Medicosnext
Many hospitals in Nepal still view their pharmacies primarily as business hubs—focused on the storage and dispensation of medicines—rather than as integral components of patient care.
As we approach World Pharmacist Day this September, it’s crucial to reflect on the progress and challenges faced by the pharmacy sector in Nepal. Despite the growing number of pharmacy graduates and the initiation of pharmacy education within the country, the sector, particularly hospital and clinical pharmacy, remains underdeveloped, leaving many pharmacists in roles that do not fully utilize their skills and expertise.
Historically, hospital pharmacies in Nepal have often been viewed primarily as business centers, focusing on the storage and dispensing of medications. In recent years, there have been positive changes, such as hospitals ceasing to lease out pharmacies to the highest bidders and instead being directed to operate their own. However, many hospitals in Nepal still view their pharmacies primarily as business hubs—focused on the storage and dispensation of medicines—rather than as integral components of patient care.
In contrast, pharmacists in many developed countries have transitioned from traditional roles to more specialized services that enhance patient care. These include Medication Therapy Management (MTM), clinical consultations, pharmacovigilance, and antimicrobial stewardship, among others. The integration of pharmacists into these roles is not intended to replace doctors or nurses but to complement their work and improve patient outcomes. This evolution is something Nepal urgently needs to emulate if it is to truly meet the health needs of its population.
Amidst all these developments happening in developed nations, let us look into the current scenario of pharmacists currently working in hospital settings in Nepal. Through their experiences and perspectives, we hope to better understand the current state of pharmacy practice in the country and identify opportunities for growth and improvement. Below are the questions that will guide the collective interview:
- How would you introduce yourself to our readers?
Suresh Bastakoti: I am a pharmacist with a distinguished career in the Military Pharmacy Sector and academia. I completed my Doctor of Pharmacy (PharmD) degree in 2010 from University of the Punjab, Pakistan. Currently, I work as the hospital and clinical services in-charge at a tertiary care hospital. I have had the opportunity to work in three different countries for over four years with the United Nations. I have also published several papers and co-authored a book in hospital and clinical pharmacy.
Dr Kapil Pandey: I’m Dr. Kapil Pandey. I completed my Doctor of Pharmacy (PharmD) degree in 2022 from Bahauddin Zakariya University, Pakistan, under the Government of Nepal, Ministry of Education scholarship programme. Currently, I am serving as a Clinical Pharmacist at Kanti Children’s Hospital.
Sarita Thapa: I’m Sarita Thapa, Head of Pharmacy Department at UDM National Institute of Neurological and Allied Sciences in Bansbari, Kathmandu. My journey in pharmacy began with a B. Pharm degree from IOM, Maharajgunj Medical Campus in 2006, followed by an M. Pharm in Clinical Pharmacy from Pokhara University, CIST College in 2017. Over the past 14 years, I’ve had the privilege of working at this prestigious institute, where I’ve dedicated myself to advancing neurological and allied sciences through clinical pharmacy practice.
Dinesh Yadav: I am a registered pharmacist with extensive expertise in both community and hospital pharmacy. I have a Master’s degree in Clinical Pharmacy from Purbanchal University. With over 15 years of professional experience, I have served in various roles, including Pharmacy Officer and Clinical Pharmacy Officer. I am currently the Pharmacy Course Coordinator at a constituent institute of CTEVT in Ilam, Nepal.
Santoshi Thapa: I am currently working as a Pharmacy Manager (Procurement & Operation) from May 2022. I previously worked as a Pharmacy Manager in Grande International Hospital. I completed my Bachelor in Pharmacy in 2014 from Purbanchal University.
- Please describe your current role and responsibilities as a pharmacist.
Suresh Bastakoti: As a pharmacist, my primary role is to ensure the safe and effective use of medications. I oversee drug procurement, inventory management, and prescription monitoring, while also dispensing medications accurately and providing patient counseling. Additionally, I help develop and implement pharmacy policies and participate in clinical services to optimize medication regimens. Overall, my goal is to provide high-quality pharmaceutical care and ensure safe medication use.
Dr Kapil Pandey: I am a Clinical Pharmacist at Kanti Children’s Hospital. I focus on optimizing medication therapy for patients by collaborating with the healthcare team. My responsibilities include reviewing and managing prescriptions, providing drug information and education to both healthcare professionals and patients, monitoring drug interactions, and ensuring safe and effective medication use to improve patient outcomes.
The integration of pharmacists into these roles is not intended to replace doctors or nurses but to complement their work and improve patient outcomes.
Sarita Thapa: As the pharmacy department head, I represent our department and work with other departments for the better clinical outcome of Patients. We work with other clinical and non-clinical teams to solve the medicine related issue in the hospital. I oversee the day-to-day operations of the hospital pharmacy, including medication dispensing, inventory management, and ensuring the pharmacy runs smoothly.
Dinesh Yadav: As a Clinical Pharmacist, my roles involve development of Drug and Therapeutics Committees (DTCs), hospital formularies, adverse drug reporting, and providing patient counseling on drug therapy.
Santoshi Thapa: I provide patient services by filling prescriptions, counseling patients, and supervising the work of Assistant Pharmacists. I develop and monitor department goals, supervise, schedule, assign, monitor, and evaluate the work of subordinate and professional, technical, and other assigned staff. I communicate and coordinate with doctors regarding medications, respond to complaints, identify issues, and seek appropriate remedies for pharmacy-related problems.
- What are the most significant challenges you face in your daily practice?
Suresh Bastakoti: As a pharmacist juggling multiple roles in the administration, hospital, academia, and international missions, I encounter a unique set of challenges. Balancing clinical duties with teaching responsibilities requires effective time management and continuous learning. Adapting my approach to pharmacy practice across diverse environments, from military hospitals to resource-limited settings, demands flexibility and problem-solving skills. Additionally, promoting pharmacy as a career and addressing the challenges faced by aspiring pharmacists in Nepal is a constant endeavor.
Dr Kapil Pandey: As a clinical pharmacist, the challenges I face is that the role of the clinical pharmacist is not fully recognized by other healthcare workers and patients, which leads to my expertise being underutilized and limited making it hard to provide the best care.
Sarita Thapa: The increasing number of brands and lack of regulation of pharmaceutical promotion within hospital premises has resulted in multiple brands prescription by different doctors. Many brands of a particular medicine are stocked in the pharmacy creating problems with inventory management and ensuring the quality of medicines. Managing complex cases involving polypharmacy, drug interactions, and patients with multiple health conditions. Quick Turnover of skilled pharmacists is another issue. Shortage and non-availability of essential and lifesaving medicines.
Dinesh Yadav: In my daily hospital pharmacy practice, one of the most significant challenges I encountered was the absence of an official regulatory directive for hospital pharmacy from 2004 to 2014. Despite this, I initiated all hospital pharmacy service activities based on my theoretical background during that period. I also established a Drug and Therapeutics Committee (DTC) and a Drug Information Unit.
Santoshi Thapa: The most significant challenges we face in our daily practice include the availability of life-saving medicines, as hospital pharmacies are often given less priority. The hospital formulary is not consistently followed by doctors, leading to the need to stock too many brands. We also face challenges related to the availability of medicines, retention of pharmacists and assistant pharmacists, and the lack of trained manpower.
- How has the role of pharmacists evolved in Nepal over the past decade?
Suresh Bastakoti: In the past, we were primarily seen as administrators. Our responsibilities were largely confined to clerical roles. However, over the past decade, there has been a notable shift towards a more patient-centric and clinical approach. Today, pharmacists are increasingly involved in medication therapy management.
Dr Kapil Pandey: Over the past decade, the role of pharmacists in Nepal has evolved from primarily dispensing medications to becoming integral members of the healthcare system. Pharmacists are now more actively involved in patient care including medication therapy management, patient counseling, public health initiatives, healthcare policy development, and pharmacovigilance.
Sarita Thapa: The role of hospital pharmacists in Nepal has evolved from traditional dispensing functions to a more dynamic and integral role in patient care. They are now essential members of healthcare teams, contributing to medication management, patient safety, and overall quality of care. Government of Nepal, has endorsed the “Hospital Pharmacy Service Guideline, 2015” to promote good hospital pharmacy practice (HPP) in Nepal. Most government hospitals have adopted the guideline and started their own hospital pharmacies whereas the implementation in private hospitals is comparatively less.
Dinesh Yadav: After the release of the Hospital Pharmacy Directive in 2015 by the Ministry of Health and Population, the role of pharmacists expanded to include Clinical Pharmacy Services and the systematic management of hospital pharmacy services. This includes the development of Drug and Therapeutics Committees (DTCs), hospital formularies, adverse drug reporting, and providing patient counseling on drug therapy.
Santoshi Thapa: The role of pharmacists in Nepal has significantly evolved over the past 2-3 decades. Hospitals have started establishing their own pharmacies and hiring pharmacists, including clinical pharmacists. Clinical pharmacists are now involved in patient care, participating in rounds with doctors. Pharmacists are also increasingly involved in establishing Drugs and Therapeutics Committees, and developing hospital formulary systems.
- Have you taken up any additional responsibility in these years of practice?
Suresh Bastakoti: As a hospital pharmacist with over 13 years in a military setting, I’ve often been tasked with responsibilities beyond the traditional roles. I’ve been involved in supporting combat operations, responding to disasters, participating in research and development initiatives, training junior personnel, and overseeing medical logistics.
Dr Kapil Pandey: Yes, I have taken on roles in antibiotic stewardship programs, patient education, and training junior pharmacists. As a secretary of the formulary development committee, I am also actively involved in hospital formulary development.
Sarita Thapa: Our hospital has started Neuro intervention with the first biplane Cath lab in Nepal. So, managing all the medicines including surgical requirements through a pharmacy department is a very challenging Job. Our hospital has successfully completed around 1000 plus neuro intervention cases in the recent year. I am happy to be a part of this team from the pharmacy department.
Dinesh Yadav: Yes, since becoming a Clinical Pharmacy Officer, I have taken on additional roles, including serving as the Member Secretary of the Drug and Therapeutics Committee (DTC), managing the pharmacy, and being an active member of the healthcare research team.
Santoshi Thapa: Yes, in addition to my role as a Pharmacy Manager, I have taken on the responsibility of procurement. This includes selecting vendors, analyzing quotations, procuring medications, and managing inventory.
- What are the most critical skills or knowledge areas for pharmacists in Nepal today?
Suresh Bastakoti: I believe that pharmacists in Nepal must possess a strong foundation in clinical expertise, patient care, education, research, management, and business acumen. Clinical skills, including critical care experience and leadership abilities, are essential for ensuring optimal patient outcomes. Additionally, multilingual fluency and strong communication skills are invaluable for effectively interacting with patients and colleagues from diverse ethnic origins.
Dr Kapil Pandey: In Nepal, the most critical skills for pharmacists include expertise in medication therapy management, strong communication and patient counseling abilities, a deep understanding of pharmacology and drug interactions, knowledge of healthcare policies, and pharmacovigilance.
Sarita Thapa: Pharmacists need a strong understanding of pharmacology, therapeutics, and drug interactions, involvement in research and CMEs. Strong leadership and teamwork skills are important for collaborating with other healthcare professionals, managing pharmacy operations, and leading community health initiatives.
Dinesh Yadav: In my opinion, the most critical skills and knowledge areas for pharmacists in Nepal include participating in clinical ward rounds, reviewing patient drug therapies, monitoring drugs and therapeutic regimens, reporting adverse drug reactions, and counseling patients on drug therapy. Additionally, adjusting doses for renal and hepatic disorders in patients with comorbidities is essential for providing optimal care.
Santoshi Thapa: Pharmacists should be able to solve medication-related problems and communicate complex medical information in a clear and understandable manner. We must provide value-added services to patients and the organization, including offering drug information. Pharmacists can also establish drug information centers for geriatric patients.
- How do you collaborate with other healthcare professionals to ensure optimal patient care?
Suresh Bastakoti: I consider that effective collaboration with other healthcare professionals is essential for optimal patient care. By working closely with doctors, nurses, social workers, and other specialists, we can leverage our combined expertise to develop comprehensive patient care plans, improve communication, and address patients’ overall well-being. This collaborative approach involves discussing medication options, monitoring patient progress, addressing social determinants of health, and educating patients about their medications.
Dr Kapil Pandey: I work closely with doctors, nurses, and other healthcare professionals to ensure patients get the best possible care. We discuss drug regimens, review medications for safety and effectiveness, and make sure that the therapies we choose are right for each patient to ensure optimal patient care.
Sarita Thapa: We work closely with doctors and nurses to review and optimize medication regimens. This includes assessing the appropriateness of drug choices, dosages, and potential drug interactions. During transitions of care, such as hospital discharge or moving between different levels of care, pharmacists play a crucial role in ensuring continuity of care. We collaborate to review and reconcile medications, prevent readmissions, and address any medication-related issues that may arise.
Dinesh Yadav: I collaborate extensively with doctors, nurses, and other healthcare professionals to provide comprehensive and coordinated care for our patients. By working together, we can address all aspects of a patient’s treatment plan, from medication management to overall health and well-being.
Santoshi Thapa: The healthcare team shares a common goal: excellent patient care. To achieve this, collaboration between nursing teams, doctors, and pharmacists is essential. Proper communication with doctors and nurses about any medication-related issues is vital.
- What are your thoughts on the availability and quality of medicines in Nepal?
Suresh Bastakoti: Availability of medicines is often an issue due to factors such as pricing regulations, supply chain disruptions, and limited importation, registration issues. While there have been improvements in quality control measures, counterfeit and substandard drugs remain a concern.
Dr Kapil Pandey: The availability and quality of medicines in Nepal present a mixed landscape. While urban areas generally have better access to a wide range of medications, rural and remote regions often face significant challenges in medicine availability. Factors such as poor infrastructure, limited supply chains, and lack of technical personnel, etc. are responsible. In addition, lack of sufficient knowledge among both health care professionals (regarding drug storage and transportation) and patients (poor medication adherence, and ignorance) is another issue.
Sarita Thapa: Access to medicines in Nepal can often be limited in different ways. People often face challenges in obtaining essential medications due to logistic issues, limited pharmacy infrastructure, and distribution inefficiencies. Improving the efficiency and reliability of the pharmaceutical supply chain can help ensure that essential medicines are consistently available. Encouraging local production with stringent quality controls can also enhance medicine quality.
Dinesh Yadav: The availability and quality of medicines are largely influenced by the drug policies within hospital services. Ensuring quality compliance, maintaining good procurement practices around the clock, and rigorous drug quality control are essential to meeting the standards set by pharmacopeias.
Santoshi Thapa: The availability of emergency and life-saving medicines in Nepal is challenging. Some medicines required for critical care units (ICU, NICU, and PICU) are difficult to procure. Managing shortages of life-saving medicines is a significant challenge in Nepal.
- How do you approach patient counseling, especially regarding medication adherence and side effects?
Suresh Bastakoti: I believe we can significantly impact Nepal’s healthcare system by enhancing medication adherence, promoting responsible antibiotic use, expanding clinical pharmacy services, and strengthening public health programs. Our expertise can also be invaluable in rural and conflict zones, improving healthcare access and providing essential services. Additionally, pharmacists can contribute to education and research, shaping the future of the profession and advancing healthcare practices. By leveraging our knowledge and skills, we can be true game- changers in building a better healthcare future for Nepal.
Dr Kapil Pandey: I approach patient counseling by clearly explaining the importance of taking medications as prescribed, discussing potential side effects, and addressing any concerns or questions the patient may have. I ensure patients understand how to use their medication correctly and why adherence is crucial for their health.
Sarita Thapa: Effective patient counseling on medication adherence and side effects is a key component of pharmacy practice. I give sufficient time to patients and listen to them carefully. I give clear and concise information regarding their medications using proper media tools. Pharmacists should use language and provide materials in the patient’s preferred language and literacy level to ensure they fully understand the information and focus on medical adherence.
Dinesh Yadav: When it comes to patient counseling, particularly regarding medication adherence and side effects, I follow these approaches:
- Use the local language during patient counseling, interpreting medical terminology for better understanding.
- Provide follow-up care.
- Use well-labeled diagrams with special instructions and precautions.
- Offer comprehensive drug information.
- Implement a feedback mechanism to monitor and adjust drug therapy as needed.
Santoshi Thapa: During the dispensing of medicines, I ensure proper communication with the patient. After dispensing, I ask the patient if they understand the instructions. If there is any confusion, I will explain again how to take the medication. I emphasize the importance of taking medications as prescribed, even when the patient feels well, and provide guidance to chronic patients on what to do if a dose is missed. I also demonstrate the proper use of devices when necessary and inform patients about common side effects and when to consult a doctor.
- Where can pharmacists in Nepal make the most significant impact on the healthcare system?
Dr Kapil Pandey: Pharmacists can play a crucial role in optimizing medication therapy, preventing medication errors, and managing drug interactions, particularly in hospitals and communities. Moreover, they also play a significant role in the healthcare system through the development and implementation of policies that ensure the safe, effective, and rational use of medications.
Sarita Thapa: Pharmacists are pivotal in ensuring product quality, improving patient outcomes through clinical practice and counseling. During pandemics, they contribute to public health through vaccinations and community education. They also play a critical role in managing chronic conditions like diabetes, hypertension, and cancer. Through journalism, pharmacists can educate the public on drug-related issues, and through research, they can explore new ideas and domestic sources like herbal medicine, contributing to national development.
Dinesh Yadav: I believe pharmacists in Nepal can make the most significant impact in the healthcare system by ensuring the selection of high-quality medicines, individualizing drug therapy to improve patient outcomes, and enhancing the quality of life while considering the economic aspects of healthcare.
Santoshi Thapa: Pharmacists can make the most significant impact in the healthcare system through hospital and community pharmacies by providing drug information and proper medication counseling to patients. The government should implement hospital pharmacies in all hospitals. Clinical pharmacists should be involved in clinical rounds and effectively communicate medication-related information with doctors.
