GOOD DISPENSING PRACTICE (GDP)

Shyam K. AdhikariDepartment of Drug Administration

DISPENSING Dispensing is an important

part of the practice of pharmacy, in which the dispenser interprets the physician's requirements on the prescription and accordingly supplies medicines for the treatment of his patient (s).

This usually involves interpreting a written prescription but may, on occasions, also include taking instructions given by word of mouth or by telephone from the physician.

Activities involved in DispensingThe various activities involved in Dispensing are:

Dispensing modulesDispensing environment

Prescription Counter Waiting Area Requirements of a good

dispensing environment Barriers, noise and distractions

that can affect dispensing Handling of Prescriptions

Receiving the prescription Reading the prescription and checking for

Legality Legibility Completeness and correctness

Processing a prescription Filling a prescription

Removal of medicines from shelves. Assembling of medicines. Billing. Packing.

Refilling a prescriptionOther aspects of dispensing

Dispensing errors Role of dispensers in promoting correct

dispensing Refusal to dispense prescriptions Alternatives to conventional prescriptions.

Dispensing Environment

Prescription counterIdeally 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

Dispensing Environment

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.

Dispensing EnvironmentWaiting areaAn 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.)

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.

Contd…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

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.

Why Good Dispensing EnvironmentWorking 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.

Handling PrescriptionReceiving the Prescription 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 .

Upon receiving the prescription, the pharmacist should confirm( i) Whether the client is the patient himself or has

come on the patient's behalf. (ii) The relation of the client with the patient.

The client may politely be requested to wait, while the pharmacist reviews the prescription for:

1. Legality and completeness of prescription. 2. Therapeutic aspects 3. Appropriateness for the individual .

Reading the Prescription and Checking for Completeness and Correctness

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.

Parts of the PrescriptionSuperscription :

The 'Rx' symbol is called the superscription. It is used as an abbreviation of the Latin word recipe,

which means, “Take thou” or “you take”. Inscription:

Inscription is the part of the prescription that comprises of a list of medicines and their strengths. E.g.

Daonil 5 mg, Novamox 250 mg. Subscription :

This part of the prescription consists of directions given to the dispenser with respect to the dosage form and the number of dosage units/quantity to be supplied. E.g. Tab. Calcium ---- (50) [Means dispense 50 tablets of calcium] Liq Digene--------1 bottle

Parts of the PrescriptionSignatura :

Signatura refers to the directions given by the doctor to the patient.

In this portion, the physician indicates to the patient, how he/she should take the prescribed medicine/s.

The directions are usually written using abbreviated forms of English and Latin. E.g., 1 tds means take one tablet thrice a day.

Signature of the doctor : The signature of the doctor in his own handwriting

is essential to mark the legality of the prescription.

Parts of the PrescriptionRefill information:

In certain cases, a single course of therapy may not be sufficient for effective treatment of the patient.

Under such circumstances, the physician may decide to repeat the course of therapy, and indicate the same on the prescription.

This information is called refill information.

LegibilityHandwritten names of patients and

medicines are often difficult to read. In case of illegibility of name, age, etc, ask

the patient for the correct spelling tactfully.Legibility is a problem requiring alertness

and critical judgment on the part of the pharmacist.

Careless handwriting and similarity in spelling of names of different drugs add to the difficulty.

Example of a Reading errorMetriz and Metrix Due to illegible handwriting of doctors, Metriz could

be read as Metrix. Metriz is a brand containing Metronidazole whereas Metrix contains Glucosamide two different drugs used for two different conditions.

When handwriting is illegible, the best thing to do is to contact the physician over the phone and confirm.

Remember, you are dealing with medicines and thus, the lives of patients so be sure of what you are dispensing.

Imagine the disastrous consequences of dispensing the wrong medicine ‘NEVER DISPENSE GUESS WORK’ .

Examples of confusing namesAZT (Azithromycin) Vs AGT

(Tinidazole)Alspan (Hyoscine Butylbromide) Vs

Alpan (Loratidine)Metlong (Metforming) Vs Metlog

(Metoprolol)Itop (Itopride HCl) Vs Metop

(Metoprolol)Aceclo (Aceclofen) Vs Seclo

(Omeprazole)T-zine (Cetrizine HCl) Vs Tizan

(Tizanidin)

Completeness and correctness The prescription serves as a vehicle for

communication from the licensed practitioner to the dispenser about the pharmaceutical care of the patient.

Details to be checked for i) Physician's details. ii) Patient's details. iii) Check the product details Checking the product

details will include checking : Name of the product. Dosage form. Strength/ potency of the medicine. Total amount to be dispensed and its availability. Dosage and directions for use. Frequency of administration.

Thank You