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Role of Dispensers in Promoting Rational Drug Use

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Title: Role of Dispensers in Promoting Rational Drug Use


1
Role of Dispensers in Promoting Rational Drug
Use
2
Objectives
  • To describe the importance of good dispensing
    practices as part of rational drug use
  • To illustrate the role of the dispenser in
    promoting quality patient care
  • To understand mechanism of good dispensing
    practices

3
Rational Drug Use Cycle
Diagnosis
Adherence
Prescribing
Dispensing
4
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

5
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 the
    prescription, 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. This situation 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).
6
Characteristics of Good Dispenser
  • In addition to reading, writing, counting, and
    pouring, 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).
7
Characteristics of Good Dispenser
  • 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).
8
Case Report
  • A female student, age 20, suffering from
    Tonsillitis, was seen by a doctor in a 200-bed
    hospital OPD. She obtained a drug from the
    hospital pharmacy and took it as instructed. She
    felt very weak after taking the drug. Three days
    later she became severely comatose and was
    admitted to the same hospital. She took
    Chlorpropamide 250 mg four times a day. The OPD
    doctor claimed that he prescribed Chloromycetine
    4x250 mg daily for her Tonsillitis. The patient
    eventually died two weeks after hospital
    admission.

9
Definition
  • Dispensing
  • Dispensing is to ensure that an effective form
    of the correct drug is delivered to the right
    patient, 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).
10
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

11
Good drug dispensing practices (2)
  • Safe, clean and organized working environment
  • Disciplined use of effective procedures
  • Qualified and trained staff, regular performance
    monitoring
  • Safe and clean dispensing / labeling
  • Ensuring patients understanding
  • Good record keeping

12
Dispensing cycle
13
Steps in the Dispensing process (1)
  • Receive and validate the prescription
  • Understand and interpret the prescription
  • 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 gender and
    age )
  • Correctly perform any calculation of dose and
    issue quantity
  • Identify any common drug-drug interactions
  • 3. Prepare items for issue

14
Steps in the Dispensing process (2)
  • 4. Record the action taken
  • Issue medicine to the patient with clear
    instruction and advice
  • 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 )
  • 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).
15
KEEP WORK ENVIRONMENT 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

16
PREPARATION OF DRUGS AND SUPPLIES (1)
  • Go into the store. Determine the supplies needed.
    Place the items on a 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

17
PREPARATION OF DRUGS AND 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,
    and written instructions for the patient.

18
PREPARATION OF DRUGS AND SUPPLIES (3)
  • 6. Open the container. Check the quality of its
    contents. Count the quantity needed in a clean,
    safe manner.

19
PREPARATION OF DRUGS AND SUPPLIES (4)
  • 7. Put the prescribed amount of drug into the
    package for the patient to take home.
  • 8. Put any extra tablets or capsules back into
    the appropriate container immediately.
  • Explain to the patient how to take the drug (see
    steps a through d below). If the patient has more
    than one prescription, dispense one item at a
    time.

20
PREPARATION OF DRUGS AND SUPPLIES (5)
  • 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 patient practice
  • c. Tell the patient to take all prescribed drugs
  • d. Ask the patient to tell you how he will take
    the drug.

21
PREPARATION OF DRUGS AND SUPPLIES (6)
  • 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.

22
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 the need 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 than speed.

23
Useful techniques to ensure quality in
dispensing include (1)
  • maintenance of records on what drugs and products
    have been issued
  • maintenance by the pharmacy department of a daily
    list of drugs in stock to inform prescribers
    which drugs are available thereby ensuring that
    only these drugs are prescribed
  • a two prescription system, whereby two separate
    prescription are written one for drugs available
    in the pharmacy, and one for those that are not
    but can be ordered this helps avoid rewriting of
    prescriptions

24
Useful techniques to ensure quality in
dispensing include (2)
  • efficient staff scheduling to make the best use
    of available staff more staff at peak hours,
    enough coverage to keep one window open during
    lunch starting and ending items coordinated with
    patient flow
  • participation by the pharmacy staff in hospital
    committees to identify and resolve patient flow
    communication and other problems

25
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

26
Dispenser-Patient Communication
  • Dispensers communicate
  • with patients how to take
  • drugs
  • Ensuring their
  • understanding is
  • very important

27
Patient counseling
  • Through verbal and written communications, the
    pharmacist informs, educates and counsels
    patients about the following items for each drug
  • Name of drug (Different names with synonyms)
  • Use of drug and its action
  • Route of administration and dosage schedule
    dosage form and 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
28
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
29
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
30
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

31
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

32
Standard indicators to measure dispensing practice
  • Dispensing Indicators
  • Average dispensing communication time
  • Percentage of prescribed drugs actually dispensed
  • Percentage of prescribed drugs properly labeled
  • Percentage of patients knowledgeable about the
    correct medication dosage/regimen

33
  • Afghanistan Medicine Use Study
  • Study results that illustrate possible irrational
    use

34
Dispensing Times
  • The average dispensing times at primary health
    care facilities is 13.3 seconds
  • 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 met the 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.

35
Dispensing Times
Time in Seconds
Health Facility
36
Average Dispensing Times Comparison with Other
Studies
  • 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 2003
37
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.

38
Percentage of Patients Who Have Knowledge of Drug
Dosage -Comparison with Other Studies
  • 29
  • 63.4
  • 71
  • 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 2003
39
Patient Care Indicators, Iran
Eastern Mediterranean Health Journal, May 2004
40
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

41
Role Play
  • Prescribing and Dispensing role-play
  • Writer of the manual should develop this
    role-play

42
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

43
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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