SOPs and Important factors affecting good dispensing practice

1. Introduction to DISPENSING and
MEDICATION COUNSELING
Ivory Diane C. Amancio, RPh
Southwestern University – College of Pharmacy
Cebu Philippines

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

3. 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

4. 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.

5. DISPENSING, is commonly assumed to be
simple, routine process that cannot go wrong.
FACTORS
Dispensing Environment
Dispensing Person
Dispensing Process

6. Dispensing
Environment
Clean Organized
Hygienic and
uncontaminated
Dispensing can be
performed
accurately and
efficiently

7. Dispensing Environment includes
the following:
• Staff
• Physical surroundings
• Shelving and storage areas
• Surfaces used during work
• Equipment and packaging materials

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

9. PHYSICAL SURROUNDINGS
• Must be 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 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.

11. 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

12. 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.

13. Dispensing environment must be 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 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.

15. DISPENSING EQUIPMENT
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

16. DIPENSING PERSON

17. 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.

18. What is the difference between
buying a grocery from buying a
medicine?

19. 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.

20. Qualities of a Good Dispenser

21. Qualities of a Good Dispenser
Knowledge about the
medicines being
dispensed:
Common use
Common side effects
Common interactions
with other medicines
Storage needs

22. Qualities of a Good Dispenser
Skills in
assessing the
quality of
preparations

23. Qualities of a Good Dispenser
Attributes to
cleanliness,
accuracy and
honesty

24. Qualities of a Good Dispenser
Attitudes and
skills required to
communicate
effectively with
patients.

25. Qualities of a Good Dispenser
Good
calculation
and arithmetic
skills

26. Factors that Influence a
Dispenser Behavior

27. Pharmacists can often be a patient’s
first source of advice, and therefore,
dispensers can greatly influence
rational medicine use in the
community.

28. Factors influence Dispenser Behavior:
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 Dispenser Behavior:
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. DISPENSING PROCCESS

32. 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.

33. What do you need to have a standard
dispensing process?
Standard Operating Procedures

34. 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

35. 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.

36. Step 2. Understand and 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. Understand and 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. Understand and 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:
Step 2. 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 may SAVE
A LIFE.

41. 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.

42. `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

43. 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.

44. 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.

45. Measure or Count quantity from
stock containers
Liquid dosage forms
Solid dosage forms

46. 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.

47. 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.

48. 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

49. Immediately after measuring
or counting, stock container
label should be rechecked for
drug name and strength.

50. Pack and label Medicine
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 label Medicine
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: 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

53. Checking of the identity of medicine
dispensed.
Checking the labels.
Countersigning the prescription.

54. Step 5: Record Action 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
Details of 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 computer program
should retained the
information, which then
be recalled to generate a
summary reports.

57. 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

58. • Advise should therefore 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: Issue Medicine 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: Issue Medicine to the Patient
with Clear Instructions and Advice
The medications
should have the
recipient repeat
back the
instructions

61. Step 6: Issue Medicine 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.