NTA Level 5 • Semester 1 • PST05105

Introduction to Rational use of Medicines

Rational Use of Medicines • Source Session/Topic 1

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Session 1: Introduction to Rational use of Medicines

Total Session Time: 120minutes

Prerequisites

None

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board and chalk/whiteboard markers

• Figure 1.1: The cycle of rational medicine use

Learning Tasks

By the end of this session students are expected to be able to:

• Give introduction of rational use of medicines

• Define common terms in rational use of medicines.

• Identify characteristics of medical prescription

• Outline six steps of rational prescribing.

• Describe avoidable mistakes in prescribing.

• Describe how to promote rational use of medicines.

• Explain criteria for assessing rational drug use

SESSION OVERVIEW

| | | |Use |

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (05 Minutes)

READ or ASK students to read the learning objectives and clarify

ASK students if they have any questions before continuing.

STEP 2: Introduction to Rational Use of Medicines(15 Minutes)

• The rational use of drugs requires that Patients receive medications

appropriate to their clinical needs, in doses that meet their own

individual requirements, for an adequate period of time, and at the

lowest cost to them and their community.

• It focuses on four important aspects of the rational use of medicines:

correct medication, correct dose, correct duration of treatment and

correct cost, irrational use occurs when one or more of these conditions

are not met.

• Rational use of medicine has three components and they are

o Availability of essential medicines

o Access and affordability of medicines

o Rationality of prescription

• In public health service system, free access of low cost medicine to all

patient is an important element in ensuring implementation of rational drug

use guidelines

• Rational Use of Medicines has several importance such as:

o Reducing the incidences of drug resistance

o Improving patience adherence to medicines

o Reducing unnecessary cost of drug acquisition

o Reducing incidences of treatment failure

o Reducing the incidences of drug adverse reaction

STEP 3: Definitions of common terms in Rational Use of Medicines.(20

Minutes)

• Irrational use of medicines

• Rational prescribing

• Irrational prescribing

• Rational dispensing

• Irrational dispensing

• Brand or trade name

• Generic name

• Adherence to treatment (compliance)

• Expirations date

• Shelf life

• International nonproprietary name (INN)

• Labeling

• Prescription

• Irrational or non-rational use of medicines:

o This is s the use of medicines in a way that is not compliant with

rational use of medicines.

• Rational Prescribing:

o The process in which the prescriber make accurate diagnosis of the

condition, selects the most suitable medication from those

available, prescribes the medicine in the right dosage for a

sufficient length of time according to the standard treatment

guidelines.

• Irrational Prescribing:

o Prescribing that does not conform to good standards of treatment

–for example, extravagant prescribing, overprescribing, incorrect

prescribing, and multiple prescribing or under prescribing.

• Rational dispense:

o To prepare and distribute/supply to a patient a course of therapy

with appropriate instructions, on the basis of prescription.

• Irrational dispensing;

o The preparation and distribution of a course of therapy to a

patient, without appropriate instructions, based on a prescription.

• Brand or Trade Name;

o This is a name given to a drug product by its manufacturer.

• Generic Name;

o A generic name is the unique INN given to the active ingredients of

a drug and is recognized worldwide.

• Adherence to treatment (Compliance);

o The degree to which patients adhere/comply to medical advice and

take medicines as directed.

• Expiration Date;

o The date after which the manufacturer can no longer guarantee the

stability, safety and potency of a drug.

• Shelf Life;

o The length of time a drug may be stored without affecting its

stability, safety, purity or potency.

• International Nonproprietary Name (INN);

o Internationally recognized name for a chemical entity.

• Labeling;

o Placing written or symbolic instructions on the immediate container

in which drugs are dispensed.

• Prescription;

o A set of instructions written by a qualified or authorized

prescriber to a dispenser for supply of drugs and provision of

information to the patient.

STEP4 : Characteristics of Medical Prescription (15 Minutes)

|Activity: Buzzing (05 Minutes) |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

|What are the characteristics of medical prescription? |

| |

|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 |

Characteristics of medical prescriptions:

• Prescriptions should promote the rational use of drugs.

• Prescription should be written after a diagnosis or a health problem has

been identified.

• The prescription will present the necessary drugs and measures sufficient

to heal or improve the state of the patient.

• The prescription must contain all necessary information clearly written.

STEP 5: Avoidable Mistakes in Medical Prescribing.(10minutes)

• Prescribing multiple drugs

• Prescribing to keep up with the latest fashion

• Prescribing an older drug out of habit

• Prescribing in order to satisfy the expectations of the patient

• Prescribing out of pressure from drug companies, other prescribers or

media.

STEP 4: Steps to Improve Rational Drug Prescribing (15 Minutes)

|Activity: Brainstorming (05 Minutes) |

|Ask students to brainstorm on the following question: |

|What are thesteps to improve rational drug prescribing? |

|ALLOW few students to respond? |

|WRITE their responses on the flip chart/ board |

|CLARIFY and SUMMARISE by using the content below |

Steps to improve rational drug prescribing:

• Identify the patient’s problem based on symptoms & recognize the need for

action.

• Diagnosis of the disease. Identify underlying cause & motivating factors.

This may be specific as in infectious disease or nonspecific.

• List possible intervention or treatment. This may be non-drug treatment

or drug treatment. Drug must be chosen from different alternatives based

on efficacy, convenience & safety of drugs including, drug inter-actions

&high risk group of patients.

• Start the treatment by writing an accurate and complete prescription e.g.

name of drugs with dosage forms, dosage schedule and total duration of

the treatment.

• Given proper information instruction and warning regarding the treatment

given e.g. side effects (ADR), dosage schedule and dangers/risk of

stopping the therapy suddenly.

• Monitor the treatment to check, if the particular treatment has solved

the patient’s problem. It may be:

o Passive monitoring – done by the patient himself. Explain to him what

to do if the treatment is not effective or if too many side effect

occurs

o Active monitoring _ done by physician or pharmaceutical personnel they

make an appointment to check the response of the treatment.

STEP 7: Promoting Rational Use of Medicines. (25 minutes)

The following are the strategies of promoting rational use of medicines

• Rational prescribing

• Rational dispensing

• Use of calibrated and graduated equipment and apparatus to improve

rational use of medicines.

Rational prescribing;

The following steps will ensure rational prescribing:

• Define the patient’s problems by doing thorough diagnosis

• Specify the therapeutic objective, Identify a suitable drug

• Write a prescription as per standard treatment guidelines

• Give the patient proper instruction and warning

• Monitor and (stop) the treatment

• Better training of practitioner’s in pharmacology and therapeutics,

• Regular supervision of auxiliaries,

• The availability of current drug information through reference manuals

and drug news periodicals,

• More active involvement of hospital and regional drug committees,

• Prescribing and dispensing restrictions,

• The promotion of cost consciousness among prescribers.

Rational dispensing

• Dispensing is a process of supplying drug(s) to a patient.

• The process requires adequate knowledge, skill and a caring attitude.

• Careful dispensing is an important component in managing drug supplies

because it is the last step which ensures that the patient has received

the right drug.

• Steps necessary for rational dispensing are:

o Approach patient cordially and receive the prescription

o Analyze prescription

o Calculate required quantities for each drug to be dispensed

o Dispense right quantity for each drug

o Check if right medicines are dispensed

o Label each dispensed medicine adequately

o Counter check dispensed medicines

o Counsel patient on medication use

o Retain prescription for records

Use of calibrated and graduated equipment and apparatus to improve rational

use of medicines

• The use of appropriate equipment and apparatus for drug dispensing and

administration will improve the rational use of medicines.

• These apparatus include those that enable correct measures of medicines

to be dispensed and/or administered. E.g. graduated measuring cylinders

of different capacities made of glass or plastic,

• Measuring spoons calibrated to dispense specified volumes e.g. 2.5ml,

5ml, 10ml, etc

• Tablet counters to enhance counting accuracy and prevent contamination

Figure 1.1: The cycle of rational medicine use[pic]

Illustration of the above cycle

• Diagnosis/follow up: It emphasizes the need for prescribers to follow a

standard process of prescribing, which starts with a diagnosis to define

the problem that requires intervention.

• Prescribing: The prescriber must decide which treatment is required,

based on up-to-date drug and therapeutics information, to achieve the

desired goal for an individual patient.

• Dispensing: Pharmaceutical personnel should dispense to the patient the

prescribed medicines in safe and hygienic manner

• Patient adherence: Making sure that the patient understands the dosage

and course of therapy then the patient takes the drug. Patient use the

medicines according to the instruction from prescriber and pharmaceutical

personnel.

STEP 6: Criteria for Assessing Rational Drug Use (10 minutes)

Rational drug use can be assessed by using the following criteria:

• Appropriate dose that is, the correct dose is given;

• appropriate indication, that is, the reason to prescribe is based on

sound medical considerations;

• Appropriate drug that is, considering efficacy, safety, suitability for

the patient, and cost.

• Correct dosage that is, with the correct administration, and for the

correct duration of treatment;

• Appropriate patient that is, no contraindications exist, and the

likelihood of adverse reactions is minimal;

• Correctly dispensed drug to the patient that is, including appropriate

information for patients about the prescribed medicines

• Adherence or compliance that is, patient use the drug accordingly

STEP 7: Key Points (05 minutes)

• The aim of any medicine management system is to deliver the right

medicine to the patient who needs the medicine.

• The steps of selection, procurement, and distribution are necessary

precursors to the rational use of medicines.

• It implies the selection of an appropriate drug for the correct

patient, given in the correct dose, dosage form, route, frequency and

duration.

• The patient must also receive appropriate instructions on how to use

the drugs.

STEP 8: Evaluation (05 minutes)

• Define rational use of drug.

• listcharacteristics of medical prescription

• What are the steps to improve rational drug prescribing?

References:

Rees, J. A., Smith, I., & Watson, (2012) J. Pharmaceutical practice (5th

ed.). London, United Kingdom: Churchill Livingstone

GoT (2013). Standard Treatment Guidelines&National Essential Medicines List

Tanzania MainLand ( 4th ed). Dar-es-salaam, Tanzania: MOHSW.

Hogerzeil HV.(1995). Promoting rational drug use: an international

perspective. 8. Br J Clin Pharmac; 39: 1-6.

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