What we in the pharmacy do for our dispensing fee.
1. Identification. On receipt of the prescription the pharmacist must first identify that the prescription is for the patient who presents it. In our pharmacy we have many patients with the same surname. We also have some with the same first name, the same surname and having the same address. For example my husband and my son have exactly the same name and address. The local doctors would also have the same problem. Where possible, patients should provide their address and their date of birth. A mobile phone number would also be useful.
2. Is the prescribed medication suitable for that patient?
If the prescription is for a Penicillin antibiotic, is the patient allergic to Penicillin?
Sometimes a patient will see a locum doctor or a weekend doctor. These doctors might not be fully aware of the patient’s medical history or aware of the patient’s other medication and often a patient may not remember all of their own medications. For example a patient on heart medication should not be prescribed Domperidone (Motilium).
3. Is the dosage of the prescribed medication correct?
For example the prescribing doctor may have inadvertently prescribed a child’s dose for an adult or more seriously an adults dose to a child.
4. Is there an interaction between the prescribed medication or with any other medication that the patient is on? A patient prescribed a Potassium sparing diuretic should not also be on a Potassium supplement.
Another example that a patient on Warfarin should not be prescribed oral Miconazole. This combination caused a death in Ireland two years ago.
Patients on Statins (anti-choloesterol) should temporarily go off the Statins if they are prescribed an anti-biotic called Clarithromycin.
5. Checks and balances.
Several pharmacies have two professional staff checking each prescription. Other pharmacies have strict Standard Operating Procedures for checking the accuracy of prescriptions and dispensing. Frequently a pharmacist will contact the prescriber to verify a prescription.
In a recent survey of Irish pharmacists 96% said that they correct three or more prescribing errors every day. The same survey showed that 60% of Irish pharmacies correct more than six prescription errors every day.
6. Legal and Legislative considerations.
A pharmacy is required to keep a record of every prescription dispensed for two years. The pharmacist has to record each dispensing of a repeat prescription. In addition the pharmacist has to sign, date and stamp each prescription. In some circumstances the pharmacist has to make an additional record of a prescription together with the name of the prescribing Doctor, the Doctor’s address, the patient’s name and address, the name and amount of the drug and the balance of the drug remaining in the drug safe.
7. Patient consultation.
Many prescriptions involve a discussion between the patient and the pharmacist. For example, some liquid anti-biotics need to be stored in a fridge once they have been re-constituted. Other prescriptions will require different consultations between patient and pharmacist such as informing the patient if the medication must be taken before, with or after food.
8. Adherence.
Some patients may not use their inhalers properly and may need help and advice. Other patients may neglect some of their prescribed medication or may not take their medication properly or at all. In these cases, the pharmacist will ask questions and encourage compliance.
9. Confusing drug names.
Some drug companies place two or more drugs in the same tablet. An example of this is a tablet called Acerycal which is a combination of two drugs called Perindopril and Amlodipine. There are four presentations of Acerycal; 5/5, 10/5, 5/10 and 10/10. Sometimes a prescriber just writes Acerycal on the prescription. In cases like this the pharmacist has to investigate by often contacting the prescriber.
10. Hand writing. Some doctors easily legible hand writing. However in some cases the prescription is incredibly difficult to decipher. It can take time to reveal the contents of the perscription.
11. Unit dose packaging. Certain patients find it difficult to manage their medicines and for these patients we can dispense their drugs in a unit dose which are measured out for days of the week and times of the day. This makes it easier for patients to correctly take their medication.
All these steps have to be covered for each prescription dispensed which is why there is sometimes a wait in the pharmacy and for which we charge a dispensing fee.