Community Pharmacy And Management PDF

1 Subscribe S R Pharmacy Community Pharmacy And Management In Easy English Prepared By S R Pharmacy Follow me on Instagram and Join Telegram Group By same name S R Pharmacy According to New Syllabus released by Pharmacy Council of India Copyright All Rights Reserved SR Pharmacy ...

1 Subscribe S R Pharmacy Community Pharmacy And Management In Easy English Prepared By S R Pharmacy Follow me on Instagram and Join Telegram Group By same name S R Pharmacy According to New Syllabus released by Pharmacy Council of India Copyright All Rights Reserved SR Pharmacy  2 Subscribe S R Pharmacy Contents S.N. Chapters P.N. 1 Community Pharmacy Practice 3 2 Good Pharmacy Practice 5 3 Prescription And Prescription Handling 9 4 Communication skills 14 5 Patient Counselling 24 6 Medication Adherence 32 7 Health Screening Services In Community 34 Pharmacy 8 Over the Counter (OTC) Medications 38 9 Community Pharmacy management 44 SR Pharmacy  3 Subscribe S R Pharmacy Community Pharmacy And Management Chapter1 Community Pharmacy Practice Definition Community pharmacy or retail pharmacy is the most popular branch of pharmacy that provides medication and heath ca re service to the people. History 1) In ancient time pharmacy practice was not recognized as today , and was no scope. 2) there was no need of community pharmacy because Yunani or aurvedic doctors dispense medicine by themselves or by their workers. 3) there were no professional courses for community Pharmacy practice. 4) when allopathic medicine system started in beginning doctors dispense the medicines themselves but with the passage of time they started having workers with them and then doctors p rescribe the drugs and workers compound and dispense the drugs to patients , from there the word "Compounder " coined. 5) before 1948 Act many of people started to sell drugs without any drug license and this was not a crime. 6) After Drugs And Cosmetic Act 1948 enforced , it was compulsory that the pharmacist are working in India , must a Pharmacist Registration Certificate issued by the state in which they wish to practice , but no qualification was required. 7) After the pharmacy education have become effective , now it was compulsory to pass a approved examination to become a new registered pharmacist. 8) the minimum qualification required is diploma in pharmacy or any other qualification approved by PCI. Development * Community pharmacist play a vital role in today's world. * The function of pharmacist has changed over the last 50 years as community health demand has increased. * Today pharmacists are giving services as medical counselor , educators , compounder , and also dispense th e prescribed and non prescribed drugs. SR Pharmacy  4 Subscribe S R Pharmacy International Scenario * In England community pharmacy play an important role in primary care. In England there are about 11700 community pharmacies and 106 million people use them every day. * People want to go to pharmacists for primary care because they are easily available and no appointment required , and their services are economical. Indian Scenario * In India there are about 600000 lincensed retail stores for selling and supplying the medication , but all the registered pharmacists don't have sufficient knowledge about medicines and diseases and practicing , which is very dangerous for Indians. * there is a problem in India to break the rules. In India all the drugs even those listed in schedule H of drugs and cosmetic Act are sold without prescription. * People want to go to pharmacists for primary care because they are easily available and no appointment required , and their services are economical. SR Pharmacy  5 Subscribe S R Pharmacy Community Pharmacy and Management Chapter 2 Good Pharmacy Practice A community pharmacist is a person who is in direct contact with public and his services are in high demand by public and patients. Professional Responsibilities Of Community Pharmacists 1) Drug Related Responsibilities : A community pharmacist ' s responsibility is very important in the field of disease prevention and promotion of health. He should guide people about proper use of OTC ( over the counter = non prescribed drugs ) and prescribed drugs. 2) Counseling The people : The pharmacist have better knowledge about drug , diseases and good health care centers , so they should guide the people about them. 3) Communicable Diseases : A community pharmacist has knowledge about communicable diseases and methods to control them. so he should pay efforts to controle them. 4) Chronic Disease Control : if any patients is suffering from a chronic disease the pharmacist should send him to an appropriate physician for treatment. 5) Health Education : A community pharmacist must promote good heath by teaching people about key points to maintain good health. 6) Drug Information Awareness Programme : It is also a responsibility of a pharmacist to held this type of programme to aware the people about side effects of OTC and other drugs like Narcotic , psychotic etc. 7) Environmental Health : It is also a responsibility of a pharmacist to aware the people about the benefits of good environment and harm effects of bad environment on the health. He should guide them how to improve the environment. 8) Disaster management : A pharmacist should help people in disaster condition. He should provide them proper guidance and healthcare services. Good Pharmacy practice It is a pharmacy Practice that responds to the need of people who use the pharmacist 's services , to provide them optimal ( best ) and evidence based care. Requirement Of Good Pharmacy Practice The main Important part of pharmacy activity to help patients through : * the supply of medicines and healthcare products. * the provision of appropriate information and advices to the patients. * the administration of medicines. SR Pharmacy  6 Subscribe S R Pharmacy Roles of Pharmacists In Good Pharmacy Practice Roles of pharmacists in GPP are to prepare , obtain , secure , distribute , administer , dispense and dispose of medical products. Some Principles of GPP 1) Facilities : the pharmacy must have following facilities : a) Premise : The pharmacy must be easily found and recognised by the general people. b) Furniture : The pharmacy should have clean shelves for storing medicines and other products in a neat , dust free , moisture free place. c) Equipments : The Pharmacy should have the basic equipment required in pharmacy like refrigerated storage facilities , sphygmomanometer , stethoscope , weighing machine etc. 2) Guidelines : Some important guidelines should be given by Chief Pharmacist to the staff and make them adhered to follow them : * procurement and inventory management * Storage inventory management * prescription handling * Dispensing * Information for patients * Patients Counseling * Profession Interaction. 3) Procurement And Inventory management * the Pharmacist should have the list of authorised suppliers as well as their specimen signature. * Before buying a product the Pharmacists should check if the product has been sold or present in stock. * All the new purchased items must added in inventory. 4) Storage A pharmacy should maintain storage policies : a) Storage Management : The products entering in pharmacy should be quarantined in a separate place , before being verified for quality , batch No , expiry etc. SR Pharmacy  7 Subscribe S R Pharmacy b) Disposal Of Expired Pharmaceutical Products : The expired drugs should be listed and returned to the vendor / distributer , and he will send them back to the manufacturer , if this is not possible , the medicines should be disposed. 5) Prescription handling When a client enters the Pharmacy , he must be made to feel welcomed and encourage to express his / her demand for prescribed and non prescribed drugs or for advice. Upon receiving the prescription the pharmacist should confirm and care : * the doctor's name , address , and registration nom. * Patient's name. potency , dose , and total to be given. * signature of prescribing doctor. * Instruction for patients. 6) Dispensing * The pharmacist should remove the medicines from the storage area , count them , make an invoice / bill and do the final review. * He should neatly pack the medicines. * He should give proper counseling to the patients. The dispensed medicines should be provided with following point in written form : 1) patient's name 2) instructions on the dosage and usage 3) delivery date 4) Instruction on storage 5) name and address of pharmacy. 7) Information For Patients The pharmacist informed the patients about proper use of medicines and other healthcare products. The dispensed medicines should be provided with following point in written form : 1) patient's name 2) instructions on the dosage and usage 3) delivery date 4) Instruction on storage 5) name and address of pharmacy. SR Pharmacy  8 Subscribe S R Pharmacy 8) Enhancement Of professional role * the pharmacist should be aware of the latest development in Pharmacy Profession. * The pharmacist should maintain healthy relationship with other health care providers. SOPs ( Standard Operating Procedure ) A standard operating procedure is a set of written instructions that document a routine or repetitive activity followed by an organization. The use of SOPs is a necessary part of a successful system , it provide a proper information to perform a job properly. On the varying the circumstances the SOPs may be different , and a pharmacist can make SOPs in the light of these principles : 1) name and address of pharmacy. 2) SOPs No. , date of SOP prepared 3) Aim of SOP 4) steps to carry out the SOPs 5) who is responsible for specific SOP. Some important objectives of SOPs To enhance the quality of services. To promote uniformity in the provided services. To eliminate errors. SR Pharmacy  9 Subscribe S R Pharmacy Chapter 3 Community Pharmacy Prescription And Prescription Handling Prescription Medical prescription is a written order from a doctor to a chemist / pharmacist that includes instructions for preparing an d dispensing medicines to a patient. Parts Of Prescription A proper prescription has following information. 1) Date : The prescriber must mention the date on prescription. 2) Name , Age , Sex , and address of the patient : Name , Age , Sex , and address of the patient must be mentioned on the prescription. 3) Superscription : R x is used to denote superscription , it is mentioned at beginning of the prescription. ( it was used to prayer Jupiter the (God of healing ) for the recovery of patient ). 4) Inscription : It is the most important part of prescription , it contains the name and quantity and other information of prescribed drugs.( active constituent , adjuvant , vehicle ). 5) Subscription : In this part prescriber provide directions for Pharmacist such as drug administer timing , like bd ( twice a day ). 6) Sign. address , and registration no. of prescriber : The name and the signature should be hand -written. All other parts of prescription may be hand written , printed or typed. Legality of prescription The minimum requirement for a legal or valid prescription are follows : 1) signature of prescriber ( hand written ) 2) Address and qualification of prescriber clearly. 3) name and address of patient. 4) age of patient if below 12 years 5) correct date 6) hand written or printed , should be clear and with a permanent ink. SR Pharmacy  10 Subscribe S R Pharmacy Prescription Handling Prescription handling is a part of Good Pharmacy practices , following steps should be followed during prescription handling. 1) Receiving : It is the duty of pharmacist to receive the prescription from the patient with a good facial expression. 2) Reading And Checking carefully : it is duty of pharmacist to check prescriber's signature , date , and prescribed drugs. 3) Collecting the Materials : Now the pharmacist gather all the prescribed materials at a clean place. 4) labeling And packaging : after collecting all the material are to be dispensed , should be labeled and packed. Labelling of Dispensed Medication Labelling means to display some things. Labeling dispensed medicine is a pharmacy practice in which all the medicines are dispensed by a pharmacist are provided with some essential information in written form that a consumer needs to take his / her medicine safel y and effectively. Three Types of labelling is commonly used in pharmacy are : 1) Main Label 2) Ancillary Label 3) Pictograms 1) Main Label Following Information are provided by main label : 1) Name And Address of patient 2) Name And Address Of supplier 3) Prices And Quantity Details 4) Storage And Shelf Life 5) Instructions to the patients : like shake before use , take with milk. 2) Ancillary Labels Ancillary Means to support. The ancillary labels provide essential informatio n that helps a patient to take his /her medicine in a safe and effective way. These type of information are given in ancillary labels For External Use Only , Drowsiness Warning , Interaction with food or drinks , SR Pharmacy  11 Subscribe S R Pharmacy 3) Pictograms Pharmaceutical Pictograms are tools in the form of picture that reduce the misunderstanding on a drug treatment , and attract attention to remind drug related information. Brief Instructions On medication Usage The medicines are being prescribed or given OTC to a Patient , he should get a brief knowledge of the medicines like : What conditions it will treat ? How and when it should be taken ? What side effects it can produce ? How it should be stored ? what are its contraindications ? for how long it is to be taken ? What to do if a does is missed ? Whether it is to be taken with food or without food ? Good Dispensing Practices Good dispensing practices are to deliver right medicines of desired quantity to the right patient in right dose , strength , frequency and dosage form with clear instruction in written form and orally with appropriate packaging for maintaining the medicine quality and efficacy. Dispensing Process Following steps are dispensing process : 1) Receiving and Validating the prescription. 2) Understanding and interpreting the prescription. 3) Preparing ( gathering) and labeling items for issue 4) making a final check. 5) Recording the actions taken 6) Issuing medicine to the patient with clear instructions. SR Pharmacy  12 Subscribe S R Pharmacy Dispensing Errors Dispensing Error is a discrepancy ( mismatching ) between a prescription and the medicine that a pharmacy delivers to the patient or to the ward on the this prescription. Causes Of Dispensing Errors 1) wrong understanding of prescription. 2) poor hand writing of prescriber. 3) Look -Alike and Sound Alike ( LASA ) drugs.** 4) similar packaging and similar labelling of different drugs. 5) non cooperative staff 6) Incorrect labeling of drugs. 7) misunderstanding of abbreviations. Some common used abbreviation s od once a day bd twice a day tds three times daily qds Four times daily om every morning on every night prn as required stat immediately ac before food pc after food SR Pharmacy  13 Subscribe S R Pharmacy Strategies To Minimise Dispensing Errors The strategies used to minimise dispensing errors are bellow : 1) Ensuring Correct Entry of the prescription : Around 15% of dispensing errors occur due to transcription errors. 2) Being careful about LASA drugs : 3) Being careful with decimal points , zeros and abbreviations. 4) reducing distractions : Dispensing errors is commonly caused by multitasking and distractions during work. 5) Reducing stress and balancing heavy workloads. 6) Storing drugs properly : looking alike drugs should be stored separately. 7) Carefully checking all prescriptions : dispensing errors can be reduced by repeated checking and counter checking of prescriptions. SR Pharmacy  14 Subscribe S R Pharmacy Community Pharmacy & Management Chapter 4 Communication skills syllabus * Definition, types of communication skills * Interactions with professionals and patients * Verbal communication skills (one-to-one, over the telephone) * Written communication skills * Body language * Patient interview techniques. Definition Communication skill a process in which two or more person share their views, suggestions , evidence , thought, ideas, emotions and feelings. Elements Of communication skill 1) Sender / encoder :- the creator of message or ideas. A sender may be a single person or a group or individual who is delivery message from a group. 2) Message :- this is the thing that sender wants to share to the receiver. 3) Receiver /decoder /listener : - the person who receives the message of sender via any medium. 4) Medium/ channel:- it is a source that helps the sender to share his message to the receiver. A medium maybe words ( orally or in written ) or electronic devices. 5) Feedback /reply :- it is very important elemen t of communication to make is successful it is the reaction or reply from receiver, it confirm that the receiver has understood the message or not. Types communication 1) verbal communication 2) Non verbal communication 1) Verbal communication :- it is a communication in which words are used to deliver the message orally ( through mouth ) or in written form. SR Pharmacy  15 Subscribe S R Pharmacy Classification Of Communication Communication Verbal communication Non Verbal Communication 1)bod language/Kinesics 2) sign and symbol Oral Communication Written Communication 3) paralanguage 4) proxemics/ space language One to One communication Telephonic Communication 5)Silence 6) Time language 7) Haptics/touch language 8) Appearance Verbal communication it is a communication in which words are used to deliver the message orally ( through mouth ) or in written form. Oral Communication Oral communication is a type of verbal communication in whi ch people communicate to each other through mouth, either direct conversation or telephone conversation. Oral communication Includes : lectures , speech , Group discussion , Interview , conferences , Meeting. Forms of oral communication 1) One to One ( face to face ) communication. 2) Telephonic Communication. ( on internet ). Advantages : 1) Facial expression and gesture make the communication effective. 2) It is best medium for discussion and interview. SR Pharmacy  16 Subscribe S R Pharmacy 3) communicator can know the reaction o f message on receiver through his facial expression and gestures. 4) it provides immediate feedback. 5) It saves time 6) listener can get immediate clarification of any doubt in his mind. Disadvantages : 1) It is not suitable in every condition. 2) It is not suitable for large number of people. 3) Low retention by listener the listener may not concentrate upon everything that has been delivered in oral communication. One to One Communication One to One Communication is also called face to face co mmunication One to one communication is a oral type of communication in which one person talk to another directly. One to One Communication has three basic elements : 1) words 2) tone 3) body language Words : Words play an important role in communicat ion to deliver the message to the listener. we should choose respectful words in our communication and we should care the level of listener to make the communication useful. Tone of Voice : The tone of voice is a mixture of various verbal feature such a s volume ( sound ) pitch (vibration level) speed , pace ( break ) and vocal quality( fluency and pronunciation) etc. Body Language : It is a source of non-verbal communication , in which various physical behaviors are used to deliver the message. L ike Gesture , facial expression etc. Advantages : 1) Facial expression and gesture make the communication effective. 2) It is best medium for discussion and interview. 3) communicator can know the reaction of message on receiver through his facial expression and gestures. SR Pharmacy  17 Subscribe S R Pharmacy 4) it provides immediate feedback. 5) It saves time 6) listener can get immediate clarification of any doubt in his mind. Disadvantages : 1) It is not suitable in every condition. 2) It is not suitable for large number of peop le. 3) Low retention by listener the listener may not concentrate upon everything that has been delivered in oral communication. Telephonic communication The communication is done over a telephone, mobile phone, electronic device is known as telephonic communication. Telephonic communication is more challenging task ( more difficult work) then face to face communication because the absence of helping factors in communication, such as facial expression , Eye contact , gesture. Some points should repair before telephone communication 1) Set topics that you have to discuss 2) Get correct details of the person you are calling 3) Should have a piece of paper and pen or pencil 4) If possible a script should be prepared make sure you your phone has enough battery and balance. Some points during call * Start communication with greeting * introduce yourself * Take the permission * use simple language * discuss important point * do not refuse the clarify on the doubts of listener. Advantages 1) Time saving : it saves a lot of time like , travelling to receiver. 2) Convenience : sometimes it is not possible to conduct One to One meeting in such cases telephone conversation provides a platform for communication. 3) Cheaper : it is cheaper than One to One communication some examples like travelling fair ,hotel expenses etc. Disadvantage SR Pharmacy  18 Subscribe S R Pharmacy 1) Lake of personal touch : personal contact increase the effectiveness of communication which is not possible in telephonic Communication. 2) Dependency on voice only: it depends only on voice and facial expression, body gesture are absence which decrease the effectiveness. 3) Poor connectivity : due to poor connectivity voice may break down which decrease the effectiveness 4) Privacy: the communication can recorded by receiver and shared anywhere by receiver , in the same way service provider companies also record the communication so telephonic communication is not safe. Written communication skill Definition: it is a type of verbal communication i n which messages are delivered with the help of words or symbols , either hand written or printed. *It is most formal form of communication. * written form of communication are generally preferred , when formal communication is required. * This type of communication is generally used for documentation. * the institutions and companies use written form for documentation of important decision and to maintain records. * There is no need to present at the same time of receiver and sender. Advantages 1) Less chances of misuse : there are less chances to misuse the written communication. 2) Documentation: documentation and maintaining record is easy and less chances for destroy. 3) Decoding time : it provides a desirable time for decoding understandi ng the message which is not possible in oral form of communication. Disadvantages 1) Formal : this is a formal type of communication and every person does not have ability of communication in this form. 2) Time consuming : it takes a lot of time to write the message in comparison to oral communication. 3) Difficulty in amendment : it is not so much easy to correct the mistake if it has been send to receiver such as a book published and sold. SR Pharmacy  19 Subscribe S R Pharmacy 4) Misunderstanding : there are chances for miss understanding in written communication and not easy to remove the misunderstanding because sender is not available to clarify the doubt. Non verbal communication Definition: it is a special type of communication in which no words are used to send or receive the message. non verbal communication it is the most powerful form of communication ,in which We can share emotions and feelings to others which are unable to express in words. It is also called wordless communication. People use 35% verbal communication and 65% non verbal communication. In non verbal communication the messages are delivered through : 1) body language / Kinesics 2) sign and symbol 3) paralanguage 4) proxemics / space language 5) Silence 6) Time language 7) Haptics /touch language 8) Appearance Body Languages / KInesics It is a source of non-verbal communication , in which various physical behaviors are used to deliver the message. Following Behaviors are used in body language : 1) Gesture : it is a behavior of body to express the message , it is a moment of body parts like limb's legs etc. SR Pharmacy  20 Subscribe S R Pharmacy 2)Facial express :It is saying that the face is the Index of the heart in face to face communication can deliver show different type of emotions like happiness sadness anger. 3) Eyes contact: Eye contact is a powerful behaviour of body language. It occurs when two people look at each other's eye at the same time. Eye contact has a great importance in the communication skill , the moment of SR Pharmacy  21 Subscribe S R Pharmacy eyes , contraction and relaxation give a d eepest feeling of once mind. 4) Posture: the way of a person stands , walk s, and sits is called poster. The posture of a person give an Idea about him , like tiredness , nervousness etc. 5) Dress code : it also induces an impact on others , d ress includes the clothes, hair style , perfumes etc. SR Pharmacy  22 Subscribe S R Pharmacy Advantages of Non verbal communication 1) It is helpful in telling ideas related to geography and maps etc. like traffic police use. 2) It is helpful in sending message to illiterate people throu gh symbols. 3) It is very very helpful to send and receive the message to those people who are physically disable. 4) Someone can use this form of communication for privacy purpose that he can set a symbol for special meaning. 5) non verbal communication is very useful to share feelings and emotions. Disadvantages 1) Sometime it does not provide accurate meaning just like verbal communication. 2) The structure and topics of non verbal communication are limited to express the message , but this limi tation is not in verbal communication. 3) There are not alternate symbo ls to clarify the doubt. Interaction with professionals and patients It is responsibility of health care professionals to inform the patients about the ways of healthier lives and to explain about diagnosis treatment and medication. Medical professional or pharmacist can use following points : To listen the patient carefully and do not interrupt: the pharmacist should listen first the patient problems carefully and then ask any question. Do not talk to fast : the pharmacist should not talk too fast that patient can't understand. Use suitable and easy words : the pharmacist should use suitable and easy words that pharmacist can understand easily, and does not use jargons and terms. To use body language : to make the communication effective he should used body language like Eye contact , facial expression etc. Patients engagement: the pharmacist should confirm that form patient is listening his talk carefully. SR Pharmacy  23 Subscribe S R Pharmacy Patient interview techniques Interview : interview is a face to face communication between two persons in which one asks questions and other is expected to answer them. Some points for patient interview Listen the patient carefully and do not interrupt : it is very necessary to listen the patient carefully and let him tell his all problems in detail. Asking clinical questions : after listening the patient problems the pharmacist should ask clinical question if needed. Non verbal communication: during interview with patience the pharmacist should care the body language like eye contact , facial expression etc. Sympathy ,validation : the pharmacist should show sympathy to patient such as offering chair to him and should validate his statement like I understood ,you are right. SR Pharmacy  24 Subscribe S R Pharmacy Community Pharmacy and Management Chapter 5 part 1 Patient Counselling Definition Patient Counselling is a process to provide Medication Information to the patients or their representatives ( attendant ) , about drug uses ,storage , dose , adverse effect , contraindications and changes in lifestyle. ( verbally or in written form ) Benefits of Patient Counselling  It increase the effectiveness of drugs  A patient receives a better and sufficient knowledge abou t the drug.  it clears patient doubt about using drug  It decrease medication mistakes  patient feel courage to ask question  It decrease the chances for Interaction of drug to drug or drug to food.  It provides the route of administration of drug  it decrease the chances for degradation of drug  It provide storage condition  it provides non pharmacological management disease  it provide a knowledge about adverse effect in case of adverse effect patient will not panic  It provides a knowledge , what to do if a dose missed.  It provides satisfaction to patients about medication. Stages Of Patient Counselling Following are the steps to be followed for Counselling : 1) Preparation For Counselling Session 2) Opening of the counselling session 3) Counselling Content 4) Closing Session Stage 1 Preparation For Counselling Session  A successful counselling depends on the skill of counsellor ( pharmacist ) before counselling pharmacist should know about patient condition and his treatment details as much as possible.  In community pharmacy resources of information includes patient , prescription and record of previous dispensing SR Pharmacy  25 Subscribe S R Pharmacy  if the pharmacist is unfamiliar to the drugs that patient is taking then Pharmacist should obtain appropriate inf ormation before counselling.  He should consider the physical and mental condition of patient Stage 2 Opening Session ( Introduction ) In this session pharmacist should consider following things : o The pharmacist should greet the patient by name and introduce himself o it is best to use prefix like Mr or Mrs or Ms o Pharmacist should tell the purpose of counselling o The pharmacist should gather information from patients about their understanding of disease and drug treatment o The pharmacist should ask open ended questions rather than close ended questions for example what did your doctor tell you about your disease ? what do you know about your disease ? o During counselling pharmacist should avoid those questions and activities that can embarrasses the pati ent. Stage 3 Counselling Content This is the most important part of the counselling session in the session the pharmacist will explain about medication and changes in lifestyle following information should be delive during counselling  Name and dose of medication  Reason why it is prescribed  Route of administration  Duration of drug administration  Expected benefits  Expected duration of treatment  Possible adverse effects  Storage recommendations  What to do if a dose is missed  Minimum duration required to show therapeutic benefit Stage 4 Closing Session Before closing the counselling session it is essential to check the patient understanding this can be achieved by feedback questions for example  how long will you take this medication ?  when will you take this medication ?  what will you do if you missed any dose ? SR Pharmacy  26 Subscribe S R Pharmacy  The Pharmacist should Ask the patient have you any doubt ?  before closing pharmacist should summarise the main points if time permits for that.  Pharmacist can share his contact number. Barriers To Effective Patient counselling The things decrease the effectiveness of Counselling are called Barriers to Effective Counselling. Three types of Barriers are following : 1) Pharmacist - Related - Barriers : a) Lack Of Knowledge about patients b) Lack Of Knowledge about patient 's disease condition. c) Lack of Confidence d) lack of skill e) age differences f) Difference Gender g) Inappropriate communication h) Language Differences i) Lack of listening. j) Lack of Time k) lack of Preparation 2) Patient - Related Barriers : a) lack of trust b) poor listening c) lack of time d) Physical or mental condition e) Gender Differences f) language Differences g) Misunderstanding of Information h) Lack of Literacy i) lack of expression. j) poor communication 3) System -Related Barriers : a) Lack of privacy b) lack of pharmacist in pharmacy SR Pharmacy  27 Subscribe S R Pharmacy c) lack of time d) Heavy patient flow for prescription filling. e) Strategies to Overcome barriers 1) increasing skill 2) Body language 3) Increasing Number of Pharmacist 4) Proper communication 5) proper listening of patients 6) Checking for understanding 7) using pictograms 8) avoiding anger 9) security of privacy 10 ) preparing before Counselling. Patient Councelling Points For Chronic Disease / Disorders Hypertension  He should counsel about non pharmacological management also.  He should advise on weight loss ,regular exercise , decrease salt intake , increase dietary fibres and avoiding smoking, alcohol etc.  The pharmacist should advise the patient for measuring blood pressure weekly or twice in a week.  The pharmacist should advise the patient to follow the directions of doctor  the pharmacist should counsel that stopping and starting of drugs on self desire is not good. Diabetes  The pharmacist should give an overview of diabetes.  The pharmacist should advise for weight loss daily exercise  The pharmacist advice to avoid sweets in foods having big amount of carbohydrate  The patient should be advised for checkup of blood sugar level  the pharmacist will tell the patient about hypoglycemic condition  he will counsel he patient regarding storage condition of insulin SR Pharmacy  28 Subscribe S R Pharmacy  he should advise the insulin dependent patient to have chocolates or other sweets with him or her on the trip and not to skip meals. Asthma  He will advise the patient to avoid allergence smoking tobacco etc.  He should council de patient to take prophylactic drug before exercise  He will train the patient on the use of metered dose inhaler and dry powder inhaler.  He should advise about sustained released from not crush or chew.  He will advise that medication must be taken on regular basis.  He will advise the patient for gargling of mouth after using inhaled drug. Tuberculosis The pharmacist should give an overview of diabetes. and some advices that pharmacist should give to the patients of TB :  To stay at home  should stay far away from other as much as possible.  Should wear mask while going outside.  Separate bed should be advised  To Cover mouth and nose while coughing or sneezing.  DOT ( Directly Observed Therapy) is highly advised.  DOT workers should wear a better mask ( N95 mask).  to take medication until doctor stop.  Pharmacist should inform the patient that stopping therapy too soon or not taking regularly , can allow TB germs to develop resistance to drug.  a clinical test should be performed to check that drugs are effective or not. COPD Pharmacist should advise the patient suffering from COPD about :  To avoid allergens.  To inhale Oxygen  to avoid mites and dust  To stop smoking  To protect him from Cold  To exercise regularly to make strong heart and lungs.  The pharmacist will train the patient on use of Metered Dose Inhalers ( MDI) , Dry Powder Inhalers ( DPI ) and nebulizer. AIDS Counslling Points : SR Pharmacy  29 Subscribe S R Pharmacy  If someone has symptoms of HIV The pharmacist advise him for test.  If someone HIV Positive He should disclose the test , this help to take PMTCT ( Prevention of Mother to Child Transmission ) services.  The HIV Positive Mother should be informed about feeding alternatives.  The Patient should be advised for ARV Therapy.  The patient should follow the directions of doctors. Patient Package Inserts Definition Patient package insert is a FDA approved document in the form of leaflet or booklet( now it is available in electronic form also) that has essential drug information. Like drug use , dose , contraindication , storage condition ,adverse effects , duration of medication etc. It is regulated by legislative health authority of the nation. It should be written in simple language and misleading should be avoided. Importance and benefits 1. it provides many essential information related to prescription in written form 2. when it is in written form it can be used anytime and no chances to forget, just like oral counselling 3. It is approved by FDA and legislative health authority so there is less chances for wrong information. 4. This is beneficial for health care providers and patient also. 5. It has all those contents that are provided by counsllin g. 6. It is evidence based information and updated time to time on the basis of clinical data available. Scenarios of PPI 1) India : The drug and cosmetic act 1940 and rules 1945 has provisions for PPI and this provisions are listed in section 6 of schedu le D second. According to these provisions PPI must includes information in English language On: I. therapeutic indications II. posology (dose ) III. method of administration IV. contraindication SR Pharmacy  30 Subscribe S R Pharmacy V. special warnings( major adverse effects VI. precautions VII. drug interaction VIII. contraindication in pregnancy and Lactation IX. Undesirable effects X. antidotes for over dosing In other Countries : Many Industrialised Countries adopted it in more effective ways. In US ( since 1968) It is Known as Patient Oriented Package Inserts , In European Union It is Known as Patient Information Leaflets. And now PPI is available in these country in printed and electronic form in US it is available at : http:/ www. Pdr.net. In European union available at: http:/ www.medicine.org. UK. In South Africa it is available at: http:/ home. intekom.com /Pharm. PIL ( Patient Information Leaflets ) Definition PIL is a written document it contains all the clinical experiments and essential information for prescribed and non prescribed drugs and it is provided by manufacturer companies with drugs. it also contains information that are not related to therapy.Like Registration number , batch. Contents Of PIL  name of Ingredients are used  pharmaceutical forms  therapeutic uses  precautions  interactions  administration route  Adverse effects  contraindications  excipients details SR Pharmacy  31 Subscribe S R Pharmacy  registration number  Pack size  manufacturer name and address etc. SR Pharmacy  32 Subscribe S R Pharmacy Community Pharmacy and management Chapter 6 Medication Adherence Definition Medication adherence or patient adherence means obeying medical instructions for administration of medicine by patient. Non Adherence Non adherence or Non Compliance : If patient dose not obey the instructions for administering the medications as directed is it called non adherence. Factors influencing Non Adherence 1) Health care system related factors : according to Makaryus et. al. the patient are discharged from hospital and not educated properly and Non adherence occurs. 2) Patient related factors : o younger age , o patient is not taking the disease seriously , o lack of symptoms, o misunderstanding regarding medication , o patient forgets to take medicines , o he has Mental problems. 3) Drug related factors :  too much adverse effects ( patient fear to take medicines ),  cost of drugs many poor patients do not afford the drugs ,  too much medication ,  root of administration 4) Therapy related factors : exact medications are not administered or prescribed 5) Education related factors : factors of medication non adherence includes lower education level and low health education level. Strategies to overcome Non-Adherence Many of studies explain that most of factors of Non Adherence are patient oriented ( related) although we consider following strategies to overcome the Non Adherence : SR Pharmacy  33 Subscribe S R Pharmacy a) it includes educating healthcare workers( pharmacist nurses ) they should be taught communication skill and counselling points properly. b) if staffs are not sufficient they shou ld be increased according to the needs. c) Cheap and best medicine should be prescribed. d) Patients should be counselled properly. e) Counselling should be orally and in written form also. f) Pictograms should be used. g) feedback questions should be asked. h) clearing patient 's doubt. i) listening the patient with patience. j) simple and easy language should be used. k) Councsellor should avoid anger. SR Pharmacy  34 Subscribe S R Pharmacy CPM Chapter 7 Health Screening Services In Community Pharmacy Definition Health Screening is a process to Look for / Identify the unrecognised disease , which are not identified properly with symptoms and to identify the diseases which have no symptoms. Scope of health screening services nowadays health screening has a variety of scopes : a. A person has knowledge of health screening he can work in hospital b. he can work in pathology laboratory c. he can work in hospital and community pharmacy d. he can run his own laboratory. e. Many of companies providing door to door health screening services he can join these companies f. he can provide services in disaster management g. he can provide his services in Pandemic condition. h. Importance Of Various Health Screening Services ( Routine Monitoring , Early Detection and referral of undiagnosed cases ) I. It helps in identification of exact problem in early stage II. It reduces the mortality rate III. It reduces the severity of disease IV. It increases the effectiveness of treatment V. It reduces the cost of treatment VI. It Provides peace of mind VII. It prevents the occurrence of high risk disease VIII. It saves the time of patient IX. with the help of early screening chronic condition can be avoided. X. Adverse effects also be avoided in case of referral o f undiagnosed cases in early stage. SR Pharmacy  35 Subscribe S R Pharmacy Types Of Health Screening Health Screening is classified into three groups based on their composition: 1) Standard Health Screen: This type of screening includes the following diagnostic tests by consulting with a medical expert: i) Glucose level test (marker for diabetes) ii) Blood cholesterol level test (total cholesterol level) iii) Measurement and evaluation of blood pressure iv) BMI (measures height weight ratio) v) Assessment of cardiac risk vi) Urine analysis (tests for elevation of protein, blood, etc. in urine) 2) Premium Health Screen: This type of screening includes the following diagnostic tests by consulting with a medical expert: i) Blood glucose level test (marker for diabetes) ii) Blood cholesterol level test (total cholesterol level) iii) Measurement and evaluation of blood pressure iv) BMI (measures height weight ratio) v) Assessment of cardiac risk vi) vi) Pulmonary function tests (lung capacity, andscreens for possible disease) vii) Liver function tests (for abnormal liver function) viii) Urine analysis (tests for protein, blood in urine and possible kidney disease infection). 3) Executive Health Screen: This type of screening includes the following diagnostic tests by consulting with a medical expert: i) Blood glucose level test (diabetes marker) ii) Blood cholesterol level test (total cholesterol levels) iii) Blood pressure measurement and assessment iv) 12 lead ECG test (measures the electrical conduction of heart) v) BMI (measures height weight ratio) vi) Assessment of cardiac risk vii) Renal profile (blood test to check kidney functions) viii) Bone profile (blood test to assess calcium and phosphate) ix) Full blood count (measures RBCs, WBCK haemoglobin etc.) x) Test for ferritin in blood (detect hereditary conditions, xi) Pulmonary function tests (lung capacity, as well as illness screening) xii) Liver function tests (for abnormal liver function) xiii) Urine analysis (tests for protein, blood in urine, and infection from kidney illness) SR Pharmacy  36 Subscribe S R Pharmacy xiv) Healthy body fat percent range Routine Monitoring Of Patients Paying a close attention to patient to identify the disease is Routine monitoring The Monitoring and screening can be performed at Community Pharmacy are Following ; 1) BMI ( Body Mass Index ) : It is used to check Obesity. Formula To check BMI 2 BMI = Weight / Height in meter BMI ( Kg/m 2 ) Classification < 20 Under weight 19-25 Desirable / good health 25-30 Over weight 30-35 Obese Class 1 35 -40 Obese Class 2 > 40 Obese Class 3 2) Waist circumference and waist to Hip Ratio : It Represent abdominal Deposition of fat , if it increases it can cause cardiovascular problems. WHR = Waist / Hip Health Risk Men Health Risk Women Low 0.9 or less Low 0.8 or less High more than 0.9 High More than 0.8 3) Depression screening : Hamilton Depression Rating Scale ( HAM -D ) , (HDRS) is used to check Depression. There are 17 items in HDRS , and these items have Questions 0 - 4 , which doctor asks the patient and ticks  if patient answers in Yes , and then all the answers are added and scored and depression is classified as : Score 0-7 Normal Score 8-20 Moderate Score > 20 Severe 17 Items Used in Hamilton scale are : 1) Depressed mood 2) feelings of Guilty 3) suicide 4) Insomnia in early night SR Pharmacy  37 Subscribe S R Pharmacy 5) Insomnia in Mid night 6) Insomnia in early hours of morning 7) work and activity 8) retardation ( slowness of thinking and speaking ) 9) Agitation 10 ) anxiety psychic 11) Anxiety somatic 12 ) somatic system GIT 13) General somatic system 14) General system s 15 ) Hypocondriasis 16 ) loss of weight 17) insight 4) Blood Pressure Measuring : 5) Body Temperature : 6) Blood Glucose Level ( for Diabetes ): a) Fasting Plasma Glucose ( FPG ) : This test is performed after Fasting for at least 8 hours for accurate result , that is why this is usually performed at morning. b) Oral Glucose Tolerance Test : ( OGTT ) This test is performed at 2 hours after drinking 75g of glucose orally. c) Random plasma glucose test (RPG): This test is performed when d iabetic symptoms are present and healthcare providers do not want to wait until patient has Fasted. D) HB A1 C or A 1 C test : This test is performed using A1C ( a part of haemoglobin ) and it shows average blood glucose level the previous three months. Blood Glucose Level In different tests Diagnostic A1C Fasting Plasma Oral Glucose Random Reports (%) Glucose(mg/dl) ToleranceTest Plasma Glucose (mg/dl) test (mg/dl) Normal Below 5- 99 or below 139 or below 139 or below 7 Diabetes 6.5 or 126 or above 200 or above 200 or above above SR Pharmacy  38 Subscribe S R Pharmacy Community Pharmacy and Management chapter 8 Over the Counter (OTC) Medications Definition OTC means over the counter , it is also called non -prescription drug , th ese are the drugs which can be purchased without valid prescription. Like anti-pyretics , expectorant , analgesic balm , acne creams etc. Need and role of pharmacist in OTC meditation dispensing  pharmacists are the person whom people contact for OTC me ditation generally , so there is great demand of pharmacist for OTC meditation  when they are initial point of contact for OTC Medication they should be careful regarding their responsibilities of otc meditation.  They should track the uses of otc meditati on.  They are required to limit to the frequency of otc medications.  The pharmacists should raise awareness about the importance of otc meditation's safety, correct usage , dosage and storage.  They should aware the people about disadvantages of otc med ication  While providing otc medication the pharmacists should analyse the patient symptoms /conditions to decide whether the medicines are suitable or not.  The pharmacist should provide drug related information while dispensing OTC drugs.  They should guide on choosing otc meditation.  They should advise the patient to contact doctors /physicians or medical staff for medical treatment  The pharmacists should advise the patient to contact Health care professionals if any drug show severe adverse effect.  The pharmacist should advise the patient to verify the drugs active constituent if they are taking multiple otc drugs. OTC Meditation in India The drugs and cosmetics Act and rules in India divided the drugs in several categories( Schedules ) and provide provisions, directions and suggestions regarding drugs Like : o which drugs can produce harmful effect if they are being used without supervision of a medical professional o which drug cannot be sold without valid prescription. * The drugs do not come under schedule H H1 and X can be obtained without a prescription from a pharmacist or a drug store. * Schedule G drugs should not be taken without a medical supervision. SR Pharmacy  39 Subscribe S R Pharmacy * Household drugs are commonly obtained as a OTC medication ,some examples of otc drugs are : paracetamol ,liquid paraffin, bacterial tropical ointment , antacids , ant diarrhoeal drugs , Anti ulcer drugs , proton pump inhibitors ,vitamins , contraceptive pills etc. Self Medication Definition The use of medicinal products to treat sel f diagnosed disorders or symptoms without the advice of a Health Care Professional.( WHO) Role of pharmacist in promoting safe practice during self Medication  The pharmacist should advise the people that it is not good idea to treat self without proper knowledge otherwise it may be dangerous.  The pharmacist should provide safe and good quality of medicine.  The pharmacist should provide drug related information.  The pharmacist should advise the patient to visit the doctors / physicians if self medication is ineffective.  The pharmacist should consider the condition of patient if patient is not present, he should ask about the symptoms of the patients.  If pharmacist seems that the drugs being asked are not suitable for the patient he should suggest the appr opriate medicine.  The pharmacist should ask some key questions related to patient condition and medication history. Responding to symptoms minor ailments, and advise for self -care in conditions such as: pain management, cough , cold , diarrhoea , co nstipation , vomiting, fever, sore throat , skin disorders , oral health ( mouth ulcer , dental pain , gum swelling). Pain : Symptom : 1) Restlessness 2) Moaning and groaning 3) Muscle spasm 4) Difficulty in sleeping 5) Difficulty in Concentrating Self-care To manage the pain the pharmacist may suggest following as home treatment : a) a towel wrapped Cold pack or ice should be used to reduce painful swelling and inflammation caused by injury. b) To relieve muscles stiffness heating pads should be applied or warm bath should be taken. c) The things trigger should be avoided like noise , sharp light , stress lack of rest and sleep. SR Pharmacy  40 Subscribe S R Pharmacy d) Light exercise should be done on a regular basis. e) analgesic balms should be used. Cough Symptoms : 1) congested or running nose 2) coughing 3) sore throat 4) breathing difficulty 5) wheezing 6) coughing out blood or sputum Self care To manage the cough the pharmacist may suggest following as home treatment : o Inhalation of warm Steam, o Taking warm Beverages such as Black tea, o use of Ginger , Clove , Cardamom , Lemon with Honey. o Use of Lozenges Like strepsils , vicks , etc. Cold symptoms 1) Sneezing 2) runny nose 3) sore throat 4) cough 5) headache 6) fever 7) nasal Congestion Self Care 1) gargling with salt water 2) Inhalation of warm Steam 3) Use of topical ointments Like Vicks VapoRub. 4) Taking enough water to replace the fluid loss. Diarrhoea symptoms loose or watery stool more than times a day. In severe diarrhoea these symptoms may be observed : 1) Fever 2) Weight loss 3) Severe pain in stomach 4) Blood in faeces. 5) Dehydr ation Self-Care To manage the diarrhoea the pharmacist may suggest following as home treatment : 1) Drinking enough water to avoid dehydration. 2) BRAT diet should be taken : B: Banana R: Rice A : Apple Sauce T : Toast ( bead ) 2) Laxative things should be avoided like ( Tea , Coffee , fig ,etc) SR Pharmacy  41 Subscribe S R Pharmacy 3) Curd , mint , may be used. Constipation Symptoms 1) Less than three time defecation a weak. 2) Dry, heard stool. 3) Difficulty in passing stool ( pain) 4) Pain in stomach or cramps. Self -care To manage the Constipation the pharmacist may suggest following as home treatment : 1) to increase water intake , 2) Intake of high Fibre diet. 3) Intake of more vegetable , fruits in diet. 4) avoiding intake of high - fat foods , meats eggs , etc. 5) Exercise at daily basis. 6) walking after taking meals. Vomiting symptoms : Empting of stomach content through mouth Voluntary or involuntary. symptoms Before vomiting 1) Abdominal Pain 2) Excessive sweating 3) Rapid pulse Self - Care 1) taking liquids gradually 2) solid food should be avoided. 3) Citrus fruits should be taken in low amount. Fever Symptoms 1) High temperature ( More than 100.4°C ) 2) Chills , trembling. 3) Fatigue 4) weakness. 5) Headache Self -Care 1) drinking more ware than usual 2) Taking Paracetamol , aspirin , 3) taking rest. Sore throat Symptoms may be different Because of different Causes : SR Pharmacy  42 Subscribe S R Pharmacy 1) Itchiness 2) Burning in throat 3) Irritation. Self care 1) intake of lemon tea. 2) Lozenges 3) Gargle with salted water. 4) Taking water time to time to prevent dryness of throat. 5) taking rest , ( teaching , too much speaking should be avoided ) 6) allergens should be avoided like dust , pollen etc. Skin Disorders Symptoms 1) Dryness of skin 2) Open sores , ulcers. 3) Rashes 4) Red , white pus filled blisters 5) Discoloured patches Self care 1) Sugar or dairy products should be avoided. 2) Skin Hygiene should be maintain. 3) fats , and high protein diet should be avoided. 4) Boiled water with neem leaves should be use to wash the affected area. 5) taking enough water to prevent dryness. 6) different types of creams and soaps should be avoided. Oral Health ( mouth ulcer , Dental pain , Gum Swelling ) Mouth Ulcer Symptoms 1) Pain in mouth 2) Increased sensation while brushing teeth. 3) Feeling of pain and irritation on eating specially spicy and salty foods. self -Care 1) Mouth should be rinsed with warm salt water 2) spicy foods should be avoided. 3)Oral Hygiene should be maintained 4) Topical anaesthetics should be used like Orajel or Anbesol. Dental Pain Symptoms 1) Pain in tooth 2) Headache 3) Swelling around tooth. Self Care 1) Gargle with warm saltwater ( half teaspoon of salt in a glass of warm water) SR Pharmacy  43 Subscribe S R Pharmacy 2) a towel wrapped Cold pack or ice should be put to painful are fore 20 minutes to reduce pain and swelling. 3) Placing Clove in mouth. or Clove oil in Cotton. 4) Household medication like Paracetamol , ibuprofen or aspirin may be used. Gum Swelling Symptoms 1) Swollen gum that bleed easily , even during brushing or eating something like Banana , apple. 2) Bad odour. Self- Care 1) Brushing of teeth at least twice a day. 2) Mouth should be rinsed with warm saltwater to remove swelling and bacteria. 3) intake of vitamin C should be increased. 4) Brushing with Neem Twig. SR Pharmacy  44 Subscribe S R Pharmacy Community Pharmacy and Management Chapter 9 Community Pharmacy management Community pharmacy management means to arrange all the necessary things which are required to run a Pharmacy in a efficient way Like legal requirements, ( Documents ) vendor selections , procurement , inventory control , financial planning and acc ountancy etc. Legal requirements to set up a community pharmacy For a community Pharmacy set up following requirements are requires which are set by pharmacy regulatory body like PCI are following : 1) Registration : to set up a community pharmacy , th e owner of pharmacy requires to register the premises with PCI. 2) Licenses : different licenses are required according to needs like : General licenses a) a license for retail sale of drugs other than specified in schedule C , C1 and X b) for drugs specified in schedule C and C 1. c) for the drugs specified in schedule X. Restricted Licence a) for the drugs , other than specified in schedule C and C1 and X b) for the drugs , specified in schedule in C and C 1 but not in schedule X. 3) Registered Pharmacist : Every Community pharmacy requires a registered pharmacist in which supervision drugs are dispensed. 4) Infrastructure : for a community pharmacy a 10 m 2 area ( room ) is considered minimum requirement and there should be storage di spensing and patient counseling area. 5) Store arrangement : a sufficient number of racks should be available for storing drugs. and a refrigerator is required for storing antibiotics , vitamins , vaccines , sera , and enzymatic preparations at 2 -6 ° C. Site Selection requirements Site selection means selection of place or area for opening community pharmacy. Good site selection is the key of success of any shop , following areas are considered good for community pharmacy : 1) Hospital or Nursing Home : a community pharmacy location near hospital or nursing home is considered quite good , because drugs are prescribed there SR Pharmacy  45 Subscribe S R Pharmacy and pharmacy business mostly depends on prescription filling. so a pharmacy near to hospital can attract the patient. 2) General Market : a pharmacy in general market also attracts people , where people go for their general needs , this location is also good. 3) Drug store market : many of developed cities have a separate market for drugs and other things so if there is drug market it suitable location for a pharmacy. 4) Parking Facility : on a road of high traffic , the those location are preferable where parking facility is available. 5) Near by a famous place : a pharmacy near to a famous place is considered good which people commonly visit like park , hotel , school , play ground etc. 6) High population area Pharmacy Designs and Interiors The organisational structure of pharmacy may vary with the size and type of the business. But some main parts should be available in every pharmacy like 1) general drug store. 2) dangerous and schedule X drugs store. 3) Cold room or refrigerator area. 4) bulk drug store area. 5) Waiting area. 6) dispensing area SR Pharmacy  46 Subscribe S R Pharmacy Vendor Selection and ordering Vendor means supplier ( a person or group who picks up drugs from Pharmaceutical companies and supplies to pharmacies and other places ) Vendor selection means selection or identifying of such supplier who provides the pharmacy needs at time and supply the good quality pharmaceuticals at minimum prices. Process of vendor selection 1) Analysis of Pharmacy needs : the first step is identifying the pharmacy needs , and document them. 2) Identification of good vendor : now the management team or owner search suitable vendors who can deliver the required materials after agreement. and get full information about required materials , now make a list of vendors with their products and prices and services. 3) Evaluation of Vendor : now select best vendor on the basis of their honesty , time of delivery , quality of products , and lower prices comparing each other. 4) Select best suppliers. 5) contract ( agreement ) negotiation : after selection of best vendors now it is time to talk with them including terms a nd conditions , price of products , timing of delivery and payment related conditions. 6) Placing Order : after final agreement now it is time to place order for required products. Procurement Procurement means " purchasing " and procurement is a pro cess of purchasing right quality and quantity of drugs at right time and right price. Good procurement is necessary for running the community pharmacy efficiently principal of procurement is " you buy a product cheap and sell that with reasonable margin process of procurement 1) Purchase requisition : The list of product to be purchased is made on the basis of product flow and patient request and needs. 2) Selection of supplier : selected right suppliers considering quality , time and price. 3) Placing order : after preparation of requisition slip and selection of supplier the order is placed in desired date , time and amount. SR Pharmacy  47 Subscribe S R Pharmacy 4) Receiving in checking products 5) Checking of invoice and bills 6) Recording of bills 7) Releasing the payment to the su pplier Inventory control methods and inventory management inventory means "stock of goods " inventory control is a technique which helps to determine how much stock to hold , when to place new order and what quantity has to be order for working a comm unity pharmacy efficiently. Inventory management : means performing all the inventory control process in a good way to meet the pharmacy needs. Inventory control Methods and managements Different methods are used for inventory control some of them are following : 1) V E D analysis 2) ABC analysis 3) minimum maximum method 4) bar coding and scanning method 5) automatic inventory management system 1) V E D analysis V ( Vital ) : the vital category contains those drugs which are very necessary for the life of patient and need to be present all the time in the community Pharmacy. E ( Essential ) : essential category contents those medicine which are less necessary in comparison to vital and they sho uld be available in community pharmacy according to their needs. D ( Desirable ) : the desirable category contains those drugs which are not necessary for the life of patient they should be kept in community pharmacy in low quantity. 2) ABC analysis in this method purchasing is done on the basis of cost and numbers of items , so products are divided into 3 categories A , B and C. A Few items which are very costly B Some items which are moderately costly C A lots of items which are less costly. SR Pharmacy  48 Subscribe S R Pharmacy we can use this method other way also A - high amount usages ( the products of this category are purchased in large amount ) B - Moderate amount usages ( the products of this category are purchased in moderate amount ) C - low amount usages (the products of this category are purchased in low amount ) 3) Minimum maximum system this is the oldest method in which maximum and minimum levels of inventory is set , maximum level indicates safety of stock and minimum level indicates reorder level. 4) Bar coding and scanning method This is a new and smart inventory method this system count sale of products quantity and track the inventory levels. It identify the products to be re - order 5) Automatic inventory management system This is a software base inventory management method and there are different softwares are available in market which provide inventory control and Management services. These software keep records of all the sold products , their selling price , name of patient and prescriber etc. These softwares automatically calculate the amount of sold products and indicate the remaining product in stock and indicate and identify the products for re-ordering. Financial planning and management financial planning is a process for collecting and using money systematically to establish and run a community pharmacy efficiently Purpose of financing : 1) to purchase or higher land rooms and equipments 2) To purchase materials for sale 3) To pay rent and salaries and electricity bills etc. SR Pharmacy  49 Subscribe S R Pharmacy Source of finance 1) Owned finance : The capital is generated by the owner , partners or shareholders are owned finance and they should be free from interest to be paid. 2) Loan ( borrowed ) finance : this is the capital generated from bank or other financial institutions and interest is paid periodically. Financial risk management 1) avoiding risk : avoiding risk means no to choose any activity is risky 2) Reducing risk : reducing risk means lowering the severity of loss like smoke detector installation in pharmacy. 3) Transferring risk : transferring risk means buying insurance. insurance policy is purchased by paying premium. Accountancy in community pharmacy - day book , cash book Accountancy or accounting is a process of recor ding the financial transactions in books of account. Accountancy is necessary to run any business smoothly and it is helpful in many aspects like : 1) In financial management 2) in settlement of taxation liability 3) In financial analysis 4) to check profit and loss 5) To reduce and detect fraud 6) To maintain evidence. Day book Day book is an original entry book in which all the transactions and drug related activities are recorded on a daily basis including all the transactions buy and sale Details of medicines sold , quantity , price of per unit and total amount of money collected for each transaction. Details of product purchased by the pharmacy including drug and equipments Cash Book It is a dairy in which all the business related transaction s are recorded , It includes : 1) all the payment done for purchase and sale of products or any equipment for pharmacy. 2) bank deposits and withdrawals. SR Pharmacy  50 Subscribe S R Pharmacy Introduction to Pharmacy operation softwares - usefulness and availability Pharmacy operation softwares are softwares programs or apps which help a pharmacist to manage pharmacy activities effectively in less time. there are a lot of softwares available in market that meet the needs of Pharmacy management. Key features of Pharmacy operation softwares A Pharmacy operation software should have following features: 1) Billing : a good software should have billing facility and recording the billing data , including patient's and medication information. 2) Inventory management : it should have inventory management system to keep record of stock level and indicate the re -ordering of products. 3)Prescription processing (scanning) facility : a good pharmacy operation software has the scanning facility of description , this feature saves the pharmacist's time of typing the items name. 4) Accounting : it should have accounting facility of Pharmacy transactions 5) Reporting : a good pharmacy software has the reporting facility , this feature reports the business performance. 6) Point of sale functionality : This facility allows the pharmacist to accept payments from customers. Usefulness 1) they provide fast services 2) they save time of pharmacists and patients 3) they recognise Expired items 4) they improve pharmacist efficacy. 5) They record patient's medical history. 6) they prevent medical fraud. Availability There are a lots of softwares available which meet the pharmacy management needs : 1) EnterpriseRx 2) Cerner Retail Pharmacy 3) PioneerRx 4) Logic ERP 5) eVitalRx etc. SR Pharmacy  51 Subscribe S R Pharmacy Customer Relation Management CRM is the combination of practices , strategies and technologies , That a pharmacist uses to make a good relationship with customers and this relationship is made through interection with customers.  The interaction with patients can be conducted online or offline  There are many customer relationship management softwares available that help a Pharmacy to increase the interaction with the customers using email marketing , automatic messaging , feedback and rating system. Advantage of CRM  Increases the satisfaction of customers  it increases sales and income of pharmacy  Customers tell others also about that pharmacy  It is records customers data which help to provide faster customer services. Audits in pharmacies Auditing or financial audit is an official examination and verification of a business 's financial record which are presented by management. Auditing gives the business partners , shareholders and government a confident and satisfaction that financial records are present by management are true and fair. Type of auditing 1) Internal Audit : An internal audit is an audit performed by a qualified auditor or accountant who is part of your company. 2) External Audit : An external audit is an audit of your financial statements made by an independent, third-party professional. 3) ISR Audit : Internal Revenue Service (IRS) audits, or tax audits, are government reviews conducted to a business to ensure that financial data has been reported in compliance with tax laws. SOP of Pharmacy management A standard operating procedure is a set of instructions and guidelines are prepared and documented by an organisation to help workers , to carry out the repeated operations (works) safely and effectively. Pharmacies make their SOPs according to their business size and needs but some key points should be included in SOPs which are following : o SOP for drug list o SOP for procurement of medicines o For drug receiving into a Pharmacy SR Pharmacy  52 Subscribe S R Pharmacy o For storage of drugs o For Vaccine storage o for temperature control o for dispensing of drugs o for Patients counselling o for compounding of Medicines o for disposal of expired drugs o for training of new pharmacists Introduction to digital health mhealth and online pharmacies Digital health refers to use of digital platform , tools and technologies for providing healthcare services , these services are provided using applications , websites or any other social media platform. Digital health includes telehealth , electronic health record , mobile health applications etc. mHealth and online pharmacies Delivery of healthcare and medical services via smart phones , tablets and computers is known as mHealth. The pharmacy that works online and receives medical orders and delivers health care services , using internet by any digital or social platform is known as online pharmacies.  Online pharmacies provide doorstep services.  Online pharmacy saves time and money of customers. SR Pharmacy