Dispensing protocols

RE: Dispensing protocols

Busybee — Fri, 12 Feb 2016 21:12:44 GMT

Thank you all for your answers! Very interesting!

RE: Dispensing protocols

Thomas Johnson — Fri, 12 Feb 2016 09:58:23 GMT

[quote user="robloxley"]

or norocarp rather than noroclav (in the days when norocarp existed),

[/quote]

That's why they changed the name from Norocarp to Carprieve, lots of reports to the VMD of adverse reactions after dispensing errors.

RE: Dispensing protocols

Stuart Jackson — Fri, 12 Feb 2016 08:51:57 GMT

[quote user="Evelyn Barbour-Hill"]I have been known to indulge in irony, but rarely in this forum. However when I write "genuinely interested" or "genuine question" I do mean it. [/quote]

you exhibit much more sarcasm than interest ;)

RE: Dispensing protocols

grumpyoldman — Thu, 11 Feb 2016 18:02:50 GMT

[quote user="robloxley"]Maybe someone dispenses 100mg carprofen rather than 20mg, or norocarp rather than noroclav (in the days when norocarp existed), or 60mg epiphen rather than 30mg, or baytril 150mg rather than 15mg to a cat etc. - none of which might be good news for the pet. Or gives 6-pack of flea treatment when 1 tube was sold which might not be good for the practice's bottom line.[/quote]

Maybe that is where the SQP thing comes in , I remember a trainee nurse a few years ago who frequently confused ,amongst other things vetmedin 1.25mg and 2.5 mg, she had 10 GCSE passes so we assumed ,wrongly as it turned out that she could be left on reception.

A few years later we had a new graduate for whom , dexafort and delvosterone were interchangeable as were panacur and panomec , also while reading biochem profiles potassium and phosphate mean't the same thing. The problem had been declared all the way through the education system from school to university , with, as is the modern way help and extra time given at each turn. Unfortunately no one told us, in consults your on your own, there is no extra help in the private sector. Explaining why some one decided to top up an iv with potassium chloride because they got muddled by a low phosphate reading is not an easy conversation or one I would wish to repeat.

The trainee nurse is now dispensing meds as a dental nurse, the vet was in a discount vaccine clinic last i heard.

you cannot regulate for other peoples undeclared cognitive deficiencies. which is where our recent dispensing errors sprang from.

RE: Dispensing protocols

Rob Loxley — Wed, 10 Feb 2016 23:40:12 GMT

[quote user="grumpyoldman"]I think everyone tries to follow the rules and stay with what is agreed when the PSS come and visit ,but you do wonder what will happen exactly if you do not ??[/quote]

Maybe someone dispenses 100mg carprofen rather than 20mg, or norocarp rather than noroclav (in the days when norocarp existed), or 60mg epiphen rather than 30mg, or baytril 150mg rather than 15mg to a cat etc. - none of which might be good news for the pet. Or gives 6-pack of flea treatment when 1 tube was sold which might not be good for the practice's bottom line.

RE: Dispensing protocols

Rob Loxley — Wed, 10 Feb 2016 23:27:00 GMT

[quote user="Charlotte Marshall"]all these small white tablets can look similar[/quote]

Maybe an answer (if one identifies it as a cause of dispensing errors) is to look at changing products e.g. from loose white tablets to blister-packs with printed names. One could say move from epiphen to phenoleptil.
Lots of things are possible to improve - where necessary, and therefore you really need to audit your current process 1st - dispensing protocols and reduce errors.

RE: Dispensing protocols

Charlotte Marshall — Wed, 10 Feb 2016 22:52:54 GMT

Nurses put up our repeat prescription from the labels and then a vet checks them all against the record and to make sure the correct product is dispensed. Reception confirm again when handed out. I know what you mean about tablets in dispensed bottles though. Vidalta 15mg are definitely darker than the 10mg but all these small white tablets can look similar. I once suggested a test where we laid out a line of white tablets and had to identify them. A couple of our young vets had a go one day. I believe they got all of them correct once allowed to turn them over to read the markings!

RE: Dispensing protocols

grumpyoldman — Wed, 10 Feb 2016 21:36:58 GMT

[quote user="sajackson"]you exhibit much more sarcasm than interest ;)[/quote]

I think everyone tries to follow the rules and stay with what is agreed when the PSS come and visit ,but you do wonder what will happen exactly if you do not ?? . Its hard to imagine a scenario where the VMD arrives in a bronze ford granada ,wheels spinning and two Regan and Carter types hop out and shout your nicked. Regulation without enforcement is really just optimistic guidance.

RE: Dispensing protocols

Stuart Jackson — Wed, 10 Feb 2016 20:51:37 GMT

you exhibit much more sarcasm than interest ;)

RE: Dispensing protocols

Clare Tapsfield-Wright — Wed, 10 Feb 2016 19:14:59 GMT

I recently saw an American pharmacy system where all the drugs were locked in compartments and the vet had to enter the required drug and dosage and apply a fingerprint identification which opened the lock on the relative compartment while simultaneously printing a dispensing label if not an Injectable . Very interesting

RE: Dispensing protocols

Evelyn Barbour-Hill — Wed, 10 Feb 2016 18:22:37 GMT

[quote user="sajackson"]Ah, I can now relax :) - you knew all along!![/quote]

I have been known to indulge in irony, but rarely in this forum. However when I write "genuinely interested" or "genuine question" I do mean it.

You might all like to make a note of that.

RE: Dispensing protocols

Stuart Jackson — Wed, 10 Feb 2016 15:04:54 GMT

[quote user="Evelyn Barbour-Hill"]Oh yes enormously[/quote]

Ah, I can now relax :) - you knew all along!!

RE: Dispensing protocols

Evelyn Barbour-Hill — Wed, 10 Feb 2016 14:07:46 GMT

[quote user="sajackson"]Does this help?[/quote]

Oh yes enormously.

That's definitely better than vet scratches head, makes a provisional decision about product, consults with owner about their ability to administer, prescribes product, writes it down, washes hands, tells client not to go away, goes to dispensary (adjacent to consulting room), opens cupboard door, looks for product required, removes it from shelf and places on counter, reads words on product, mentally compares words with product required, closes cupboard door, picks up pen, writes dispensing label, looks again at what he's written as product description on label as comparison to words on product, looks for least unsuitable space on product to stick label, sticks label on while wondering yet again why manufacturers don't provide a suitable space, returns briskly to consulting room, shows client how to administer product by administering first dose himself, washes hands, accompanies client to reception, gives instruction for next appointment, calculates charge, remains while client is asked for money in case of any problem or unhappiness, nips into side room for quick gulp of coffee, calls next client in.......

RE: Dispensing protocols

Stuart Jackson — Wed, 10 Feb 2016 09:51:57 GMT

[quote user="Evelyn Barbour-Hill"]You in the consulting room print a label somehow which you then hand to the person dispensing? [/quote]

The vet prescribes a product, prints a label (printer in the dispensary), goes to the dispensary (adjacent to the consult rooms), takes the label, opens a cupboard door, selects the product from the shelf, reads the batch number on the label, reads the batch number on the product, sticks the label on the product (if they match), gives the product to the client, explains how to use it.

When a client orders a repeat prescription, the nurse does the same but the products are set aside for a vet to match the product to the label, to check the clinical records, to sign if off and place it in the area of the dispensary where processed products are stored ready for collection.

Does this help?

RE: Dispensing protocols

Evelyn Barbour-Hill — Tue, 09 Feb 2016 19:31:58 GMT

[quote user="sajackson"]

[quote user="Evelyn Barbour-Hill"]I can't really see how this works[/quote]

because they've got different bns

[/quote]

You're not really explaining this.

Is it what Mr. Loxley suggested? You in the consulting room print a label somehow which you then hand to the person dispensing? I see.

My way of working would not permit this, but then my way of working would not permit the sort of error described.[quote user="sajackson"]

[quote user="Evelyn Barbour-Hill"]I don't agree. But then I suppose it would vary with the particular ways of working of individual practices.[/quote]

Don't agree with bns, the discipline or the error thing. If there are errors in dispensing by a vet, then it happens in the consulting room and bns help reduce errors.

[/quote]

I don't agree that error in the consulting room is a common type of dispensing error.

[quote user="robloxley"]I think drug manufacturers could help things with making colour-coding of pots or tablets more obvious: felimazole 2.5 is pink and 5mg is orange but try telling Vidalta 10 and 15mg apart.[/quote]

Oh crikey yes. Carprieve 50mg and 20mg used to worry us until I labelled the pots with huge figures in magic marker.

RE: Dispensing protocols

skatealexia — Tue, 09 Feb 2016 17:06:06 GMT

[quote user="Neil Wheadon"]

Trying to get to the core of mistakes and having worked in lots of practices I have seen the odd mistake

1) Vets putting up their own drugs within a consult. I've never seen this. The vet is familiar with the drug and if they hand it to the client and explain it, you'll pick up any mistake at that poin

[/quote]

This. We do all our own drugs within the consult. We also do all repeats.

RE: Dispensing protocols

Stuart Jackson — Tue, 09 Feb 2016 15:37:37 GMT

[quote user="Evelyn Barbour-Hill"]I can't really see how this works[/quote]

because they've got different bns

[quote user="Evelyn Barbour-Hill"]I don't agree. But then I suppose it would vary with the particular ways of working of individual practices.[/quote]

Don't agree with bns, the discipline or the error thing. If there are errors in dispensing by a vet, then it happens in the consulting room and bns help reduce errors.

RE: Dispensing protocols

Thomas Johnson — Tue, 09 Feb 2016 15:20:57 GMT

[quote user="Neil Wheadon"]

1) Vets putting up their own drugs within a consult. I've never seen this. The vet is familiar with the drug and if they hand it to the client and explain it, you'll pick up any mistake at that point

2) Double checking does help. However it's tough if they have already been put up. One small white tablet looks like any other unless you open the bottle and look at the tablet and are familiar with the intracacies of markings. i've seen mistakes here. Epiphen is a classic.

[/quote]

When medication is dispensed out of its original packaging (brown pill pot, envelope, etc.) the nurses put the medication, and the pot or box it has come from next to each other, often with a rubber band around them, so the vet can confirm it is the right medication.

RE: Dispensing protocols

Rob Loxley — Tue, 09 Feb 2016 13:47:05 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Stuart Jackson"] eg it stops a six pack being given out instead of a 3 pack; or a 100ml bottle instead of a 32, or a cat item to a dog (unless you have stock control over species specific selling) etc etc.[/quote]

I'm sure I'm being very stupid, but I can't really see how this works.

[/quote]

I guess you print the batch number on the label and make sure it matches with the drug dispense. Requires your batch tracing to be spot-on, you to invoice the correct drug (easily mis-clicked on many drop-down lists) and assumes people can match 2 alphanumeric codes with more accuracy than checking the 32ml on the label matches 32ml on the product box?

I think drug manufacturers could help things with making colour-coding of pots or tablets more obvious: felimazole 2.5 is pink and 5mg is orange but try telling Vidalta 10 and 15mg apart.

RE: Dispensing protocols

Neil Wheadon — Tue, 09 Feb 2016 08:20:46 GMT

Trying to get to the core of mistakes and having worked in lots of practices I have seen the odd mistake

1) Vets putting up their own drugs within a consult. I've never seen this. The vet is familiar with the drug and if they hand it to the client and explain it, you'll pick up any mistake at that point

3) Relying on someone to dispense the drug whlist you carry on consulting. it is totally out of the vets hands isn't it? I have seen mistakes here.

The safest repeat prescription method I have seen and to be honest the easiest is for 2 people to do it together. The vet checks the repeat whilst the 'assistant' gets the drug and puts it up bringing the packet/bottle with them.

Mistakes are made due to time pressure, either because the consults are too short or the vet checking repeats does it as in many places as a thing to do if there is a gap in the day.

Neil

RE: Dispensing protocols

Evelyn Barbour-Hill — Mon, 08 Feb 2016 23:55:09 GMT

I'm sure I'm being very stupid, but I can't really see how this works.

[quote user="Stuart Jackson"] It is a discipline in the consulting room when prescribing during consults when most mistakes happen (?). [/quote]

I don't agree. But then I suppose it would vary with the particular ways of working of individual practices.

RE: Dispensing protocols

Stuart Jackson — Mon, 08 Feb 2016 16:23:52 GMT

[quote user="Evelyn Barbour-Hill"]

Batch numbers......

[quote user="Stuart Jackson"]Oh Yes - it's excellent for stock control, staff management a[/quote]

Could you enlarge upon this? I'm genuinely interested.

[/quote]

Well it doesn't really, specifically, help with stock "control", but with "management" and accurate prescribing and cost (loss) management - eg it stops a six pack being given out instead of a 3 pack; or a 100ml bottle instead of a 32, or a cat item to a dog (unless you have stock control over species specific selling) etc etc. It is a discipline in the consulting room when prescribing during consults when most mistakes happen (?). If you can't match the batch number with a label number for a prescribed item, then you've chosen the wrong one.

RE: Dispensing protocols

Rob Loxley — Sun, 07 Feb 2016 21:55:45 GMT

Most double checks are that the drug in the pot is the same as what's on the label, but I'd suggest you also want to check that someone has priced up the correct drug (not mis-clicked on the computer) and so the label is correct.

To which end, make sure you PMS won't allow you to dispense daft things - such as 500mg synulox to a cat or feline urinary food to a dog. Also if your PMS can save what drug/dose the animal is on, then repeats can be generated much more accurately from that point.

RE: Dispensing protocols

Mark Hedberg — Sun, 07 Feb 2016 19:54:23 GMT

[quote user="Kate Richardson"]

We have a list on the computer of repeat requests and each day a vet is allocated a time slot to go throught this list. Our pharmacy nurse is available for that time slot (usually) and she gets the medications ready and then the vet and nurse do the repeats together each checking with each other that a) the repeat is allowed b) the correct dose and medication is dispensed and c) it is priced correctly.

[/quote]

I *like* this - genius.

RE: Dispensing protocols

Emily Rainbow — Sun, 07 Feb 2016 19:27:25 GMT

All our scripts are written in a particular book. Whenever a vet free they sit down and put the drugs up having checked history etc. Reception then put labels on stock and initial the label. Drugs are then double checked by reception as they are given to the client and second initial placed.