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1. dispensing
07/31/2022
By: Fitsum.T

2. Outline
 Handling of pharmaceuticals
 Prescription analysis
 Selection & manipulation
 Labeling & supply
 Counseling
 Documentation

3. Chapter one
Introduction to dispensing practice

4. What are drugs?
 can be defined as “chemicals that can alter
functions of living organisms at small
concentration” are all drugs
 For medical case these drugs are intended
for: treatment, diagnosis, prevention and
control of diseases are called
medications

5. Terminologies
Dosage Forms / Routes of Administration
Common Routes of Administration
Enteral are given orally and pass through the
GI tract .This includes oral, naso-gastric,and
rectal routes.
Parenteral medications refers to injection
Inhalation routes of administration are inhaled
through the mouth or the nose and usually act
directly on the respiratory system
Topical dosages are applied to the skin surface
or a mucous membrane

6. Dosage Form
 Tablet
 Capsules
 Oral Suspensions The drug is mixed with liquid
 Syrups Contain a high concentration of sucrose or
sugar to sweeten, for ease of use.
 Elixirs contain between 5% and 40% alcohol.
 Tinctures May contain as little as 17% alcohol or as
much as 80% alcohol.
 Emulsions is a suspension involving one liquid in a
second liquid with which the first will not mix. (oil in
water or water in oil)

7. Dosage Form……
 Oral powders Drugs which are in a powder form and
are usually dissolved in juice or water before
administration
 Lozenge and TrocheLozenges and Troches are meant
to be dissolved slowly in the mouth
 Rectal Suppositories Solid or semi-solid bullet shaped
dosage forms.
 Enemas Drug is suspended in a solution and infused
into the rectum.
 Transdermal patch A medicated adhesive patch
applied directly on the skin
 Inhalation Inhaled through the mouth or nose and
usually act directly on the respiratory system

8. 1. Dispensing medicine
Definition
 Includes all activities ,which occur from the time the
prescription is received in the dispensary until the items
have been collected by the patient . Therefore it
includes
 Review of prescription
 Any action to address concerns so identified
 Correct dispensing in appropriate container with
correct label and
 Provision of advice or information as appropriate

9. Dispensing medicine…
Dispensing requires a basic knowledge of:
pharmacology
Principle of compounding
Stability of medication and their ingredients
Counseling information and advice
Dispensing containers and packaging methods
Labeling of dispensed medicine
Storage
Incompatibility (physical, chemical, therapeutic)
Legal requirements

10. Dispensing medicine…
Dispensing practice
 Good dispensing practice refers to the delivery of a
correct drug ,to the right patient, in the required dosage
and quantity, in the package that maintains acceptable
potency and quality for the specified periods with clear
information .

11. Dispensing medicine…
Irrational dispensing practice – it is a practice including
the following
¥ Dispensing prescription only drugs without prescription
¥ Dispensing prescription only drugs with partial dose
even with prescription
¥ Poor labeling of dispensed items
¥ Inappropriate patient counseling
¥ Incomplete recording
¥ Charging patients with unreasonable high price

12. 2. The premise
 The premise on which a dispensing service is
provided would reflect the quality of service and
inspire confidence in the nature of the health care
that is delivered.
 Every dispensing staff is recommended to maintain
the premises in a clean and tidy manner to facilitate
accurate and efficient dispensing
I. Safety
 Working conditions are arranged as to take into
consideration the safety and health of the public and
people working in the premise.

13. The premise……
II. Condition
 The walls, floors window ceiling and all other parts of
the premise are recommended to be kept clean and
hygienic to avoid risk of infestation and contamination
 Waste should be properly kept and timely disposed of.
 Walls are recommended to be finished with smooth
impervious materials
 Maintaining clean environment requires regular cleaning
of shelves, daily cleaning floors and working surfaces,
and daily removal of garbage (waste)

14. The premise……
III. Tidiness
All parts of the premise are recommended to be
maintained in orderly and tidy condition.
 Stock containers and pre-packed medicines must be
stored in organized manner e.g alphabetical
 All stock containers must be clearly and accurately
labeled to ensure safe selection so that error is
minimized.
 Stock rotation should be carried out e.g FIFO,FEFO
 The expiry date of medicines should be regularly
monitored
 Dangerous drugs should be stored separately under
lock and key

15. The premise……
 The environment in which you work will have
considerable influence on your efficiency and
therefore it is important to develop a tidy and
organized method of working. The pharmacist who
works with a dispensing bench cluttered with several
containers all containing different ingredients is more
likely to select the incorrect one. Always return
ingredients to their appropriate shelf when you have
measured out the required quantity.

16. The premise……
IV. Environment
 All medicines should be store under suitable
conditions ,appropriate to the nature and stability
of the material concerned.
 They should be protected from contamination
sunlight, moisture, freezing and other temperature
extremes and dampness.
 Level of light ,heat, noise ventilation etc ,are
recommended not to exert adverse effect on
personnel.

17. The premise……
V. size
Dispensaries would be designed to accommodate the
anticipated work load .
VI. Security
 Careful consideration is to be given to the overall
security of the dispensary and stores .
 Special attention for drugs to be locked properly

18. 3.Dispensary design and
equipment
The Dispensary, its fittings and equipment should be
adequate for the purpose of dispensing
Working surfaces and shelving
 Working surfaces ,cupboards and shelves need to be in a
good state of repair and in clean and tidy condition.
 they are recommended to be smooth ,washable, and
impervious to moisture
 A clear area of bench space is recommended to be set
aside for dispensing
 Food and drinks should be kept away from the working
area.

19. Dispensary design…………
Water supply
 The dispensary is recommended to be provided with
distilled and /purified water
Dispensary equipment
 All dispensing equipment is recommended to be of
suitable material ,clean and good state of repair .The
following is the recommended list
1. Tablet and capsule counting device
 They should be cleaned regularly to prevent cross
contamination b/n products

20. Dispensary design…………
 Uncoated tablets leave a layer of powder on
surfaces they touch ,this can be transferred to
other tablets or capsule counted on the same
surface ----called cross contamination
e.g dangerous cross contamination with Aspirin
or Penicillin,to one of which a patient is
sensitive.
Therefore, cleaning any equipment used for
handling different products between use and at
the end of the day is essential .

21. Counting triangle
http://iforg.com/blog/?p=17

22. Capsule counter

23. Perforated Counting Tray
http://www.adelphi-coldstream.uk.com/products/pharmacyl-dispensing-equipment/tablet-capsule-
counters/tumatic-capsule-counter.html

24. Dispensary design…………
2. A range of graduated ,stamped /plastic
measures
3. A refrigerator equipped with a maximum
/minimum thermometer and capable of
storing products at temperature between 2
dc and 8 dc.
 The refrigerator needs to be cleaned and
checked periodically to ensure efficient
running
 Regular monitoring of the refrigerator
temperature should be established
 The refrigerator should be used strictly for
medicines only.

25. Dispensary design…………
4.A suitable range of dispensing containers for
pharmaceutical products with separate set for internal
and external use.

26. Pre -dispensing Activities
 Check the following:-
The room, shelves and dispensing
counter are clean and organized
Wear a clean and white gown
 Attach your identification tag on the
gown in such a way that it is visible to
clients
Availability dispensing aid,(counting
try, labeling materials, packaging
materials, sufficient no of spoons etc).

27. Cont…
 Availability updated drug list, OTC list
,good dispensing manual, STG,
formulary ,prescription registration
book.

28. Reception
 As clients come into the pharmacy
section, they must be made to feel
attended to and comfortable by:
Friendly gestures
 A smile
Eye-to-eye contact
 A friendly welcome
Politeness
 Feeling of caring
 NB. Verbal request can be done only for OTCs with

29. Arrangement of medicines
 Medicines should be arranged on
shelves made of steel or treated wood
and the shelves should be strong and
robust. Health institutions and
medicine retail outlets can use one or
a combination of the following
commonly used methods of medicine
arrangement:
1. Pharmacotherapeutic category
2. Alphabetical order by generic name

30. In arranging medicines, the following
points should be considered:
• Each dosage form of medicine is
arranged in separate and distinct
areas
• Sufficient empty space should
demarcate one medicine or dosage
form from another.
• Put medicine in well ventilated ,dry
and place protected from direct sun
light and heat.

31. Cont…
• Store liquids in a pallet on the floor or
on the lowest shelf.
• Do not store anything directly on the
floor.
• Always store cold-chain items in the
refrigerator.

32. SAQ-05
 The prescriber prescribes a
combination of amoxycillin and
clavulanate and mentions the dose as
take 5ml twice a day. It is available as
Amoxicillin 125mg+ Clavulanic acid
31.25mg and Amoxicillin 200mg+
Clavulanic acid 28.5mg. Which one to
dispense?
 In this case the pharmacy professional
has to be sure about which
preparation to dispense. The best

33. Con…
What to do?
 If the strength is not stated on the
prescription, mostly it may be
necessary to contact the prescriber for
confirmation of the appropriate
strength.

34. Expiry date
 Remember if the expiry date of a
product is labeled as July 2011, then
the product can be used until the end
of July 31st 2011. In case the duration
of therapy or total quantity to be
dispensed is not mentioned, it will be
necessary to contact the prescriber.

35. LEARNING OUTCOME two
Processing prescription and medication
order

36. Introduction
 A practitioner's decision to treat a
patient assumes that the patient has
been evaluated and diagnosed. Drug
therapy is most commonly chosen.
 In most cases, this requires the writing
of a prescription.
 The prescription order is the most
important therapeutic transaction
between a physician and a patient.

37. 2.1. Definition of prescription
“A medical prescription is an order from a
prescriber to a dispenser that includes instruction
for preparing and dispensing medicines to a certain
patient.”
 The prescription represents a mechanism through
which a treatment modality is provided to the
patient.
 The prescription for each patient is a unique entity,
designating a specific medication or medications for
a specific patient at a specific time.

38. Who is prescriber ?
 A prescription order may be written and issued by a
physician, nurse, dentist, veterinarian, or other
properly licensed medical practitioner.
Who is dispenser ?
A dispenser is pharmacist, pharmacy technician or
any licensed medical personnel.
 All prescription orders should be correct,
unambiguous, without cross-outs and signed clearly
for optimal communication between prescriber,
pharmacist, and nurse

39. 2.2.Types of prescription
Prescriptions can be classified as
compounded and noncom pounded.
Compounded prescription, or
extemporaneous prescription is an order that
requires mixing of one or more ingredients
(active medicaments) with one or more
pharmaceutical necessities (vehicle,
suspending agent).
The physician selects the drugs, doses, and
pharmaceutical form that he/she desires and the
pharmacist prepares the medication accordingly.

40. The name of each drug is placed on a separate line
right under the preceding one
Example of compounded prescription
Rx. Calamine 4 gm
Zinc oxide 4 gm
Bentonite 1 gm
Glycerine 1 ml
Ca (OH) q.s 50ml
Sig. apply once a day

41. Noncompounded prescription does not require
mixing of two or more ingredients to obtain a
finished product.
A precompounded order consists of a drug or a
mixture of drugs supplied by a pharmaceutical
company by its official or proprietary name and, if it
contains more than one substance, the specific
ingredients do not have to be listed.
Example
Rx Doxycycline 100 mg
#14 caps

42. Other types of prescription include
 Inpatient
 Out patient
 Handwritten
 Electronically generated
 While the prescription can be written on any piece
of paper, it usually takes a specific printed form.
 That form possesses blank spaces for the necessary
information.
 Such blanks are often supplied to the physician in
the form of a pad containing approximately 100
blank forms.

43. Prescription Registration
book(PRB)

44. SAQ-01

45. SAQ-02
2. The main part of prescription order,
contains the name and prescribed
ingredients or drugs
 Subscription
 Inscription
 Subscription
 All

46. SAQ-03
3. A part of prescription that comprises
direction to pharmacist
 Signature
Subscription
 Inscription
 Superscription

47. SAQ-04
4. One of the following prescription
information are used to adjusting of the
dose of the drugs
 Sex
 Age
 Address
 Diagnosis

48. 2.3. COMPONENT PARTS OF THE
PRESCRIPTION
 The prescription consists of seven parts
1. date
 Here written are: the name and the surname of the
doctor, the hospital, clinic or polyclinic medical
center, their address, and the date.
 The date is important for ascertaining or
determining the life of the prescription.

49. Example
 The prescription of narcotics and controlled
substances are governed by special laws and
regulations – it cannot be filled after more than
30 days from the date of issuance

50. 2. SUPERSCRIPTION
 consists of the message to the dispenser.
 the symbol ℞ from the Latin recipe, meaning
“take.”
 Always Written at the beginning of the drug
information
3. INSCRIPTION
 is the main part of the medical prescription,
because this is the doctor’s order.
 Here are the names of drug, the dosage forms,
strength and the dosages.

51. a) Name of drug are required to begin with a
capital letter
b)the dosage form is placed after the drug’s
name.
c)the dose is noted after dosage form.
d)The strength of the medication should be
written in metric units.
Example: Rx./ Paracetamol tab 500 mg

52. 4. SUBSCRIPTION
In this part are written, if necessary, instructions to
the chemist such as
 how to make the preparation(extemporaneus)
 Total quantity to be dispensed
 the number of doses, or dosage forms to be
supplied to the patient.
Exampe: Rx./ Paracetamol tab 500 mg
Da scatulam № 2 ( D. scat. №2 ) = Give 2
blisters

53. 5. SIGNATURA (MARK, LABEL)
 it is usually preceded by an S to represent the Latin signa,
meaning “mark.” The signatura is where the health care
provider indicates what instructions are to be put on the
outside of the package to tell the patient
 This information must be sufficient to allow the patient to
understand fully
 the amount of the drug product to be taken
 the frequency of administration
 At what time the drug to be taken:
 if the drug has to be used externally only, or to be shaken
well before use, or whether it is a poison, and other such
facts are included.
Example: Signa or Scribe (S.) one tablet three times a day

54. 6.Name, qualification and address of the
prescriber
 The signature of the doctor may be placed on the
designated area, or after the last drug, and this is for
identification data.
7. Patient information
 Name, address, card no., weight and age of the
patient.
 This part serves to identify for whom the
prescription is intended. The full name and the
address are required by law on all prescriptions for
controlled substances.

55.  The age of the patient is a good additional piece
of information, especially with pediatric pаtient
where dosage calculations have to be double-
checked for safety. This part is located on the
designated area.

58. 2.4. JUSTIFICATION FOR VARIOUS
PARTS
OF A PRESCRIPTION
 A prescription has various parts; some of
them “mandatory and some of them
though not mandatory, important for
better understanding of the prescription
by the pharmacist and the patient also.
 The justification may arise from
rationality, legality, practicality or
situational realities.
 These various aspects are discussed

59. A. Details pertaining to the prescriber
Prescribers 's full name
Why needed?
To authenticate the prescription before
dispensing. The prescription is a legal document.
It can be used in the court of law.
Legal Requirement? – yes
What happens if missing?
The pharmacy personnel will be in dilemma
whether the prescription is genuine. If the
prescription is from a hospital, it is not known
which of the faculty doctors has prescribed it.

60. A. Details pertaining to the prescriber….
 Doctor's details such as address,
Consultation timings, telephone/Contact
numbers printed on the letterhead
Why needed?
 Helps the patient as well as the
Pharmacist to contact the doctor in case of
discrepancies and doubts Over
prescription
Legal Requirement? – yes
What happens if missing?
 The prescription cannot be dispensed

61. A. Details pertaining to the prescriber….
Doctor's Qualification printed on the
letterhead.
Why needed?
 For verifying the authenticity of the doctor
Legal Requirement? – yes
What happens if missing?
 The patient may end up taking medicines
prescribed by unauthorized personnel

62. A. Details pertaining to the prescriber….
 Doctor's full Signature and date,both in
blue indelible ink.
Why needed?
 for verifying the authenticity of the doctor
and ,to avoid misuse of blank prescription
pads.
Legal Requirement? – yes
What happens if missing?
 If the prescription has been typed or
printed, the Pharmacy personnel cannot
confirm that it is the doctor who has

63. A. Details pertaining to the
prescriber….
 Date of prescribing
Why needed?
 To know the validity of Prescription and to
avoid Unnecessary refilling of the
prescription.
Legal Requirement? – yes
What happens if missing?
 Pharmacy personnel cannot identify an
old Prescription brought for refill; and in
many cases not advisable..

64. A. Details pertaining to the
prescriber….
 Rx superscription
Why needed?
 This is a matter of practice..
Legal Requirement? – no
What happens if missing?
 None

65. B. Details pertaining to MEDICINES
Name of medicine
Why needed?
 handwriting, and too many confusing,
similar generic & brand names cause
difficulties in the Pharmacy Pharmacists
have problems
Legal Requirement? – yes
What happens if missing?
 Chances of errors during dispensing can
increase.

66. B. Details pertaining to MEDICINES
Strength or potency of medicine
Why needed?
 Many medicines are available in varying
potencies, and unless potency is correctly
written the pharmacist cannot dispense the
correct medicine.
Legal Requirement? – yes
What happens if missing?
It becomes difficult for the pharmacy to decide
which
Particular strength the doctor intended to
prescribe.

67. B. Details pertaining to MEDICINES
 Dosage form
Why needed?
 Unless correct dosage form is written, the
pharmacist often is in a dilemma which
particular one to give, because at times,
medicines are available in different forms E.g.
cap or tablet, or syrup etc.
 A dosage form suitable for one patient may not
be suitable for another. For example a child
may require a syrup form rather than a tablet.
 Legal Requirement? – yes

68. What happens if missing?
 Pharmacy has to do guesswork often
the pharmacist is not available for
making a decision

69. B. Details pertaining to MEDICINES
 Dosage & dosing instructions
Why needed?
 Patient needs to know the quantity of
tablets/cap/liquid & number of times the
medicine needs to be taken.
 The pharmacist can also counsel the patient.
Legal Requirement? – yes
1. Dose The amount of medicine to be taken
taken, or given, at one time.
2. The sum of doses may be the dosage or the
total dose.

70. What happens if missing?
 Patient is confused what dose to take
and how often.
 What the pharmacy may suggest may
not always coincide with what the doctor
had in mind.
 Also, the pharmacist cannot predict the
dose in all cases, since it is based on
diagnosis or extent of disease/ailment.

71.  Total quantitiy
Why needed?
 Avoid ambiguity for both patient and the
pharmacist as to the quantity to be
dispensed.
 Prevent patients from using more/less of
the medicine.
Legal Requirement? – yes
What happens if missing?
 This leaves the Prescription open for
Repeat purchase with no controls

72. 3. Details pertaining to PATIENT
Patient's Full Name
Why needed?
 For proper Identification of a patient.
Legal Requirement? – yes
What happens if missing?
 If the name is absent, it cannot be linked
to a Particular patient with certainty.
 There is room for error

73. 3. Details pertaining to PATIENT
Patient's age, weight
Why needed?
 Useful Information especially for
children for whom dosage is based on
body weight
 It acts as a safety measure against
dosage errors .
Legal Requirement? – No
What happens if missing?
 Maymake it difficult for the pharmacy to
confirm the medication.

74. 3. Details pertaining to PATIENT
 Patient's address and Telephone number
Why needed?
 Essential for follow-up of patient, or to get
in touch with the patient, especially in case
of prescribing or Dispensing errors.
Legal Requirement? – No
What happens if missing?
 Difficult to trace the patient in case of a
dispensing problem/error.
 Writing the address on the cash memo is a
Legal requirement.

75. 3. Details pertaining to PATIENT
 Patient's Sex
Why needed?
 Important for pharmacist to know/ assess
Appropriateness for patient, particularly in view
of illegible handwriting or Confusingly similar
names.
 Special precautions are required in pregnancy
and breastfeeding.
Legal Requirement? – No
What happens if missing?
 Medicines for Gynecological problems are
Obviously unsuitable for male patients.

78. 2.5. Types of prescription
papers
1. Standard drug prescription paper
 Is a prescription paper for regular
(normal) use drugs ( i.e drugs that are
not narcotic or psychotropic)
e.g of drugs
 Antiinfectives
 Cardiovascular drugs
 Drugs acting on autonomic nervous
system,etc

79. Types of prescription papers …
2. Narcotic drugs prescription paper
is a prescription that contains the
following narcotic drugs
 Codeine Phosphate
 Fentanyl
 Morphine 5.
 Pethidine
 Methadone
 Others if present

80. Types of prescription papers …
3. psychotropic drugs prescription paper
is a prescription that contains the
following psychotropic drugs
 Alprazolam
 Pentobarbitone
 Chlordiazepoxide
 Phenobarbitone
 Clonazepam
 Temazepam
 Diazepam
 Other combination drugs containing
 Medazepam controlled psychotropic substances

81.  Over-the-counter medicines( OTC):
Medicines that can be dispensed
without prescription

82. 2. SYMBOLS AND ABBREVIATIONS
USED IN PRESCRIPTION
 Common Route Abbreviations:
 PO (by mouth)
 PR (per rectum)
 IM (intramuscular)
 IV (intravenous)
 ID (intradermal)
 IN (intranasal)
 TP (topical)
 SL (sublingual)
 BUCC (buccal)
 IP (intraperitoneal)

83. Common Frequencies Abbreviations:
 daily (qd)
 every other day (q.o.d)
 BID/b.i.d. (Twice a Day)
 TID/t.id. (Three Times a Day)
 QID/q.i.d. (Four Times a Day)
 QHS (Every Bedtime)
 Q4h (Every 4 hours)
 Q4-6h (Every 4 to 6 hours)
 QWK (Every Week)

84. Table P9 Abbreviations commonly used in prescriptions
abbreviation Latin Meaning
ac ante cibum before meals
ad lib ad libitum freely, as desired
agit. ante us agita ante usum shake before taking
alt hor alternis horis every other hour
bid bis in die use twice a day
c Cum With
gtt Guttae Drops
od omni die Right Ear
oh omni hora every hour
om omni mane every morning
on omni nocte every night
pc post cibum after eating
po per os by mouth
prn pro re nata use as needed
qd quaque in die use every day
qh quaque hora use every hour
qid quater in die use four times a day
ql quantum libet as much as desired
s Sine Without
sig Signa Label
soln Solutio Solution

85. 2.7. UNITS OF MEASUREMENT
USED IN THE PRESCRIPTION
The strength of the drugs should be written in metric
units.
 Quantities of drugs are measured in grams,
milligrams , and micrograms.
 The gram (g) is the basic unit of weight in the metric
system.
 One one-thousandth of a gram is 1 milligram (mg).
One one-thousandth of a milligram is 1 microgram
(μg) or 1 mcg. One thousand grams is one kilogram

86.  The liter is the basic unit of volume in the
metric system.
 commonly use the milliliter (ml), which
is one one-thousandth of a liter.
 The unit cubic centimeter, or cc, is used as
an equal to ml.

88. 2.8. Steps of prescription processing

89. Objectives
UPON COMPLETING THIS CHAPTER, YOU SHOULD
BE ABLE TO DO THE FOLLOWING:
 Describe the responsibilities of a technician filling
prescriptions within a community setting.
 List the necessary information required for prescriptions
 Demonstrate the ability to prioritize the filling of
prescriptions.
 Differentiate filling methods between controlled substances
and non–controlled substances.
 Describe laws pertaining to the technician’s responsibilities
when filling prescriptions.
 List the steps of carefully filling a medication order.
 Differentiate between inpatient and outpatient information
requirements.

90. s
Dispensing
process
Recording
transaction
Receive &
validate
prescription
Understand and
interpretation of
prescription
Selection and
manipulation of
medicine
Labeling &
packaging of
medicine
Provision of
information
and
instruction

91. Six major steps (activities) of dispensing
process include
1. Receive and validate prescription
2. Understand and interpret prescription
3. Select appropriate medicine/item
4. Label and packaging of medicine
5. Issue the drug to the patient with clear
instruction and advice
6. Record the actions taken

92. step 1.
Receive and validate
prescription

93. step 1. Receive and
validate………………….
A prescription can arrive in a pharmacy by various
methods.
 written order
 Faxed A prescription can be faxed from the
physician’s office to the pharmacy.
 E-prescribing Computer generated prescriptions,
with electronic transmission online or via mobile
devices, are becoming common as well.
 Use good communication skill
 Upon receiving confirm the name of patient to assure the
right patient gets the right medicine,
 Validate verbal request ( only for OTC drugs)
5/8/2024

94. Reception
As clients come into the pharmacy section, they
must be made to feel attended to and comfortable
by the following good communication skills:
Friendly gestures
A smile
Eye-to-eye contact
A friendly welcome
Politeness
Feeling of caring

95. step 2. Understand and
interpret prescription

96. step 2. Understand and interpret………………
I. Legality
 The pharmacy personnel should confirm the
legality of prescription
A prescription is legal when:
 It is written (can also be typed) and signed by an
authorized prescriber
 The medicines are written on the right prescription
such as normal, NPS and ART
 Date of issue not exceeding 15 days for narcotic
and psychotropic substances and 30 days for other
medicines
 Has all the information required to be contained
with respect to parts of prescription

97. step 2. Understand and interpret……
II. Legibility
 A brief examination of each prescription
should be made immediately upon receiving
it from the patient to ascertain the legibility
of various parts of the prescription.

98. e.g of prescription with illegible handwriting

99. Example of a Reading error:
 Medoprazole and Mebendazole - Due to illegible
handwriting of prescribers, Medoprazole could be
read as Mebendazole.
Medoprazole is a brand containing omeprazole
where as
mebendazole is an antihelmentic two different
medicines used for two different conditions.
 When handwriting is illegible, the best thing to do
is to contact the prescriber over the phone and
confirm.
‘NEVER DISPENSE GUESS WORK’

100. step 2. Understand and interpret……
III. Completeness of prescription
Details to be checked for completeness of the
prescription
A. Seal of the health institution or header
B. Prescriber’s details (Name of prescriber’s,
Qualification, Signature and Date )
C. Patient's details (Patient Name, Patient
Address, Sex, Age, Weight and Diagnosis)
D. Medicine details

101. step 2. Understand and interpret……
Checking the medicine details will
include checking:
 Name of the medicine
Dosage form
 Strength/ potency of the medicine
 Total amount to be dispensed and its
availability
 Dosage and directions for use
 Frequency of administration and
duration of the treatment

102. A) Name of the medicine
 The name of medicine must be legible and
correct without a doubt.
 Since many brands sound alike, brand confusion
is quite common especially if the handwriting is
illegible
Example: The prescription could state –
Diclofenac 50mg rather Voltaren 50
 If the prescriber writes the generic name alone,
the pharmacy professional can give a brand of
his choice.

103. Activity
Discuss the following situation:
 A client comes to the pharmacy in the
late evening for a prescription of
 1) ‘A’ brand of Vibromycin for severe
pain and inflammation. You do not have
‘A’ brand stock, there is no other
pharmacy close by, and the prescriber is
not contactable. What do you do?

104. B) Dosage form
 The same medicine could be available as tablets,
capsules, and even injections.
 It is important to check the prescriber’s prescription
for the dosage form.
 If the dosage form is not specified, it is advisable to
call up the prescriber and find out, especially if the
medicine is available as different formulations.
Examples –diclofenac available 50mg tab., 100mg
tab., 100mg suppository and 75m/3ml inj.

105. C) Strength/potency of the medicine
 check that the strength is mentioned.
 There may be cases for prescribers to prescribe the
medicine without the strength.
 Forexample:
Amlodipine 5mg………………………..Correct way
Amlodipine……………………………...Incorrect way
What to do?
 If the strength is not stated on the prescription,
mostly it may be necessary to contact the prescriber
for confirmation of the appropriate strength.ssss

106. IV. Correctness of prescription
A. Double medication:
same medicine or different medicine with
same pharmaco-therapeutic effect concurrently
prescribed by the same or different prescribers to
the same patient undergoing treatment
B. Interactions:
 Many medicines are known to interact with other
prescribed or OTC medicines, food, diseases, herbal
medicines, and laboratory results.

107. Example –
 Acetylsalicylic acid taken can increase the
effect of an anticoagulant (warfarin) that a
patient is taking, and may thus lead to
bleeding.
 Patients taking ciprofloxacin should avoid
taking antacid within 2-3 hours because the
antacid can drastically reduce the absorption
of ciprofloxacin

108. Contraindication
 The age, sex, disease(s) conditions, or
other characteristics of a patient may
cause certain prescribed medicines to be
contraindicated.
e.g, pregnancy ,breast feeding, children
,elderly etc
 The pharmacy professional should check
for such contraindications.

109. Examples–
 Aspirin is not recommended for
children below 12 years of age
 Atenolol is contraindicated in asthma.
 Tretinoin contraindicated in pregnancy

110. V. Interprete abbreviation
 Although widely used in prescription writing,
abbreviations can kill!!
 Different pharmacy professionals may assume or interpret
abbreviations differently
Examples
 ‘HCT’ 25mg was intended to mean Hydrocortisone
25mg, but Hydrochlorthiazide was dispensed.
 ‘CPZ’ may refer to Chlorpromazine, an antipsychotic or
to Carbamazepine, which is an anticonvulsant.
 ‘CPM’ can mean Chlorpromazine or Chlorpheniramine

111. VI. Correctly perform any calculations of dose and
the quantity to be issued
VII. Appropriateness of the individual
 Confirm that the dose and duration of prescribed
medicine are in the normal range for the patient
(noting sex and age or weight)
VIII. Call the Prescriber (verify the prescription)
 If any details are illegible, missing or incomplete,
this prevents any mistakes/ errors while dispensing.

112. PRESCRIPTION PAPER Code: 0124
Institution Name: Bole 17 Health Center Tel. No 011552---
Patient’s full Name: Hana Metasebia Sex: F Age: 29 Weight: 68 Card
No.10 964/03 Region: A.A Town: A.A Woreda Bole Kebele 17 House No.
6245 Tel. No: 09123…. Inpatient Outpatient
Diagnosis, if not ICD: Osteomyelitis, Vaginal Candidiasis ,
Prescriber’s
Full name
TaddessessTilahu
Registration 661/2003
Signature (signed)
Qualification HO
Dispenser’s
Marta Tarekegn
Druggist 772/1998
Date: May 7, 2012

113. Summary of step two
The pharmacy personnel should
check the legality of prescription
check the legibility of prescription
Check the completeness prescription
Details to be checked for completeness of
the prescription
 Seal of the health institution or header
 Prescriber’s details (Name of prescriber’s,
Qualification, Signature and Date )
 Patient's details (Patient Name, Patient Address, Sex,
Age, Weight and Diagnosis)
 Medicine details

114.  Correctly Interpret any abbreviation
 Correctly perform any calculations of dose
and the quantity to be issued
 Check appropriateness of the individual
 verify the prescription by calling the
Prescriber

115. Step 3: Selection
and manipulation
of the medicine

116. This includes:
1. Select stock container of pre-pack reading
the label and cross matching the medicine
name and strength against the
prescription.
2. Read the container label at least twice
during the dispensing process.
3. Do not select the prescribed medicine
according to the color or location of
container.

117. 4. Do not open many stock containers at the
same time. This trend will lead to errors
and/or expose the medicines to air and
eventually leads to deterioration in quality.
5. Open and close containers once at a time.
6. While counting, pouring or measuring, the
following points should be noted:
◦ short and/or over counting should be avoided
◦ Clean counting tray and/or spoon used

118. ◦ Graduated measuring cylinder and/or flask
must be used for measuring liquid reduction.
◦ If small volume is to be measured, small
measuring cylinder/flask has to be used (if
compounding is performed in the pharmacy).
7. Appropriate balance should be used (if
compounding is performed in the pharmacy)

119. 8. In dispensing liquids (if compounding is
performed in the pharmacy):
 Must be measured in a clean vessel and
should be poured from the stock bottle with
the label kept up ward. This avoids damage
to the label by any spilled or dripping liquid.
 Pour the measured liquid preparation into the
appropriate container/bottle and label it.
 Dispense liquid preparations in suitable
containers
 Do not use patient’s own bottle
 Dispense each medicine in a different bottle

120. 9. In dispensing tablets and capsules:
• Do not use fingers to count tablets as this
can lead to contamination of medicines
• Use a spoon to put tablets and capsules
onto a counting tray
• Count and put them in a labeled medicine
container or pack
• Close stock containers tightly after
dispensing
• Keep the spoon clean at all times
• Do not keep the spoon inside the container

121. Step 4: Labeling and packaging of
the medicine in an appropriate
container

122. A. Packaging of medicines
 Medicines must be suitably contained,
protected and labeled from the time of
manufacture until they are used by the
patient.
 The container must maintain the quality,
safety and stability of the medicine
throughout this period.
 The containers used for dispensing must be
appropriate for the product dispensed.

123. The selection of packaging for medicines
depends on:
• Nature of the medicine
• Type of patient
• Dosage form
• Method of administering the medicine
• Required shelf-life
• Use, such as for dispensing.

124.  Original containers used by manufacturers are
expected to protect medicines for their specified
shelf-life.
 Because original containers may contain large
amount of medicines, repackaging of medicines
into another container may be necessary in
order to dispense medicines for patients.
 Prepackaging is the process by which the
pharmacy professional transfers a medication
manually from a manufacturer's original
commercial container to another type of
container in advance (before clients come to
medicine retail out lets)

125. Upon completion of prepackaging, all unused
medicine stock, unused labels and finished packages
should be removed from the prepackaging area.
The packaging equipment should then be completely
emptied, cleaned, and inspected before commencing
the next prepackaging operation.
All prepackaged medicines should be stored in a
temperature and humidity controlled environment.
 Prepackaging materials should be stored and used
in accordance with the manufacturer's instructions.

126. Advantages of prepackaging medicines
 it allows enough time for patient counseling
and
 minimizes dispensing errors resulting from
hectic operation due to heavy patient load.
NB Unfortunately, the materials commonly used
for repackaging in many medicine retail outlets
of Ethiopia are ordinary papers and the
labeling is incomplete.
 In such cases, repackaging of medicines is
likely to have many disadvantages than
advantages

127. Packaging aids and materials
The materials used for repackaging include:
 glass bottles,
 plastic bottles,
 collapsible tubes,
 paper envelops,
 plastic envelops, etc.
Paper has the least value as the primary
packaging material in terms of maintaining
the quality, safety and stability of packaged
medicine containers for packaging different
DF

128. Case study 2.1.
 Ato Kebede went to a pharmacy with a
prescription for nitroglycerin sublingual
tablets. The pharmacy worker
repackaged the prescribed number of
tablets in paper envelops and
dispensed with appropriate instructions
for use. Some other day, Ato Kebede
consulted the pharmacy professional
about decreasing efficacy of the
medicine dispensed. Comment.

129. Labeling of medicines
 The main functions of a label on a dispensed
medicine are to uniquely identify the contents of
the container
i.e and to ensure that patients have clear
and concise information about the use of the
medicine.
 Each dispensed medicine must be appropriately
labeled to comply with legal and professional
requirements.
 All medicines to be dispensed should be
labeled and
 the labels should be unambiguous, clear, legible

130. Case study 2.2.
 The pharmacy professional received a
prescription with the following
information:
Tabs Ibuprofen 400mg
Mitte 60
One t.i.d.
 The pharmacy professional dispensed 60
tablets of ibuprofen 400mg.and wrote a
label that the patient should take three
tablets daily with or after food. Comment

131. Step 5:
The provision of information and instruction
to client

132. General Steps of Counseling
 All medicines should be dispensed with
adequate and appropriate information
and counseling.
 questions and answers should be used
to check the patient understands.
 Written information should be provided
to supplement verbal communication
as appropriate.

133. Issue medicines to patient with clear information and
advice
The information in the form of verbal
and/or written instructions should include
the following,
Name and description of the medicine
 Intended use of the medicine and
expected out come
 Dosage form, dose, route of
administration
◦ How much and how often to take the medicine
◦ When to take the medicine (e.g., before or after
meals)

134. Duration of therapy with emphasis given to
completing the entire course especially for antibiotics
How long the treatment is to last (e.g., why the
entire course of an antibiotic treatment must be
taken)
Expected time to see a response of the medication
instructions on what to do if the medicine appears not
to have the desired effect.
The time the medicine should be taken in relation to
other medicines, food, life style interactions etc
Which types of foods and beverages should avoid
while taking the medicine

135. Clear instructions on measurement and
administration of medicine.
i.e, If necessary a demonstration such as
opening and closing containers or using an
aerosol may be necessary.
Explanation of harmless effects of the
medication such as urine discoloration,
 Common severe side or adverse effects
or interactions and therapeutic interactions
that may be encountered, including their
avoidance and the action that required if
they occur

136. e.g Patients should also be informed
not to stop treatment when side
effects occur or in the absence of
response without consulting the
prescriber or dispenser.

137. Storage instructions
How to store the medicine (e.g., avoid heat, light and
dampness)
Advice regarding keeping medicines out of reach and
sight of children, and
clarification on the consequences of sharing medication
or keeping extra doses at home
Not to share medicines with other persons
 Prescription repeats information
Finally, check whether patients have understood the
information provided

138. Communicating with a patient at the
dispensary

139. Step six
Recording and
documenting the
transaction

140.  Prescriptions should be recorded and
documented as proof of transaction
between the patient and the dispenser
 All dispensing units should have a
standardized Prescription Registration
Book (PRB) for recording every
pharmaceutical issued to a patient
 A computerized dispensing and
registration system may also be used, but
should always be supported by paper
back up.

141. a) Recording
The registration book should be
completed at the time of dispensing
or at the close of the working day
PRB should be used both when
prescriptions are
 retained in the pharmacy and
 when they are returned to the patient

142. For a prescription which is returned to a patient
 the medicines that have been dispensed from
the pharmacy should be copied on a blank
prescription and the prescription should be filed
appropriately.
 stamp the word “dispensed” on the
prescription, which is retained by the patient,
 entered the dispensing information PRB before
returning the prescription to the patient.

143. For prescription retained in the
pharmacy
 Enter the detail of dispensing
information in to the PRB before
dispensing or at the end of working
day

144. Information to enter in to PRB include
 Date
 Prescription number
 Patient information (name of patient , sex, age, weight)
 Diagnosis
 Description of medicine dispensed( name of medicine,
dose, strength, Qty dispensed,
 Prescriber information ( name of prescriber,
qualification)
 Dispenser information (name of dispenser,
qualification)
 Remark (credit ,free,prisoner)

145. Auditable Pharmaceuticals Transactions
and Dispensing Solutions (APTDS) Base
codes
Dosage Form Base Code Range
➢ Capsules ➢ 01 to 09
➢ Tablets, Lozenge ➢ 10 to 19
➢ Oral preparation (such as
suspension, syrup, solution, drop,
elixir, gel, emulsion, oral powder,
paste) ➢ 20 to 29
➢ Injectable, implants, Infusion ➢ 30 to
39

146. APTDS
➢ Eye, Ear & Nasal preparations (such
as drops, solution, suspensions,
ointments, spray, Inhaler, aerosol) ➢
40 to 49
Topical preparations (such as cream,
ointments, lotion, shampoo, gel,
powder) ➢ 50 to 59
Note: Cream Starts from 50 whereas
ointment starts from 56 but lotions and
shampoos start from 50

147. APTDS
 Suppositories, pessaries, Vaginal
creams, Vaginal ointment and tablets,
Vaginal Ovule ➢ Note: Creams starts
from 60 and vaginal ointment starts
from 66
60 to 69
➢ Medical Supplies Reagents (such as
lab reagents), radiology chemicals ➢
70 to 99

148. APTDS
 Raw chemical for Laboratory, raw
materials for extemporaneous
preparation) ➢ 1-01 to 1-09
 Sanitary chemicals (antiseptics and
disinfectants) ➢ 2-01 to 2-09
 Consumable instruments ➢ 3-01 to 3-
09
 Others (like close, woods etc.…) ➢ 4-
01 to 4-09

149. b) Documentation and report
 The receipts for requisition, receiving as well as the
prescription registration book should be kept properly.
 Blank prescription should be kept carefully, only
prescribers have access to them.
 Filled prescription should be kept as a receipt.
Prescriptions for narcotic and psychotropic Substances
should be kept for 5 years and other prescriptions for 2
years.
 Prescription should be disposed carefully in the
presence of appropriate body.

150.  Regular reports on medicine consumption and
prescribing pattern from patient prescription
registration book should be prepared and report
to the appropriate body timely.
 Information obtained from prescription
registration book could be used for further
planning and efficient utilization of resource.
 The report on physical inventory shall be
documented

151. Prescription filing
 Each prescription should be signed and
accountability accepted by the dispenser or other
authorized person for the correctness of the.
1. At the close of each day all dispensed
prescriptions should be organized
2. Prescriptions should be filed sequentially by day
in a single container/ carton for each month. The
container should be labeled with the month and
year.
3. Containers should be arranged on a monthly basis.
.

152. 4. Normal prescriptions should be filed
securely for two years and special
prescriptions for 5 years.
5. Prescriptions, patient and medication
related records and information should
be documented and kept in a secure
place that is easily accessible only to
the authorized personnel
THANKS