Pharmacy practice

For 4th yr pharmacy students

By: Amsalu G. ( B.Pharm, MSc)

1 12/06/2025
 Evolution of professional pharmacy practice
No one can be sure when
pharmacy started.
However, early humans most likely
discovered that by applying water,
mud, and some plants on the skin
By trial and error, humans slowly
discovered things in nature that
helped them.
Therefore pharmacy was practiced
instinctively as people used the
elements around them for
soothing compresses on wounds
2
and ailments. 12/06/2025
 1. Pharmacy in Ancient Babylonia
Babylon provides the earliest known record of
practice of the art of the apothecary. Practitioners of
healing of this era (about 2600 B.C.) were priest,
pharmacist and physician, all in one.

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 Pharmacy in Ancient Babylonia…

Medical texts on clay tablets record first the

symptoms of illness, the prescription and

directions for compounding, then pray to the
gods.
 Ancient Babylonian methods find equivalent in

today's modern pharmaceutical, medical, and

spiritual care of the sick.
4 12/06/2025
 2. Pharmacy in Ancient China
Chinese Pharmacy stems from Shen Nung (about 2000
B.C.), emperor who search for and investigated the
medicinal value of several hundred herbs.

"Divine Farmer" or "Divine Husbandman

He had tested many of them on himself, and to have

written the first Pen TSao (native herbal), recording
5 365 drugs. 12/06/2025
 Pharmacy in Ancient China…

Shen Nung examined many herbs, barks,

and roots that are still recognized in Pharmacy

today.

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 Ebers Papyrus…

 Ebers Papyrus is the best known and

most important pharmaceutical record

from ancient history.
particular note in the papyrus is
inclusion of quantities of substances ,
which were largely missing from
Babylonian clay tablets.
Many modern dosage forms are also
referred to in the Ebers Papyrus as
gargles, inhalations, suppositories,
9 ointments,and lotions. 12/06/2025
 In ancient Greece
 Hippocrates was a Greek

Physician and considered one of

the most outstanding figures in
the history of medicine.

 He is credited with greatly

advancing the medical profession

and for writing the Hippocratic
oath. 12/06/2025
11
 In ancient Greece…
While the oath is rarely used in its original form
today, it serves as a foundation for other, similar
oaths and laws that define good medical practice and
morals.
He also formulated the theory of the four humors that
parallel the four elements.
•blood,
•phlegm
•black bile
•yellow bile.
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 When the humors

He summarized that were balanced, a

person was healthy.
The belief was that
disease was caused by an too much or too
little of any of the
imbalance of these bad humors cause
disease.
humors.

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 In Ancient Rome
Galen (130-200A.D) was a prominent physician,
surgeon, and philosopher.

Practiced and trained both Pharmacy and Medicine in

Rome;

Developed principles of preparing and compounding

medicinal agents

His principles of preparing and compounding

medicines ruled in the Western world for 1,500 years
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 The Middle Ages

Medicine and pharmacy were for the first time separated

from each other.

Pharmaceutical Knowledge and the number of drugs

available began to grow considerably

Pharmacy as a separate activity began to develop and

privately owned pharmacies were established in Islamic

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lands.
 Evolution of the Pharmacist’s
Role
The role of the pharmacist, during the 20 th
century, has changed dramatically to keep
pace with medical and scientific advances.
There are four distinct eras:
The Traditional Era

The Scientific Era

The Clinical Era

The Pharmaceutical Care Era

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 Traditional Era
Beginning of the 20th century, pharmacists formulated
and compounded medications from natural sources.
Prescriptions were compounded by hand, using a
mortar and pestle, ingredients and dosages tailored
to individual patients.
Less than 1% of all prescriptions today are
compounded.
Pharmacists-in-training served as apprentices,
learning the trade in pharmacies rather than sitting in
a classroom.
Pharmacognosy – the knowledge of the medicinal
functions of natural products from animal, plant, or
mineral origins was a piece of the limited education
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pharmacist focused on at this time.
 Scientific Era
Post WWII period, pharmaceutical
manufacturers developed and tested new
drugs and dosage forms..

Educational institutions increased the

emphasis on the sciences and expanded
the pharmacy curriculum.

Pharmacology – the scientific study of

drugs and their mechanisms of action, was
a required course of study.
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 Clinical Era
Combining the traditional role of pharmacist with a
dispenser of drug information to the patient and
physician.

Pharmaceutics – the study of how drugs are

introduced to the body, was added to the pharmacy
curriculum.

1973, the American Association of Colleges of

Pharmacy (AACP) reevaluated the mission of the
pharmacy profession.

Development of clinical- or patient-oriented pharmacy

20 resulted in a change to the pharmacy curriculum12/06/2025
and
the adoption of the PharmD degree program.
 Clinical Era
New courses were also developed:
Pharmacokinetics – individualizing doses of
drugs based on absorption, distribution,
metabolism, and excretion from the body.
Therapeutics – the study of applying
pharmacology to the treatment of illness and
disease states
Pathophysiology – the study of disease and
illnesses affecting the normal function of the
body.

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 Pharmaceutical Care Era
Pharmaceutical care – expands the
mission of the pharmacy profession to
include responsibility for ensuring positive
outcomes for drug therapy.

“Medication therapy management” (MTM)

may include recommending a less costly
drug to a physician, identifying a potential
serious drug-drug interaction, or counseling
a patient. .

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 Additional Responsibilities
Based on the pharmacy setting
pharmacists may have specific
responsibilities.

Community Pharmacies:

Institutional Pharmacies:

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Pharmacy practice and the healthcare system

Five main areas in which pharmacy makes major

contributions to health outcomes

1. Medicine management
– drug development
– dispensing of medicine
– patient counseling

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 2. Management of chronic conditions:
– monitoring therapeutic outcomes
– improvement in quality of life
3. Management of common diseases:
– counseling
– recommendation of line of action

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3. Promotion and support of healthy lifestyles:
– health education
– health screening

4. Advice and support for other healthcare professionals

– provision of information on clinical and technical aspects

of drug use
– participation in research and development.

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 Pharmacist interventions in the healthcare system

1. Ensuring rational use of medicines by

Participation in the development of formularies, clinical guidelines

and protocols, and analysis of prescribing information and drug

use evaluation data.

Disease management: enhancement of compliance , adherence to

evidence-based clinical guidelines and monitoring patient outcomes.

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 Management of drug therapy
Ensures that
Safe and effective use of drug
Drug accessibility
Ensuring rational prescribing with other health
professionals
accessing patients’ profiles and medical records,
undertaking
patient monitoring to identify problems and
suggest actions to solve problems.

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2. Identifying groups of patients with special needs
Patients suffering from certain diseases, such as:

– acute myocardial infarction

– chronic pain
– mental health problems

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 Age groups:

- extremes of age – the young and the elderly

Drug treatment:

– narrow therapeutic index drugs

– expensive drugs

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3. Achieving cost-effective patient care
Value for money and cost- effectiveness are important

considerations in selecting rational therapy.

This may involve substituting a generic drug for the

original

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 Medicine presentation and administration

When administering medicines, it is important to ensure that:

7R
The Right medicine
At the Right dose,
In the Right form
Is administered to the Right patient,
at the Right time,
by the Right route,
using the Right technique,

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and the Right documentation is kept 12/06/2025
 Medicine safety

Safety in the home

To keep all medicines out of reach of children

Safe disposal of unwanted medicines

Storage at conditions appropriate for the specific

medicine
Proper labeling on container to include dosage regimen

and cautionary labels (e.g. ‘Warning: may cause

33 drowsiness’). 12/06/2025
Include advisory labels

(e.g. ‘Shake the bottle’)

Do not change containers or remove from carton.

Cautionary labels
May cause drowsiness.

Do not drive or operate machinery (e.g. antihistamine-

containing preparations).
 Cetirizine , Chlorpheniramine , Clemastine
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 Diphenhydramine and Loratadine etc
  Avoid alcoholic drink (e.g. metronidazole)

 Take at regular intervals. Complete the prescribed

course unless otherwise directed by physician or

pharmacists due to ADR
. . . with or after food (e.g. non-steroidal anti-

inflammatory drugs)

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Swallow whole, do not chew (e.g. enteric- coated and

modified-release oral formulations such as bisacodyl).

To be spread thinly (e.g. corticosteroid preparations for

application on the skin)

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 Advisory labels

Shake the bottle (e.g. calamine lotion).

For external use only (e.g. for products to be applied

externally).
Discard 4 weeks after opening (e.g. eye drops).

This medicine may color the urine (e.g. levodopa)

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 Barriers to proper use of medicines

Patient confusion

Communication problems

Side-effects

Dispensing errors

Cost of medicines

Accessibility

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 Drug-related problems

Improper drug selection

Sub-therapeutic dose

Overdose or toxic dose

Adverse drug reactions

Drug interactions

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 Adverse drug reactions

Adverse drug reactions: ‘unexpected,undesired

or excessive response’ to a drug

An ADR can lead to:

drug discontinuation

dose modification

hospital admission

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 An ADR can lead to…

prolonged hospitalization

requirement of supportive treatment

complication of diagnosis

temporary/permanent harm, disability or death

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 Adverse drug reaction monitoring and
reporting program

ADR surveillance:
monitoring occurrence.
ADR documentation:
 documenting incident.
Reporting of ADRs:
reporting to national regulatory authority (e.g.
FMHACA).
The national regulatory authority undertakes
coordination and monitoring of suspected ADRs on a
local and an international level
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Pharmacists should participate in mechanisms that

monitor the safety of drug use in high-risk

populations (e.g. older people, children, HIV patients).
Pharmacists should lead education of health

professionals regarding potential ADRs.

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Processes of an ADR monitoring program

Monitoring

Detecting

Evaluating

Documentation

Reporting to authorities

Updates & discussions with healthcare team

members

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Drug interactions

Administration of two or more drugs at the same time may lead to an

exertion of their effects independently or may cause an interaction.

The interaction may be potentiating or antagonism of one drug by

the other.
Occurrence and impact of drug interactions should be evaluated on the

basis of clinical significance and potential for hazardous outcomes

Examples of clinically significant drug interactions:

Aspirin- warfarrin: enhanced anticoagulant effect

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 Medication errors

Types of medication errors

Prescribing error: medication prescribed is

inappropriate. (Types of irrational prescribing)

Dispensing error: medication dispensed is inappropriate

(e.g. due to incorrect interpretation of the prescription).

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 Medication errors…

Omission error: dose skipped or medication is not

being administered.
Time error /dose error /administration technique

error:

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Some practices to reduce medication errors during prescribing

Avoid unnecessary use of decimal points:

E.g. quantities less than 1 gram should be written in

milligrams
Avoid use of abbreviations:

E.g. micrograms
Names of drugs must be written clearly and not

abbreviated
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 Poisoning

Poisoning may take place with

immediate action poisons (e.g. alcohol (ethanol)) or

delayed action poisons (e.g. paracetamol)

Prevention of absorption of poison

Carried out by using activated charcoal.

Charcoal binds to many poisons and reduces their

absorption.
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 Prevention of absorption of poison…

It is relatively safe and the sooner it is given the more

effective the procedure will be

Antidotes can be provided:

Atropine sulphate is given in the case of organo-phosphorus

poisoning
Flumazenil, a benzodiazepine antagonist, is used in

anesthesia and intensive care to reverse benzodiazepine –

induced sedation; it is also used to treat benzodiazepine over
57
dosage. 12/06/2025
 COMMUNITY PHARMACY

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 Community pharmacy:
It is known as community pharmacies because they serve

the local community in which they are located

There is face-to-face interactions b/n the pharmacist,

technicians, and patients

Community pharmacy staff is usually more accessible to

the general public

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 Community pharmacy…

Pharmacist in retail pharmacies:

Dispense pharmaceuticals

Answer questions about prescription and OTC drugs

Give advice about health care supplies and durable

medical equipments

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 Organization of a community pharmacy

Human resource
Pharmacists (chief/manager and others)
Pharmacy technicians,
 cashier
Other support staffs
 accounta
nt
 cleaner
 guard

Pharmacist(s) and other staff on duty must wear

a name tag or badge indicating his/her name
and designation.
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 Minimum standards for pharmacy premises(BULIDING)

1. Appearance of pharmacy
premises

Design and layout:

Permit logical flow of work, effective

communication and supervision and ensure
effective cleaning and maintenance

Minimize the risk of errors, cross-

contamination and anything else which
62 would have an adverse effect on the quality
12/06/2025
 Minimum standards
 The external appearance of the pharmacy
must portray a professional image.

Entrances, dispensing counters and

doorways must be accessible to disabled
persons.

2.Security in pharmacy premises

Careful consideration must be given to
the overall security of the pharmacy.
Access to a pharmacy when it is locked
63 Control of access to medicine. 12/06/2025
 Minimum standards
3. Safety of pharmacy premises
Working conditions
Fire extinguisher
Electrical equipment → safe and
maintained regularly.
A safety procedure

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 Minimum standards
4.Condition of pharmacy premises:
The walls, floors, windows, ceiling,
woodwork and all other parts of the
premises
 clean and good order, repair and condition

 shelves and walls

finished in a smooth, washable and
impermeable material.

Site of premises
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 Far from areas or premises that can cause
 Minimum standards
5. Construction of pharmacy premises
Prevent:
 floods
 entry of insects, animals or birds

Easily cleaned and disinfected

Allows adequate lighting and air
movement
Ceiling:
 Type that minimizes effects of high temperatures
 Adequate height

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 Minimum standards
6. Environment in pharmacy
premises
Products stored according to
recommended conditions
Levels of heat, light, noise, ventilation,
etc., must exert no adverse effects on
pharmaceutical stock as well as
personnel.
Suitable and effective means of heating
or cooling, lighting and ventilation.
Background music or other broadcasts →
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distraction
 Minimum standards
7. Hygiene in pharmacy premises
Regular program for cleaning premises
Area for washing equipment and other
utensils (hot and cold tap water).
Toilet facilities must be kept clean and in
good order.
Hand-washing facilities

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 Minimum standards
PREMISES:
Dispensary
 The size of the dispensary:
volume of prescriptions dispensed and

allow a safe and efficient flow of work and

effective communication and supervision

Waiting area
Comfortable seating must be provided.
Appropriate health-related literature must be
69 provided 12/06/2025
 Minimum standards
Suitability of dispensary
The dispensary, its fittings and
equipment must be adequate and
suitable for the purpose of dispensing.
The temperature in the dispensing area
must be maintained below 25°C.

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 Minimum standards
Semi-private area
This area is for the provision of information
and/or advice that may occur in an area
visible to other patients.
In such an area, patient counseling may
take place in a professional manner
regarding medicine use and other relevant
information,
Does not provide the privacy required to
advise patients on sensitive issues.

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 Counseling area
Semi-private area

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 Counseling area: Semi-private area

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 Minimum standards
Separate private area
a small private room within the pharmacy,
which is in close proximity to the
dispensary.
the area should be professionally planned,
tastefully and professionally furnished and
equipped,
allows the pharmacist to counsel patients
on:
 sensitive emotional or health care problems and
 their medicines, and other related issues.

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 Minimum standards
Storage areas in pharmacy
premises
Self-contained and secure
Large enough → orderly arrangement and
proper stock rotation
Separate storage area for stocking
veterinary pharmaceuticals
Sufficient shelving
Ethiopian guideline: 16 m² minimum for
storage with shortest side not less than 3
m.
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 Minimum standards
Other issues
Waste disposal → SOPs
 Suitable and adequate means in written form

Dispensing equipment and materials

Adequate, suitable dispensing equipment.
Maintained clean, in good repair and of
suitable material.
Common ones include:
Tablets and capsules counting
equipments/apparatuses.
For compounding purposes
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 Minimum standards
Reference sources
Current editions recommended:
Drug interactions reference source;
a comprehensive textbook on
pharmacology/pharmacotherapy;
Standard Treatment Guidelines and
Essential Drug List for the appropriate level
of care.
A pediatric dosing reference guide (where
applicable);
A medical dictionary;

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 Minimum standards
the latest copy of the pharmacy legislation;
Code of ethics
Good dispensing practice manual;
Good_Dispensing_manual_new_2.pdf
Pharmacopoeia (BP, USP) (where
applicable);
Others as applicable and appropriate;
Electronic access to the required
references is also acceptable in some
countries.

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 Services provided by the community pharmacy

Supply medicine (OTC and prescription)

Counseling of patients at the time of dispensing

Drug information to health professionals , patient and the

general public
Participation in the health promotion programms.

They maintain links with other health professionals in

primary health care

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Ensure the quality of the product they supply 12/06/2025
 1. Processing the prescription

 verify the legality, safety and appropriateness of a

prescription order
 Checks the patient medication record before

dispensing the prescription

 Ensures that the quantities of medication are dispensed

accurately

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 Processing the prescription…

 Decide weather the medication should be

handed by the patient with appropriate

counseling
 The community pharmacist is in the unique

position to be fully aware of patients past and

current drug history
And provide essential advice to the prescribers
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 2. Care of patients or clinical pharmacy

 Collect and integrate information the patient’s drug

history
 Clarify the patient’s understanding of the intended

dosage regimen and method of administration

 Advise the patient of drug related precautions

 In some country monitor and evaluates the therapeutic

response
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 3. Monitoring of drug utilization

Practice research projects for drug utilization

Analyzing prescriptions for the monitoring of

adverse drug reaction

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 4. Extemporaneous preparations

Is small scale preparation

Prepare medicine in the pharmacy

Enables to adapt the formulation of a medicine to the

needs of an individual patient

Must be according to manufacturing and distribution

practice guidelines

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5. Traditional and alternative medicine

In some countries pharmacists supply traditional

medicines and dispense homeopathic

6. Responding to symptoms of minor ailments

The pharmacist receives requests from members of the

public for advice

When indicated, refers the inquires to a medical
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 Responding to symptoms of minor ailments…

If the symptoms relate to self limiting minor ailment the

pharmacist can supply a non prescription medicine with

advice to consult a medical practitioner if the symptoms
persist for more than a few days

Alternatively the pharmacist may give advice without

supplying medicine
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 7. Informing health professionals and the public

The pharmacist can compile and maintain information

on medicines
Provide this information to other health care

professionals and to patients

Promote rational drug use by providing and explanations

to physicians and to members of the public

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 8. Health promotion

On drug related issues (RDU, alcohol abuse, tobacco use,

drug use during pregnancy, poison prevention)

On other health problems (diarrheal disease, TB, leprosy,

HIV-infection)
Family planning

Disease prevention ( immunization, malaria)

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 3.Good dispensing practice

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 Assessment of the pharmaceutical sector in Ethiopia in

2006 showed that:

The national average dispensing time was 78.69

seconds,
On average, only 19.95% of medicines dispensed to

patients in health facilities were adequately labeled

while the ideal value is 100%.
Only 12.18% of the respondents knew how to take their

medicines as compared with an Ideal value of 100%.

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 Introduction
Definition:
Good dispensing practice refers to the delivery
of the correct drug and medical supply to :
the right patient,
in the required dosage and quantities,
in the package that maintains acceptable potency
and quality for the specified period
with clear drug information.

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 Introduction…
Evaluation of prescriptions is a crucial step of the
dispensing process
Counseling patients on medications is a major part of
dispensing
Lack or improper counseling by dispensers leads to
incorrect use of medicines by patients
In correct use results in loss of efficacy or occurrence of
adverse effects.
Dispensers should be able to equip themselves with up-
to-date medicine information
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 Introduction…
Dispensers need to have communication skills so as to
effectively deal with patients or health care providers.

All information should be provided by the language

the patient or care provider can understand.

Dispensers should check whether the information is

understood by patients or their caregivers

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 3.1. Principles of good dispensing practice

Dispensing practice plays a central role in the

provision of rational drug therapy

Dispensing - the process of preparing drugs and

distributing them to their users with provision of an

appropriate information

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 Dispensing- all the activities that occur b/n the time the

prescription or oral request of the patient is presented

and the drug issued to them.

The dispensing process involves:

The correct interpretation of the prescription or oral

request

10 12/06/2025
0
 SodoHospital

prescription paper
Patient name: Kedir Mohammed
Age: 60yrs
Diagnosis:______________
Rx—Amytriptillin 25mg po 1 tab noct for 1 month
Prescriber name:_________________________________
Qualification:__________________________________
Sign:_______________________________________
Leku Hospital
prescription paper
Patient name: Berhanu Tamirat
Age: 40yrs
Diagnosis:______________

Rx—Lasix 80mg po Bid for 1 wk

Nefidipine 40mg po Bid for 1 wk
Prescriber name:_________________________________
Qualification:__________________________________
Sign:_______________________________________

10 12/06/2025
1
 Accurate preparation and labeling of drugs with

provision of appropriate information.

Dispensing the drug in a safe and hygienic manner

Making sure that the patient understands and

appreciates the value of taking specific drugs for

specific indications.
10 12/06/2025
2
 Good dispensing practices ensure that

The correct drug is delivered

To the right patient

In the required dosage and quantities

 With clear instructions, and

 In package that maintains an acceptable potency

and quality of the drug.

10 12/06/2025
3
 Determinates of dispensing

The training & supervision the dispenser has received

 The drug information available to the dispenser

 A shortage of dispensing materials and

 Insufficient dispensing time due to heavy patients

load may also have adverse impacts on dispensing.

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4
 Some ways to reduce dispensing errors:

 prepackaging and labeling commonly used drugs

Involving more than one individual to process each

prescription
Keeping the pharmacy professionals up to date

Improving communication skill

professional code of ethics by pharmacy professionals

10 12/06/2025
5
 The dispensing environment should possess:

Appropriate temperature

Sufficient lighting

 Humidity control

Cold storage facilities

Adequate shelving to ensure integrity of the stored drugs

 Dispensing table, aids, etc.

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1
 Stock management

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3
Elements that insure proper stock management

A. Acquisition of drugs
Before drugs and medical supplies are issued from store to

dispensing room
 store requisition/delivery (issue) form should be filled by

the dispenser & duly signed by authorized personnel

all drugs found in drug retail outlets must be obtained or

collected from legal sources.

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 When you receive drugs for dispensing:

Ensure that there is sufficient storage place

Prepare and clean the areas for receiving and storing

Inspect packages for damaged and/or expired

products
Check that all original boxes, tins, or bottles are

unopened and are in good condition.

11 12/06/2025
5
 If products are defective:
Separate the damaged or expired stock from the

usable stock
Refuse to accept the products

Follow your facility’s procedure for handling

damaged or expired stock.

 Report quality problem to the nearest regulatory

body.

11 12/06/2025
6
 Ensure the expiry date is visibly marked on every

package or unit
 Arrange products in the storage area in FEFO or FIFO

procedure.
Take note of the unit price of each drug and medical

supplies and compare it to the previous unit price.

11 12/06/2025
8
 B. Stock keeping

Dangerous drugs should be stored separately under lock

and key

Place liquid products on the lower shelves or on bottom

Store products that require cold storage in appropriate

temperature controlled zones.

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9
 Stock keeping…
 Keep high security/high value products in appropriate

secured places
Separate damaged or expired products from the usable

stock with out delay and dispose using established

disposal procedures
Always store all products in a manner that facilitates

FEFO policy for stock managements.

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 Stock keeping…

Keep veterinary drugs separated from drugs for

human use
Report to appropriate body for redistribution of

drugs with near expiry date

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1
 C. Stock rotation

Always issue products that will expire first

 To facilitate FEFO, place products that may expire

first in front of products with a latter expiry date.

Write expiry dates on stock cards

Supplies with no expiry or manufacture date (e.g.

gauze, cotton, etc.) should be stored in the order

received and dispensed accordingly.
12 12/06/2025
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 D. Arrangement of drugs

Commonly used methods of drug arrangement:

Alphabetical order by generic name

 Pharmacotherapeutic category

 Dosage forms

Coding
12 12/06/2025
3
 In arranging drugs
Each dosage form is arranged in separate & distinct areas
Sufficient empty space should demarcate one drug or
dosage form from another
Put drugs in dry place protected from direct sun light and
heat
Store liquids in a pallet on the floor or on the lowest shelf
Do not store anything directly on the floor
Always store cold-chain items in the refrigerator

12 12/06/2025
4
 E. Storage condition

1. Normal Storage conditions

Unless special storage conditions are stated, drugs

should be stored in a dry, adequately ventilated, shady

and cool store room.

12 12/06/2025
5
 When a product label states “Protect from moisture”

 store the product in a space with no more than 60%

relative humidity
 Free air circulation by opening windows, using fans or

air conditioners

12 12/06/2025
6
 Some products are photosensitive and will be damaged

if exposed to light.
To protect products from sunlight:

Shade the windows or use if they allow the passage

of direct sunlight,
Keep products in cartoon

Do not store or pack products in sunlight

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7
 Cold storage conditions

Maintained by using refrigerators and freezers for products

that may be degraded rapidly when kept at room temperature

or even at cool places, e.g. vaccines, insulin, etc.

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8
 Special storage conditions

Narcotic and psychotropic substances, and

combustibles requires special storage condition

Narcotic drugs, psychotropic substances, and their

documents should be kept in securely locked rooms or

cupboards.
 The keys should be kept in a secure place and it is

preferable that only the chief of pharmacy should have

access to them.
12 12/06/2025
9
 Combustibles

Includes alcohol, ether and other organic solvents

Must be stored in special or separate rooms.

 Use a small, separate outbuilding as a special store for

inflammable supplies, since it virtually guarantees that

fire will not spread throughout the store.

13 12/06/2025
0
All stores should be equipped with fire extinguishers.

A good alternative to fire extinguishers is represented by

wooden or metal buckets filled with sand

13 12/06/2025
1
 The dispenser…

Have good calculation and arithmetic skills

 Have skills in assessing the quality of preparations

Have attributes of cleanliness, accuracy and honesty

Have attitudes and skills required to communicate

effectively with patients

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 The dispenser…

Good administrative knowledge and skill

Fair attitude towards patient interest and commercial

pressure
Respect to pharmacy law and professional code of

ethics.

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4
 The dispenser…

Sufficient training according to the level of the health

institution
 Knowledge about national polices and working

guidelines
Good knowledge of societal norms and cultural values

Good working relation with other health care

professionals
13 12/06/2025
5
 Good Dispensing Process

13 12/06/2025
6
13 12/06/2025
7
13 12/06/2025
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13 12/06/2025
9
14 12/06/2025
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 Good Dispensing Process

Step 1. The interpretation and evaluation of a prescription

Step 2. The selection and manipulation of the medicines

Step 3. The labeling and supply of the medicine in an appropriate container

Step 4. The provision of information and instructions to a patient

Step 5. Recording the transaction

Step 6: Prescription filing

14 12/06/2025
1
 Step 1. Receive and validate prescription or

verbal request
Ask the patient to give his/her name and check the

name with that on the prescription.

Cross checking the name and identity of the patient

must also be done when issuing the drugs.

14 12/06/2025
2
 Check the following information on the prescription:
 Patients name, sex, age, card number, address

Diagnosis (ICD code number)

Drug name, strength, dosage form, course of treatment

 The prescriber name, qualification, signature,

registration number

14 12/06/2025
3
 Step 1.

 Date of the prescription

Whether appropriate prescription form is issued or

not (e.g. for controlled drugs)

14 12/06/2025
4
 Step 2. Understand and interpret prescription

Carefully read the prescription or validate verbal request

Check if the prescription is legally and currently written

Correctly interpret any abbreviations used by the

prescriber
Confirm that the doses prescribed are in the normal range

for the patient (noting sex and age)

14 12/06/2025
5
 Step 2…

Identify common drug- interaction(s)

Verify inadequately written prescription and make

necessary correction with the prescriber’s consent.

Correctly perform any calculations of dose and the

quantity to be issued

14 12/06/2025
6
 Step 3. Prepare items for issue

Select stock container of pre-pack reading the label and

cross matching the drug name and strength against the

prescription.
Read the container label at least twice during the

dispensing process.
Do not select the prescribed drugs according to the color

or location of container.
Do not open many stock containers at the same time.
14 12/06/2025
Open and close containers once at a time.
7
 Step 3

While counting, pouring or measuring, the following

points should be noted:

 Short and/or over counting should be avoided

Clean counting tray and/or spoon used

Graduated measuring cylinder and/or flask must be

used for measuring liquid reduction.

14 12/06/2025
8
Labeling of dispensed drugs should contain

The drug name (use generic name),

 Strength (usually in mg)

 The dose, quantity dispensed and frequency

 Direction for use in a familiar language

 Expiry date or use by date

14 12/06/2025
9
 Labeling…

 The name of the patient

The name and address of pharmacy

 Dispensing date

 Dispenser name and initials

 Special caution (whenever applicable)

15 12/06/2025
0
 Labeling of dispensed medicines should be
clear, legible, tailored, and simple to understand

Labels should be printed, typewritten or stickers.

Abbreviations and unfamiliar expressions should not be

used

For those who cannot read pictorial or graphic

labels/symbols should be given in addition to written
instruction
15 12/06/2025
1
Information on strips or blisters is by no means a
substitute for labeling
The required label should be affixed on the
strips/blister
Identify the best location on the package to write or
affix the label
The design should allow addition of the label
without covering important patient information
provided on the manufacturer’s label

The provision of label and medicine use information

is required for all adult and pediatric dosage forms
15 12/06/2025
2
 Example of label –Cloxacillin

15 12/06/2025
3
 Example of label –Clotrimazole

15 12/06/2025
4
 Example of label –Gentian Violet
XYXT ሆ ስፒ ታ ል መ /ቤ ት : c.l 047362…

የመ ድ ኃኒት አጠ ቃ ቀ ም መ ረጃ

Gentian Violet 0.5%, # 1 bottle

Öª ƒ u_____ c¯ ƒ ቆ ስሉ ን ይ ቀ ቡ ት
T ታ  u _____ c¯ ƒ ቆ ስሉ ን ይ ቀ ቡ ት

ለ 3 ቀ ናት
ሊ ደረጉ የሚ ገባቸ ው አስፈ ላጊ ጥ ንቃ ቄ ዎ ች ፡-
1. u› õ ¾T >¨ cÉ › Ã ÅKU !!
2. c¯ ~” Ö wk ¨ <ይ ቀ ቡ ት !!
3. ŸK?L c¨ <Ò` › Ã Ò\ !!
4. S É ’ >
~” ¨ cŬ ÁM} KS Æ U M¡ „ ‹ " ÒÖ V ƒ KvKS <
Á¬ „ KA ÁT ¡ \ !!
5. ¾I S U U M¡ ƒ eKÖ ó w‰} hK˜ wKA መ ቋ[ Ø ¾Kw­ ƒ U !!
6. መ ድ ሃ ኒቱ ን በቁ ስሉ ላይ ብ ቻ ይ ቀ ቡ ት !!
7. የቆ ሰለዉ ቦታ በፍ ጹ ም መ ሸፈ ን የለበት ም !!
8. የል ብ ስ ቀ ለም ል ያበላሽ ይ ች ላል !!
9. ል ብ ስና አንሶላን ሁ ል ጊዜ ማ ጽ ዳት አለብ ዎ ት ም !!
10. መ ድ ሃ ኒቱ ን በተ ገዛ በአንድ ሳም ንት ጊዜ ዉ ስጥ መ ጠ ቀ ም አለብ ዎ ት ፡ የተ ረፈ ካለ ይ ድ ፉ ት !!
11. Ñ>
² ? ÁKð uƒ ” ¨ à ”U ¾wMi ƒ U MŸƒ Ád¾” S É ’ >ƒ › ÃÖkS < !!
12. S É H’ >
ƒ G< MÑ>² ? u^c<S Á¹ uÅ”w } ŸÉ • w` H” uT à Åር euƒ uÅ[ p“ k ´ n ³ x Áek U Ö <
!!

¾ታ ² ² Kƒ c¬ eU : ወ /ሮ ብ ዙ ነሽ ተ ሰማ
k ” : የካት ት 27፣2005 Expiry date፡ J an 2014

Q é“ ƒ uT Ã Å` c<
uƒ x à k S Ø !!
15 12/06/2025
5
 Step 4. Issue drugs to patient with clear
instructions and advice

The information in the form of verbal and/or written

instructions should include the following:

 How much and how often to take the drug

When to take the drug (e.g., before or after meals)

How long the treatment is to last (e.g., why the entire

course of an antibiotic treatment must be taken)

How to take the drug (e.g., with water, chewing or
15 12/06/2025
6
 Step 4…
How to store the drug (Avoid heat, light and dampness,
Keep out of reach of children )
 Not to share drugs with other persons

 To keep drugs out of reach of children

 Way of administration (e.g. Inhalation , suppository)\

 Which types of foods and beverages should be

taken/avoided while taking the medicine

 Checking weather the patient understood the information

15 12/06/2025
7
 Step 5. Recording, documentation and reporting

A record book and or computer should include

The date, the patient’s name, sex, age

The drug name, dosage strength and dosage form

 The name, address and qualification of the prescriber

The date on which the drug was prescribed

15 12/06/2025
8
 Step 5…

The amount issued and the dispenser’s name and

initials
The date of dispensing

 Details of any repeat indications

15 12/06/2025
9
 Step 6 Prescription filing

Each prescription should be signed and filed

The following procedures should be followed while
filing prescriptions:
At the close of each day all dispensed prescriptions
should be organized
Prescriptions should be filed sequentially by day in a
single container/carton for each month.
The container should be labeled with the month and
year and should be arranged on a monthly basis.

16 12/06/2025
0
 Step 6, cont’d.
Normal prescriptions should be filed securely for two
years and special prescriptions for 5 years.

Prescriptions, patient and medication related records and

information should be documented and kept in a secure
place that is accessible only to the authorized personnel.

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1
 HOSPITAL PHARMACY
SERVICES

16 12/06/2025
2
 INTRODUCTION
 Pharmaceutical services are an essential component of
hospital care.
 Effective pharmaceutical services promote:

 the safe, rational and cost-effective use of drugs.

 Maximizing health gain and
 Minimizing risk to patients

 Ensures the continuous availability of all pharmaceuticals that

are required for patient care

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3
OPERATIONAL STANDARDS FOR
PHARMACY SERVICES
1. The hospital has DTC which implements measure to
promote the rational and cost effective use of
medicines
2. The hospital has a medicines formulary listing all
pharmaceuticals that can be used in the facility
 The formulary is reviewed and updated every 2 year
 The hospital has out patient, inpatient, emergency
pharmacies and a central medical store each directed by
a registered pharmacist

16 12/06/2025
4
 OPERATIONAL STANDARDS FOR
PHARMACY SERVICES…..
4. The hospital ensures that all types of drug
transaction and patient medication related
information are properly recorded and
documented.
5. The hospital has Standard Operating Procedures
(SOPs) for all compounding procedures carried out
6. The hospital provides access to drug information to
both healthcare providers and patients in order to
optimize drug use

16 12/06/2025
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 OPERATIONAL STANDARDS FOR
PHARMACY SERVICES…..
8. The hospital has policies and procedures for
identifying and managing drug use problems,
including: monitoring ADRs, prescription
monitoring and drug utilization monitoring

9. The hospital has a drug procurement policy

approved by the DTC that describes methods of
quantification, prioritization, drug selection,
supplier selection and ordering of pharmaceutical
supplies of stock-outs, wastage, over supply and
drug expiry
16 12/06/2025
6
 OPERATIONAL STANDARDS FOR
PHARMACY SERVICES…..
10. The hospital conducts a physical inventory of all
pharmaceutical in the store and each dispensing
unit at a minimum once a year.
11. The hospital ensures proper and safe disposal of
pharmaceutical wastes and expired drugs
12. The hospital has adequate personnel, equipment,
and facilities to store pharmaceutical supplies
and carry out compounding. Dispensing, and
counseling services.
16 12/06/2025
7
 DRUG AND THERAPEUTIC
COMMITTEE

“Each hospital should establish a Drug and Therapeutic

Committee to promote the safe, rational and cost-
effective use of medicines”

16 12/06/2025
8
 MEMBERSHIP OF DTC
 The DTC Should be multidisciplinary including, as a
minimum:
 Chief Clinical Officer, or equivalent (Chair Person)
 Senior Pharmacist (Secretary)
 A representative from each case team
 A representative clinician from each specialty
 (internal, Surgery, pediatrics, Obs/gynae)
 Senior nurse representative
 Representative from hospital finance department
 Representatives from other services as deemed
16 12/06/2025
9 necessary
 MEMBERSHIP OF DTC…
 All DTC member, especially the chair and
secretary, should be given sufficient time for
their daily functions, and this should be
included in their job descriptions.
 Other non-voting, non executive members may
be invited to attend DTC meetings to discuss
issues that require their particular expertise.

17 12/06/2025
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 PROCEDURE OF DTC MEETINGS
 The DTC should meet at a minimum of every two
months, or more often as the need rises
 Minutes should be kept of all DTC meetings
 The agenda, supplementary materials and minutes
of the previous meeting should be prepared by the
secretary and distributed to members for review in
sufficient time before the meeting.
 All DTC recommendations should be disseminated
to the medical staff and other concerned parties
and authorities in the hospital.
17 12/06/2025
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 ROLES AND RESPONSIBILITIES OF THE
DTC
1. To develop and maintain hospital formulary:
 The hospital should have a Hospital Formulary listing all
pharmaceuticals that can be used in the facility
 A participatory process should be followed to develop the
formulary involving clinical, laboratory, diagnostic imaging
and finance personnel.
 The formulary should be reviewed and updated at least
annually?

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BENEFITS OF AN EFFECTIVE FORMULARY
SYSTEM
 Approved and efficacious drugs available for use:
Only the most effective and safe products

Drugs that have been evaluated systematically

Drugs that are chosen and approved to treat the

diseases of the region or country
Physicians develop greater experience with fewer
drugs

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 BENEFITS OF AN EFFECTIVE
FORMULARY SYSTEM……
 Drug therapy at lower cost:
Ineffective, high-cost drugs will not be available
Availability of most-effective drugs leads to
improved outcomes and lower cost
Reduced inventory cost

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 BENEFITS OF AN EFFECTIVE
FORMULARY SYSTEM…..
 Consistent supply of drugs:

 Regulating the number of drugs will improve

procurement and inventory management

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 BENEFITS OF AN EFFECTIVE
FORMULARY SYSTEM……
 The selection of pharmaceuticals for the
formulary should be based on:
 The national drug list (List of Drugs for Ethiopia)

 FMoH’s Essential Health Services Package

 The national Standard Treatment Guidelines (STG)

 The local pattern of diseases

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 BENEFITS OF AN EFFECTIVE
FORMULARY SYSTEM…..
 During the preparation of the formulary
emphasis should be placed on:
 Drug description using generic names

 Dosage form, strength and package size – in basic

units (e.g., amoxicillin 500mg, capsule, 100 per pack)

 Inclusion of a limited number of drugs to improve

drug availability, adherence to treatment, focused
prescribing, and to simplify supply managment

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7
2. To develop standard clinical/treatment
guidelines
 STGs promote rational drug use and provide a bench
mark of optimum treatment for the monitoring and
audit of drug use.
 The DTC should implement national STGs for use in
their own hospital
 Hospital should develop their own STGs for common
clinical conditions that are not covered by national
STGs
 A participatory process should be followed to develop
STGs involving clinical, laboratory and diagnostic
17 imaging personnel 12/06/2025
9
 ADVANTAGES OF STGS
Health Care Providers:
 Provides assistance/standardized guidance to
practitioners
 especially to those with lower skill levels
 Promotes high quality of care
Health Care Officials:
 Provides a system for controlling costs
 Provides a basis for evaluating quality of care
 Provides information for forecasting and ordering
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 ADVANTAGES OF STGS…
Patients:
 Patients receive optimal drug therapy
 Helps provide good outcomes
 Lower cost

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1
 DISADVANTAGES…??
 Inaccurate guidelines will provide the wrong
information.

 Guideline development and maintenance takes

much time and effort

 May give false sense of security and discourage

ongoing critical thinking

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 ESTABLISHING THE GUIDELINE
 Determining appropriate treatment options:
 Use fewest drugs necessary
 Choose cost effective treatment
 Use formulary drugs
 Give 1st, and when appropriate 2nd, and 3rd Line
treatment options
 Provide dose, duration, contraindications, side-effects

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 ESTABLISHING THE GUIDELINE….
 Determine what information should be included in the
STG:
 Clinical condition
 Diagnostic criteria and exclusions
 Treatment objectives
 Non-drug treatment
 Drugs of choice
 Important prescribing information
 Referral criteria
 Patient education information
 What to do when clinical response is poor
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3. To develop policies and guidelines for managing
formulary and non formulary items
 Policies/guidelines for the selection,
quantification, procurement and distribution of
pharmaceuticals.
 Policies/guidelines for generic substitution and
therapeutic interchange
 Policies/guidelines on the use of specific
medications. For example, narcotics,
chemotherapeutic agents, highly expensive
medications, etc.

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 4. To establish mechanisms to identify
and address drug use problems
 The DTC should establish policy and procedures
for identifying and managing drug use problems
including, as a minimum:
 Monitoring ADRs
 Prescription monitoring
 Drug utilization monitoring
 Antimicrobial prescribing and use

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 5. To establish and oversee the DIS
 Each hospital should establish a drug information
service that provides information and advice to
health professionals, patients and the public

18 12/06/2025
9
 6. To develop an annual action plan
 The DTC should prepare an annual action plan,
describing the main tasks to be under taken in the
year with corresponding budget requirements to
cover areas such as trainings, printing, etc

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HOSPITAL PHARMACEUTICAL SERVICES
 Clinical pharmaceutical services
 Dispensing and medication use counseling
 Emergency pharmacy services
 Compounding of extemporaneous preparations
 Drug information services
 Monitoring of drug use problems
 Drug supply management
 Pharmaceutical waste management

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 CLINICAL PHARMACY SERVICES
 Clinical pharmacy services are patient-oriented
services developed to promote the rational use of
medicines, and more specifically:
 to maximize therapeutic benefits (optimize treatment
outcomes),
minimize risk, reduce cost, and
support patient choice and decision thereby
 Ensuringthe safe, effective and economic use of
drug treatment in individual patients.

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Functions of clinical pharmacists:
1. Provide advice to doctors, nurses and other
healthcare providers on the clinical use of
medicines, economic drug utilization and safety
2. Offer direct patient care services through, for
example, medication history taking, medicines
education and advice
3. Offer hospital managers, including clinical
managers, appropriate advice and support to enable
them to make informed decision with respect to
medicines policy, procedures and guidelines
designed to ensure safety, effectiveness and
economy in medicine use
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 Emergency pharmacy services
 Emergency pharmacy service is one of the basic
healthcare services to be provided under the
emergency service unit of a hospital.
 Directed by a register pharmacist who is accountable
to the emergency unit of hospital.
 Service should be available 24 hours a day
 The pharmacist is responsible to coordinate and
prepare emergency pharmaceutical list and
ambulance kits for the hospital.
 Ensures continuous availability of these
pharmaceuticals
19 12/06/2025
6
Emergency pharmacy services:
 May receive orders by words of mouth or through
telephone but should be written and documented
within 48 hours
 The quantity ordered should be limited to emergency
period only
 Ensure safe and correct use of medications as
medication error is significant in this service area

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 Drug information services
 All hospitals should provide drug information service
for health care professionals, patients and the public.
 The service generally responds to patient-oriented
drug problems received from clinical staff or patients
 But, the drug information service can also provide
education and training to health professionals and/or
the public regarding appropriate and safe drug use

19 12/06/2025
8
 Drug information services….
 DIC should be established in each hospital.
 The center should have:
 Sufficient space
 Furnitures: filing cabinet, computer, printer
 Telephone
 Internet access
 Current reference materials: books, journals, drug profiles,
formularies

19 12/06/2025
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 Drug information services…
 DIC should be open during normal pharmacy
hours
 Should be staffed with appropriate skilled
personnel who are trained in the provision of
drug information

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 Monitoring of Drug Use Problems
 The hospital should develop and implement a policy
for monitoring drug use and to identify drug use
problems that include:
 Monitoring ADRs

 Monitoring of prescription

 Drug utilization monitoring

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 Monitoring and Reporting of ADRs
 Side effects/ ADRs may range from mild to serious and
life threatening
 Detection of SEs and ADRs is important to optimize
patient care and prevent harm
 An important element of post marketing surveillance

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 Monitoring and Reporting of ADRs….
 Individuals susceptible to an ADR include:
 Those with multiple diseases
 Those on multiple drug therapy
 Geriatric or pediatric patients
 Those receiving medicines that are known to be associated
with serious adverse effects
 Those receiving drugs with a low therapeutic index or
potential for multiple interactions

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  Those with organ impairment that may alter drug PK
 Those who have had a previous ADR
 A standardized form should be used to record
and report ADRs

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 An ADR focal person should be appointed by the DTC.
He/she is responsible to:
1. Ensure that all health professionals are involved in
detecting, assessing, managing and reporting
potential ADRs
2. Ensures that ADR report forms are readily available
in all clinical areas and that health professional are
familiar with the form and how to complete it
3. Receive ADR report forms from clinical staff
4. Investigate potential ADRs
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 5. Analyze ADR data and compile reports
6. Provide regular reports to the DTC/and the
Hospital Management on ADRs in the facility
7. Report all ADRs to the Regulatory Body

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  The DTC should receive regular reports from
the ADR focal person and make any necessary
decisions regarding the use of the drug in the
facility
 Where necessary the hospital formulary should
be amended to take account of detected ADRs

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Suspected ADRs should be investigated and
managed as follows:
1. Assess suspected ADR with respect to:
a) Patient details: age, gender, organ function, height,
weight, Dx and comorbidities prior to ADR, previous
exposure to the suspected drug(s) or related drug(s)

b) Medicine details: non-prescription drug, alternative

treatments, recently ceased medicines; name, dose,
route of administration, manufacturers, batch; date
and time commenced’ date and time discontinued (if
applicable); indication

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 c) Comprehensive adverse reaction details:
 description of the reaction;
 time of onset and duration of reaction;
 complications and sequelae;
 treatment and outcome of treatment;
 relevant investigation results or autopsy report

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2. Perform causality assessment to assess likelihood
of the drug causing the observed reaction.
 A literature review to assess the likelihood that a
suspected ADR was caused by a particular drug and/ or
advice of other health professional may be sought

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 3. Make recommendation on treatment
options, including possible alternative
treatments taking into consideration:
 The likelihood of the suspected drug(s) causing
the reaction,
 The clinical significance of the reaction
 The condition of the patient,
 The requirement for therapy

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 Prescription Monitoring
 Prescription issued by each Case Team should be
regularly mentioned to identify problems or
opportunities for optimizing treatment.
 The DTC should establish a policy that outlines the
responsible person(s), the process and frequency with
which prescription monitoring will be conducted for
each Case Team

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 Patients and their medicine therapy should be
monitored for:
 Legality, legibility and completeness of prescription
 Relative efficacy of the medication for the clinical indication
 Compliance with the hospital formulary or applicable STG
 The appropriate dose, route of administration, duration
 Possible altered kinetics of A, D, M or E
 Significance of DI
 Possible drug/disease incompatibilies
 Drug/laboratory test interference
 Duplication of therapeutically similar drugs

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 Drug utilization Monitoring
 The purpose of drug utilization monitoring is to assess
the over all drug utilization pattern of the hospital and
identify problem areas for intervention and the impact
of interventions.
 Two main methods:
1. Indicator study methods
2. Drug use evaluation (DUE) methods

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 a) Indicator study methods
 Can be developed to assess prescribing, patient
care or facility practice.

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 Prescribing indicators
 Average number of medicines per encounter
 % of medicines prescribed by generic name
 % of encounters with an antibiotic prescribed
 % of encounters with an injection prescribed
 % of medicines prescribed which are from the
essential medicines list or formulary list

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 Patient care indicators
 Average consultation time
 Average dispensing times
 % of medicines actually dispensed
 % of medicines that are adequately labelled
 % of patients who know how to take their
medicines

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 Facility indicators
 Availability of essential medicines list or formulary

 Availability of STG

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 Drug Use Evaluation Methods (DUE)
Particularly important to investigate:
 Perceived overuse or underuse of medications
 Problems identified by indicator studies,
 High numbers of ADRs
 Excessive amounts of non-formulary medicines
used
 Use of high-costs medicines when less expensive
alternatives exist
 Use of excessive numbers of medicines within a
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 Steps to conduct a DUE study
1) Define appropriate medicine use
2) Audit actual prescribing practice against the set
criteria
3) Analyze data, prepare report and
recommendations based on findings
4) Present report and recommendations to DTC and
relevant staff
5) Implement recommendations arising from the
study, repeat study to assess the impact

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 Reading assignment

Pharmaceutical Waste
Management??

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 Pharmaceutical Waste Management
 Pharmaceuticals which are eligible for disposal
include the following:
All expired/damaged pharmaceuticals
All unsealed syrups or eye drops (expired or
unexpired)
All cold chain products not stored as per
manufacturers’ recommendations (e.g.: insulin,
hormones, gamma globulins and vaccines)
All bulk or loose tablets and capsules with containers
which are not sealed, properly labelled or within
broken blister pack, and
All unsealed or damaged tubes of creams, ointments,
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 Each hospital should establish a pharmaceutical
disposal committee comprised of representatives
from:
 pharmacy,
 finance/audit, and
 sanitation services

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 Each hospital should establish an SOP for the
management of pharmaceutical waste
 The SOP should include:

The schedule,

Methods of disposal

Materials for the disposal

Equipment required for disposal

The responsible person.

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  The SOP should be approved by the hospital
DTC.
 Disposal of pharmaceutical wastes should be
supported by proper documentation, including
the price of the products, for audit and other
legal requirements.

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Basic steps to be adhered for the disposal
of pharmaceutical wastes are:
Step 1: Pharmaceuticals that are expired/ damaged or
unfit for use should be counted, recorded and placed
segregated from the other pharmaceuticals in the
hospitals.
Step 2: List of pharmaceuticals expired or unfit for use
should be submitted to the responsible body for
disposal.
Step 3: The pharmaceuticals should be sorted out based
on the pharmaceutical dosage form and chosen
disposal method.
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Step 4: The pharmaceuticals should be disposed of in
accordance with the appropriate method and in the
presence of delegates from the responsible body.
Step 5: Signed and stamped certificate of disposal
format should be issued by the authorized body
entitled to dispose the drugs.
Step 6: Adjustments for each disposed drug should be
made in the available inventory management system.

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 Hospital pharmacy and cleaning staff should be
trained/ well informed about the potential risks of
hazardous pharmaceutical wastes and their
management.
 Cleaners and others handling hazardous
pharmaceutical wastes should wear protective devices
such as apron, plastic shoes, gloves, head gears, eye
glasses, and goggles.

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 General Disposal Methods:
 Return to donor or manufacturer: Whenever practical,
the possibility of returning unusable drugs for safe disposal
by the manufacturer/donor should be explored;
particularly for drugs which present disposal problems,
such as antineoplastics.
 Waste immobilization/encapsulation: This involves
immobilizing pharmaceutical wastes in a solid block within
a plastic or steel drum filled to 75% capacity.
 The remaining space should be filled and sealed with
cement or cement/lime mixture and water in proportions
15:15:5 by weight.
 The sealed drums are then placed at the base of a land fill
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Landfill:
 Place the expired or ‘unfit for use’ pharmaceuticals
directly into a land disposal and cover it with municipal
waste to prevent scavenging. It should be noted that
discarding in open, uncontrolled dumps with
insufficient isolation from water courses can lead to
pollution.

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Sewer:
 Some liquid pharmaceuticals, e.g. syrups and
intravenous fluids, can be diluted with water and flushed
into the sewers in small quantities over a period of time
without serious public health or environmental effect.
 Fast flowing water courses may likewise be used to flush
small quantities of well-diluted liquid pharmaceuticals or
antiseptics.
 In this case, disposal should be done in consultation with
the hospital sanitarian/environmental health specialist.
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Traces of pharmaceuticals and other chemicals from
the compounding and sterile preparation (if
applicable) can be discharged directly into the
sewerage system
Burning in open containers: Pharmaceuticals should
not be disposed by burning at low temperature in open
containers, as toxic pollutants may be released into the
air.
Paper and cardboard packaging, if they are not to be
recycled, may be burnt but polyvinyl chloride must not
be.
It is strongly recommended that only very small
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Incineration:
 Expired solid form of pharmaceuticals are burned
using a two chamber incinerator that operates at a
minimum temperature of 850 0C.

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 Product specific disposal methods:
1. Solids, semisolids and powders:
 Medium temperature incineration should be applied
for solid forms.
 If there is no incinerator, encapsulation of the drugs
before discharge to a land fill is necessary.
 Solids, semisolids and powders should be removed from
their outer packages but should remain in their packaging.
 The disposed drugs then should be covered by municipal
waste immediately to prevent scavenging.

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  Pharmaceuticals classed as biodegradable
organic material in the solid or semisolid form
such as vitamins, can also be disposed of in a
landfill.

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 2. Liquids
 Pharmaceuticals that can be classified as readily
biodegradable organic materials such as liquid
vitamins can be diluted and flushed into a sewer.
 Harmless solutions of different concentrations of
certain salts, amino acids, lipids or glucose may
also be disposed of in sewers.
 Small quantities of other liquid pharmaceuticals
which are not controlled drugs, antineoplastics or
anti-infective can also be flushed into sewers.

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 3. Ampoules
These should be crushed on a hard impermeable
surface (e.g. concrete or in a metal drum) and the
crushed glass should be swept up, placed in a
container, sealed and disposed of in a land fill.
Ampoules should not be burnt or incinerated as
they will explode, possibly causing injury to
operators and damage to the incinerator by
melting and clogging.

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4. Anti-infectives
 Anti-infective drugs should not be discarded in an
untreated form. Generally they are best incinerated and
if this is not possible they can be encapsulated.
 Liquid anti-infective may be diluted in water, left for
two weeks and disposed to the sewer.
 Controlled substances should be rendered unusable, by
encapsulation, and then dispersed among the
municipal solid waste in a land fill or incinerated.

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5. Antineoplastics
 These drugs should be segregated from other
pharmaceuticals and kept separately in clearly marked
containers.
 They should be returned to the supplier if contract
supports; otherwise, they should be destroyed in a high
temperature incinerator of at least 1200 °C.

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 Antineoplastics should never be disposed of in a land
fill without encapsulation or inertization.
 They should never be disposed into sewers and water
courses.
 Work teams handling these drugs should avoid
crushing cartons or removing the product from its
packages

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6. Aerosol canisters
 Disposable aerosol canisters and inhalers should not
be burnt or incinerated, as high temperatures may
cause them to explode, possibly causing injury to
operators and /or damage to the incinerator.
 Provided they do not contain poisonous substances,
they should be disposed of in a landfill dispersed
among municipal solid wastes.

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 Waste types not to be incinerated
 Pressurized gas containers.
 Large amounts of reactive chemical waste.
 Silver salts and photographic or radiographic wastes.

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 Halogenated plastic such as polyvinyl chloride (PVC),
which is mostly used for I.V. fluids container.
 Waste with high mercury or cadmium content; such as
broken thermometers, used batteries, and lead-lined
wooden panels.
 Sealed ampoules or ampoules containing heavy metals

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 THE END
THANKS!

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