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Role of Dispensers
inPromoting Rational Drug Use
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Objectives
To describe the importance of good dispensing
practices as part of rational drug use
To illustrate the role of the dispenser in promotingquality patient care
To understand mechanism of good dispensing
practices
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Diagnosis
Dispensing
PrescribingAdherence
Rational Drug Use Cycle
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Outline
Introduction
The Dispensing Process
Activity One: Identifying the Dispensing Process
The Dispenser
The Dispensing Environment
The Role of the Dispenser in the Proper Use of
Medicines Techniques for Ensuring Quality Dispensing
Summary of Session
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Introduction
A superficial look at dispensing suggest that it is a
process of supplying goods to a patient on the
basis of a written order, and that it can be done
successfully by anyone who can read theprescription, count, and pour. As a result,
dispensing is often delegated to any staff members
who has nothing else to do, who then perform this
function with out any training or supervision. Thissituation is irrational and dangerous.
Management Sciences for Health. Ensuring Good Dispensing Practices (chapter 2, Pg 485). In: Managing
Drug Supply, Second Edition, Kumarian Press (1997). 5
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Characteristics of Good Dispenser
In addition to reading, writing, counting, andpouring, the dispenser, or dispensing team,
needs additional knowledge, skills, and
attitudes to complete the dispensing process,
including:
Knowledge about the medicines being
dispensed (common use, common dose,
precautions about the method of use, common
side effects, common interaction with other
drugs or food, storage needs);
Management Sciences for Health. Ensuring Good Dispensing Practices (chapter 2, Pg 485). In: Managing
Drug Supply, Second Edition, Kumarian Press (1997). 6
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Good calculation and arithmetic skills
Skills in assessing the quality of preparations
Attributes of cleanliness, accuracy and
honesty
Attitudes and skills required to communicate
effectively with patients
Management Sciences for Health. Ensuring Good Dispensing Practices (chapter 2, Pg 485). In: Managing
Drug Supply, Second Edition, Kumarian Press (1997).
Characteristics of Good Dispenser
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Case Report
A female student, age 20, suffering fromTonsillitis, was seen by a doctor in a 200-bedhospital OPD. She obtained a drug from thehospital pharmacy and took it as instructed. Shefelt very weak after taking the drug. Three dayslater she became severely comatose and wasadmitted to the same hospital. She tookChlorpropamide 250 mg four times a day. The
OPD doctor claimed that he prescribedChloromycetine 4x250 mg daily for her Tonsillitis.The patient eventually died two weeks afterhospital admission.
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Definition
Dispensing:
Dispensing is to ensure that an effective form
of the correct drug is delivered to the rightpatient, in the prescribed dosage and quantity
with clear instruction, and in a package that
maintains the potency of the drug.
Management Sciences for Health. Ensuring Good Dispensing Practices (chapter 2, Pg 485). In: Managing
Drug Supply, Second Edition, Kumarian Press (1997). 9
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Good drug dispensing practices (1)
Good dispensing means ensuring that an effective form
of the correct drug is delivered:
To the right patient;
In the prescribed dosage and quantity;
With clear instructions;
In a package that maintains potency;
Dispensing is the last step in the drug pathway between
manufacturer and patient. No matter how many precautions are
taken to guarantee and maintain drug quality during production,
packing, transport, storage and distribution, they will all be useless
if drug quality is not preserved during this last step;10
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Good drug dispensing practices (2)
Safe, clean and organized working environment
Disciplined use of effective procedures
Qualified and trained staff, regular performancemonitoring
Safe and clean dispensing / labeling
Ensuring patients understanding
Good record keeping
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Dispensing cycle
Dispensing
process
1. Receive
and validate
the
prescription
2. Understand
and interpret
the
prescription
3. Prepareitems forissue
4. Recordthe actiontaken
5. Issuemedicine tothe patientwith clearinstructionand advice
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Steps in the Dispensing process (1)
1. Receive and validate the prescription
2. Understand and interpret the prescription
Read the prescription
Correctly interpret any abbreviations used by theprescriber
Confirm that the doses prescribed are in thenormal range for the patient (noting gender andage )
Correctly perform any calculation of dose andissue quantity
Identify any common drug-drug interactions
3. Prepare items for issue
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4. Record the action taken
5. Issue medicine to the patient with clear instructionand advice
When to take the medicine (particularly in relationto food and other medicines)
How to take the medicine (chewed, swallowedwhole taken with plenty of water )
How to store and care for the medicine
Management Sciences for Health. Ensuring Good Dispensing Practices (chapter 2, Pg 485). In: Managing
Drug Supply, Second Edition, Kumarian Press (1997).
Steps in the Dispensing process (2)
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KEEP WORKENVIRONMENT CLEAN
Dispensing environment must be clean
Physical environment should be kept free of dust and
dirt
Shelves and cupboard should be kept tidy and clean
Working area, and surface used during work should
be hygienic and uncontaminated
Staff must maintain good personal hygiene and
should wear protective clothing
Facilities to wash and dry hands should be available
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PREPARATIONOF DRUGSAND SUPPLIES (1)
1. Go into the store. Determine the supplies needed. Place the items ona tray. Take them to the dispensing area.
2. Keep supplies in the dispensing area organized
3. Check that the prescription is appropriate for the patient
Read the prescription and make sure that it is complete.
Name of the patient
Name of the drug (full name and generic name) and the strength
Dosage of the drug ( be particularly careful for children)Route of administration
Time and frequency of administration
Date and time when the prescription was written
Signature of the person writing the prescription
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PREPARATIONOF DRUGSAND SUPPLIES (2)
4. Collect a container of an item, and check its expiry
date.
5. Label the package clearly with the patients name,
date, name of the item, quantity dispensed, andwritten instructions for the patient.
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6. Open the container. Check the quality of its
contents. Count the quantity needed in a
clean, safe manner.
PREPARATIONOF DRUGSAND SUPPLIES (3)
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7. Put the prescribed amount of drug into the
package for the patient to take home.
8. Put any extra tablets or capsules back intothe appropriate container immediately.
Explain to the patient how to take the drug (seesteps a through d below). If the patient has
more than one prescription, dispense one
item at a time.
PREPARATIONOF DRUGSAND SUPPLIES (4)
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a. Tell the patient the name of the drug, its form (tablet,syrup, etc.), what is for, and the dosage.
The dosage includes
When to take the drug ( for example, in the morning)
How much of the drug to take ( for example, 1 tablet)
For how long to take the drug ( for example , 3 days)
How to take the drug ( for example, with food)
b. Show the patient how to prepare the dose. Give the patientpractice
c. Tell the patient to take all prescribed drugs
d. Ask the patient to tell you how he will take the drug.
PREPARATIONOF DRUGSAND SUPPLIES (5)
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9. Tell the patient to keep all drugs and medical
supplies in a safe place at home, and out of
the reach of the children.
10. Explain patients that they should not share
their drugs with other patients.
11. Register the drugs delivered to patient in a
register or daily sheet.
PREPARATIONOF DRUGSAND SUPPLIES (6)
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Promoting Efficient Management in Dispensing
Good dispensing practices are under the
greatest threat when there is a crowd of
patients demanding immediate attention. The
need for speed must be balanced with theneed for accuracy and care in the dispensing
process. At this point the patients care, or
even life, is in the hands of the dispenser. In
dispensing, accuracy is more important thanspeed.
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Useful techniques to ensure quality
in dispensing include (1)
maintenance of records on what drugs and productshave been issued
maintenance by the pharmacy department of a dailylist of drugs in stockto inform prescribers whichdrugs are available thereby ensuring that only thesedrugs are prescribed
a two prescription system, whereby two separate
prescription are written: one for drugs available in thepharmacy, and one for those that are not but can beordered this helps avoid rewriting of prescriptions
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Useful techniques to ensure quality
in dispensing include (2)
efficient staff schedulingto make the best use ofavailable staff more staff at peak hours, enoughcoverage to keep one window open during lunchstarting and ending items coordinated with patient
flow
participation by the pharmacy staff in hospitalcommittees to identify and resolve patient flow
communication and other problems
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Roles of Pharmacist/Dispenser in
Ensuring Rational Drug Use
Procurement
Distribution
Prescribing
Information
Additional roles:
Communication with physician
Treatment guidelines Research on prescribing and utilization
Consumer education
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Dispenser-Patient Communication
Dispensers communicate
with patients how to take
drugs
Ensuring their
understanding is
very important
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Patient counseling
Through verbal and written communications, the pharmacistinforms, educates and counsels patients about the following itemsfor each drug:
Name of drug (Different names with synonyms)
Use of drug and its action
Route of administration and dosage schedule; dosage formand time of administration
Directions for preparations.
Direction and precautions for administration
Common side effects of the drug.
Self-monitoring of drug therapy
Adequate storage of drugs Contraindications and interactions of the drug
Information about prescription refill
What to do in the event of missed dose
Specific information to specific patient or drug
Source: Hospital and Clinical Pharmacy, Second Year Diploma in Pharmacy A. V. YADAV B. V. YADAV
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Factors contributing to Noncompliance
Following are the various factors that result in the patient non-compliance:
Poor understanding of instructions
Unpleasant taste of medications
Fear of becoming drug dependent
Side effects of the drug
Multiple drug therapy
Asymptomatic nature of the patient
Delay of physician or pharmacist resulting in bored waiting for the drug
Measurement of medication
Cost of medication
Frequency of administration
Duration of therapy
Illness
Source: Hospital and Clinical Pharmacy, Second Year Diploma in Pharmacy A. V. YADAV B. V. YADAV
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Steps to improve compliance:
Identification of risk factors that may contribute to
non-compliance
Educating the patient : by means of effective verbal
and written communication with the patient
Development of treatment plan with recognition of
patients normal pattern of activities
Designation of specific items of day at which
medication is to be taken
Monitoring therapy
Patient motivation
Source: Hospital and Clinical Pharmacy, Second Year Diploma in Pharmacy A. V. YADAV B. V. YADAV
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Dispensing in the Public and Private Sector
Public Sector
Cheap but long delays and frequent stock-outs
Generic drugs
Private Sector
Expensive but convenient
Brand name drugs
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Type of dispensing errors
Wrong drug dispensed
Wrong strength dispensed
Wrong quantity dispensed
Wrong form dispensed (e.g. tablet instead of liquid) Labeling error
Wrong drug name, strength or quantity on label
Wrong patient name on label
Failure to supply drug
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Standard indicators to measure
dispensing practice
Dispensing Indicators
Average dispensing communication time
Percentage of prescribed drugs actuallydispensed
Percentage of prescribed drugs properly
labeled
Percentage of patients knowledgeable aboutthe correct medication dosage/regimen
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Afghanistan Medicine Use Study
Study results that illustrate possible
irrational use
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Dispensing Times
The average dispensing times at primary health care facilities is 13.3seconds
The range for all health facilities is 4.3 to 27.8 seconds across all
facilities studies
Average dispensing times are very low and indicate a lack of time and
commitment by dispensers to counsel patients on important drug use
issues.
A secondary indicator, adequate labeling, was also done. No labels metthe criteria for being adequate labeled name of patient, name of drug
and strength, directions for use.
Source: Green, T., Z. Omari, Z. Siddiqui, J. Anwari, and A. Noorzaee. 2010. Afghanistan Medicine Use Study: A Survey of 28 Health
Facilities in 5 Provinces.Submitted to the U.S. Agency for International Development by the Strengthening Pharmaceutical Systems
(SPS) Program. Arlington, VA: Management Sciences for Health.34
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0.0
5.0
10.0
15.0
20.0
25.0
30.0
A B C D E F G H I J K L M N
Dispensing Times (seconds), by health facility
Dispensing Times
Health Facility
TimeinSeconds
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Average Dispensing Times
Comparison with OtherStudies
13.3 Seconds
149 Seconds
70 seconds
Afghanistan Medicine Use study
March 2009
SCA - Afghanistan May 2003
WHO -International Studies
May 2009
Source: WHO -Medicine Use in Primary Care in Developing and Transitional Countries. May 2009. WHO
Press, Geneva
Source: SCA - Swedish Committee for Afghanistan, Baseline Drug Indicator Study, A Comparative Cross
Sectional Study in SCA Health Facilities in Afghanistan, Part II: Results and Next Steps, April 200336
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Percentage of Patients with Knowledge of
Drug Dosage
Percentage of patients with adequate knowledge of
medicine dosage (dosage, frequency of use, duration of
use, and route of administration) is 29%
The range is 1-63% for across all health facilities
The overall knowledge of drug dosage is poor and needs
improvement to ensure that patients take their medications
correctly and they receive optimal drug therapy
Source: Green, T., Z. Omari, Z. Siddiqui, J. Anwari, and A. Noorzaee. 2010. Afghanistan Medicine Use Study: A Survey of 28 Health
Facilities in 5 Provinces.Submitted to the U.S. Agency for International Development by the Strengthening Pharmaceutical
Systems (SPS) Program. Arlington, VA: Management Sciences for Health.
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Percentage of Patients Who Have Knowledge of
Drug Dosage -Comparison with OtherStudies
Afghanistan Medicine Use
study
March 2009
SCA - Afghanistan May 2003
WHO -International Studies
May 2009
29%
63.4%
71%
Source: WHO -Medicine Use in Primary Care in Developing and Transitional Countries. May 2009. WHO
Press, Geneva
Source: SCA - Swedish Committee for Afghanistan, Baseline Drug Indicator Study, A Comparative Cross
Sectional Study in SCA Health Facilities in Afghanistan, Part II: Results and Next Steps, April 200338
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Eastern Mediterranean Health Journal, May 2004
Patient Care Indicators, Iran
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Activity One:
Identifying the Dispensing Process
A 45 year old patient come in the dispensing window
with a prescription.
One person will play the role of the 45 year old patient
and another will play the role of the dispenser.
The dispenser must analyze the prescription out loud
The participants will analyze the actions and behavior
of the dispenser during the entire analysis and make
comments after the simulation
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Role Play
Prescribing and Dispensing role-play
Writer of the manual should develop this role-
play
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Conclusion
Dispensing is a critical part of drug use
Dispensing is often neglected in training and
Essential Drugs Program
Interventions exist to improve dispensing Patients benefit from better dispensing
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Summary
Good dispensing practices enhance
patient adherence, satisfaction, and treatment
outcomes
A dispenser has responsibility to ensure that
drugs are given To the right patient;
in the prescribed dosage and quantity; with clear instructions and
In a package that maintains potency;
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