Ethical Duties in the Dispensing Process

The dispensing process and the duties in it

Ethics is not only about big dilemmas. It is about ordinary actions at each step of the dispensing process.

1. Receiving the prescription

• Greet the patient politely, and treat everyone fairly, whatever their age, wealth, tribe, religion or illness.
• Check that the prescription is complete, readable and valid: patient, prescriber, date, medicine, strength, dose and quantity. See the lesson on prescriptions in BDT 251.
• Query anything that is unclear, unusual or unsafe. Never guess.
• Watch for signs of alteration or forgery, and report them to the pharmacist.
• Protect the patient's privacy. Do not ask for private details where others can hear.

When to query or refuse

2. Preparing the medicine

• Work in a clean, orderly space.
• Read the label of the stock bottle three times: when taking it, when measuring, and when putting it back.
• Check the name, strength, form, batch and expiry date.
• Count and measure carefully. Never rush, and never "estimate".
• Do not substitute one medicine for another unless the law and the pharmacist allow it, and the patient is told.
• Do not change the dose, the quantity or the directions. Only the prescriber and pharmacist can.
• Do not supply expired, damaged or suspect products.

3. Labelling and checking

• Make the label accurate and clear. See the lessons on labels.
• The pharmacist checks the final product before it is handed over.
• Never put the label of one patient on another's medicine.

4. Handing out and counselling

• Confirm who the patient is, by name, before handing over.
• Explain how to take the medicine, for how long, and the main warnings such as "finish the course" or "may cause drowsiness". Use plain words.
• Check understanding: ask the patient to repeat the main points.
• Speak privately where possible. Do not discuss the patient's illness or medicines in public.
• Be honest about the medicine's purpose and its side effects, and about the price.
• Do not give advice beyond your role. Refer it to the pharmacist.

5. Controlled and commonly abused medicines

Some medicines, such as strong painkillers, sedatives and stimulants, can be misused or sold illegally. Ethical duties include:

• keeping them in a locked place with limited access;
• recording every receipt and issue exactly, and checking the balance;
• supplying them only on a valid prescription or as the law allows;
• being alert to repeated requests, large quantities, or several prescribers;
• reporting concerns to the pharmacist.

6. Honesty in prices and stock

• Charge the correct, fair price. Do not overcharge or add hidden charges.
• Never sell expired or damaged medicines, or products of unknown source.
• Be careful about fake and substandard medicines. Buy only from approved suppliers, and report a suspect product.
• Do not push a more expensive product when a cheaper, equally good one will do, unless there is a reason.
• Do not exaggerate what a medicine can do.

7. Records

• Record what was dispensed, to whom, and when.
• Keep records honest and complete. Never alter or destroy a record to hide a mistake.
• Keep patient records confidential and safe.

Putting it together

Before handing over any medicine, ask yourself:

1. Is it the right patient, medicine, strength, dose and quantity?
2. Is it in date and in good condition?
3. Has the pharmacist checked it?
4. Does the patient understand how to use it?
5. Would I be comfortable explaining what I did to the patient and the pharmacist?