If in doubt, don’t give it out!
(Anonymous)
The supply of medication has always been a core role for the community pharmacist. The importance of the supply function is underlined by the definition of dispensing as an essential service in the pharmacy contract.
However, as the community pharmacist moves towards more patient-centred services, the practical issues surrounding the supply function need to be examined more closely. This chapter aims to look at a range of key issues that impact on the pharmacist’s role of supplying medication.
Wide-ranging areas such as practical dispensary design, the integration of newer roles for support staff and different ways of accessing medication, such as patient group directions and pharmacist prescribing, are all dis-cussed in this chapter.
Dispensary design and workflow
The ideal dispensary is tidy and clean with uncluttered work surfaces, a logical layout of dispensing stock and a natural workflow. The minimum standards for any dispensary include:
■ a good basic standard of decoration for the walls, ceilings and all paintwork
■ a cleanable floor Checkpoint
Before reading on, think about the following questions to identify your own knowledge gaps in this area:
■ How is an accredited checking technician prepared for their role?
■ What are some of the advantages of non-medical independent prescribing?
■ Describe the stages involved in managing a dispensing error.
■ adequate fixtures and fittings, uncluttered surfaces that are smooth and impervious to dirt and moisture
■ a clean refrigerator that is regularly defrosted and contains a minimum/maximum thermometer
■ clean sinks with both hot and cold water available
■ the proper storage and disposal of waste materials.
Even when these basic minimum standards are met, there needs to be considerable thought about the way that the workflow of the dispensary is arranged to be able to offer an efficient and safe dispensing service. An example of efficient workflow in a pharmacy is outlined in Figure 7.1.
The cost of labour is by far the greatest cost in running a dispensary.
With the potentially reduced involvement of the pharmacist in dispens-ing activities, the day-to-day management of the dispensary should ideally be delegated to a pharmacy technician. An efficient workflow has the following advantages:
■ more economic and efficient use of labour
■ reduced waiting times for patients
■ increased time available for contact and interaction with patients
■ less likelihood of dispensing errors
■ more efficient stock-rotation procedures
■ reduced frustration in an ordered working environment, resulting in increased staff morale.
The overall design of a dispensary should depend on the type of dispens-ing that is takdispens-ing place. For example if there is a large proportion of repeat dispensing, there needs to be a large working area that is assigned to this activity. When considering the design of the dispensary and arrangement of stock it is useful to refer to the standard operating procedure (SOP) for dispensing. The SOP for dispensing will be specific for a pharmacy and should take into account any specific design features that impact on the dispensing process.
The dispensing process can be divided into seven stages:
1 prescription reception 2 legal and clinical check 3 labelling of item(s) 4 assembly of item(s) 5 checking of item(s) 6 final check
7 hand to patient/counselling.
Prescription reception
An efficient dispensing service is dependent on a clearly defined prescription-reception procedure. The area where prescriptions are
A Pharmacist based ‘front of house’ to interact directly with clients. Pharmacist has access by laptop to patient medication records and a good view of the entire pharmacy. Any acute ‘waiting’ prescriptions are passed directly to the pharmacist for checking.
B The client can walk into the consultation room easily from the shop floor to have a confidential conversation.
C There is a clearly defined administration area (access to email, fax and telephone) where a designated member of staff can answer all queries relating to repeat prescriptions. A large area is available for filing paperwork.
D Waiting prescription dispensing area.
E Repeat prescription dispensing area.
F Clear area for storage of prescriptions, out of view of the customer but close to the reception desk.
Figure 7.1 Example of a pharmacy design to allow efficient workflow. Plan reproduced with kind permission of Kevin Smith, community pharmacist, Harborough Field Pharmacy, Rushden and Crescent Installations Ltd.
handed in should be clear and unambiguous. Any support staff involved in this process must have been trained to a basic minimum level.
Assisting in the supply of prescribed items, which involves taking in a prescription and issuing prescribed items, is part of the specific knowl-edge and understanding required for the Pharmacy Services Scottish/
National Vocational Qualification (S/NVQ) level 2. To ensure a smooth prescription process the member of staff receiving a prescription should be able to:
■ recognise different types of prescription form. The Prescription Pricing Division of the NHS Business Services Authority has a useful website that outlines all the different types of NHS prescription and the legal
requirements for prescription writing:1
■ ensure that the patient’s name, including forename and address are legible
■ establish if the prescription is being handed in by the patient or their representative
■ verify the age of the patient if the prescription is for a child
■ take any prescription charge that is due or deal with any exemption prescription queries. In practice this will mean that the member of staff should be able to recognise contraceptive items that are exempt from prescription charges and items that attract a multiple prescription charge, and be fully aware of the procedure for completing the back of the prescription form. Point-of-dispensing checks act as an important deterrent for patient fraud and have contributed to a 60% reduction in patient prescription fraud in recent years. It is vital that the member of staff receiving a prescription is fully aware of the procedures involved in checking exemption from prescription charges2
■ access the patient medication record (PMR) system. It is useful if the member of staff can access the PMR system to confirm patient details, and change any administrative details such as address. Sometimes at this stage of the process a patient may ask a non-clinical question such as the timing of their repeat prescription. This type of query should be
answered promptly without interrupting the dispensing process
■ adopt a safe procedure when the prescription item can be purchased and costs less than a prescription charge. This will involve liaison with the pharmacist as this involves interpreting the prescription and prescriber’s intentions
■ determine the time it will take for the prescription to be dispensed and communicate this to the patient.
Some busy pharmacies prefer to use a numbered docket system when receiving prescriptions. This can be useful in areas where there are poten-tial language difficulties. The SOP for prescription reception needs to take into account all of the above requirements.