PST04101 Dispensing

NTA Level 4 • Semester 1 • PST04101 Dispensing – Complete Full Notes Complete educational source text in one page Completeness safeguard: this page keeps the complete educational module/source wording in one place so learning material is not lost when browsing topic by topic. Presenter/tutor metadata is intentionally excluded. | | UNITED REPUBLIC OF TANZANIA Ministry of Health, Community Development, Gender, Elderly and Children Facilitator Guide Copyright © Ministry of Health, Community Development, Gender, Elderly and Children – 2016 Table of Contents Background iv Acknowledgment v Introduction vii Abbreviations/Acronym ix Session 1: Introduction to Dispensing 1 Session 2: Medical Prescription 6 Session 3: Interpretation of Various Medical Symbols and Abbreviations in a Prescription 14 Session 4: Guidelines on Prescribing Medicines 29 Session 6: Prescriptions Errors 55 Session 7: Dispensing Procedures in Pharmacy 62 Session 8: Determining Quantities of Medicine for Dispensing 72 Session 9: Medicines Packaging Materials 87 Session 10: Medicines Label 96 Session 11: Generic and Brand Names of Medicines 105 Session 12: Giving Appropriate Medicine Information to Patients 111 Session 13: Adverse Drug Reactions, Drug Overdose and Intoxication 132 Session 14: Documentation of Medicines and Medical Supplies 141 Session 15: Rational Use of Medicines 152 Session 16: Irrational Prescribing of Medicines 158 Session 17: Irrational Dispensing of Medicines 166 Session 18: Sections in a Pharmacy Department 174 Background There is currently an ever increasing demand for pharmaceutical personnel in Tanzania. This is due to expanding investment in public and private pharmaceutical sector. Shortage of trained pharmaceutical human resource contributes to poor quality of pharmaceutical services and low access to medicines in the country (GIZ, 2012). Through Public-Private-Partnership (PPP) the Pharmacy Council (PC) together with Development Partners (DPs) in Germany and Pharmaceutical Training Institutions (PTIs) worked together to address the shortage of human resource for pharmacy by designing a project named “Supporting Training Institutions for Improved Pharmaceutical Services in Tanzania” in order to improve quality and capacity of PTIs in training, particularly of lower cadre pharmaceutical personnel. The Pharmacy Council formed a Steering committee that conducted a stakeholders workshop from18th – 22ndAugust 2014 in Morogoro to initiate the implementation of the project. Key activities in the implementation of this project included carrying out situational analysis, curriculum review and harmonization, development of training manual/facilitators guide, development of assessment plan, training of trainers and supportive supervision. After the curricula were reviwed and harmonized, the process of developing standardised training materials was started in August 2015 through Writer’s Workshop approach. The approach included two workshops (of two weeks each) for developing draft documents and a one-week workshop for reviewing, editing and formatting the sessions of the modules. The goals of writers workshops were to build capacity of tutors in the development of training materials and to develop high-quality, standardized teaching materials. The training package for pharmacy cadres includes a facilitator guide, assessment plan and practicum. There are 12 modules for NTA level 4 making 12 facilitator guides and one practicum guide. Acknowledgment The development of standardized training materials of a competence-based curriculum for pharmaceutical sciences has been accomplished through involvement of different stakeholders. Special thanks go to the Pharmacy Council for spearheading the harmonization of training materials in the pharmacy after noticing that training institutions in Tanzania were using different curricula and train their students differently. I would also like to extend my gratitude to St. Luke Foundation (SLF)/Kilimanjaro School of Pharmacy –Moshi for their tireless efforts to mobilize funds from development partners. Special thanks to John Snow Inc (JSI), Deutsche GesellschaftFür Internationale Zusammenarbeit (GIZ), Merck Kgaa, BoehringerIngelheimGmbhand Bayer Pharma Ag and action medeor.V for the financial and technical support. Particular thanks are due to those who led this important process to its completion, Mrs Stella M. Mpanda Director, Childbirth Survival Intenational, and Members from the secretariat of National Council for Technical Education (NACTE) for facilitating the process. Finally, I very much appreciate the contributions of the tutors and content experts representing PTIs, hospitals, and other health training institutions. Their participation in meetings and workshops, and their input in the development of this training manual/facilitators guide have been invaluable. These participants are listed with our gratitude below: Mr.Wilson Mlaki DSt. Luke Foundation/Kilimanjaro School of Pharmacy Mr.Samwel M. Zakayo- Pharmacy Council Ms. Ester A. Tuarira MUHAS Ms. Tumaini H. Lyombe MUHAS Ms. Dilisi J. Makawia KSP Ms. Julieth Koimerek KSP Rev. Baraka A.M. Kabudi MEMS Mr. Kelvin E. Mtanililwa Royal Pharmaceutical Training Institute Ms. Rose Bulilo CEDHA Ms. Diana H. Gamuya CEDHA Dr.Melkiory Masatu CEDHA Mr. Habel A. Habel City College of Health and Allied Sciences Ms. Zaina Msami Meru District Council Director of Human Resources Development Ministry of Health, Community Development, Gender, Elderly and Children Introduction Module Overview This module content is a guide for tutors of Pharmaceutical schools for training of students. The session contents are based on sub-enabling outcomes and their related tasks of the curriculum for Basic Technician Course in Pharmaceutical Sciences. The module sub-enabling outcomes and their related tasks are as indicated in the in the Basic Technician Certificate in Pharmaceutical Sciences (NTA Level 4) Curriculum Target Audience This module is intended for use primarily by tutors of pharmaceutical schools. The module’s sessions give guidance on the time, activities and provide information on how to teach the session. The sessions include different activities which focus on increasing students’ knowledge, skills and attitudes. Organization of the Module The module consists of eighteen (18) sessions; each session is divided into several parts as indicated below: • Session Title: The name of the session • Total Session Time: The estimated time for teaching the session, indicated in minutes • Pre-requisites: A module or session which needs to be covered before teaching the session. • Learning Tasks: Statements which indicate what the student is expected to learn by the end of the session • Resources Needed: All resources needed for the session are listed including handouts and worksheets • Session Overview: The session overview box lists the steps, time for each step, the activity or method used in each step and

NTA Level 4 • Semester 1 • PST04101 Determining Quantities of Medicine for Dispensing Dispensing • Source Session/Topic 8 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 8: Determining Quantities of Medicine for Dispensing Total Session Time: 120 minutes + 1 hours Assignment Prerequisites • Session 1, 5 and 6 Learning Tasks By the end of this session students are expected to be able to: • Interpret Information in the Prescription for Medicine Quantities for Dispensing • Determine Quantities of Tablets/Capsules to be Dispensed • Determine Eye/Ear/Nasal Preparations to be Dispensed • Determine Quantities of Injectable Medicine to be Dispensed • Determine Quantities of Ointment/cream to be Dispensed • Determine Quantities of Syrup to be Dispensed Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board, chalk and whiteboard markers • Worksheet 8.1: Determine quantities of tablets and capsules to be dispensed • Worksheet 8.2: Determine eye/ear/nasal preparations to be dispensed • Worksheet 8.3: Determine quantities of injectable medicine to be dispensed • Worksheet 8.4: Determine quantities of ointment and cream to be dispensed • Worksheet 8.5: Determine quantities of syrup and solution to be dispensed SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 |10 minutes |Presentation |Interpretation of Information for | | | | |Medicine Quantities to be Dispensed | |3 |20 minutes |Presentation |Quantities of Tablet and Capsule to | | | |Case study |be Dispensed | |4 |20 minutes |Presentation |Quantities of Eye/Ear/Nasal | | | |Case study |Preparations to be Dispensed | |5 |20 minutes |Presentation |Quantities of Injectable Medicines | | | |Case study |to be Dispensed | |6 |20 minutes |Presentation |Quantities of Ointment/Cream to be | | | |Case study |Dispensed | |7 |15 minutes |Presentation |Quantities of Syrup to be Dispensed | | | |Case study | | |8 |05 minutes |Presentation |Key Points | |9 |05 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. STEP 2: Interpretations of Information in the Prescription for Medicine Quantities to be Dispensed (10 minutes) • Whenever a dispenser is required to dispense medicines, make sure always to; • Identifying different information which provides information about medicines to be dispensed • Interpret of information of the prescriber so you can get quantities of medicine to be dispensed • Example: In a certain prescription of a specific patient the following medicines were prescribed: |Paracetamol tabs 1g tds x 5/7 | |Amoxicillin caps 500mg tds x 5/7 | Interpretation: • One Paracetamol tablet has a dosage strength of 500mg, so 1g means 2 tablets of Paracetamol o Thus calculation is 2 tablets x 3 times a day x 5 days = 30 tablets of Paracetamol o Therefore the patient will receive 30 tablets of Paracetamol • One Amoxicillin capsule has dosage strength of 250mg, so 500mg means 2 capsules o Thus 2 tablets of Amoxicillin x 3 times a day x 5 days = 30 tablets of Amoxicillin o Therefore the patient will receive 30 capsules of Amoxicillin STEP 3: Quantities of Drug to be Dispensed – Tablets and Capsules (20 minutes) |Activity: Case Study (15 minutes) | | | |DIVIDE students into small manageable groups. | | | |[pic]REFER students to Worksheet 8.1: Calculating quantities of tablets| |and capsules | | | |READ or ASK one student to read the scenario in the worksheet and | |CLARIFY | | | |ASK all groups to answer the three questions in the worksheet for 15 | |minutes. | | | |ALLOW few groups to present and the rest to add on points not | |mentioned | | | |CLARIFY and SUMMARIZE by using the content below | The Calculations • A Paracetamol tablet has dosage strength of 500mg, so 1g means 2 tablets of Paracetamol o One unit of Paracetamol tablet means one tablet, thus calculation for the total quantity Paracetamol tablets is 2 tablets x 3 times a day x 5 days = 30 tablets of paracetamol o Thus dispense total of 30 tablets of paracetamol • Ampiclox capsule has strength of 500mg, so 500mg means 1 capsule o One unit of Ampliclox capsule means one capsule. o Thus total quantity of Ampiclox Capsules to be dispensed is: 1 tablets x 3 times a day x 5 days = 15 capsules o Therefore dispense a total of 15 capsules of Ampiclox Capsules STEP 4: Calculation of Quantities of Drug to be Dispensed – Ear and Eye Preparations (20 minutes) |Activity: Case Study (15 minutes) | | | |DIVIDE students into small manageable groups. | |[pic]REFER students to Worksheet 8.2: Calculating quantities of ear and| |eye preparations | | | | | |READ or ASK one student to read the scenario in the worksheet and | |CLARIFY | | | |ASK all groups to answer the three questions in the worksheet for 15 | |minutes. | | | |ALLOW few groups to present and the rest to add points not mentioned | | | |CLARIFY and SUMMARIZE by using the content below | • Information given: Prednisolone Eye drops 0.5% is available in 5ml bottle and assume 20 drops in 1ml Calculation for Prednisolone: o Firstly calculate total number of drops of prednisolone needed in 14 days as follows: 1drop x 4 times a day x 14 days = 56 drops o Then calculate number of mLs containing 56 drops of prednisolone Iml = 20 drops ? mls = 56 drops = 56 drops/20drops x 1 ml = 2.8mls o Dispense one bottle of 5mls of prednisolone. ▪ The patient should discard the remained prednisolone (2.2mls) after finishing the dose required (2.8ml) • Information given: Sodium Cromoglycate 2% is available in 5ml bottle.

NTA Level 4 • Semester 1 • PST04101 Dispensing Procedures in Pharmacy Dispensing • Source Session/Topic 7 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 7: Dispensing Procedures in Pharmacy Total Session Time: 120 minutes Prerequisites • Session 1 Learning Tasks By the end of this session students are expected to be able to: • Define dispensing, dispenser, medicine and good dispensing procedures • Explain good dispensing procedures • Demonstrate good dispensing procedures Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board, chalk, and whiteboard markers • Worksheet 7.1: Demonstration on Good Dispensing Procedures • Worksheet 7.2: Sample Prescription Serial No. 001 SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 |10 minutes |Presentation |Definition of Dispensing, Dispenser, | | | | |Medicine and Good Dispensing | | | | |Procedures | |3 |35 minutes |Presentation |Good Dispensing Procedures | | | |Brainstorming | | |4 |60 minutes |Presentation |Demonstration of Good Dispensing | | | |Role play |Procedures | |5 |05minutes |Presentation |Key Points | |6 |05 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. Step 2: Define Dispensing, Dispenser, Medicine and Good Dispensing Procedures (10 minutes) • Dispensing: The act of preparing medicines and/or medical supplies and distributing to users with adequate information, counseling and appropriate follow up • Dispenser: Any person who is licensed or authorized by the appropriate body to dispense medicines and/or medical supplies • Medicine: Any substance or mixture of substances used in the diagnosis, treatment, mitigation or prevention of a disease in human o Medicines include narcotic drugs, psychotropic substances and precursor chemicals, traditional medicines, complementary or alternative medicine; poisons, blood and blood products, vaccine, radioactive pharmaceuticals, cosmetics and sanitary items and medical instruments • Good Dispensing Procedures: 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 STEP 3: Good Dispensing Procedures (35 minutes) |Activity: Brainstorming (5 minutes) | | | |Ask students to brainstorm on the following question: | | | |What procedures to follow in Good Dispensing? | | | |ALLOW few students to respond? | | | |WRITE their responses on the flip chart/ board | | | |CLARIFY and SUMMARISE by using the content below | Dispensing Procedures • Procedure 1: Evaluation and interpretation of a prescription In this step a dispenser should do the following after welcoming and greeting the patient; o Make sure that all important parts of the prescription are correct and complete (refer session 1) o Arrange prescriptions in order so as to prevent possibility of confusion o Dispenser should have knowledge of transcribing the prescription o Make sure that the name of the medicine, dose, dosage, duration are correct o The prescription should be in writing or typed but must be signed by the prescriber in ink • Procedure 2: Selection and handling of the medicine. This includes: o Select stock container of pre-pack reading the label and cross matching the medicine name and strength against the prescription o Read the container label at least twice during the dispensing process. o Do not select the prescribed medicine according to the color or location of container o Do not open many stock containers at the same time ▪ This trend will lead to errors and/or expose the medicines to air and eventually leads to deterioration in quality o Open and close containers once at a time o While counting, pouring or measuring, the following points should be noted: ▪ Short and/or over counting should be avoided ▪ Clean counting tray and/or spoon used ▪ Graduated measuring cylinder and/or flask must be used for measuring liquid reduction ▪ If small volume is to be measured, small measuring cylinder/flask has to be used (if compounding is performed in the pharmacy) provide appropriate bottles with caps for repackaging liquid preparations o Dispense liquid preparations in suitable container ▪ Do not use patient’s own bottle ▪ Dispense each medicine in a different bottle In dispensing tablets and capsules: • Do not use fingers to count tablets as this can lead to contamination of medicines • Use a spoon to put tablets and capsules onto a counting tray • Count and put them in a labeled medicine container or pack • Close stock containers tightly after dispensing • Keep the spoon clean at all times • Do not keep the spoon inside the container • Labeling of dispensed medicines should be clear and legible • Use separate plastic boxes for different patient's requirements of medicines • To avoid mix-ups of medicines of different patients, it is a good procedure to assemble medicines of different patients in separate/different boxes, till they are billed and packed • Procedure 3: Labeling and packaging of the medicine in an appropriate container o The containers used for dispensing must be appropriate for the product dispensed o All containers intended for medicinal products must be protected and kept free from contamination o Medicines must be suitably contained, protected and labeled from the time of manufacture until they are used by the patient o The container must maintain the quality, safety and stability of the medicine throughout this period • Procedure 4: The provision of information and instruction to client o All medicines should be dispensed with adequate and appropriate information and counseling. Information must be structured to meet the needs of individual patients and questions and answers should be used to check the patient understands. o Written information should be provided to supplement verbal communication as appropriate. ▪ Counseling should

NTA Level 4 • Semester 1 • PST04101 Prescription Errors Dispensing • Source Session/Topic 6 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 6: Prescription Errors Total Session Time: 120 minutes + 1 hour assignment Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • Define prescription error • List common prescription errors • Identify common prescriptions errors Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board chalk, and whiteboard markers • Worksheet 6.1: Prescription Errors SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 |10minutes |Presentation |Definition of Prescription Error | | | |Brainstorming | | |3 |30 minutes |Presentation |Common Prescription Errors | | | |Buzzing | | |4 |60minutes |Presentation |Identification of Common | | | |Small Group |Prescription Errors | | | |Discussion | | |5 |05 minutes |Presentation |Key Points | |6 |05 minutes |Presentation |Evaluation | |7 |05 minutes |Presentation |Assignment | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning Tasks and clarify ASK students if they have any questions before continuing. STEP 2: Definition of Prescription Errors (10 minutes) |Activity: Brainstorming (5 minutes) | | | |Ask students to brainstorm on the following question: | | | |What is a prescription error? | | | |ALLOW few students to respond | | | |WRITE their responses on the flip chart/ board | | | |CLARIFY and SUMMARISE by using the content below | • Prescription errors encompass those related to the act of writing a prescription • Prescribing faults encompass irrational prescribing, inappropriate prescribing, under prescribing, overprescribing, and ineffective prescribing o These faults arise from erroneous medical judgement or decisions concerning treatment or treatment monitoring STEP 3: Common Prescription Errors (30 minutes) |Activity: Buzzing (5 minutes) | | | |ASK students to pair up and buzz on the following question for 5 | |minutes | | | |What are the common Prescription Errors? | | | |ALLOW few pairs to respond and let other pairs to add on points not | |mentioned | | | |WRITE their response on the flip chart/board | | | |CLARIFY and SUMMARIZE by using the content below | The following are the common prescription errors: • Omission error • Wrong dose error • Extra dose error • Wrong dose form error • Wrong time error • Wrong drug • Wrong route of administration • Wrong frequency • Wrong duration of treatment, • Poor legibility of handwriting (unknown abbreviations) • Unintended omissions • Incomplete Medical Prescription (If any component of a Medical Prescription is not filled) STEP 4: Identification of Common Prescription Errors (60 minutes) |Activity: Small Group Discussion ( 40 minutes) | | | |DIVIDE students into small manageable groups | | | |ASK students to discuss on the following question | | | |What are the errors in the provided prescriptions? | |[pic]REFER students to Worksheet 6.1 Prescription Errors SERIAL No. | |001-005 | | | |ALLOW students to discuss for 15 minutes | | | |ALLOW few groups to present and the rest to add points not mentioned | | | |CLARIFY and SUMMARIZE by using the contents below | Students should be able to identify the following Prescription errors: • Serial No.001 o Incomplete name of the patient o No signature o Duration of medicine missing (erythromycin) o Wrong frequency of paracetamol • Serial No. 002 o Name of the institution is not known o Strength of paracetamol is not known o Prescriber’s name is missing • Serial No.003 o Age of the patient is missing o Polypharmacy- no need to dispense two analgesics (paracetamol and aspirin) o Atenolol strength is not 5.0 but there is 50 mg or 100 mg, mistake in writing • Serial No.004 o Sex is not indicated (gender) o Doxycycline and magnesium should not be given together, they interact each other o Magnesium strength is not shown • Serial No.005 o No date o Tetracycline Bd ×2/52 o Wrong medicine for the indication i.e. amoebiasis is treated with Nitronidazole (Metronidazole, Ttinidazole, Secnidazole) o Medicine does not tell the dosage form i.e. is it tablet, ointment capsule. o Drug name should be generic and not trade name (Tulizamol should be written as Paracetamol) STEP 5: Key Points (5 minutes) • Medication errors are common in general practice and in hospitals. • Both errors in the act of writing (prescription errors) and prescribing faults due to erroneous medical decisions can result in harm to patients • Any step in the prescribing process can generate errors • Inadequate knowledge or competence and incomplete information about clinical characteristics and previous treatment of individual patients can result in prescribing faults, including the use of potentially inappropriate medications STEP 5: Evaluation (5 minutes) • What are prescription errors? • What are the common prescription errors? References Cornish, P.L, Knowles, S.R, Marchesano, R, Tam, V, Shadowitz, S, Juurlink, DN, Etchells, E, E. (2005). Arch Intern Med: Unintended medication discrepancies at the time of hospital admission. 2005;165:424–9. Dean, B., Schachter, M., Vincent, C, Barber, N (202). Lancet: Causes of prescribing errors in hospital inpatients: a prospective study. 359:1373–8. Dean, B., Vincent, C, Schachter, M., Barber, N (2005). Drug Saf:The incidence of prescribing errors in hospital inpatients: an overview of the research methods.. 28:891–900. Knudsen, P., Herborg, H., Mortensen, A,R., Knudsen, M., Hellebek, A .(2007). Qual Saf Health Care:Preventing medication errors in community pharmacy: root-cause analysis of transcription errors. 16:285–290. Lesar, T.S., Briceland, L., Stein, D, S. (1997). JAMA:Factors related to errors in medication prescribing.. 277:312–317. Spinewine, A., Schmader, K,E., Barber, N., Hughes, C., Lapane, K,L., Swine, C., Hanlon, J,T. (2007). Lancet: Appropriate prescribing in elderly people: how well can it be measured and optimised? 370:173–184. Tam, V,C., Knowles,

NTA Level 4 • Semester 1 • PST04101 Policies and Guidelines on Prescribing Medicines Dispensing • Source Session/Topic 5 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 5: Policies and Guidelines on Prescribing Medicines Total Session Time: 120 minutes Prerequisites • No Learning Tasks By the end of this session students are expected to be able to: • Define Essential Medicine and Essential Medicine List • Identify Hospital Formulary • Explain Tanzania National Formulary(TNF) • Distinguish between British National Formulary(BNF) and WHO Model formulary Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board, chalk, and whiteboard markers • Handout 4.1 NEMLIST SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 |20 minutes |Presentation |Essential Medicine, Essential | | | |Brainstorming |Medicine List | |3 |30 minutes |Presentation |Hospital Formulary | | | |Buzzing | | |4 |20 minutes |Presentation |Tanzania National Formulary(TNF) | | | |Brainstorming | | |5 |30 minutes |Presentation |British National Formulary(BNF) and | | | | |WHO Model Formulary | |6 |05 minutes |Presentation |Key Points | |7 |10 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. STEP 2: Definition of Essential Medicine and Essential Medicine List (20 minutes) |Activity: Brainstorming (5 minutes) | | | |Ask students to brainstorm on the following questions: | | | |What are the essential medicines? | |What is Essential Medicine List? | | | |ALLOW few students to respond | | | |WRITE their responses on the flip chart/ board | | | |CLARIFY and SUMMARISE by using the content below | Essential medicines • Are medicines that satisfy the priority health care needs of the population o They are selected with due regard to public health relevance, evidence on efficacy and safety, and comparative cost-effectiveness o Are intended to be available within the context of functioning health systems ▪ at all times in adequate amounts ▪ in the appropriate dosage forms ▪ with assured quality and adequate information ▪ at a price the individual and the community can afford The essential medicine list • Is the list that gives information of medicines on the name, route of administration, pharmaceutical forms and strength and indicates the lowest level of health facility where the medicine may be available o It aims to identify cost-effective medicines for priority conditions, together with the reasons for their inclusion, linked to evidence- based clinical guidelines and with special emphasis on public health aspects and considerations of value of money. [pic]REFER Students to Handout 5.1: Essential Medicine List STEP 3: Hospital Formulary (30 minutes) |Activity: Buzzing (5 minutes) | | | |ASK students to pair up and buzz on the following question for 2 | |minutes | | | |What is Hospital Formulary? | | | |ALLOW few pairs to respond and let other pairs to add on points not | |mentioned | | | |WRITE their response on the flip chart/board | | | |CLARIFY and SUMMARIZE by using the content below | The Hospital Medicine Formulary • A list consisting of the most cost-effective, safe, readily available medicines of assured quality that will satisfy the health care needs of the majority of the patients in the hospital. • Formularies cover all the categories of medicines that patients needs o Constantly revised and updated to make sure that patients receive appropriate medications • Before a medicine is added to or removed from the formulary, teams of pharmacists, physicians and other healthcare professionals in the hospital do evaluation to make sure that they are safe, work well and are cost-effective • These formularies can differ from one institution/hospital to another STEP 4: Tanzania National Formulary (TNF) (20 minutes) |Activity: Brainstorming (5 minutes) | | | |Ask students to brainstorm on the following question: | | | |What is Tanzania National Formulary? | | | |ALLOW few students to respond | | | |WRITE their responses on the flip chart/ board | | | |CLARIFY and SUMMARISE by using the content below | • Tanzania National Formulary provide guidelines which promote safe, rational, economic and effective use of medicines in the United Republic of Tanzania o Concentrates on medicines listed in the NEMLIST and STG o Users are therefore encouraged to use both books together as they complement one another STEP 5: British National Formulary (BNF) and WHO Model Formulary (30minutes) British National Formulary (BNF) • Is a pharmaceutical reference book that contains a wide spectrum of information and advice on prescribing and pharmacology, along with specific facts and details about many medicines • It is written by Royal Pharmaceutical Society of Great Britain together with the British Medical Association and it is used in many countries including Tanzania as a reference book. • It reflects current best practice as well as legal and professional guidelines relating to the uses of medicines. Contents include: o Guidance on the drug management of common conditions o Details of medicines with special reference to their uses, cautions, contra-indications, side-effects, doses, and relative costs ▪ Guidance on prescribing, monitoring, dispensing, and administering medicines WHO Model Formulary • Since its first publication in 2002, the WHO Model Formulary has become a source of independent information on essential medicines for pharmaceutical policy-makers and prescribers worldwide. • For each medicine, the Formulary provides information on use, dosage, adverse effects, contraindications and warnings, supplemented by guidance on selecting the right medicine for a range of conditions STEP 6: Key Points (5 minutes) • Essential medicines list aims at providing medicines informations of common disease in the country based on efficacy, safety and cost- effectiveness. • Since prescribers and dispensers are encouraged to prescribe/dispense medicines only when they are

NTA Level 4 • Semester 1 • PST04101 Guidelines on Prescribing Medicines Dispensing • Source Session/Topic 4 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 4: Guidelines on Prescribing Medicines Total Session Time: 120 minutes Prerequisites • None Students Learning Tasks By the end of this session students are expected to be able to: • Define Standard Treatment Guideline (STG) • Explain the Importance of STG • Describe Categories of Athorized Prescribers Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board, chalk and whiteboard markers SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 |05 minutes |Presentation |Standard Treatment Guideline (STG) | |3 |30 minutes |Presentation |Importance of STG | | | |Brainstorming | | |4 |60 minutes |Presentation |Categories of Authorized Prescribers | | | |Small Group | | | | |Discussion | | |5 |10 minutes |Presentation |Key Points | |6 |10 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. STEP 2: Introduction to Standard Treatment Guideline (STG) (5 minutes) Standard Treatment Guideline • STGs may be defined as ‘systematically developed statements to help practitioners or prescribers make decisions about appropriate treatments for specific clinical conditions’ • STGs or treatment protocols are a proven, effective strategy to promote appropriate prescribing, when used in conjunction with educational strategies to promote their use • As a minimum, they should contain information on clinical features, diagnostic criteria, non-drug and drug treatments (first-, second-, third-line) and referral criteria STEP 3: Importance of Standard Treatment Guidelines (30 minutes) |Activity: Brainstorming (5 minutes) | | | |Ask students to brainstorm on the following question: | | | |What is the importance of Standard Treatment Guidelines? | | | |ALLOW few students to respond | | | |WRITE their responses on the flip chart/ board | | | |CLARIFY and SUMMARISE by using the content below | Standard Treatment Guidelines are very useful in: • Providing guidance to health professionals on the diagnosis and treatment of specific clinical conditions • Orienting new staff about accepted norms in treatment • Providing prescribers with justification for prescribing • Providing a reference point by which to judge the quality of prescribing • Aiding efficient estimation of drug needs and setting priorities for procuring and stocking drugs STEP 4: Categories of Authorized Prescribers (60 minutes) |Activity: Small Group Discussion ( 40 minutes) | | | |DIVIDE students into manageable groups | | | |ASK students to discuss in groups on the following question: | | | |Who are the authorized prescribers? | | | |ALLOW students to discuss for 20 minutes | | | |ALLOW each groups to present | | | |CLARIFY and SUMMARIZE by using the contents below | The following are the authorized prescribers: • Assistant Clinical Officer Dispensaries • Clinical Officer Dispensaries, Health Centers • Assistant Dental Officer Health Centers, District Hospital • Dental Officer District Hospital, Regional Referral Hospital • Assistant Medical Officer Health Centers, District Hospital, Regional Referral Hospital • Medical Officer Health Center, District Hospital, Regional Referral Hospital • Specialists Regional Hospital, Zonal referral Hospitals, National and specialized Hospitals STEP 5: Key Points (10 minutes) • Standard Treatment Guidelines is defined as ‘systematically developed statements to help practitioners or prescribers make decisions about appropriate treatments for specific clinical conditions o Provide guidance to health professionals on the diagnosis and treatment of specific clinical conditions STEP 6: Evaluation (10 minutes) • What is STG? • What is the importance of STG? • Who are the authorized prescribers? References GoT (1998). Tanzania National Formulary (1st ed.). Dar es salaam, Tanzania: MOHSW. GoT (2013). Standard Treatment Guidelines& National Essential Medicines List Tanzania MainLand ( 4th ed). Dar-es-salaam, Tanzania: MOHSW. GoT (2014-2019). Staffing Levels for Ministry of Health and Social Welfare Departments, Health Service Facilities, Heath Training Institutions and Agencies. (Revised). Dar es salaam, Tanzania: MOHSW. ← Previous TopicNext Topic →View all Dispensing topicsOpen Complete Full Notes PDF / OFFLINE NOTES Unataka kutumiwa notes hizi kupitia WhatsApp?Kwa notes zilizopangiliwa vizuri kwa kusoma offline au PDF, bonyeza kitufe hapa chini. Ujumbe wenye Level, Semester, Module na Topic utaandaliwa moja kwa moja.TUMIWA NOTES WHATSAPP WhatsApp: 255620339260

NTA Level 4 • Semester 1 • PST04101 Interpretation of Various Medical Symbols and Abbreviations in a Prescription Dispensing • Source Session/Topic 3 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 3: Interpretation of Various Medical Symbols and Abbreviations in a Prescription Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • Explain the Overview of Prescription Abbreviations and Symbols • Describe Various Medical Symbols and Abbreviations • Interpret Different Medical Symbols and Abbreviations from Filled Prescriptions Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board chalk and whiteboard markers • Handout 3.1: Master List of Prescription Abbreviations • Worksheet 3.1: Sample Filled Prescription Forms Serial No. 001-005 SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 |15 minutes |Presentation |Overview of Prescription Abbreviations | |3 |30 minutes |Buzzing |Various Medical Symbols and | | | |Presentation |Abbreviations | |4 |60 minutes |Small Group |Different Medical Symbols and | | | |Discussion |Abbreviations of Filled Prescriptions | | | |Presentation | | |5 |05 minutes |Presentation |Key Points | |6 |05 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. STEP 2: Overview of Prescription Symbols and Abbreviation (15 minutes) • Abbreviations are shortened form of a word or name that is used in place of the full word or name • A symbol is a thing that represents or stands for something else, especially a material object representing something abstract • These abbreviations and symbols are Latin terms and they usually indicate the route of drug administration and the frequency of dosing • These abbreviations should be understood by the dispensers and are internationally recognised • In every prescription, prescribers use different medical abbreviations to order medication to a patient STEP 3: Various Medical Abbreviations (30 minutes) |Activity: Buzzing (5minutes) | | | |ASK students to pair up and buzz on the following question for 3 | |minutes | | | |What are the common medical symbols and abbreviations used in | |prescription writing? | | | |ALLOW few pairs to respond on the question and let other pairs add on | |points not mentioned WRITE their response on the flip chart/board | | | |CLARIFY and SUMMARIZE by using the content below | Table 1: Abbreviations and Symbols for Frequency of Dosing | | | | | |Symbols |Definition | |Abbreviatio| | | | |n | |I |One | |o.d. |once a day | |Ii |Two | |b.i.d. |twice a day | |Iii |Three | |t.i.d. |three times a | | | | | |day | |Iv |Four | |q.i.d. |four times a | | | | | |day | |5X |five times | |q.h.s. |everynight at | | |a day | | |bedtime | |Rx |Take this | | | | | | | |q.4h |every four | | | | | |hours | | | | |q.6h |every six | | | | | |hours | | | | |q.o.d |every other | | | | | |hour | | | | |Prn |as needed | | | | |gtt. |Drop | | | | |a.c. |before meals | | | | |p.c. |after meals | Table 2: Abbreviations for Route of Drug Administration |Abbreviation |Interpretation | |p.o. |By mouth, orally (per oral) | |SL |Sublingual, under the tongue | |ID |Intradermal | |IM |Intramuscular | |IV |Intravenous | |IV PB |Intravenous piggyback | |SC |Subcutaneous. | |GT |Gastrostomy tube | |NJ |Naso-jejunal tube | |p.r |Per rectum | |p.v |Per vagina | |O.D (RE) |Right eye | |O.S (LE) |Left eye | |O.U BE) |Both eyes | |A.D |Right ear | |A.S |Left ear | |A.U |Both ears | STEP 4: Interpreting Medical Abbreviations of Filled Prescriptions (60 minutes) |Activity: Small Group Discussion ( 20 minutes) | | | |DIVIDE students into small manageable groups | | | |PROVIDE 5 different Sample Filled Prescription Forms to each group | | | |ASK students to discuss on the following question | | | |What are the interpretations of the abbreviations on the Sample | |Prescription Forms? | |REFER Students to Worksheet 3.1: Sample filled Prescriptions Forms | |Serial No. 001-005 | | | |ALLOW students to discuss for 15 minutes | | | |ALLOW few groups to present and the rest to add points not mentioned | | | |CLARIFY and SUMMARIZE by using Master List of Prescription | |Abbreviations Handout | STEP 5: Key Points (5 minutes) • Abbreviations in the prescriptions have been drawn from Greek and Latin words. It is important to understand the interpretations of abbreviations used in the prescription before dispensing • In every prescription, prescribers use different medical abbreviations to order medicines to a patient STEP 6: Evaluation (5 minutes) • What are the most common used abbreviations in medical prescriptions? References Bentley, A. O., & Rawlins, E. A. (1977). Bentley's textbook of pharmaceutics (8th ed.). London, United Kingdom: Bailliere Tindall. Cooper, J. W., Gunn, C., & Carter, S. J. (2008). Cooper and Gunn's dispensing for pharmaceutical students (12th ed.). New Delhi, India: CBS. Rees, J. A., Smith, I., & Watson, J. Pharmaceutical practice (5th ed.). London, United Kingdom: Churchill Livingstone Medical Terminology Abbreviations. Retrieved from http://www.delmarlearning.com/companions/content/1401852467/student_resource s/termabbrev.pdf. Master List of Prescription Abbreviations. Every Patient’s Advocate. Retrieved from http://www.everypatientsadvocate.com/columns/prescriptionabbreviations. pdf. |[pic] |Handout 3.1: Master List of Prescription Abbreviations | |Abbreviation |From the Latin |Meaning | |Aa |Ana |of each | |Ad |Ad |up to | |a.c |ante cibum |before meals | |a.d |aurio dextra |right ear | |ad lib |ad libitum |use as much as one desires; freely | |admov |Admove

NTA Level 4 • Semester 1 • PST04101 Medical Prescription Dispensing • Source Session/Topic 2 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 2: Medical Prescription Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • Define a Medical Prescription • List Parts of a Medical Prescription • Identify Features of Different Parts of a Medical Prescription Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board, chalk and /whiteboard markers • Handout 2.1: Sample of a Filled Medical Prescription SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 |05 minutes |Presentation |Definition of a Medical | | | | |Prescription | |3 |50 minutes |Presentation |Parts of a Medical Prescription | | | |Small Group Discussion| | |4 | 50 minutes |Presentation |Features of Different Parts of a | | | |Small Group Discussion|Medical Prescription | |5 |05 minutes |Presentation |Key Points | |6 |05 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. STEP 2: Definition of Medical Prescription (5 minutes) Medical Prescription • A legal written order from a qualified prescriber to a qualified dispenser which contains instructions to dispense or compound and administer specified medicines to a clearly mentioned patient Or • It is an order for medication issued by a physician, dentist or other properly licensed medical practitioner o A prescription designate specific medication and dosage to be prepared by a pharmacist/pharmaceutical technician and administered to a particular patient o A medical prescription can be printed or written in ink Categories of a Medical Prescription • Those written for single component or prefabricated products and not requiring compounding or mixing by the pharmacist/pharmaceutical technician • Those written for more than a single component and requiring compounding [pic] Fig 2.1: Sample Prescriptions STEP 3: Parts of a Medical Prescription (50 minutes) |Activity: Small Group Discussion ( 30 minutes) | | | |DIVIDE students into small manageable groups | | | |ASK students to discuss on the following question | | | |What are the Parts of a Medical Prescription? | | | |ALLOW students to discuss for 30 minutes | | | |ALLOW few groups to present and the rest to add points not mentioned | | | |CLARIFY and SUMMARIZE by using the contents below | The following are parts of a Medical Prescription: • Name of the institution/health facility • Prescriber information and signature • Patient information • Date prescription was written • The superscription (Rx symbol) • Inscription (medication prescribed) • The subscription (dispensing instruction to the pharmaceutical personnel) • Transcription/ Signatura (Direction to the patient) [pic] Figure 2.2: Sample of Filled Medical Prescription [pic][pic] Refer students to Handout 2.1: Sample of a filled Medical Prescription STEP 4: Features of Different Parts of a Medical Prescription (50 minutes) |Activity: Small Group Discussion ( 30 minutes) | | | |DIVIDE students into small manageable groups | | | |[pic] ASK students to discuss on the following question | |What are the features of different parts of a Medical Prescription? | | | |[pic] Refer students to Handout 2.1: Sample of a Filled Medical | |Prescription | | | |ALLOW students to discuss for 15 minutes | | | |ALLOW few groups to present and the rest to add points not mentioned | | | |CLARIFY and SUMMARIZE by using the contents below | The following are features of different parts of a medical prescription: • Name of the institution/ health facility o Full address of the institution • Prescriber’s information and signature o Name, address and signature of the prescriber together with professional qualification. (ACO, CO, AMO, MD or DS etc) written and signed in indelible/permanent ink • Patient information o Patient information which includes the patient full name, address, hospital registration number, sex, age and /or body weight of the patient • Date prescription was written o The date prescription was written showing day, month and year • The superscription (Rx symbol) o Consists of the heading where the symbol Rx (an abbreviation for recipe, the Latin for ‘take thou’) is found o The Rx symbol comes before the inscription • Inscription o Is also called the body of the prescription o Provides the names and quantities of the chief ingredients of the prescription to be dispensed o The dose/strength and dosage form, such as tablet, suspension, capsule, syrup is found • The subscription (dispensing instruction to the pharmaceutical personnel) o This gives specific directions for the pharmaceutical personnel on how to compound the medication o These directions to the pharmaceutical personnel are usually expressed in Latin or may consist of a short sentence such as: "make a solution," "mix and place into 10 capsules” or "dispense 10 tablets" • Transcription o This gives instructions to the patient for use: ▪ On how to take the drug; route by which the drug is to be administered. ▪ How much, how many times per day (frequency of administration), when and how long the drug is to be taken ▪ These instructions are preceded by the symbol “S” or “Sig.” from the Latin, meaning "mark." Or “Label” ▪ Also may contain special instructions, warnings considered important for the patient STEP 5: Key Points (5 minutes) • A medical prescription should be clearly written for easy reading and to prevent unnecessary mistakes in interpretation o If not written clearly, check with the prescriber and never guess • Not all medications require prescriptions. There are certain medications on the market that can be purchased over the counter, thus their name Over-the-Counter drugs (OTC) STEP 6: Evaluation (5 minutes) •

NTA Level 4 • Semester 1 • PST04101 Introduction to Dispensing Dispensing • Source Session/Topic 1 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 1: Introduction to Dispensing Total Session Time: 60 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • Define Dispensing, Dispenser and Medicines • Describe Importance of Dispensing in Pharmacy Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board, chalk and whiteboard markers SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 |15 minutes |Buzzing |Definition of Dispensing, | | | |Presentation |Dispenser and Medicine | |3 |30 minutes |Presentation |Importance of Dispensing in | | | |Small Group Discussion|Pharmacy | |4 |05 minutes |Presentation |Key Points | |5 |05 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning Tasks and clarify ASK students if they have any questions before continuing. STEP 2: Definition of Dispensing, Dispenser and Medicine (5 minutes) |Activity: Brainstorming (5 minutes) | | | |Ask students to brainstorm on the following question: | | | |What is Dispensing, Dispenser, Medicine? | | | |ALLOW few students to respond? | | | |WRITE their responses on the flip chart/ board | | | |CLARIFY and SUMMARISE by using the content below | Dispensing: The act of preparing medicines and/or medical supplies and distributing to users with adequate information, counseling and appropriate follow up Dispensing involves: • Receiving and Interpretation of prescription from prescriber • The preparation, packaging, labeling, record keeping, and transfer of a pre scription drug to a patient or an intermediary, who is responsible for administration of the drug • Dispensing includes; o The preparation and transfer of a medication to a client o Taking steps to ensure the pharmaceutical and therapeutic suitability of the medication for its intended use, o Taking steps to ensure its proper use of medicines o It may also include accepting payment for a medication on behalf of a nurse's employer. • Dispensing occurs when the medications are given to a client • Dispenser: Any person who is licensed or authorized by the appropriate body to dispense medicines and/or medical supplies • Medicine: Any substance or mixture of substances used in the diagnosis, treatment, mitigation or prevention of a disease in human o Medicines include narcotic drugs, psychotropic substances and precursor chemicals, traditional medicines, complementary or alternative medicine; poisons, blood and blood products, vaccine, radioactive pharmaceuticals, cosmetics and sanitary items and medical instruments STEP 3: Importance of Dispensing (30 minutes) |Activity: Small Group Discussion ( 15 minutes) | | | |DIVIDE students into small manageable groups | | | |ASK students to discuss on the following question | | | |What are the importance of dispensing? | | | |ALLOW students to discuss for 15 minutes | | | |ALLOW few groups to present and the rest to add points not mentioned | | | |CLARIFY and SUMMARIZE by using the contents below | The following are importance of dispensing: • Ensure patient receives; o Correct medicine, o Crrect amount of medicines o Correct dose and dosage o At lower cost • Patient receives proper information of his/her medicine • Improves patient compliance to their medications • As a subject (module) in pharmaceutical dispensing course, it ensures student is equipped with knowledge, understanding, attitude and skills necessary for dispensing practices STEP 4: Key Points (5 minutes) • Dispensing refers to the process of preparing and giving medicines to a named person on the basis of prescription • Dispensing involves the correct interpretation of the wishes of the prescriber and the accurate preparation and labelling of medicine for use by th patient • Dispensing process may take place in a public or private clinic, health center, hospital or community pharmacy setting • Dispensing is carried out by pharmacists, pharmaceutical technicians, nurses, pharmaceutical assistants and medicine dispensers STEP 5: Evaluation (5 minutes) • What is dispensing? • What are the importance of dispensing? References Ansel, H. C. (2012). Pharmaceutical Calculations (14th ed.). Philadelfia,United States of America: LWW. . Bentley, A. O., & Rawlins, E. A. (1977). Bentley's textbook of pharmaceutics (8th ed.). London, United Kingdom: Bailliere Tindall. Cooper, J. W., Gunn, C., & Carter, S. J. (2008). Cooper and Gunn's dispensing for pharmaceutical students (12th ed.). New Delhi, India: CBS. Rees, J. A., Smith, I., & Watson, J. Pharmaceutical practice (5th ed.). London, United Kingdom: Churchill Livingstone Next Topic →View all Dispensing topicsOpen Complete Full Notes PDF / OFFLINE NOTES Unataka kutumiwa notes hizi kupitia WhatsApp?Kwa notes zilizopangiliwa vizuri kwa kusoma offline au PDF, bonyeza kitufe hapa chini. Ujumbe wenye Level, Semester, Module na Topic utaandaliwa moja kwa moja.TUMIWA NOTES WHATSAPP WhatsApp: 255620339260