Drug Dispensing Practices: Dr. Dinesh Kumar Meena, Pharm.D

DRUG DISPENSING PRACTICES
Dr. Dinesh Kumar Meena, Pharm.D

Ph.D. Scholar
Department of Pharmacology
JIPMER
CONTENTS
1. Introduction
2. The dispenser
3. Qualities of good drug dispenser
4. Dispensing environment
5. Dispensing process
6. Dispensing errors
7. Strategies to minimize dispensing errors
8. Investigating drug dispensing practices
9. Conclusion
INTRODUCTION
Dispensing refers to
“process of preparing medicines and distributing them to users

with provision of an appropriate information, counselling and
follow-up”
• All the resources involved in patient care prior to dispensing
may be wasted if dispensing does not result in the delivery of
medicines in an effective form.
• Dispensing is one of the vital elements of the rational use of

medicines.
• Good dispensing practice ensures that the right medicines at
desired quantity are delivered to the right patient with the
right dose, strength, frequency, dosage form together with
clear instructions with appropriate packaging and
counselling.
• Staff dispensing medicines should be trained and equipped

with the technical knowledge and skills necessary to dispense
medicines and communicate patient effectively.
THE DISPENSER
• Dispenser is any person who is licensed or authorized by the

professional body to dispense medicines or medical supplies.
• Since the dispenser is often the last person to see the patient
before the medicine is used, it is important that the dispensing
process be efficient, as it affects medicine use.
• In India, pharmacy should be managed under the overall
supervision of pharmacist
• Pharmacist working in the pharmacy should:
1. Hold at least Diploma in pharmacy and preferably a

degree in pharmacy.
2. Be registered as a pharmacist with the pharmacy council

of state in which he is practicing.
3. Have undergone adequate practical training in a

community pharmacy.
4. Undergone in house training as per the organization’s staff
training policy.
5. Have a communication skills and capabilities to give

adequate and proper advise to the patients on appropriate use
of medicines, illness etc. to achieve optimal patient
compliance
QUALITIES OF GOOD DRUG DISPENSER
• Good knowledge about medicines.
• Good calculation and arithmetic skills
• Skills in assessing the quality of prescriptions
• Attitudes and skills required to communicate effectively with

patients
• Knowledge about relation with other health care professionals

• Respect to pharmacy law and professions code of ethics
• Good knowledge on medicine supply management
• Knowledge on quality assurance of services
• Good clinical knowledge

DISPENSING ENVIRONMENT
Good dispensing environment includes following:
• Staff
• Physical surrounding
• Equipments and other facilities

Staff:
Staff members involved in dispensing must maintain good

personal hygiene. and should wear a neat apron. All
pharmacists should wear a badge displaying their name and the
word “pharmacist”.
Physical surrounding:
The physical surrounding must be kept clean and dust free.

Dispensary should be designed so that access to dispensary
area should restricted to only authorized persons
Equipments and materials:
Pharmacy should have all the equipments required to perform
dispensing process. All the equipments should be kept clean
and should check for cleanliness prior to each use.
Pharmacy should have:

• A dispensing bench or dispensing counter
• Tablets or capsule counter
• A refrigerator equipped with a maximum/minimum
thermometer
• Range of dispensing container for pharmaceutical products
• Adequate shelves or lockable cabinets
• Reference material
• Patient information leaflets
• Some basic instruments like sphygmomanometer, glucometer,

stethoscope, weight and height scale
DRUG DISPENSING PROCESS
RECEIVE AND VALIDATE THE PRESCRIPTION
UNDERSTAND AND INTERPRET THE PRESCRIPTION
SELECT AND LABEL MEDICINE FOR ISSUE

MAKE A FINAL CHECK
RECORD THE ACTION TAKEN
ISSUE MEDICINES TO THE PATIENT WITH

CLEAR INSTRUCTION AND ADVICE
Receive and validate the prescription
Pharmacist should ensure that prescription should have
following information:
• Patient information: name, age and ID of patient
• Rx symbol in the upper left corner
• Name, strength, dose form, frequency, route of

administration and duration of treatment.
• Any additional instructions for the pharmacist regarding
preparation and supply of medicine.
• Refill instructions (in case of long term therapy)
• Name and signature of prescriber

Understand and interpret the prescription
• Correctly interpret any abbreviations used by the prescriber
• Confirm dose, frequency and duration of each medicine
• Confirm that the doses prescribed are in the normal range for the
patient
• Correctly perform any calculations of dose and quantity to be

issued
• Identify any common drug-drug interactions and contraindications.

Selecting the medicines:
An appropriate system should be established for selecting the

medicines to prevent any medication error.
•Double check should be done to ensure that correct medicine is
selected.
•Check the expiry date of dispensed medicines to ensure that they
remain unexpired for the duration of supply course.
•Choose the oldest stock (first-in/first-out)
• Tablets/capsules should not be removed from the
strips/blisters when dispensing
• Medicines which need to be packed should be packed into a

clean, dry container or plastic envelop which will not
compromise the quality of the product after dispensing
Labelling of medicine
Label should include following information:

• Patient name
• Generic name, strength and dose form of the medicine
• Frequency and duration
• Quantity of medicine dispensed
• How to take medicine
• Storage conditions
Counter checking
It can be done as a self-check but it is valuable to have final
check done by other staff member
The countercheck should include:
• Reading and interpreting the prescription without looking at

medicines dispensed.
• Checking the appropriateness of doses prescribed.
• Checking for drug interaction

• Checking the medicines dispensed
• Checking the label
• Finally counter signing the prescription

Record the action taken
Following details of the medicines should be recorded:

• Date of dispensing
• Patient details like name, age and sex
• Medicine name
• Strength
• Amount issued
• Dispenser’s name
Issue medicine to the patient with clear instruction and
advice
Tell name and indication of medicine Tell how many times and when to refill
Tell route and frequency of each Emphasize benefits of the medicine

medicine
Tell how long to take medicine Discuss major side effects of medicine
Ask for any allergy Discuss drug-drug, drug-food, drug-disease and

drug-herb interaction
Tailor medicine to daily regimen Discuss precautions and measure to be taken to
improve treatment outcomes.
Ask if patient have any problem in taking Discuss storage recommendations
medicine
Tell how long it will take for the Demonstrate and provide adequate information
medicine to show an effect about special dosage forms
Educate techniques for self monitoring Ask patient to repeat key information to check his
understanding
DISPENSING ERRORS
Dispensing error are errors that can occur at any stage of

dispensing process
Dispensing error can be defined as any discrepancy between a

prescription and the medicine that pharmacist deliver to the
patient
Types of dispensing errors
Dispensing medicines to the wrong patient
Dispensing the wrong medicine to the patient
Dispensing the wrong drug strength
Dispensing at the wrong time
Dispensing the wrong dosage form
Dispensing an expired medicine
Omission ( failure to dispense )
Dispensing of medicine of inferior quality
Dispensing an incorrectly compounded medicine
Dispensing with the wrong information on label
Dispensing with wrong verbal information to the patients

STRATEGIES TO MINIMIZE DISPENSING ERRORS
• Confirm that prescription is complete and correct: check

the prescription for its completeness and correctness
• Name of the drug: One-third of dispensing errors are due to

similar drug names
Amantadine Amioderone
Amiloride Amlodepine
Amoxicillin Amphotericin
Betamethasone Beclomethasone
Bupropion Buspirone
Indocin Lincocin
Methadone Methylphenidate
Abbreviations
Misinterpretation of abbreviations is common cause of
dispensing errors
AD, AS, AU (right ear, left ear, each OD, OS, OU (right eye, left eye, each
ear) eye)
qod (every other day) qd (daily), qid (4 times a day)
Trailing Zero (1.0mg) 1.0 mg mistaken as 10 mg
Naked decimal points (.5mg) .5 mg mistaken as 5 mg
Drug name and dose run together Mistaken as Inderal 140 mg
(Inderal40)
AZT (zidovudine) Mistaken as azathiopurine or
azetreonam
• Workplace
• Distraction on work place
• Workload
• Patient education
INVESTIGATING DRUG DISPENSING PRACTICES
Quality indicators: Good drug dispensing guidelines of WHO

recommended following indicators to investigate drug dispensing
practices:
1. Average dispensing communication time
2. Percentage of prescribed items actually dispensed
3. Percentage of prescribed medication that are adequately

labelled
4. Patient knowledge provided to patient

Average dispensing communication time
Purpose:
To measure the average time that personnel dispensing drugs

spend with patient.
Formula:
Total time for dispensing drugs to a series of patients
Total number of encounters

Percentage of prescribed medicines actually dispensed
Purpose:
To measure the degree to which health facilities are able to

provide the drugs which are prescribed
Formula:
Number of drugs dispensed
×100
Total number of drugs prescribed
Percentage of prescribed medication that are adequately labelled
Purpose:
To measure the degree to which dispenser’s record essential

information on the drug package they dispense
Formula:
Number of drug packages containing at least patient name, drug name
and when the drug should be taken
×100
Total number of drug packages dispensed
Percentage of patient knowledge of correct dosage
Purpose:
To measure the effectiveness of the information given to patient

on the dosage schedule of the drugs they received
Formula:
Number of patients who can adequately report the dosage schedule
for all drugs
×100
Total number of patients interviewed
CONCLUSION
Dispensing is one of the vital elements of the rational use of

medicines. Safe, clean and organized dispensing environment
provides a basis for good dispensing practices. Dispensing process to
go right or wrong depends on the dispensing personnel. It is therefore
dispensing staff should be competent enough and well equipped with
all the knowledge needed for the dispensing process.
Thank You

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DRUG DISPENSING PRACTICES

Dr. Dinesh Kumar Meena, Pharm.D

3. Qualities of good drug dispenser

7. Strategies to minimize dispensing errors

8. Investigating drug dispensing practices

“process of preparing medicines and distributing them to users

• Dispensing is one of the vital elements of the rational use of

• Staff dispensing medicines should be trained and equipped

• Dispenser is any person who is licensed or authorized by the

• Pharmacist working in the pharmacy should:

1. Hold at least Diploma in pharmacy and preferably a

2. Be registered as a pharmacist with the pharmacy council

3. Have undergone adequate practical training in a

5. Have a communication skills and capabilities to give

• Good knowledge about medicines.

• Good calculation and arithmetic skills

• Skills in assessing the quality of prescriptions

• Attitudes and skills required to communicate effectively with

• Knowledge about relation with other health care professionals

• Good knowledge on medicine supply management

• Knowledge on quality assurance of services

• Good clinical knowledge

Good dispensing environment includes following:

• Equipments and other facilities

Staff members involved in dispensing must maintain good

The physical surrounding must be kept clean and dust free.

Pharmacy should have:

• Adequate shelves or lockable cabinets

• Patient information leaflets

• Some basic instruments like sphygmomanometer, glucometer,

RECEIVE AND VALIDATE THE PRESCRIPTION

UNDERSTAND AND INTERPRET THE PRESCRIPTION

SELECT AND LABEL MEDICINE FOR ISSUE

RECORD THE ACTION TAKEN

ISSUE MEDICINES TO THE PATIENT WITH

• Patient information: name, age and ID of patient

• Rx symbol in the upper left corner

• Name, strength, dose form, frequency, route of

• Refill instructions (in case of long term therapy)

• Name and signature of prescriber

• Correctly interpret any abbreviations used by the prescriber

• Confirm dose, frequency and duration of each medicine

• Correctly perform any calculations of dose and quantity to be

• Identify any common drug-drug interactions and contraindications.

An appropriate system should be established for selecting the

• Medicines which need to be packed should be packed into a

Label should include following information:

• Generic name, strength and dose form of the medicine

• Frequency and duration

• Quantity of medicine dispensed

• How to take medicine

The countercheck should include:

• Reading and interpreting the prescription without looking at

• Checking the appropriateness of doses prescribed.

• Checking for drug interaction

• Checking the label

• Finally counter signing the prescription

Following details of the medicines should be recorded:

• Patient details like name, age and sex