This document outlines the principles and practices of good dispensing in pharmacy, emphasizing the importance of accurate and safe medication provision to patients. Key components include proper prescription handling, patient counseling, maintaining a hygienic dispensing environment, and ensuring staff are well-trained. It also highlights the ethical responsibility of healthcare professionals to minimize medication errors and improve treatment outcomes through effective communication and adherence to established guidelines.

1. GOOD DISPENSING
PRACTICES
MRS MABEL JOHNSON

2. INTRODUCTION
• Dispensing is the process of preparing and providing prescribed
medications to patients
• It also refers to the process of preparing and supplying medicines to
person with clear instruction and counseling where necessary on the
use pf the medicine.

3. DISPENSING
• Is an important part of pharmacy, in which the pharmacy aide (under
the direct supervision of the pharmacist) interprets the physician’s
requirements on the prescription and accordingly supplies for the
treatment of his patient(s)
• Involves the correct interpretation, accurate preparation and labeling
of medicine for use by the patient.
• Dispensing is the act by a validly registered pharmacist of filling a
prescription or doctor’s order on the patient’s chart.

4. GOOD DISPENSING PRACTICE (GDP)
• Good dispensing practicing refers to a set of guidelines and standards
designed to ensure the safe, accurate and consistent dispensing of
medications and other healthcare products to patients
• Good Dispensing Practice ensures that the right medicines of desired
quality are delivered correctly to the right patient with the right dose,
strength, frequency, dosage form and quantity, together with right
instruction, both written and verbal and with appropriate packaging
suitable for maintaining the quality and efficacy of the medicine.

5. GDP
• Good medicine dispensing practice refers to the delivery of the
correct medicine to the right patient, in the required dosage and
quantities, in the package that maintains acceptable potency and
quality for the specified period, clear medicine information counseling
and appropriate follow up. This practice is a key step for effective
treatment outcome.
• Though rational medicine therapy requires the concerted efforts of
all health care professionals, the role of pharmacy professional is
immense

6. KEY ELEMENTS OF GDP
• Accurate Prescription Handling
• Proper Medication Storage
• Labeling and Packaging
• Patient Counseling
• Safe Handling of Controlled Substances
• Hygiene and Cleanliness

7. DISPENSING ENVIRONMENT
The dispensing environment includes;
• Trained or Qualified staff
• Appropriate physical surroundings
• Adequate shelving and storage areas
• Proper work surface
• Suitable equipment
• Necessary packaging materials

8. DISPENSING ENVIRONMENT
• Staff members involved in dispensing must maintain good personal
hygiene and should wear appropriate clean cloth (lab coat)
• Physical surroundings must be kept free from dirt
• Although the dispensary must be accessible to patients, care should
be taken to locate it in a protected place and not beside, or open to, a
road or other area where dust, dirt, and pollution are commonly
present

9. DISPENSING ENVIRONMENT
Prescription counter
Ideally Prescription counter should:
• Be accessible to the patients.
• 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 others parts of the pharmacy.
• Feedback mechanisms.

10. 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 center)
• Maintain a high standard of cleanliness and hygiene through regular cleaning and
sanitizing.

11. DISPENSING ENVIRONMENT
• The premises on which a dispensing service is provided would reflect
the quality of service and inspire confidence on patients in the nature of
pharmaceutical service delivered. Therefore, working conditions are
recommended to take into considerations the safety and health of the
public and people working on the premises.
• Dispensing environment must be clean, because most medicinal
products are for internal use, making it important that they be hygienic
and uncontaminated
• The environment must also be organized so that dispensing can be
performed accurately and efficiently.

12. DISPENSING ENVIRONMENT
• Ideally, the dispensary should be designed so that access to the
dispensing area itself is restricted to authorized personnel only
• Maintaining a clean environment requires a regular routine of
cleaning shelves, daily cleaning of floors and working surfaces and
daily removal of waste

13. REQUIREMENT OF A GOOD DISPENSING ENVIRONMENT
The dispensing environment should possess:
• Appropriate temperature and Optimum humidity control
• Sufficient lighting
• Cold storage facilities
• Adequate number and type of shelves
• Lockable cabinet for Narcotic medicines , Psychotropic substances
and poisons

14. • Patient/care provider waiting area
• Dispensing aids, etc.
No loud music playing, talking or television
Careful consideration is to be given to the overall security of the
dispensary and the stores.
Special attention must be paid to controlled medicines and flammables,
which must be kept separately from other medicines and be locked
properly.

15. SIGNIFICANCE OF GOOD DISPENSING PRACTICE
• Patient Safety: The primary reason for adhering to GDP is to
ensure patient safety. Accurate dispensing reduces the risk of
medication errors, which can lead to harmful consequences for
patients, including adverse reactions, ineffective treatment, or
even life-threatening situations.
• Preventing Medication Errors: GDP practices help minimize the
occurrence of medication errors caused by factors such as
illegible prescriptions, incorrect dosing, drug interactions, or
misunderstanding patient instructions.

16. * Effective Treatment: Properly dispensed medications are essential for achieving the
desired treatment outcomes. Incorrect dosages, substitutions, or interactions can
compromise the efficacy of treatment, affecting patient recovery and well-being.
* Professional Reputation: Healthcare institutions and professionals are judged
based on their commitment to patient safety and quality of care. Adhering to GDP
helps maintain a positive reputation and fosters trust among patients and the
broader healthcare community.
Minimizing Adverse Events: Accurate dispensing minimizes the occurrence of
adverse drug reactions, allergic responses, and other unexpected effects that can
arise from incorrect medications or dosages.

17. • Healthcare Costs: Medication errors and related adverse events can lead to increased
healthcare costs due to hospitalizations, additional treatments, and prolonged patient
care.
• Patient Adherence: Clear instructions and patient counseling during the dispensing
process improve patients' understanding of their medications, leading to better
adherence to prescribed regimens.
• Ethical Responsibility: Healthcare professionals have an ethical duty to provide safe
and effective care to patients. Good dispensing practices reflect this commitment to
patient well-being.

18. DISPENSING PERSON
• Responsibility for the accuracy and quality of the medicines supplied
lies on the persons overseeing the dispensing process.
• It is important that the staff dispensing medicines are trained and
equipped with the technical knowledge and the skills necessary to
dispense the range of medicines prescribed and to communicate
effectively with patients/ caregivers.

19. DISPENSING PERSON
• In addition to reading, writing, counting and pouring, the dispenser or
dispensing team needs specific additional knowledge, skills, and
attitudes to complete the dispensing process
These include;
• Knowledge about medicine being dispensed
• Good calculation and arithmetic skills
• Skills in assessing the quality of preparation
• Attributes of cleanliness, accuracy and honesty
• Good communication skills

20. CONT’D
• Pharmacy professionals involved in dispensing of medicines have the
need for medicines information in order to keep themselves up to
date with developments related to medicines and to provide such
information to patients, other health professionals and to the general
public.
• Because of an increasing number and complexity of medicines, the
need for up-to-date information is greater than ever.

21. CONT’D
• The provision of medicines information to prescribers and other
professionals is mainly directed at improving prescribing and
medicines administration.
• On the other hand, because counseling of patients on medications is
an integral part of the medicines dispensing process.
• Medicine dispensers should be adequately equipped with up-to-date
medicine information

22. CONT’D
• Lack of knowledge and information by patients about the medicines
they take leads to incorrect use which in turn results in loss of efficacy
or occurrence of adverse effects.
• Communication skills are very important for dispensers dealing with
patients or health care professionals to convey relevant medicine
information effectively and clearly, which can be done verbally and/or
in written form.
• Medicine dispensers must have the ability to explain information
clearly by the language the patient or care provider can understand
and check whether the information is being understood

23. Who should be involved in the process of
dispensing
• Screening of Prescription: Healthcare professional (Registered medical
practitioner/ registered dentist/ pharmacist)
• Preparation of Medicines': Pharmacist, registered medical practitioner or a
person under immediate supervision of a pharmacist/ medical practitioner
• Supplying the Medicines': Registered medical practitioner, registered dentist
or pharmacist
• Counselling : By healthcare professional

24. DISPENSING EQUIPMENT
• The facility should make sure that the equipment on the premises are
adequate and suitable for all the operations that have to be carried
out.
• All equipment should be kept clean and should be checked for
cleanliness prior to each use.
• With the exception of non -returnable containers, equipment must be
of good material and be kept in such good condition as to enable it to
be thoroughly cleaned to prevent any risk of contamination.
• Use of stainless steel and glass is recommended

25. CONT’D
Equipment should include:
• A dispensing bench of adequate size having a smooth, impervious
working surface.
• Tablets and capsules counting devices.
• A refrigerator equipped with a maximum/minimum thermometer
• A suitable range of dispensing containers for pharmaceutical products
with separate sets for internal and external use.
• Adequate shelves, lockable cabinet etc

26. DISPENSING PROCESS
• The dispensing process includes all activities that occur between the
time the prescription or request for medicine is presented up to the
time the medicines or other prescribed items are issued to the
patient.
• Adherence to good dispensing procedures is vital in ensuring that
medicines are dispensed correctly and any potential or real errors
which may occur during the dispensing process are detected and
rectified before medicines reach the patient.

27. DISPENSING PROCESS
• The dispensing of medicine involves interpretation of the prescription
instruction, technical knowledge required to carry out the instructions
& delivers with accuracy & safety to the patient by an authorized &
qualified pharmacy professional.
• There are a considerable variety of factors that require close attention
in dispensing, and proficiency requires the establishment of a routine
system which can be followed safely even under stress.

28. CONT’D
• 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.
• The framework for such SOPs may be based on the six major areas of
activity

29. AREAS OF ACTIVITY
1. Receive and validate the prescription
2. Understand and interpret the prescription
3. Prepare and label items for issue
4. Make a final check
5. Record the action taken
6. Issue medicine to the patient with clear instructions and advice

30. Step 1. Receive and validate the prescription
• Upon receiving a prescription, the staff member responsible should confirm the
name of the patient.
• 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 patients may mix up prescriptions.
• Cross-checking the name and identity of the patient must also be done when
issuing the medicines.
• The use of matching numbers or symbols (one attached to the prescription and
one given to the patient) can also contribute to making sure the right patient gets
the right medicines and is especially helpful in situations where many people
share the same surname.

31. Parts of Prescription
1. Patient Information
Name, address, contact number, age, sex and weight
2. Date
Time the prescription is written
A lapse of time more than a couple of days between the date the prescription was
written and the date it was brought to the pharmacy may be questioned by a
pharmacist to determine if the intent of the physician and the needs of the patient can
still be met
3. Rx Symbol or Superscription
- "take thou" or "you take"

32. • 4. Medication Prescribed or Inscription
• - body or principal part of the prescription
contains the name, strength, route of administration, dose and of the prescribed
drug
• 5. Dispensing Directions to Pharmacist or Subscription
• - Contains directions for the pharmacist for preparing the prescription
• 6. Directions for the Patient
• - As indicated by the prescriber, the directions for the patient's use of the medication

33. • 7. Refill, Special Labeling or Other Instructions
- Indicate the number of authorized refills in the prescription by
its prescriber
If no refill information is provided, it is understood that no
refills have been authorized.
• 8. Prescriber's Signature, Address, name, stamp, place of
practice and Other Pertinent Information

34. Classification of Drugs
1. Prescription or Ethical Drugs
- these drugs can only be dispensed upon a written order of a
validly-registered physician, dentist or
veterinarian.
2. Non-prescription or Over-the-Counter(OTC) Drugs
- purchased without a prescription

35. NOTE
•* Names of medicines prescribed should be written in
generic name and abbreviations should not be used.
Brand (trade) names should be avoided as far as
possible.
•If a patient must be given a particular brand, it should
be indicated on the prescription.

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 doses prescribed are in the normal range for the patient
(noting sex and age)
* Correctly perform any calculations of dose and issue quantity
* Identify any common drug-drug interactions

37. • It is assumed that the prescription will be in written form.
• Verbal orders for medications should be given only in
exceptional and emergency situations.
• In such cases, the order should be repeated back to the
prescriber to ensure accuracy, and written confirmation should
be supplied within an agreed-upon period.
• Computerized prescribing and dispensing systems are becoming
more widespread, especially in large hospitals. If the person
dispensing the medicine has any doubt about what is required
by the prescriber, he or she must check with the prescriber.

38. • Illegible writing by prescribers has serious implications when
many product names are confusingly similar. Checking a
prescription may save a life.
• All calculations should be double checked by the dispenser
or counter-checked by another staff member. An arithmetical
error could be fatal.

39. The person receiving the prescription should check for:
* Dose, frequency and duration
* Drug interactions, medicine duplication, polypharmacy, inappropriate
drug therapy, contra-indications.
* Allergies
* Unusual usage and suspected drug misuse or abuse.
NB; For partial medicine supply, ensure that the second or subsequent
supply does not exceed the quantity for the duration prescribed.

40. Handling Prescriptions which Require Clarification
If an incomplete prescription or one which requires further
clarification is received, attempts must always be made to
contact the prescriber:
i. If the prescriber can be contacted and is available on site,
arrange for the incomplete/missing details to be inserted on
the prescription by the prescriber.
Remedial action for such prescriptions should be discussed with
the prescriber prior to sending the prescription back to him/her

41. ii. If the prescriber is not available to amend the prescription himself/herself,
authorization to make the change may be obtained verbally through the phone.
ili. The amendments to the prescription should be repeated back to the prescriber
to ensure accuracy. The amendments should be documented on the prescription
and endorsed with "PRESCRIBER CONTACTED" (PC), dated and initialed by the
pharmacist/person dispensing.
iv. If the prescriber cannot be contacted, patient should be informed and the
prescription must be sent back to the prescriber with information on the
clarification/action needed.
v. Prescriber should document any changes made to the patient's medical record.

42. Handling Prescriptions In A Stock-Out
Situation
Stock-out is defined as a situation where the prescribed medicine is
not available at the pharmacy when a prescription is being processed.
This may be due to the medicine being temporarily out-of stock at that
time or the pharmacy does not keep stock of that particular medicine.
If such situation occurs:
i. Inform the prescriber.
If the medicine cannot be substituted with another medicine that is
available, inform the patient.

43. ii. If the patient agrees for it to be supplied at a later time, arrange to get
stocks so as to enable prompt supply the medicine to the patient;
iii. If the patient requires the medicine urgently, the pharmacist/person
dispensing must communicate with the prescriber to discuss if the
prescribed medicine can be substituted with another medicine which is
readily available.
iv. Any substitution of medicine must be approved by the prescriber and
documented on the prescription.
v. Prescriber should document these changes in the patient's medical record.

44. Step 3. Prepare and label items for issue
• Preparation of items for issue is the central part of the dispensing process, and it
must include procedures for self-checking or counter-checking to ensure accuracy.
• This part of the process 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.
• Select stock container or prepack. A good dispenser selects the item by reading the
label and cross-matching the product name and strength against the prescription.
• The dispenser should check the stock to make sure that it has not expired and choose
the oldest stock (first-in/first-out) or first expiry, depending on the stock rotation
method used.

45. • Most well-trained staff members deliberately read the container label at least
twice during the dispensing process.
• Selecting according to the color or location of the container, without consciously
reading the label, is poor dispensing practice and may have fatal consequences.
• Another dangerous practice that should be discouraged is having many stock
containers open at the same time.
• In this situation, product selection is frequently made only according to
appearance, which could lead to errors.
• In addition, medicines continuously exposed to the air eventually deteriorate in
quality. It is important to open and close containers one at a time.

46. • Measure or count quantity from stock containers.
• Liquids must be measured in a clean vessel and should be poured from the stock
bottle with the label kept upward.
• Using this technique avoids damage to the label from any spilled or dripping
liquid.
• Tablets and capsules can be counted with or without the assistance of a counting
device.
• The most important rule to follow is that the dispenser's hands must not be in
direct contact with the medicine.
• Using the hands is bad practice for both hygienic and product quality reasons.

47. Counting should be done using one of the following-
* Clean piece of paper and clean knife or spatula
* Clean tablet-counting device
* Lid of the stock container in use
* Any other clean, dust-free surface
• Immediately after measuring or counting, the stock container lid should
be replaced and the stock container label should be rechecked for drug
name and strength.

48. Pack and label medicine.
• Tablets or capsules should be packed into a clean, dry container, such
as a bottle, plastic envelope, cardboard box, or paper envelope.
• Any of these containers are satisfactory in a dry climate.
• During the rainy season or in a humid climate, however, cardboard or
paper will not protect tablets and capsules from moisture in the air,
which can quickly ruin medicines and make them unfit for use.
• Capsules and sugar-coated tablets are the most vulnerable to
moisture.

49. LABELING
• Every medicine containing any scheduled poison sold or supplied must
be prepared and labelled by or under the immediate personal Ins
supervision of the medical practitioner or dentist.
• All dispensed medicines should be labelled according to the
requirement stated by law.
• It is advisable for labels to be printed.
• If handwritten, it should be neat and legible with clear instructions on
use.

50. Label should contain:
• Name, address and contact number of hospital/ clinic/ pharmacy
• Patient’s name
• Name of medicines (generic and/or trade name)
• Dosage form with the strength and quantity per unit dosage form: mg/ml of
liquid, mg/g for semi-solid preparations
• Directions for use: dose, frequency and duration (if necessary)
• Date of supply
• Expiry date (especially if dispensed medicine is not in its original packaging)

51. • "Controlled Medicine" should be labelled for all controlled medicine
• Medicine for external use should be dispensed in suitable containers and should be
labelled conspicuously with the words "Not to be Taken" or "For External Use Only"
printed in red OR on a red background
• Special precautionary labels should be used where necessary (e.g., "Complete the course"
for antibiotics, "May cause drowsiness" for sedating drugs, etc)
• Whenever possible, always dispense the medicine in its original packaging so that
patients will have access to the product information.
• If a medicine is not dispensed in its original packaging and it is not possible to include all
the necessary information on the label, it should be written/printed separately and
dispensed together with the medicine. Patient information leaflet (PIL) should be
provided where available.

52. Selecting the Medicines
• When selecting the medicine to be dispensed, prevent any medication
errors by establishing an appropriate system to ensure that the correct
medicine is selected, especially if there are medicines with similar names
and packaging.
Pick the medicine by reading the label at least twice and cross-checking the
medicine name and strength against the prescription.
* If a barcode system is available, it should be used to enable correct and
accurate selection of the medicine.
* Check the expiry date of dispensed medicines to ensure that they remain
unexpired for the duration of the supply course.

53. * Medicines should be dispensed in original packaging as far as possible.
* Tablets/capsules should not be removed from the strip/blister when
dispensing.
* Bulk loose packs for supply are not encouraged. Avoid direct contact
with the hand if loose packs are to be used.
• Medicines which need to be packed such as loose capsules/tablets
should be packed into a clean, dry container, such as a bottle or plastic
envelope which will not compromise the quality of the product after
dispensing.

54. Extemporaneous Preparation/ Compounding
Extemporaneous preparations should only be prepared if there is no equivalent
product available commercially and the product has to be compounded based on the
patient's needs.
• For compounding of psychotropic substance, no person shall dispense, compound or
mix any psychotropic substance with any other substance, whether a psychotropic
substance or not, for the purpose of it being used for medical, dental or animal
treatment unless he is a licensed pharmacist; or a pharmacist in the public service.
• However, a pharmacy assistant or medical assistant employed in any government
facility may also compound or mix any psychotropic substance for the purpose of
medical treatment upon prescription prescribed by a registered medical practitioner
or registered dentist.

55. • Compounding of extemporaneous preparation should only be done on a patient-specific
basis.
• Ingredients used for compounding are sourced from recognized pharmaceutical suppliers.
• Ensure that the preparation is prepared according to formulation from a reputable
reference.
• There should be worksheets for the compounding which should be checked by a staff
member knowledgeable in compounding and counter-checked by a pharmacist/ another
qualified staff member / doctor.
• Staff involved in compounding should be competent to perform this task under the
supervision of pharmacist or registered medical practitioner.
• Availability of requisite facilities and equipment (Appendix 2) which are maintained in good
order.

56. • In a situation where hazardous substance, such as cytotoxic
medicines (as listed under NIOSH List of Antineoplastic and
Other Hazardous Drugs in Healthcare Settings 4) is to be
handled, staff should use appropriate Personal Protective
Equipment (PPE) and follow the stipulated procedures.
• Once the preparation is ready, label the product with necessary
particulars including expiry date/ special requirements for safe
handling and storage.

57. Keep worksheets or record books for a minimum of two years. The document should
contain information as below:
* Formula
* Ingredients and quantity used
* Manufacturer, batch number and expiry date of ingredients used
* Patient & prescription details
* Names of persons involved in preparing and counterchecking the product
* Date of compounding
• Note: The MOH Extemporaneous Formulation" and Garis Panduan Pembancuhan
(Compounding) Sediaan Ekstemporanus" can be used as references.

58. Step 4. Make a final check
At this point, the dispensed preparation should be checked against the prescription and
against the stock containers used. Although this step can be done as a self-check, it is
valuable to have the final check done by another staff member.
The final check should include
• reading and interpreting the prescription before looking at the dispensed medicines;
• checking the appropriateness of doses prescribed and checking for drug interactions;
• checking the identity of the medicine dispensed;
• checking the labels;
• and finally countersigning the prescription.

59. Step 5. Record action taken/ Record Keeping
• Records of issues to patients are essential in an efficiently run
dispensary. Such records can be used to verify the stocks used in
dispensing, and they will be required if a need arises to trace any
problems with medicines issued to patients.
• Three different methods can be used to keep a record of medicines
dispensed. When the prescription is retained, the dispenser should
initial and annotate the prescription with strength and quantities
dispensed and either file it or enter the details into a record book as
soon as time is available.

60. • When the prescription is returned to the patient, details
of the medicines dispensed must be entered into a record
book before the items are issued to the patient.
The date, the patient's name and age, the medicine name
and strength, the amount issued, and the dispenser's
name should be entered into the register.
• When dispensers use computers to record the dispensing
details, the computer program should retain the
information, which can then be recalled to generate
summary reports.

61. Proper record keeping is an essential part of dispensing as it facilitates good management and
monitoring of services provided. Such records can be used to verify the stocks used in
dispensing, and will be required if a need arises to trace patients dispensed with a particular
medicine.
All sale or supply of poisons in private facilities must be recorded in a "Prescription Book" on
the day of the sale or supply?
The following particulars need to be recorded:
1. Date of sale or supply and the serial number of the entry of the prescription (if any);
2. Name of the active ingredients of the medicine or in the case of a proprietary medicine, the
name of the medicine and the quantity supplied
3. Name and address of the patient

62. • • All sale or supply of Psychotropic Substances must be recorded in a
"Prescription Register for Psychotropic Substances" on the day of the
sale or supply".
The following particulars need to be recorded:
1. Date and serial number of sale or supply
2. Name and strength of the psychotropic substance and the quantity
sold/ supplied/ administered
3. Name, identity card/passport number and address of the patient

63. 4. The balance stock should be updated for each supply of the psychotropic substance in possession
5. The required entry must be in chronological order with respect to the previous entries in the
register
6. Any correction to the entry must be made by way of a marginal note or a footnote which must
specify the date on which the correction is made. Correction should not be made by cancellation /
deletion /using liquid paper.
7. Each strength or type of psychotropic substance must be recorded in a separate register or a
separate part of the register
• All record books must be in the form of a bound book". Records kept as soft copy must be printed
daily (if there is a transaction) and form a bound book.

64. Step 6. Issue medicine to the patient
• The medicine must be given to the named patient, or the patient's
representative, with clear instructions and any appropriate advice
about the medicine.
• The appropriate level of informational detail about possible side effects
varies from patient to patient. Verbal advice is important, because
illiteracy and poor labeling may both be problems.
• Apart from information on the dose, frequency, length of treatment,
and route of administration, priority should be given to providing
information that will maximize the effect of the treatment.

65. dispensing the medicine
ensure the 5Rs:
• Right Dose
• Right Medicine
• Right Dose
• Right Route
• Right Time
• Check the name and ID to verify the patient
• Medications supplied for a person under 18 years of age is for the purpose of his medical treatment
only?.
• Ask about allergies or known adverse drug reactions (ADR).
• Give clear instructions and proper advice on how to take/ use the medicines dispensed.

66. • Ensure the patient is made aware if there are special requirements during
transportation, proper storage conditions and usage requirements for the
medicines.
• Compliance aids (e.g. measuring spoon or syringe) for the appropriate dose
should be provided, if required.
• Every effort must be made to ensure that the recipient understands the
information/instructions and advice provided.
• Advise patients to inform the clinic/pharmacy should they encounter any adverse
drug reactions (ADRs) when taking the dispensed medicines.
• Supply of medicines based on prescription, the name of the person who
dispensed the medicines, address and the date of supply should be written on the
prescription above the doctor's signature as a form of endorsement.

67. MEDICATION COUNSELING
Advice should therefore concentrate on:
* When to take the medicine (particularly in relation to food and other medicines)
* How to take the medicine (chewed, swallowed whole, taken with plenty of water,
etc.)
* How to store the medicine
• Warnings about possible side effects should be given cautiously.
• Common but harmless side effects (nausea, mild diarrhea, urine changing color)
should be mentioned to prevent a frightened patient from stopping the treatment.

68. • 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.
• Every effort must be made to confirm that the patient understands
the instructions and advice.
• This can be difficult to do if someone other than the patient is
collecting items for the patient or for several patients, particularly
when the same medicines are prescribed in different dosages.
• Whenever possible, the staff member dispensing the medications
should have the recipient repeat back the instructions

69. • 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, and efforts should be made to
structure medicine collection so that advice to patients can be as individual
as possible.
• The person receiving the instructions may be feeling ill, and the success of
treatment depends on the accuracy and effectiveness of the dispenser's
communication with the patient.
• It is encouraged to counsel patients with chronic diseases on multiple
medications.
• Maintain records of the counselling done.

70. . Maintaining Pharmaceutical Stocks
Store all medicines in the original containers as supplied by the manufacturer. If the
contents need to be transferred to other containers (pre-packing), care must be taken to
avoid contamination and mix up. The new containers of the pre-packed / repacked
medicines should be labelled appropriately with:
* Name, address, and contact number of clinic/pharmacy
* Name of medicines (generic and/or trade names)
* Dosage form with the medicine strength (mg of tablet, mg/ml of liquid, mg/g for semi-
solid preparations)
* Manufacturer batch number
* Manufacturer expiry date

71. * Store medicines under suitable conditions, taking into consideration the general
usage of the medicine (internal/ external item should be segregated/ store
separately), stability of the drug and manufacturer recommendations.
* Protect medications from contamination, sunlight, moisture and adverse
temperatures.
* All psychotropic substances must be stored in a locked cabinet, safe or receptacle
and can only be locked or unlocked by the registered medical practitioner or
pharmacist.
* Application of Tallman Lettering, Handling of Look Alike, Sound Alike Guideline and
High Alert Medications Guideline in arranging medication stocks is encouraged in
order to prevent medication error.

72. Disposal of Pharmaceutical Stocks
* Segregate deteriorated/ recalled/ expired/ returned medicines for proper
disposal and store in an appropriate bin/ container to prevent unauthorized access.
* Management of disposal of expired/ returned medicines should follow as below:
1. Poisons (Psychotropic Substances) Regulations 1989ª for disposal of
psychotropic substance - needs to be witnessed by a Pharmacy Enforcement
Officer, Ministry of Health.
2. The Guidelines on the Management and Handling of Clinical Waste in Malaysia"
by the Department of Environment, Ministry of Natural Resources & Environment
for disposal of medicines.

73. Supply of Medicines on Long-term
Prescription
• Partial supply of medicines is based on the validity of the
prescription and duration for its supply.
• ensure that a copy of the original prescription is kept for recording
purposes. Also, ensure that the quantity supplied by the pharmacy
is recorded on the original prescription as reference for the next
supply.
• The original prescription should be returned to the patient as it
will be required for the next supply.

74. Delivery of Repeat Medicines by Post
I. First time supply must always be dispensed at the pharmacy
counter.
II. Delivery service should only be provided for prescription that is
partially supplied.
III.The delivery service is only applicable when it has been established
that the patient/caregiver understands the use of the medicines
and direct face-to-face contact with the patient or caregiver is
deemed not necessary for subsequent refills of the prescription.

75. Criteria for eligibility:
• Only stable and compliant patients should be eligible to receive
medicines through the delivery service.
• Only partial supply medicines for chronic diseases should be
considered for delivery services. Only medicines that do not require
specific storage conditions can be delivered through post.
• Psychotropic drugs and medicines containing pseudophedrine,
ephedrine, codeine and tramadol should not be delivered by post.

76. iv. Agreement from the patient must be obtained prior to providing the
delivery service and appropriate records of request for the service must
be kept.
v. The delivery mechanism used must be secure and medicines
delivered promptly to the patient so as not to compromise on the
quality of medicines and to ensure continuity of their medicines

77. . Non-Prescription Medicines
When non-prescription medicine is supplied, ensure that:
1. Sufficient information is gathered from the client to assess nature of
problems, symptoms and past medical / medication history (if any)
2. Select an appropriate medicine
3. Label for the medicines prepared
4. Checking of the medicine before issuing it
5. Recording done
6. Medicine is supplied with proper instruction

78. Promoting efficient management in dispensing
• Good dispensing practices are most threatened when dispensing staff face a
crowd of patients demanding immediate attention.
• The need for speed must be balanced with the need for accuracy and care in
the dispensing process. At this point, the patient's care, or even life, is in the
hands of the dispenser.
• In dispensing, accuracy is more important than speed.
• Prior agreement with the prescribers to prescribe only items that are
available at the pharmacy or listed on the hospital or clinic formulary
prevents unnecessary delay and confusion for the patient and improves
efficiency in the dispensing process.

79. • Organizing patient flow, such as establishing systems to receive payment and prescriptions
and issue medicines, can reduce the potential for dispensing errors by removing the
dispenser from the intense scrutiny of ten or more patients anxiously waiting at the
dispensary window.
• Strategies such as giving information on the current waiting time and issuing numbers
linked to the order in which prescriptions will be dispensed can encourage patients to use
the waiting time to access other hospital or clinic services, helps to prevent long queues
and crowding at the dispensary window, and can improve patient satisfaction.
• One good way to reduce dispensing time and improve safety is to prepackage and label
commonly used medicines.
• This process also distributes some of the dispensing workload to less busy periods of the
day.

80. • Another way to prevent staff from making errors when under
pressure is to organize the work so that more than one
individual is involved in the dispensing process for each
prescription.
• This method introduces a system of using counter-checks,
which is a wise precaution in most situations.
• One example of such a system assigns one person to receiving
and checking prescriptions, another to preparing the
medicines, and a third person to handing them to the patient
with advice; the team members then rotate responsibility for
these activities at regular intervals.

81. Techniques to ensure quality in dispensing include
• Requiring that all staff work in accordance with written SOPs
• Maintaining records on what medicines and products have been issued
• Scheduling worker shifts to make best use of staff: providing more staff at
peak hours, maintaining enough coverage to keep the dispensary open
during breaks, and coordinating shift starting/ending times with patient
flow
* • Involving the pharmacy staff in hospital/facility committees to identify
and resolve problems involving patient flow, communication, and other
areas

82. POINTS TO REMEMBER
* Containers used in dispensing should be appropriate to the particular product being
dispensed.
* It is important to open and close containers one at time
Note: air eventually deteriorate quality of medicines.
Labels of medicinal products should be legible and clear.
A prescription record book should be used for recording dispensed prescriptions. It
should be open for inspection anytime when the pharmacy is open for business and
must be preserved for a period of two years after the last entry in it has been made.

83. POINTS TO REMEMBER
* All fully served prescriptions must be recorded in the prescription
record book, numbered consecutively and shall be put on file for two
years.
* Smoking and eating should not be permitted in the dispensing area.
• Patients should receive the appropriate medicine, in the proper dose,
for an adequate period of time, and at the lowest cost to them and
their community.

84. •THANKS FOR YOUR
ATTENTION………..