LEC7 28-04-24 Dispensing during off hours.pdf

Dispensing during off hours PharmD Pharmacy Practice-IVA (Hospital Pharmacy) Dr. Syed Saad Hussain  Content Dispensing revision Off hours Dispensing methods during off hours  Drug dispensing re...

Dispensing during off hours PharmD Pharmacy Practice-IVA (Hospital Pharmacy) Dr. Syed Saad Hussain  Content Dispensing revision Off hours Dispensing methods during off hours  Drug dispensing review Drug dispensing is the preparation, packaging, labeling, record keeping, and distribution of a drug or medicine to a patient or an intermediary, who is responsible for administration of the drug. Otc drugs or medicine Prescription medicine Control drug substances.  Drug dispensing review Drug dispensing elements and activities Evaluate and validate prescription. Checks prescriptions are complete, legal and authentic. Obtains information needed to make prescriptions complete and correct. Verifies prescriptions received by fax, telephone or email Assess prescriptions Determines whether individual prescriptions should be dispensed or not Priorities prescriptions. Determines the stock availability of prescribed medicines.  Drug dispensing review Correct dispensing procedures Evaluate and Validate prescription. Review prescribed medicine. Check the drug safety. Fill prescription accurately. Package medicines to optimize safety. Calculate and inform total cost of the drugs. Maintain dispensing record. Hand over the dispensed drugs properly with Patient counseling regarding proper usage and storage. Note: Avoid dispensing without a prescription, incomplete , confuse and prescription from an unauthorized prescriber.  Drug dispensing review Dispensing Cycle 5. Issue medicine to patient with 1. Receive and validate clear instructions and advice prescription 2. Understand and 4. Make a final check interpret prescription 3. Prepare and label items for issue 6  Categories of dispensing errors Wrong dispensing of medicines could be categories as follows: Dispensing Error may cost a life (hypothetical case) For the wrong patient The wrong medicine A patient visits the pharmacy with a Maxalon - antiemetic prescription. Due to The wrong drug strength poor handwriting the dispenser could only The wrong quantity make out the first letter i.e. “M” and the last letter “n”. The wrong dosage form The dispenser is unable to interpret the Expired drugs name correctly and dispensed a medicine Incorrect drug strength that he knew of starting with the letter “M” and ending at “n”. The dispenser dispenses The wrong information on the label “Marevan” tablets – an antiplatelet/blood thinning tablet and the patient dies of Incorrectly compounded medicine. excessive bleeding.  Dispensing errors Potential errors can be reduced by 1. Readable handwriting or computer generated prescription. 2. Interpret prescription carefully or clear oral communications. 3. Writing complete drug orders. 4. Do not hesitate to contact prescriber for any clarification. 5. Use generic and brand names when possible. 6. Do not abbreviate drug names. 7. Specifying the route of administration.  Dispensing errors Potential errors can be reduced by 7. Use TALL MAN lettering in drug name. 8. Specifying the drug strength, e.g. 100mg. 9. Never abbreviate unit as "U": Spell out "unit“. 10. Never use a trailing zero: 1mg, not 1.0mg. 11. Never leave a decimal point "naked": Use 0.25mg or 250 microgram, not.25mg. 12. Specifying directions for when required medicines, include frequency, total daily dose and indication for use.  Dispensing errors STRATEGIES FOR MINIMIZING DISPENSING ERRORS 1. Confirm that the prescription is correct and complete It is important to call the prescriber to clarify any uncertainties or doubts regarding the prescription. 2. Beware of look-alike, sound-alike drugs (LASA) A new, unfamiliar drug may be read as an older, more familiar one. Some of these errors are fatal. 3. Be careful with zeros and abbreviations Misplaced zeros, decimal points, and faulty units are common causes of medication errors due to misinterpretation. 4. Organize the workplace properly Proper lighting, adequate counter space, and comfortable temperature and humidity can help facilitate a smooth flow from one task to the next, thus reducing the chances of dispensing errors.  Dispensing errors STRATEGIES FOR MINIMIZING DISPENSING ERRORS 5. Reduce distraction and multitasking when possible Avoid multitasking and distractions Improve the internal environment 6. Focus on reducing stress and heavy workloads Regular breaks Sharing responsibilities 7. Take the time to properly store the drugs and other items in shelves and refrigerator. Store lookalike drugs away from each other Lock-up drugs with a high potential of error  Dispensing errors STRATEGIES FOR MINIMIZING DISPENSING ERRORS 8. Thoroughly check the dispensed prescriptions (Triple Check System) Repeated checking and counterchecking is an important strategy to minimize dispensing errors. It is advisable to have the rechecking done by another person, typically a pharmacist. If this is not possible, delayed self-checking rather than continuous self-checking is an alternate strategy. 9. Always provide thorough patient counseling/ guidance Counselling should also include the instructions on how to take the medication and appropriate route of administration. Educating patients about safe and effective use of their medication promotes patient involvement in their health care, which will likely reduce medication errors  OFF HOUR DISPENSING It was always criticized that the pharmaceutical services should be for 168 hours per week (24 hours). In hospitals where there is no round the clock pharmaceutical service, or no enough pharmacists are available. The procurement and distribution of the drug and ancillary supplies could be according to the different processes.  OFF HOUR DISPENSING Use of Nursing Supervisors Most common method, the evening and or night nurse supervisor (s) enters a limited portion of the pharmacy and get the required medicines. It is although the most widely used but most criticized and illegal practice in some hospitals. Pharmacy has to be made in such a way that secures a portion of the pharmacy that has to be separated from the permitted area. Should be used with caution  OFF HOUR DISPENSING Emergency Boxes Some large teaching hospitals or tertiary care hospitals have given the concept of “emergency carts” and “resuscitation carts” having all the supplies present on the emergency bases with addition of the resuscitation items like suction catheter, surgical supplies and the administration of oxygen. The pharmacist has to maintain the emergency ward pharmacy and especially for the drugs which are deteriorated in units must be checked periodically. For this an inventory checklist card is placed in the emergency box , which gives the information about last check, maintains the inventory and provides information to the nurse about the replenishment of the inventory.  OFF HOUR DISPENSING Emergency Boxes Emergency box also known as “STAT BOX” is an integral part of even 24-hour pharmacy but in small hospitals. It also could be placed by expand the inventory of the necessary supplies required by each floor / ward in the hospital. The box should be placed in an accessible place known to all ward personnel. The nurse withdraw the medicine and medical items charge on the Pt. file for drugs used and send it to pharmacy for the record purpose.  OFF HOUR DISPENSING Night Drug- Supply Cabinets It is adjunct to charge floor stock medications on each floor. It could be a simple cabinet or a large installation that include a narcotic vault and refrigerated compartments. The night supply cabinets could be constructed along the wall of the pharmacy so that it could be accessed from inside the pharmacy ( for pharmacy staff ) and from the outside for nursing staff. The pharmacy must maintain the cabinets inventory periodically. The nurse must maintain a inventory card mentioning the quantity of the drug removed form the cabinet and to whom it is administered, the pharmacy checks the inventory for patient billing when used and missing items.  OFF HOUR DISPENSING Use of Physician More drawbacks hence this system is discouraged One of the factor is burden and shortage of physicians Unfamiliar surroundings for physician in pharmacy  OFF HOUR DISPENSING Pharmacist-On-Call Organizations contracts with the pharmacist to serve them round the clock if required by visiting the pharmacy on call. This may be supported by some bonus or extra payment plan or allowance. This may be on rotational plan so not to burden any individual. This may be utilized by more than one institute in a community.  OFF HOUR DISPENSING Purchased Service (Community Pharmacy acquired services) In hospitals where there is limited staff pharmacists or the pharmacists are on leaves the hospital may obtain the services of the community pharmacy for drug supply in the hospital called off site pharmacy service. In selecting a pharmacy in a community where more than one pharmacy is established, a bid should be invited by the pharmacies for pre-described pharmaceutical services to avoid any politics or favouritism  OFF HOUR DISPENSING Reasons for switching from off hour dispensing to full time service Provide continuity in following services – Drug information and monitoring – IV admixture – Unit dose programs – Prevention of medication errors – Provide medication to night staff which is least experienced Thank you