Practice standards in pharmacist dispensing

Then, let’s move to the practice standards in pharmacist dispensing. The first role of pharmacists defined in GPP guideline, is to prepare, obtain, store, secure, distribute, and administer, dispense, and dispose of medical products. So, the government should establish minimum national standards for these activities in dispensing practice. For pharmacist dispensing, GPP guidelines require that pharmacists should ensure that appropriate facilities, trained personnel, standard dispensing practices, and documentation procedures are in place in the pharmacy for the supply and dispensing of prescribed products.

Regarding to appropriate facilities, dispensing surroundings should be quiet and bright, and the workflow need to be smooth. Previous studies have reported that the lighting level is associated with medication errors. Enough lighting could reduce medication errors. In addition, the dispensing errors also increase if pharmacists are often interrupted and distracted by noise during dispensing. In our pharmacy, The dispensing area is an independent area and bright and clean. We design a standard dispensing area, the locations of each medication are fixed and labeled in each dispensing area to reduce dispensing errors.

To ensure all pharmacists follow the standard dispensing practice, we establish a clear standard operation procedures for each pharmacy. The SOP could provide a correct procedure and avoid medication errors. In our SOP, it clearly defines the staff’s responsibilities, the process of dispensing and documentation, the working area and operation time. For some emergent events, such as a PC system crush, temporary operation time change, there also has a clearly instruction in the SOP. To ensure all pharmacists are familiar the standard practice, personnel training is very important. We design a 2 year pharmacist training course for new staffs. Not only training for standard practice, we also provide professional training course in this 2 years.

The training course contains several problem-based learning courses, case report meetings, combined training courses with other medical staffs, adverse drug reaction and medication error meetings and journal club. After training, we evaluate new pharmacists performance through the direct observation of procedural skills for dispensing procedures and objective structured clinical examination for professional skills.

In GPP guidelines, pharmacists are also required to assess and evaluate prescriptions. If possible, pharmacists should also consider the therapeutic, social, economic and legal aspects of the prescribed indications before supplying medications. In Taiwan Good Dispensary Practice standards, it also requires that pharmacists should verify the appropriateness of each prescription and contact doctors immediately when an inappropriate prescription occurs. And keep records and make statistic analysis regularly for further improvement measures. Because our physician use CPOE system, so, for pharmacist to evaluate prescriptions, we establish a computerized pharmacist verifying system. Through the computerized system, pharmacists could perform verifications right after physician prescribing.

In addition, this system contains prescriptions linked to many drug database, warning and query systems, and patient medical data, and also the drug price. So, pharmacists can comprehensively and efficiently verify prescriptions. When pharmacists find an inappropriate prescription, they would directly contact doctors immediately and make pharmacy records. Through this verifying system, the performance of pharmacist verification can be also reviewed and analyzed regularly. Through real-time verification, our clinical pharmacists avoid five hundred inappropriate events every month.