Systems and Controls
Database-driven dispensing programs are essential. But like all technologies, they are only as good as the way in which they are handled.
Use of Information Technology
Scanners are strongly recommended and where used properly, they have been shown to reduce error by providing an additional layer of checking.
- Check data entered – an error can be multiplied
- Control access and administrator rights
- Avoid double entry of data
- Use consistent and ‘decipherable’ abbreviations and notations
- Regularly update data
These are tools of the trade only, they do not replace human involvement.
The steps advised below are based on the Quality Care Pharmacy Program. They are aimed at reducing or eliminating dispensing errors including: wrong drug, wrong strength, interactions, misinformation and patient medication abuse.
If you would like to download a PDF outlining all of the steps, click here.
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RISK CONTROL
The script is received and registered on the system. Its legality is established and contact details and key person data is confirmed.
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Patient details
- Name
- Address
- Phone number
- Mobile number
- Concessional entitlements
- Medicare Number
- Allergies
- Child's age
- Weight
- (remote/rural: where will be next stop)
Prescription details
- Date
- Doctor's signature
- S4 requirements
- S8 requirements
- HIC Authority Approval
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RISK CONTROL
The computer record is checked for abuse, interactions and information needs. (CMIs). The label is attached and scanned for a double
check. The screen is checked during the scan.
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Checks agains patient history
- Enter script into computer checking for:
- Change of dosage
- Interactions
- Evidence of misuse
Selection against script
Labelling
Check directions on label against those on the original script
- Expiry date
- Drug, strength and quantity
- Attach label to product leaving bar code exposed
Scanning and screen 'double check'
Scan barcode and re-check screen for:
- Patient name and address, and date
- Drug
- Strength
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RISK CONTROL
The near-finished items are collated and additional warnings affixed.
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Packaging and warnings
- Attach appropriate cautionary and advisory labels
- Place in container which leaves all items visible, with relevant paperwork
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RISK CONTROL
The finished items are presented for collection. Counselling, if necessary, provided.
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Communication
- Determine level of counselling required
- Provide CMI if required
- Maintain privacy and confidentiality
- Consider special needs of patient
Double checks
- Verify drug against script
- Verify recipient
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The steps advised above are based on the Quality Care Pharmacy Program. They are aimed at reducing or eliminating dispensing error including: wrong drug, wrong strength, interactions, misinformation and patient medication abuse.
Manufacturer Grouping
The similarity in packaging style between different drugs from the same manufacturer immediately increases the risk of an incorrect selection. If this practice is followed in your pharmacy consider implementing a new system.
Separation of Strengths
Dispensing the incorrect strength of a drug (for example Warfarin) can be as dangerous as dispensing the wrong drug! Strengths should be separated on the shelf, even though the drug is the same.
Separation of Similar Names
Awareness is critical, similar names are a fact of life in pharmacy! Solutions include:-
- Use of scanners.
- Absolute separation of similar names and avoidance of a purely alphabetical organizational system.
- Prominent display of an up-to-date list of similar names to encourage recognition among all members of your pharmacy team.
- Reorganization of stock when a new similar name appears.
Expired stock
Rotate stock. Systems for restocking must be designed to reduce the risk of dispensing expired goods.
Specialist Drugs..and High Volume
It is recommended that drugs with a greater risk profile (eg, special usage requirements and/or high risk of interaction) are stored separately to the more commonly prescribed drugs.
Workflow Management
Directional workflow is recommended to help reduce double handling or possible confusion. Each dispensing station should be self contained to avoid risks that may arise from sharing of resources such as label and repeat printers.
- The pharmacist must be involved at the beginning of the dispensing process and at the conclusion.
