Question

1. What do you think are the elements of good medicine dispensing practice?
2. Does premises and facilities influence or affects the quality of pharmaceutical service provided to patients? Why or why not?
3. Counting tablets or capsules should be kept clean at all times, why?
4. Briefly describe the concept of FEFO and FIFO policy.
5. What do you think are the safety considerations when storing or displaying liquid dosage forms? Briefly explain each.
6. Why is storage instruction crucial for drug products? Give some scenarios or procedures that emphasize the importance of compliance to storage instruction. 10 pts
7. As a member of health care team, how can you encourage collaboration among other health care professionals?
8. What are the qualities or characteristics of ideal package or container?
9. What will you do if a temperature sensitive drugs will be carry by the nurse during conduction process? What are the helpful tips you can share to the nurse?
10. How can you ensure that a pharmaceutical refrigerator is properly working? A few plastic bottles of water can be added to refrigerator if there is enough or extra space, why? However, do not keep staff food in the refrigerator, why is it prohibited?

Answer 1

1. Elements of good medicine dispensing practice may include the following

• Staff factors: hygiene, calculation skills and knowledge about the medicine being dispensed
• Premises : regular cleaning of the working areas and removal of waste
• Equipment: Proper maintenance of the equpment and packaging materials

2.Yes, the quality of premises affects the quality of the drug. The layout of the premise must be in such a way that it facilitates easy cleaning, removal of waste in order to minimize the risk and avoid cross contamination. Lighting, temperature,humidity and ventilation requirements are different for different pharmaceutical products. Adequate exposure to preferable components or avoidance of exposure must be ensured to prevent adverse effects on the drug. Entry of insects, rodents or animals can also cause contamination. Work area must be sealed to avoid entrance of animals. Restriction to entry of unauthorized individuals may also protect from mishandling, illegal drug deals and aids in effective quality control.

3. A clean counting tray or spatula may be used to count the tablets or capsules. The pills tray must be free of dust and dirt. Individuals handling the pills must be wearing clean clothes and use sterile techniques.Residues on the pill tray or hands leads to cross contamination or allergic reactions. Using disposable trays, frequent cleaning and sterilization can protect the patients from adverse effects due to mishandling. Tablets and capsules are easily destroyed by exposure to moisture and heat.

4. FEFO (First Expired,First Out) and FIFO(First In First Out) policy aims at supplying pharmaceutical products without wastage. It includes supplying drugs close to expiration first(FEFO) . When the expiry dates are same, giving out the oldest one first(FIFO).These policies aims at quality control and prevents expiration of large quantities of drugs in the pharmacy itself that may cause financial loss.

5. Storage of combustible liquids or those are highly radioactive, narcotics or which are at risk of abuse, must be under additional safety measures.Liquid forms like insulin must be stored following the temperature requirements.Review the storage recommendation of each drug before designating to storage spaces.Majority of liquid forms needs to be stored in cool dry place away from moisture. Avoid areas like kitchen, bathroom medicine cabinets for drug storage as excessive heat or humidity can alter the chemical composition. Medications should also be stored away from reach of children and pets. In hospital settings liquids must be stored on lower shelves to prevent spillage or accidental falls.

6. Drugs should always be stored in the assigned drug compartments in alphabetical order with proper labels

LASA drugs (Look alike Sound alike) drugs should be categorized and stored separately with clear labels to avoid errors

Periodic checking for expiry date and cross checking expiry date before administration helps to avoid complications.

Monitor the temperature and humidity of the storage area on daily basis

Keeping strict inventory helps to prevent pilferage, theft or loss.

IV fluids must be stored in adequately spaced areas without exposure to direct sunlight.

Recently received drugs with a longer period of expiration must be placed behind the older ones.

Ensure that tablet containers or bottles with lids are tightly closed

Clean the tablet counters after each use

When refrigeration is necessary, use "medications Only"refrigerator to avoid drug interaction and contamination.

7. Collaboration can be improved by delegation of tasks as per qualification and effective communication with the team members. Sharing of responsibilities avoids issues with decision making and leadership. Sharing of client related information with multidisciplinary team keeps everyone updated, aids in better communication and creates a better working environment.

8. An ideal package must carry a label with appropriate mentioning about the contents in it

Packaging should not affect the quality of its contents

Should be able to protect the content stability in high temperature too

Must be strong and puncture proof

Should ensure protection from moisture,light and air

Should be non toxic in nature

Should be made of material that are cost effective and easily available.

9. Ice lined refrigerator can be used for storing vaccines and temperature sensitive drugs. Such drugs must not be exposed to room temperature. Following tips can be given to the nurse:

• Do not transport temperature sensitive medications unless it is necessary
• Gel packs or conditioned frozen water bottles can be used for transport
• Opened multi dose vials which are temperature sensitive must never be transported
• Avoid freezing of drugs or vaccines while transporting
• Medication must be immediately transferred to appropriate storage device on arrival to the destination.

10. Ensuring proper air circulation: over packing may block the circulation by fan and causes freezing. Ensure orderly arrangement of items.

Accumulation of dust around the compressor and condensor can affect the cooling function. Checking and cleaning of dust may ensure proper cooling.

Storing the refrigerator in a place with adequate ventilation and space will avoid damage caused due to over heating.

Regular maintenance can improve the efficiency and life span of refrigerators.

• Properly sealed water bottles may pose little risk of contamination with medicines. In case if spillage happens, Water being a clear liquid can manifest color changes or taste difference with contamination.
• The rationale of separating food items from medicines is to avoid contamination of food by accidental spillage of drugs. It may become difficult to identify the taste or color of a minimum amount of drug mixed with a food item and can cause poisoning.