Transcript Slide 1

Safe Dispensing in Doctors’ Office
Dr. TSOI Lai To,
BSc Pharm., M.D. (Canada)
FHKCFP, FRACGP
What does a pharmacist need
to learn?
Curriculum of a Bachelor Degree of
Pharmacy Programme
First Year of Attendance
 PHA1000
Introduction to Pharmacy 2
 PHA1110 Fundamentals of Organic Chemistry 2
 PHA1211, 1212 Dosage Form Science I, II 2 each
 PHA1311, 1312 Basic Dispensing Techniques I, II
3, 2
 PHA1421, 1422 Biochemistry/Biotechnology I, II 1, 3
 PHA1431, 1432 Anatomy/Physiology I, II 3 each
 PHA1440 Microbiology 1
Second Year of Attendance
 PHA2110
Medicinal Chemistry 3
 PHA2130 Pharmaceutical Analysis 3
 PHA2210 Dosage Form Science III 3
 PHA2220 Biopharmaceutics and Pharmacokinetics 2
 PHA2310 Pharmacy Practice I 3
 PHA2320 Pharmacy Law 2
 PHA2411, 2412 Pharmacology and Therapeutics I, II
3 each
 PHA2510 Pharmacognosy I 3
 PHA2710 Pharmaceutical Research Methods and
Techniques 2
Third Year of Attendance
 PHA3310
Pharmacy Practice II 3
 PHA3411, 3412 Pharmacology and Therapeutics III,
IV 3 each
 PHA3510 Pharmacognosy II 3
 PHA3611, 3612 Pharmacy Clerkship/Project I, II 3, 9
The 3 years all round and in depth training will
prepare the pharmacist to work in various
pharmaceutical disciplines such as retail
pharmacy, research pharmacy, industrial
pharmacy and hospital pharmacy.
Is it feasible or reasonable
to ask a Pharmacist equipped
with intensive training and
years of hard work, to work in
a doctor’s dispensary?
Functional Differences
Doctor’s dispensary
Retail pharmacy
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Dispensing
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One doctor
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Little administration
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Dispensing, OTC,
Professional advice
Unlimited number of
doctors
A lot of administration
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Ready made formulations
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Mixing/Compounding
Doctor’s dispensary
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Retail pharmacy
Education level
Done by clinic assistants,  Requires University level
learn dispensing by on
of training,
job training.
Bachelor degree of
pharmacy
Cost to run
Relatively low
 high
Variety of drugs
Simple, the choice of
 Complex, be prepared for
drugs lies on one
all kinds of prescriptions
doctor’s preference
from different doctors
Operation
Doctor’s dispensary
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Simple, direct and instant
communication with the
prescriber.
Directly supervised by
the prescriber himself
Retail pharmacy
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Complicated, prescriber
may not be available,
needs to identify forgery
and fraudulent
prescriptions, thefts.
Supervised by
pharmacists
It is quite clear that it is
neither practically feasible nor
reasonable to request a
pharmacist to work in a
doctor’s dispensary because
the years of hard work and in
depth training will be wasted.
It becomes necessary that we
have to manage our own
dispensaries without the help
of pharmacists.
How Do We Manage Our
Dispensary Safely?
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It is important to remember in any
dispensing process that the end product is
going to be used or taken by a person. It
is therefore important that the medicine is
of the highest achievable quality.
Good Pharmacological Knowledge
Watch out for the following:
Pharmacokinetic interactions
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Cytochrome enzymes inhibition(dilantin increases
effectiveness of coumadine) and induction(rifampicin
reduces effectiveness of coumadine)
Pharmacodynamic interactions
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Drug-drug enhanced adverse reactions(additive effect of
antihistamine and sedative)
Drug-disease – β-blockers causes more bronchospasm in
COPD
Drugs with severe adverse reactions
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Digoxin
Theophylline
Diuretics
Anticoagulants
ACEI inhibitors
Before reading the
prescription
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The environment of the dispensary should be
clean, tidy and organized.
The dispensing staff who works with a
dispensing bench cluttered with several
containers all containing different ingredients is
more likely to select the incorrect one.
Always check the ordered drugs carefully.
Doctors will be required to fax their request for
drugs to the drug firm from Jan 08.
Reading the Prescription
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The prescription must be read carefully. Many
medicines have very similar names but different
actions. Confusion may be fatal.
Methyldopa/ Levodopa, Diphenhydramine/
Dimenhydrinate, Dipyridamole/disopyramide,
Diamicron/Daricon/Dimethicone
Minocycline/Minipress
Reading the Prescription
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Check that the dosage and directions are
appropriate
Unusually high and low doses should be
queried with the prescriber although an
unusual dose may be prescribed quite
intentionally and may indeed be
underlined and endorsed in some other
way by the prescriber.
Before Dispensing the Medicine
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Check any calculations
Check the storage requirements.
Write the label – two main functions.
Identify the contents of the container.
Ensure clear and concise information.
Enable most effective and appropriate way
to use.
It should also be noted that provision of
an adequate label does not remove the
need to counsel the patient.
The Label
The name of the preparation (commonly
used name)
 Instructions for the patent:
the dosage, the route of administration
 The patient’s name
 The date of dispensing
 The name and address of the clinic
 Precautions where applicable
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Preparing the Medicine:
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Ensure that the dispensing bench is tidy and
clear from previous prescriptions in order to
reduce the risk of errors.
Select the correct medicine, taking care to
obtain the correct dosage form, strength
and size as applicable.
“Look-alike” Drugs
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Look-alike packaging
(both bulk bottles and unit-dose packages)
Flagyl (metronidazole)
Glucophage (metformin)
While preparing the Medicine
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Check the expiry date of the product.
An expiry date should always be used when
a product has been diluted, thereby
affecting the stability and shelf life.
An expiry date should always be indicated
when the preparation is sterile, it is
therefore recommended that eye drops and
eye ointment should be discarded 4 weeks
after opening.
Nitroglycerine tablets lose their efficacy
owing to the volatility of the active
ingredient, the tablets must be disposed of
8 weeks after the container is first opened.
Check the Finished Preparation:
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The label should be rechecked against the
prescription and the stock container. Double
checking system reduces errors to a
minimum.
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Double checking is important because:
A study of more than 1 million dispensed
items in British hospital identified 178
errors (0.018%).
The error rate was 0.01% when the
dispensing of pharmacists and technicians
was double-checked,compared with
0.035% when there was no double-check.
Spencer MG. A multicentre study of dispensing errors
in British Hospital. Int. J. Pharm Pract 1993; 2: 142-146
Counsel the Patient
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It is good practice to check the patient’s
name and address against that written on
the prescription before handing over the
medicine.
The dispenser may reinforce the
information given on the label and give
any necessary additional verbal advice or
information.
Is Safe Dispensing Important?
Because Medication Errors can
happen during
 Prescribing
 Dispensing
 Administering
Medical Mishaps Occur in All
Health Care Settings.
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In the United States, it is estimated that
7,000 deaths each year are caused by
medication errors.
In Australia, hospitals show that about 1%
of all admissions suffered adverse event
as a result of medication error.
Dispensing Errors
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Of 1,000 consecutive claims reported to
the Medical Protection Society from 1st
July 1996, 193 (19.3%) were associated
with medication and prescribing.
To Avoid Unnecessary
Accidents, we need to Practise
Safe Dispensing.
Source: Apple Daily (A17) 09-06-2005
Medication Errors Cause Serious
Consequences to
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Patients (physical harm; death)
Doctors (reputation; psychological harm;
liability in tort; professional misconduct;
criminal liability)
The Medical Profession (trust; relationship
between doctors and patients)
Errors do happen, we need to
Minimize the
Consequences of Error
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Encourage staff to report immediately if
anything goes wrong
Communicate with patients and allow
channels for enquiry and complaint
To Avoid Accidents, the
Following Rules May Help:
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Prescriptions should always be well written.
Keep the dispensing bench tidy, clean, and well
illuminated.
Keep medicines for external use in coloured
bottles.
Keep medicines in their original bottles as
much as possible, if not, always cross and
double check the procedure of transferring
from the original bottle to another
by a second personnel and that bottle should
be labeled with the generic name.
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Avoid mixing, especially in bulk.
Stay away from compounding or
extemporaneous dispensing.
Always use generic names to avoid confusion.
Perform 3 checks to help assure the dispensing
procedure is foolproof.
1.
2.
3.
While taking the bottle off the shelf check the label
carefully.
Once the prescription is filled, hand it over to
another personnel for checking.
Before handing it over to the patient, check again.
Thank You,
and have a nice
day.