Hospital Pharmacy FAQ
Introduction
Time really flies. It has been more than 8 years since I graduated from university.
Different from old days, contract system is being employed for new generations of provisional registered pharmacists at Malaysia.
- Permanent positions will only be offered to better performers.
Similar to concept in Intro to Community Pharmacy, I am now writing a post addressing few basic questions for future hospital pharmacists.
What can I expect once I entered hospital provisional registered pharmacist training?
In most hospitals, you first introduction to your workplace is through an induction period during which you are shown many different areas and meet many new people.
- Induction period may be the only time during the year when you can be relatively relaxed.
In overall, there is a maximum of 9 training modules that you have to complete in 1 year time (which will cover all hospital pharmacy departments).
- Clinical pharmacokinetics services
- Drugs and poisons information services
- Inpatient pharmacy services
- Inventory or store management
- Manufacturing and prepacking
- Oncology pharmacy service*
- Outpatient pharmacy services
- Parenteral nutrition/intravenous additives services*
- Ward pharmacy practice
* Optional training modules subjective to facility
Working life is very tiring and suffering, but you should complete each training logbook on a well-planned schedule.- The minimum passing marks for each training module is 60%.
- I highly recommend you to perform the best of you in this provisional registered year and be an active learner.
- If you perform badly in any training rotation, your relevant training may be extended for few weeks.
Also, you probably will start to converse in Malay language more often than university time.
- For a non-Malay, you might face some challenges here, but you will improve a lot after a month.
What should I prepare?
To be honest, the assessment starts even the first day (or even the first moment) you enter the pharmacy. Hence, make a good first impression by being prepared.
- Wear a proper attire (e.g. white laboratory coat, work clothes, comfortable shoes), be humble and work professionally.
- If you are clumsy, keep a few cheap pens on hand.
- Be ready with calculator and pharmacy-related mobile applications.
- Make an effort to get to know your team and your workplace.
- It will be better if you can take own initiative to learn and help the works, instead of waiting for instructions.
- Also, there will be times when you will be asked to do things that you consider to be boring or beneath your role as a provisional registered pharmacist, such as helping in the dispensary.
- Never expect anyone to have the responsibility to teach you step-by-step or force you to study.
- If there is any question from fully registered pharmacists, please feedback to them. They are not going to chase you for the answer.
In terms of knowledge, I generally divide the preparations into 2 key parts:
- Familiar yourself with common oral medications that you probably encounter in a daily basic (including both indications and dosage).
- Paracetamol
- NSAIDs - e.g. ibuprofen, mefenamic acid
- Antacids - e.g. magnesium trisilicate mixture or tablet
- Antibiotics - e.g. cloxacillin, cefuroxime, erythromycin, metronidazole, penicillin v
- Proton Pump Inhibitors - e.g. pantoprazole, omeprazole, esomeprazole
- Antihypertensives - e.g. amlodipine, bisoprolol, losartan, perindopril, valsartan, telmisartan, frusemide
- Antidiabetics - e.g. metformin, gliclazide, vildagliptin, empagliflozin
- Dyslipidaemia - e.g. atorvastatin, simvastatin, fenofibrate, ezetimibe
- Antiepileptics - e.g. phenytoin, sodium valproate, carbamazepine
- Laxatives - e.g. lactulose, bisacodyl
- Learn up the basics before entering each new rotation
- It will be good if you have some ideas on Ministry of Health Formulary and prescriber categories (NOT to be confused with poison groups in Poisons Act 1952).
- You should be at least familiar with insulin and inhalers counselling before entering ward, inpatient or outpatient.
- You may also refresh knowledge of clinical pharmacokinetics, total parenteral nutrition, chemotherapy and medical terms before entering the relevant rotations.
What to do if I did not know the answer to questions from patients or doctors?
Provisional registered pharmacist year is the only time when you do not feel ashamed to ask any seemingly silly questions.Hence, do not be afraid to ask questions to your fully registered pharmacist.
- But, before you ask the question, make sure you have made some effort in searching the answer.
- If there is any doubt on the information that you found, you may also double confirm with them.
Stop have the mentality to sit there and expect someone to come and speak to you and tell you what to do next.
- This is not going to happen in a busy working environment.
Which local references do you suggest?
Apart from Malaysian Clinical Practice Guidelines, other recommended local references include:
- ADR Reporters Guide
- Ampang Protocol, 2012
- Anticoagulation MTAC Protocol, 2020
- Antidote Quick Guide, 2022
- Cancer Drug Counselling A Guide for Pharmacist, 2023
- Clinical Pharmacokinetics Pharmacy Handbook, 2019
- Code of Ethics for Pharmacists, 2018
- Critical Care Pharmacy Handbook 2020
- Malaysian Diabetes Education Manual, 2016
- Dilution Guide for High Alert Medications, 2011
- Dilution Guideline Injectable Drugs Part 1 Antimicrobial, 2020
- Dilution Guide for Fluid Restricted Critically Ill Adutls, 2024
- Extemporaneous Formulation, 2015
- Forum for Injection Technique Malaysia, 2017
- Garis Panduan Farmasi Berhenti Merokok, 2019
- Garis Panduan Kaunseling Methadone
- Garis Panduan Kaunseling Ubat-ubatan, 2019
- Garis Panduan Pembekalan Ubat Farmasi Pesakit Dalam, 2019
- Garis Panduan Pengurusan Farmasi Logistik, 2020
- Garis Panduan Permohonan Ubat KPK, 2016
- Geriatric Pharmacy Pocket Book, 2021
- Good Compounding Practice, 2018
- Guide to Antimicrobial Therapy in the Adult ICU, 2023
- Guide to the Development of Sterile Pharmaceutical Preparation Facilities, 2010
- Guidelines for Adult Immunization, 2020
- Guideline: Management of Snakebite, 2017
- Guideline on Good Distribution Practice, 2018
- Guideline on Safe Use of High Alert Medications, 2020
- Guideline on Ward Pharmacy Activities, 2023
- Guidelines for Submission of Dossier for Listing into the MOH formulary, 2019
- Guides to the Development of Pharmacy Facilities, 2022
- Handling of Inhaler Devices, 2011
- Handbook of Children's Palliative Care Malaysia, 2021
- Handbook of Palliative Medicine in Malaysia, 2015
- ICU Management Protocols, 2019
- JKN Selangor Dilution Protocol, 2017
- Malaysia Drug Code, 2010
- Malaysian Guideline for Good Clinical Practice, 2018
- Manual for Sterile Preparations, 2021
- Medical Nutrition Therapy Guidelines for Critically Ill Adults, 2017
- MOH Systemic Therapy Protocol, 2016
- National Antimicrobial Guideline, 2024
- Oncology Pharmacy Service Guide, 2024
- Panduan Berpuasa Bagi Pesakit, 2013
- Panduan Penggunaan Ubat-ubatan yang Mengandungi Unsur Tidak Halal Kepada Pesakit Muslim di Kementerian Kesihatan Malaysia, 2017
- Pediatric Pharmacy Services Guideline, 2015
- Pediatric Protocols for Malaysian Hospitals, 2019
- Pharmacist’s Handbook of Parenteral Nutrition in Neonates and Pediatrics, 2023
- Polisi Operasi Farmasi Ambulatori, 2022
- Practical Guide to Inpatient Glycaemic Care, 2020
- Renal Pharmacy Handbook A Practical Guide to Drug Therapy, 2018
- Sarawak Handbook of Medical Emergencies, 2019
- Topical Preparations Counselling Guide for Pharmacists, 2018
- Warfarin Interaction Handbook, 2017
- X-Temp Master Formulation Sheets, 2023
NOTE: Most of the references above can be found at Pharmaceutical Services Programme, Ministry of Health Malaysia website. Alternatively, you may download some of the bookmarked important Malaysia pharmacy reference here.
Is it very different from I learnt in university and real practice?
As a hospital pharmacist, I find the clinical therapeutics that I learned during university is highly relevant to practice.
- It somehow forms the foundation that kickstarts the whole pharmacy journey.
- There is no one there to slowly guide you over each common chronic drugs, but you probably have some basic ideas because you have come across them in university.
Plus, you start to realise that there are no textbook patients and what you have learned is not as black and white as you thought.
- In the real world, one patient can have multiple comorbidities with one possibly affecting the other. Also, patient may also not adhere to their medications.
- There is often more than one correct answer!
From now on, you are on a solo learning journey with new information to acquire.
- Everyone is giving you extra tasks to do and you have to learn about such things as drugs and conditions about which you know nothing.
Is it normal to felt lost in the journey?
Yes, it is a norm for us to feel lost in the middle of a quest.
- I still remember the days when I was at clinical rotation, I sometimes asked myself, am I too obsessed in finishing logbook requirements (clerking cases) on time or am I improving my clinical knowledge (which should be the primary goal).
- Once this happens, I would like you to not overfocus on achievement milestones, but slow yourself down to take a break and have a fresh start later.
- People learn and develop at different rates, so do not compare yourself too much with others.
At the end of the day, hospital provisional registered pharmacist training is a place for you to foster your knowledge and become a competent pharmacist.
- It is never the end of journey.
- In this journey, you meet lots of good preceptors as well as batchmates.
- Remember to be kind and helpful to your juniors!
What is the career pathway of a government hospital pharmacist?
In the government sector, your pharmacist grade (and hence salary) depends on years of working.
- Hence, working at government clinic or hospital long enough will unconsciously put us in a comfort zone.
- On the other hand, you should keep your passionate at learning new knowledge and helping patients, as you first started this journey.
Working at a government hospital or clinic equals to a stable income, but you will not become very rich also.
- Nonetheless, you can perform professional clinical skills without conflict of interest.
- You may also have a better work-life balance.
- A junior pharmacist describes our job in helping patients is full of kindness, although exhausting.
Summary
You may be a student at the start, but should be a professional by the end.
- Develop your attitudes and behaviours to those of a pharmacist.
Life is tough and work can be stressful, but it is important to keep going.
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