The Pharmaceutical Journal
Vol 272 No 7285 p153
7 February 2004

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  Dose alteration
  CD regulations
  New contract
  Clinical trials
  Dispensing
  Developing countries
  SOS action
  The Charter

Letters to the Editor

Dispensing

Open-plan dispensaries can improve care and reduce errors

From Mr R.V. Kasaven, MRPharmS

I agree that open-plan dispensaries can cause distractions and can be off-putting with patients staring at you while you dispense (PJ, 17 January, p52, and 31 January, p120). However, I also believe that open-plan dispensaries can improve patient care and counselling as well as reduce dispensing errors and near misses.

The advantage of an open-plan dispensary is that the patient is standing in front of you, which allows them to become more “involved” with their medication and treatment. This can be helpful to the pharmacist: for instance, if the patient should not recognise the medicine being dispensed it could be a sign that they have not had that medicine before or that it is a different brand from the one they are used to.

Although it can be quite disruptive to the dispensing process by patients saying “That isn’t what I normally have” or “Has the colour of the boxes changed?”, I think it can also be a useful way to identify areas where there is a lack of patient knowledge about the medicine; this can provide counselling opportunities for the pharmacist.

A patient not recognising what is being dispensed could also mean the wrong medicine has been selected by the pharmacist (or dispenser). This can provide an opportunity for the error to be corrected, thus optimising patient safety.

There are a lot of disadvantages of open-plan dispensaries and it can be extremely stressful working in that type of environment. However, we should turn these disadvantages into advantages to benefit our patients by concentrating on increasing patient safety and educating them so that they understand their medication better.

Ravin Vishnu Kasaven
Watford, Hertfordshire

Open-plan dispensing provides a speedy, efficient service

From Mr D. S. Wright, MRPharmS

I was concerned to read the letter from John Horncastle criticising open-plan dispensaries (PJ, 31 January, p120).

In community pharmacy dispensing areas, we are pharmacists: not “shopworkers” or sleight-of-hand magicians, but trained health care professionals who deserve a degree of respect from patients or their representatives similar to that expected by other professionals in the NHS.

In this regard, some gentle re-education may be necessary and, in my experience, such action has been beneficial to both pharmacists and patients. Patients, or more usually, their representatives, primarily require a speedy, efficient service which, along with associated improvements, open-plan dispensing provides.

David Wright
Orpington, Kent

A way to help minimise dispensing errors

From Ms S. D. Roberts, MRPharmS

We have developed a system in our pharmacy to incorporate our checking technician and to reduce errors. It also provides an audit trail, which can be checked by retrieving prescriptions from the Prescription Pricing Authority.

On receipt of a prescription, a grid (see diagram) is marked in the bottom right hand corner (a place identified by us as unused) and the prescription assessed both clinically and for its suitability for accuracy checking by a qualified technician. If it is not suitable (eg, a Controlled Drug) an “X” is marked at position C in the grid and the final check must be made by the pharmacist in charge.

Labels are generated according to a standard operating procedure. The person producing the label initials the grid at position A and places labels with the prescription in a dispensing basket for assembly.

The prescription is assembled and the person assembling initials at position B.

The contents of the basket are then checked according to the SOP either by the technician or pharmacist. The checker initials at position D.

In most cases there should be at least two different initials on the grid. An accuracy checking technician should not have been involved in the dispensing of a prescription when making the final check. In exceptional cases where there is only one set of initials it must be those of the pharmacist in charge.

We do not use the system to apportion blame but to try to understand the processes involved when errors are made and thereby minimise them. Through taking ownership of each stage of the dispensing process, the concentration and focus of the participants is increased. We have found that since introducing this system the number of real errors and near misses have reduced markedly.

Sarah Roberts
Roberts Chemists Ltd
Wareham, Dorset

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