A community pharmacy

A pharmacy is a place where medicines are compounded or dispensed. In the UK, the term a сhemist’s (shop) is more commonly used. In the USA, there are many drugstores, which are small or average-sized retail shops in a town center, where medicines and miscellaneous articles (such as candy, cosmetics, and usually refreshments) are sold, while in Europe a drugstore is a place where medicines are sold, but no compounding or dispensing is done.

In an average community pharmacy, there is usually a large hall for the customers where non-prescription drugs, parapharmaceuticals, home diagnostic aids, and some medical devices and appliances, as well as cosmetic products are displayed in aisle counters. There is a self-service form of catering there, with payments made at a check-out counter.

Non-prescription drugs are commonly called over-the-counter (OTC) drugs because they may be bougt without a prescription. They are generally regarded as safe for the customers to use by following the required label directions and warnings. Several consultant pharmacists, ready to guide the customers and to offer advice, cater for the customers in the OTC department.

Prescription drugs may be dispensed to customers only by a registered pharmacist. Usually, the procedure of filling a prescription is as follows:

- the patient presents the prescription to a pharmacist or technician;

- the technician enters standard information into computer software;

- if no therapeutic concerns are raised, the technician proceeds to fill the prescription;

- the pharmacist councels the patient on prescription while the technician is completing the dispensing process;

- the prescription is checked by the pharmacist when the dispensing process is completed by the technician;

- the technician concludes prescription processing by completing the billing procedures concerning cash, charge, insurance billing, etc;

- if therapeutic concerns are raised, the prescriber is contacted, and the problem is jointly resolved.

A pharmacy must be licensed for drug compounding. For compounding prescriptions, a community pharmacy must have proper equipment. A minimum list of equipment required for licensing by the state boards of pharmacy in the USA includes:

1.Class A prescription balance and/ or electronic balance.

2.Hot plate.

3.Magnetic stirrers.

4.Electric mixers.

5.Special containers for packaging.

6.Graduated cylinders from 10 to 1000 ml.

7.Glass, Wedgwood, and porcelain mortars and pestles.

8.Funnels of various sizes.

9.Weighing and filter paper.

10.Spatulas of various sizes including plastic spatulas.

11.Ointment / Pill tile.

12.Capsule filling machine.

13.Ointment filling machine.

14.Autoclave.

15.Laminar flow clean bench.

16.Special suppository molds.

17.Stirring rods (glass).

18.Record-keeping system (compounding log book).

19.Glass beakers from 50 to 1000 ml.

Many pharmacies actively involved in compounding have allotted a separate area in the pharmacy to this process. An ideal location is away from heavy foot traffic and near a sink where there is enough space to work and to store all the chemicals and equipment. For compounding of sterile products a laminar air flow hood and a clean room are current practice.

Extemporaneous compounding by the pharmacist or a prescription order from a licensed pharmacist, as well as dispensing of any prescription drug, is controlled by the state boards of pharmacy. A pharmacist must ensure that the correct drug, dose and directions for drug administration are provided to the patient, and the patient is properly instructed regarding proper storage of the drug, and its adverse effects.

Pharmacists obtain small quantities of the appropriate chemicals or drugs from wholesalers. A wholesale distributor of prescription drugs must be licensed by the authorities of the region where it does business.

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Boots chemists’ error killed newborn baby

By Adrian Lee

Two chemists were fined yesterday for making a catastrophic mistake in a prescription that killed a baby boy.

Lisa Taylor Lloyd and Ziad Khattab, who worked at a branch of Boots, used a dilution of chloroform which was 20 times too strong, a court heard.

Four-day-old Matthew Young turned blue and fell into a coma after his parents dripped the prescription into his mouth. He suffered severe brain damage and died 18 days after being prescribed peppermint water to treat colic. Matthew’s parents Neil and Collette said last night that they were preparing a civil case for damages against Boots.

Manslaughter charges against the two chemists were dropped shortly before they were due to face trial at Chester Crown Court. Taylor Lloyd was fined £ 1, 000 and Khattab £ 750 after both admitted supplying defective medicine last May.

The court heard that Khattab, 25, a trainee pharmacist, confused double strength chloroform water with concentrated chloroform. His colleague Taylor Lloyd, 27, who supervised him, was not qualified to do so and failed to check his work.

Boots said after the case that it had now tightened its procedures.

The Royal Pharmaceutical Society, the governing body for chemists, said it would review its training and had alerted its members to the need for vigilance when preparing prescriptions. Taylor Lloyd, of Crewe, is likely to face disciplinary proceedings which could result in her being struck off. Her colleague, from Eccles, Greater Manchester will escape further investigation because he is not qualified. The society said that its guidelines required supervising chemists to have three years experience but Taylor Lloyd had only two. Boots could also find itself before the society’ misconduct committee, which has the ultimate sanction of preventing a chemist from selling medicines.

The court heard that Matthew was prescribed 150 millilitres of peppermint water. Unusually, because most medications are now supplied ready prepared by large pharmaceutical companies, it was to be made up by a chemist.

Peter Hughes, QC, for the prosecution, said that the formula was contained in a large book at the chemists, at the Hallwood health centre, in Runcorn. It was both misleading and out of date.

During interviews Khattab told police that he had difficulty understanding the instructions. He said: “There seemed to be lots of numbers’ all over the place. I couldn’t quite make head nor tail of it.” He said he had not realized the significance of notes at the side of the page, made by another chemist, which clarified the method.

A “catastrophic mistake was made”, said Mr Hughes.

Taylor Lloyd initialled a box on the label indicating that the prescription had been checked, before giving the medicine to the baby’s mother, Collette Jackson.

Matthew died after his life-support machine was turned off at Alder Hey Hospital, Liverpool. His mother described how she then held the child’s body; “We had just had him christened and he was dressed in his robes. He looked so beautiful. I cuddled him, stroked his head, counted his toes, the way I had done the day he was born.”

The couple have another young child.