Thursday, November 11, 2010

Primary Care Attachment story

Ok, this post, I would like to share with you guys about my experience for the latest just finished Primary Care attachment.

The grouping for this attachment is the same while we were having Primary Care attachment during 3rd year. So I was in the same group with Nami, Marr, Pui Yan and Kak Mimi 'the kaki sembang' =p. This group is just nice for me, no problem and we had fun working together.

For this time around, we were attached to a highly technology Klinik Kesihatan (KK) in Putrajaya Presint 9. It's so near to my house, and I can reach it by walking, but during the first day, I was the last person that arrived... =p.

Yes, about the highly technology, KK Putrajaya is using computerized system for almost all process in the pharmacy department. I still remember when we were attached in Klinik Kesihatan Bukit Changgang in Banting, we were struggling to understand the doctor's handwriting for the prescription screening. However, the difficulty was no longer exist by the use of computerized system in KK Putrajaya.

This Primary Care attachment was done for 3 days (tuesday-thursday). On the first day, we started with prescription screening and filling. The assistant pharmacists there were really helpful and we have learnt a lot on the best way to screen through the medication and also to fill the medication as fast as possible.

Interestingly about the computerized system is, the waiting time can be recorded. Basically, the patients should not be asked to wait for more than 30 minutes after the patients have scanned their registration card at the pharmacy department. Thus, the filling process must be accurate and prompt.

There are 4 main dispensing counters in KK Putrajaya and basically, the dispensers are all pharmacists, either PRP (Provisional Registered Pharmacist) or FRP (Full Registered Pharmacist). On the second day, we started to practice to do the dispensing.

We were given the chance to dispense the medications hands on to the real patients. For dispensing techniques, we were trained to 'treat' the patient by asking few questions related to their medication.

The dispensing session was more interactive and the main intention is to help the patient to effectively use the medication prescribed to them.

Nearly to the afternoon, we were given a briefing about the drug store in the pharmacy department by pharmacist in-charged, Pn Nadira. Almost all about the process to handle drug store were revealed during the briefing.

Basically, handling drug store job scope is slightly different and the toughest part might be to handle the financial/budgeting and the responsibility to make sure the safety and amount of the products in the drug store.

Here, the quality of leadership and management of a pharmacist is highly needed because everything must be in the right order and the staffs issue also need to be resolved wisely. I would think that a pharmacist that has good experience in handling drug store in KK or hospital can be a good candidate to manage a retail pharmacy.
Other than that, we were lucky to observe few live counseling sessions done by pharmacists with some patients. The counseling session was on the correct technique to use salbutamol inhaler for the asthmatic patient.

Counseling session is crucial to teach the patients about their medications so that the medication can be delivered to the target site correctly and the patient will get the maximum therapeutic effect of their medications.

For sure, the communication skills as a pharmacist must be great. Great here does not mean a pharmacist need to use bombastic words to impress the patients, however, it does mean to communicate effectively so that the patient can well understand the instruction given.

The best part after the counseling session is, the patient should feel encouraged to appreciate their medication and motivated to achieve their health target.

In stead of usual counseling session, KK Putrajaya is currently promoting a Smoking Cessation program. The new product that they use is Champix. Champix is a new medicinal product that can help someone to quit smoking.

The common products used for smoking cessation are Over The Counter (OTC) Nicotine replacement products such as skin patches, chewing gums and lozenges. However for Champix, it does not use Nicotine at all. The main active ingredient is Verenicline. It is for oral use and in the film coated tablet of dosage form.

Pharmacologically, Verenicline works by binding to neuronal nicotinic acetylcholine receptors, where it acts as a partial agonist - a compound that has both agonist activity, with lower intrinsic efficacy than nicotine, and antagonist activities in the presence of nicotine. Champix is given for 12 weeks and the dose is increased gradually.

Based on the Smoking Cessation program testimonial, Champix has helped many patients to reduce the frequency of smoking and there are patients who have successfully stop smoking. There are few common side effects of using Champix have been addressed such as nausea and vomiting.

So, if you are a smoker and intended to stop smoking, you may find Champix at retail pharmacies near you at cost around RM120. However, if you think it is expensive, let's have a try to join the Smoking Cessation program at KK Putrajaya. You can get it... FOR FREE! =)

Another honorable campaign held in Pharmacy department in KK Putrajaya is No Plastic Bag Campaign (I forgot the real name of the campaign, but the sounds and intention is similar.. =p). By this campaign, patient is not supplied with plastic bag at the end of the counseling session.

Usually, patient will be advised to bring their own bag to carry their medication. Sometimes I felt sympathy to patients who were dispensed with many medication but they did not bring any plastic bags. However, that's the truth that we need to reduce, stop the use of plastic bags to protect our earth as plastic is non biodegradable.

Thus as a reminder for me and others, if we are going to go to hospital or KK, kindly do not forget to bring along any bags to carry our medication k? =)

On the last day, we were assessed by our clinical pharmacy lecturer, Pn Umi by using mock pharmacy procedure regarding the prescription screening, filling, labeling and dispensing. First, we were given a prescription. We need to screen through the prescription for any medication errors or wrong related information.

Then we need to fill the medication and label it accordingly including the instruction to the patient. After done with the 3 phases, we need to dispense it to Pn Umi. I was the first student being assessed. I got a 51 years old female patient with the diagnosis of unstable angina. The medication prescribed were GTN, ticlopidine, trimetazidine, tramadol, simvastatin, mecobalamine and calcium carbonate.

Everything was fine at the beginning but a funny thing happened, I forgot to show the medication to the patient. I was only dispensing it by showing the label that I wrote. Now I realized that my patient went home without medication, but only the labels!! Hahahahahahaha..

Hmm.. There will be mistakes along the way of learning. It can be embarrassing, it can be painful, it can be burdening someone. But I will take it easy and come back with greater knowledge. Sometimes, it's better to do mistakes and then we learn rather than not doing any mistakes but assuming we are too clever for nothing.. right? =p

Well that's some of my experience for the 3 days Primary Care attachment in the 7th semester at KK Putrajaya. I believed that I have learnt something especially on the exposure about the 5s system of drug storing and high-tech computerized system of drug preparation and dispensing.

I have to point out that, what I learn in university is basically academically, which we try to add in almost all the related information on a case. However during the working life, everything will be more simplified and focused to the most righteous and main indication. Load of information is lesser but the responsibility is increasing as we will be dealing with real patients.

Thanks to all pharmacists and assistant pharmacists in KK Putrajaya for guiding us through out the days. You guys have been so kind and helpful. Till we meet again! =)


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