A REPORT ON SIX WEEKS EXPERIENTIAL TRAINING AT KWADASO

S.D.A. HOSPITAL, KUMASI

As part of the Introductory Hospital Pharmacy Practice Experience (IHPPE I)
in the Doctor of Pharmacy programme, 2nd year students were tasked to
undergo 4 weeks hospital pharmacy practice experience and 2 weeks of
nursing orientation. I started the programme on the 18th of March, 2015 and
ended on 26th June, 2015 at Kwadaso S.D.A. Hospital. Kwadaso S.D.A.
Hospital is a mission hospital under the Christian Health Services. The
hospital is situated in Kumasi and offers quality healthcare service to all
patients that visit the facility. My training was supervised by the pharmacistin-charge, Pharmacist Edmund Agyei Boadu.
ACTIVITIES
During my training I partook in various activities which are briefly outlined
below:
Nurses orientation
The hospital has four main wards namely, the females ward, the males
ward, the surgical ward and the maternity ward. It also has an Accident and
Emergency unit. I was assigned to the females medical ward, which admits
females from ages 10 and above, for close monitoring. I participated in the
following activities

I took part in ward rounds, in which a doctor on duty visits every ward
on the facility to assess patients response to treatment. I learnt some
skills the doctor uses to complete this task. Open ended questions are
usually asked by the doctor and the patients response is noted. The
doctor uses a four-hourly vitals chart in conjunction with the questions.
The outcome is that, either the patient is discharged or is allowed to
continue admission in order to monitor their health status. Physical
examination such as palpation etc. is carried out by the doctor to

confirm some suspicions.

I was taught how to dust the ward and did so anytime I was on the
morning shift. Dusting is performed in the hospital to keep sanitary
conditions in the ward for the invalids. It is usually done every morning
and includes straightening patients bed sheets, disinfecting their
lockers and bed railings with a suitable disinfectant, and cleaning the
windows. This activity makes the ward conducive and reduces

microbial contaminations which may lead to nosocomial infections.

I was taught how to monitor the vital signs of patients. The vital signs
monitored included the blood pressure, temperature, pulse, and
respiration rate. They are recorded and plotted on a graph, then
interpreted to judge how effectively patients are responding to
treatment. This was done 4-hourly every day. In addition, I was able to
check the random blood sugar levels of patients. The chart is a really
important tool in the ward. The medical condition of the patient is
indirectly reflected on the chart. For example, feverishness is recorded
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as elevated temperature. In some cases, the chart provides

information as to whether to continue with a particular medication or
withdraw it. The pattern of the graph, studied for each parameter, ie.
Temperature, blood pressure, pulse and respiratory rate shows the

patients response to treatment.

I was taught how to lay beds for the sick and appreciated how special
beds are laid for patients with respiratory tract disorders such as
asthma. The beds are disinfected with a suitable disinfectant before
and after the beds are occupied by patients. The beds for asthmatic

patients are adjusted so that they lie in bed while propped up.
I was taught how patients are admitted into the ward through
documentation. This was done using the nurses notes. The nurses
notes were also used to document every medical care and intervention
offered to the patient while on admission. As part of the admission
process, I realized that, patients were asked their complaints and then
reassured of speedy recovery. Inasmuch as physical treatment is

important, the emotional state of the patient is also taken care of.
I assisted in administering oral medication to the patients. Through
this, I learnt how to follow the frequency of the doses of every oral
medication the patient was placed on as prescribed. It was also
documented using a drug administration chart which made the process
every efficient. Patients who were to be discharged had to have their

medications explained to them for therapy to continue at home.

I also assisted in setting IV lines and administering medication via the
intravenous route and through a naso-gastric tube. Basically, the IV
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lines are used to deliver medications for systemic use. The line is
passed through a straight vein via a cannula, then appropriate
medication administered. The rate of flow is regulated to prevent fluid
accumulation in tissues. The naso-gastric tube is used when patients
are unable to take in food and water orally. Usually food given through
the tube is diluted with sufficient water. The quantity of food and water
served is almost equivalent to that which the healthy patient would
have taken. In addition, I assisted in preparing injectables for
intramuscular administration of medicines.

Pharmacy training
The hospital facility is equipped with three dispensaries; the main hospital
pharmacy, a private pharmacy and a chronic care unit dispensary. The main
hospital pharmacy serves the out-patients and in-patients while the chronic
care unit attends to patients with retroviral diseases.

Through these dispensaries, I was exposed to the patients folders. I

familiarised myself with the names of some medical conditions and
some medical terms. For example, PDHx when written meant patients

drug history, etc.

I was taught how to read prescription and serve appropriate
medication as prescribed. Prescriptions written by the physicians are
not legible to the untrained eye. I was orientated on how to read the
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prescriptions and serve them accordingly. In situations where the

information was not clear, I had to ask the expert pharmacy

technicians whom I worked with for clarification.

I took part in dispensing medicines to the patients, educating them
when they did not understand what their medicines do, and how to
properly take them. Most patients had to know the safe way of taking
their medications while taking note of their possible side effects. I was
exposed to the way in which questions are asked to verify the name of
the patient and the complaints they have. This was done to make sure
that the right patient was taking the right drug. In the hospital
pharmacy, I was able to apply some knowledge acquired in school on
some possible drug interactions which reduce the efficacy of the
medication. As such, appropriate instructions were given to patients in
order to prevent this effect. Where necessary, I was taught how to
suggest some lifestyle changes to patients since our diet and

environment impact our health.

I observed patient-counselling sessions with patients with retroviral
diseases. The hospital facility is one of the few hospitals that issue
antiretroviral drugs to the populace. Through these counselling
sessions, I was taught that HIV/AIDS is managed with a combination of
antiretrovirals such as combivir which is a combination of zidovudine
and lamivudine. Since patients were often stigmatised because of their
condition, they were often counselled on how to improve their lifestyle
in terms of diet, how to prevent others from being infected and when
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to report to the hospital during their treatment. Some side effects were
also common on taking the medicines, which the patients were made

aware of.
I also assisted in managing the medicine store in the dispensary
through stock taking, etc. The hospitals medicines requirements were
handled by the pharmacist. Periodic stock taking was done to keep the
dispensary updated on the quantity of medications available for use. In

the process, expired drugs were identified and disposed of.

I observed how concurrent drug utilisation review took place while
dispensing i.e. in situations where the doses of medicines had to be
adjusted for safe use by the patient.

CHALLENGES
I encountered some challenges during the course of my training.

I could not dispense very accurately, paediatric doses, as the childs

age and weight were to be considered.

The ratio of patient to healthcare provider was very large and this

made my training stressful.

Since the local dialect was used very often i.e. Twi, I found it quite
difficult to convey some medical terms to the patients.

OBSERVATIONS AND RECOMMENDATIONS

I realised that, in the typical hospital setting, the pharmacist is seen as

the dispenser of medications although pharmacy technicians and
dispensing assistants can do same fairly well. Hence, the current
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Pharm D program is a step in the right direction to clarify this

misconception.
I also realised that the British National Formulary (BNF) helped a lot in

guiding how medicines are to be taken.

I would also recommend that, some allowance should be arranged to
be given to students to cater for our transportation.

CONCLUSION
The vacation training programme has equipped me with basic nursing skills
and exposed me to the work of the pharmacist in the hospital. In the end, I
appreciate that the pharmacist must be patient centred. In addition, the well
being of the patient is dependent on the collaborative effort of all health
service providers in the hospital.

KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOGY

FACULTY OF PHARMACY AND PHARMACEUTICAL SCIENCES
DEPARTMENT OF CLINICAL AND SOCIAL PHARMACY
INTRODUCTORY HOSPITAL PHARMACY PRACTICE EXPERIENCE I
(IHPPE I)

TOPIC: A REPORT ON SIX WEEKS VACATION TRAINING AT KWADASO

SDA HOSPITAL
BY: FRIMPONG-MANSON KOFI (PHARM D 2)
INDEX NUMBER: 9878113
DATE: 28TH JUNE, 2015