purchasing
o Fast retrieval and reporting
STOCK COUNTS
- Should be done at least annually
- Best approach: cyclic counting
o Perpetual inventory
o Superior to annual stock count
o No need for operation shut down
o Easier to solve discrepancies
CYCLIC COUNTING
1. Divide into counting groups
2. One group is counted each week/ month
3. Reconcile discrepancies
4. Another group the week after
RECEIVE AND DISPATCH ORDERS
a. purchase order
b. POS/ inventory system
Quality Issues on Delivery:
- Rejecting medicines from supplier
Pas/ Owners
o How do we ensure that we are receiving
quality medicines?
o Accreditation process of couriers
delivering medicine supplies to
pharmacies
RETURNS
 STORAGE TEMPERATURES OF PHARMACEUTICAL
PRODUCTS
Term Condition
Cold Place not exceeding 8ºC
a. Freezer cold place that is
thermostatically
controlled at -25ºC to -
10ºC
b. Refrigerator cold place that is
thermostatically
controlled between 2ºC to
8ºC
Cool any temperature between Temperature and Security Zones
8ºC to 15ºC Temperature and Security Zones
Room Temperature temperature prevailing in *Each storage zone should at least have 1 thermometer,
a working area (usually record temperatures daily at the hottest time of the day
20ºC to 25ºC)
*Controlled Room 20ºC to 25ºC or 15ºC to
Temperature 30º
Warm 30ºC to 40ºC
Excessive Heat above 40ºC
ZONING STOCK WITHIN THE STORE
Zoning
- most basic way in which supplies are arranged
Zone Secure storage
- can be a building. or room, locked cupboard, a • Narcotics, controlled substances, frequently
ref, freezer or a cold room stolen non-narcotics, expensive products
Combination of Temperature and Security (antiretrovirals)
• Room equipped with red warning light or
warning bell when door is unlocked
*Not more than 2 assigned officers should have access
(Senior RPh or senior store keeper & director of store)
Controlled Drugs
• Narcotics (pethidine injection, Morphine preparations)
• Security measures in the pharmacy:
• A safe & reinforced double lock cabinet with
light (red)
 • A special register recording details of each
receipt or issue (with 2 signatures, physical counting *Cold chain equipment should meet WHO standards
after each entry & signatures at “handover-takeover”) - Top-loading refs & freezers are most appropriate
• Independent audit choices
Attractive Items - Electric refs of the ice-lined type (good “hold-over” in
• Expensive items (cimetidine, PZQ, ARVs) the event of power failure)
• Antibiotics - Front loading types are used in areas with stable supply
• Psychotropics of electricity
• Equipment (scissors, safety razors, hypodermic
needles, rolls of cotton)
Security measures:
- Stored in a separate area & locked
- Audits
- Embossing
Storage at uncontrolled room temperature
- most of the products (unless specified), some
can even be stored at +40˚C in temperate
climates
Storage at controlled Temperature & Humidity
• Hot climates
 air conditioned Items Needing Freezing or Refrigeration
• Humid - Vaccines
 use dehumidifiers - Biologicals
• Cold climates - Blood products
 heated stores Temperature Monitoring
Items Needing Storage in A Controlled Environment
- Injectable products
- Suspensions (e.g. Stavudine suspension has shter
t1/2 than p.o. form)
- IV fluids
- Suppositories, pessaries, creams, ointments
- X-ray films & chemicals
- Products containing rubber, latex, cellulose or
some plastics
Cold storage:
• Vaccines, sera, test kits Temperature Mapping
• Cold chain: +4˚C cold room: twin refrigeration units,
recording thermometer, alarm;
• -20˚C freezer recording thermometer, alarm
• Ice packs and cold boxes
• Standby power supply

Flammable
• ROH, ether
• Separate building
• Well ventilated, fireproof
• Explosion hatch
• Fuels must never be stored near a medical
store
 • On the label of thee immediate container
outside of the principal display panel will
appear the following information
o Formulation
Flammable & Corrosives o Indication(s)
Categories of flammable liquids (UN hazard o Mode of administration/directions for
classification):
use
• Flash point of -18˚C (Acetone, Ether)
o Batch and lot number
• Flash point of -18˚C to +23˚C (ROH before dilution)
o Expiry/expiration date and date of
• Flash point of +23˚C to +61˚C (kerosene)
manufacture
o Separate outdoor store o Registration number
o Firefighting equipment should be readily o Storage conditions
available o (For Rx) Foods, Drugs and devices and
o Well ventilated steel cabinet with label “Highly Cosmetic Act Prohibits dispensing
flammable liquid” without prescription

Highlights
ARRANGE AND DISPLAY PHARMACEUTICAL PRODUCTS • Sound-alike, Look-alike
Stock Classification • High Alert Medications
• Therapeutic or pharmacological • Assist in Temperature Mapping
o For smaller stores where keeper is also • Practice FEFO
the dispenser
• Alphabetical order (by INN)
Dispense Pharmaceutical Products
o Attractive for small # of items
Dispensing
• Dosage form
• Delivery of product-related and clinical services
o Used for smaller warehouse
to patients and health care providers.
• Random Bin
• Dispensing is the procedures required in
o Unique storage space ID by a code (eg.
completing the filling of prescriptions (e.g.,
B1, B2)
checking, pouring, counting, packaging, labeling,
Article code vs. Location code review….etc.).
• Location code • The fundamental concept is to give the right
o Independent of article code and is medication to the right patient after proper
similar to Random bin principle identification.
▪ Correct storage temperature • Drugs should be dispensed at the right dose,
▪ Correct security level route of administration, form and duration of
▪ Flammability treatment.
▪ Building where it is located
Prescription
▪ Pack size
• A Physician’s order for the preparation and
▪ Pharmaceutical form
administration of a drug or device for a patient
Arrangement of Stock • RA 6675: Generics Act
• Commonly by Therapeutic category, clinical
Parts of a prescription:
indication, dosage form or alphabetical order
• DEA Number
w/n categories.
• Prescriber Information
• Tx rooms/medicines trolley should be arranged
• Patient information
by therapeutic class
• Date Prescription was written
• Liquids for internal use must be separated from
those for external use • Superscription – Rx meaning recipe
• Inscription – medication prescribed
Principal Display Panel
 • Subscription – actions (instructions) to o Keep prescription
pharmacist o Report to nearest DOH office
• Signa/Transcription – directions for patients
• Special instructions The Minimum Dispensing Cycle
1. Receive and validate prescription
2. Understand and interpret prescription
a. Patient
b. Medicine
c. Dose
3. Prepare and label items for issue
4. Make a final check
5. Record action taken
6. Issue medicine to patient with clear instructions
and advice

Example SOP for Basic Dispensing of Prescription Drugs

1. Receive and validate prescription
2. Understand and interpret prescription
Types of Prescription:
3. Let pharmacist check the prescription
• Erroneous Prescription
4. Prepare and label items for issue
o The brand name precedes the generic
5. Get the product from the shelf
name
6. Compare the product label with the
o The generic name is the one in
prescription
parenthesis
7. Pass the product to the pharmacist
o The brand name is not in parenthesis
8. Issue medicine to the patient with appropriate
• Violative Prescription
instructions and advice
o The generic name is not written
9. Record the transaction
o The generic name id not legible and a
brand name that is legible is written
o The brand name is indicated and
instructions added (such as the phrase
“No substitution”) that tend to
obstruct, hinder, or prevent generic
dispensing
• Impossible Prescription
o Only the generic name id written but is
not legible
o The generic name does not correspond
to the brand name
o Both the generic name and the brand
name are not legible
Important tips for using OTC medicines
Procedures to be followed for each incorrect
1. Always follow the printed directions and
prescription
warnings. Always seek the advice of the
• Erroneous prescription
pharmacist
o Filled
2. Ask if the Patient is Pregnant of Breast feeding
o Keep prescription
3. Children and older patients should always take
o Report to nearest DOH office
special care wen taking OTC medicines
• Violative or Impossible prescription
4. Before giving the medicine check if the
o Do not fill
 a. Symptoms is very bad
b. Ascertain the condition/symptoms
c. Allergies
d. Long term conditions

Prescription Drug
• Requires RPh
• Do not dispense or ask for assistance