2014.2-30.Remarks

                                                                                                                            article in PDF  
Our Dermatol Online.  2014; 5(2): 213-214
DOI:.  10.7241/ourd.20142.56
Date of submission:  27.02.2014 / acceptance: 30.03.2014
Conflicts of interest: None
 

REMARKS ON THE PRESCRIPTIONS AND THE DISPENSING OF THE MEDICATIONS

Khalid Al Aboud

Department of Public Health, King Faisal Hospital, Makkah, Saudi Arabia
 

Corresponding author:  Dr Khalid Al Aboud    e-mail: amoa65@hotmail.com


 

Sir,
     Several researchers have called for reforms in drug naming, labeling, and packaging standards. Giving the patients the medications remains the most important stage in patients care. There are medical errors associated with this stage. In the following disquisition, we shall highlights on some points on the prescriptions and the dispensing of the medications. We wish that these points encourage further discussions by the readers.
 
Enhancing and strengthening the knowledge of the health care providers about the medications.
One way to achieve this is by creating a websites for this purpose and teaching the health care providers how to utilize these websites efficiently. It will be very helpful, also, if all pharmaceutical firms establish and maintain a drug information centers for their products. Important resources such as medication guides and Physicians’ Desk Reference (PDR) should be readily available to the practitioners. PDR is a commercially published compilation of manufacturers’ prescribing information (package insert) on prescription drugs, updated annually. PDR is available in many forms, including the annual publication, online (PDR.net), and integrated directly into electronic health record (EHR) systems. The 2011 version is the 65th edition, and has information on over 1,116 of the most commonly prescribed drugs [1]. It is hoped that there will be PDR edition for each specialty. There is already published PDR for ophthalmology. Practitioners should know also how to deal with incidences of drug poisoning and should have training programs on the knowledge of basic poison management. Establishing Drug and Poison Information Center (DPIC) should provide support in this regards [2].
 
Improving drug packaging
The pharmaceutical packaging including secondary packaging items (cartons, labels, and package inserts), is an essential constituent of medical products because it guarantees its stability and integrity. Important details like expiry date should be printed clearly and should not be easily erased from the packages. An easy-to-use pharmaceutical packaging also guarantees the good use of medicinal products and promotes patient compliance (for example, pack and calendar blisters).It is also a safety guarantee when it uses specific methods, such as single-dose packaging or safety caps for children.Pharmaceutical packaging also help to recognize the drug, which in itself is part of the safety process all along supply chain. Indeed, drug packaging’s major role is to avoid confusion with other drugs among professionals and patients alike [3].
 
Improving the drug labeling
Drug labeling refers to all of the printed information that accompanies a drug, including the label; the wrapping and the package insert (PI) [4-6]. The labeling of medications encompasses the provision of information and instructions to ensure the safe and effective use of the products by patients. The labels of dispensed medications represent one of the most important sources of information available to patients. Legitimately, labeling information includes but is not limited to the following categories: patient identification, medication name, dosage, frequency, route of administration, production and expiration date and some medication storage requirements [4]. Good medication labeling practices are imperative to ensure safe medication use. International standards such as labeling guidelines issued by in the Institute for Safe Medication Practices (ISMP) should be followed. PI (formally prescribing information in the United States; in Europe, Patient information leaflet for human medicines or Package Leaflet for veterinary medicines) is a document provided along with a prescription medication to provide additional information about that drug [7,8]. In January 2006, the FDA released a major revision to the patient PI guidelines. The new requirements include a section called Highlights which summarizes the most important information about benefits and risks; a Table of Contents for easy reference; the date of initial product approval; and a toll-free number and Internet address to encourage more widespread reporting of information regarding suspected adverse events [7]. In each country the PI is available in one or two languages only. Language Localization System is a one-year effort by the European Commission to produce a prototype tool which will support the creation of various kinds of medical documentation simultaneously in multiple languages, by storing the information in a database and allowing a variety of forms and languages of output [2]. International organizations such as World Health Organization are encouraged to establish standards for writing PI.There are many initiatives to improve the quantity and quality of information in PI as well as accessibility and readability of PI.Proper use of colors, diagrams in PI might be helpful. Information in PI should be comprehensible, understandable by the patients and not misleading. South Africa has taken the initiative of making all package inserts available electronically via the internet, and Canada is working on a similar capability. The UK-based electronic Medicines Compendium provides freely-available online access to both Patient Information Leaflets (intended for consumers) and Summary of Product Characteristics (aimed at healthcare professionals) for products available in the UK [2]. In November 2005, aimed to replicate these leaflets in more accessible formats, including Braille, large print and on CD-ROM. It is a venture by the Royal National Institute of the Blind, the National Library for the Blind and Datapharm Communications [3].
 
Increasing the communication between health care providers (physician and pharmacist) and the patients regarding the drugs
It has been shown that personal recommendation from health care providers is more helpful and more accepted by the patient than PI [4].
 
Computerizing the labeling and the dispensing of the medications
It is expected that computerized systems in medical fields could prevent prescription errors by automatically checking prescriptions. In contrast to PI, the computer-generated leaflets can be personalized and thus irrelevant information can be omitted and only age-specific information included, leading to a shorter but more relevant leaflet. Another major advantage of electronically generated leaflets is that they can instantly updated [5]. The proper use of technology throughout the medication use process was shown to possibly improve medication safety and minimize medication errors.
 
Effective implementation of laws regarding proper dispensing of medications
The laws mandate that medications purchased from a community pharmacy are dispensed in their original packages with PI inside it. However, it is a common observations in many countries that the pharmacists is selling the patients one strip of the drugs as a patient cannot afford to buy the complete course. Drugs should be dispensed in a child resistant containers instead of envelops. The patients should be warned for the hazards of careless storage of drugs inside homes. Only Over-The-Counter (OTC) medications could be given without prescription. Violating this rule had led to serious complications particularly to dermatology patient from misuse of potent topical steroids. Self-medication should be forbidden [6].
 
Adherence to the proper uniform for pharmacy staff
It is well known that white coat symbolize professionalism, and represent provider-patient fiduciary relationship. A good appearance of the staff increases the trust of patients in them.
 
REFERENCES
1. Physicians’ Desk Reference. [A page on the Internet]. From Wikipedia, the free encyclopedia Wikipedia® is a registered trademark of the Wikimedia Foundation, Inc. [This page was last modified 2013July8; cited 2012 Feb18].Available at; http:// en.wikipedia.org/wiki/Physicians%27_Desk_Reference.
2. Al-Barraq A, Farahat F. Pattern and determinants of poisoning in a teaching hospital in Riyadh, Saudi Arabia. Saudi Pharm. J 2011; 19:57-63.
3. Poitou P. [The role of the packaging in terms of safety and good use of medicines]. Ann Pharm Fr. 2003;61:300-3.
4. Alkhani S, Ahmed Y, Bin-Sabbar N, Almogirah H, Alturki A, Albanyan H, et al. Current practices for labeling medications in hospitals in Riyadh, Saudi Arabia. Saudi Pharm J. 2013;21:345-9.
5. Poon EG, Cina JL, Churchill W, Patel N, Featherstone E, Rothschild JM, et al. Medication Dispensing Errors and Potential Adverse Drug Events before and after implementing bar Code Technology in the Pharmacy. Ann Intern Med. 2006;145:426–34.
6. Kuiper SA, McCreadie SR, Mitxhell JF, Stevenson JG. Medication errors in inpatient pharmacy operation and technologies for improvement. Am J Health Syst Pharm. 2007;64:955–9.
7. Package insert. [A page on the Internet]. From Wikipedia, the free encyclopedia Wikipedia® is a registered trademark of the Wikimedia Foundation, Inc. [This page was last modified 2013Nov6; cited 2014Feb19]. Available at; http://en.wikipedia.org/wiki/Package_ insert.
8. Patient information leaflets. [A page on the Internet]. From Wikipedia, the free encyclopedia Wikipedia® is a registered trademark of the Wikimedia Foundation, Inc. [This page was last modified 2013April5; cited 2014 Feb19]. Available at; http:// en.wikipedia.org/wiki/Patient_information_leaflet.
9. Stahl C, Brauer S, Zeitler H, Gulich M.How important is a package insert for drug therapy in ambulatory care? J Public Health. 2006;14: 174-77.
10. Sawalha A, Sweileh W, Zyoud SH, Jabi S. Comparative analysis of patient package inserts of local and imported ant-infective agents in Palestine. Libyan J Med. 2008;3:181-5.
11.Amran S, Ahmed M, Shaheen SM, Morshed SN, Khandakar J, Rahman M, et al. Short communication: a study on the packaging information of essential drug products used at Union and Thana health complex level in Bangladesh. Pak J Pharm Sci. 2007;20: 327- 32.
12. Alghanim SA.Self-medication practice among patients in a public health care system. East Mediterr Health J. 2011;17:409-16.
13.Khanfar NM, Zapantis A, Alkhateeb FM, Clauson KA, Beckey C. Patient attitudes toward community pharmacist attire.J Pharm Pract. 2013;26:442-7.


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