DISPENSING AND MEDICATION COUNSELING

WHAT IS DISPENSING?
• refers to the sum of processes
performed by a pharmacist from
reading, validating, and interpreting
prescriptions; preparing; packaging;
labeling; record keeping; dose
calculations; and counseling or giving
information, in relation to the sale or
transfer of pharmaceutical products,
with or without a prescription or
medication order; to the named person
in the presciption

• Involves correct interpretation of the

wishes of the prescriber and the
accurate preparation and labeling of
medicine for use by the patients
• One of the vital elements of the rational
use of medicines

WHO: rational use of medicine is when THE TEN COMMANDMENTS

 px receive the medication is appropriate to
his/her clinical needs
 doses
 given for an adequate period of time
 lowest cost
DISPENSING PROCESS
The consistent, repeated use of good dispensing
procedures is vital in ensuring that error are
detected and corrected at all stages of the
dispensing process
1. Acknowledge customer
2. Receiver order
3. Understand, interpret and validate Rx
4. Encode order and check availability
5. Finalize order and process payment
6. Pick order from the shelves
7. Prepare and label items for dispensing
8. Make a final check
9. Record action taken
10. Dispense medicine to patient with clear
instruction and advice

7– steps Acknowledge customer

1. Review the completeness of the • and greet customer by NAME
prescription • Introduce yourself
2. Validate the appropriateness of the • Ask customer how you can help them
prescription • REMEMBER: Be SENSITIVE on how your
3. Check the availability of medicine customer feels.
4. Apply legal and ethical considerations • EMPATHY is a MUST!
in dispensing
• Legal: signature of doc Receive order
• Ethical: respect the px’s • Assess if order requires Rx:
autonomy and confidentiality • Prescription drugs
5. Secure proper label and packaging • PDEA controlled drugs (Yellow
6. Counter – check of the prepared Rx)
prescription and medication order • OTC drugs
(hand in hand compare everything) • Food supplement
7. Patient counseling
Validation of RX
Understand and interpret
• Understand and interpret the Rx
- DO NOT play guessing game
- The RPh must be able to confirm the
correctness of the interpretation of the
Rx (If not, DO NOT dispense)
Check
• Check Rx date
- Take note that a prescription has expiry
date (esp for controlled drugs &
antibiotics)
6 months: standard prescription
28 days – 2 months: controlled & dangerous
Only a certain period of time: antibiotics
Check
• Check validity of Rx
- Erroneous – dispense
- Violative or impossible – DO NOT
dispense
Encode order and check availability
• Encode order by placing the items in
the point of sale system
• Check availability as reflected in the
system
• Present the menu of generically
equivalent drugs
Finalize order and process payment
• Repeat- Repeat order of customer
• Check- Check pricing and discounts
available
• Compute- Compute for total payment
needed
• Check- Check payment options – cash,
credit/debit card
• Collect- Collect payment from
customer – take note of the amt
received if payment mode is CASH
Pick order from shelves
• Check expiry date of products
• Observe FEFO policy!
 FEFO: First Expiry, First Out
- Display in front of the gondola the
nearest expiration date
 FIFO: First In, First Out
Kung sinong bagong dating na stock, sya
mauunang idispense
Prepare and label items
• Items for reconstitution
• Check mL of distilled water
needed
• For clear liquids, the lower
meniscus must be checked
• Validate reconstitution
technique
• Loose tabs
• Use tableting counter
• Wipe/clean tableting counter
• PDEA Controlled drugs
• Ensure proper recording is
done
• Items for compounding
• Follow GMP
Make a final check
• Actual dispensed medicines should be
checked and double checked against
the Rx and against the label
• The final check should include
• Reading and interpreting the
Rx before looking at the
dispensed medicine
• Checking the appropriateness
of the dosage form prescribed
• Checking for drug interaction
• Checking for identity of
medicines prescribes
• Checking the labels
• COUNTERSIGNING the Rx
• Partially FILLED: Write the words USED
for ________ and how much has been
filled. Deduct from original. Indicate
the no. of dispensed medicine. Return
the prescription to the patient.
• Completely FILLED/ Fully filled/ Fully
Served: Must stamp the word FILLED in
bold diagonally across the original
 copy. Retain prescription and file for 2
years.
– Pag hiningi ni patient and
reseta, iphotocopy mo then
bigay mo sa kanya yung
photocopy and then keep mo
yung orginal
Record action taken
Dispense Medicine
• The medicines must be dispensed to
the NAMED PX or his/her
representative with CLEAR instructions
and any appropriate advice about the
medicine
• The appropriate level of informational
detail about possible side effect varies
from px to px and the severity of known
s/e and ADR
• Verbal advice is important, because
illiteracy and poor labelling may both
be problems
Advice should therefore concentrate on:
• When to take the medicine (particularly
in relation to food and other medicines
taken)
• How to take the medication (chewed,
swallowed, crush, SL, buccal, etc.)
• How to store the medicine
• What to AVOID
• What to EXPECT (indication and known
major side effect)
• Other infos that will maximize the
effect of the tx
Other Notes:
Tableting counter: clean before and after use
Loose tables: write the expiration date 6 months
after the day it has been transferred from the big
bottle.
Dangerous Drug Board, DDB (for dangerous
drugs)
– Need ng personalized prescription
– Yellow Rx: dangerous drug
– White Rx: controlled drug
– Should be triplicate ( 1 orig & 2 copies).
1 orig: kept by RPH after dispensing
1st copy: for the Px
2nd copy: for the prescribing doctor
Things to Look for in Prescription
• Date of the prescription
• Name of patient
• Prescribing doctor
• Professional Tax Receipt (PTR)
• S2 License #
• Address and telephone no. of the clinic
• Brand and Generic name
• Total number of units to be supplied in
words (katabi and Roman Numeral)
• Words that says NON-REPETITION
• Signature of the prescriber
• Specified direction of use
•
Other Licenses:
S2 License: authorized to prescribe dangerous
drugs
S3 License: retail dealers of DDP (pharmacy)
S4 License: whole sale dealers of DDP
S5-C License: manufacturers & repackers of DDP
S5-I License: importer of DDP
S5-E License: Exporter of DDP
PATIENT COUNSELING
WHAT IS PATIENT COUNSELING?
WHAT ARE THE OBJECTIVES OF PATIENT
COUNSELING?
• Importance of medication
• Relationship
• Understanding
• Patient compliance
• Information
• Pharmaceutical care
• Drug interaction and ADR
EFFECTIVE PATIENT COUNSELING
• Understanding
• Adherence
• Effective drug treatment
• Reduced unnecessary costs
• QOL
 • AE b. Eye contact & Facial
• Relationship expression: indicator of your
attention
WHO SHOULD THE RPH COUNSEL? c. Body posture: do not cross
• Confused patients your arms
• PWD
• Poor literacy Note: take the next dose prescribed as per
• Change in therapy schedule and do not double dose
• New patients
• Parents CONTENT: WHAT TO SAY?
• Special storage and directions • name and strength of the medication.
• reason why it has been prescribed or
• Asthmatic patients how it works
• Diabetic patients • how to take the medication
• Patients taking 4 or more prescribed • expected duration of treatment.
medications (polypharmacy) • expected benefits of treatment.
• Patients who are mentally ill • possible adverse effects.
• Patients misusing drugs • possible medication or dietary
• Patients who are terminally ill interaction.
• Epileptic patients • advice on correct storage.
• minimum time duration required to
STEPS IN COUNSELING show
1. Intro • therapeutic benefit.
a. Review the px record • what to do if a dose is missed.
b. Introduce yourself • special monitoring requirements
c. Explain the purpose of
counseling CONCLUSION
d. Obtain the drug related info Ask for feedback. Nakakasunod po ba?
(allergies, what is being Summarize by emphasizing key points.
treated?) Given an opportunity to ask questions.
2. Process Content and Issues
3. Conclusion

ENVIRONMENT
• Comfortable
• Confidential
• Safe

COMMUNICATION SKILLS IS THE KEY!

1. Verbal
a. do not use medical jargons
b. Tone: represents what you
want to achieve. It should be
serious, professional,
understanding. The lower the
volume the better
c. Speed: speak more slowly
2. Non-verbal
a. Proximity: maintain a min.
distance of 45 cm