Irrational Dispensing of Medicine
Session 17: Irrational Dispensing of Medicine
Total Session Time: 120 minutes
Prerequisites
None
Learning Tasks
By the end of this session students are expected to be able to:
Resources Needed:
SESSION OVERVIEW
|Step |Time |Activity/ |Content |
| | |Method | |
|1 |05 minutes |Presentation |Introduction, Learning Tasks |
|2 |10 minutes |Presentation |Definition of Irrational |
| | |Brainstorming |Dispensing |
|3 |55 minutes |Presentation |Irrational Dispensing Practices |
| | |Small Group | |
| | |Discussion | |
|4 |15 minutes |Presentation |Factors Contributing to |
| | | |Irrational Dispensing |
|5 |20 minutes |Presentation |Measures to Alleviate Irrational |
| | |Brainstorming |Dispensing |
|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 Irrational Dispensing (10 minutes)
|Activity: Brainstorming (5 minutes) |
| |
|Ask students to brainstorm on the following question: |
| |
|What is Irrational Dispensing? |
| |
|ALLOW few students to respond |
| |
|WRITE their responses on the flip chart/ board |
| |
|CLARIFY and SUMMARISE by using the content below |
occurring during the dispensing process in the pharmacy
o They are different from prescribing errors or errors during
consumption of medicine
STEP 3: Irrational Dispensing Practices (55 minutes)
|Activity: Small Group Discussion ( 20 minutes) |
| |
|DIVIDE students into small manageable groups |
| |
|ASK students to discuss on the following question |
| |
|What are the Different Practices of irrational dispensing observed |
|from Dispensers? |
| |
|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 |
information)
|Activity: Exercise ( 25 minutes) |
| |
|DIVIDE students into small manageable groups |
| |
|ASK students to Discuss and Comment on cases 17.1-17.3 below |
|Case 17.1 |
|Mary James, pharmacist, has filled some prescriptions for carbimazole|
|on one working day. On the same day a customer, epileptic patient, |
|presented him a prescription for carbamazepine. Glancing at it, Abebe|
|thinks it is carbimazole once again, and that is what he dispensed. |
|The patient went to his prescriber with complaints of no improvement.|
|Comment on this case. |
| |
|Discussion: Mary James, the pharmacist, failed to read and understand|
|the prescription correctly. This has led to failure of treatment |
|regimen prescribed for the epileptic patient. Because of the |
|existence of similarity with the names of some medicines, it is |
|important to read and understand the prescribed medicines carefully |
|and correctly. |
| |
|Case 17.2 |
|Frank Chacha, went to a medicine shop and made verbal request for |
|ampicillin and cough syrup for her 8 years old daughter with |
|complaints of cough and poor appetite. As she did not have enough |
|amount of money, she wanted to purchase only ten capsules of |
|ampicillin and one bottle of cough syrup suspension. The dispenser |
|fulfilled her request. Comment. |
| |
|Discussion: Frank chacha made a verbal request for a prescription |
|medicine (ampicillin) and an OTC cough syrup. The dispenser should |
|have asked her a prescription at least for ampicillin. Secondly, |
|dispensing inadequate quantity of ampicillin even with prescription |
|is irrational. Such clients should be referred to authorized |
|prescribers. prescription at least for ampicillin. Secondly, |
|dispensing inadequate quantity of ampicillin even with prescription |
|is irrational. Such clients should be referred to authorized |
|prescribers. |
| |
| |
| |
| |
|Case 17.3 |
|a pharmacy. The total quantity to be dispensed is not indicated. One |
|Tab. BID po for 4 weeks is written after Sig. All other information |
|tablets. Comment. |
|Discussion: The total quantity dispensed is not correct. According to|
|the prescription, 56 tablets (2 tablets a day for 4 weeks or 28 days)|
|should be dispensed. |
| |
|ALLOW students to discuss for 15 minutes |
| |
|ALLOW few groups to present and the rest to add points not mentioned|
| |
| |
|CLARIFY if there is any question. |
STEP 4: Factors Contributing to Irrational Dispensing (15 minutes)
The following are factors contributing to irrational dispensing practices:
o Incorrect interpretation of the prescription
o Inaccurate counting, compounding, or pouring
o Inadequate labeling
o Unsanitary procedures
o Packaging:
o Inadequate verbal instructions
o Inadequate counseling to encourage adherence
o Inadequate follow-up/support of patients
o Treatments or instructions that do not consider the consider the
patient’s beliefs, environment, or culture or culture
[pic][pic] Refer students to Handout 17.1: Factors contributing to
Irrational Dispensing
STEP 5: Measures to Alleviate Irrational Dispensing (20 minutes)
|Activity: Brainstorming (5 minutes) |
| |
|Ask students to brainstorm on the following question: |
| |
|What are the measures to alleviate irrational Dispensing? |
| |
|ALLOW few students to respond |
| |
|WRITE their responses on the flip chart/ board |
| |
|CLARIFY and SUMMARISE by using the content below |
policy
attitudes to carry out the dispensing process rationally. These includes
o Knowledge about the medicines being dispensed (common use, usual
dosage, precautions about the method of use, common side effects,
common interactions with other medicines or food, storage condition)
o Good calculation and arithmetic skills
o Skills in assessing the quality of preparations
o Attributes of cleanliness, accuracy and honesty
o Attitudes and skills required to communicate effectively with
patients,
o Sufficient training according to the level of the health institution
and medicine retail outlet
o Knowledge about national polices and working guidelines
o Good knowledge of societal norms and cultural values
o Good working relation with other health care professionals
o Good knowledge on medicine supply management
pharmacy, with the possible cause/reason for the error
o Try to work out systems/processes, to avoid such errors in future
o Essential information is missing or doubtful, and the prescriber
cannot be contacted
o Safety of the medicines is doubtful
o The prescription does not conform to legal requirements
STEP 6: Key Points (5 minutes)
occurring during the dispensing process in the pharmacy. Improper
attention, careless attitude while dispensing, not checking carefully
before dispensing are among the factors that contribute to irrational
dispensing
attitudes to carry out the dispensing process rationally
STEP 7: Evaluation (10 minutes)
Dispensers?
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
FMHACA of Ethiopia (2012). Manual for Medicine Good Dispensing practices.
(2nd ed.). Ethiopia
Rees, J. A., Smith, I., & Watson, J. Pharmaceutical practice (5th ed.).
London, United Kingdom: Churchill Livingstone
Management Sciences for Health (1988). Health Center Prescribing and Child
Survival in East Java and West Kalimantan, Indonesia. Boston: United States
of America
Quick, J.D., Foreman, P., Ross-Degnan, D., et al. Where Does the
Tetracycline Go?
Ross-Degnan, D., Laing, R.O., Quick, J,D., et al. (1992). Soc Sci and Med:A
strategy for promoting improved pharmaceutical use: The International
Network for Rational Use of Drugs. 35 (11) 1329–41.
Senya ,S. S, Mwasha, C.Y, Muyinga, A. M, Amiri,R. I. and Mauga E.A.S.K.
(2011) Tanzania Pharmaceutical Handbook ( 2nd ed. ) Dar eS Salaam,
Tanzania: School of Pharmaceutical Sciences
Vance, M.A., Millington, W.R., (1986). Int J Health Serv: Principles of
irrational drug therapy. 1986;16(3):355–61.
|[pic] |Handout 17.1 Factors Contributing to Irrational Dispensing |
[pic]
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