20/11/08

Martin King

Pharmacy Practice

Task 1: Receipt and storage of medicines

Introduction

Whilst visiting a retail pharmacy, and a hospital pharmacy, I observed and recorded the different
methods and procedures involved for ordering, receiving and the storing of pharmaceutical
substances.

Outcome

The ordering of drugs tended to be done via modem, although orders via telephone were
apparently not uncommon. One of the largest suppliers for retail and hospital pharmacy is the
company AAH. In the retail pharmacy I visited, AAH owned the computer system. When an item
is dispensed, the computer records, and puts it down for automatic reorder. This order can be
adjusted manually as needed. Both pharmacies I visited had two deliveries per day from AAH,
one at around 9am (items must have been ordered the previous evening) and another at around
4pm (items must have been ordered by 12.30pm). In the hospital I visited, the stores department
was managed by a senior technician, and they were in charge of ordering. The pharmacist
overlooked all drug orders at the retail pharmacy.

When the pharmacy orders were received the boxes were signed for. Included with each box was
a receipt and a picking ticket stating what the box contained. All items on each picking ticket
were to be checked to assure that the correct item was present, and that each had an acceptable
expiry date. In retail pharmacy controlled drugs must be signed for, and recorded in the ‘CD’
book by a pharmacist. A senior technician was able to do both of these in the hospital pharmacy.

In both pharmacies I visited, the items were manually put away into the correct place; ensuring
stock rotation is carried out to reduce the likelihood of a box expiring on the shelf. I was also
informed that many hospital pharmacies have a robot which can hold 10’s of thousands of
individual drug skillets. Each individual box is put onto a conveyor belt and the robot scans, puts
away and dispenses each item as requested.
Some items have different storage requirements

For example:

1 Freezer items: gemeprost pessaries, botulinum toxin

2 Fridge items: latanoprost eye drops, liposomal cytarabine, vaccines
3 Light sensitive items: glucose 25% IV solution, TPN’s

It is very important to take note of storage requirements for 2 reasons.

1 The patient could receive an inactive or harmful product.

2 Drugs are very expensive (liposomal cytarabine is approximately £1223 for one 50mg
vial)

Vaccines are particularly vulnerable to warm and very low temperatures. Therefore it is vital to
refrigerate them as soon as possible to keep the temperature of the product within the
recommended range. This tends to be between 2 degrees Celsius and 8 degrees Celsius. An
auditable ‘cold chain’ has to be kept from manufacturing to dispensing to assure quality. The
fridge in which they are stored must have a monitor to indicate the temperatures in which it has
ranged.

Other items requiring special handling include cytotoxic drugs. Cytotoxic means cell destroying,
so the reasons for special handling are obvious. They are much more widely used in hospital
pharmacy, and generally used to treat cancers. The only cytotoxic drug that was stored at the
retail pharmacy was methotrexate 2.5mg tablets. This group of drugs have the potential to cause
harm if not handled correctly e.g. burns, and even cancer. This is why gloves should be worn
when handling cytotoxic products at all stages from delivery, reconstitution and dispensing. In
the hospital pharmacy, cytotoxic spill kits were at hand and standard operating procedures were
to be followed in case of any accidents.

Some items have to be specially ordered for a patient. Reasons could include the pharmacy not
having the item in stock. As each pharmacy has two or more deliveries a day this isn’t always
such a problem as the patient would get an owing slip and come back when the item was in. This
could be a more troublesome problem if the item wasn’t commercially available as a specials
laboratory would need to make the item and this takes around a week.

The hospital pharmacy had a production unit which regularly made extemporaneous products in
their non-sterile area. An example is clobazam suspension 1mg in 1ml for an epileptic infant.
The product was made on a weekly basis and sent from the hospital to the named patient’s
doctor’s surgery.
Other problems that can arise could be a national shortage due to failed industrial batches. I was
informed at the hospital that for a long period of time diamorphine injection was in low supply
throughout the country. The pharmacists had to step in at this point and prioritise who was in
more need of the drug. In this instance, it was deemed to be a more suitable analgesic for women
in labour due to diamorphine having a shorter half life in the body compared to morphine. Other
diamorphine orders were refused and it was suggested that they order morphine.