CLERKSHIP BOOK
Name RUTUJA WAGHMARE
Class PHARM-D (V YEAR)
Exam Seat No
Enrollment No
Sign of Faculty/Incharge Sign of HOD Principal
SHIVLINGESHWAR COLLEGE OF PHARMACY
ALMALA TQ. AUSA, DIST. LATUR
CERTIFICATE BY THE GUIDE
This is to certify that Miss. Rutuja Waghmare of Pharm. D Vth Year has
satisfactorily completed the clerkship postings as prescribed by the Pharmacy Council of
India during the academic year 2023-24 in partial fulfilment of the requirement for the
degree of Doctor of Pharmacy.
Sign of Faculty/Incharge Sign of HOD Principal
CONTENTS
S.NO IP NO. DIAGNOSIS
RESPIRATORY
1
2
3
4
5
MEDICINE
1
2
3
S.NO IP NO. DIAGNOSIS
RESPIRATORY
1
2
3
4
5
1
2
3
5
RESPIRATORY
PATIENT CASE PROFILE - 01
Patient
Details:
Name: BK Age/sex:55/M DOA:07/04/2024 DOD: 10/04/24
Dept: Respiratory Ward/Unit: ICU IP No: Case No:1
Chief Complaints:
c/o - Difficulty in breathing } 4-5 DAYS
SOB
Cough
Past Medical History:
Nil
Past Medication History:
Nil
Social History:
Alcohol: Nil Marital status: Nil
Tobacco: Nil Sleep: Normal
Education: 12th Appetite: Normal
Occupation: Farmer Bowel and bladder: Regular
Allergies: Nil
Physical examination:
Vitals 1 2 3 4
Blood pressure(mmHg) 90/70 120/90 110/80 110/80
Heart rate(beats/min) 78/min 79/min 81/min 81/min
Temperature (oC or oF) 100 102 99 101
Respiratory rate(breaths/min) 14/min 18/min 20/min 21/min
LAB INVESTIGATIONS:
Blood sugar 01 02 03 04 05 06 07
RBS (70-110mg/dl) 110
FBS > 110
PPBS > 110
COMPLETE BLOOD PICTURE:
HAEMATOLOGY 01 02 03 04
Hb (11-16.5gm/dl) 11.6
RBC (3.80-5.80m/cu) 3.7
TC (3500-10000/cum) 2600
Lymphocytes (15-30%) Mid cells (2-10%) Polymorphs
Neutrophils (40-70%) 65% ,
Eosinophils (1-6%) Lymphocyte
s 6% ,
ESR:M(0-10mm/hr) F(0-20mm/hr) 9
Platelets (1-4lakh cells/cum) 126400
PCV (35-50%) 33 %
Retic count (0.5-2.6%)
Blood group O+
MCV 91.1%
MCH 29.4%
MCHC 33.2 %
P.T: Test
Control
LIVER FUNCTION TEST:
01 02 03 04
Total protein (6.8- 8.3g/dl) 6.44
SGOT 218.0
SGPT 184.0
ALP
Bilirubin total (0.5- 0.6mg/dl) 0.99
Bilirubin direct (0-0.6mg/dl) 0.65
Bilirubin indirect (0- 0.4mg/dl) 0.34
ELECTROLYTES:
01 02 03 04
Sodium 132
(135 -145mEq/I)
Potassium 3.2
(3.5-5.5mEq/I)
Chlorides 88
(98- 107mEq/I)
Magnesium
(1.62-2.8mg/dl)
Sr.calcium
(8.4- 10.8)
RENAL FUNCTION TEST:
1 2 3 4 5 6 7
Sr. Creatinine 0.6
(M:0.6-1.1mg/dl
F:0.5-0.9mg/dl)
Sr. Urea(3-8 mmol/L) 4.8
BUN (10-50mg/dl) 18
Uric acid (2.6-7.2mg/dl)
OTHER INVESTIGATIONS: USG, WIDAL Test,
DIAGNOSIS: -
COPD ACUTE EXACERBATION
TREATMENT CHART:
S.NO B.NAME G.NAME DOSE FREQ 01 02 03
1 Inj. Pan Pantoprazole 40 mg OD
2 Inj. Emset Ondansetron 4 mg TDS
3 Inj. Augmentin Amoxicillin 1.2 mg TDS
4 Tab Telekast L Monteleukast 650 mg HS
5 Syp Ascoril Albuterol Sulphate 1 tsp BD
6 Tab. Azee Azithromycin 500 mg BD
7 Tab Asthalin Salbutamol 4 mg TID
8 Tab Pulmometry Piperacillin Tazobactam 4.5 mg BD
9 Syp Mucolite Ambroxol 2 tsp BD
11
DISCHARGE MEDICATIONS:
S.NO Trade name Generic name Dose Frequency Duration
1 Tab Pantop D Pantaprazole 40 mg OD 10 days
2 Tab. Asthalin Salbutamol 4 mg BD 10 days
3 Tab. Reflusmart Reflumilast 500 mg BD 10 days
4 Syp. Mucolite Ambroxol 2 tsp BD 10 days
FOLLOW UP DETAILS: REVIEW AFTER 10 DAYS
Signature of student Signature of faculty\in-charge
PATIENT COUNSELLING DOCUMENTATION FORM
Patient Details:
Name: BK Age/sex:55/M DOA: 07/04/2024 DOD: 10/04/24
Dept: Respirstory Ward/Unit: ICU IP No: Case No:
Social History:
Alcohol: Nil Marital status: Nil
Tobacco: Nil Sleep: Normal
Education: 12th Appetite: Normal
Occupation: Farmer Bowel and bladder: Regular
Other patient’s specific background information collected?
Yes No
Diagnosed Disease counselled:
Yes No
Prescribed medications counselled:
Yes No
Any major barriers involved:
Yes No
If Yes,
Patient based Provider based System based
Quote specific barrier (if any):
If yes, whether barrier was rightly overcome?
Yes No
Time taken for counselling:
Less than 10 min
10 to 20 min
More than 20 min
Counselling provided to
Patient Patient Representative
Whether counselling was conducted at appropriate place?
Yes No
If patient‘s representative , give reason:
Patient is unconscious
Language problem
Hearing problem
Paediatric patient
Other
(please specify)
Counselling aids used: Verbally
Counselling material provided: NO
Content of patient counselling:
Pharmacological:
Complete full course of antibiotics.
Take analgesics for fever or pain.
Use expectorants as directed.
Follow proper inhaler technique.
Adhere to Dosage regimen.
Attend follow-up appointments.
Report any worsening symptoms.
Non –Pharmacological
Rest and stay hydrated.
Eat a balanced diet.
Use humidifiers for comfort.
Avoid smoke and pollutants.
Practice good cough etiquette.
Signature of student signature of faculty\in-charge
Drug Information Request Form
Name of the enquirer: Rutuja Waghmare Time: 10 AM Date: 07/04/2024
Received by: BK Unit: ICU Phone No: xxxxxxxxx
Enquirers Professional Status:
Physician Resident PG Surgeon
Intern Nurse CP Other
Details of Enquiry:
Purpose of enquiry:
( ) Update Knowledge ( ) Better Patient Care ( ) Other
Answers needed:
( ) Immediately ( ) Within 2-4 hours ( ) Within A day ( ) Within 1-2 days
Patient Details:
Age: 55 year Weight: 60 kgs Sex: M/F
Liver/Renal Allergies Current Medical Relevant Drug
Functions Problem Therapy
No allergies TAB. Azee
COPD ACUTE Syp. Mucolite
EXACERBATION
Other Details:
If Pregnant
1st Trimester 2nd Trimester 3rd Trimester
If Breast
feeding:
Signature of student signature of faculty\in-charge
Drug Interaction Reporting Form
Name of reporter: Rutuja Waghmare Patient IP/OP No:
Designation: Date of Admission: 07/04/2024
Location of Event: Respirstory Diagnosis: COPD ACUTE
EXACERBATION
Drug 1 Drug 2 Interaction Severity
azithromycin decreases
effects of amoxicillin
Tab.Azee Amoxicillin by Minor
pharmacodynamic anta
gonism
Antibiotic Antibiotic
Action Required: monitor
Drug 1 Drug 2 Interaction Severity
Prescribed for: Prescribed for:
Describe the mechanism of interaction:
Action Required:
Signature of student signature of faculty\in-charge
MEDICATION ADHERENCE FORM
Patient
Details:
Name: BK Age/sex:55/M DOA:07/12/23 DOD: 11/12/23
Dept: Respiratory Ward/Unit: ICU IP No: Ht: 160
Wt: 60
MORISKY MEDICATION ADHERENCE SCALE
S. No MMAS – 8 YES NO
(0) (1)
1 Do you sometimes forget to take your medication?
2 People sometimes miss taking their medications for reasons other
than forgetting. Over the past 2 weeks, were there any days when
you did not take your medication?
3 Have you ever cut back or stopped taking your medication without
telling your doctor because you felt worse when you took it?
4 When you travel or leave home, do you sometimes forget to bring
along your medication?
5 Did you take your medicine yesterday?
6 When you feel like your health concern (disease) is under control, do
you sometimes stop taking your medicine?
7 Taking medication every day is a real inconvenience for some
people. Do you ever feel hassled about sticking to your treatment
plan?
8 How often do you have difficulty remembering to take all your
medications?
Never/Rarely - 0
Once in a while - 1
Sometimes - 2
Usually - 3
All the time – 4
Total score: 8
Patient has -- High adherence
MORISKY MEDICATION ADHERENCE
SCALE
Response choices are “yes” or “no” for items 1 through 7 and Item 8 has a five-point Likert response scale.
Each “No” response is rated as 1 and each “Yes” response is rated as 0 except for item 5, in which each
“yes” response is rated as 1 and each “no” response is rated as 0.
For item 8, if a patient chooses response ‘‘0”, the score is ‘‘1” and if they choose response ‘‘4”, the score is
‘‘0”. Responses ‘‘1, 2, 3” are respectively rated as ‘‘0.25, 0.75, 0.75”.
Total scores on the MMAS-8 range from 0 to 8, with scores of:
8 reflecting High adherence,
7 or 6 reflecting medium adherences, and
<6 reflecting Low adherence.
Signature of student signature of faculty\in-charge
MEDICATION ERROR REPORTING FORM
1.Date of Event: 07/04/24 Time of Event: 10 pm
2.Location of Event:
Ward OPD Pharmacy Others
3.Type of Error:
Prescribing Dispensing
Administration Others:
4.Patient Details:
Age: 65yrs Weight: Sex: male
5.Description of the event: (how did the event occur and how was it detected?)
6.Details of medicines involved in the event:
S. No Dosage form Generic name Strength Frequency
7.Did the Error reach the patient?
Yes No
8.Outcome of Event:
No error A. Events have potential to cause error
Error, no harm B. Error did not reach patient
C. No harm
D. No harm but requires monitoring
Error, harm E. Temporary harm requiring treatment
F. Temporary harm requiring hospitalization
G. Permanent harm
H. Near death event
Error death I. Death
9.Possible causes & contributing factors:
Lack of knowledge / experience Unavailable patient information
Illegible prescription Peak hour
Look alike/ Sound alike Miscommunication
(LASA) medication
Wrong labelling / instruction Failure to adhere to work procedure
Use of abbreviations Others: prescribing error
10.Details of reporter:
Name: RUTUJA WAGHMARE
Designation: PHARM D INTERN
Mobile No: XXXX
11. Intervention done:
Administered antidote Communication improved
Education/Training provided Policy/Procedure changed
Informed staff who made error No action needed
Changed to correct drug/dose/frequency Others:
12. Suggestions for future to prevent such type of incidents:
During Prescription writing should check drug/dose/frequency twice.
Signature of student signature of faculty\in-charge
Adverse drug reaction reporting form
Patient Details:
Name: BK Age/sex: 55/M DOA: 07/04/2024 DOD: 11/04/24
Dept: Respiratory Ward/Unit: IP No: Case No:
ICU
Suspected ADR:
Date of treatment started Date of treatment stopped
(d/m/y) (d/m/y)
Suspected Medication:
S.NO Name Manufac Batch Exp. Dose Route Frequency Therapy dates (if Reason
(brand and turer (if No./ Lot Date (if used used known give for use of
/or generic known) No. (if known) duration) prescribed
for
name) known)
Date started
Date
stopped
1.
2.
3.
4.
ADR Reported:
Reaction abated after drug stopped or dose reduced Reaction reappeared after reintroduction
S.No Yes No Unknown NA Reduced dose Yes No Unknown NA If
reintroduce
d dose
1.
2.
3.
4.
Relevant tests / laboratory data with dates: NONE
Other relevant history including pre-existing medical conditions (e.g. allergies,
race, pregnancy, smoking, alcohol use, hepatic/ renal dysfunction etc): NONE
Concomitant medical production including self medication and herbal
remedies with therapy dates (exclude those used to treat reaction):NONE
Seriousness of the reaction:
( )Death(dd/mm/y y) ( )Required intervention to prevent permanent
impairment/damage
( ) Life threatening ( ) Congenitial anomaly
() Hospitalization initial ( ) Other ( Specify )
( ) Disability
Outcomes:
Fatal Recovering
Continuing Recovered
Unknown Others Specify
Name and Professional Address:
Pin code: E-mail
Signature of student signature of faculty\in-charge
