Pabna University of Science and Technology, Pabna

Department of Pharmacy
Assignment on
Hospital pharmacy practice in Bangladesh
and other developed countries
Course code: BPH 4209
Course title: Pharmacy Practice – I

Submitted By : Submitted to:

Fahmida Hasan Rukshy Most Reshma Akter
Roll no : 161337 Lecturer
Session: 2015-2016 Department of Pharmacy
4th year 2nd semester Pabna University of Science and
Technology, Pabna
Department of Pharmacy
Pabna University of Science and
Technology, Pabna

Submission date: 12 May 2021

 Assignment
On
Hospital pharmacy practice in
Bangladesh and other
developed countries
 Index
Title Page No
1. Introduction 01-02

2. Hospital graduate pharmacists is imperative for

comprehensive health care services 02-04

3. Irrational pharmacy practice and inadequate

health care services in Bangladesh: a lesson
learned from COVID-19 pandemic 04-06

4. Conclusion 06
Introduction:
The conventional role of pharmacist is to manufacture and supply medicinal
products. Recently, however there is a significant change in the pharmacy
profession in terms of professional services delivery due to the increased demand
of pharmacists. Complexities due to increases in range of medicines and poor
compliance have shifted the focus of pharmacist toward patient-centered approach.
This situation has made pharmacy discipline to be recognized as an equally
important profession in the multidisciplinary team for the provision of health care.

Hospital pharmacists work in a hospital pharmacy service and are responsible for
ensuring the safe, appropriate and cost-effective use of medicines. Hospital
pharmacists use their specialist knowledge to dispense drugs and advise patients
about the medicines they have been prescribed. They work collaboratively with
other health care professionals to devise the most appropriate drug treatment for
patients. Hospital pharmacists also involve in the preparation of medicines or
admixture in hospital premise.

Hospital pharmacy practice is one of the most vital parts of a hospital for better
patient care and drug safety management. World Health Organization (WHO)
recommends that standard hospital pharmacy practice should be carried out under
the super vision of professionally competent legally qualified graduate pharmacist.
WHO clearly recommends that the management of drug procurement, storage and
distribution should be the responsibility of the pharmacy graduates.

The WHO consultative group describe that the pharmacy graduates acquire
necessary knowledge, training and understanding of the scientific principles and
techniques of the pharmaceutical sciences and the ability to keep pace throughout
their careers with development and management of pharmacy.

In many parts of the world, pharmacists have played a significant role in provision
of pharmaceutical care services. In addition, it is also widely believed that
pharmacists can make a great contribution to the provision of the primary health
care, especially in developing countries (Smith, 2004; Jesson et al., 2006).
Literature review showed that there was very limited information of this type of
research within the hospital in-patient pharmacy services in Bangladesh. Many
researchers have found that, prescribers are in favor of the new extended roles of
practicing pharmacists as patient counselors and drug information providers. The
objective of this study was to summarize the current scenario of pharmacy
practices in the four hospitals of Bangladesh. and to identify the pharmacist’s
activities in these hospitals.

Hospital graduate pharmacists is imperative for

comprehensive health care services:
Speakers at a policy dialogue on Good Pharmacy Practice (GPP), held in Dhaka on
19 September 2019, identified the need of competent pharmacists in hospital
pharmacy settings as an imperative step for ensuring comprehensive health care
services.

The event aimed to identify steps and solutions to establish Good Pharmacy
Practice in health care settings; improve practices and appropriate use of
medicines; decrease medication errors and improve reporting on medication-
related adverse events, thus contributing to enhance the quality of health care
services for people in need.

Speaking at the dialogue as the Chief Guest, Dr Shirin Sharmin Chaudhury MP,
Speaker of Bangladesh National Parliament said, “doctors and pharmacists should
work hand-in-hand to utilize the expertise of pharmacists in hospital settings”. She
called upon the doctors and pharmacists to develop comprehensive treatments
plans and to help in achieving universal health coverage.
Organized by Pharmacy Council of Bangladesh (PCB) in collaboration with World
Health Organization (WHO) Bangladesh, the policy dialogue was attended by Mr.
Zahid Maleque, Minister of Health and Family Welfare (MOHFW), Mr. Farhad
Hossain, Minister of State, Ministry of Public Administration, Prof Dr. A K Azad
Chowdhury, Professor Emeritus, Department of Clinical Pharmacy &
Pharmacology, University of Dhaka as special guests.

Addressing the participants, Mr. Zahid Maleque declared that “pharmacists are
playing a vital role in health services in the country. We need graduate pharmacist
posts in different hospitals. There is no conflict between the roles of doctors and
pharmacists, they will work together for the betterment of health sector of the
country”.

During the discussions, participants urged the Government to take immediate

initiative to formulate a policy for appointing graduate pharmacists in all section of
hospitals. Also, competency-based curriculum, training and examination should be
developed before appointing pharmacists to ensure quality services.

“Ministry of Health and Family Welfare should formulate policy and create posts
for hospital pharmacy as soon as possible to ensure better health services” said Mr.
Farhad Hossain.

Furthermore, the participants recommended actions to improve doctor-patient,

doctor-pharmacist and pharmacist-patient communication for ensuring appropriate
use of medicines, and exploring options for enhancing clinical training of graduate
pharmacists, including in-service training, post-graduate courses and cross-
disciplinary training.

Tackling the issue of responsible use of medicines, Dr Bardan Jung Rana, WHO
Representative to Bangladesh also emphasized the need of better training for
pharmacists that will be reflected in increased responsibility of their activity: “To
address medication-related needs, pharmacists should accept greater responsibility
for the outcomes of medicines use and evolve their practices to provide patients
with enhanced medicines-use services”.

Chaired by Mr. Ashadul Islam, Secretary Health Services Division, MOHFW and
Chairperson of PCB, the event was attended by prominent academia, policy
planners and renowned pharmacists and physicians of the country, among others.

WHO remains committed in supporting the Government of Bangladesh to

strengthen the pharmaceutical sector and professionalize the staff for ensuring
quality health services and further progress towards achieving Universal Health
Coverage.

Irrational pharmacy practice and inadequate health care

services in Bangladesh: a lesson learned from COVID-19
pandemic:
Bangladesh is a densely populated country in South Asia, with over 162 million
people. The first case of coronavirus disease (COVID)-19 was detected in the
country on Mar 8, 2020, and until Feb 09, 2021, 538,378 active cases and 8,221
death so far recorded from this deadly contagious disease . The government of
Bangladesh responded promptly against COVID-19 with its limited number of
health professionals and resources. In this crisis moment, a greater responsibility
lies on pharmacists who can play their critical roles in meeting healthcare needs by
serving in pharmacy and pharmaceutical company in Bangladesh.

Pharmacists are health professionals who specialize in the rational use of

medicines by practising pharmacy, including dispensing prescription drugs,
monitoring drug interactions and counselling patients regarding the effects and
proper usage of drugs and dietary supplements . However, pharmacists are limited
to only manufacturing drugs in Bangladesh, and they cannot provide other crucial
services to improve the health care system. Most central government hospitals in
Bangladesh have no or a few hospital pharmacists (negligible in number), and the
country is yet to introduce hospital pharmacy services run by the graduate
pharmacist . Chinese community pharmacists played a crucial role in facing this
pandemic by collaborating with communities and drug companies. They offered
online consultation to provide pharmaceutical and care to COVID-19 positive
patients .

However, community pharmacy practice has not even seen in Bangladesh, leading
to polypharmacy practice and dose mismanagement without knowing drug profile
accurately . Therefore, multidrug resistance has become a common term, and most
antibiotics are becoming ineffective because of the irrational use and availability of
antibiotics without prescriptions in Bangladesh . Even that having a law of
punishment for selling the drug without a prescription, people have regularly
bought different drugs, including ivermectin, hydroxychloroquine and even
dexamethasone, to prevent and treat COVID-19 reported by a newspaper in
Bangladesh . The absence of community pharmacy practice is the most significant
cause of this condition.
Historical and empirical evidence shows the importance of hospital pharmacist in
the healthcare system; their involvement eases the system and made effective by
reducing drug-drug or -food interaction, raising adverse-effect related awareness
and confirming proper drug application and dose. In the continuity of pharmacists
responsibilities as a frontline healthcare provider, they proved their necessity in the
pandemic condition and played a substantial role in ambulatory or hospitalized
patient management and medication.

It has been seen on some occasion that several areas remain uncovered by doctor
or nurses during this pandemic. The community pharmacists have filled those gaps
by serving at the ground level and providing necessary ailments to reduce the
contamination at the community level. Besides, the complexity of COVID-19
infection needed multidisciplinary knowledge to manage immediate critical
symptoms; again, pharmacists proved helpful to optimize patient condition by
providing expertise in doses adjustment or adverse-effect reduction. In addition,
pharmacists’ knowledge in pharmacodynamics and pharmacokinetics can help set
a combination therapy to recover or comfort critical patients. For example, many
COVID-19 patients admitted to the ICU frequently treated with an anticoagulant,
and a pharmacist could ensure proper dose requirement and avoid multiple
comorbid conditions.

The pharmacy practice in Bangladesh and worldwide is different as pharmacists

only allow to manufacture, distribute and produce drugs in Bangladesh. This
limited practice made them unavailable in the major area where they needed most,
and it has been suffered during the current pandemic. However, Bangladesh has
promoted a developing country, but the people are still suffering from insufficient
healthcare service. One of the main reasons behind that pharmacist is not involved
in the mainstream. It is an urgent need for this country health ministry to realize
now and allow the pharmacist to practice in hospital and community clinic. Again,
the country struggled to tackle this pandemic situation because of insufficient
healthcare workers, while the biggest part of this sector was left behind and
avoided by the ministry. It raises two big questions, “Why pharmacists are not
being allowed to work on the scenario?” “Is that the lack of knowledge of the
Health Ministry?”

In neighbouring countries, pharmacists are primarily working at hospitals and

clinics to ensure the proper management of disease and disorders, but pharmacists
in Bangladesh are limited only in drugs manufacturing and marketing area. It could
be the biggest mistake of the country when the government of Bangladesh trying to
promote the healthcare system. The government and some private hospitals, with
many hopes and enormous expectations, attempted to establish the hospital
pharmacy in the name of “Model Pharmacy” at the country level . The so-called
model pharmacy was a part of the retail pharmacy; nonetheless, the biggest part of
Bangladesh healthcare system, public hospitals, was not covered by this project. It
was an usher for the country’s pharmacist community to come to the big picture,
but due to a lack of policies and guidelines, the project proved as a failure.

Conclusion:
National Drug Policy 2005 of Bangladesh suggests that medicine distribution and
utilization in retail pharmacies and hospitals should be under the supervision of
qualified pharmacists. But reality is that no graduate pharmacist is working in retail
pharmacies or government hospitals of Bangladesh except very few tertiary level
private hospitals. These one or two hospitals can not improve the overall health
care system in Bangladesh. Along with lack of human resources, the profession
seriously lacks government interest. Actually the first foot steps should come from
the government by making it mandatory to have at least a graduate pharmacist in
every hospitals. 192 Paul et al. / Bangladesh Pharmaceutical Journal 17(2): 187-
192, 2014.

It is also recommended to the hospital administrators that hospital pharmacy

should be launched to ensure patient compliance and therapy outcome and to
provide healthcare services of international standard. Pharmacists and pharmacy
services are a vital part of healthcare system. To attain the ideal healthcare service
doctor, pharmacist, nurse and other healthcare professionals must work together.
Legal reform is needed to achieve the health objectives of the nation to contribute
towards attainment of the Global Millennium Development Goals (MDG) and to
achieve the acceptance of the pharmacy profession as an integral part of a well
structured health care system. Government of Bangladesh should ensure the
hospital pharmacy service to all the peoples in order to reduce medication related
errors and to improve patients care and safety.