Taking keys and syrup week

Many people are always curious about what pharmacist’s job is all about. But I can never explain that with a sentence or two, simply because our roles in a hospital are a little diverse. We are often doing our job behind the counter, involving thousands of processes the public or doctors can’t really see through. For example, while the patients are waiting for half an hour out there to take their medicines, we are at the inside verifying doctor’s prescriptions (including making interventions by calling back the doctor which takes up more time), allocating the right type, formulation and amount of drugs, physically filling in the drugs, counter checking by pharmacist and finally dispensed to the patient. These whole process involves at least 10 to 15 minutes on its own, depending on the length of the prescriptions, not to mention that we normally deal with tens and hundreds of patients’ medicines at one time.

So in the light of fortunate, I was given the task of taking keys to open the outpatient department (OPD) and to prepare syrups for patients in OPD. Taking keys is never my favourite as it means I need to be there at 7am when everyone starts working earliest at 7.30am, because I need to get the keys from ED and rush back to OPD to open all the lights and computers to get the OPD going. But more often that not, some patients are even more hardworking than me. They are already sitting there waiting for the counter to open to get their medicines. I can understand them: who doesn’t want to avoid the queue later and quickly get away with their medicines first?

The syrup making work was a challenging work for me. First of all, please allow me to lament a bit. No one (like pegawai) was at there to brief me practically how should I prepare the bulk syrups and to assess my skills while I am first time doing it; all they do is to ask another senior prp like me who was in charge of the syrups last week to “pass” their knowledge and skills to me. Well..all this just seems a bit risky. Who could be sure that the information passed on would be still accurate and up to standard? PRPs are all still-learning pharmacists. Phewwww…second, there is not a clear standard operating procedure as in what should be done by steps, in which part of the table, etc. At least I was not brief on that, not even about what to wear while doing syrups. I only know what to wear by looking at the notice board in front of me telling me to dress like a lab person. I have my ugliest time at the back of the pharmacy huhu…luckily it was not in front of the patient, otherwise they will be dread to see how I pour and play with their syrups..haha..i am just joking kay. Third, there were definitely not enough measuring cylinders and bigger bottles to prepare bulk syrups. Why no one has ever feedback on that! Well, I am in Malaysia. I must have forgotten! In here everyone just do what they have been ordered to, feedback was not necessary.

complaints/feedback:

no one actually briefed the new prps on making the syrup in practical and checked the syrups made.

incomplete instructions on manufacturing sheet  (sildenafil) leading to avoidable error

not enough measuring cylinder 

lack of robust SOP for extemp preparations

unorganised bottles and caps

So throughout this week, my task is to prepare three bulk syrups which many cardiology paeds patients will need to take. And to prepare other individual syrups as the Rx comes. I could proudly said that in this week I have done much more syrups than the total extemporaneous that I did during my university years and I could honestly said I try my best to keep to the high standard of a extemporaneous preparation - no pouring or contamination here and there, no miscounting tablets or quantities of syrups. So they are safely to be drink. However, there is still no guarantee from me - who tells my skills were not assessed. I couldn’t be hundred present sure what I did was right. Here is the list of syrup I have done so far:

Frusemide 5mg/ml susp

Spironolactone 5mg/ml susp

Captopril 1mg/ml susp

TB syrup - Rifampicin 25mg/ml

Propanolol syrup

Baclofen syrup

Sildenafil syrup

And ya I have made sooooo many sildenafil syrups and TB syrups this week!! Don't like the bloody red rifampicin, powders flying everywhere while I attempted to open the capsules.. on the other hand, the sildenafil syrup is a nice sky blue syrup, and each tablet cost the government around rm 100 plus! However sildenafil syrup is always tricking the newcomers - why? Because it actually needs to add a little bit water to let the content of the tablet bursts out, and this step is not stated in the manufacturing sheet. 

And lucky enough I was able to see and involved into making omeprazole syrup. This is one of the tricky syrups to do as it involves withdrawing sodium bicarb from the ampoules using syringe. 

Pity the patients. Most of them are paeds who need to take medicines in the form of syrup. Thus I always need to be extra careful when making syrups as they are indicated for the kids. While I was making the syrups, I pray in my heart hoping that the patients would feel better after drinking the medicines.

After a week's training, I can regard myself as a syrup queen now muahaha..imagine myself working in a traditional pharmacy shop full of syrups. Woah that would be fun.