Norny-PPPP 1241 Principles of Dispensing 2024 PDF

PPPP 1241 Fundamentals of Pharmacy Practice. PRINCIPLES OF DISPENSING AP Dr. Norny Syafinaz Binti Ab Rahman Dept. of Pharmacy Practice, Kulliyyah of Pharmacy Special thanks to Dr. Tengku Karmila & M...

PPPP 1241 Fundamentals of Pharmacy Practice. PRINCIPLES OF DISPENSING AP Dr. Norny Syafinaz Binti Ab Rahman Dept. of Pharmacy Practice, Kulliyyah of Pharmacy Special thanks to Dr. Tengku Karmila & Mdm. Siti Halimah Bux bt. Shaikh Rahman Bux Outline What is Dispensing? Dispensing Procedures Dispensing Personnel Process of Good Dispensing Practices Appendices Anatomy of a drug label Interpretation of Doses - difference between dose & dosage  Introduction The rational and quality use of medicine requires that patients receive medications appropriate to their clinical needs. It should be:- Appropriate- medicines are appropriate to their clinical needs Suitable doses to meet individual requirements Use medicines for an adequate period of time Lowest cost to patient Judicious- use all medicines only when appropriate Safe- use all medicines safely Effective- ensure that medicine use achieves therapeutic goals What is Dispensing?  Dispensing refers to the process of preparing medicines and supplying to users (patients) together with appropriate information, counselling and follow up. It involves:  Interpretation of prescription or oral request  Labelling of medicines to provide appropriate information  Dispensing the medicine in a safe and hygienic manner  Provide clear instructions, both written and verbal Dispensing Procedures Receive, interpret & evaluate the prescription Select, label & pack the medicine Provide information and instruction to the patient Record the amount of medicines dispensed to ensure stock balance*  Who should be involved in the process of dispensing a) Screening of Prescription: Healthcare professional (Registered medical practitioner/ registered dentist/ registered pharmacist) b) Preparation of Medicines : Pharmacist, registered medical practitioner or a person under immediate supervision of a pharmacist/ medical practitioner c) Supplying the Medicines : Registered medical practitioner, registered dentist or pharmacist d) Counselling : By healthcare professional  Dispensing Personnel Require appropriate level of training to be able to know and identify:- i. common use and dose of medicines ii. method of use and its precautions iii. common side effects / adverse effects iv. common interactions with other drugs or food v. proper storage vi. calculation skills vii. assess quality of preparations viii. effective communication skills towards patients Process of good dispensing practices Good Dispensing Practice ensures that the ▪ right medicines of desired quality are delivered correctly to the ▪ right patient with the ▪ right dose ▪ right strength ▪ right frequency ▪ right dosage form and quantity …. together with clear instructions ( written and verbal) with appropriate packaging for maintaining the quality and efficacy of the medicine. Processing the Prescription 1. Screening On receiving a prescription, it should be screened and validated to ensure that it is for the correct patient and that it complies with the requirements in the Poisons Act. read and understand the prescription thoroughly, detect any incompatibility should consult the prescriber for any changes made to the prescription Validation of prescription The prescription should have the following information: Patient Details Name Address Identification number (IC/Passport No) Prescription Details 1. Drug regimen (name of medicine, dose, frequency, administration and duration) 2. Doctor’s signature, stamp and registration number 3. Doctor’s name and address 4. Date of prescribing  Interpreting the Prescription 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. **For partial medicine supply, ensure that the second or subsequent supply does not exceed the quantity for the duration prescribed. Handling Prescriptions which Require Clarification ▪ 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. ▪ If the prescriber is not available to amend the prescription himself/herself, authorisation to make the change may be obtained verbally through the phone ▪ The amendments to the prescription should be repeated back to the prescriber to ensure accuracy. ▪ The amendments should be documented on the prescription, endorsed with Prescriber Contacted dated and initialled by the pharmacist/person dispensing. Handling Prescriptions which Require Clarification…..cont. ▪ 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. ▪ Prescriber should document any changes made to the patient’s medical record.  ▪ Inform the prescriber. If the medicine cannot be substituted with another medicine that is available, inform the patient. ▪ If the patient agrees for it to be supplied at a later time, arrange to get stocks so as to enable prompt supply of the medicine to the Handling patient ▪ If the patient agrees to buy from a pharmacy, Prescriptions photocopy the prescription to the patient (esp. In A Stock- if it is a poison item) ▪ If the patient requires the medicine urgently, the Out Situation pharmacist/person dispensing must communicate with the prescriber to discuss if (no stock) the prescribed medicine can be substituted with another medicine which is readily available. Any substitution of medicine must be approved by the prescriber and documented on the prescription. Prescriber should document these changes in the patient’s medical record.  a) Selecting the Medicines ▪ Ensure that the correct medicine is selected, especially if there are medicines Preparing the with similar names and packaging. Pick the medicine by reading the label at least twice Medicines: and cross-checking the medicine name and Filling of strength against the prescription. ▪ Check the expiry date of dispensed prescription medicines to ensure that they remain unexpired for the duration of the supply course.  Medicines should be dispensed in original packaging as far as possible. Tablets/capsules should not be removed Preparing the from the strip/blister when dispensing. Medicines: Avoid direct contact with the hand if loose packs are to be used. Filling of Medicines which need to be packed such prescription as loose capsules/tablets should be packed into a clean, dry container, such as a bottle (cont.) or plastic envelope which will not compromise the quality of the product after dispensing  - Is prepared if there is no equivalent product available commercially and the product has to be compounded based on the patient’s needs. - Once the preparation is ready, label the Preparing the product with necessary particulars including expiry date/ special requirements for safe handling and storage. Medicines: Extemporaneous *Note: There should be worksheets for the Preparation/ compounding which should be : Compounding ❑checked by a staff member knowledgeable in compounding and ❑counter-checked by a pharmacist/ another qualified staff member   Keep worksheets or record books for a Preparing the minimum of two years.  The work sheet should contain information as Medicines: below: ▪ Formula Extemporaneous ▪ Ingredients and quantity used Preparation/ ▪ Manufacturer, batch number and expiry date of ingredients used Compounding ▪ Patient name & prescription details (cont.) ▪ Names of persons involved in preparing and counterchecking the product ▪ Date of compounding Preparing the Name, address, and contact number of hospital / clinic / pharmacy Medicines: Patient’s name Labelling Name of medicines (generic and/or trade names) 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 Preparing the “Controlled Medicine” or ”Ubat Terkawal” should be labelled for all controlled Medicines: medicines Labelling Medicines for external use should be (cont.) dispensed in suitable containers and should be labelled conspicuously with the words “Not to be Taken” or “For External Use Only” in Bahasa Malaysia and/or English 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) Preparing the Medicines: Check the prescription and the filled Checking medicines to ensure that the filled medicines correlate with the prescription. Counter-checking Counter-checking should be done by a second person, other than the staff who did the previous filling and labelling tasks. Check all the medicines prepared for dispensing against the prescription. Once the counter-checking is done, the person performing this task should initial on the prescription. Recording 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. 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. Issuing Medicines to the Patient When dispensing the medicines, ensure the 5Rs: Right Patient Right Medicine Right Dose Right Route Right Time Issuing Medicines to the Patient Check the name and ID to verify the right patient. Give clear instructions and proper advice on how to take/ use the medicines dispensed. Dispensing Process Flow Chart Medication Where necessary, provide medication Counselling counselling to patients to ensure proper use of medicines dispensed. It is encouraged to counsel patients with chronic diseases on multiple medications. Maintain records of the counselling done. Anatomy of a proprietary drug label Front of box Manufacturer Brand name strength Packing Generic name Back of box Registration No. Hologram Denotes a poison item What is the difference between dose and dosage ?  Dose and dosage Dose is the amount of medicine to be taken, or given, at one time. The sum of doses may be the dosage or the total dose. Dosage is the amount of medicine to be taken, or given, in a period of time. INTERPRETATION OF DOSES Minimum dose is the lowest dose exerting the desired therapeutic effect in the average patient. Maximum dose is the highest dose usually tolerated without undesirable effects in the average patient. Toxic dose is the dose capable of producing marked functional derangement in the body.  Dose and dosage …(cont.) Lethal dose is the smallest dose which is able to have produced a human death. Prophylactic dose is the dose necessary to prevent the onset of a disease. Therapeutic dose is the dose necessary to treat an established disease. Loading/bolus dose : A dose higher than the maintenance, given on the initiation of therapy to give rapid drug plasma levels equivalent to that reached after multiple dosing. Maintenance dose: A dose given to maintain the therapeutic level of a drug in the body Dispensing Lab (Level 2, Kulliyyah of Pharmacy) Dispensing Lab (Level 2, Kulliyyah of Pharmacy)