DEPARTMENT OF PHARMACEUTICS AND

PHARMACEUTICAL TECHNOLOGY

ACHIEVERS UNIVERSITY

OWO, ONDO STATE

PCT 201

DISPENSING, PRESCRIPTION & LABEL

OLUTAYO ADELEYE
Learning Objectives

To define the concept of dispensing and its significance in pharmacy practice.

To the explain the ethical principles guiding pharmacy practice

To outline the standard procedures involved in dispensing of medicines

To identify common errors in dispensing and approaches to prevent them.

To interpret the components of a prescription, including drug name, dosage, frequency, and
instructions.

To identify the key information that must be included on labels of dispensed medicines

Introduction

Dispensing is defined as the process of preparing, packaging, labeling, and supplying medicines to patients

in accordance with a prescription. It involves ensuring the right medicine is given to the right patient in the

right dose and form, with clear instructions, advice and counselling on the use of these medicines for

safe and effective therapy.

Dispensing is a legal responsibility of Pharmacist ensures that patients receive the correct medications with

the proper guidance for safe and effective use

Sources of Information for Dispensing

In dispensing, information is vital to ensure the safe, accurate, and effective dispensing of medications. so

reliable and current sources of information are essential for accurate dispensing. These sources are classified

as;

Primary Sources

Prescriptions: this is the primary source of dispensing information provided by authorized prescribers.

Medical Records: Patient-specific information to ensure compatibility and safety.

Secondary Sources

Official Reference Books: these books provide standards for the identity, strength, purity, and quality of

medications. Examples of such books are;

British National Formulary (BNF)

United States Pharmacopeia (USP)

British Pharmaceutical Codex (BPC)

All these books provide comprehensive drug information, including doses, indications, contraindications

and stability of medicines.

Tertiary Sources

Online Databases: examples are drug interactions database like Epocrates, Medscape etc

Pharmaceutical Manufacturers: package inserts and websites.

Standard Treatment Guidelines: WHO or national guidelines for disease-specific treatment protocols.

Principles and Ethics of Dispensing

Dispensing is governed by ethical and professional principles to ensure that patients receive the

correct medication, in the correct dose, at the right time, and with the proper instructions for safe

and effective use. By adhering to these principles and ethics, pharmacists can ensure the dispensing

of safe and effective medications to patients thereby contributing to improved patient health and

well-being.

The most vital principles are; accuracy, confidentiality, patient safety and accountability

These principles are important for patient safety and optimal therapeutic outcomes.

Accuracy: the pharmacist must ensure that the correct drugs, doses, and formulations are

dispensed. Errors must be avoided. The medicine’s name, dose, strength, and formulation must be

double-checked to avoid dispensing errors. And labels must be ensured to be accurate, including

patient name, medication details, and instructions.

Confidentiality: patient information and prescription details must be protected. The patient’s must

be privacy and confidentiality must be maintained when discussing medical or prescription details.

Patients records must be securely stored and shared only with authorized individuals.

Patient Safety: potential drug interactions, allergies, or contraindications must be screened. The

pharmacist must confirm that the patient is not allergic to the prescribed medication or related
drugs. The medical conditions or medications that may contraindicate the prescription must be

identified and potential interactions with other drugs, food, or alcohol should be evaluated.

Accountability: the pharmacist should take responsibility for any dispensing errors.

PRESCRIPTION

A prescription is an order that is written by a duly registered and licensed prescriber such as

physicians, dentists etc. instructing the pharmacist to supply medications and other pharmaceutical

commodities (e.g. medical devices) to a patient.

The Pharmacist is entrusted with the legal responsibility of compounding or filling and dispensing

of a valid prescription order among many other responsibilities. Their primary duty is to prepare

medications following a prescription order. So, the pharmacist must be diligent and effective in

understanding and interpreting a prescription. The prescription must be checked or evaluated for

accuracy and completeness before dispensing to ensure that there are no errors and that they are

appropriate and safe for the individual patient. To ensure this, the following should be done;

 Assess the patient and the patient’s health history and medication record;

 Verify prescription information and dosage

 Determine that the proposed therapy is appropriate for the patient

 Fulfill the pharmacist’s responsibilities to counsel the patient and to monitor the patient’s

drug therapy

Components of a Prescription

Generally, a prescription consists of the following elements

1. Hospital’s Information - Hospital’s name, address and telephone numbers. This

information is usually found at the top of the prescription.

2. Prescriber’s Information - Prescriber’s name, degree, address and telephone number

3. Patient’s Information - Patient’s name, address, age, sex and the date of prescription.
4. The symbol (Rx) – This is called superscription. This symbol represents ‘‘recipe.’’ Or

‘‘take thou’’ or ‘‘you take’’.

5. The main part of the Prescription - This part is the medication prescribed by the

prescriber which includes the dispensing instruction. It is called inscription.

This part states the following;

a. Name and strength of the medication (e.g. Paracetamol 1000mg). In the case of

compounded prescriptions, this part states the name and strength of active ingredients.

b. Amount of the medication to be taken per dose (e.g. Paracetamol 1000mg was prescribed

but the available paracetamol is 500mg strength, then you need 2 quantities of the 500mg

strength to give you a dose of 1000mg).

c. Dosage form and route by which the medication is to be taken. The dosage form indicates

if the medicine prescribed is tablet, capsules, syrups, injections, eye drops etc. and route

indicates how the medicine should be taken. Some examples of route of drug

administration are PO (per oral – by mouth), PR (per rectum), IM (intramuscular), IV

(intravenous), SQ (subcutaneous).

d. Frequency and duration by which the medication is to be taken. This indicates how often

to take the medication. This can be from a once a day, once a night, twice a day etc. Some

abbreviations used to indicate frequency of dosage administration b.i.d. (two times daily),

t.i.d. (three times daily), q.i.d. (four times daily). Duration of therapy can be written as 1/52

(indicating one week), 5/7 (indicating 5 days), 1/12 (indicating 1 months) etc.

Example 1

Rx

Tab Paracetamol 1000mg t.i.d. x 5/7

If the pharmacist has only 1000mg tablet in the store, how many tablets should be given to

the patient?
 Example 2

Rx

Erythromycin caps 500 mg

Sig: i cap bid. 10 days

If the pharmacist has only 250 mg capsules in the inventory, how many capsules should be

given to the patient

6. Prescriber’s Signature

The signature of the prescriber must be appear on at the bottom of the prescription.

Types of Prescription

Simple prescription: These are prescriptions containing medicines which are already produced

by pharmaceutical companies and available in the market for dispensing. They products on the

prescription do not require compounding.

Example –

Rx

Tab Paracetamol 1000mg t.i.d. x 5/7

Compound prescription: This type of prescription contains recipe for the preparation of

extemporaneous preparation hence, it requires compounding.

Example –

Rx

Ammonium Chloride and Morphine Mixture BP 1988

E-prescriptions: Electronic prescription is the use of electronic means for the generation and

transmission of prescriptions. It can be used for simple and compound prescriptions.

In-patient prescription: The in-patient prescription is written on a patient’s medication order

form which is only used in the hospital setting. This medication order form is created for the
Physician to prescribe the medications to be administered to admitted patients thereby making

nursing process to be easy. The medication order form usually contains the service unit information

(the name of ward, unit etc.), the drug, the dose, dosage, dosage form, and the date and time when

the drug has to be administered.

Prescription management sequence

Receive prescription – validate the prescription (verify that information on the order is

complete and accurate) – compound or fill the prescription (you need to do some calculations

here) – write prescription label – hand over the prescribed medication or commodity to the patient

– record and file the prescriptions.

There are some basic steps required in the management of a prescription

1. Receiving the prescription

2. Interpreting and validating the prescription

3. Billing of prescription

4. Recording information into the appropriate register (eg computer system - if computerized)

5. Filling prescription

6. Labeling

7. Issuing the prescription to the patient

8. Filing the prescription

Receiving the prescription

A prescription can be a written order on prescription sheet that can be taken to the pharmacy

(hospital or community). You should receive it with respect from the patient. For e-prescription,

it is sent from the physician’s office to the pharmacy (this can only be done in the hospital). Also,
the in-patient prescription known as medication orders is sent to the pharmacy by hand delivery

by staff or patients relative.

Interpreting and validating the prescription

When reading an order, make sure you get the name, strength or dose, dosage form, route of

administration, frequency and duration of administration of the medication. If it is difficult to get

the name of the medication or any of the above, it means that the information is not legible or

incomplete. If you are in doubt and to avoid making error, it is best to request clarification from a

colleague or the prescriber depending on the information that is missing or not legible.

In validating the prescription, we need to ensure that the prescription is appropriate and safe for

the patient.

Billing of prescription

The prescription is costed based on the quantity of medication to be supplied. The patient goes to

make payment as costed and returns to the pharmacy with the payment receipt.

Entering the information on the prescription

Hard copy of prescription is recorded into the appropriate register which could be a book or a

computer. If it is e-prescription, information goes directly into the database.

Filling or compounding of prescription

Filling or compounding of a prescription is the primary duty of a pharmacist. At this stage some

calculations must have been done. Pull out the correct medication (tablets, pills, capsules or

liquids) with the correct strength from the shelf for a simple prescription and material (magnesium

sulphate, light magnesium carbonate, water etc.) for a compound prescription. Count, measure or

weigh the appropriate quantity required according to what was calculated.

You must ensure accuracy to avoid less or excess quantity. If 20 capsules of Amoxicillin 250mg

were calculated from the prescription, check and double check you are filling the envelope with

20 capsules of Amoxicillin 250mg.

If a prescription says “Ampiclox 250mg po tid x 7 days,” how many mL of Ampiclox 250mg/5

mL is required to fill a 7-day supply

Labeling the prescription

Labels are added to products to direct customers on when and how to use the product/medicine. It

may also contain some cautionary instruction such as for external use only, not to be swallowed

etc. The information on the label must be clear and explicit.

Issuing the prescription to patient

This stage is very vital; it offers the Pharmacist the opportunity to ensure that the patient

understands how and when to use the medication. So, good communication and interpersonal

skills are most essential to be displayed by the Pharmacists to make patient use their medication

accordingly.

Filing the prescription

Before filing the prescription, the prescription should be marked as cancelled to show it has been

dispensed. These prescriptions (original hard or electronic copy) are then stored in a secured place

in a way that it can be easily located and retrieved when needed for a duration of 2 years from the

date the prescription was dispensed. Both hard copies and electronic records may be destroyed

once the required time frame has expired.

The essence of filing prescription is for insurance purposes, protection of the dispenser and support

for organization in case of legal or other challenges (query). It is a good risk mitigation tool.

GENERAL DISPENSING PROCEDURE

The Pharmacist is essentially the last line of defense to prevent tragic mistakes that could cost life

of a patient. At this point errors should be prevented. The two types of errors that could occur are

Prescription (medication) and Dispensing Error. Prescription error emanates from the doctor while
dispensing error is caused by the pharmacist. Dispensing error can be prevented by following the

dispensing procedure as specified by the World Health Organization.

Step One: Receive

Receive the prescription from the patient.

Step Two: Understanding, interpreting and validating the prescription

Make sure you understand and interpret the prescription exactly. Confirm the hospital’s

information, prescriber’s information and the patient’s information. Also confirm and be sure that

the patient's name and personal information on the prescription match with the correct patient.

Verify and make sure that the prescription is complete (signed and not outdated) and accurate. If

the handwriting of the prescriber is poor and not legible, do not assume or guess, seek clarification

from the prescriber to avoid error. The prescription must contain the right medication, in the right

dose, for the right patient, at the right time, by the right route of administration.

Step Three: Filling, labeling and issuing the prescription

To avoid error during filling, select the right medication with the right strength from the shelf.

Make sure to compare the prescription and the medication label twice to be absolutely sure you

have selected the right drug. Confirm that the medication is not expired. If the medication is a

capsule or tablet, count the number of medication required with a counting device such as counting

tray. Do not use bare hands to count because the medication might be contaminated or you might

even contaminate yourself especially with some certain potent drugs. After filling, write the label

by printing the name of the drug, the dosage, the name of patient, date of issue etc. Fix it on the

pack e.g. envelopes, bottles etc. Before handing the drug to the patient, check the label and

prescription again against the medication pack for accuracy.

PRESCRIPTION LABEL

A prescription label contains information about the specific instructions on how to correctly take

a medicine as prescribed. It also gives warnings or precautions to be taken when a medicine is

prescription label to be fixed on the container of prescribed medication. Fix the label neatly and

not flying and make sure that the patient can read the information on the label clearly and easily.

If auxiliary label is required, ensure it does not cover any information.

INFORMATION ON THE LABEL OF A DISPENSED MEDICINE

Name and address of the pharmacy

Date of the prescription

Name of the patient

Name of the prescriber

Name of the dispensing pharmacist

Name and strength of the drug

Dosage form and dosage of the drug

The quantity of medicine to be dispensed

Directions on how take/use the medication

Expiry date of the medicine may be included

At times appropriate cautionary statements (auxiliary label) may be included e.g.

 Store in a cool dry place

 Keep in the refrigerator

 Keep out of reach of children

 For external use only

 Do not swallow whole

 Not to be taken

 Take with food

 Take on empty stomach

Prescription and Label Errors

Prescription errors are usually unintentional mistakes in the interpretation transcription,

dispensing, and administration of medication on a prescription order. Some prescription errors

include wrong patient, incorrect medication, inappropriate dose, wrong time, wrong route of

administration, and wrong frequency of administration.

Exercise

Identify the errors in the below prescription and label

General Hospital

08011187288

Patient Name: Ambrose Elli (3 months) Date: 2/2/87

Address: ABUAD

Rx

Cap Cephalexin (500mg) i qid x 1/52

signed

Dr Daramola O.

Label
 Jack Pharmacy

08071539942

Ambrose Elli (Adult) Date: 2/1/87

Address: ABUAD

Cap Cephalexin 500mg 40 Capsules

Take one capsule four times a day for seven days

Pharm. Ramos Dr Dara O.