Minimizing Dispensing Errors

Pharmacists are multi-tasking professionals. Most of the pharmacy works are done and accomplished by a registered pharmacist. From the management down to client care, a pharmacist is always needed in a pharmacy to effectively provide optimum service to the community with good quality and effective medicines. Pharmacist's important role is to interpret prescription orders, dispense drug order and counseling patients regarding all information needed to know about their medicine. But because pharmacists are multi-tasking individuals sometimes the most important key function they must be is disregarded. Due to this circumstance dispensing errors occur.

Dispensing Errors

Dispensing Errors are errors committed by pharmacists, pharmacy technicians and/or any personnel who are involved in dispensing medicines before, during and after the transaction with the client. Errors can be either human error, technical, procedural or machine errors. These errors could be associated with the drug error, labeling error and issuance error.

Classification and Type of Dispensing Errors

1. Drug Error
   a. Incorrect drug dispensed
   b. Incorrect strength dispensed
   c. Incorrect dosage form dispensed
   d. Expired/deteriorated/substandard drug
   e. Failure to supply drug
   
   
2. Labeling Error
   a. Incorrect drug name on label
   b. Incorrect strength on label
   c. Incorrect dosage form on label
   d. Incorrect directions/warning on label
   e. Incorrect patient name on label
   f. Incorrect ward/cost center/ prescriber
   h. Completely wrong label on bottle
   
   
3. Issuance error
   a. Incorrectly given to wrong patient
   b. Incorrectly bagged

Contributory Factors Affecting Dispensing Procedure Leading to Errors and Possible Remedies to Prevent them.

1. Workload and Pressure
   Prevention: Take each work at a time. Finish one task before engaging to another task. This can help you to prevent error. Focusing on a single work can eradicate error. Relax from time to time to remove pressure.
2. Similar drug names and levels
   Prevention: Separate drugs with the most similar names away from each other to avoid confusion. When sorting out a drug and find out that the drug has similar drug name or packaging syle try to read the label's information to differentiate between them the required drug. The best thing to do is consulting you superior or supervisor regarding this.
3. Incorrect display or storage area
   Prevention: See to it that the medicines are properly displayed in an arrangement of either therapeutically, alphabetically or an arrangement desired that can be easily memorized and remembered. Shelves and storage areas should be free from any blockage or barrier that can hinder identification and acquisition.
4. Staffing levels and job dissatisfaction
   Prevention: Poor benefits and incentives can insecure staff. Poor basic provisions such as drinking water rest days and breaks can lead to personnel inefficiency. Conflict about seniority and superiority can also be a problem. It can be fixed by discussing the problems in an open forum meeting or one on one discussion.
5. Poor eye sight, handwriting and listening skills
   Prevention: Poor eye sight can be corrected using eye glasses or contact lens. Instead of cursive writing one may choose all capital letters to clearly understand what is being indicated. While poor listening can be corrected through use of earphone, headset or noise reduction gadget when using phones to minimize noise. When communicating with each other physically speak clearly and be near to each other to understand what is being talked.
6. Interruptions/distractions and Noise
   Prevention: Avoid too much conversation and gossip among each others if the topic is not related to work. Television, loud radio sounds, or even social media visiting much not be done during work time.
7. Lack of space or design of dispensary
   Prevention: A pharmacy with a scarce area to work on can lead to confusion, so that preparations and dispensing of medicines will commit error. Same as for design of dispensary, when the design is inappropriate errors may occur. The best thing to do is to maximize the area. Provide storage area for other stocks, fluids and boxes. If the space is just enough and storage area cannot be provided, shelves and gondolas can be affixed on walls. This will help to occupy other spaces around your pharmacy that are not being used much. Other products can be stored there and freeing floor spaces with unnecessary boxes, stocks and others. Dispensary must complement with the design of the pharmacy to maximize the use of it.
8. Lack of staff knowledge, staff inexperience and inflexibility
   Prevention: Conduct assessment test regarding their performance. This will help you to identify whom of your staff and personnel really need special training, seminars or even attending another crash course. These solutions can eliminate incompetency, inexperience, lack of knowledge and inflexibility of your staff.
9. Misread and complex prescription and ambiguous directions
   Prevention: Approach others opinion regarding a doubtful prescription. Two heads are better than one! Interview patient to find clarity to the order. The best way to do is to communicate with the patient's attending physician and clarify his medication order for his patient.
10. Failure to check
    Prevention: Should be included in the standard operating procedures that every time a drug is to be dispensed checking should be done, any step in the procedure, so that drug to be dispensed will correspond to the prescription order given to patient. Best time to check is when the patient will pick up the medicines. The pharmacist can itemize the medicines in front of the patient. In this case the patient sees the product completeness and the pharmacist double or triple checks the medicines.
11. Lack of procedures and/or failure to follow standard operating procedures
    Prevention: Should provide and mandate every staff to follow step-by-step procedures. Everyone must have a copy of it and must be obedient to it.
12. Poor communication
    Prevention: Avoid the use of communication barriers such as earphones, loud speakers, television, jammers and alike during work. If possible to do so pharmacy should not be placed along traffic and highways.
13. Computer software
    Prevention: Should be user friendly, easily to manipulate and access and have highest security protection against hackers, malwares, adwares and alike.
14. Proximity of drugs on shelves
    Prevention: Medicines should be reachable. Fast moving drugs should be placed where can be easily accessed. Package names should be visible always. If the medicine is located in the highest level in the shelves provision of a foot stool or small ladder must be available.
15. No breaks
    Prevention: Exhaustion can lead to dispensing error. Break or recess can help to refresh ones mind and body. A relaxation for a moment can re-energize and revitalize staff again.
16. Hunger, Fatigue, and Stress
    Prevention: Breaks can help to resolve hunger, fatigue and stress. Weekly rest at least 2 days may lessen fatigue and stress from work.
17. Lack of concentration
    Prevention: Avoid day dreaming, gossiping and other materials that can take away your concentration from you work.
18. Lighting
    Prevention: Pharmacy should be well-lighted especially in the dispensary, counter, and shelf areas where the drugs are mostly located. A well-lighted pharmacy can improve the identification and acquisition of the right drug without any mistake.
19. Lack of support/assistance and lone worker
    Prevention: Chief pharmacist and supervisors should be available at all times when a pharmacy technician or other pharmacy staff needed their assistance. Do not let a personnel works alone, especially when the prescription filling is too much. There must be at least two or three personnel in every shift to complement with the gravity of work.
20. Lack of cleanliness and orderliness
    Prevention: The pharmacy must always be clean and neat. Empty boxes, bottles, scrap papers and other clutters should not be messed or mixed with the good stocks to avoid mistake. Sometimes when the pharmacy is not orderly and neat the personnel's mind can attract disorganization also. Regularly cleaning of the pharmacy is a very important to do.
21. Personal and Family problems
    Prevention: Personal and family problems are the most cause of errors during dispensing. Because when a personnel has a problem his focus is being divided between work and problem. He can think his problem while working, thus, causing him to error. Best way to do is to ask for a leave or vacation. During this time off you can resolve your personal or family problems and come back to work with full concentration again.

Errors and mistakes are sometimes inevitable and unavoidable. They usually happen unexpectedly. Pharmacists are also human beings and tend to err also. But because of the seriousness and gravity of their function and responsibility that can lead to patient's harm or even death mistakes has no room to their profession. I, too, had experienced dispensing errors twice before but not that too serious. I believe that every pharmacist had experienced it. No body is exempted to it. Maybe in your entire career at least once or twice you have committed it. Instead errors staying on you, you can turn that in to a positive perspective. Take your dispensing errors experience as your learning lesson. A lesson that should not be committed anymore and teaches you to be prudent and to love your work even more. Everybody deserves second chance. Remember that you have earned your degree with hardship and you do not want to take it from you that easily. Or worst of all you can be penalized for your wrong doings and be sentenced and thrown against bars that you do not want to happen to you. Love your work, be happy always and smile each time a customer enters your pharmacy. Happy dispensing!

Food and Drug Administration (FDA) Philippines in Transitional Status

From its former name Bureau of Food and Drugs (BFAD) to its new name Food and Drug Administration,(FDA). FDA Philippines is in transitional situation. Because of this transition business registration, processing, offices, manpower, budgeting, schedule of fees, regulation, policies and other scope of their power are constantly changing in accordance with the FDA Act of 2011.

This article focuses on the changes of registration and processing of application. Maybe a lot of business owners, personnel, and liaisons, especially those pharmacists' of companies, are confused of these changes the agency are imposing. Most of their policies and regulations are unstable and changing every time. Why is that so?

Here are few things why FDA Philippines is imposing such changes:

1. To efficiently bring service to the public.
2. To eliminate unscrupulous processing of applications with fixers, bribe and red tape.
3. To mandate full regulation and product surveillance in the the market.
4. To mandate full regulation of the laws.
5. To sustain high quality of products, and balanced employment and services.
6. To be competent enough for international regulations and standards.
7. To carry out public information and dissemination of rights of the end users.
8. To generate income to sustain the institution itself.
9. To give ease and facilitate business registration and applications.
10. To standardize application and processing rules.

Opinion:

But what I can see now is that the agency is in the middle of trial and error, searching for the best scheme to follow. Example is the future of online application. NCR and Region IV-A have already mandated to do so. However, as I read the terms of processing and procedures I felt the online processing would cost the public longer application time and redundancy. I attended a seminar conducted by FDA Region 1 and alike was also discussed. I had watched also the informative PAIR discussion youtube video in FDA site, also available here, and I found it very hard to accomplish. I have to say this because of the following reasons:

1. Step-by-step procedures have time limit and/or scheduled. When scheduled date is missed rescheduling will be given and if no show on the rescheduled date application will be denied and payment shall not refund.
2. Payments are either bank payment or cashier payment and also terms in No. 1 are applied.
3. You should know your computer more, because most of the application processes use computer and internet.
4. Documents and other requirements are to be scanned and saved to USB and submit to FDA.
5. It makes the application processes longer and tedious.
6. Although it is online application, why are you mandated to go to their office to submit original documents.
7. And if ever the online application is fully implemented, another problem will arise. When I attended seminar in the FDA Region 1 two months ago they disclosed that FDA regional offices will be removed, so that regional FDA offices and regional food and drug regulatory officers (FDRO) will be clustered. For example, clustering the Region 1, 2, 3 and CAR. And another thing any FDRO can inspection you any time, he or she may come from another region or unexpectedly an officer from FDA Alabang. They added FDA wants to achieve paperless and centralized application.
8. Another thing if the online application will be fully implemented and regional offices will be eradicated, pharmaceutical companies from Mindanao, Visayas and Northern Luzon need to travel by land or air just to submit the documents and requirements needed to finish the application. That will be expensive, time consuming, redundant, no assurance if your application will be approved.
9. There is no assurance if the online application will be successfully submitted or received by both applicant and receiver. You cannot remove the reality of err and fallibility.
10. Submission of insufficiency and lacking need to be scheduled before they entertain you.
11. You need to watch the PAIR youtube video to understand what I say.

If there are disadvantages of online processing there also advantages of it.

1. They say LTO will be sent to your respective email address. Moreover, LTO can be easily get is also can be easily revoked or suspended when the insufficiency and violations are found during inspection.
2. Tracking application can remove worries about the application status.
3. Can pay to any branch of Landbank.

Conclusion:

The role of FDA in the public is to give service and regulate pharmaceutical businesses. The public needs efficient, facilitated and consistent policies and procedures to make their errands and works more convenient. For me I want the old system of business application, because you do not need to schedule you application to be able to be entertained. The old system is a one day processing if ever there is no lacking or problem. Submission, interview and payment can be done in one errand and voila you are finished. What you need to do next is to wait for the inspection to be done and when everything is okay you will wait for you LTO to be delivered or released. Unlike this new system, you need to apply online, wait for your reference code, submit online, schedule payment, schedule submission of payment, scanned docs, saved in USB and submit again. And in the end you need to appear in their MAIN OFFICE in Alabang to submit everything. So why should I waste my time in all of that, provided, when in the end I will be appearing in their office still. So I keep saying the redundancy word because of that.

I am not against online application. My concern is that I hope the processing will be only one day processing and does not need to go around the bush. It should be direct and simplified. I hope FDA Philippines will be opted to give the public an option whether to apply online or apply physically. And I hope that the regional offices will not be disappeared instead to strengthen them and fortify them to continue servicing the pharmaceutical industries that located in the far flung areas that cannot be simply reached by the main office.

FDA Public Assistance Information and Receiving (PAIR) Video Tutorial

Food and Drug Administration (FDA) Philippines tutorial regarding the online application, renewal and other transaction for the future registration. This tutorial only applies to National Capital Region and Region IV-A. But, is this online application will facilitate application process, or it will just make the process longer? Make up your mind when you watch this.