PRP in Hospital Sungai Buloh

 
Hi guys, so i got a lot of q's from juniors asking about the prp here. unfortunately i dont have time to properly answer yall one by one. so i decided to make a blog post about it - to make it easier for me and u guys (coz im busy as hell here sobs). and u guys can ask q's/comment at the end okay? <3

idk how to begin honestly. so forgive me kalau u rasa post ni teratur, member tgh serabut ciked

DEPARTMENTS

first of all, the departments we have here is 

1. OPD (including OPD PKKN Sg Buloh) - 12 weeks

2. IPD - 8 weeks

3. Manufacturing -3 weeks

4. TDM - 4 weeks

5. Clinical (divides into two - medical and pediatrics) - each 4 weeks (total 8 weeks)

6. Drugs/poisons info - 4 weeks

7. Store - 4 weeks

8. TPN - 5 weeks

If u noticed, we dont have CDR here. so sbbkan takde CDR, if u prp here, u will only do prp for 48 weeks, instead of the usual 52 weeks. means u guys akan hbs awal compared to member2 hospital lain. but really, i never ask if their hospital ada berapa weeks in total.

WORKING HOURS

overall, most of the department u keje office hours meaning 8am-5pm. u datang on time, u balik pun on time. ada 1 department je u kena sacrifice huhu datang awal pagi like 6.30am and balik after 5pm (clinical department), nanti i explain why. 

and ada department juga u kena balik lambat sikit utk settlekan kerja yg u tak sempat siap masa office hours tu (opd and ipd), nanti i explain gak why

ed night & weekend shift - usually 1 prp akan kena keje 1 ed night and 1 weekend shift dalam satu bulan. tp kalau ramai prp dah takde, means dah keluar from that hospital jadi frp, so prp kena kerja 2 weekends shift but no ed night bcs got no staff

ED NIGHT

ed night ni means u keje at pharmacy emergency department. u keje 10pm-8am. so if u kena keje ed night, contoh hari isnin, so hari isnin tu u keje mcm biasa 8am-1pm. then 1pm u boleh balik rumah utk rehat. then 10pm dtg keje until 8am next day. so 8am next day tu u auto dapat off day, tidur kat rumah yay! tapi if u keje ed night on friday, sabtu 8am kan u dah mmg off day, so apa u dapat is off hours 8-9 hours. meaning nanti2 u boleh claim nak off day ke off am ke off pm ke gituu. 

WEEKEND SHIFT

weekend shift ni u keje sama ada sabtu or ahad. shift ada dua. prp 1 (8am-5pm), prp 2 (10am-6pm). basically weekend shift ni meaning u keje IPD but on weekends

if keje weekend shift pun u guys akan dapat claim off hours, 8-9 hours. 

OFF HOURS

usually prp here tak guna Cuti Rehat/annual leave (total ada 23 ke 25 hari tak silap). for 1 year of prp-ship, selalunya akan guna off hours je. and i pernah apply for pm off and am off je, tu pun sbb nk prepare for clinical presentation. cuti rehat prp usually prp guna masa tgh float (means dh hbs prp, and tgh tunggu new posting at new hospital). masa tu u hbskan la cuti tu puas puas.

LOGBOOK

kena print and isi. takyah gigih buat logbook kat hospital coz u got no time pun. encouraged to do logbook everyday after work or at home so that u tak terkejar2 siapkan masa nk due date. tp most of prp here yg i tahu mmg last minit pun lol. so benda tak baik u jgn ikut k

apa2 u buat time keje make sure amik gmbr. utk rekod dlm logbook

MANUAL / SYSTEM?

hospital ni 100% guna system EHIS. so senang. u takyah susah2 baca tulisan cacing dr and nak paham BHT patient tu sbb semua dlm system. ada a few times je manual - kalau system down/dr takleh order ubat dlm system gitu. tp jarang sgt lah

Now lets talk deeply/specifically about each department. tp i nk bgthu sesiap i only cerita department yg i pernah attach ok. yg belum pernah attach i tak tahu

OPD

basically jobscope sini ada byk so u kena multitask gila bb

so biar i terang dulu rupa opd tu cane so u paham. opd ni outpatient pharmacy yg u bg ubat kat pesakit2 luar, bukan pesakit yg warded dlm hospital. so dlm opd ni ada 4 main task as a pegawai farmasi: verify, allocate, countercheck and dispense.

-verify: verify ni tugas pegawai je, prp takleh buat. basically lepas patient dpt nombor, PPF akan register kan ubat yg dr order utk patient dlm system. so tugas pegawai is to verify ubat dr order tu sama ada dos, frequency, duration etc betul ke tak. kalau tak betul, kena call dr utk verify betul ke nak dose ni etc

-allocate: lepas dah verify, kena allocate qty berapa nk bg ubat tu kt patient. ni prp and pegawai punya keje. usually pegawai akan allocate waktu pagi sbb bz. waktu ptg bila dah reda sikit, prp yg kena allocate. so kalau ubat kronik yg ulangan mcm ubat darah tinggi, kencing manis, kolesterol yg kena makan tiap hari, pt dtg amik setiap bulan, so kita bg qty 30 gitu. kalau ubat antibiotics kena bg ikut duration 5 hari ke 7 hari gitu

-countercheck: pegawai je buat. so pegawai ni kena check semua betul ke tak. ubat yg letak dlm plastik tu betul ke, dos verify td betul ke, allocate qty tu betul ke

-dispense: dispense ubat to patient. so keje u bg ubat kt patient je cth: ni ubat darah tinggi amik 1 biji 1 kali sehari, ni ubat kolesterol amik 1 biji malam, ha mudahkan? mudah tp repeat 300x haha

time dispense gak if ada ubat yg perlu kaunseling u kena buat. cth ubat fortrans/fleet phospho soda - utk patient prep bowel dia before colonoscopy. or counsel eye drop / ear drop / suppository etc

other tasks that u have to do while attaching at opd:

- SPUB: means transfer ubat to other hospital sbb patient nk amik kat situ sbb dekat dgn rumah dia gitu. so time patient ckp dia nk spub so u kena print rx dia, make photocopy, tulis details dia etc. so every week akan ada sorg prp yg incharge utk keyin spub dlm excel utk simpan as rekod. so keje ni kalau patient tak ramai, u boleh la buat sesiap time keje, tp kalau bz mmg tak sempat, keje ni la yg memerlukan u utk stay back after 5pm kejap utk keyin. 

- MYUBAT: means patient nk ubat tu post directly ke rumah dia. time patient ckp dia nk post ubat, so u kena assist dia guna app MYUBAT tu. after pt dah register dlm app, u kena keyin pulak ubat apa patient tu nk post dari dlm ehis system to myubat punya system. keje ni jugak yg memerlukan u utk stay back. sbb patient nk post ubat everyday tu byk so u kena siapkan everyday so that senang u tak terkejar2 at the end of the week

- DD: basically prp kena check&found DD cabinet every day at 8.30 am. and kena topup if DD tak cukup

- Extemp preparation: ada certain ubat dia punya syrup tak commercially available. so kita kena bancuhkan utk patient. so ni keje prp kalau DD. kalau tak DD selalunya PPF je buat.

- tag verify: since u takleh buat verify. so u kena tag verify je. means ada hari2 terpilih, u akan dapat certain topic, so u kena study topic tu. then masa hari tag verify, u kena duduk sebelah pegawai yg tgh verify, then dia akan soal2 psl topic tu. basically ni dah ada soalan bocor so u takyah risau sgt, tinggal hafal je 

at opd ada dua shift for prp.

1. 7.30-4.30: datang awai utk buka farmasi, buka all pc, buka all pintu etc

2. 8.30-5.30: balik time farmasi tutup, and do closing, tutup pc, pintu, etc

gambar opd 👇🏻👇🏻👇🏻👇🏻

IPD

jobscope hari2 lebih kurang je

1. hari Mon, Wed, Fri = regular day. means kena fill regular utk all wards. fill regular meaning before this patient ni dah start ubat tu, so kita jsut sambung supply bape hari. fill regular utk UOU (unit of use) wards means Mon fill 2 hari (cover mon tues), Wed fill 2 days (cover wed thurs), Fri fill 3 days (cover fri sat sun). fill = allocate kat opd tu, beza nya u bg ubat kat patient dlm ward

2. fill regular kena siap before 9am. at the same time ada trolley for MUOD ward. modified unit of dose. trolley ward ni kena fill hari2 1 day. ha phm tak? if tak paham buat buat je paham k

3. lepas pukul 9, semua yg u fill tadi kena 'deliver' dlm system. meaning ubat tu like dah dispensed to patient

4. after that from 9-11.30 am terus fill new. fill new ni means ubat yg baru dr order dlm system. u bayangkan, kat dlm ward sana, dr dr tgh buat ward round, so sambil dorg ward round, sambil tu dorg order ubat dlm system. then pegawai akan verify apa dr order tu and prp akan fill qty berapa. so bila hari pertama patient tu dapat ubat tu, kira new, if esoknya dia sambung ubat sama, dah dipanggil regular.

5. after dah fill new semua, kena print fill list. meaning semua benda u fill td kena print. so kertas print ni kita akan guna utk countercheck. like betul ke u fill qty tu? ada kurang ke ada lebih ke? ada duplicate ke?

6. at the same time, every mon-thurs from 8am-12pm kita ada buat floorstock for all wards, clinic, units. floorstock means kita supply barang2 common dlm tempat tu, so that dorg tkyah order dlm system byk kali. kita bg banyak terus. 

7. then 12pm-1pm u tolong pegawai buat discharges. means tgk system, mana patient yg nk discharge. so u cek ubat yg dr order sama tak dgn discharge summary dia. ada dr yg lupa order ubat la, salah order ubat la. so u like tolong countercheck everything. then tgk ubat tu patient ada on kat dlm ward, tp discharge takde pun ubat tu, so u have to call ward and tanya nk ke ubat tu gitu la. 

part discharge ni u kena selalu berlatih. like honestly mcm i pun tak pro lg, sumpah takut gila nk buat lol. sbb u mana pro mana betul mana salah kan haha. so nk enquiry apa dgn dr pun tak pro. so disini gunanya segala knowledge u belajat kat uni lol. for example kena tahu apa set ubat utk pt yg ada NSTEMI/stroke/helicobacter pylori etc

8. 1-2pm u gi la lunch

9. 2-4pm u fill new je lg

10. 4-5pm u tolong pegawai buat discharges lg

# every hour, akan ada hourly prp datang ipd utk hantarkan ubat discharges to patient, ini dipanggil bedside dispensing. at the same time if ada counseling they have to do also. hourly prp = prp from other department (other than ipd & opd).

at ipd ada dua shift for prp. 

1. 8-5pm: u do all as i mentioned above

2. 8.30-5.30: u dipanggil 'counseling prp'. from 8-5pm, if ada dr request for counseling, cth insulin injection/inhaler technique counseling for newly started patient, so u kena pegi buat. tp u r busy, u can ask hourly prp to do the counselling

so if attach at ipd, u guys akan balik lambat sikit. sbb segala bedside dispensing / bedside counseling yg u buat kena keyin dlm system.

nak kata penat ke tak, u byk duduk je actually. yg byk berjalan akak2 ppf tu je sbb fill ubat semua, and buat floorstock. tp u akan penat/stressful kat sini sbb u takut dgn certain ppl there & penat berjalan time pegi wad ke wad utk buat hantar ubat discaj. 

MANUFACTURING = heaven

1. best sbb takde pegawai. so u free sikit. ada akak ppf je sorg. 

2. hari2 akan buat internal / external preparation

3. ada hari byk gila prep sampai u nyampah buat, ada hari rilek2 je

4. tp selalunya 3pm gitu dah takde keje, so boleh main phone haha

gambar manufacturing 👇🏻👇🏻👇🏻👇🏻

TDM

1. kita ada 10 ubat yg kita covers for tdm. keje at tdm ni, u duduk depan pc je from 8-5pm

2. cth ubat: vancomycin, sodium valproate, phenytoin, pcm - basically 10 ubat from Clinical Pharmacy Pharmacokinetics Handbook

3. so keje u pagi2, tgk dlm system ada dr order tdm tak utk pt dorg. if ada u tunggu je sampai result tu keluar, if result tu keluar u tinggal interpret je. lepas interpret, inform dr and keyin notes dlm system

4. how to interpret? cth kalau low, u suggest increase dose, if high u suggest withhold for 1 day, if within therapeutic range u suggest to continue. 

5. lupakan semua yg prof mansor ajar. u baca ni je Clinical Pharmacy Pharmacokinetics Handbook. sbb semua kitorg ikut ni

6. dia akan jadi leceh bila level dia higher/lower than therapeutic range. so u kena buat kira2 sikit utk u suggest next plan for dr

basically hujung kiri kat meja panjang ni tempat Clinical medical/paeds - sebelah dia tu tempat TDM - dalam pintu yg ada sticker merah tu TPN department

CLINICAL (MEDICAL)

1. clinical attachment ni for me okay sbb i dpt pegawai yg sumpah baik gila/tak judge i bodoh. dia akan jadi scary kalau pegawai u scary. dr dr pun okay sbb dia buat takthu je kat u. kalau pegawai u takde je, baru dr dr akan tanya u pulak. tp during my attachment here, ada 1-2 kali je dr ckp dgn i lol. sbb dorg tahu i just prp & sbb i tak pro nk intervene/give suggestions etc. if u pro, then just do it

clinical (medical) means medical punya ward. pt yg penyakit2 common, mcm hpt, diabetes, kidney disease, stroke, plg byk NSTEMI/STEMI. so disini guna segala CPG yg ada.

kat sini ada ward ward lain just fyi, mcm orthopedic, surgery, plastic, neuro, o&g etc

2. clinical punya workflow:

-pagi pagi u dtg seawal 6.30 am utk clerk case. clerk case meaning u tulis cp2 patient by referring to dr notes in system. cp2 including pt details, CC, HOPI, DX, lab values, C&S, current meds etc. so everyday org dlm ward tu tak semestinya sama kan? so everyday u akan clerk same patient and new patient. if clerk same patient means u kena update je la apa meds, lab values, c&s, current dx. if new patient u buat dari 0 gitu. so apa relevant nya dtg awal 6.30 am? sbb ward round start 9am selalunya, u usually tak sempat siap all cp2 kalau dtg 8am. sbb u kena understand all the cases carefully, sbb nnt dlm ward tu u guys akan jumpa all the patient yg u clerk case, and dr akan discuss about the patient, so u kena paham la apa yg jadi, but no worries usually i tak paham pun whats going on :(

-WARD ROUND. ward round at my place usually consist of 1 specialist, 1 MO, 1 HO, 1 pharmacist, 1 prp. usually starts 9am, finishes around 1pm kalau byk pt baru. so usually MO/HO akan present the case to their specialist, and dorg akan discuss ubat apa nk bg. fx pharmacist kat sini is to bg cadangan/intervene apa dr plan, to ensure pt got the right medicines

-so after ward round habis, usually prp akan pegi interview pt utk buat cp1. cp1 means tanya apa med history dia, ada drug allergy ke tak?, any underlying disease, ada amik supplement tak? etc. after interview pt, kena keyin cp1 dlm system

-after lunch, usually keje u tinggal keyin all cp1, hantar discharges, buat couselling to pt in ur ward. and keyin everything into system. so u always balik lambat gak sbb nk keyin. depends. tp i usually balik 7-8pm gitu? sbb byk gila? stress igt balik

3. if u attach here, u kena korbankan ahad u. sbb hari sabtu ahad patient ramai discharge. so hari isnin ramai patient baru, kalau isnin pagi u baru nk clerk case all patient. mmg tak sempat mat. so u kena dtg hari ahad utk clerk all patient, then hari isnin tu beban u tinggal sikit. 

DRUGS INFO/PRIC (pharmacy resources and info centre)

1. u mcm kaunter drug info utk all staffs 

2. jobscope:

- everyday u akan dapat call mostly dr/nurses tanya psl dose/renal adjsutment dose/dilution etc. dalam satu hari u akan dpt dlm 5-10 soalan. so semua soalan ni u kena jawab. and discuss w pegawai first before u get back with the caller. jawapan ni semua u refer to all reliable sources. nnt if rajin i will make a post about the ref u can refer to

- allergy card. u akan terima borang allergy card from dr/nurses/pharmacist. so tugas u just prepare ther card, keyin dlm excel, and pass the card to patient w counseling

- u incharge of the bilik seminar(bilik utk discussion/CME talk/meeting etc) so if ada apa2 event memerlukan laptop, projector, google meet, attendance form, e-cert, so u incharge of all of that

-trace medication. usually akan ada prp/pharmacist from other hosp akan hantar email utk mntk medication history patient (for their cp1), so u have to reply their email with the details

3. homework/assignment:

- newsletter: basically buat like 1 poster using canva about 1 topic

- drug speech: buat slides presentation with voice over then convert jadi video about 1 topic. usually sama topic with newsletter. so newsletter tu u masuk dlm slides

- adr: u kena buat 5 adr reporting, basically clerk case about how the patient get the adr

- queries: u kena jawab 100 past queries. isi dlm kertas first, then tunjuk kat pegawai for any correction. if semua dh ok have to key in dlm excel

- critical appraisal: u akan dapat 2 ubat yg memerlukan kelulusan KPK. so u kena find reliable reference to support utk dpt kelulusan tu

# stressful sikit sbb keje banyak and u got a lil time to finish all. mmg kena pandai manage masa. 

Ni bilik DIS. basically u duduk kat tmpt arrow tu

disclaimer: bak kata semua org, mana2 hospital sama je stress. its how u handle it je. mcm i selalu akan fikir masalah i ni sikit je, kecik je, compared to other people. cth: if u stress at one department/about that one work, after balik, u kosongkan la ur mind, u fikir stress tu semua at that one place je. dont let the stress consume u. but tbh ada je i felt so stress, i cried. rasa nk give up etc. tp jgn give up k, gaji 4k tau.

basically tu je buat masa ni. pape can comment below. nnt i reply. 

*******UPDATES*******

VIVA

1. at the end of ur attachment in each department, akan ada viva. viva ni mcm jwb exam. ada certain department ada oral je, ada written je, ada yang dua dua.

2. my experience

-Manufacturing - written viva

-TDM - written viva

-clinical medical - takde viva sbb my preceptor chill betul and time tu dia nk amik anak balik sekolah lol (supposedly oral viva)

-drugs/poisons info - written viva

#mostly soalan viva ni repeat dr senior je. so nnt mntk je senior, then korg study tu je

ok pape i update lg

HI GENG! UPDATESS 9/1/2023

harini i rajin and baik hati sikit so i nak hbskan post ni. since i pun nk hbs prp end of this jan.

so i akan write about dept yg i ta mention lg kat atas

STOR

1. ada 4 weeks total. each week tu u akan pegi lain dept in the store

week 1 - kaunter receive barang yg kita order from supplier

week 2 - drugs store; basically org order barang dr u then u bg

week 3 - sama mcm week 2, beza dia: item non drugs

week 4 - u akan attach kat mana2 boss suruh

2. best sbb takyah study, akak2 baik friendly, dapat rasa keje gov ~ start keje 9am habis 4.30pm

3. actually kerja stor as a pegawai lg rumit dari yg i mentioned kat atas ni. tempat2 u attach tu basically bukan jobscope pegawai. keje pegawai actually kena plan ubat/barang apa nk order,  kawal bajet, and order. so sbbkan pegawai bz dorg tak dapat ajar prp buat keje. so sepanjang 4 weeks u attach tu, u kena cari pegawai2 stor ni semua and minta dorg bg u briefing on their jobscope

VIVA

-oral - tp best sbb senang je

-includes all the briefings and general knowledge yg u gain sepanjang u attach at stor

ni ofis stor. pegawai semua kat sini

bilik drug stor. sini korg prepare barang2 yg orang indent then sebulan sekali ada buat check&found

kaunter receive barang

ni briefing yg i ckp td

CLINICAL (PAEDIATRICS)

1. basically sama je mcm clinical medical, beza dia u cover wad budak

2. ada 1 preceptor - baik gila - Pn Amiirah, she'll guide u from A-Z

3. workflow:

-7am: datang hosp to clerk case

-9am: ward round

-11-12pm habis ward round so u can do ur CP1/counselling/discharge. then keyin everything in system

-1pm lunch

-2-5pm: usually akan ada case discussion, about 3 topics per week. so u guys akan decide which date to do case discussion(~1 hour). if takde discussion, send discharges meds/buat counselling.

4. nanti i share the link  benda2 u kena baca before attach. if baca ni confirm nnt perform

5. VIVA

-written and oral. written basically based on topics yg u buat discussion. oral basically just gen knowledge

6. PRESENTATION

-kena present on 1 topic while u attach at this dept

-nnt i share example of my slides presentation okie (got u bestie)

TPN

1. workflow (ROUGHLYY)

-7.15-7.30am: record pressure/temperature/humidity of clean room etc + swab passbox

-7.30-8am: pegi NICU and check how many  babies on TPN bag, check their TPN bags in fridge, then check pharmacy own stock in our fridge

-8am-9am: melepet

-9am: pegawai keluarkan 'gutt slip' basically just a paper bgthu harini nak produce how many eyedrops/TPN bags/IV admixture > prp prepare labels > prp tunggu bila dorg suruh utk swab all the barang

-10am-10.30am: masuk swab , habis swab keluar je

-10.30am: duduk luar as standby incase akak PPF/pegawai needs anything + masukkan stok yg dorg tgh buat tu dlm system > then transfer the stock to OPD or IPD > buat worksheet

-10.30am-2-3pm: usually time ni dorg tgh prepare the barang. so keje u duduk je depan pc and  buat apa yg patut

-3pm: selalunya melepet dah

-4pm: tolong hntr ubat discaj inpatient

-5pm: balik

2. rehat takleh kat luar sbb u kena standby je and jawab call

3. VIVA and PRESENTATION nnt i update balik sbb dua dua belum buat ehek

eye drop ni sekali buat mmg 800+ bottles 

example of worksheet. korg isi gitu2 je, 10 mins siap semua

cth baby yg on TPN bag kat NICU

gutt slip

i think thats all for now! bye xx