DRUG DISPENSING

PRACTICES
CONTENTS
• 1. Introduction
• 2. The dispenser
• 3. Qualities of good drug dispenser
• 4. Dispensing environment.
• 5. Dispensing process
• 6. Dispensing errors
• 7. Strategies to minimize dispensing errors
• 8. Investigating drug dispensing practices
• 9. Conclusion
INTRODUCTION
• Dispensing refers to
• "process of preparing medicines and distributing
them to users with provision of an appropriate
information, counselling and follow-up"
• All the resources involved in patient care prior to
dispensing may be wasted if dispensing does not
result in the delivery of medicines in an effective
form.
• Dispensing is one of the vital elements of the
rational use of medicines.
• Good dispensing practice ensures that the right
medicines at desired quantity are delivered to the
right patient with the right dose, strength,
frequency, dosage form together with clear
instructions with appropriate packaging and
counselling.
• Staff dispensing medicines should be trained and
equipped with the technical knowledge and skills
necessary to dispense medicines and communicate
patient effectively.
THE DISPENSER
• Dispenser is any person who is licensed or
authorized by the professional body to dispense
medicines or medical supplies.
• Since the dispenser is often the last person to see
the patient before the medicine is used, it is
important that the dispensing process be efficient,
as it affects medicine use.
• pharmacy should be managed under the overall
supervision of pharmacist
• Pharmacist working in the pharmacy should:
• 1. Hold at least Diploma in pharmacy and preferably a degree in
pharmacy.
• 2. Be registered as a pharmacist with the pharmacy council of
state in which he is practicing.
• 3. Have undergone adequate practical training in a community
pharmacy.
• 4. Undergone in house training as per the organization's staff
training policy.
• 5. Have a communication skills and capabilities to give
adequate and proper advise to the patients on appropriate use
of medicines, illness etc. to achieve optimal patient compliance
QUALITIES OF GOOD DRUG
DISPENSER
• Good knowledge about medicines.
• Good calculation and arithmetic skills
• Skills in assessing the quality of prescriptions
• Attitudes and skills required to communicate effectively with
patients
• Knowledge about relation with other health care
professionals
• Respect to pharmacy law and professions code of ethics
• Good knowledge on medicine supply management
• Knowledge on quality assurance of services
• Good clinical knowledge
DISPENSING
ENVIRONMENT
• Good dispensing environment includes following:
• Staff
• Physical surrounding
• Equipments and other facilities
• Staff:
• Staff members involved in dispensing must
maintain good personal hygiene. and should wear a
neat apron. All pharmacists should wear a badge
displaying their name and the word "pharmacist".
• Physical surrounding:
• The physical surrounding must be kept clean and
dust free. Dispensary should be designed so that
access to dispensary area should restricted to only
authorized persons
• Equipments and other facilities:
• Pharmacy should have all the equipments required
to perform dispensing process. All the equipments
should be kept clean and should check for
cleanliness prior to each use.
• Pharmacy should have:
• A dispensing bench or dispensing counter
• Tablets or capsule counter
• A refrigerator equipped with a maximum/minimum
thermometer
• Range of dispensing container for pharmaceutical
products
• Adequate shelves or lockable cabinets.
• Reference material
• Patient information leaflets
• Some basic instruments like sphygmomanometer,
glucometer, stethoscope, weight and height scale
DRUG DISPENSING PROCESS
STEPS PROCESS

1 Receive and validate the prescription.

2 Understand and interpret the

prescription.

3 Select and label medicine for issue

4 Make a final check

5 Record the action taken

6 Issue medicines to the patient with clear

instruction and advice.
Receive and validate the
prescription
• Pharmacist should ensure that prescription should have
following information:
• Patient information: name, age and ID of patient
• R, symbol in the upper left corner
• Name, strength, dose, form, frequency, route of
administration and duration of treatment.
• Any additional instructions for the pharmacist regarding
• preparation and supply of medicine.
• Refill instructions (in case of long term therapy)
• Name and signature of prescriber
Understand and interpret the
prescription
• Correctly interpret any abbreviations used by the
prescriber
• Confirm dose, frequency and duration of each
medicine
• Confirm that the doses prescribed are in the normal
range for the patient
• Correctly perform any calculations of dose and
quantity to be issued
• Identify any common drug-drug interactions and
contraindications.
Selecting the medicines:
• An appropriate system should be established for
selecting the medicines to prevent any medication
error.
• Double check should be done to ensure that correct
medicine is selected.
• Check the expiry date of dispensed medicines to
ensure that they remain unexpired for the duration
of supply course.
• Choose the oldest stock (first-in/first-out)
• Tablets/capsules should not be removed from the
strips/blisters when dispensing
• Medicines which need to be packed should be
packed into a clean, dry container or plastic
envelop which will not compromise the quality of
the product after dispensing.
Labelling of medicine
• Label should include following information:
• Patient name
• Generic name, strength and dose form of the
medicine.
• Frequency and duration
• Quantity of medicine dispensed
• How to take medicine
• Storage conditions.
Counter checking
• It can be done as a self-check but it is valuable to
have final check done by other staff member
• The countercheck should include:
• Reading and interpreting the prescription without
looking at medicines dispensed.
• Checking the appropriateness of doses prescribed.
• Checking for drug interaction
• Checking the medicines dispensed
• Checking the label
• Finally counter signing the prescription
Record the action taken
• Following details of the medicines should be
recorded:
• Date of dispensing
• Patient details like name, age and sex
• Medicine name
• Strength
• Amount issued
• Dispenser's name
 Issue medicine with clear
instruction and advice
Tell name and indication of medicine
Tell route and frequency of each medicine
Tell how long to take medicine
Ask for any allergy
Tailor medicine to daily regimen
Ask if patient have any problem in taking
medicine
Tell how long it will take for the
medicine to show an effect
Educate techniques for self monitoring
Tell how many times and when to refill
Emphasize benefits of the medicine
Discuss major side effects of medicine
Discuss drug-drug, drug-food, drug-
disease and drug-herb interaction
Discuss precautions and measure to be
taken to improve treatment outcomes.
Discuss storage recommendations
Demonstrate and provide adequate
information about special dosage forms.
Ask patient to repeat key information to
check his understanding
DISPENSING ERRORS
• Dispensing error are errors that can occur at any
stage of dispensing process
• Dispensing error can be defined as any discrepancy
between a prescription and the medicine that
pharmacist deliver to the patient
Types of dispensing errors
Dispensing medicines to the wrong patient

Dispensing the wrong medicine to the patient

Dispensing the wrong drug strength

Dispensing at the wrong time

Dispensing the wrong dosage form

Dispensing an expired medicine

Omission (failure to dispense)

Dispensing of medicine of inferior quality

 Dispensing an incorrectly compounded medicine

Dispensing with the wrong information on label

Dispensing with wrong verbal information to the patients

Abbreviations
• Misinterpretation of abbreviations is common
cause of dispensing errors.
AD, AS, AU (right ear, left ear, each OD, OS, OU (right eye, left eye, each
ear) eye)

qod (every other day) qd (daily), qid (4 times a day)

Trailing Zero (1.0mg) 1.0 mg mistaken as 10 mg

Naked decimal points (.5mg) .5 mg mistaken as 5 mg

Drug name and dose run together Mistaken as Inderal 140 mg

(Inderal40)

AZT (zidovudine) Mistaken as azathiopurine or

azetreonam
• Workplace
• Distraction on work place
• Workload
• Patient education
INVESTIGATING DRUG
DISPENSING PRACTICES
• Quality indicators: Good drug dispensing guidelines
of WHO recommended following indicators to
investigate drug dispensing practices:
• 1. Average dispensing communication time
• 2. Percentage of prescribed items actually
dispensed
• 3. Percentage of prescribed medication that are
adequately labelled
• 4. Patient knowledge provided to patient
• Average dispensing communication time
• Purpose:
• To measure the average time that personnel
dispensing drugs spend with patient.
• Formula:
Total time for dispensing drugs to a series of patients
Total number of encounters
• Percentage of prescribed medicines actually
dispensed
• Purpose:
• To measure the degree to which health facilities are
able to provide the drugs which are prescribed
• Formula:
Number of drugs dispensed ×100
Total number of drugs prescribed
• Percentage of prescribed medication that are
adequately labelled
• Purpose: To measure the degree to which
dispenser's record essential information on the
drug package they dispense
• Formula:
Number of drug packages containing at least patient
name, drug name and when the drug should be
taken ×100
Total number of drug packages dispensed
• Percentage of patient knowledge of correct
dosage
• Purpose: To measure the effectiveness of the
information given to patient on the dosage
schedule of the drugs they received
• Formula:
Number of patients who can adequately report the
dosage schedule for all drugs *100
Total number of patients interviewed
CONCLUSION
• Dispensing is one of the vital elements of the
rational use of medicines. Safe, clean and organized
dispensing environment provides a basis for good
dispensing practices. Dispensing process to go right
or wrong depends on the dispensing personnel. It is
therefore dispensing staff should be competent
enough and well equipped with all the knowledge
needed for the dispensing process.