DISPENSING 2 - MODULE 1: Medication Orders and Patient Medication Profile

Dispensing

Refers to the sum of processes performed by a pharmacist from reading, validating, and interpreting prescriptions; preparing; packaging; labeling; record keeping; dose calculations; and counseling or giving information, in relation to the sale or transfer of pharmaceutical products, with or without a prescription or medication order.

Over-the-Counter Household Remedies

May be dispensed even without a written order from a physician, dentist, or veterinarian.

Over-the-Counter Pharmacist-only OTCs

OTC medicines classified to be obtained only from a licensed pharmacist.

Prescription

Can only be dispensed upon a written order of a validly-registered physician, dentist, or veterinarian.

Prescription

The doctor’s orders on the patient’s chart for the use of specific drug(s) shall be considered a _____.”

Prescription

Prescription or Medication Order?

Used in Outpatient/Ambulatory settings

Prescription

Prescription or Medication Order?

May cover any of the registered drugs in the country

Medication Order

Prescription or Medication Order?

Used in Inpatient/Institutional settings

Medication Order

Prescription or Medication Order?

Covers drugs which are part of the institution’s formulary

Parts of a Prescription

• Prescriber Information

• Patient Information

• Date

• Superscription

• Inscription

• Subscription

• Transcription/Signa

Parts of a Medication Order

• Date & Time

• Prescriber Information

• Patient Information

  • Usually includes ward & bed no.

  • May include unique patient code

• Inscription (Medication/s Ordered)

• Subscription (Dispensing Directions)

• Directions for administration

Medication Safety Issues in Prescriptions and Medication Orders

1. Illegible Handwriting

2. Look-Alike Names

3. Sound-Alike Names

4. Error-Prone Abbreviations

5. Ambiguous Orders

Illegible Handwriting

Which Medication Safety Issue is this?

To minimize chances of misinterpretation:

• Encourage physicians with poor handwriting to print prescriptions/medication orders in BLOCK LETTERS

• Ask physicians to include the purpose of the medication as part of the prescription

• Independent double-checks should be in place

Look-Alike Names

Which Medication Safety Issue is this?

To minimize chances of misinterpretation:

• Provide up-to-date education on all new medications

• Encourage physicians to write both the generic and brand names legibly, as well as the intended purpose of the medication

• Changing the appearance of look-alike product names (ex. use of tall man letters)

Institute for Safe Medication Practices

ISMP meaning

ISMP List of Look-Alike Drug Names with Recommended Tall Man Letters

ISMP List of Confused Drug Names

• Contains drug name pairs and trios with recommended, bolded tall man (uppercase) letters

• Helps draw attention to the dissimilarities in look-alike drug names

Sound-Alike Names

Which Medication Safety Issue is this?

To minimize chances of misinterpretation:

• Spoken orders should be limited to true emergencies or circumstances in which the prescriber is physically unable to write/electronically transmit orders

• Prohibit verbal orders for selected high-alert medications

• Verbal orders should be taken only by authorized personnel

• If possible, a second person should listen while the prescription is being given

• Verbal orders should be transcribed then “read back”

• Obtain the prescriber’s phone number in case it is necessary for follow-up questions

• The prescribed agent should make sense for the patient’s clinical situation

Error-Prone Abbreviations

Which Medication Safety Issue is this?

To minimize chances of misinterpretation:

• Drug names should not be abbreviated

• Examples:

  • U for “units”

  • Q for “every”

  • D/C for “discontinue” or “discharge”

ISMP List of Error-Prone Abbreviations, Symbols, and Dose Designations

• Contains abbreviations, symbols, and dose designations that have been reported and have been involved in harmful or potentially harmful medication errors

• Should never be used when communicating medical information (both written and electronic)

Ambiguous Orders

Which Medication Safety Issue is this?

Improperly Expressed Orders:

• Zeroes and decimal points (Coumadin 1.0 mg → Coumadin 1 mg)

• Leading zeroes (Vincristine .4 mg → Vincristine 0.4 mg)

• Tablet strengths

• Liquid dosage forms / injectable medications

• Variable amounts

• Spacing (Tegretol300 mg BID)

Preparing & Dispensing Medications

• An important safety enhancement for preventing dispensing errors is the development of a system of redundant checks

• From the time the original prescription is ordered in the physician’s office to receipt in the pharmacy and through dispensing and administration

• The more independent “looks” an order receives (while efficient workflow is maintained), the better