First Time Dispensing

Introduction

When you see a fresh provisional registered pharmacist doing his or her first-time dispensing, you will soon realise

  • Their dispensing could be inefficient, error-prone and not well-organised.
  • The anxiety and inexperience when facing questions from patients, hence the lack of confidence.
  • There could also be a pseudo-language barrier when a non-Malay pharmacist trying to counsel medications in lay man Malay term (i.e. They face difficulty in expressing themselves).
  • They could be too focus on checking medications and prescription at hands, instead of having a live conversation with patients in front. There might be body language of patients that doubtful.

Nonetheless, the answer to all these possible situations is practice makes perfect (after observing how seniors do dispensing and handle difficult situations).

NOTE: If you are not able to convey the knowledge in your brain to patients, it means little to your patient.



OSCE

Objective structured clinical examination (OSCE) is a trend in pharmacy education.

  • By practicing through stimulated scenarios, it prepares us for the demands of our future work.
  • Certainly, it also helps to evaluate clinical competence and communication skills among pharmacy students.

I still remember, in the first OSCE in university years, we are required to identify the potential barriers in medication counselling, such as



Guide to Dispensing

Here is a quick format of dispensing at hospital outpatient pharmacy.
  • Quickly go through the medication lists on the prescription and identify any potential issues.
    • Are the medication dose and frequency sound reasonable?
    • Are there any indications of medication with which you are not familiar? If yes, please quickly check it up.
    • Are the quantities of medications prepared sufficient?
  • Make sure you are dispensing to the right patient - Start off by asking patient's name.
  • When encountering medications such as antibiotics and NSAIDs, please clarify if patients have any drug allergy history?
  • Start to dispense the medication according to the sequence written in prescription, instead of a random sequence. This is especially important for prescriptions with long medications list.
  • Counsel patients on indication, dose, frequency, and important things to take note (e.g. prandial advice, adverse effects and monitoring parameter).
  • If there is any doubt, please clarify with senior pharmacists.
  • If the medications are only partially supplied, write the follow-up pharmacy supply date at the back of prescription and inform the date to the patient. Next, pass back the presription to the patient for subsequent collection.
  • End the conversation with "Is there anything that you would like to clarify?"

Again, the key here is not to understand the steps by heart, but to practice them in daily work as if it is a second nature.



Few More Rules to Know

Subjected to Ministry of Health Medicines Formulary (MOHMF) prescriber category and facility policy (i.e. the closed formulary), there are medications which can only be prescribed by certain consultant or discipline.

All prescriptions should fulfil the requirements listed in Section 21 of Poisons Act 1952, Regulation 11 of Poisons (Psychotropic Substances) Regulations 1989 and Regulation 11 of Dangerous Drugs Act 1952 and Regulations.

  • Doctors should write a separate memo (NOT on government prescriptions) if patients have to buy certain medications at private community pharmacy.
Maximum duration of prescriptions is 6 months only from the date of prescription written. Due to COVID-19 pandemic, the maximum duration of prescriptions at government hospitals is extended to 1 year (prescriptions at government clinic remains 6 months).

As per Jadual Pelupusan Rekod Perubatan 2016, all medical records (including fully dispensed prescription) have to be kept for 2 years before proper disposal.

Medication supply to foreigners at government facilities is only limited to 5-day supply for non-communicable disease. Full supply of medication is only for certain group of foreigners as stated in Garis Panduan Pembekalan Ubat kepada Pesakit Warga Asing di Fasiliti-fasiliti KKM, such as

  • Permanent resident with Malaysia Identity Card
  • Children under 12 years old with Malaysia birth certificate and one of the parents is Malaysia citizen or Malaysia permanent resident.
  • Husband or wife of a Malaysia citizen with proof of marriage certificate
    • If husband or wife of the foreigner passed away or divorce, the foreigner no longer eligible for full medication supply.
  • Medications for treatment of communicable disease for the foreigner (e.g. tuberculosis).
  • Full regimen of antibiotics.
  • Foreigner with valid UNHCR card.
  • Foreigner under detention (illegal immigrants under immigration detention, lock-up and prison)
  • Pregnant foreigner - provided the medication is for treatment, not as supplement.
  • Injections that must be administered by healthcare personnel, e.g. psychiatric issues.
  • Discharge cases from hospital where the doctors stated there is a critical need for more than 5 days medications.

Be careful when dispensing LASA (look alike, sound alike) medications, such as

  • Amlodipine 5 mg and 10 mg
  • Bisoprolol 2.5 mg and 5 mg
  • Carbimazole 5 mg and Carbamazepine 200 mg
  • Dabigatran 75 mg, 110 mg and 150 mg



Summary

At outpatient pharmacy, dispensing by provisional registered pharmacists should ideally be under supervision.

  • Though we may assume they are doing fine, there could be unidentified knowledge gap (contributed by lack of experience and lack of self-learning initiatives), which then lead to incorrect information passed to patients.



External Links

Comments

  1. kerolauraMay 23, 2021 at 10:59 AM

    Personally, I will counter check the item against the prescription then dispense them according to the categories of medication. I find this helpful for patients to understand the use of medication. Then if there's time to spare, help them categorize timing of admiration medications to suit their day.

    ReplyDelete

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