24-Hour Hospital Pharmacy & Medication Support

The Pharmacy at AS Medical Complex provides 24-hour medication support for hospital patients, Emergency patients, admitted patients, and individuals receiving treatment through different clinical departments.

Hospital pharmacy is an important part of safe patient care.

Its role goes beyond simply supplying medicines.

Pharmacy services support the safe and appropriate use of medication by helping ensure that the:

• Correct medicine

• Correct strength

• Correct dosage form

• Correct quantity

• Correct instructions

• Relevant patient information

are considered during the medication-use process.

The Pharmacy may support patients receiving care through:

• Emergency Department

• Outpatient clinics

• Inpatient wards

• Labour Room

• Operating Theatre

• Dialysis

• Medical departments

• Surgical departments

• Critical or higher-acuity care where applicable

• Discharge services

• Other hospital clinical areas

Medication safety is especially important because patients may be taking several medicines at the same time, may have allergies or kidney/liver disease, or may experience treatment changes during hospital admission.

WHO's Medication Without Harm initiative identifies medication-related harm as a major patient-safety issue and emphasizes safer systems involving patients, healthcare professionals, medicines, and medication-use processes.

Our Pharmacy Services

Depending on prescriptions, clinical requirements, medicine availability, and hospital policy, Pharmacy services at AS Medical Complex may include:

• 24-hour hospital Pharmacy support

• Prescription dispensing

• Outpatient prescription medicines

• Emergency medication support

• Inpatient medication supply

• Ward medication support

• Operating Theatre medication support

• Labour Room medication support

• Selected emergency medicines

• Injectable medicines where prescribed

• Oral medicines

• Topical medicines

• Inhaled medicines

• Selected ophthalmic and ENT medicines

• Diabetes medicines

• Blood-pressure medicines

• Cardiac medicines

• Gastrointestinal medicines

• Pain-management medicines

• Antibiotics when prescribed

• Other prescribed anti-infective medicines

• Selected pediatric medicines

• Obstetric and gynecological medicines

• Renal-related medicines

• Discharge medication dispensing

• Prescription review

• Medication counselling

• Medication-use instructions

• Medication reconciliation support where applicable

• Review of allergy information

• Identification of selected medication duplications

• Identification of selected drug interactions

• High-risk medicine safety procedures

• Controlled-medicine handling according to applicable requirements

• Appropriate medication storage

• Refrigerated medicine storage where required

• Medicine-expiry monitoring

• Adverse-drug-reaction awareness

• Coordination with doctors and nursing teams regarding medication-related questions

• Referral back to the prescribing clinician when prescription clarification is required

Availability of individual medicines can change according to procurement, supply conditions, prescribing patterns, and clinical requirements.

Safe Prescription Dispensing

A prescription contains important information about the medication a doctor intends a patient to use.

Before a medicine is supplied, the Pharmacy may review relevant details such as:

• Patient identity

• Medicine name

• Strength

• Dose

• Dosage form

• Route of administration

• Frequency

• Duration

• Quantity

• Relevant prescription instructions

Where information appears incomplete, unclear, or potentially unsafe, clarification with the prescribing clinician may be appropriate before dispensing.

Safe dispensing is particularly important when medicines have:

• Similar names

• Similar packaging

• Multiple strengths

• Complex dosing

• Significant interaction potential

• Narrow safety margins

WHO specifically recognizes look-alike and sound-alike medicines as a medication-safety concern and recommends systems designed to reduce confusion and medication errors.

Patient Identification & Medication Safety

Correct patient identification is an important part of medication safety.

Hospital processes should help reduce the risk that medication intended for one patient is supplied or administered to another.

Patients may be asked to confirm information such as:

• Name

• Hospital registration information

• Prescription

• Other identifying details

before medicines are dispensed.

For children, older adults, unconscious patients, or patients who require assistance, medication information may also need to be confirmed with:

• Parent

• Guardian

• Caregiver

• Nursing staff

• Treating clinical team

according to the situation.

Medication Allergies

Patients should tell their doctor, nurse, and pharmacist about any known medication allergies.

Important information includes:

• Name of the medicine

• Type of reaction

• Approximate time the reaction occurred

• Whether emergency treatment was required

Examples of medication reactions can include:

• Rash

• Hives

• Facial swelling

• Breathing difficulty

• Severe skin reaction

• Other symptoms

Simply saying “I am allergic to medicine” without identifying the medicine can make safe prescribing more difficult.

Patients should provide as much accurate information as possible.

Side Effect vs Allergy

A medication side effect and a medication allergy are not always the same.

For example, some medicines can cause expected adverse effects such as:

• Nausea

• Drowsiness

• Constipation

• Dizziness

• Stomach discomfort

An allergic reaction involves a different biological process and may include symptoms such as:

• Hives

• Swelling

• Wheezing

• Severe skin reactions

• Anaphylaxis

Patients should describe what actually happened rather than automatically labelling every unwanted effect as an allergy.

This helps clinicians make safer future medication decisions.

Drug Interactions

Medicines can sometimes interact with:

• Other prescription medicines

• Over-the-counter medicines

• Herbal products

• Supplements

• Foods

• Alcohol

• Certain medical conditions

An interaction may:

• Increase medicine levels

• Reduce effectiveness

• Increase bleeding

• Affect blood pressure

• Affect blood glucose

• Increase sedation

• Alter heart rhythm

• Cause other unwanted effects

Patients should therefore provide an up-to-date list of everything they are taking.

Multiple Medicines & Polypharmacy

Some patients need several medicines at the same time.

This is particularly common in patients with:

• Diabetes

• Heart disease

• High blood pressure

• Kidney disease

• Neurological conditions

• Multiple chronic illnesses

Using several medicines is not automatically inappropriate.

However, unnecessary or poorly coordinated polypharmacy can increase the risk of:

• Drug interactions

• Duplicate treatment

• Side effects

• Medication confusion

• Incorrect dosing

• Reduced adherence

WHO identifies medication safety in polypharmacy as one of its major medication-safety priorities.

Medication review is therefore particularly valuable when a patient is taking many medicines.

Hospital Admission & Medication Reconciliation

When a patient is admitted to hospital, the clinical team may need to determine which medicines the patient was taking before admission.

This process may involve reviewing:

• Prescription medicines

• Diabetes medicines

• Blood-pressure medicines

• Blood thinners

• Heart medicines

• Inhalers

• Anti-seizure medicines

• Steroids

• Psychiatric medicines

• Supplements

• Other regular treatment

Medication reconciliation involves comparing the patient's existing medication regimen with medicines being considered or prescribed during the new stage of care.

WHO identifies transitions of care, including hospital admission and discharge, as an important period for preventing medication-related harm.

Patients can help by bringing an accurate medication list whenever possible.

Bring Your Medicines or Medication List

When coming to hospital, particularly for admission, patients may benefit from bringing:

• Current medication list

• Recent prescriptions

• Medicine packaging

• Insulin information

• Inhaler information

• Allergy information

• Supplement list

when practical.

This information can help clinicians understand:

• What the patient is currently using

• Which medicines have already been stopped

• Which doses are being taken

• Whether duplicate medicines exist

Do not delay urgent Emergency care because medicines or records cannot immediately be found.

Inpatient Pharmacy Support

Hospitalized patients may receive medicines through a coordinated system involving:

• Doctor

• Pharmacist

• Nurse

• Other clinical professionals

The Pharmacy may supply medicines required for treatment on the ward according to hospital procedures.

Inpatient medication therapy may change during admission because of:

• Laboratory results

• Kidney function

• Liver function

• Blood pressure

• Blood glucose

• Infection

• Surgery

• Clinical improvement

• Side effects

• Other medical developments

Patients should therefore not assume that their home medication schedule will remain unchanged during hospitalization.

Do Not Take Home Medicines Independently During Admission

Patients admitted to hospital should tell the clinical team about medicines brought from home.

They should generally not continue taking their own medicines secretly or independently without informing the treating team.

Doing so could result in:

• Double dosing

• Drug interactions

• Excessive blood thinning

• Low blood pressure

• Low blood glucose

• Other complications

The treating clinician should determine which existing medicines should:

• Continue

• Stop

• Change

• Temporarily pause

during hospitalization.

Emergency Medication Support

The Pharmacy may support the Emergency Department by providing access to medicines used in the urgent management of selected conditions.

Depending on clinical circumstances, these may include medicines for:

• Severe allergic reactions

• Asthma and respiratory conditions

• Pain

• Infection

• Blood glucose abnormalities

• Seizures

• Cardiac emergencies

• Other acute conditions

Emergency medications should be selected and administered by appropriately trained healthcare professionals according to the patient's condition.

The Pharmacy supports the availability and medication-management pathway but does not replace Emergency clinical assessment.

High-Risk Medicines

Some medicines can cause serious harm when used incorrectly.

WHO identifies high-risk situations and high-risk medicines as an important medication-safety priority.

Examples of medicines that may require additional precautions can include selected:

• Insulin

• Anticoagulants

• Opioids

• Sedatives

• Concentrated electrolytes

• Chemotherapy medicines

• Other high-alert medications

depending on hospital policy.

Safety measures may include:

• Clear storage

• Restricted access

• Dose verification

• Additional prescription checks

• Careful administration

• Patient monitoring

The exact high-alert medicine list should be defined by AS Medical Complex's medication-safety policy.

Insulin Safety

Insulin is essential for many people with diabetes but can cause significant hypoglycemia if:

• The wrong insulin is used.

• The wrong dose is administered.

• Food intake changes unexpectedly.

• Doses are duplicated.

• Other treatment factors change.

Patients should understand:

• Insulin name

• Strength

• Dose

• Timing

• Relationship to meals

• Storage instructions

Insulin should not be casually exchanged between products simply because the names appear similar.

Blood Thinners

Anticoagulant and antiplatelet medicines may be prescribed to reduce blood-clotting risk.

Depending on the condition, these medicines can be important for preventing:

• Stroke

• Blood clots

• Other cardiovascular complications

However, they can also increase bleeding risk.

Patients should tell doctors, pharmacists, dentists, and surgeons when they take a blood thinner.

Do not stop prescribed anticoagulation independently before surgery, dental treatment, or another procedure.

The prescribing or treating clinician should determine the correct plan.

Opioids & Sedating Medicines

Selected strong pain medicines and sedatives can cause:

• Drowsiness

• Reduced alertness

• Impaired coordination

• Breathing suppression in excessive doses

• Other serious effects

Patients should follow prescribed dosing carefully.

They should avoid:

• Taking additional doses without instructions

• Sharing medicines

• Combining sedating medicines casually

• Driving when significantly impaired

Some medications require additional control and documentation according to applicable laws and hospital policy.

Prescription-Only Medicines

Certain medicines should only be supplied or used following an appropriate prescription.

The fact that a medicine was previously prescribed to:

• A family member

• A friend

• The patient during another illness

does not mean it is appropriate for the current condition.

Prescription requirements exist because factors such as:

• Diagnosis

• Dose

• Age

• Pregnancy

• Kidney function

• Liver function

• Drug interactions

• Allergies

can affect whether a medicine is appropriate.

Antibiotics & Responsible Use

Antibiotics are used for appropriate bacterial infections.

They do not treat every:

• Fever

• Cough

• Cold

• Flu-like illness

• Sore throat

because many illnesses are caused by viruses or other non-bacterial conditions.

Antibiotics should be used according to an appropriate clinical prescription.

Patients should:

• Follow the prescribed dose.

• Follow the prescribed schedule.

• Avoid using another person's antibiotics.

• Avoid saving leftover antibiotics for an unrelated illness.

• Seek medical advice if significant side effects develop.

Pharmacy services should support responsible antimicrobial use alongside doctors and clinical teams.

Over-the-Counter Medicines

Some medicines can be purchased without a prescription.

However, “over the counter” does not mean risk-free.

OTC medicines can still:

• Cause side effects

• Interact with prescription medicines

• Be unsafe during pregnancy

• Affect kidney or liver disease

• Cause overdose if multiple products contain the same ingredient

Patients should ask for professional advice if they are unsure which medicine is appropriate.

Duplicate Ingredients

Different medicines may contain the same active ingredient.

For example, a patient may unknowingly take:

• One medicine for pain

• Another medicine for cold or flu

that contains the same pain-relieving ingredient.

This can result in accidental overdose.

Patients should check:

• Active ingredients

• Strength

• Dosing instructions

rather than relying only on brand names.

Herbal Medicines & Supplements

Patients should tell their healthcare team about:

• Herbal remedies

• Vitamins

• Minerals

• Dietary supplements

• Traditional medicines

because these products may interact with prescription medication or affect:

• Blood clotting

• Blood pressure

• Blood glucose

• Sedation

• Liver metabolism

• Other body functions

“Natural” does not automatically mean free from medication interactions.

Medicines During Pregnancy

Pregnant patients should tell the doctor or pharmacist before using:

• Prescription medicines

• OTC medicines

• Herbal products

• Supplements

Some medicines can be used safely during pregnancy, while others may require:

• Dose adjustment

• Substitution

• Avoidance

• Specialist assessment

Patients should not stop essential prescribed treatment automatically after discovering pregnancy.

Stopping important medication can also place the mother or pregnancy at risk.

The treating clinician should determine the safest plan.

Medicines During Breastfeeding

Some medicines pass into breast milk in varying amounts.

The significance depends on:

• Medicine

• Dose

• Infant age

• Infant health

• Amount absorbed

• Duration of treatment

Breastfeeding patients should tell their clinician or pharmacist before beginning a new medication.

Many medicines are compatible with breastfeeding, while others require additional consideration.

Pediatric Medicines

Children are not simply smaller adults.

Medication doses may depend on:

• Age

• Weight

• Body surface area

• Kidney function

• Clinical condition

Liquid medicines also come in different concentrations.

Parents and caregivers should carefully check:

• Medicine name

• Strength

• Dose

• Measuring device

• Frequency

A kitchen spoon is not an accurate replacement for an appropriate medicine-measuring device.

Medicines for Older Adults

Older patients may be particularly vulnerable to medication-related problems because they may:

• Take several medicines

• Have reduced kidney function

• Have reduced liver function

• Experience dizziness

• Be more sensitive to sedating medicines

• Have difficulty remembering complex schedules

Medication review may therefore be particularly valuable in older adults.

Sudden confusion or falls should not automatically be attributed to age because medication can sometimes contribute.

Kidney Disease & Medicines

Kidneys help remove many medicines from the body.

When kidney function is reduced, some drugs may require:

• Lower doses

• Longer intervals

• Alternative treatment

• Closer monitoring

Patients with:

• Chronic Kidney Disease

• Acute Kidney Injury

• Dialysis

should tell the prescribing clinician and pharmacist.

Do not assume that a normal adult dose is appropriate for every patient with kidney disease.

Liver Disease & Medicines

The liver processes many medicines.

Significant liver disease may alter:

• Drug metabolism

• Drug concentration

• Side-effect risk

Patients with chronic liver disease should make their healthcare team aware of their condition before using new prescription or non-prescription medicines.

Medication Storage

Medicines must be stored according to appropriate conditions.

Depending on the product, storage requirements may involve:

• Controlled room temperature

• Protection from moisture

• Protection from sunlight

• Refrigeration

• Other manufacturer-specified conditions

Incorrect storage can reduce medication quality or effectiveness.

Hospital Pharmacy systems should maintain appropriate storage processes according to individual medicine requirements.

Refrigerated Medicines

Some medicines require refrigerated storage.

Examples can include selected:

• Insulins

• Biological medicines

• Vaccines

• Other temperature-sensitive products

Exact storage temperatures depend on the product.

Patients should follow the instructions provided with their specific medicine rather than assuming every refrigerated product has identical requirements.

Do Not Freeze Medicines Unless Specifically Required

Medicines requiring refrigeration should not automatically be placed in a freezer.

Freezing may damage some products.

Similarly, medicines should not be left for prolonged periods in:

• Direct sunlight

• Hot vehicles

• Areas of excessive heat

Patients receiving temperature-sensitive medicine should ask how it should be transported and stored.

Medicine Expiry Dates

Medicines should be used within appropriate expiry and storage conditions.

Expired or improperly stored medicines may:

• Lose effectiveness

• Become unsuitable for use

• Create avoidable treatment risks

Hospital Pharmacy processes should include expiry-date monitoring and stock rotation.

Patients should also periodically review medicines stored at home.

Do Not Share Medicines

Medicines prescribed for one person should not automatically be given to another person.

Even when symptoms appear similar, patients can differ in:

• Diagnosis

• Allergies

• Age

• Pregnancy

• Kidney function

• Other medicines

• Required dose

Sharing prescription medication can therefore be unsafe.

Discharge Medicines

When a patient leaves hospital, the discharge medication plan may differ from the medicines taken before admission.

Possible changes can include:

• New medicines

• Stopped medicines

• Dose changes

• Frequency changes

• Temporary treatment

• Replacement medicines

Medication reconciliation at discharge helps compare the patient's previous regimen with the final discharge medication plan.

AHRQ describes medication reconciliation as a key process for reducing unintended medication discrepancies during admission, transfer, and discharge.

Understand Your Discharge Prescription

Before leaving hospital, patients should ideally understand:

• Which medicines to take

• Why they are being taken

• Dose

• Frequency

• Duration

• Which previous medicines were stopped

• Important precautions

• Required follow-up

AHRQ's discharge medication guidance emphasizes providing patients with an updated medication list and counselling about the discharge regimen.

If instructions are unclear, ask before leaving the hospital.

Medication Counselling

Medication counselling can help patients use treatment more safely and effectively.

Depending on the medicine, counselling may cover:

• Purpose

• Dose

• Timing

• Duration

• With or without food

• Storage

• Common side effects

• Important warning symptoms

• Missed-dose instructions

• Drug interactions

• Other precautions

FDA patient medication information resources similarly emphasize helping patients understand directions for safe and effective medicine use.

What Should I Do If I Miss a Dose?

The correct action after a missed dose depends on the medicine.

It is not appropriate to automatically double the next dose.

For some medicines, the patient may:

• Take the missed dose when remembered

• Skip it if the next dose is close

• Follow another specific instruction

The correct approach depends on the medication.

Patients should follow the prescribed information or ask a pharmacist or clinician if uncertain.

Do Not Change Your Dose Yourself

Patients should not independently:

• Increase a dose because symptoms remain

• Reduce a dose because they feel better

• Stop chronic medicines abruptly

• Double doses after missed treatment

Some medicines can cause significant problems if suddenly discontinued.

Examples may include selected:

• Steroids

• Anti-seizure medicines

• Cardiac medicines

• Psychiatric medicines

• Other treatments

Changes should generally be discussed with the prescribing clinician.

Adverse Drug Reactions

An Adverse Drug Reaction – ADR is an unwanted or harmful response associated with a medicine.

Reactions can range from mild to serious.

Examples can include:

• Rash

• Nausea

• Dizziness

• Abnormal bleeding

• Severe skin reactions

• Liver injury

• Kidney injury

• Other unexpected effects

Patients should report suspected medication reactions to their healthcare team.

In Pakistan, DRAP operates national systems for healthcare professionals and patients to report suspected adverse events and adverse drug reactions.

Serious Medication Reactions

Some symptoms after taking a medicine require urgent medical assessment.

These can include:

• Difficulty breathing

• Swelling of the tongue or throat

• Collapse

• Severe widespread blistering rash

• Severe uncontrolled bleeding

• Loss of consciousness

• Severe confusion

• Other significant deterioration

A patient experiencing a potentially life-threatening reaction should seek Emergency care rather than waiting for routine Pharmacy advice.

Medication Errors

Medication errors can occur at different stages, including:

• Prescribing

• Dispensing

• Administration

• Monitoring

• Transitions between healthcare settings

Medication-safety systems aim to identify risks before they cause patient harm.

WHO's Medication Without Harm framework emphasizes that medication safety requires coordinated improvement involving healthcare workers, patients, medication products, and healthcare systems.

If a patient believes they received or took the wrong medicine, they should:

• Stop and verify what happened where clinically appropriate.

• Keep the medicine packaging.

• Contact the healthcare team promptly.

• Seek Emergency care if significant symptoms develop.

Pharmacy & Laboratory Monitoring

Some medicines require Laboratory monitoring.

Examples may include selected medicines affecting:

• Kidney function

• Liver function

• Blood cell counts

• Blood clotting

• Electrolytes

• Blood glucose

• Drug concentrations

The prescribing clinician determines which monitoring is required.

Pharmacy and Laboratory services can support this medication-management process.

Pharmacy & Emergency Department

The Pharmacy supports the Emergency Department by helping maintain access to medicines needed for acute patient care.

Emergency medication decisions remain the responsibility of appropriately trained clinicians who evaluate:

• Diagnosis

• Vital signs

• Allergies

• Organ function

• Other medications

• Clinical urgency

Patients with potentially serious symptoms should therefore attend Emergency rather than going to the Pharmacy only to request medicine.

Pharmacy & Inpatient Departments

Hospital Pharmacy support may extend across:

• General Medicine

• Cardiology

• Neurology

• Gastroenterology

• Nephrology

• Pulmonology

• Pediatrics

• Gynecology

• Surgery

• Orthopedics

• Other departments

depending on the medicine needs of admitted patients.

This integration helps keep medication supply connected to the wider treatment plan.

When Should You Speak With a Pharmacist?

Ask for medication advice when you are unsure about:

• How to take a prescribed medicine

• Timing

• Storage

• Whether it should be taken with food

• Possible interactions

• Use of OTC medicines with your prescriptions

• A missed dose

• Medicine-measuring devices

• Other medication-use instructions

For changes to diagnosis or treatment, the pharmacist may need to refer the question back to your doctor.

When Should You Contact Your Doctor?

Clinical review may be required when:

• Symptoms are worsening despite treatment.

• Significant side effects develop.

• Treatment appears ineffective.

• A new medical condition has developed.

• Pregnancy occurs while taking important medication.

• Laboratory monitoring is overdue.

• A medicine needs changing.

• Another clinical problem is suspected.

A pharmacist can assist with medicine-related questions but does not replace the treating physician's diagnosis and overall treatment plan.

When Is Emergency Care Required?

Do not wait for routine Pharmacy or outpatient advice if a medication-related problem causes:

• Severe breathing difficulty

• Facial or throat swelling

• Collapse

• Severe allergic reaction

• Severe bleeding

• Seizure

• Loss of consciousness

• Severe confusion

• Suspected major overdose

• Other life-threatening symptoms

These situations require immediate Emergency assessment.

Bring the medicine packaging or medication list where possible, but do not delay emergency treatment while searching for it.

Multidisciplinary Medication Care

Safe medication use requires cooperation between:

• Doctors

• Pharmacists

• Nurses

• Laboratory teams

• Emergency teams

• Surgical teams

• Other healthcare professionals

• Patients

• Families and caregivers

depending on the clinical situation.

Pharmacy therefore functions as an important link between the prescription and the safe use of medicine by the patient.