3. RUD Dispensers - July 22, Nk

8/3/2019 3. RUD Dispensers - July 22, Nk

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Role of Dispensers

inPromoting Rational Drug Use


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Objectives

To describe the importance of good dispensing

practices as part of rational drug use

To illustrate the role of the dispenser in promotingquality patient care

To understand mechanism of good dispensing

practices

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Diagnosis

Dispensing

PrescribingAdherence

Rational Drug Use Cycle

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Outline

Introduction

The Dispensing Process

Activity One: Identifying the Dispensing Process

The Dispenser

The Dispensing Environment

The Role of the Dispenser in the Proper Use of

Medicines Techniques for Ensuring Quality Dispensing

Summary of Session

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Introduction

A superficial look at dispensing suggest that it is a

process of supplying goods to a patient on the

basis of a written order, and that it can be done

successfully by anyone who can read theprescription, count, and pour. As a result,

dispensing is often delegated to any staff members

who has nothing else to do, who then perform this

function with out any training or supervision. Thissituation is irrational and dangerous.

Management Sciences for Health. Ensuring Good Dispensing Practices (chapter 2, Pg 485). In: Managing

Drug Supply, Second Edition, Kumarian Press (1997). 5


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Characteristics of Good Dispenser

In addition to reading, writing, counting, andpouring, the dispenser, or dispensing team,

needs additional knowledge, skills, and

attitudes to complete the dispensing process,

including:

Knowledge about the medicines being

dispensed (common use, common dose,

precautions about the method of use, common

side effects, common interaction with other

drugs or food, storage needs);




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Good calculation and arithmetic skills

Skills in assessing the quality of preparations

Attributes of cleanliness, accuracy and

honesty

Attitudes and skills required to communicate

effectively with patients


Drug Supply, Second Edition, Kumarian Press (1997).

Characteristics of Good Dispenser

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Case Report

A female student, age 20, suffering fromTonsillitis, was seen by a doctor in a 200-bedhospital OPD. She obtained a drug from thehospital pharmacy and took it as instructed. Shefelt very weak after taking the drug. Three dayslater she became severely comatose and wasadmitted to the same hospital. She tookChlorpropamide 250 mg four times a day. The

OPD doctor claimed that he prescribedChloromycetine 4x250 mg daily for her Tonsillitis.The patient eventually died two weeks afterhospital admission.

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Definition

Dispensing:

Dispensing is to ensure that an effective form

of the correct drug is delivered to the rightpatient, in the prescribed dosage and quantity

with clear instruction, and in a package that

maintains the potency of the drug.




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Good drug dispensing practices (1)

Good dispensing means ensuring that an effective form

of the correct drug is delivered:

To the right patient;

In the prescribed dosage and quantity;

With clear instructions;

In a package that maintains potency;

Dispensing is the last step in the drug pathway between

manufacturer and patient. No matter how many precautions are

taken to guarantee and maintain drug quality during production,

packing, transport, storage and distribution, they will all be useless

if drug quality is not preserved during this last step;10


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Good drug dispensing practices (2)

Safe, clean and organized working environment

Disciplined use of effective procedures

Qualified and trained staff, regular performancemonitoring

Safe and clean dispensing / labeling

Ensuring patients understanding

Good record keeping

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Dispensing cycle

Dispensing

process

1. Receive

and validate

the

prescription

2. Understand

and interpret

the

prescription

3. Prepareitems forissue

4. Recordthe actiontaken

5. Issuemedicine tothe patientwith clearinstructionand advice

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Steps in the Dispensing process (1)

1. Receive and validate the prescription

2. Understand and interpret the prescription

Read the prescription

Correctly interpret any abbreviations used by theprescriber

Confirm that the doses prescribed are in thenormal range for the patient (noting gender andage )

Correctly perform any calculation of dose andissue quantity

Identify any common drug-drug interactions

3. Prepare items for issue

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4. Record the action taken

5. Issue medicine to the patient with clear instructionand advice

When to take the medicine (particularly in relationto food and other medicines)

How to take the medicine (chewed, swallowedwhole taken with plenty of water )

How to store and care for the medicine


Drug Supply, Second Edition, Kumarian Press (1997).

Steps in the Dispensing process (2)

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KEEP WORKENVIRONMENT CLEAN

Dispensing environment must be clean

Physical environment should be kept free of dust and

dirt

Shelves and cupboard should be kept tidy and clean

Working area, and surface used during work should

be hygienic and uncontaminated

Staff must maintain good personal hygiene and

should wear protective clothing

Facilities to wash and dry hands should be available

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PREPARATIONOF DRUGSAND SUPPLIES (1)

1. Go into the store. Determine the supplies needed. Place the items ona tray. Take them to the dispensing area.

2. Keep supplies in the dispensing area organized

3. Check that the prescription is appropriate for the patient

Read the prescription and make sure that it is complete.

Name of the patient

Name of the drug (full name and generic name) and the strength

Dosage of the drug ( be particularly careful for children)Route of administration

Time and frequency of administration

Date and time when the prescription was written

Signature of the person writing the prescription

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4. Collect a container of an item, and check its expiry

date.

5. Label the package clearly with the patients name,

date, name of the item, quantity dispensed, andwritten instructions for the patient.

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6. Open the container. Check the quality of its

contents. Count the quantity needed in a

clean, safe manner.


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7. Put the prescribed amount of drug into the

package for the patient to take home.

8. Put any extra tablets or capsules back intothe appropriate container immediately.

Explain to the patient how to take the drug (seesteps a through d below). If the patient has

more than one prescription, dispense one

item at a time.


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a. Tell the patient the name of the drug, its form (tablet,syrup, etc.), what is for, and the dosage.

The dosage includes

When to take the drug ( for example, in the morning)

How much of the drug to take ( for example, 1 tablet)

For how long to take the drug ( for example , 3 days)

How to take the drug ( for example, with food)

b. Show the patient how to prepare the dose. Give the patientpractice

c. Tell the patient to take all prescribed drugs

d. Ask the patient to tell you how he will take the drug.


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9. Tell the patient to keep all drugs and medical

supplies in a safe place at home, and out of

the reach of the children.

10. Explain patients that they should not share

their drugs with other patients.

11. Register the drugs delivered to patient in a

register or daily sheet.


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Promoting Efficient Management in Dispensing

Good dispensing practices are under the

greatest threat when there is a crowd of

patients demanding immediate attention. The

need for speed must be balanced with theneed for accuracy and care in the dispensing

process. At this point the patients care, or

even life, is in the hands of the dispenser. In

dispensing, accuracy is more important thanspeed.

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Useful techniques to ensure quality

in dispensing include (1)

maintenance of records on what drugs and productshave been issued

maintenance by the pharmacy department of a dailylist of drugs in stockto inform prescribers whichdrugs are available thereby ensuring that only thesedrugs are prescribed

a two prescription system, whereby two separate

prescription are written: one for drugs available in thepharmacy, and one for those that are not but can beordered this helps avoid rewriting of prescriptions

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Useful techniques to ensure quality

in dispensing include (2)

efficient staff schedulingto make the best use ofavailable staff more staff at peak hours, enoughcoverage to keep one window open during lunchstarting and ending items coordinated with patient

flow

participation by the pharmacy staff in hospitalcommittees to identify and resolve patient flow

communication and other problems

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Roles of Pharmacist/Dispenser in

Ensuring Rational Drug Use

Procurement

Distribution

Prescribing

Information

Additional roles:

Communication with physician

Treatment guidelines Research on prescribing and utilization

Consumer education

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Dispenser-Patient Communication

Dispensers communicate

with patients how to take

drugs

Ensuring their

understanding is

very important

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Patient counseling

Through verbal and written communications, the pharmacistinforms, educates and counsels patients about the following itemsfor each drug:

Name of drug (Different names with synonyms)

Use of drug and its action

Route of administration and dosage schedule; dosage formand time of administration

Directions for preparations.

Direction and precautions for administration

Common side effects of the drug.

Self-monitoring of drug therapy

Adequate storage of drugs Contraindications and interactions of the drug

Information about prescription refill

What to do in the event of missed dose

Specific information to specific patient or drug

Source: Hospital and Clinical Pharmacy, Second Year Diploma in Pharmacy A. V. YADAV B. V. YADAV

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Factors contributing to Noncompliance

Following are the various factors that result in the patient non-compliance:

Poor understanding of instructions

Unpleasant taste of medications

Fear of becoming drug dependent

Side effects of the drug

Multiple drug therapy

Asymptomatic nature of the patient

Delay of physician or pharmacist resulting in bored waiting for the drug

Measurement of medication

Cost of medication

Frequency of administration

Duration of therapy

Illness


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Steps to improve compliance:

Identification of risk factors that may contribute to

non-compliance

Educating the patient : by means of effective verbal

and written communication with the patient

Development of treatment plan with recognition of

patients normal pattern of activities

Designation of specific items of day at which

medication is to be taken

Monitoring therapy

Patient motivation


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Dispensing in the Public and Private Sector

Public Sector

Cheap but long delays and frequent stock-outs

Generic drugs

Private Sector

Expensive but convenient

Brand name drugs

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Type of dispensing errors

Wrong drug dispensed

Wrong strength dispensed

Wrong quantity dispensed

Wrong form dispensed (e.g. tablet instead of liquid) Labeling error

Wrong drug name, strength or quantity on label

Wrong patient name on label

Failure to supply drug

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Standard indicators to measure

dispensing practice

Dispensing Indicators

Average dispensing communication time

Percentage of prescribed drugs actuallydispensed

Percentage of prescribed drugs properly

labeled

Percentage of patients knowledgeable aboutthe correct medication dosage/regimen

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Afghanistan Medicine Use Study

Study results that illustrate possible

irrational use

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Dispensing Times

The average dispensing times at primary health care facilities is 13.3seconds

The range for all health facilities is 4.3 to 27.8 seconds across all

facilities studies

Average dispensing times are very low and indicate a lack of time and

commitment by dispensers to counsel patients on important drug use

issues.

A secondary indicator, adequate labeling, was also done. No labels metthe criteria for being adequate labeled name of patient, name of drug

and strength, directions for use.

Source: Green, T., Z. Omari, Z. Siddiqui, J. Anwari, and A. Noorzaee. 2010. Afghanistan Medicine Use Study: A Survey of 28 Health

Facilities in 5 Provinces.Submitted to the U.S. Agency for International Development by the Strengthening Pharmaceutical Systems

(SPS) Program. Arlington, VA: Management Sciences for Health.34


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0.0

5.0

10.0

15.0

20.0

25.0

30.0

A B C D E F G H I J K L M N

Dispensing Times (seconds), by health facility

Dispensing Times

Health Facility

TimeinSeconds

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Average Dispensing Times

Comparison with OtherStudies

13.3 Seconds

149 Seconds

70 seconds

Afghanistan Medicine Use study

March 2009

SCA - Afghanistan May 2003

WHO -International Studies

May 2009

Source: WHO -Medicine Use in Primary Care in Developing and Transitional Countries. May 2009. WHO

Press, Geneva

Source: SCA - Swedish Committee for Afghanistan, Baseline Drug Indicator Study, A Comparative Cross

Sectional Study in SCA Health Facilities in Afghanistan, Part II: Results and Next Steps, April 200336


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Percentage of Patients with Knowledge of

Drug Dosage

Percentage of patients with adequate knowledge of

medicine dosage (dosage, frequency of use, duration of

use, and route of administration) is 29%

The range is 1-63% for across all health facilities

The overall knowledge of drug dosage is poor and needs

improvement to ensure that patients take their medications

correctly and they receive optimal drug therapy

Source: Green, T., Z. Omari, Z. Siddiqui, J. Anwari, and A. Noorzaee. 2010. Afghanistan Medicine Use Study: A Survey of 28 Health

Facilities in 5 Provinces.Submitted to the U.S. Agency for International Development by the Strengthening Pharmaceutical

Systems (SPS) Program. Arlington, VA: Management Sciences for Health.

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Percentage of Patients Who Have Knowledge of

Drug Dosage -Comparison with OtherStudies

Afghanistan Medicine Use

study

March 2009

SCA - Afghanistan May 2003

WHO -International Studies

May 2009

29%

63.4%

71%

Source: WHO -Medicine Use in Primary Care in Developing and Transitional Countries. May 2009. WHO

Press, Geneva

Source: SCA - Swedish Committee for Afghanistan, Baseline Drug Indicator Study, A Comparative Cross

Sectional Study in SCA Health Facilities in Afghanistan, Part II: Results and Next Steps, April 200338


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Eastern Mediterranean Health Journal, May 2004

Patient Care Indicators, Iran

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Activity One:

Identifying the Dispensing Process

A 45 year old patient come in the dispensing window

with a prescription.

One person will play the role of the 45 year old patient

and another will play the role of the dispenser.

The dispenser must analyze the prescription out loud

The participants will analyze the actions and behavior

of the dispenser during the entire analysis and make

comments after the simulation

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Role Play

Prescribing and Dispensing role-play

Writer of the manual should develop this role-

play

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Conclusion

Dispensing is a critical part of drug use

Dispensing is often neglected in training and

Essential Drugs Program

Interventions exist to improve dispensing Patients benefit from better dispensing

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Summary

Good dispensing practices enhance

patient adherence, satisfaction, and treatment

outcomes

A dispenser has responsibility to ensure that

drugs are given To the right patient;

in the prescribed dosage and quantity; with clear instructions and

In a package that maintains potency;

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3. RUD Dispensers - July 22, Nk