2. Community pharmacy
• Community pharmacy means any place under the direct supervision
of a pharmacist where the practice of pharmacy occurs or where
prescription orders are compounded and dispensed other than a
hospital pharmacy or a limited service pharmacy.
• What is the role of the pharmacist?
• Pharmacist responsibilities include a range of care for patients, from
dispensing medications to monitoring patient health and progress to
optimize their response to medication therapies.
... Pharmacists educate and advise physicians, nurses, and other
health professionals on medication therapy decisions.
3. Background
• Community pharmacists are the most accessible healthcare professional, where
no appointment is needed to council a pharmacist and the patient can receive a
free advice anywhere without long waiting times at clinics or at other health
facilities.
• Medications include Over-The-Counter medications (OTC) as well as prescription
only medications (POM). Nonprescription (or OTC) products are a group of
pharmaceuticals considered to be sufficiently safe for use without the
intervention of a physician.
• Because over-the-counter medications are used so frequently. It is important to
know the differences between prescription and over-the-counter medications.
• For pharmacists to safely and effectively manage minor ailments requires
considerable knowledge (about the diseases and their clinical signs and
symptoms) and skill (mainly communication skills)۔
4. • Medication administration, maximize benefits, minimize
adverse effects, and drug interactions
• Primary role is to ensure that medications are taken
effectively and appropriately
• Can recommend an over-the-counter (OTC) product for pain
relief, demonstrate the proper use of an asthma inhaler, and
help patients manage their diabetes.
• Advise on medication storage, missed doses, and what foods
or activities to avoid.
5. Pharmacists contribute to the health care system by:
• Compounding, preparing and dispensing drugs
• Medication histories and maintaining patient drug
profiles
• Safety counselling to patients and caregivers
• Making recommendations to prescribers and other
health care professionals for adjustments to patients’
drug therapies
6. • A prescription:
A physician's order to prepare / to dispense a specific Tr -
usually medication- for an individual patient.
7. Rational prescribing:
Like any other process in health care, writing a prescription
should be based on a series of rational steps:
1- Make a specific diagnosis
2- Consider pathophysiologic implications of diagnosis
3- Select a specific therapeutic objective
4- Select a drug of choice
5- Determine appropriate dosing regimen
6- Devise a plan for monitoring drug’s action & determine
an end point for therapy
7- Plan a program of patient education.
8.
9. Parts of prescrition:
• Superscription: name, professional degree, contact no.
address of prescriber,
date when order is written.
name, address & age of patient; & symbol Rx (an
abbreviation for "recipe," Latin for "take thou." _
• Inscription : body of Pres. containing name, strength of
each drug, & dosage form .
• Subscription: quantity to be dispensed directions to
pharmacist, usually consisting of a short sentence: "make
a solution," "mix & place into 10 capsules," or "dispense
10 tablets."
• Transcription : labeling of instruction to Patient,
• prescriber's signature.
10. • When writing drug name:
- either generic name (nonproprietary name) is used.
- OR brand name (proprietary name)
- strength of medication should be written in metric units
(Not apothecary).
1 gr = 60 mg
15 gr = 1 g
1 ounce (oz) by volume = 30 ml
1 tsp = 5 ml
1 tbsp= 15 ml
20 drops= 1 ml
2.2 ponds (Ib) = 1 kg.
11. Principles for writing pres. for both controlled &
uncontrolled drugs
Prescribers should:
• ALWAYS write legibly in ink (clear writing)
• Use metric system (g, L)
• ALWAYS sign & date the prescription
• Precise
• Accurate
• Use precautions to remind patients about SE
• NEVER abbreviate drug names
12. Prescription for uncontrolled drugs include:
- date
- identification of patient: name, hospital number, age, sex
- name of drug
- dose of drug
- frequency of administration
- route & method of administration
- amount to be supplied
- prescriber's signature.
13. Classification of controlled substances. Based on estimated
addiction liability
ExamplesRationale for category & Rx rulesPotenti
-al for
abuse
Class
Heroin, LSD (Lysergic
Acid Diethylamide),
marijuana
No accepted medical use, All no research
use forbidden, can Not be prescribed
lack of accepted safety as drug
High
abuse
potential
I
Opioids as morphine,
amphetamines
Current accepted medical use but abuse
may lead to severe physical/ psychic
dependence
HII
Weaker opioids such
as codeine, some
amphetamine-like
drugs
Current accepted medical use. moderate
or low potential for physical & high
potential for psychologic dependence, No
refills, Rx must be rewritten after 6 months
< class IIIII
14. Diazepam,
phenobarbital,
chloral hydrate etc
Medical use is
accepted. Limited
/ low potential for
dependence
< IIIIV
cough syrups e
codeine ,
antidiarrheal e
diphenoxylate etc
Medical use is
accepted.
! least potential
for abuse
< IVSchedule V
15. Rx for controlled drugs:
• Should not be typed & written by hand
• Written in ink
• Signed & dated
• Carry prescriber's full name, address & registration
number
• State form of drug
• State total quantity of drug or number of doses units
(10.0 mg i.e. ten milligrams)
Not be refillable > than 5 times in a 6 months period for
schedule III-IV-V Rx;
• No refilling for schedule II Rx.
20. Computerized physician order entry (CPOE):
is a process of electronic entry of physician instructions for
of patients (particularly hospitalized patients) under his or
her care.
These orders are communicated over a computer network
to medical staff (nurses, therapists, pharmacists, or other
physicians) or to departments (pharmacy, laboratory or
radiology) responsible for fulfilling order.
21. Nutrition Counseling
• Community pharmacist can make, significant
contributions in assuring adequate nutrition by
advising his patients about basic food needs, keeping
to correct improper food habits in children, advising
on special requirements, suggesting special diet
instructions for diabetic patients and people with food
allergy and participating in school lunch programs and
schemes like mid-day meals etc. in rural areas.
22. Women Welfare-Pregnancy and Infant Care
• A famous Sanskrit Shloka from Manusmriti scriptures goes as
"Yatra Nariyastu Poojayanta, Ramante Tatra Deva" which
means, "where women are worshipped Gods preside there".
Women are the corner stone for effective public health and
investing in women translate into investing in family,
community and the Nation.
23. Rational Use of Drugs
• A community pharmacist can also advise on the
administration of the medication, provide information on the
storage of the medication and wherever necessary he can
counsel the patient. Education regarding the disadvantage of
polypharmacy can also be given to the patient. Drug
information system should be set up and access to adverse
drug reaction system should be made. A community
pharmacist should do therapeutic drug monitoring and he
should have a sound knowledge of genotype reporting i.e.
predictive pharmacology.
24. Alcohols, Drug Abuse and Smoking Cessation
• The diseases of alcoholism and drug abuse also come under the
preview of the community pharmacist. The pharmacist has a key role
to help individuals who become dependent upon alcohol.
• Smoking is the greatest single preventable cause of morbidity and
mortality. It is the responsibility of a community pharmacist to take an
active role in helping the smokers to stop smoking.
25. Homely Remedies
• A homely remedy is another name for a non-prescription
medicine that is available over the counter in community
pharmacies. They can be used in a care home (with and
without nursing) for the short-term management of minor,
self-limiting conditions, e.g. headache, cold symptoms,
cough.
• The decision to administer may be taken by the care worker
without necessarily consulting the General Practitioner.
26. Retail business
• Managing the business
• Owner / manager / pharmacist
• Retail manager
• Dispensary manager
27. Role of Manager
• Management of staff
• Dealing with problems (customers/suppliers…)
• Training
• Role model
• H & S
• Responsibility for pharmacy standards
• +/- Financial management
28. Essential Skills of a Community
Pharmacist
• Organisation
• Time management
• People management (staff & customers!)
• Stock management
• Nursing homes, GPs, mental health services,
• ADS, community nursing, professional organizations.
30. Steps in Dispensing Drugs
• The customer will approach the pharmacy and call the attention of
one of the personnel.
• The pharmacist or pharmacy assistant will greet the customer and
must sustain good manners all through the transaction.
• The personnel will ask the patient about his/her prescription or drug
needs.
31. • After the presentation of prescription/s or details of drug/s needed,
the personnel shall check the availability of stock on the shelves, the
price, the expiration date and other generic equivalence of that brand
or drug/s.
• The prescription/s or drug/s will be priced. Allow the customer to
budget his/her money to decide if he/she can afford the brand of that
drug/s.
• Introduce to him/her other generic equivalence or other drugs that
contain the same generic name, strength, dosage form and alike,
which can help him/her to save money or budget his/her money.
32. • Take time to let the customer to decide what price of drug he/she will
buy and the quantities to be sold.
• If decision was made, prepare the decided drug/s (with the cheapest
price) to be bought by acquiring them from the shelves. Blistered or
foiled packaging will be cut in the pieces requested by the customer
and/or if the packaging is loose count the number of the drug needed
in the tablet counter and placing them into compact plastic bottle,
wide-mouthed amber bottle or small capsule cellophane that placing
the information of the patient, information of the drug and quantity
of the drug. Check the drug before and after removing from the shelf
if it is the required drug. Check also for expiration of the drug and
stability of it.
33. • When the drug is prepared proceed to billing.
• Take back his/her change if there is and counter-check the drug's
name, count and quantities in front of him.
• Counsel the customer about the instruction given to him/her by the
physician, the storage condition, and other information about the
drugs.
• End the transaction by speaking “Thank you!” and “Come back
again!”. The prescription shall be filed and kept.
36. Dispensing Errors: The Numbers
• 98.3% accuracy in dispensing medications
• Therefore, 1.7% inaccuracy rate
• Over 3 billion medications dispensed per year
• 4 errors per day per 250 prescriptions filled
• Over 51 million dispensing errors per year
37. Most Prevalent Dispensing Errors
• Dispensing incorrect medication, dosage
strength, or dosage form
• Dosage miscalculations
• Failure to identify drug interactions or
contraindications
38. Types of Dispensing Errors
• Commission versus omission
• Mistake versus slip
• Potential versus actual
39. Errors of Omission
• Failure to counsel the patient
• Failure to screen for interactions and
contraindications
40. Errors of Commission
• Miscalculation of a dose
• Dispensing the incorrect medication, dosage
strength, or dosage form
41. Mistakes and Slips
• Mistake
• Do things intentionally but actions are incorrect
because of a knowledge or judgment deficit
• Behavior in problem solving mode
• Example: dose prescribed that exceeds maximum safe limit
• Slip
• Do things unintentionally incorrect because of an
attention deficit
• Behavior in automatic mode
• Example: dispense chlorpromazine when prescription was
clearly written for chlorpropamide
43. Dispensing Errors:
Improving Workload
• Ensure adequate staffing levels
• Eliminate dispensing time limits (quotas)
• Examples of limiting workload
• Dispense ≤150 prescriptions per pharmacist per day
• Require rest breaks every 2–3 hours
• Brief warm-up period before restarting work tasks
• Require 30-minute meal breaks
44. Dispensing Errors:
Combating Distractions
• Phones
• Fax machines, auto refill, voice mail, priority
processing, trained support personnel
• Prohibit distractions during critical
prescription-filling functions
• Centralized filling operations
• Train support personnel to answer the
telephone
45. Dispensing Errors
in the Work Area
• Clutter (return used containers immediately)
– Ensure adequate space
– Store products with label facing forward
– Choose high-use items on the basis of safety as well as
convenience, use original containers
– Telephone placement
• Poor ergonomics
• Lighting
• Heat, humidity
• Noise (TV, radio)
46. Dispensing Errors
in the Work Area
• Labels on bins and shelves
• Separate by route of administration
• Use auxiliary labels for externals
• eview published safety alerts for look-alike/ sound-
alike drugs and frequent dispensing errors
47. Cognitive and Social Factors
• Use of high-intensity task lights and magnification
• Use of a device to hold prescriptions/orders at eye
level
• Posting alerts in strategic locations with error-
prone products
• Use of exaggerated, unconventional type fonts to
enhance reading of drug names
48. Well-Designed Drug Storage
• Adequate space
• Label facing forward
• Agents for external use should never be stored
with oral medications
• Separate by route of administration
• Mark and/or isolate high-alert drugs
• Separate sound-alike/look-alike drugs
49. Errors Related to Information About the
Drug or Patient
• Misleading or erroneous references
• Ambiguity in handwritten and typed
documents
• Computerized prescribing
• Wrong patient errors
• Errors in dosage
51. Dispensing Errors
Caused by Poor Labeling
• Pharmacy computer-generated labeling and
production of medication administration
records should be optimized
• Nonessential information should be excluded
from labels and reports
• Samples may be poorly labeled
52. Syringe and Admixture Labels
• Standardization of the way labels are placed on
syringes can reduce errors
• Use of “For Oral Use Only” labels on oral
syringes
• Placement of labels on IV bags
• Warning labels for special parenterals
• Vinca alkaloids, other antineoplastics
• Medications with specific infusion rates
55. Outpatient Label Content
• Patient name
• Medication name
• Dosage strength
• Dosage form
• Quantity
• Directions for use
• Number of refills
• Prescriber name
• Purpose of medication
57. Errors Related to
Dispensing Methods
• 24-hour pharmacy service reduces errors
• Unit-dose dispensing should be utilized
whenever feasible
• Requiring multiple tablets to be taken for one
dose may result in an underdose
58. Dispensing Errors Caused by Poor
Patient Education
• Failure to adequately educate patients
• Lack of pharmacist involvement in direct patient education
• Failure to provide patients with understandable written instructions
• Lack of involving patients in check systems
• Not listening to patients when therapy is questioned or concerns are
expressed
59. Counseling Patients
• Up to 83% of dispensing errors can be discovered
during patient counseling and corrected before the
patient leaves the pharmacy
60. Good Patient Education
• Inform patients of drug names, purpose, dose,
side effects, and management methods
• Suggest readings for patient
• Inform patient about right to ask questions and
expect answers
• Listen to what patient is saying and provide
follow-up!
61. Assessing Prescriptions
• Clarify illegible handwriting, nonstandard
abbreviations, or incomplete information
• Analyze patient’s profile
• Review drug interactions and allergies
• Verify appropriateness of medication and
dosage
• Consider computer alerts
• Highlight unusual dosage form or strength
62. 10 Steps to Maximize
Dispensing Accuracy
1.Lock up or sequester drugs that could cause disastrous
errors
2.Develop and implement meticulous procedures for drug
storage
3.Reduce distractions, design a safe dispensing environment,
and maintain optimum workflow
4.Use reminders such as labels and computer notes to
prevent mix-ups between look-alike and sound-alike drug
names
5.Keep the original prescription order, label, and medication
container together throughout the dispensing process
63. 10 Steps to Maximize
Dispensing Accuracy
6. Compare the contents of the medication container with
the information on the prescription
7. Enter the drug’s identification code (e.g., national drug
code [NDC] number) into the computer and on the
prescription label
8. Perform a final check on the prescription, the
prescription label, and manufacturer’s container; when
possible, use automation (e.g., bar coding)
9. Perform a final check on the contents of prescription
containers
10. Provide patient counseling
64.
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79.
80.
81. Family planning
• Definition
• the practice of controlling the number of children one has and the
intervals between their births, particularly by means of contraception
or voluntary sterilization.
82.
83. • Barrier methods
• Barrier methods include the diaphragm, cervical cap, male condom,
and female condom and spermicidal foam, sponges, and film. Unlike
other methods of birth control, barrier methods are used only when
you have sexual intercourse. Be sure to read the instructions before
using a barrier method.
84. • Diaphragm
• A diaphragm fits inside the vagina and is used each time you have sex. It
covers your cervix (entrance to the uterus) and stops sperm from getting
through to join an egg.
• HOW DO YOU USE A DIAPHRAGM?
• Diaphragms should always be used with spermicide. This is jelly that kills
sperm.
• Before you have sex, put spermicide onto the diaphragm. Then put it into
your vagina so it covers your cervix.
• Keep it in place while you have sex and for at least six hours afterwards.
Then remove it, wash and dry it and put it away until next time you want to
use it.
85. • WHAT ARE THE ADVANTAGES?
• No hormones
• Few side effects
• Protects your cervix – so can help prevent cancer of the cervix and
some sexually transmissible infections (STIs)
• Does not affect your menstrual cycle
• WHAT ARE THE DISADVANTAGES?
• Some women are allergic to rubber or spermicide
86. • Cervical cap
• A cervical cap is a silicone cup you insert in your vagina to cover your
cervix and keep sperm out of your uterus.
• Advantages
• Cervical caps are safe and easy to use.
• They do not cause urinary tract infections.
• They are relatively cheaper than other contraceptives.
87.
88. • Disadvantages of cervical cap
• it may cause the cervix to swell.
• Cervical cap is not suitable for women who have had a normal
delivery.
• Use of cervical cap produces unpleasant vaginal odour.
89. • Condoms
• Condoms are one of the most commonly used methods of
contraception today. Contraceptive methods help to prevent
pregnancies. This means using condoms is essentially a means of
birth control.
• Advantages of Using a Condom
• The condom may be purchased without a prescription.
• The condom is easy to use.
• Condom have a variety of flavours and textures
90. • Disadvantages of Using a Condom
• those with latex allergies may not be able to use regular condoms.
• Post contraceptive method
• Contraception after you have a baby. After having a baby, using an
effective method of contraception such as a contraceptive implant or
intrauterine device (IUD) will help in preventing an unplanned
pregnancy
91. . IUDs are either copper or hormonal. ParaGard is an example of a copper IUD. Liletta are examples of
hormonal IUDs
92. • Skin patches, and vaginal rings are examples of it.
• The skin patch is a method of hormonal contraception. It's a small,
square patch that looks like a plastic bandage. It sticks to
your skin and gradually releases hormones into your body to prevent
pregnancy. You replace it once per week
93. • Advantages
• It is simple to use
• Can be used by just one partner
• Needs to be applied only once a week and not in relation to
intercourse, improving patient compliance.
94. • Disadvantages
• It does not provide protection against sexually transmitted infections
(STIs), including HIV
• Must be prescribed by a health care provider
• The estrogen levels are higher with the patch than with other
hormonal methods
• Skin irritation may occur in some women
95. • The vaginal ring is a type of contraception that works in a similar way
to the oral contraceptive pill to prevent pregnancy. A soft,
flexible ring is worn inside the vagina for three out of every four
weeks. It slowly and steadily releases synthetic forms of the natural
hormones oestrogen and progestogen
96. • Hormonal methods of birth control prevent eggs from being released
from the ovaries, thicken cervical mucus to prevent sperm from
entering the uterus, and thin the lining of the uterus to prevent
implantation.
• Hormonal contraception refers to birth control methods that act on
the endocrine system. Almost all methods are composed of
steroid hormones It contains oestrogen or progesterone (another
hormone). These hormones inhibit the production of FSH, which in
turn stops eggs maturing in the ovaries. They greatly reduces the
chances of mature eggs being produced
97. Terminal methods
• Vasectomy is a surgical procedure for male sterilization or permanent
contraception. During the procedure, the male vas deferens are
severed and then tied or sealed in a manner so as to prevent sperm
from entering into the urethra and there by prevent fertilization
Tubal ligation or tubectomy (also known as having one's "tubes tied")
is a surgical procedure for sterilization in which a woman's fallopian
tubes are clamped and blocked or severed and sealed.
98.
99. • Natural family planning(NFP) is fertility awareness, which is simply
knowledge of a couple's fertility. It is a means of reading the body's
signs of fertility and infertility
calendar method
Rhythm method
100. References
Flynn E, Barker KN, Carnahan BJ. National observational study
of prescription dispensing accuracy and safety in 50
pharmacies. J Am Pharm Assoc. 2003;43:191–200.
Ukens C. Deadly dispensing: an exclusive survey of Rx errors by
pharmacists. Drug Topics. March 13, 1997:100–11.
