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CHAPTER 3

OBSERVATIONS

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 OBSERVATIONS

DAY1:
i. PHARMACY LAYOUT
Pharmacy Layout is the schematic arrangement of areas within a pharmacy.

 The location of the pharmacy was on the road

 Easily accessible to costumers
 Had Enough parking facility.
 Despite being located in an area of competition, the traffic flow of customers was
incredible.

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STYLE OF LAYOUT DESIGN:
 The general layout of the Pharmacy was Grid type Layout.
 All the racks and counters were arranged at a right angle to one another.
 The products were displayed in straight and parallel lines, on racks and shelves
respectively.
 The entrance was large enough to allow the wheelchair to enter.
 The surveillance system was exceptional.
 The floor of the pharmacy was smooth, easy to clean, and acid-resistant.
 The walls of the pharmacy were painted white.
 The lighting was good to minimize the errors.
 The ventilation facility was provided and the whole pharmacy was air-conditioned.
 The Customer Area was wide and fully spaced avoiding the crowd.
 Racks along the walls contained major companies' drugs that require easy access.
 Counters in the back area contained drugs that were of minor companies and sold
less.
 The Pharmacist Counter was within the customer proximity where patients were
counseled
 Consumer Goods Counters were present at the start of the entrance with easy
access to customers.
 The Controlled Items Counter was present away from the customer area and was
properly monitored by the Pharmacist. The narcotic drawer was checked by the
pharmacist twice a day.
 Cognitive Services Counter was present at the front of the entrance.
 Surgical Items Counter was also separately facilitated.
 Expiry Racks were located in-store to keep them separated from the rest of the drugs.
 The Store was present in the back area of the pharmacy with proper ventilation and
controlled temperature, containing extra supplies of drugs.
 Refrigerators were present along the wall for drugs that require to be stored at the 2-
8°C temperature range. Both refrigerators were provided with temperature sensors.
 OTC and Supplement Rack were located within the patient vicinity.
 Supports and Medical Devices were present with customers' maximum interaction.

TYPE OF LAYOUT DESIGN:

 Personal Services was observed in the case of prescription drugs where the customer
has maximum interaction with personals rather than drugs.
 Only a small area was allowed as self-service for consumer items

ii. LEGISLATION

 According to Punjab Drug Rule 2007, the new pharmacies to be formed must be
registered according to LICENSE 9.
 The license is only issued to a qualified person (Pharmacist).

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  It contained the information of the Pharmacist registered under Section 24(A) of
the Pharmacy Act 1967.
 This license was necessary to be present in every Pharmacy for proper functioning.
 The license was inspected every year and renewed after every 2 years.
 The picture of the Pharmacist along with his/her credentials was mentioned on it.
 It was displayed above the cash counter on the front wall of the pharmacy.

DAY 2 :
i. PLACEMENT OF DRUGS

 The drugs were arranged in racks according to the Manufacturer's names.

 Each rack was specifically assigned to a particular Manufacturer.
 Following this type of placement minimized the dispensing errors.
 In the case of fridge items, the drugs were categorized as
 Fridge A contained all types of vaccines and Hormones
 Fridge B contained enzymes, ophthalmic and other thermolabile products
 This method was advantageous as the drugs can be tracked easily.
 Liquid dosage forms like syrups suspensions emulsions were placed separately.
 OTC Drugs were placed in separate OTC Rack.
 Controlled items had separate counter present in no patient zone.
 Expiry Drugs were placed in separate racks away from common shelves.
 Milk products and Nutritional Supplements were separately placed on racks.
 All surgical items and Supports were assigned a separate counter.

DAY 3:

STORAGE CONDITIONS

 In the case of drugs, proper storage conditions are ensured to prevent deterioration
and eliminate undesirable reactions in patients due to inappropriate storage.
 Mercuric thermometers were fixed along the walls of the pharmacy and Digital
thermometers were placed on the refrigerator to control premises and refrigerator
temperature respectively.
 A temperature sheet was attached to the wall and refrigerator with the temperature
record for the whole month.
 The temperatures were recorded after every 2 hours and signed by on duty
Pharmacist.
 The temperature for the premises of the pharmacy was maintained between 15-30˚ C
and for fridge items, it was 2-8˚C.
 Heaters or Air Conditioners were used depending upon the conditions.
 Relative Humidity (RH) levels were also kept at less than 60%. Air Conditioners and
or dehumidifying devices were used.
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 Also, the drugs were protected from direct sunlight.

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 DAY 4:
OVER THE COUNTER (OTC) DRUGS

 The medicines that are sold directly to the patient without prescription are called Over
the Counter or Non-Prescription Drugs
 OTC medicines were sold directly to the patient on the demand or sometimes on the
recommendation of a Pharmacist.
A list of 50 OTC Drugs available in Clinix is given in Annexure 1

DAY 5:
PRESCRIPTION DRUGS

 The drugs that are sold in pharmacies with the prescription of a registered
Physician and under the supervision of a Pharmacist are called Prescription Drugs
A list of 50 Prescription Drugs in Clinix is given in Annexure 2

DAY 6:
PRESCRIPTION HANDLING

 A prescription is a written, verbal, or electronic order from a registered

medical practitioner to a pharmacist for a particular medication for a specific
patient.
 The Prescription was given by the patient at the counter to the employee standing
at the prescription counter of the pharmacy.
 The pharmacist checked the legality, legibility, and correctness of the prescription.
 The employee saved the record of the patient and medication on the computer.
 The medicines were retrieved and the bill was generated.
 The bill along with the medicines was transferred to the cash counter and before
giving the medicines to the patient, their expiry and packaging were checked again to
avoid any inconvenience.

DAY 7:

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 PATIENT COUNSELING

 Patient counseling means the written and oral communication by the pharmacist to the
patient or caregiver to ensure proper use of drugs, devices, dietary supplements, etc
 Patient counseling is the ultimate responsibility of the Pharmacist.
 The Pharmacist was involved in providing the following information to the patient
 Guiding the patient about the disease,
 About the medicines
 The possible side effects
 Route of administration
 Use of certain medical devices
 Interactions with food or other drugs.
 Prescription in case of minor ailments like cough, fever
 Guiding the lifestyle modification

DAY 8:
COGNITIVE SERVICES

 The use of specialized knowledge by the pharmacist for the patient to promote
effective and safe drug therapy.
 In CLINIX, the following Cognitive Services were offered
 Blood Pressure Checking
 Body Weight Measuring
 Blood Glucose Monitoring
 The weight measurement & BP testing were provided free of cost.
 The pharmacy charged for blood glucose testing for the separate lancet.
 A separate counter was present to offer these services.
 Pharmacist & trained staff was available to provide the services.

DAY 9:

TIME MOTION STUDY

 It is the method to determine the time taken by the Pharmacy staff to facilitate the
patient.
 In Community Pharmacy, the time consumed in the process of prescription
handling, billing, and receiving the medicines by the customer is included in Time
Motion Study.
 The average time required by one customer was 3 to 4 minutes while in some cases it
was increased to 10-15 minutes if the Patient needed Counseling.

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 DAY 10:
INVENTORY CONTROL

 Inventory Control is the maintenance of Drug Supply to a level neither too much to
burden the expenses of the Pharmacy nor too less not meet the patient demand.
 Inventory control is vital for the maintenance of Pharmacy supplies.
 Managing Inventory helps to maintain
 A steady supply to the patient
 A balance between sale and purchase
 Prevents product stock out
 Prevent deadstock
 Minimize the cost of holding inventory
 Reduces the chances of losses and theft

 In CLINIX, the staff regularly maintained the stock by following the FIFO Rule of
Management ‘First In First Out’ that is the product first received in stock will be
utilized first and offered for sale on a priority basis.
 The drugs that are sold are recorded in the software.
 At the end of the day, the manager of the pharmacy observes the sales and prepares a
list of drugs that need to be purchased or the products that need to be returned
according to the demand and budget of the Pharmacy.
 The purchase or return invoice is sent to the Head Office Purchase or Expiry
Department respectively
 The software used to control inventory in Clinix was ABUZAR CONSULTANCY
Invoices were sent daily, whereas the renewal of supplies was done on weekly basis.

DAY 11:

DRUG PROCUREMENT SYSTEM

 Procurement is defined as a process of acquiring supplies through purchases from

the manufacturers, their agents like distributors, or private or public suppliers.
 There are two systems of drug purchases
Local Purchase: In this system, every branch individually gets supplies from
company distributors
Centralized Purchase: In this system, the head office purchases drug directly from
distributors or manufacturers and send supplies to pharmacies according to demand.
The drugs required in less quantity were purchased from distributors whereas the
drugs required in bulk were purchased directly from the manufacturing company.
 In CLINIX, the Centralized Purchase System of Drug Procurement was followed
 The invoice sent by Pharmacy was regulated in the Purchase Department of the Head
Office and the order was sent to suppliers
 The stock was received, payment was made and then the supplies were sent to the
Individual Pharmacies to meet the demands.
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 Day 12:
MAINTENANCE OF NARCOTIC RECORD

 To prevent the misuse of the drugs specified in Schedule B and D (including

narcotics, Tricyclic Antidepressants, Psychotropic Agents, Antibiotics, and some
controlled drugs). A Narcotic Registered was maintained.
 The Pharmacist was responsible for keeping the narcotics record
 Every sale of narcotics was checked by a pharmacist twice a day.
The details mentioned in the narcotic register were:
 Quantity of the drug sold
 Quantity of the drug available
 Name of Prescriber
 Name of Patient
 The date on which the drug is sold
 Name and branch number of the product
 Signature of Pharmacist
 The Narcotic Registered was properly maintained.

DAY 13:

EXPIRY MANAGEMENT

 Drug expiration is the date after which a drug might not be suitable for use
 So, a Pharmacist must check the expiry date of all the medicines present in the
pharmacy to prevent the sale of expired medicines to a patient.
 Regular Expiry (Simple): 4 months before written expiry
 Regular Expiry (Advance): 5 months before written expiry
 Intimate expiry: There are some products for which their manufacturer indicates to
send their expiry. Such a type of expiry is called an intimate expiry.
 In CLINIX, there were separate Racks for Regular simple, Regular Advance, and
Intimation Expiry for both Drugs and Consumer Products.
 The expiry management was done on regular basis and an Expiry Record Registered
was kept in the Pharmacy record was maintained.

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 DAY 14 :

FRIGDE ITEMS RRECORD

There are two refrigerator maintained at pharmacy. The temperature of these

refrigerators maintained between 2-4 degree Celsius and 4-8 degree Celsius respectively. The
temperature is recorded after each hour. Digital thermometers are placed to check the temperature.
Mercury thermometers are placed in the premises of pharmacy to maintain pharmacy temperature.
Temperature control chart was displayed on the wall and was regularly maintained and signed by
pharmacist.
Fridge A: contained all types of vaccines
Fridge B: contained steroidal products and some opthalmics and other thermolabile products .

DAY 15:
SURGICAL ITEMS

 Lungs exerciser
 Nebulizer mask
 Fitting tube
 Surgical blades
 Epidural for anesthesia
 Ear plugs
 Scalper
 Cord plug
 Surgical gloves
 Infusion
 Urinary bags
 Specific container for detection of urine
 BP apparatus
 Sugar testing

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