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Introduction to dispensing and medication counseling
The document provides an overview of dispensing and medication counseling. It discusses the dispensing process which involves 6 steps: receiving and validating prescriptions, interpreting prescriptions, preparing and labeling items, making a final check, recording actions taken, and issuing medicine with instructions. Key aspects of each step are outlined such as selecting the proper stock, counting medications accurately, and ensuring the dispensed items match the prescription. The importance of accuracy, cleanliness and quality control throughout the dispensing process is emphasized.
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Introduction to dispensing and medication counseling
- 1. Introduction to DISPENSINGand MEDICATION COUNSELING Ivory Diane C. Amancio, RPh Southwestern University – College of Pharmacy Cebu Philippines
- 2. What is Dispensing? Whatare the things that you DO during your community internship that made experience “DISPENSING”?
- 3. DISPENSING, includes allthe 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
- 4. Where does dispensingtakes 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.
- 5. DISPENSING, is commonlyassumed to be simple, routine process that cannot go wrong. FACTORS Dispensing Environment Dispensing Person Dispensing Process
- 6. Dispensing Environment Clean Organized Hygienic and uncontaminated Dispensingcan be performed accurately and efficiently
- 7. Dispensing Environment includes thefollowing: • Staff • Physical surroundings • Shelving and storage areas • Surfaces used during work • Equipment and packaging materials
- 8. STAFF • Staff members involvedin dispensing must maintain GOOD PERSONAL HYGIENE and should WEAR a UNIFORM or other CLEAN CLOTHING
- 9. PHYSICAL SURROUNDINGS • Mustbe kept as and . 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.
- 10. SHELVING and STORAGEAREAS 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.
- 11. SHELVING and STORAGEAREAS 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
- 12. DISPENSING EQUIPMENT Used formeasuring 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.
- 13. Dispensing environment mustbe organized: should be sufficient to allow movement by staff during dispensing process. DISPENSING EQUIPMENT The distance that the dispenser must cover during the dispensing process should be to maintain efficiency.
- 14. DISPENSING EQUIPMENT Stock containersand 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.
- 15. DISPENSING EQUIPMENT Stock bottlesmust be kept closed except when use. Limited range of preparations will be used with greatest frequency. Fast movers maybe placed in most accessible areas
- 16.
- 17. A superficial lookat 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.
- 18. What is thedifference between buying a grocery from buying a medicine?
- 19. Therefore, in additionto writing, counting, and filling of the written order, the Dispensing team needs specific additional knowledge, skills, and attitudes to complete the dispensing process.
- 20. Qualities of aGood Dispenser
- 21. Qualities of aGood Dispenser Knowledge about the medicines being dispensed: Common use Common side effects Common interactions with other medicines Storage needs
- 22. Qualities of aGood Dispenser Skills in assessing the quality of preparations
- 23. Qualities of aGood Dispenser Attributes to cleanliness, accuracy and honesty
- 24. Qualities of aGood Dispenser Attitudes and skills required to communicate effectively with patients.
- 25. Qualities of aGood Dispenser Good calculation and arithmetic skills
- 26. Factors that Influencea Dispenser Behavior
- 27. Pharmacists can oftenbe a patient’s first source of advice, and therefore, dispensers can greatly influence rational medicine use in the community.
- 28. Factors influence DispenserBehavior: Training and knowledge Professional compensation (salary; prestige) Economic incentives (mark-up & volume of sales) Supply (out-of-stock)
- 29. - counting trays- vials - bottles - syringes - labels Factors influence Dispenser Behavior: Available product Information Availability of dispensing equipment
- 30. Factors influence DispenserBehavior: 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
- 31.
- 32. WHAT is DispensingProcess? It is a repeated procedures that covers all activities involved, from receiving the prescription to issuing of the prescribed medicine to the patient.
- 33. What do youneed to have a standard dispensing process? Standard Operating Procedures
- 34. 6 Major Areasof 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
- 35. Step 1. Receiveand 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.
- 36. Step 2. Understandand Interpret the prescription Interpreting a prescription must be done by a staff member who can: Read the prescription Correctly interpret any abbreviations used by the prescriber Confirm 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
- 37. Step 2. Understandand Interpret the prescription 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.
- 38. Step 2. Understandand Interpret the prescription 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.
- 39. For Computerize Prescribing: Step2. Understand and Interpret the prescription If the person dispensing the medicine has any doubt about what is required by the prescriber, he or she must check with the prescriber.
- 40. Checking a Prescription maySAVE A LIFE.
- 41. Step 3: prepareand 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.
- 42. `Step 3: prepareand Label Items for Issue 3 important procedures Select stock container or pre-pack Measure or Count quantity from stock container Pack and label Medicine
- 43. Select stock containeror 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.
- 44. Why do stockcontainers 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.
- 45. Measure or Countquantity from stock containers Liquid dosage forms Solid dosage forms
- 46. Liquid dosage forms Liquidmust 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.
- 47. Solid dosage forms Howare 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.
- 48. Solid dosage forms Countingshould 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
- 49. Immediately after measuring orcounting, stock container label should be rechecked for drug name and strength.
- 50. Pack and labelMedicine 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:
- 51. Pack and labelMedicine 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
- 52. Step 4: Makea 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
- 53. Checking of theidentity of medicine dispensed. Checking the labels. Countersigning the prescription.
- 54. Step 5: RecordAction taken 3 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.
- 55. Partially Filled Prescription Detailsof the medicines dispensed must be entered into the record before items are issued to the patient Date Patient’s Name and Age Medicine name and strength Amount used Dispenser’s name
- 56. theComputer Generated Prescription The computerprogram should retained the information, which then be recalled to generate a summary reports.
- 57. Step 6: IssueMedicine 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
- 58. • Advise shouldtherefore concentrate on: Step 6: Issue Medicine to the Patient with Clear Instructions and Advice 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
- 59. Step 6: IssueMedicine to the Patient with Clear Instructions and Advice 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
- 60. Step 6: IssueMedicine to the Patient with Clear Instructions and Advice The medications should have the recipient repeat back the instructions
- 61. Step 6: IssueMedicine to the Patient with Clear Instructions and Advice 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.
Editor's Notes
- #6 Because any failure or error on the dispensing process can simply affect the care of the patient. All the resources involved in patient care prior to dispensing maybe wasted.
- #13 Ask for examples from students.
- #18 This situation becomes irrational and dangerous, if you happen to have an untrained staff plus an absence of supervision from a pharmacist.
- #19 With medicines the recipient/patient usually does not know the correct use and is unable to judge the quality of the product he or she receives. Therefore, responsibility for the correctness and quality of medicines or products supplied lies entirely with the person dispenses (assumed to be a simple routine process that cannot go wrong) them, and the patient must rely on the dispenser’s ability.
- #23 Compounding procedure = insure that it follows the correct method or processes. ex. Good for uncoated tablet only the cleaning of the equipments after use
- #25 “ Customers may not always be right, but pharmacist should always be courteous and patient. “ One must have a good listening skills. Problem to communication is sometimes, We listen to reply but we don’t listen to understand.
- #31 Pharmacists verifies to the physician
- #33 The consistent, repeated use of good dispensing procedures is vital in ensuring that errors are detected and corrected at all stages of the dispensing process.
- #34 The development and use of written standard operating procedures (SOPs) for the dispensing process will improve consistency and quality of work and can be used for training and reference.
- #36 1. This action is particularly important when the clinic is dealing with a large crowd of people and when there is any risk that staff or patient may mix up prescriptions. 2. Can contribute to making sure the right patient gets the right medicines and is especially helpful in situations where many people share the same surname.
- #38 Arithmetical error could be fatal
- #40 Computerize prescribing and dispensing systems are becoming more widespread, especially in large hospitals.
- #42 Preparation and label items for issue if the CENTRAL PART of dispensing process and it must include procedures for self-checking or counter checking to ensure accuracy.
- #44 Selecting according to the color or location of the container without consciously reading the label, is a poor dispensing practice and may have a fatal consecquences.