Presentation

on
hospital
training

PHR 508
Presented by
Group E
name Class roll
Kazi aaquib mosharaf SH 12
Faria Mannan Mithi SN-43
Snigdha bardhan SN -49
Tabassum jannat SN-53
Farina Aziz SN-55
Sara Ali SN-58
Mafruha kumkum RK-105
Dilruba Akter Rk-108
Fairuz jahan piyal RK-113
Overview on hospital training

– We were assigned to Medicine, Surgery, Cardio, Nephro, Pediatric,

Emergency and surgery department.
– The time frame of our training period was from may 07 –
September 30.
– During this training we interacted with doctors, patients,
supporting staff, nurses and learned various aspects of disease
management.
– We observed the process only.
Role of pharmacist in hospital

– check prescriptions to make sure there are no errors and that they're appropriate
and safe for the individual patient
– provide advice on the dosage of medicines and the most appropriate form of
medication, for example, tablet, injection, ointment or inhaler;
– participate in ward rounds to take patient drug histories;
– liaise with other medical staff on problems patients may experience when taking
their medicines;
– make sure medicines are stored appropriately and securely;
– prepare and quality-check sterile medications, for example, intravenous
medications.
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Emergency and Casualty Unit DMCH

emergency [e-mer´jen-se]
an unlooked for or sudden occurrence, often dangerous, such as an accident or an urgent or pressing
need. emergency department an area of a hospital especially equipped and staffed for emergency
care.

Dhaka medical emergency outdoor is mainly referral emergency system.

It can divided into two categories

1. EMERGENCY ROOM (the gateway)

2. The resuscitation area (also known and casualty )
Arrival of patient collect a ticket (BDT 10)

placement of the patient in the Emergency Room

primary assessment by Emergency Medical officer (EMO)

referred transfer to resuscitation room

and further action
Types of patient
Infrastructure
Role of pharmacist
 Optimizing medication use through participate in direct patient care
 Medication order review
 Medication therapy monitoring
 Care of boarded patient
 Obtaining medication histories
 Medication reconcillation
 Documentation of associated interventions
 medication errors & ADR
 In emergency departments, pharmacist prescribers can also explore patients’ o
ver-the-counter medicines, something that doctors often overlook, and can prov
ide a medicines review to identify issues, such as adverse drug reactions (ADR
s), which might have led to their admission to emergency.
Medicine

Hospital Training

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Overview
Structure

• Units-12
• Wards-2 per unit
• Beds-40 per unit
• Each day admission in two units is performed
Medicine department
Sub-sectors

This department can be divided into two sectors

• General medicine
• Specialized
• cardiology
• nephrology
• neurology
• endocrinology
• gastrology
• respiratory
Organization body
Internal medicine

• Head of the department- prof. khan Abul Kalam Azad

• Associate professor -12 (unit chief)
• Assistant professor
• Clinical assistant
• Registrar
• IMO/HMO -2
• Approximately 20 HMO per unit
• 2-4 interns per unit
• 3-4 MD students
Cont.
Medicine

• Total government physicians: 35-40

• Assistant/associate professor: 20-25
• Non-government physicians:200-250
• Nurses-floor wise distribution
• 4govt and 10non-govt physicians per unit ( appointed for 6months)
outdoor
sectors

Two departments working under medicine which are

generally outdoor based:
-Physical medicine
-Transfusion medicine
Others
-Skin
-Psychiatry
Additional
specialized departments

Rheumatology clinic

SLE clinic

Headache clinic(neurology)
Facilities
Medical ( 24 hours continuous service)

• Less price
Investigation
• Free for poor patients

Blood transfusion • 24 hours service

Drug • 30-60% free

Accommodation
Types

Paid bed
Non- 275tk/Day
AC Free
AC
cabin bed
cabin Cabin
475tk/day

AC cabin
1000tk/day
Patient flow
From reception to treatment

emergency

Emergency
treatment

medicine

Specialized d
Grand round
epartments
Medicine
Hematology/oncology

Internal medicine
patient
Referred
by CA Hematology(thalassemia,
leukemia,multiple myeloma)

Oncology(normally palliative
treatment)
Medicine department
Common diseases

• Fever
• Typhoid
• UTI
• Pneumonia
• Septicemia
• Poisoning
• TB
• Acute kidney injury
• Meningitis
• Arthritis
• CKD
• CLD
Management
General procedure
• History taking C/C; Present illness; past medi
cal history; drug history; socia
• Initial diagnosis
l history
• Initial treatment
• Investigations
• Final diagnosis
• Pharmacological treatment by- HMO/RMO CA professor
• Counseling and follow up
Management cont.
Example

Patient history with i

nitial diagnosis
Cont.
Treatment
 PEDIATRIC
DEPARTMENT
 Structure of Pediatric Department
Pediatric
department

Pediatric Special
Pediatric Pediatric Pediatric hematology care baby
nephrology surgery medicine & oncology unit

No. of No. of No. of

No. of
wards wards wards
wards
3 1 1
2
 ORGANIZATION BODY
Departments HEAD of the No. of Associate No. of Assistant
Department Professors Professors

Pediatric Prof. Sayeeda 2 4

Medicine Anwar

Pediatric 1 1
nephrology ----------------------

Pediatric 2
Hemato- ---------------------- ------------------
Oncology(PHO)
Neonatology Prof. Manisha 1 2
Banerjee
 CONT.
DESIGNATION Number of Doctors
Residential Physician 1
Registrar 6
Research Assistant 1
Assistant Registrar 8
IMO 11
MO 2
 FACILITIES

Diagnostic facilities
Supply of
medication
Services of
doctors & nurses
 FEATURES OF PEDIATRIC
DEPARTMENT
• Pediatrics is the branch of medicine that deals with the medical
care of infants, children and adolescents, and the age limit usually
ranges from birth up to 18-21 years of age
• In DHAKA MEDICAL COLLEGE AND HOSPITAL, only patients
aged below 12 years are admitted to this department. Patients
above 12 years of age are usually treated as adults.
DOSE CALCULATION:
The dose of the drug is determined considering the
patient’s body weight and Body surface area (BSA). This
is the only department we observed where they consider
Body weight and Body surface area to calculate dose.
 Patient Flow
• Pediatric medicine unit is one of the most important unit of pediatric
department.

Emergency
Pediatric
Or
Medicine
Outdoor

Pediatric
Pediatric Pediatric
Hemato-
surgery Nephrology
Oncology
DISEASES HANDLED BY THE DEPARTMENT
• During our rotation of the pediatric medicine department we
encountered the following diseases which were prevalent:

Encephalitis,
Febrile convulsion
Cerebral malaria

Meningitis,
Meningo- Tuberculosis
encephalitis

Bronchopneumonia
 MANAGEMENT
General procedure: Chief Complain(C/C);
History taking Present illness; Past
medical history; Family
Initial diagnosis history of illness;
Immunization History etc.
Initial treatment

Investigation

Final diagnosis
By HMO/RMO;
Pharmacological CA; Professor
intervention
Follow up
 Example
Chief complain(C/C)

Present Illness

On
Examination(O/E)
 Treatment

Body surface area (BSA)

calculation
 Facilities to improve
Attendance restriction To prevent
nosocomial
infections
Hygiene management

Continuous assessment of The medicine required

for treatment is ordered
critically ill patients by the on-duty physician
but it takes several hours
for the hospital
management to process
Medicine inventory
the order

Introduction of help desk

 Scope of clinical pharmacists
Including of pharmacist in the pediatric team in the context of DMCH can result into the following
advantages:
 Detailed information about pharmacokinetic and dose of drugs, because for children correct and
precise dose is more important
 Selection of proper antibiotic, anti-viral and anti-fungal drug for pediatric patients.
 Pharmacists can also recommend a better product of a drug to physicians (for example instead of ½
stick of 250mg Paracetamol suppository, the pharmacist can recommend 125mg suppository).
 PEDIATRIC
NEPHROLOGY
 PEDIATRIC NEPHROLOGY
Pediatrics nephrology is an individual department under pediatric section of Dhaka Medical
College Hospital.

This department is devided into two wards accommodating around 16 patients in total.

Pediatric
nephrology

Ward Ward
203a 203b
 DISEASE MANAGED IN PEDIATRIC
NEPROLOGY
This department mostly deals with the following diseases:

Nephrotic syndrome

Acute glomerulonephritis (AGN)

Acute kidney injury (AKI)

Chronic kidney disease (CKD)

HEALTHCARE SERVICES
Though pediatric nephrology is a small department without any subdivision it provides most of the
healthcare services required by the patients admitted here.

Provisional diagnosis to Prescribe necessary Provide pharmacological

provide immediate patient Follow up patient condition,
investigational tests to identify treatment based on the
care response to the treatment
the disease tests
MANAGEMENT OF NEPHRITIS
8 years old patient with the symptoms of
swelling of whole body
cough and cold
fever and vomiting

IF

albuminuria, higher creatinine to protien ratio in blood

hyperlipidemia is present

nephritis is diagnosed

deltasone and meropen and vancomycin are given

 ADDITIONAL SERVICES
CHILD DEVELOPMENT CENTER

Pediatric outdoor has a child development center. Children who suffer from difficulties in development
are given healthcare services by:

physician

psychologist

physiotherapist
Vaccination:

pediatric outdoor also provides vaccination. Children of 6 months of age and above can get vaccination
facilities from this section.
Nephrology Department
Introduction
• The Department of Nephrology at Dhaka Medical College &
Hospital, is dedicated to the understanding of kidney diseases,
their development, progression, treatment and prevention.

Different nephrology diseases treated:

• Chronic kidney disease

• Acute kidney disease
• Glomerular disease (glomerulonephritis)
• End stage kidney failure
 Patient flow:

Medicine
Emergency Cardiology Outdoor Hematology
department

Nephrology
department
About

• Location: New building, 3rd & 8th floor

• Structure: 2 units
Dialysis: hemodialysis & peritonial dialysis
Genaral Nephrology : 901(male), 902(female)
Dialysis Unit:

• 21 machines
• Hemodialysis: Blood is filtered using a dialyzer and
dialysis machine.
• Peritoneal dialysis: Blood is filtered inside the body
after the abdomen is filled with a special cleaning
solution.
• 6 months package;20 thousands; 2 times per week
• Dialysis time:4 hrs
• Medicines needed: heparin, normal saline, dopamine,
erythropoietin, iron, vit D
Common drugs used in kidney diseases:

• Erythropoietin (rhEPO) therapy and iron replacement therapy

• Medicines for electrolyte imbalances.
• Diuretics
• ACE inhibitors
• Medicines for symptom relief
Cardiology Department
Overview of the Department
• The Cardiology department is located in the 2nd floor
at DMCH-2 building of the hospital.

• It is treated as a branch of Medicine, meaning it is

directed at treating patients with drug intervention
rather than surgery. However, in some cases, the
patients will go under some sort of surgery.

• The department consists of physicians of various

ranks from professors to intern doctors and provide
services for diseases involving cardiovascular system.
Structure of the Department
Coronary Care Unit (CCU) Deals
Cardiovascular with the most critical patients. It
Department is equipped with the modern
instruments to monitor patients
ECHO 24/7.
CCU PCCU ECG facility
facility

16 Beds 32 Beds
The department contains two wards – CCU
and PCCU. The CCU contains 16 beds and
the PCCU contains 32 beds.
Other than the Wards, the department floor
houses the facilities for ECG and Echo as
they are routine tests for the patients of this
department.
Post-CCU (PCCU) ward handles
patients who have been treated
by CCU and deemed healthy
enough to remove from
continuous monitoring system.
Patients who are less critical may
be directly admitted to PCCU.
Furthermore, If there are no bed
in CCU, patients are admitted to
PCCU.
Structure of the Department Cont.
• The Facilities consist of
• Indoor
1. Clinical
2. Interventional
a) Angiogram
b) Angioplasty
c) PTMC (valve repair)
d) Temporary and Permanent Pacemakers
• Outdoor
 Organization Of the Workflow
Out-patient service CCU

Patient Referred to CCU

Referred to Surgery
or PCCU

Emergency service
PCCU

Release

This flowchart shows how patient service is organized in the

department. Patients are admitted to the department through the
out-patient or emergency service. They can be admitted to CCU or to
PCCU. CCU patients are transferred to PCCU when they feel
comparatively better. Finally, they are released from PCCU.
Counseling Services
• The Department consists of 1 professor, 1 associate professor, 2 assistant professors, 1
registrar, several sub-registrars,medical officers and 2 consultants.
• They are always available for counseling of patients.
• Furthermore, the CCU and PCCU are always equipped with a large number of doctors to
monitor and handle any patients.
Treatment
• In Cardiology department they treat all kinds of heart and blood vessel diseases including:
• Myocardial Infarction (MI)
• Heart Failure (HF)
• Cardiomyopathy (CM)
• Chronic Rheumatoid Heart Disease (CRHD)
• Hypercholesterolemia.
• Aortic Stenosis (AS)
• Heart disease symptoms:
• Chest pain or discomfort (angina)
• Shortness of breath
• Palpitations
• Leg swelling
Common Drug Used in Cardiology
The common drug used in the Cardiology Department-

• Angiotensin converting enzyme (ACE) Inhibitors

• Angiotensin Receptor Blockers (ARBs)
• Diuretics
• Calcium channel blockers (CCBs)
• β-blockers & α-blockers
• Nitrates
• Anti-hyperlipidemic drugs ( Mainly Atorvastatin)
• Vasodilators
• Warfarin
• Gastrointestinal drug ( Mainly Pantoprazole )
SURGERY DEPARTMENT
 Introduction :

• Vital Department of any hospital.

• Dhaka Medical College Hospital also have surgery

department consisting of 6 units with 150 bed each.

• Departmental head is Professor Dr.A.Z.M Moshtak

Hossain Tuhin.
 Why Surgery Unit ?
• One of the largest units in DMCH.
• 20 days of placement.
• Patient follow up information for 20 days.
• Observation of various surgical cases (mostly abdominal
cases).
• Observation of medication, different tests, patient handling.
• Scopes of inconveniences , lacking and impacts.
 Surgery department
Location of Surgery Department General

Orthopedics

ENT
• Surgery Department is situated in the Main
Plastic Surgery
Building of DMCH.
Urology

• General Surgery is divided into 6 units located Ophthalmology

on the first floor. Thoracic surgery

Neuro Surgery

Pediatric Surgery

Cardiovascular Surgery

Casualty (Traumatology)
 Patient Handling :

• Emergency unit for primary

Emergency admission in the hospital.
• Emergency surgery unit for
Patient severe and emergency surgery.

• Admission in the surgery unit

Casual according to the day of the
week .
Patient • Surgery is carried out
according to the admission day.
Patient Handling :
 Patient Handling :

• Medications are given from hospital’s pharmacy.

• Post operative stay 7-15 days.

• After taking proper counseling patient is discharged

from hospital.
 Pre operative assessment :

• Creatinine (Kidney)
• ECG , Echo (MI)
• Urine analysis (pregnancy test, UTI)
• Diabetes test
• Respiratory (abnormal sound)
• Blood Group (cross matching)
• Cardiac (Heart Murmur)
 Common Surgeries :

General Surgeries
• Anal Fistula , Inflammatory Bowel Disease , Acute
Appendicitis , Kidney stone treatment , Nasal and sinus
disorder , Hernia , Tonsillectomies etc.
Special Surgeries
• Cardiac surgery , Orthopedic Surgery , Pediatrics Surgery
etc.
 Commonly Used Drugs :

• Analgesics : Pathidine , Rolac , Ketorolac , Anadol.

• Antibiotics : Ceftrioxone , Cefixime , Metronidazole ,
Ciprofloxacine.
• Anesthetic : Morphine , Lidocaine , Procaine .
• Anti emetic : Ondensatron , Largectile .
• Peptic Ulcer Drug : Omeprazole , H2 Blocker etc.
• Saline : 5% DNS, Hartsol .
 Overall Environment Inconveniences in
Surgery Unit :
1. Cleanliness not up to the standard
2. Patient to bed ratio- poor

3. Improper ventilation

4. Bad odor

5. Washroom- always damp and wet

6. Supplied food- poor quality

7. Use of broad spectrum antibiotics

8. No safe keeping of narcotic analgesics

 Measures To Be Taken :

• Number of beds should be increased.

• Doctors are short in numbers than patient , so number
of doctors should be increased .
• Doctors should be more friendly with patients.
• Number of nurses should be sufficient .
• Overall cleanliness should be maintained.
PHARMACY
- The main medical store is at the entrance of outdoor unit.
- Medicines for both indoor and outdoor patients are dispensed
from here.
- There is a main store where all the medicines are stored.
- Medicines are dispensed to required area from the two sub
stores (tablet /capsules and IV products).
 Senior Lecturer of Practical Pharmacy (SLPP)
Physician
 Diploma pharmacists (4 months Diploma Course)
 The Chief Pharmacist The Pharmacists will
The Physician writes
modifies the Indent dispense the drugs
the Prescription
based on experience based on the Modified
(Medication Order)
and available stock Indent

The Nurses check all The Dispensed drugs

The Chief Pharmacist
the Medication orders are sent to the specific
receives the Indent
in Ward Ward

The Nurses notes the The Chief Nurse

bed numbers and prepares an Indent The Patient receives
number required in (Requisition order) and the medications as per
each bed for each drug sends it to the medication order.
in a Ledger Book Pharmacy
 The Out-patient Physician writes
the Prescription

The Physician's assistant provides

The Medication slips are kept by the Medication slips against the
Dispenser for future References medicines which are available in the
Pharmacy

The Dispenser Pharmacist dispensesThe Patient supplies the Medication slips

the medications to the Dispenser Pharmacist
 Allthe medicines are kept in room temperature.
 For products needed to keep at lower temperature,
refrigerator is used.

Recommendation:
- The system should be more arranged.
- Registered pharmacists should be appointed.
Future direction

• Number of doctors 20-25doctors:1-2 nurses

• Number of nurses per ward

1800bed
• Number of beds Minimum 2500 patients

• Investigation facilities -Number of machines

-Types of facilities

EMR: electronic medical

• Record keeping record

• Include hospital pharmacist in healthcare service

In hospital
•Supply of medicine to be increased
•Control of visitors
•Cleanliness
In hospital

•Reduction of prescription error

•Personalized treatment
•Dose calculation
•Reduction of ADR
•Cost reduction in medication
•Early discharge of patient
•In ICU in case of multiple organ failure
To improve health care service

•Establishment of specialized clinical pharmacy in intensive care settings in collaboration between intensive
care professionals and the pharmacy department
•Participation of clinical pharmacists with post graduate degree
To improve hospital training

•To reduce the communication gap between DMC authorities and Pharmacy students
•Assign a MO for every group in each department
•Improvement of schedule