Good Dispensing

Practice
Dr. Murtaza
Pharmacy Legislation
 Itis useful to consider the historical development of relevant
legislation that has influenced the manner in which
pharmaceutical compounding has been conducted in the UK.
 Before the 1850s, medicinal products could be sold by any
individual who was at liberty to use the title ‘pharmaceutical
chemist’.
 Moreover, there were no formal controls on the premises
from which such individuals operated the business of selling
medicines, with obvious outcomes in terms of the quality and
uniformity of products available.
Important legislation since 1850 Development of the pharmacopoeias
1. The Pharmacy Act 1852  London Pharmacopoeias
 The first London Pharmacopoeia (Pharmacopoeia Londinensis) 1618 - The first
2. The Pharmacy Act 1868 recognised pharmacopoeia?
3. Poisons and Pharmacy Act 1908  The 1650 edition of the London Pharmacopoeia (second edition)
 The London Pharmacopoeia 1677 (Pharmacopoeia Collegii Regalis Londini) (third
4. National Insurance Act 1911 edition)
5. Venereal Disease Act 1917  The London Pharmacopoeia 1721 (fourth edition)
 The London Pharmacopoeia 1746 (fifth edition)
6. Ministry of Health Act 1919  The London Pharmacopoeia 1788 (sixth edition)
7. Therapeutic Substances Act 1925  The London Pharmacopoeia 1809 (seventh edition)
 The London Pharmacopoeia 1824 (eighth edition)
8. Pharmacy and Poisons Act 1933  The London Pharmacopoeia 1836 (ninth edition)
9. National Health Services Act 1946  The last London Pharmacopoeia 1851 (tenth edition)

10. National Insurance Act 1946  The Edinburgh Pharmacopoeias

 The Dublin Pharmacopoeia
11. Pharmacy Acts 1953 and 1954  Unofficial reference works (Published before official Pharmacopoeia and afterwards, to
12. Therapeutic Substances Act 1956 translate Official Pharmacopoeia)
 The British Pharmacopoeia (BP) – The latest version is BP 2021
 The British Pharmaceutical Codex (BPC)
 The International Pharmacopoeia (World Health Organization)
 United States Pharmacopoeia
 Indian Pharmacopoeia
 Pakistan Pharmacopoeia
Obsolete dosage forms, equipment and methods of preparation *
 Galenicals  Snuffs
 Bougies  Syrups
 Cachets (capulae amylaceae, oblata)
 Collodions
 Tinctures (tincturae)
 Confections  Vinegars (aceta)
 Decoctions (decocta)  Waters (aquae)
 Extracts (extracta)
 Wines (vina)
 Eye discs (lamellae)
 Glycerins (glycerita or glycerites)  Old pharmaceutical equipment
 Infusions (infusa)  Weighing and measuring
 Juices (succi)
 Comminution
 Lozenges (trochisci, troches)
 Mucilages (mucilagines)
 Equipment for the manipulation of formulations
 Oxymels (acid honeys)  Old pharmaceutical containers
 Pills (pilulae)
 Glass phials
 Plasters (emplastra)
 Poultices
 Medicine bottles and containers
 Resins  Bulk liquid containers
DISPENSING
 Unlike compounding, manufacturing creates drugs in pre-set formulas or doses
on an industrial scale. ... The large-scale benefits society by providing quick and
easy access to pre-formulated medications; but leaves little room for customization
when patients have special needs.
 Compounding involves preparation, mixing, labeling and packing of a personalized
medicine.
 Dispensing involves giving already available packed medicine (manufactured by
pharmaceutical manufacturers or a hospital pharmacist) to patient or patient's
caretaker by evaluation of prescription.
 Def: Dispensing is an important part of pharmacy practice, in which the dispenser
 interprets the physician's requirements on a lawful prescription,
 supplies medicines for the treatment of his patient(s),
 Counsel his patient(s), and
 provide appropriate information about follow-up.
 following special regulations when preparing and dispensing controlled
substances.
 The dispensing of drugs should be carried out by trained pharmacists.
Dispensing is one of the vital elements of the
rational use of medicines.
All the resources involved in patient care prior
to dispensing may be wasted if dispensing does
not result in the delivery of medicines in an
effective form.
Good dispensing practice ensures that the right
medicines at desired quantity are delivered to the right
patient with the right dose, strength, frequency,
dosage form together with clear instructions with
appropriate packaging and counselling.
Staff dispensing medicines should be trained and
equipped with the technical knowledge and skills
necessary to dispense medicines and communicate
patient effectively.
Dispensing modules
Dispensing modules
1. Staff - Staff members involved in dispensing must maintain good personal
hygiene and should wear a neat apron. All pharmacists should wear a badge
displaying their name and the word “pharmacist”.
2. Equipment and materials: Pharmacy should have all the equipment
required to perform dispensing process. All the equipment should be kept
clean and should check for cleanliness prior to each use.
3. Prescription Counter
4. Waiting Area
5. Requirements of a good dispensing environment - The physical
surrounding must be kept clean and dust free. Dispensary should be
designed so that access to dispensary area should restricted to only
authorized persons
6. Barriers, noise and distractions that can affect dispensing
1. Staff - Dispenser
 Dispenser is any person who is licensed or
authorized by the professional body to dispense
medicines or medical supplies.
 Since the dispenser is often the last person to see the
patient before the medicine is used, it is important
that the dispensing process be efficient, as it affects
medicine use.
Cont…..
 In Pakistan, pharmacy is managed under the overall supervision of pharmacist
 Pharmacist working in the pharmacy should:
1. Hold at least Diploma in pharmacy and preferably a degree in pharmacy.
2. Be registered as a pharmacist with the pharmacy council of state in which he is
practicing.
3. Have undergone adequate practical training in a community pharmacy.
4. Undergone in house training as per the organization’s staff training policy.
5. Have a communication skills and capabilities to give adequate and proper advice
to the patients on appropriate use of medicines, illness etc. to achieve optimal
patient compliance.
Cont…
Qualities of good drug dispenser
 Good knowledge about medicines.
 Good calculation and arithmetic skills
 Skills in assessing the quality of prescriptions
 Attitudes and skills required to communicate effectively with patients
 Knowledge about relation with other health care professionals
 Respect to pharmacy law and professions code of ethics
 Good knowledge on medicine supply management
 Knowledge on quality assurance of services
 Good clinical knowledge
2. Pharmacy Equipment
 A dispensing bench or dispensing counter
 Tablets or capsule counter
 A refrigerator equipped with a maximum/minimum
thermometer
 Range of dispensing container for pharmaceutical
products
 Adequate shelves or lockable cabinets
 Reference material
 Patient information leaflets
 Some basic instruments like sphygmomanometer,
glucometer, stethoscope, weight and height scale
3. Prescription counter
Ideally Prescription counter should:
Be accessible to the client.
Preferably be separate and in a quite location. If
there are other separate section (e.g., cosmetics,
general items, OTC section), it should be slightly
away from them.
Be clean, orderly attractive, and with an identifying
sign or symbol, which can easily be identified and
seen from other parts of the pharmacy.
A different color, appearance, demarcation etc. may
be given to the prescription section to provide added
emphasis.
Have a waiting area for clients who wait for their
prescriptions to be dispensed/filled.
4. Waiting area
An ideal waiting area provide:
 Comfortable chair/places to sit (at least for the
elderly/disabled/sick patient to rest)
 Current popular health magazines, and carefully selected
material related to good health to keep the client busy/occupied,
and prevent boredom while waiting to receive medicines
 Pamphlets, and posters related to public, family and other
individual health problems prominently displayed (as the waiting
area could be used as a health education centre.)
5. Requirements of a Good Dispensing Environment
 Be clean: To give a professional impression and outlook to the pharmacy.
 Be organized: To provide for a safe and efficient working area. (Such that things are
found in the right place at the right times and there are minimum obstructions and
hurdles).
 Have sufficient space For easy movement of personnel in the pharmacy, and to prevent
congestion and physical contact among staff while working.
 Temperature and humidity controlled as appropriate temperature and humidity are
necessary for stability of medicines till the expiry date.
 No loud music playing, gossiping, talking, or television (e.g. a cricket match or a
movie) :To avoid distractions during dispensing.
 Have medicines stored in an organized way on shelves in alphabetical order or using the
method normally employed in that particular pharmacy: To ensure quick, but safe
selection of the correct medicines from the shelves to minimize dispensing errors.

 BE CLEAN, GET ORGANISED!! GIVE THE PHARMACY A PROFESSIONAL LOOK

Conti….
Maintaining a clean environment requires
A regular routine of cleaning shelves,
medicines/products, and a daily cleaning of
floors.
A regular schedule for checking, cleaning and
defrosting the refrigerator.
Immediate wiping of accidental spills due to
breakage, etc, during dispensing.
Conti….
Why Good Dispensing Environment
 Working in a clean and an organized environment in a pharmacy,
aids in accuracy while dispensing, and also gives a professional
look to the pharmacy.
 Presence of a separate prescription counter and waiting area can
further Highlight professionalism and competence of the
dispenser.
 Dispensers handle medicines, and a slight dispensing error could
result in serious consequences i.e. health wise for the patient, and
for the pharmacy – a loss of reputation.
 Thus a good dispensing environment is recommended for every
pharmacy.
6. Factors responsible for dispensing distraction
Barriers
Noise
Distractions
Activities involved in Dispensing
or
handling of prescription
Activities involved in Dispensing or
handling of prescription
The various activities involved in Dispensing are:
1. Receive and validate the prescription
Pharmacist should ensure that prescription should have following information:
 Patient information: name, age and ID of patient
 Rx symbol in the upper left corner
 Name, strength, dose form, frequency, route of administration and duration of treatment.
 Any additional instructions for the pharmacist regarding preparation and supply of medicine.
 Refill instructions (in case of long-term therapy)
 Name and signature of prescriber
 As clients come into the pharmacy, they must be made to feel attended to and comfortable by :
 Friendly gestures
 A smile
 Eye-to-eye contact
 A friendly welcome
 A cozy ambience
 Courtesy
 Feeling of caring

Communication should be initiated in such a manner that it encourages the client to convey his/her needs
by producing a prescription or by asking for other products or advice.
2. Understand and interpret the prescription
 Correctly interpret any abbreviations used by the prescriber
 Confirm dose, frequency and duration of each medicine
 Confirm that the doses prescribed are in the normal range for the patient
 Correctly perform any calculations of dose and quantity to be issued
 Identify any common drug-drug interactions and contraindications.
 Upon receiving the prescription, the pharmacist should confirm
 Whether the client is the patient himself or has come on the patient's behalf.
 The relation of the client with the patient.
 The client may politely be requested to wait, while the pharmacist reviews the prescription

for:
 Legality and completeness of prescription.
 Therapeutic aspects.
 Appropriateness for the individual.
Cont….
 While reading and checking the prescription, the dispenser Should:
 Be alert and concentrate on the prescription.
 Not be distracted.
 Not engage in talking or chatting.
 Engage/ use his professional/ experience in assessing the prescription.
 After receiving the prescription, it is important for the dispenser to read the prescription to verify
whether :
 It is legal and complete with respect to the various parts of the prescription,
 It can be dispensed as such, or not.
 A prescription is legal when
 It is written (can also be typed) by a R.M.P.
 Signed by the R.M.P.
 Has all the information required to be contained with respect to parts of prescription.
3. Selecting the medicines
 An appropriate system should be established for selecting the medicines to
prevent any medication error.
 Double check should be done to ensure that correct medicine is selected.
 Check the expiry date of dispensed medicines to ensure that they remain
unexpired for the duration of supply course.
 Choose the oldest stock (first-in/first-out)
 Tablets/capsules should not be removed from the strips/blisters when
dispensing
 Medicines should be packed into a clean, dry container or plastic envelop.
 Filling a prescription
 Removal of medicines from shelves.
 Assembling of medicines.
 Billing
 Refilling a prescription
4. Labelling of medicine
Label should include following information:
 Patient name
 Generic name, strength and dose form of the medicine
 Frequency and duration
 Quantity of medicine dispensed
 How to take medicine
 Storage conditions
5. Counter checking
 It can be done as a self-check but it is valuable to have final
check done by other staff member
 The countercheck should include:
 Reading and interpreting the prescription without looking at
medicines dispensed.
 Checking the appropriateness of doses prescribed.
 Checking for drug interaction
 Checking the medicines dispensed
 Checking the label
 Finally, counter signing the prescription
6. Record the action taken
Following details of the medicines should be recorded:
 Date of dispensing
 Patient details like name, age and sex
 Medicine name
 Strength
 Amount issued
 Dispenser’s name
Issue medicine to the patient with clear instruction and advice
 Tell name and indication of medicine
 Tell how many times and when to refill
 Tell route and frequency of each medicine
 Emphasize benefits of the medicine
 Tell how long to take medicine
 Discuss major side effects of medicine
 Ask for any allergy
 Discuss drug-drug, drug-food, drug-disease and drug-herb interaction
 Tailor medicine to daily regimen
 Discuss precautions and measure to be taken to improve treatment outcomes.
 Ask if patient have any problem in taking medicine
 Discuss storage recommendations
 Tell how long it will take for the medicine to show an effect
 Demonstrate and provide adequate information about special dosage forms
 Educate techniques for self monitoring
 Ask patient to repeat key information to check his understanding
DISPENSING ERRORS
DISPENSING ERRORS
Dispensing error are errors that can occur at any
stage of dispensing process
Dispensing error can be defined as any discrepancy
between a prescription and the medicine that
pharmacist deliver to the patient
Types of dispensing errors
 Dispensing medicines to the wrong patient
 Dispensing the wrong medicine to the patient
 Dispensing the wrong drug strength
 Dispensing at the wrong time
 Dispensing the wrong dosage form
 Dispensing an expired medicine
 Omission ( failure to dispense )
 Dispensing of medicine of inferior quality
 Dispensing an incorrectly compounded medicine
 Dispensing with the wrong information on label
 Dispensing with wrong verbal information to the patients
STRATEGIES TO MINIMIZE DISPENSING ERRORS
 Confirm that prescription is complete and correct: check
the prescription for its completeness and correctness
 Name of the drug: One-third of dispensing errors are due to
similar drug names
Cont…
Abbreviations
 Misinterpretation of abbreviations is common cause of dispensing errors.
INVESTIGATING DRUG
DISPENSING PRACTICES
INVESTIGATING DRUG DISPENSING
PRACTICES
Quality indicators: Good drug dispensing guidelines of WHO
recommended following indicators to investigate drug dispensing
practices:
1. Average dispensing communication time
2. Percentage of prescribed items actually dispensed
3. Percentage of prescribed medication that are adequately labelled
4. Patient knowledge provided to patient
Average dispensing communication time
Purpose: To measure the average time that dispensor spend with
patient.

Formula: Total time for dispensing drugs to a series of patients /

Total number of encounters
Percentage of prescribed medicines
actually dispensed

Purpose: To measure the degree to which

health facilities are able to provide the drugs
which are prescribed

Formula: 100 (Number of drugs dispensed /

Total number of drugs prescribed)
Percentage of prescribed medication that
are adequately labelled
Purpose: To measure the degree to which dispenser’s
record essential information on the drug package they
dispense

Formula: 100 (Number of drug packages containing at

least patient name, drug name and when the drug should
be taken / Total number of drug packages dispensed)
Percentage of patient knowledge of correct dosage

Purpose: To measure the effectiveness of the information

given to patient on the dosage schedule of the drugs they
received
Formula: 100 (Number of patients who can adequately
report the dosage schedule for all drugs / Total number of
patients interviewed)
CONCLUSION
Dispensing is one of the vital elements of the rational use
of medicines. Safe, clean and organized dispensing
environment provides a basis for good dispensing
practices. Dispensing process to go right or wrong depends
on the dispensing personnel. It is therefore dispensing staff
should be competent enough and well equipped with all the
knowledge needed for the dispensing process.
Thank you