Basic Dispensing lecture notes.docx
- 1. PCT 212 LECTURE NOTES WEEK ONE SCOPE OF HOSPITAL DISPENSING PRACTICE Dispensing is defined as the review of a prescription and the preparation, packaging, labeling, record keeping and transfer of the prescribed medicine including counseling to a patient, their agent, or another person who is responsible for the administration of the medicine to that patient. Good medicine dispensing practice refers to the delivery of the correct medicine to the right patient, in the required dosage and quantities, in the package that maintains acceptable potency and quality for the specified period, clear medicine information counseling and appropriate follow up. This practice is a key step for effective treatment outcome. Though rational medicine therapy requires the concerted efforts of all health care professionals, the role of pharmacy professional is immense. Traditionally, pharmacy professionalsâ primary responsibility has been stocking, distributing and maintaining quality of medicines dispensed. Nowadays, this role has emphasized more on advising the prescribers and other health professionals about medicine therapy, counseling patients about medicines and monitoring medicine use. Pharmacy professionals bridge the gap between the prescriber and the patient and serve as the gate-keepers of medicine supply system. The dispenser plays a very important role in ensuring that medicines are used appropriately and that patients benefit from treatment. All efforts and resources to make medicines available at health facilities will be wasted if the patient is not given the correct medicine, dose, and information needed to make sure that he or she takes the medicines correctly. Dispensing includes all the activities that occur between the time the dispenser receives the prescription and when the dispenser hands it to the patient. Good dispensing takes time. Good dispensing practices ensure that each patient receives: ï· His/her correct medicine
- 2. ï· The correct dosage and quantity ï· Correctly labelled, well-packaged container to maintain medicine quality A safe, clean, and organized working environment provides a basis for good practice. Dispensing must be performed accurately and should be done in an orderly manner, with disciplined use of effective procedures. Care should be taken to read labels accurately. The dispenser must count and measure carefully and guard against contamination of medicines by using clean equipment and never allowing skin contact with the medicines. The dispensing environment includes: ï· Staff ï· Physical surroundings ï· Shelving and storage areas ï· Surfaces used during work ï· Equipment and packaging materials. Staff members who dispense must be trained in the knowledge, skills, and practices necessary to dispense the range of medicines prescribed at the facility. Their performance should be regularly monitored. Ensuring patients understanding of how to take their medicines is a primary responsibility of dispensers. Dispensers should check understanding by asking each patient to repeat instructions. Good records, though sometimes neglected, are an essential part of dispensing; they facilitate good management and monitoring of services provided. Differences between Dispensing and Compounding COMPOUNDING DISPENSING It involves preparation, mixing, lebelling and packing of a drug/medicine. It involves giving already available packed medicine/drug manufactured by pharmaceutical manufacturers to patient or patientâs caretaker by evaluation of
- 3. prescription. Compounding could be performed only in pharmacy. Dispensing is performed in pharmacy and chemist. Technical knowledge is required for compounding, so it must be carried out by pharmacist itself. It doesnât require deep technical knowledge, so it can be carried out by helper under supervision of pharmacist. Standard references should be followed during compounding and compounded medicines should be labeled properly. It doesnât necessarily need standard reference to follow because already packed medicines/drug involves in the process. WHAT IS PRESCRIPTION? A Prescription is the written medication ordered by a doctor, dentist, surgeon, veterinarian or any other registered medical prescriber to the pharmacist, for the supply of a medicine, dressing or surgical appliance to a patient. Pharmacists are increasingly being given prescribing privileges by enactment of sate collaborative drug therapy management ( CDTM) legislation. This allows pharmacists to order new medication or change the dose of existing medications under established protocols or guidelines agreed upon by the pharmacist and physician. Prescriptions may be written, presented orally (by telephone), or presented electronically (i.e., via fax or computer network) to the pharmacist. The prescription serves as a vehicle for communication from the prescriber to the pharmacist about the needs of the patient.
- 4. WEEK TWO HISTORY OF PHARMACY PRACTICE IN NIGERIA The pharmacy profession did not originate from Nigeria. Pharmacy practice technically was the first form of science when humans use nature e.g herbs to treat diseases. The pharmacy program was part of medical science. It went a separate way from medical science in the year 1240 by the emperor of the Holy Roman Empire, Federick II of Hohenstaufen. The first ever know pharmacy shop in the world was in Baghdad, Iraq during the 8th century. It took centuries before the first ever pharmacy shop came to Nigeria. Early Years of European Pharmacy Practice This era covers the period from the late 19th century to the first few decades of the 20th century. Pharmacy education during this period started with training of Nigerians in dispensing through apprenticeship under physicians, to prepare simple solutions and mixtures and subsequently either serving as dispensers in the hospitals or opening medicine shops to serve Nigerian community. An example of such early shops was that of Mr Richard Zaccheus Bailey, which was opened in 1887 along Balogun Street in Lagos. Later on experienced dispensers and reputed pharmaceutical companies were allowed to train others. Again, Mr Bailey was an example of such early trainer of dispensers. With time apprenticeship training in hospitals under physicians became more formal and regular. By the beginning of the 3rd decade of the 20th century (i.e the 1920âs). it became clear that the apprenticeship programme could no longer meet the need for pharmacy services in nigeria, and preparations were made through legislation to open school of pharmacy for training of dispensers. This plan materialized through the establishment of a school of pharmacy at Yaba, Lagos for the purpose in 1925. Hospital Pharmacy Practice A clear majority of the âpharmacistsâ in the early part of this era were actually âdispensersâ. The hospitals or dispensaries were managed under the supervision of
- 5. the medical officers in charge of such hospitals in Nigeria as at 1990. These hospitals were located in Lagos, Asaba, Abeokuta, and Calabar, three of which were government hospitals and one, a mission (catholic) hospital. These hospitals used a common hospital formulary. There were also a number of mission medical set-ups before this date in some coastal towns, which could not be described as hospitals. However, there was a steady growth in the number of hospitals both government and mission between 1900 â 1960. Community Pharmacy Practice In community practice, the first medicine shop was opened in 1887 by Mr Richard Zaccheus Bailey in present day Balogun street of Lagos state. It was primarily to cater for his European clients and a few African elites. Other retail pharmacies did not come into existence until the 1920âs and much later. The West African drug Company Ltd was established in 1924, while commercial Medicine stores (by Chief S.T. Hunponu-Wusu and Mr Robert Olatunji Adebowale) and Phillips Medicine Stores (by Thomas King Ekundayo Phillips) were established in the 1940âs all in lagos. Several years went by before retail pharmacies were opened in the towns of the old Western, eastern and Northern regions of Nigeria. By the end of 1960, as many as 150 community pharmacy shops had been established while a total number of registered pharmacists (many of who were not in community or general pharmacy practice) was 542. Industrial Pharmacy Practice Industrial pharmacy was evident with the arrival of May and Baker in 1944, Glaxo and Pfizer in 1954. These pharmaceutical companies were mainly into importation and marketing of pharmaceuticals. Large-scale drug production began in the 60âs involving governmental agencies, multinational companies and private enterpreneurs. Presently, there are more than 115 registered pharmaceutical manufacturers in Nigeria. These companies manufacture various pharmaceutical dosage forms cutting across various therapeutic classes. In addition to providing dependence high â quality pharmaceutical products to medical professionals and
- 6. patients in various communities in Nigeria and west Africa, they have also contributed greatly to the economic growth of the nation. HOSPITAL PHARMACY PERSONNEL AND THEIR FUNCTIONS 1. Chief Pharmacist ï Implementation of decision of Therapeutic Committee ï Dispensing of drugs, pharmaceuticals and chemicals to different areas. ï Maintenance of approved stock of emergency drugs and antidotes. ï Dispensing of narcotic drugs and accounting. ï Specification for various fluids ï Inspection of drugs at various points of use ï Preparation of indents, issue and receipt voucher ï Inventory control ï Maintenance of stores, ledgers and records ï Provision of alternate electricity supply ï Inspection and quality control ï Teaching and training of pharmacist ï Periodic utilization report of pharmacy ï Patient education. 2. Records and Registrars ï Stock ledger of different group of drugs ï Indent and receipt voucher ï Drug inspection report ï index registrar and bin cards ï Expiry date registrar ï Adverse reaction record ï File of correspondence with suppliers and units ï Ledger account for payment of vouchers ï Condemnation record for non-consumables and consumables ï Annual stock verification record
- 7. ï Hospital formulary ï Antibiotic policy. 3. Hospital Pharmacists ï Check prescriptions to make sure there are no errors and that theyâre appropriate and safe for the individual patient. ï Provide advice on the dosage of medicines and the most appropriate form of medication, for example, tablet, injection, ointment or inhaler; ï Participate in ward rounds to take patient drug histories; ï Liaise with other medical staff on problems patients may experience when taking their medicines. ï Discuss treatments with patientsâ relatives, community pharmacists and GPs; ï Make sure medicines are stored appropriately and securely ï Supervise work of less experienced and less qualified staff. ï Keep up to date with, and contribute to, research and development; ï Write guidelines for drug use within the hospital and implement hospital regulations. 4. Pharmacy Technicians / Assistant Pharmacists ï Assisting the pharmacists to prepare medications for patients ï Receiving and verifying the prescriptions ï Pricing and filling of prescriptions ï Obtaining pharmacistâs approval ï Completing patient paperwork related to the filling of prescription ï Assisting with insurance claims processing (usually a pharmacist will handle this, but assistantâs help will be needed â the entire process is done online) ï Stocking and pricing of medications in inventory ï Ensuring availability of drugs by delivering them to patients or facilities ï Maintaining pharmacyâs (and its patientsâ employeesâ) safety by adhering to infection-control procedures, policies and regulations.
- 8. ORGANOGRAM OF A HOSPITAL PHARMACY Assignment 1. Differentiate between community pharmacy and hospital pharmacy. 2. Outline the organogram of a community pharmacy. 3. Who is a dispenser? WEEK THREE UNDERSTANDING PARTS OF PRESCRIPTION PARTS OF A PRESCRIPTION The prescription contains the following information:
- 9. 1. Date of the Prescription: ï This is necessary for the prevention of misuse of prescription, especially the ones which contain narcotics and controlled drugs. ï It also helps the pharmacist to keep day-day Patientâs record in chronological order which helps the pharmacist or a physician to refer the old case in future. ï The pharmacist should advice the patients to visit the doctor again. 2. The Patientâs Name, Age, Sex and Address: ï Name, Age, Sex and Address of the patient must be written on the prescription. ï Name helps the pharmacist to identify the correct Patients avoiding any chance of giving the medicine to a person other than the one it is dispensed for. ï Note: patientâs full name must be written instead of nicknames or surnames.
- 10. ï Age of the patient becomes important in the case of the Pediatric (children) and Geriatric (old people) cases. Because the dose of drugs in such cases varies (due to their differences in ability to metabolize drugs). ï Hence dose of the drugs are calculated based on the age factor in such cases. ï Note: In some cases, weight and height of the patients are also required. ï Sex/Gender of the patient also plays major role in prescription because the dose of drugs may also vary based on the sex/gender of the patients (as their abilities to metabolize/response towards drugs may vary in many cases). ï Address of the patient is generally recorded to contact the person at the later stage or to deliver the medication personally. 3. Superscription: ï This part of the prescription is represented by the symbol RX. ï In the ancient times it is considered as a prayer to Jupiter the God of healing for the fast recovery of the patient. ï Nowadays, it is used as an abbreviation for the Latin term âTake Thouâ which means âyou takeâ. 4. Inscription: ï This is considered as the main part of the prescription order. ï It contains the names and quantities of the prescribed ingredients. ï The name of each ingredient is written on a separate along with its quantity. ï In the complex prescription containing several ingredients the inscription can be divided into the following parts: ï· Base (active medicament of therapeutic action) ï· Adjuvants (substances added to increase action of medicament/its palatability). ï· Vehicle (substances used to dissolve medicament/increase volume of prescription). 5. Subscription:
- 11. ï This part of prescription contains directions of the prescriber to the pharmacist regarding the type and compounding of dosage form along with number of doses to be dispensed. ï This is important because dose of drug also depends on the type of the dosage form. 6. Signatura: ï This part of the prescription contains directions to the patient regarding the administration of drugs. ï It is generally represented as âSigâ on the prescription. ï The instructions for the patient may include: ï· The method of administration and application ï· The dose if the preparation is for internal use. ï· The time of administration or application ï· The diluents (e.g water) if relevant, or means of application (e.g. brush). ï· The part of body where the preparation is to be applied, in case of external use. 7. Renewal instructions: ï In this part, the prescriber whether the prescription can be renewed or not. ï It also should include the specifications like how many times it can be renewed. ï It is of utmost importance incase of narcotic/other habitat forming drugs. 8. Signature, Address and Regd.no of the prescriber: ï The signature and Regd.no of the prescriber turns the prescription into legal and authentic order to the pharmacist. ï This helps in preventing the use of spurious drugs. ï Regd.no is of utmost importance in prescription containing narcotic drugs.
- 12. PRESCRIPTION ORDER SAMPLE ASSIGNMENT: Mention the roles of the following in dispensing and prescription. 1. Medical practitioner 2. Veterinary surgeon 3. Pharmacist 4. Pharmaceutical technologist 5. Pharmacy assistant 6. Nurse attendant.