MPharm Programme Introduction to Dispensing PDF

WEEK 18 MPharm Programme Introduction to Dispensing John Sherwood MRPharmS Slide 1 of 23 PHA113 Introduction to Dispensing WEEK 18 Learning outcomes • List the legal requirements which need to be present on a prescription • List the information which should appear on a dispensing label • Li...

WEEK 18 MPharm Programme Introduction to Dispensing John Sherwood MRPharmS Slide 1 of 23 PHA113 Introduction to Dispensing WEEK 18 Learning outcomes • List the legal requirements which need to be present on a prescription • List the information which should appear on a dispensing label • List the stages involved in dispensing a prescription • List the essential reference sources which can be used when dispensing a prescription • Describe the three checking processes designed to minimise errors when dispensing prescriptions Slide 2 of 23 PHA113 Introduction to Dispensing WEEK 18 Prescription statistics (England) 2021/22 • Medicines are the most frequent intervention in the NHS • Total NHS spend on medicines in 2021/2 was £17.8 billion • £9.05 billion cost in primary care • 1.05 billion prescriptions dispensed in community pharmacies Slide 3 of 23 PHA113 Introduction to Dispensing WEEK 18 Slide 4 of 23 Medicines returned by one patient to a pharmacy in London PHA113 Introduction to Dispensing WEEK 18 Dispensing prescriptions • The traditional role of the pharmacist • The public’s perception of what a pharmacist ‘does’ • Originally, a compounding role (‘making up a medicine’ – extemporaneous dispensing) • Now medicines are manufactured and packaged elsewhere • Is dispensing ‘Picking a box off the shelf and putting a label on it’? • There is much more to dispensing than a simple supply function Slide 5 of 23 PHA113 Introduction to Dispensing WEEK 18 What is a prescription? • A written authority by an appropriate practitioner to supply a POM to a patient • Important points • Written authority • Appropriate Practitioner e.g. doctor, dentist and others • POM – Prescription Only Medicine • Other legal classes of medicines in the UK are: • General Sales Medicines (GSL) • Pharmacy Medicines (P) Slide 6 of 23 PHA113 Introduction to Dispensing WEEK 18 Slide 7 of 23 How can you find out if a medicine is a POM? PHA113 Introduction to Dispensing WEEK 18 What stages are involved when dispensing a prescription? Check the prescription is legally complete Check the medicine is safe for the patient to take (dose, allergies, drug interactions) 3. Pick the correct drug from the shelf 4. Supply the correct quantity 5. Generate a dispensing label 6. Affix label to product 7. Check the correct medicine is supplied in the correct strength, form and labelled correctly 8. Complete legally required records (if any) 9. Make sure the patient knows how to take/use the medicine (patient counselling) 10. File the prescription What’s the most important stage? 1. 2. Slide 8 of 23 PHA113 Introduction to Dispensing WEEK 18 Slide 9 of 23 Essential Reference Sources PHA113 Introduction to Dispensing WEEK 18 Legal requirements on a prescription • • • • • • • The prescription must be written in indelible ink Signature of the prescriber Address of the prescriber Date (prescriptions are valid for 6 months) Name and address of the patient Age of the patient if they are under 12 years old Profession of the prescriber Slide 10 of 23 PHA113 Introduction to Dispensing WEEK 18 Is this prescription legally complete? • Signature of the prescriber • Address of the prescriber • Date • Name and address of the patient • Age of the patient if they are under 12 years old • Profession of the prescriber Slide 11 of 23 PHA113 Mrs Rosie Red 4 Front Street Gosforth NE3 4NN Atenolol tablets 50mg 1 mane Mitte: 28 I M Illegible Dr I M Illegible The Practice 1 Front Street Gosforth NE3 4NN Introduction to Dispensing 25.11.22 WEEK 18 Other requirements needed on a prescription • Information about the medicine • • • • • Name Form Strength Dose Quantity Atenolol tabs 50mg 1 mane (28) Atenolol tabs 50mg 1 mane (28) Atenolol tabs 50mg 1 mane (28) Atenolol tabs 50mg 1 mane (28) Atenolol tabs 50mg 1 mane (28) • Know the difference between dose and strength • Be exact when identifying the missing component Slide 12 of 23 PHA113 Introduction to Dispensing WEEK 18 Latin abbreviations on a prescription • • • • Use no longer encouraged But still used in practice See the back of the BNF for a short list Most common abbreviations include od bd tds qds Slide 13 of 23 nocte mitte ex aq Rx PHA113 pc cc ac mane Introduction to Dispensing WEEK 18 Labelling dispensed medicines • It is a legal requirement that dispensed medicines must be labelled by the pharmacy • The label must legally include • • • • • • Name of patient Date of dispensing ‘Keep out of the reach of children’ (or similar wording) Name of product Directions to use the product Name and address of the pharmacy • It is good practice to include • BNF cautionary and advisory labels • Any labels relating to storage or use of the medicine • Any information added to the prescription by the prescriber which the patient needs to know Slide 14 of 23 PHA113 Introduction to Dispensing WEEK 18 What counselling do patients need? • May depend on whether they have had the medicine before • Minimum requirements are: • • • • • • Name of the medicine What the medicine is used for Dose to take Any special dosing instructions (e.g. with/after food) Common side effects What to do if a dose is missed • Ask the patient if they have any questions • Pharmacists need to use professional judgement to decide who needs counselling and what to tell them Slide 15 of 23 PHA113 Introduction to Dispensing WEEK 18 What happens to prescriptions after they have been dispensed? • NHS prescriptions • Sent to the NHS Business Services Authority (NHSBSA) • NHSBSA will reimburse the pharmacy for the cost of the medicine and add a professional fee • NHSBSA retains all prescriptions for 2 years • Private prescriptions • Must be retained at the pharmacy for 2 years Slide 16 of 23 PHA113 Introduction to Dispensing WEEK 18 Making an error when dispensing a prescription • Errors can easily happen • Errors can have fatal consequences • Some errors never reach the patient – these are called ‘near miss’ errors • Some errors will reach the patient • Pharmacies are required to keep records of errors made so that they can learn from them • Dispensing errors will be covered in a lecture next week Slide 17 of 23 PHA113 Introduction to Dispensing WEEK 18 First check: Legal check • Is the prescription genuine? • Do you recognise the prescriber’s signature? • Has anything on the prescription been altered or added by someone else? • Are all the legal details present? - If a prescription is dispensed and a legal requirement is missing then you have committed a criminal offence Slide 18 of 23 PHA113 Introduction to Dispensing WEEK 18 Slide 19 of 23 PHA113 Introduction to Dispensing WEEK 18 Second check: Clinical check • Is the medicine a new medicine for the patient? • • • • • Is the medication indicated for the condition being treated? • Is it appropriate and recommended? • Is the formulation appropriate? Are there any cautions? Are there any contraindications? Is the dose appropriate for the patient? Are there any interactions with an existing drug or disease? • Does the patient have any allergies? • Is the duration appropriate? Slide 20 of 23 PHA113 Introduction to Dispensing WEEK 18 Third (final) check: Accuracy check Check the dispensed item for: • Correct drug • Correct strength • Correct form • Correct quantity Check dispensing label • Correct drug details • Dose written exactly as written on the Rx • Correct patient name (full details – title, first name and surname) • Correct quantity Slide 21 of 23 PHA113 Introduction to Dispensing WEEK 18 Dispensing classes in Level 1 • Dispensing sessions in Level 1 provide an introduction to dispensing • Dispensing and pharmacy law are taught in Level 2 in a separate module (PHA221) • Dispensing classes – you must bring your white tunic and be punctual – if you are late to the class you will not be let in • Try to get work experience in a pharmacy to help prepare for law and dispensing in Level 2 Slide 22 of 23 PHA113 Introduction to Dispensing WEEK 18 Further information • Royal Pharmaceutical Society www.rpharms.com For access to ‘Medicines, Ethics and Practice’ (MEP) • Medicines Complete (access to online BNF/cBNF) www.medicinescomplete.com • The BNF/cBNF is also available as a free app (not for use in dispensing classes!) 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