Good dispensing practice

1. Shyam K. Adhikari
Department of Drug Administration

2. DISPENSING
 Dispensing is an important
part of the practice of
pharmacy, in which the
dispenser interprets the
physician's requirements
on the prescription and accordingly supplies
medicines for the treatment of his patient (s).
 This usually involves interpreting a written
prescription but may, on occasions, also include taking
instructions given by word of mouth or by telephone
from the physician.

3. Activities involved in Dispensing
The various activities involved in Dispensing
are:

4. Dispensing modules
 Dispensing environment
 Prescription Counter
 Waiting Area
 Requirements of a good
dispensing environment
 Barriers, noise and distractions
that can affect dispensing
 Handling of Prescriptions
 Receiving the prescription
 Reading the prescription and checking for
 Legality
 Legibility
 Completeness and correctness

5.  Processing a prescription
 Filling a prescription
 Removal of medicines from shelves.
 Assembling of medicines.
 Billing.
 Packing.
 Refilling a prescription
 Other aspects of dispensing
 Dispensing errors
 Role of dispensers in promoting correct dispensing
 Refusal to dispense prescriptions
 Alternatives to conventional prescriptions.

6. Dispensing Environment
Prescription counter
 Ideally Prescription counter should:
 Be accessible to the client.
 Preferably be separate and in a quite location. If there
are other separate section (e.g., cosmetics, general items,
OTC section), it should be slightly away from them.
 Be clean, orderly attractive, and with an identifying sign
or symbol, which can easily be identified and seen from
other parts of the pharmacy

7. Dispensing Environment
 A different color, appearance, demarcation etc. may be
given to the prescription section to provide added
emphasis.
 Have a waiting area for clients who wait for their
prescriptions to be dispensed/filled.

8. Dispensing Environment
Waiting area
 An ideal waiting area provide:
 Comfortable chair/places to sit (at least for the
elderly/disabled/sick patient to rest)
 Current popular health magazines, and carefully
selected material related to good health to keep the
client busy/occupied, and prevent boredom while
waiting to receive medicines
 Pamphlets, and posters related to public, family and
other individual health problems prominently displayed
(as the waiting area could be used as a health education
centre.)

9. Requirements of a Good
Dispensing Environment
 Be clean: To give a professional impression and
outlook to the pharmacy.
 Be organized: To provide for a safe and efficient
working area. (Such that things are found in the right
place at the right times and there are minimum
obstructions and hurdles).
 Have sufficient space For easy movement of personnel
in the pharmacy, and to prevent congestion and
physical contact among staff while working.

10. Contd…
 Temperature and humidity controlled as appropriate
temperature and humidity are necessary for stability of
medicines till the expiry date.
 No loud music playing, gossiping, talking, or
television (e.g. a cricket match or a movie) :To avoid
distractions during dispensing.
 Have medicines stored in an organized way on shelves in
alphabetical order or using the method normally employed
in that particular pharmacy: To ensure quick, but safe
selection of the correct medicines from the shelves to
minimize dispensing errors.
BE CLEAN, GET ORGANISED!! GIVE THE PHARMACY
A PROFESSIONAL LOOK

11. Maintaining a clean environment
requires
 A regular routine of cleaning shelves,
medicines/products, and a daily cleaning of
floors.
 A regular schedule for checking, cleaning
and defrosting the refrigerator.
 Immediate wiping of accidental spills due to
breakage, etc, during dispensing.

12. Why Good Dispensing Environment
 Working in a clean and an organized environment in a
pharmacy, aids in accuracy while dispensing, and also
gives a professional look to the pharmacy.
 Presence of a separate prescription counter and
waiting area can further Highlight professionalism and
competence of the dispenser.
 Dispensers handle medicines, and a slight dispensing
error could result in serious consequences i.e. health -
wise for the patient, and for the pharmacy – a loss of
reputation.
 Thus a good dispensing environment is recommended
for every pharmacy.

13. Handling Prescription
 Receiving the Prescription As clients come into the
pharmacy, they must be made to feel attended to and
comfortable by :
 Friendly gestures.
 A smile.
 Eye-to-eye contact.
 A friendly welcome.
 A cozy ambience.
 Courtesy.
 Feeling of caring .
 Communication should be initiated in such a manner that
it encourages the client to convey his/her needs by
producing a prescription or by asking for other products or
advice .

14. Upon receiving the prescription,
the pharmacist should confirm
( i) Whether the client is the patient himself or has come
on the patient's behalf.
(ii) The relation of the client with the patient.
The client may politely be requested to wait, while the
pharmacist reviews the prescription for:
1. Legality and completeness of prescription.
2. Therapeutic aspects
3. Appropriateness for the individual .

15. Reading the Prescription and Checking for
Completeness and Correctness
 While reading and checking the prescription, the
dispenser Should:
 Be alert, and concentrate on the prescription.
 Not be distracted.
 Not engage in talking or chatting.
 Engage/ use his professional/ experience in
assessing the prescription.

16. After receiving the prescription, it is
important for the dispenser to read the
prescription to verify whether :
 It is legal and complete with respect to the various
parts of the prescription,
 It can be dispensed as such, or not.
 A prescription is legal when
 It is written (can also be typed) by a R.M.P.
 Signed by the R.M.P.
 Has all the information required to be contained with
respect to parts of prescription.

17. Parts of the Prescription
Superscription :
 The 'Rx' symbol is called the superscription.
 It is used as an abbreviation of the Latin word recipe, which
means, “Take thou” or “you take”.
Inscription:
 Inscription is the part of the prescription that comprises of a
list of medicines and their strengths. E.g.
Daonil 5 mg, Novamox 250 mg.
Subscription :
 This part of the prescription consists of directions given to the
dispenser with respect to the dosage form and the number of
dosage units/quantity to be supplied. E.g.
 Tab. Calcium ---- (50) [Means dispense 50 tablets of calcium]
 Liq Digene--------1 bottle

18. Parts of the Prescription
Signatura :
 Signatura refers to the directions given by the doctor to
the patient.
 In this portion, the physician indicates to the patient,
how he/she should take the prescribed medicine/s.
 The directions are usually written using abbreviated
forms of English and Latin. E.g.,
 1 tds means take one tablet thrice a day.
Signature of the doctor :
 The signature of the doctor in his own handwriting is
essential to mark the legality of the prescription.

19. Parts of the Prescription
Refill information:
 In certain cases, a single course of therapy may
not be sufficient for effective treatment of the
patient.
 Under such circumstances, the physician may
decide to repeat the course of therapy, and
indicate the same on the prescription.
 This information is called refill information.

20. Legibility
 Handwritten names of patients and medicines are
often difficult to read.
 In case of illegibility of name, age, etc, ask the
patient for the correct spelling tactfully.
 Legibility is a problem requiring alertness and
critical judgment on the part of the pharmacist.
 Careless handwriting and similarity in spelling of
names of different drugs add to the difficulty.

21. Example of a Reading error
Metriz and Metrix
 Due to illegible handwriting of doctors, Metriz could
be read as Metrix. Metriz is a brand containing
Metronidazole whereas Metrix contains Glucosamide
two different drugs used for two different conditions.
 When handwriting is illegible, the best thing to do is
to contact the physician over the phone and confirm.
 Remember, you are dealing with medicines and thus,
the lives of patients so be sure of what you are
dispensing.
 Imagine the disastrous consequences of dispensing the
wrong medicine ‘NEVER DISPENSE GUESS WORK’ .

22. Examples of confusing names
 AZT (Azithromycin) Vs AGT (Tinidazole)
 Alspan (Hyoscine Butylbromide) Vs Alpan
(Loratidine)
 Metlong (Metforming) Vs Metlog (Metoprolol)
 Itop (Itopride HCl) Vs Metop (Metoprolol)
 Aceclo (Aceclofen) Vs Seclo (Omeprazole)
 T-zine (Cetrizine HCl) Vs Tizan (Tizanidin)

23. Completeness and correctness
 The prescription serves as a vehicle for communication
from the licensed practitioner to the dispenser about
the pharmaceutical care of the patient.
 Details to be checked for
 i) Physician's details.
 ii) Patient's details.
 iii) Check the product details Checking the product
details will include checking :
 Name of the product.
 Dosage form.
 Strength/ potency of the medicine.
 Total amount to be dispensed and its availability.
 Dosage and directions for use.
 Frequency of administration.