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Pharmacy chains use queuing systems to make direct
dispensing more efficient
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Last week, Moss Pharmacy launched its own version of direct dispensing
(p660). The concept is not new, however. Some Boots pharmacists have
been dispensing prescriptions in front of their customers for several
years. Moss says that the idea behind direct dispensing, which it has
named “face-to-face” dispensing, is to encourage greater
patient involvement in the prescription dispensing process.
So why are two of the UK’s biggest pharmacy chains going down the
direct dispensing route? Tricia Kennerley, NHS services director and
superintendent pharmacist at Moss Pharmacy, says: “With community
pharmacy changing rapidly, we believe that personal contact between our
pharmacy staff and their customers will be vital, especially with more
emphasis being placed on the need to offer services that engage customers.”
The advantages of this type of service are clear. A patient is given
ample opportunity to ask questions about his or her medicines, to raise
queries about the products being supplied and to indicate when they have
not received a medicine before. Likewise, the technician preparing the
prescription and the pharmacist checking it can involve the patient in
the process, determine patients’ understanding of their medicines
and identify early in the dispensing process any drug-related problems.
David Wilson, pharmacist at Moss’s Nuneaton branch, has been operating
a direct dispensing service for the past two months and says that benefits
have already been observed. “In the first few weeks this system
[of greater customer interaction] has picked up five cases of patients
taking their statin dose in the morning rather than at night.” Another
benefit is that advice given to patients can be backed up by showing
them their own medication record or a medicine’s data sheet since
each dispensing station has internet access.
Steve Churton, assistant pharmacy superintendent at Boots the Chemists,
says direct dispensing, or carousel dispensing, has been running successfully
at Boots since 1997. “On the whole, customers enjoy the interaction
they have with the dispenser,” he says.
Valid concerns
Direct dispensing has had its critics though and the subject has been
raised from time to time in the letters pages of The Journal. David
Phillips, a community pharmacist in the West Midlands, believes that
staff working directly in front of customers can be put under unnecessary
stress. What is more, he does not believe that improved concordance
is the driving force behind companies adopting direct dispensing systems. “The
motivation is high throughput,” he says.
Another concern is patient confidentiality. Judith
Rees, senior lecturer
at the University of Manchester school of pharmacy, points out that the
Code of Ethics places great emphasis on patient confidentiality (PJ,
22 November 2003, p709). “Open style dispensaries allow someone
other than the patient to see what is being picked off the shelf, labelled
and given to the patient.” She is not convinced by the argument
that prescriptions requiring greater privacy can be dispensed elsewhere. “Who
makes that judgement on privacy? The patient or the pharmacist,” she
asks.
Both Moss and Boots tackle the privacy issue by using individual dispensing
stations separated by screens. Floor markings and other signposts are
also employed to direct customers. “If the customer behind gets
too close, the pharmacist should ask them to move back,” says Mr
Churton.
David Wright, a community pharmacist in Kent, has worked in open-plan
dispensaries and suggests that privacy is not a big issue. “Only
once have I had to ask a customer to refrain from leaning over to look
at another patient’s prescription,” he says.
Customer interaction could distract pharmacy staff from the job in hand.
Mr Phillips comments: “In my opinion [the staff] become more prone
to making mistakes.” And he suggests that pharmacy technicians
may be “crowded” by patients pushing them to work faster.
Clare Powell, a dispensing technician at Moss’s Nuneaton branch,
says that having patients standing in front of her while she is preparing
their prescriptions was distracting at first. “It was awkward the
first time and a bit daunting, but since then I have enjoyed it.” She
thinks the increased interaction between patient and technician is positive
rather than negative. “Before we just had contact with the prescription
and the medicines. Now patients get to know us and they feel more at
ease about asking questions.”
Ms Kennerly agrees: “Surprisingly, the technicians don’t
mind being observed when they work.” She also believes that the
opportunities for errors are hugely reduced. “Technicians are focused
on the task in hand. They’re focused on an individual’s prescription
and do not have to deal with orders being delivered or the telephone
ringing.”
However, Ms Kennerly acknowledges the concern some people have that technicians
and pharmacists will be distracted by customers and says that safety
is an issue that has to be addressed. “We need to make sure that
what we are introducing doesn’t compromise patient safety.” To
this end, Moss is monitoring error reporting rates at its three direct
dispensing pilot sites. Initial signs look promising, with the near miss
reporting rate at the company’s Nuneaton branch having fallen since
direct dispensing began.
Boots, too, says that patient safety is not adversely affected by direct
dispensing. “If anything, we have seen safety improvements,” says
Mr Churton. Carousel dispensing, which involves moving shelves, is more
likely to result in accurate product selection, he says. And because
patients are more engaged in the process, they may spot mis-selections.
Sue Kilby, the Royal Pharmaceutical Society’s head of practice,
supports the concept of direct dispensing and has seen the Boots system
in action. “The store I visited presented a professional image.” Furthermore,
because the contents of the dispensary are on display there is an added
incentive to keep it neat and tidy. “Pharmacy staff are less likely
to make mistakes if they are working in a clear, tidy area,” she
says. Maintaining public confidence
How pharmacists deal with dispensing errors when they are made directly
in front of patients is crucial for maintaining public confidence in
pharmacy. It is also important that confidence in GPs is not undermined
when clinical queries arise from a prescription.
Mr Wilson has systems in place for both scenarios. When a dispensing
error is made he quietly says to the technician “this item needs
checking again” and ensures that the mistake is corrected. “Because
the process is interactive, it is not uncomfortable,” he says.
And when a prescription needs to be discussed with a patient’s
GP, the traditional dispensing system kicks in. The patient is asked
to take a seat while a telephone call to the GP practice is made. Any
queries are sorted out before the prescription is dispensed.
There is certainly a mixed reaction to the concept of direct dispensing.
There are benefits that should be welcomed but companies that adopt the
system, for whatever reason, need to listen to staff who raise concerns.
Acting on those concerns could lead to improved systems that will benefit
not only patients but pharmacy as well. |
The
Pharmaceutical Journal