Introduction to dispensing and medication counseling

Introduction to DISPENSING and MEDICATION COUNSELING

Ivory Diane C. Amancio, RPh

Southwestern University – College of PharmacyCebu Philippines

What is Dispensing?

What are the things that you DO during your community internship that made experience “DISPENSING”?

DISPENSING, includes all the activities that occur between the time the prescription is

presented and the time the medicine or other prescribed items are issued to the patient.

It involves the following process:– Preparing and giving medicine to a named person

on the basis of prescription– Correct interpretation of the prescriber’s order– Accurate preparation and labeling of medicine

Where does dispensing takes place?

Public or private Clinic

Health Centers

Hospital

Shops

Community Pharmacy

No matter where dispensing is done or

who does it, any error or failure in the

dispensing process can seriously affect

the care of the patient.

DISPENSING, is commonly assumed to be simple, routine process that cannot go wrong.

FACTORS

Dispensing Environment

Dispensing Person

Dispensing Process

Dispensing Environment

Clean Organized

Hygienic and uncontaminated

Dispensing can be performed

accurately and efficiently

Dispensing Environment includes the following:

• Staff• Physical surroundings• Shelving and storage areas• Surfaces used during work• Equipment and packaging materials

STAFF

• Staff members involved in dispensing must maintain GOOD PERSONAL HYGIENE and should WEAR a UNIFORM or other CLEAN CLOTHING

PHYSICAL SURROUNDINGS

• Must be kept as free of dust and dirt as possible.

• Dispensary should be designed to access dispensing area it self and restricted to authorized person only.

Ideal Dispensary should be located in protected place and not beside or open to a road or other area where dust, dirt and pollution is present.

SHELVING and STORAGE AREAS

Maintaining a clean environment

requires a REGULAR CLEANING of shelves and DAILY cleaning

of floors and surfaces and DAILY

removal of garbage.

Regular schedule for the CHECKING, CLEANING and DEFROSTING of

refrigerator

Regular monitoring of temperature: +2-8

degrees

Refrigerator are strictly for medicines only.

SHELVING and STORAGE AREAS

Spills must be wipe out immediately, especially if

the liquids are sticky, sweet and are attractive

to insects or flies.

Food and Drink must be kept out away from the

dispensing area

DISPENSING EQUIPMENT

Used for measuring liquids, weighing solids, or counting tablets or capsules.

When does cross-contamination happen?

Remedy:cleaning any equipment used for handling different

products, both between uses and at the end of the day.

Dispensing environment must be organized:SPACE should be sufficient to allow movement

by staff during dispensing process.


The distance that the dispenser must cover during the dispensing process should be minimized to maintain efficiency.


Stock containers and prepacked medicines must be stored in an organized way on shelves, preferably

according to dosage forms and in alphabetical order.

Systems of stock notation should be determine which items are to be used first,

(FIFO or FEFO) basis.


Stock bottles must be kept closed except when use.

Limited range of preparations will be used with greatest frequency.

Fast movers maybe placed in most accessible areas

DIPENSING PERSON

A superficial look at dispensing suggests that it is a process of supplying goods to a patient on the basis of written order.

Therefore, it can be done successfully by anyone who can read the prescription, count and fill.

As a result, dispensing is often delegate to any staff member.

What is the difference between buying a grocery from buying a

medicine?

Therefore, in addition to writing, counting, and filling of the written order, the Dispensing team needs

specific additional knowledge, skills, and attitudes to complete the

dispensing process.

Qualities of a Good Dispenser


Knowledge about the medicines being

dispensed:

Common useCommon side effectsCommon interactions with other medicines

Storage needs


Skills in assessing the

quality of preparations


Attributes to cleanliness,

accuracy and honesty


Attitudes and skills required to

communicate effectively with

patients.


Good calculation

and arithmetic skills

Factors that Influence a Dispenser Behavior

Pharmacists can often be a patient’s first source of advice, and therefore,

dispensers can greatly influence rational medicine use in the

community.

Factors influence Dispenser Behavior:

Training and knowledge

Professional compensation(salary; prestige)

Economic incentives (mark-up & volume of sales)

Supply (out-of-stock)

- counting trays - vials- bottles - syringes- labels


Available product Information

Availability of dispensing equipment


Public-versus private-sector promotional and marketing techniques

Social Status of a dispenser(his or her role in the health care system)

Dispenser-prescriber relationship

Lack of communication skills

DISPENSING PROCCESS

WHAT is Dispensing Process?

It is a repeated procedures that covers all activities involved, from receiving the

prescription to issuing of the prescribed medicine to the patient.

What do you need to have a standard dispensing process?

S.O.P.Standard Operating Procedures

6 Major Areas of Activity of the Dispensing Process

Receive and validate the prescription

Understand and interpret the prescription

Prepare and label items for issue

Make a final check

Record action taken

Issue medicine to the patient with clear instructions and advice

Step 1. Receive and validate the prescription

Upon receiving a prescription, the staff member responsible should confirm the name of the

patient.

Cross-checking the name and Identity (the use of matching number or symbols) – one attached

to the prescription and the one given to the patient.

Step 2. Understand and Interpret the prescription

Interpreting a prescription must be done by a staff member who can:

Read the prescriptionCorrectly interpret any abbreviations used by the

prescriberConfirm that the dose required are in normal range (noting

gender and age)Correctly perform any calculations of dose and issue

quantity

Identify any common drug-drug interactions


It is assumed that the prescription will be in written form.

Verbal orders for medications should be given only in exceptional and emergency

situations.All calculations should be double checked

by the dispenser or counter-check by another staff member.


For Verbal Prescribing:

The order should be repeated back to the prescriber to ensure accuracy and written confirmation should be supplied within an

agreed-upon period.

For Computerize Prescribing:


If the person dispensing the medicine has any doubt about what is required by the

prescriber, he or she must check with the prescriber.

Checking a Prescription may SAVE

A LIFE.

Step 3: prepare and Label Items for Issue

Begins after the prescription is clearly understood and the quantity has been

calculated.

it is good practice to write the label at this point as a form of self-check.

`Step 3: prepare and Label Items for Issue

3 important procedures

Select stock container or pre-pack

Measure or Count quantity from stock container

Pack and label Medicine

Select stock container or pre-pack

• Read the label and cross-match the product name and strength against the prescription.

• Check on the expiration date.– Choose on the old stock or first expiry

• Read the container label at least twice during the dispensing process

• Avoid opening stock containers at the same time.

Why do stock containers open at the same time is discourage?

Some products has the same appearance and contribute to confusion during product

selection.

Medicines continuously expose to air eventually deteriorate its quality.

Measure or Count quantity from stock containers

Liquid dosage forms

Solid dosage forms

Liquid dosage forms

Liquid must be measured in a clean vessel and should be

poured from the stock bottle with the label KEPT UPWARD.

Using the technique avoids damage to the label from any

spilled or dripping liquid.

Solid dosage forms

How are you going to count solid

dosage forms from its stock container?

General rule: The Dispenser’s hands must not be in direct contact with the medicine. Using hands are bad practice for both hygienic and quality

reasons.

Solid dosage forms

Counting should be done, using the

following:

Clean piece or paper and clean knife or spatula

Lid of the stock container in use

Clean tablet-counting device

Any other clean or dust free surfaces

Immediately after measuring or counting, stock container

label should be rechecked for drug name and strength.


Desirable Packing should meet listed requirements for a period greater than 30 days

Acceptable Packing should meet listed requirements for at least 30 days

Undesirable Packing provides no protection from dirt, moisture or other contaminants, thus permitting rapid deterioration or contamination

Category of packing:


Tablets and capsules should be packed into a clean and dry container

such as; bottle, plastic envelope, cardboard box or paper envelope.

Capsules and sugar-coated tablets are the most vulnerable to moisture

Step 4: Make a final check

It is valuable to have the final check done by another staff member. The final check should include the following:

Reading and interpreting the prescription before looking at the dispensed medicines.

Checking of the appropriateness of doses prescribed

Checking for drug interactions

Checking of the identity of medicine dispensed.

Checking the labels.

Countersigning the prescription.

Step 5: Record Action taken3 Methods to keep record of

Medicines dispensed:

Fully filled prescription

The dispenser should initial and annotate the prescription with strength and quantities

dispensed.

File it or enter the details on record book as soon as time is available.

Partially Filled Prescription

Details of the medicines dispensed must be entered into the record before items are

issued to the patient

DatePatient’s Name and Age

Medicine name and strengthAmount used

Dispenser’s name

theComputer Generated Prescription

The computer program should retained the

information, which then be recalled to generate a

summary reports.

Step 6: Issue Medicine to the Patient with Clear Instructions and Advice

Medicine should be given to named patient or the patient’s representative

with clear instructions and any appropriate advice about the medicine.

Information detail about the side effect of the drug vary from patient to patient

• Advise should therefore concentrate on:


When to take the medicine ( particularly the relation to food and other medication)

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

How to Store the medicine


Warnings about the possible side effects should be given cautiously. Common but harmless side effects (nausea, mild diarrhea, urine changing in

color)

More serious side effects should be mentioned only with the agreement of the prescriber, who

needs to take those risks into account when prescribing the medicine


The medications should have the recipient repeat

back the instructions


Every patient must be treated with respect.

The need for confidentiality and

privacy when explaining the use of some types of medicine must be

recognized.

Education

Introduction to dispensing and medication counseling