Unit 204 Assist with the assembly of prescribed items

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1 Element 1 Assemble prescribed 171

2 172

3 Element 1 Assemble prescribed Background Assembling prescribed is a complex process. The two main components of this process are labelling and dispensing. It is essential that both of these components are undertaken accurately to ensure that medicines are used safely and effectively. Before a prescription can be labelled and dispensed, it needs to be validated to ensure that it is legal and meets the written requirements stated in the British National Formulary, and that the medicine prescribed is appropriate for the patient. This includes confirming that the doses and frequency of the medicines are correct and that the patient is not allergic to the medicines. Validation also confirms that there are no interactions between the medicines or any other medicine the patient is taking, including any bought over the counter from a chemist or any other retail shop. This process is part of the 'clinical screen' and is conducted by the pharmacist. It is usually performed before labelling of medicines begins. To produce a label for a medicine, you must read and interpret the prescription as well as confirm the patient's details. 173 Accuracy in labelling ensures that the whole dispensing process runs smoothly and that medicines are costed to the correct specialties in the hospital. It also means that when the prescription details are added to the computer the information on a patient's medication history is recorded for future reference. It is therefore important that all details are recorded accurately and correctly. Dispensing the medicine is the third stage in the process and requires you to collect the medicines from storage, usually from the shelves in the dispensary. Selecting the correct medicine against the prescription is very important and there are many factors that need to be checked. When the correct medicine has been selected and packed the label needs to be attached, in the correct manner, to give the patient written details on how to take the medicine. It is important at this stage to recheck the label to make sure it is clear and gives full instructions to the patient. Before the medicine can be given to the patient, the prescription must be finally checked for accuracy by a pharmacist or accredited checking technician. Whilst carrying out these activities, you must be aware of health and safety issues relating to the assembly of prescribed at all times. Within this section you will also find exercises in interpretation of prescription abbreviations and calculation of doses.

4 Key words and concepts These definitions are provided to explain how key words and concepts are used in this unit BNF British National Formulary Client refers to the patient, the patient's representative, e.g. carer, nurse, doctor or the customer. Standard Operating Procedures these are referred to as SOPs and protocols or written procedures. They state the way your organisation requires tasks to be carried out to ensure a quality pharmacy service is provided; this would include, how certain should be labelled, who to check certain things with, the checking procedures. 174 Valid the prescription must be legible, complete and signed and dated by the appropriate prescriber. It must also meet the government's requirements in respect of payment and exemption of prescription charges, where applicable.

5 Knowledge and Understanding You must show that you know and understand: Identify hazards K1 The limits of your own authority and when to refer to a pharmacist or a pharmacy technician. K2 K3 K4 K5 K6 K7 K8 K9 K10 The importance of maintaining dispensary records including the use of the dispensary computer. The relevant current ethical and legal requirements that govern the dispensing and issuing of a prescription. That some clients will have special needs and how you would deal with these. The procedures for the assembly of prescribed plus the principles underlying these. Basic hygiene and the importance of maintaining a clean working environment and equipment. The importance of personal hygiene and the use of protective clothing. Factors which cause deterioration of stock: environmental and storage conditions. Handling and storage of hazardous material and procedures to minimise risk. SOPs for the assembly of prescribed and the reasons for following them. 175

6 Activities 1. Find out where your dispensary procedures for labelling, pricing and dispensing medicines are kept. Read them and discuss key points with your Trainer/Assessor. 2. Identify and list all the details that are legally required to be printed on a dispensed medicines label. Discuss this with your Trainer/Assessor. Print a copy of a label from the computer and write on it which aspects are legal requirements. Put this in your portfolio. 3. Complete the prescription interpretation exercise (APPENDIX 1) using the BNF with help from your Trainer/Assessor. With your Trainer/Assessor, interpret an agreed number of actual prescriptions, including all types used within your department. 4. Undertake training to label prescriptions. After this, arrange time with your Trainer/Assessor for labelling practice Identify and list examples of possible queries on a prescription and who you would refer these to before labelling. 6. Describe the roles and responsibilities of pharmacists, pharmacy technicians and pharmacy assistants in the dispensary. Discuss this with your Trainer/Assessor. 7. Discuss with your Trainer/Assessor the importance of pricing medicines correctly, and consequences of inaccurately pricing medicines. 8. Complete the calculations exercises (APPENDIX 2). Ask your Trainer/Assessor to show you an agreed number of prescriptions. Calculate and record the quantities of each item that you would dispense. 9. Referring back to your prescription interpretation exercise (APPENDIX 1), fill in your local computer codes for common directions on the label, e.g. one tablet twice a day. Ask your Trainer/Assessor to check this when complete. 10. Describe what the term 'additional labels' and 'warning labels' means. Identify where you would find this information. Find out how you would add additional/warning labels as needed. Keep an agreed number of examples for your portfolio. 11. Produce your own written checklist to ensure that all the details on the finished label are correct. 12. Find out when a label is not acceptable according to your local procedures. List any specific customers that may require alternative labelling requirements. 13. Draw a plan of the dispensary showing where medicines are stored, highlighting any special areas of storage, e.g. controlled drugs.

7 Activities 14. Ask your Trainer/Assessor to observe you selecting an agreed number of medicines against their prescriptions. 15. With your Trainer/Assessor, describe the consequences of dispensing the following: Expired medicine Short dated medicine An unfit medicine 16. Find out, according to your local procedure, what you would do if the medicine was of stock. Get your Trainer/Assessor to observe you carrying out the local procedure for dealing with out of stock medicines. 17. List the equipment that is available to assist you in dispensing medicines. Which types of medicines can be counted using the equipment on your list. Find out and undertake the cleaning process for the equipment on your list. 18. List any medicines that have special containers and closure requirements used locally. Get your Trainer/Assessor to observe you packaging medicines in the right containers and labelling them correctly Identify the routine sundry that you would supply with the following dispensed medicines:- a) Internal liquid b) Internal liquid for a dose under 5ml c) Steroid medicine d) Tablets that need to be halved e) An anti- coagulant medicine, e.g. Warfarin - Discuss this with your Trainer/Assessor 20. Find out what special sundry may be supplied according to prescriptions or local procedures, e.g. spacers/dosettes 21. Find out what a 'PIL' means. Discuss with your Trainer/Assessor the legal requirements for supplying 'PILs'. Describe any situations when you would not supply a "PIL" according to local procedures. 22. Get your Trainer/Assessor to observe you endorsing a prescription. Describe why it is necessary and important to endorse the prescription. Discuss with your Trainer/Assessor the information that should be endorsed on the prescription. 23. Produce your own written checklist to ensure that all the details on the finished dispensed medicine are correct. 24. Find out and obtain signatures of the appropriate or designated staff within the dispensary that are able to perform the final accuracy check.

8 Questions K1 The limits of your own authority and when to refer to a pharmacist or a pharmacy technician. What are your roles and responsibilities relating to the assembly of prescribed? 178 What are the roles and responsibilities of the other members of your team who are involved in the assembly of prescribed?

9 K1 The limits of your own authority and when to refer to a pharmacist or a pharmacy technician. Under what circumstances would you refer to a pharmacy technician when assembling prescribed? 179 Under what circumstances would you refer to a pharmacist when assembling prescribed?

10 K1 The limits of your own authority and when to refer to a pharmacist or a pharmacy technician. Which other healthcare professionals might you refer to when assembling prescribed? 180 Under what circumstances would you refer to these other healthcare professionals when assembling prescribed?

11 Questions K2 The importance of maintaining dispensary records including the use of the dispensary computer. What dispensary records must be kept in your workplace? Why is it important to maintain these records? What could happen if these records were not maintained? 181 What are your roles and responsibilities in maintaining these records? What are the roles and responsibilities of the other members of your team in maintaining these records?

12 Questions K3 The relevant current ethical and legal requirements that govern the dispensing and issuing of a prescription. What are the current ethical and legal requirements that govern the dispensing and issuing of a prescription? What are the key points covered in these requirements? 182 Why is it important that you follow these requirements? What could happen if you did not follow these requirements?

13 K3 The relevant current ethical and legal requirements that govern the dispensing and issuing of a prescription. For legal purposes, what information must be included on a prescription? Why is it necessary to include this information on a prescription? 183

14 K3 The relevant current ethical and legal requirements that govern the dispensing and issuing of a prescription. For legal purposes, what information must be included on a label? Why is it necessary to include this information on a label? 184

15 K3 The relevant current ethical and legal requirements that govern the dispensing and issuing of a prescription. What are the legal requirements regarding closures on medicine containers? 185

16 Questions K4 That some clients will have special needs and how you would deal with them. Why is it important to establish the needs of your clients? What could happen if you did not do this? 186 What can you do to ensure that you establish the needs of your clients?

17 K4 That some clients will have special needs and how you would deal with them. What special needs might your clients have? 187 What can you do to ensure that you establish the requirements of your clients with special needs? What action should be taken when supplying prescribed to clients with special needs?

18 K4 That some clients will have special needs and how you would deal with them. Under what circumstances would you deal with clients that have special needs yourself? 188 Under what circumstances would you refer a client with special needs to a pharmacy technician? Under what circumstances would you refer a client with special needs to a pharmacist?

19 Questions K5 The procedures for the assembly of prescribed plus the principles underlying these. What procedures are in place in your department and organisation for assembling prescribed? What are the key points covered in these procedures? 189 Why is it important that you follow these procedures? What could happen if you did not follow these procedures?

20 K5 The procedures for the assembly of prescribed plus the principles underlying these. According to your local procedures, what information must be included on a prescription for it to be valid for dispensing? Why is it necessary to include this information on a prescription? 190

21 K5 The procedures for the assembly of prescribed plus the principles underlying these. What common abbreviations are used on prescriptions? What do these abbreviations mean? (See prescription interpretation exercise APPENDIX 1) 191 What different types of prescription are used in your organisation? Under what circumstances are these different types of prescription used?

22 K5 The procedures for the assembly of prescribed plus the principles underlying these. According to your local procedures, what information must be included on a label? Why is it necessary to include this information on a label? What could happen if this information was omitted from a label? 192

23 K5 The procedures for the assembly of prescribed plus the principles underlying these. Why is it important that the information included on a label is accurate? What could happen if this information was inaccurate? 193

24 K5 The procedures for the assembly of prescribed plus the principles underlying these. What different drug forms are used in your organisation? Under what circumstances are these different drug forms used? 194 Why is it important to dispense the correct drug form? What could happen if you dispensed the incorrect drug form?

25 K5 The procedures for the assembly of prescribed plus the principles underlying these. Why is it important to dispense the correct drug strength? What could happen if you dispensed the incorrect drug strength? 195 What is meant by a generic product? What is meant by a branded product?

26 K5 The procedures for the assembly of prescribed plus the principles underlying these. Under what circumstances must you dispense a branded product? 196 Why is it important to dispense a branded product in these circumstances? What could happen if you did not dispense a branded product in these circumstances?

27 K5 The procedures for the assembly of prescribed plus the principles underlying these. Why is it important to check the expiry of the drug you are dispensing? What could happen if you dispensed an expired drug? 197 What do the following terms mean? Use before Do not use after Expires Use by According to your local procedures, what action must you take when dispensing short dated drugs? Why is it necessary to take this action when dispensing short dated drugs?

28 K5 The procedures for the assembly of prescribed plus the principles underlying these. Which drugs must be dispensed in their original containers? 198 Why must these drugs remain in their original containers? What could happen if these drugs were transferred from their original containers?

29 K5 The procedures for the assembly of prescribed plus the principles underlying these. What different containers are used in your department for dispensing from bulk packs? Under what circumstances are these different containers used? 199 Why is it important to use the correct container when dispensing from bulk packs? What could happen if you used the incorrect container?

30 K5 The procedures for the assembly of prescribed plus the principles underlying these. What procedures are in place in your department relating to closures on medicine containers? What are the key points covered in these procedures? 200 Why is it important that you follow these procedures? What could happen if you did not follow these procedures?

31 K5 The procedures for the assembly of prescribed plus the principles underlying these. What sundry must you include when assembling prescribed? Under what circumstances must these sundry be included when assembling prescribed? 201 Why is it important to include these sundry in these circumstances? What could happen if these sundry were not included?

32 K5 The procedures for the assembly of prescribed plus the principles underlying these. What written information must you include when assembling prescribed? Under what circumstances must this written information be included when assembling prescribed? 202 Why is it important to include this written information in these circumstances? What could happen if this written information was not included?

33 K5 The procedures for the assembly of prescribed plus the principles underlying these. Why is it important to dispense prescribed accurately? What could happen if you did not dispense prescribed accurately? 203 What evidence do you have to show that you can dispense prescribed accurately?

34 K5 The procedures for the assembly of prescribed plus the principles underlying these. What procedures are in place in your department regarding annotating prescriptions once dispensing is completed? What are the key points covered in these procedures? 204 Why is it important that you follow these procedures? What could happen if you did not follow these procedures?

35 K5 The procedures for the assembly of prescribed plus the principles underlying these. What procedures are in place in your department regarding checking prescriptions once dispensing is completed? What are the key points covered in these procedures? 205 Why is it important that you follow these procedures? What could happen if you did not follow these procedures? Which people in your department can check prescriptions once dispensing is completed?

36 K5 The procedures for the assembly of prescribed plus the principles underlying these. Where are completed prescriptions filed and stored? 206 For how long is it necessary to keep completed prescriptions?

37 Questions K6 Basic hygiene and the importance of maintaining a clean working environment and equipment. Why is it important to maintain a clean working environment? What could happen if a clean working environment was not maintained? 207 How is the cleanliness of your working environment maintained? How is the cleanliness of your working environment monitored?

38 K6 Basic hygiene and the importance of maintaining a clean working environment and equipment. What are your roles and responsibilities in maintaining a clean working environment? 208 What are the roles and responsibilities of the other members of your team in maintaining a clean working environment?

39 K6 Basic hygiene and the importance of maintaining a clean working environment and equipment. What equipment do you use when assembling prescribed? Under what circumstances is this equipment used? 209 Why is it important that this equipment is decontaminated before and after use? What could happen if this equipment is not decontaminated before and after use?

40 Questions K7 The importance of personal hygiene and the use of protective clothing. What procedures are in place covering personal presentation and hygiene in your workplace? What are the key points covered in these procedures? 210 Why is it important that you follow these procedures? What could happen if you did not follow these procedures?

41 K7 The importance of personal hygiene and the use of protective clothing. What protective clothing are you required to wear in your workplace? Under what circumstances must you wear this protective clothing? 211 Why is it important that you wear this protective clothing in these circumstances? What could happen if you did not wear this protective clothing?

42 K7 The importance of personal hygiene and the use of protective clothing. What procedures are in place covering personal conduct in your workplace? What are the key points covered in these procedures? 212 Why is it important that you follow these procedures? What could happen if you did not follow these procedures?

43 Questions K8 Factors which cause deterioration of stock: environmental and storage conditions. What procedures are in place in your department relating to the storage of pharmaceutical products? What are the key points covered in these procedures? 213 Why is it important that you follow these procedures? What could happen if you did not follow these procedures?

44 K8 Factors which cause deterioration of stock: environmental and storage conditions. Which pharmaceutical products that you come into contact with in your job role have special storage requirements? How can you identify these pharmaceutical products? How should these pharmaceutical products be stored? 214

45 K8 Factors which cause deterioration of stock: environmental and storage conditions. Why is it important that these pharmaceutical products are stored correctly? What could happen if these pharmaceutical products are not stored correctly? 215 What implications could there be for the patient if these pharmaceutical products are not stored correctly?

46 Questions K9 Handling and storage of hazardous material and procedures to minimise risk. What procedures are in place in your department and organisation relating to the handling of hazardous material? What are the key points covered in these procedures? 216 What could happen if you did not follow these procedures?

47 K9 Handling and storage of hazardous material and procedures to minimise risk. What procedures are in place in your department and organisation relating to the storage of hazardous material? What are the key points covered in these procedures? 217 Why is it important that you follow these procedures? What could happen if you did not follow these procedures?

48 K9 Handling and storage of hazardous material and procedures to minimise risk. What hazardous material do you come into contact with in your job role? How can you identify these materials? What special precautions do you need to take when working with these materials? 218

49 Questions K10 SOPs for the assembly of prescribed and the reasons for following them. (See K5 The procedures for the assembly of prescribed plus the principles underlying these). 219

50 Prescription abbreviation exercise - Appendix 1 For each direction, write down the meaning and any other relevant information. You may use the back of the BNF to help you. Direction Answer Your local labelling code Correct Y/N (Signature of Trainer/ Assessor and date) OD BD TDS QDS PRN PV 220 PO IV IM MANE NOCTE S/L 2/52 MDI 3/7 S/C 3XWEEK OP TOP OC GUTTE UNG STAT PR

51 Calculations - Appendix 2 Answer the following questions by calculating the amount required for issuing: If you have any problems, ask your Trainer/Assessor to work through them with you. Questions How many Flucloxacillin capsules 250mg would you dispense for a prescription that reads: One capsule FOUR times a day for 14 days. Answer Correct Y/N (Signature of Trainer/Assessor and date) How many Paracetamol tablets 500mg would you dispense for a prescription that reads: TWO tablets FOUR times a day for 7 days. How much Lactulose solution would you supply for a prescription that reads: 10mls TWICE a day for 7 days. 221 How many Metoprolol 50mg tablets would you supply for a prescription that reads: 25mg THREE times a day for 14 days. What quantities of Phenytoin 100mg and 50mg capsules would you dispense for a prescription that reads: 150mg TWICE a day for 28 days. How many Ciprofloxacin 250mg tablets would you dispense for a prescription that reads: Ciprofloxacin 750mg TWICE a day for 14 days. How much Flucloxacillin 125mg/5ml syrup would you need to supply for a prescription that reads: 125mg FOUR times a day for 5 days.

52 Calculations - Appendix 2 Questions How many Methotrexate 2.5mg tablets would you need to supply for a prescription that reads: 15mg ONCE a week for 6 weeks. Answer Correct Y/N (Signature of Trainer/Assessor and date) How many Predisolone 5mg tablets would you need to dispense to complete a reducing course, starting at 60mg and reducing by 5mg every 2 days until 0mg? 222 You need have a prescription for Warfarin 3mg/4mg on alternate days for one month. How many 1mg and 3mg tablets would you need to dispense? Calculate the amount of vials needed for the following prescription: Calcitonin inj 100u/ml (100u/ml 1ml vial), 220u Three times a day for 12 days. How many micrograms are in Digoxin tablets mg? How many milligrams are there in 1.5g of sulfasalazine 0.5g tablets How many milligrams are there in Levothyroxine 100 microgram tablets? How many mls would you give each time for a dose of 1mg of folic acid syrup 2.5mg/5ml.

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