Can you read this Prescription ???

There were days when teachers used to scold us for bad handwriting at school citing it as doctor’s handwriting. I was unable to decipher the exact meaning of it at that time. Days gone, I am getting the exact taste of that sarcasm.

When I started my professional career as a Hospital Pharmacist the first thing I had to do was to understand the code language [ doctor’s way of writing medications] in the prescription. Now after more than two years of work at hospital pharmacy the cycle is repeating and for how long I am unsure. 

During day to day encounter with such prescriptions, I have seen really bad to very good written prescriptions. Errors are bound to happen and I have experienced it. Sometimes wrong medicine was prescribed which I corrected by consulting the doctor. I have received some prescriptions with wrong dosing issues [ ciprofloxacin 200mg two times a day, ciprofloxacin 500mg three times a day, azithromycin 500mg three times a day and so on] but corrected them through doctor consultation. I sent back those prescriptions containing narcotics but without name of the prescriber and the date. Some prescriptions were so bad that I got confused whether the drug should be taken for certain days, week or months. So yup, we can minimize the errors and we are only the right person to do so.

I wonder why doctors don’t think it important to write the prescriptions correctly and neatly. Patients waste their entire day to meet the physicians. Doctor fill up the prescription but what is its use if it cannot be understood by the pharmacist who dispense the medicines to the patients. A mere change in letter can change the medicines given to the patients. Then what if wrong medicines are dispensed. Aren’t we playing with lives of people. Are doctors so much busy that they cannot even write it clearly what patient need to take in order to cure the diseases. 

Grow up, I still remember a quote by Dr. Vikash during the Pharmacovigilance training at Yak and Yeti hotel “gone are the days where doctors with bad handwriting were thought to be good doctors. Reality is if a doctor cannot write a medicine properly then he/she cannot be considered as good one. They are the bad ones’. I agree with this statement.

In the present context most of the overdosing and medication errors are due to bad prescription writing and wrong dispensing. The confusion with LASA medications and guess work by the pharmacist is another reason. We have read the characteristics of the good prescription. We are the one to dispense correctly and we are responsible for anything wrong that happen due to medications. So we must be careful while reading the prescriptions. 

Why not we send the confusing and badly written prescriptions back to the doctors or we can contact the doctor and clarify the issue. We cannot repeat mistake just by guessing wrong. If you get the prescriptions with narcotics without details of the prescriber and the patients, send back. It’s not your fault. 

Now time has come to be good at writing prescriptions. The medication errors that we are getting today can only be resolved when doctors give some extra seconds to write neat prescriptions. Doctors should at least consider writing the name of drug, dose and the frequency of taking the medicines correctly. This is directly linked with people’s lives. What about try E-prescriptions. This can minimize errors by 80 % I guess. On the other side of the coin, we should update ourselves on handling prescriptions. Training might help this out. Reading leaflets and searching about the daily used medicines on internet will enrich you. 

The diagnosis and treatment that a doctor does is finally complete when the patient gets correct medications and gets cured. Otherwise everything is of waste. So pharmacist should play a role in controlling bad dispensing. Never guess the medicines. Say no to bad prescriptions. 

HOSPITAL PHARMACISTS AND THE RISK OF INFECTIONS

“We pharmacist are the bridging link between the Physicians and the patient” Nobody can deny this fact. People from outside world [outside the pharmacy] only see Pharmacists reading out prescription carefully and dispensing medicines. They only look at the aprons and IDs of the dispenser.  Nobody ever thinks of the risk involved while handling the medicines.

Firstly, we pharmacists are unaware about the packaging, handling and transport of medicines. The environment at which the medicines are exposed to. Secondly, once the medicines are brought for dispensing, are handled by many individuals over a time. With bare hands the medicines are taken out from the package and dispensed to the patient party. How many of we without doubt tell about the condition of our hands. Are they really free of germs or bacteria? I doubt.

Also, there is a system of medicines return if they are not needed by the patients or the physicians prescribe another one. Also, the medicines from Hospital wards are returned to the pharmacy once they become unused. These are the medicines handled by the patients: may be suffering from fatal diseases. With regular contact with the patients, the medicines may also contain bacteria and germs, which may get transferred to other healthy individuals. We pharmacists are most susceptible to these.

Patients with communicable diseases come to visit the pharmacy coughing and sneezing. We pharmacists come in direct contact with such patients. Is that not a risk? Certainly, a huge risk. The droplets from the patients carrying the carrier agents pose greater threat of infection transfer.

I frequently hear hospital staffs complaining about headaches, uncured cough and fever. Even doctors and nurses come to the pharmacy asking for medications. This is all due to the infection transfer from the patients.

So, we should consider the risk factors involved while dispensing the medicines and act carefully. Use of disposable masks and gloves may be a better option. But what about the returned medicines? Can they be sterilized at first before dispensing again? Are the manufacturer prepared for the sterilization of such medicines? Until and unless these questions remain unanswered, the risk factor still remains. 

HOSPITAL PHARMACISTS: Dynamic Approach

When anyone talks about Hospital pharmacists, it’s not only about dealing with medicines. It is necessary to understand the system of the hospital and dealing with the patients as a whole. It is a learning process and we tend to learn new things each and every day.

Hospital pharmacists come across different people during day to day affairs. How they deal with them is very important as it is directly linked with the reputation of the hospital. However there is no such rule or method of dealing with people visiting the pharmacy as it depends on the capacity, knowledge and behavior of the pharmacists. But polite behavior with a combo of smile adds to the persona of a pharmacist.

 Below are the types of customers that pay a visit to the Hospital Pharmacy.

Regular customer: These are the one who come to purchase the old medications and know how to take them. They are probably recognizable and are easy to deal with.Just smile and provide the medicines. Have a short Outside talk in between if you have time.

  Curious customer: These are over curious about their diagnosis and the medications that they need to take. They want every detailing of medicine from dose, pharmacological uses, side effects and time to take it. Be up to date. Follow the prescription while counselling and never overdo with your explanation. The less you explain the less chance of creating mistakes. Some things are hidden from the patients for effective treatment, never revel that secret.

Emergency Patient: Topmost priority should be given to such patient. The way of reacting to emergency situation is directly related to the life and death of the patient.

Investigator:  These are the one who comes just to investigate about the availability of medicines. These may also be the Medical Representatives (M.R) who come to know about the condition of their products. Help them if you are free.

Opportunists: Some of the customer see opportunity to steal the medicines and surgical items. They sometimes come in group with planning and distract the pharmacist to fulfil their desire. Be careful of these kind. Handover the medicines only after the bill is paid.

 Drug abuser: Common visitors who ask for syringes or narcotic medicines. They pretend to be in serious need of the medicine. They show false prescription with stolen signature of the prescriber. While asking for the syringes, they try to fool the pharmacist by claiming it to be needed for veterinary purposes. Deal with them with care. Speak politely and pretend about the unavailability of the medicines or syringes. Unethical use of narcotics is strictly prohibited and doing it is a criminal act.

Salesman/ Exchanger: These group of customers generally bring medicines for exchange purposes. They ask the pharmacist to give some other medicines by exchanging with their medicines. They even ask for low price of their medicines. Never do this. It’s against the ethics of pharmacy profession.

Talkative: They come to buy the medicines in hurry and start talking over the mobile phone. They are unavailable for quite a time and again come back in hurry. Also, some customers start talking after giving the prescription to the pharmacist and do not listen to what he says. Ask them to be serious.

 Passive: Some people come just to buy what the doctor has written. They do not know what the medicine is for, how long to take and when to take. They even do not ask about it to the pharmacist. Explain properly about the medicine and their use. It is the duty of pharmacist to make them aware of what they need to do and what not to do.

Discount crazy: This has become a culture nowadays. People ask for discount after every purchases of medicines. Discount rate may however vary with type of medication and the person who is buying it. Some people are just annoying as they start giving lecture regarding high profits in medicine business and ask for high discount.

Brand crazy: These are conscious group in one way. But some are really crazy. People often inquire whether same prescribed medicines are available or not. They do not want to change the brands. This is logical in one way as the prescribed medicines may be good: quality wise. But when this is not the case then it seems crazy. People waste their precious time wandering in search of low quality medicines as well. Duty of pharmacist is to convince them to change the brands. But one must be sure in the quality of the substituted medicines.

 Self-Doctor: A person knowing something about disease and medicines act as self-Doctor. They do self-diagnosis of their illness, self-prescribe the medicines; From OTC medicines to antibiotics. This is really wrong act and we pharmacists should not promote it. The diagnosis and treating part shall be handled by authorized prescriber.

Intentionally Aggressive: Some people are really irritating, finding faults in the medicines and complaining. They come with intention to create a hill out of moll. These people should be handled with care. We should be calm and composed while dealing with such customers. Our aggressive approach will create unnecessary discussions which is not beneficial for the image of us and the pharmacy.

Economically Backward: Really, sometimes you get in a situation where a person needs lot of medicines but does not have money to pay. Some people even borrow money from relatives to cover up the medicine charges. You feel like helping but you can’t. As a pharmacist you can provide certain discount to help them buy the medicines.

Foreigners: Have you ever been in a situation where you see a foreigner and start your conversation in English but the foreigner replies in Nepali?? Common isn’t it? While dealing with foreigners we should ask them whether they know Nepali language or not? If yes than it is fine but if not we can converse in English. A sweet smile adds flavor to the conversation. They are our guests, so give priority to them so that they do not get entangled in a line of many people wanting their medicines first. This will create positive image in them about Nepali Pharmacists.

 Hospital Staffs: These are the part of our hospital family.

VIP: Doctors and other high ranked officers; from hospitals or government may visit the pharmacy. They really do not have time for standing in a queue which actually does not look good. Their time is invaluable so they must be given priority. Way of conversing is important while dealing with them. Being relaxed and formal can help a bit. Nervous mind will make you commit mistakes which is embarrassing.

It is quite surprising to see people being so reckless in buying medicines. They even do not bother to hear the proper way of taking medicines. They spent lot of hours queuing for diagnosis in front of physician room but do not show patience in front of pharmacy. Why don't they understand the value of proper counselling? This has affected a lot in disease cure.

Wrongly taken medicines never help. Side effects are bound to happen and result is longevity of illness. People should understand that counselling is also an important part of getting cured. Now, with the addition of clause in the constitution of Nepal 2072 regarding the rights to be aware about the medicines, a patient takes for cure, we hope that more emphasis for counselling will be given in future. 

Inspiring Kabin Maleku!!!

When you look for inspiration among youths in present contexts you may come up with many names. Among them Kabin Maleku is one of many; young, energetic and inspiring.

My senior during my Bachelor in Pharmacy, Kabin Maleku, M Pharma in Pharmaceutics, is actively involved in social services apart from his Professional work as a Lecturer at CIST.

I still remember those days at Raichur, India where we used to share the same roof (Hostel) and conduct programs for Nepali friends. “Nawo Lochan Sahitya-kunj” was a group formed by Kabin and his friends (9 members).

This group grew in size with the admission of new Nepali students. We got chance to sharpen our writing and speaking skills through this group. We as a group tried to promote Nepali literature and culture in India.

His bold presentation skill was the highlight at that time. His constant inspirational words were the cornerstone for mine growth at India. He used to push me do well in every step of my Pharmacy Career.

Nawa Lochan Sahitya-kunj Meet

Also, we four Pharmacy students me, Mr. Kabin, Dr. Ajay Chandra and Pankaj Bhattarai went to Bangalore as delegates, representing Nepali students from our college to participate in a meeting held at R.R. Campus. This meeting was held to unify all the Nepali students studying pharmacy in India. This was one of those instances where we got to meet new Nepali friends and shared our experiences about our stay at India.

Meeting at R.R Campus ,Bangalore

While in Nepal we formed a blog “Pharmasastra” which is  dedicated to Pharmacy students and professionals . We constantly update the blog with innovative ideas, articles related to pharmacy profession, news from pharma world, legal aspects in pharmacy, job opportunities in pharma sector and many more. I feel lucky to have him around as my senior, guide and a friend.
[www.pharmasastra.blogspot.com ]

Now, his social contribution has been noticed up late. He was very active in India as well striving for improving  the lives of Nepali people. His work during devastating earthquake whether to bring tones of medicines from India and distributing in Nepal or building up of schools in Nuwakot is quite appreciable. Now, he is working under Medication for Nepal along with Sumana Shrestha sister procuring and distributing medicines to different parts of Nepal with the help of certain number of volunteers. I feel proud to be related to this group somehow.

Recently, I listened to his interview in Radio City 98.8 and my eyes got filled with joys. His words of wisdom were so inspiring. He appealed all the youths to come under same platform to work for society. No political parties or group is needed to work for the benefits of the people, a strong will is all required. He also stressed on the necessity of bioequivalence tests for those medicines from Nepali and Indian companies before reaching to the people. This is important to control those medicines which have compromised in quality. He was upset with the obstacles created by Government of Nepal in working for the people and hoped for the change.

Brother, I wish you all the best for your future ahead. Hope for your support and guidance furthermore in future. 

Thuli Pathivara Devi Darshan

This was one of my longest and hardest trips; Thuli pathivara (Taplejung)Darshan. After about 6 hours of walk from mathilo fedi to reach the top, I was even struggling to prepare tika for conducting puja. I some how managed it by using the snow from the ground. Enchanting snowcapped himalayas, breathe taking views surrounding the place was the overall highlight.

Gosh!! Why are People so Crazy for BRANDS???

While I was busy with my duty at a Pharmacy, a person so hurriedly arrived and took out a strip of Tablet; Prolomet XL 25 which is Metoprolol sustained release tablet. He enquired whether it was available in our pharmacy or not? I searched through the computer and told him that it was shortage in the market. He was so tensed and reasoned that it was a must needed medicine and he had not taken it from past 1 week. I was greatly surprised. I tried to convince him that there were other brands available in our pharmacy and he could take anyone of them. He was not sure of that. He was so adamant.

Same was the case for Repace H; an Antihypertensive drug with losartan potassium and Hydrochlorothiazide. Recently, it was shortage in the market and people were in search of this brand day and night. I was surprised why people waste so much time in searching for a particular brand when there are other renowned and effective brands available as substitutes. Add to this, the psychological effect. How can a person with hypertension added     with other diseases get proper treatment in this scenario? 

I see several messages written on the walls of some Facebook pages about the scarcity of a particular branded medicines whose substitutes are available abundantly. I still don’t find a proper logic behind this search.

With the permission of some doctors and by convincing the patients, I have been able to change the brand of some medicines that are not available in the market. Proper medicine and health care is our priority. We, pharmacists are the bridging force between the Doctors and the patients. So it is our sole duty to convince them, for effective medical services.

I feel Doctors should not stick to one brand and force the patients to search the medicine even if it is hard to find. Better is to write the alternatives. Why not start writing the Generic form.

Brands are not primary things, the drug that is incorporated within the medicine is the utmost thing. People should understand that. There are many good Nepali, Indian and Bangladeshi brands available in Nepali market.There are some very good Nepali companies supplying quality medicines. Every Nepali medicines cannot be weighed in same balance. And there are some Indian companies whose products are bogus. So why a particular brand. Be choosy…

Proper advice can save the time of the patient. Nothing is worse than psychological effect. This can also be minimized. We have been struggling in the society in establishing ourselves as a strong force in patient care. Time has come to eradicate the thought from people’s mind. So training for proper counselling is the most. The stereotyped behaviour of people can only be changed with everyone’s support; Pharmacists, Doctors and Nepali companies, all should take responsibility for this.