This week we will continue to cover the following courses:
- Professional Practice Part 1
- Dispensing
- Patient Care
Code of Health and Disability Consumers' Rights
The piece of legislation we will cover in this topic may seem complicated at first, but is relatively easy to make sense of. These regulations promote and protect the rights of consumers of health and disability services such as pharmacy services.
The regulations set out ten consumer rights that any provider of health and disability services must uphold.
Upholding consumer rights is core to the pharmacy technician's role.
While you work through this next activity, reflect on your experiences as a service consumer and also as a service provider in the pharmacy environment. It will help you reflect on what you already know and learn more.
Consider these questions:
- As a pharmacy customer, can you think of a situation when you felt your rights were upheld?
- What was the situation?
- How did it make you feel?
- As a pharmacy customer, can you think of a situation when you felt your rights were not upheld?
- What was the situation?
- How did it make you feel?
Open each of the "rights" below by clicking the label or (+) sign so you can view more information about legislation protecting consumers and services.
- Every consumer has the right to be treated with respect.
- Every consumer has the right to have his or her privacy respected.
- Every consumer has the right to be provided with services that take into account the needs, values, and beliefs of different cultural, religious, social, and ethnic groups, including the needs, values, and beliefs of Māori.
Every consumer has the right to be free from discrimination, coercion, harassment, and sexual, financial, or other exploitation.
Every consumer has the right to have services provided in a manner that respects the dignity and independence of the individual.
- Every consumer has the right to have services provided with reasonable care and skill.
- Every consumer has the right to have services provided that comply with legal, professional, ethical, and other relevant standards.
- Every consumer has the right to have services provided in a manner consistent with his or her needs.
- Every consumer has the right to have services provided in a manner that minimises the potential harm to and optimises the quality of life of that consumer.
- Every consumer has the right to cooperation among providers to ensure quality and continuity of services.
- Every consumer has the right to effective communication in a form, language, and manner that enables the consumer to understand the information provided. Where necessary and reasonably practicable, this includes the right to a competent interpreter.
- Every consumer has the right to an environment that enables both consumer and provider to communicate openly, honestly, and effectively.
- Every consumer has the right to the information that a reasonable consumer, in that consumer’s circumstances, would expect to receive, including:
- an explanation of his or her condition and
- an explanation of the options available, including an assessment of the expected risks, side effects, benefits, and costs of each option; and
- advice of the estimated time within which the services will be provided and
- notification of any proposed participation in teaching or research, including whether the research requires and has received ethical approval and
- any other information required by legal, professional, ethical, and other relevant standards; and
- the results of tests and
- the results of procedures.
- Before making a choice or giving consent, every consumer has the right to the information that a reasonable consumer, in that consumer’s circumstances, needs to make an informed choice or give informed consent.
- Every consumer has the right to honest and accurate answers to questions relating to services, including questions about —
- the identity and qualifications of the provider, and
- the recommendation of the provider, and
- how to obtain an opinion from another provider; and
- the results of research.
- Every consumer has the right to receive, on request, a written summary of information provided.
- Services may be provided to a consumer only if that consumer makes an informed choice and gives informed consent, except where any enactment, or the common law, or any other provision of this Code provides otherwise.
- (Every consumer must be presumed competent to make an informed choice and give informed consent unless there are reasonable grounds for believing that the consumer is not competent.
- Where a consumer has diminished competence, that consumer retains the right to make informed choices and give informed consent to the extent appropriate to his or her level of competence.
- Where a consumer is not competent to make an informed choice and give informed consent, and no person entitled to consent on behalf of the consumer is available, the provider may provide services where —
- it is in the best interests of the consumer and
- reasonable steps have been taken to ascertain the views of the consumer and
- either, —
- if the consumer’s views have been ascertained, and having regard to those views, the provider believes, on reasonable grounds, that the provision of the services is consistent with the informed choice the consumer would make if he or she were competent; or
- if the consumer’s views have not been ascertained, the provider takes into account the views of other suitable persons who are interested in the welfare of the consumer and available to advise the provider.
- Every consumer may use an advance directive in accordance with the common law.
- Where informed consent to a health care procedure is required, it must be in writing if —
- the consumer is to participate in any research; or
- the procedure is experimental, or
- the consumer will be under general anaesthetic, or
- there is a significant risk of adverse effects on the consumer.
- Every consumer has the right to refuse services and to withdraw consent to services.
- Every consumer has the right to express a preference as to who will provide services and have that preference met where practicable.
Every consumer has the right to have one or more support persons of his or her choice present, except where safety may be compromised or another consumer’s rights may be unreasonably infringed.
The rights in this Code extend to those occasions when a consumer is participating in, or it is proposed that a consumer participate in, teaching or research.
- Every consumer has the right to complain about a provider in any form appropriate to the consumer.
- Every consumer may make a complaint to —
- the individual or individuals who provided the services complained of; and
- any person authorised to receive complaints about that provider and
- any other appropriate person, including —
- an independent advocate provided under the Health and Disability Commissioner Act 1994 and
- (the Health and Disability Commissioner.
- Every provider must facilitate the fair, simple, speedy, and efficient resolution of complaints.
- Every provider must inform a consumer about the progress of the consumer’s complaint at intervals of not more than one month.
- Every provider must comply with all the other relevant rights in this Code when dealing with complaints.
- Every provider, unless an employee of a provider, must have a complaints procedure that ensures that —
- the complaint is acknowledged in writing within five working days of receipt unless it has been resolved to the satisfaction of the consumer within that period, and
- the consumer is informed of any relevant internal and external complaints procedures, including the availability of —
- independent advocates provided under the Health and Disability Commissioner Act 1994 and
- the Health and Disability Commissioner, and
- the consumer’s complaint and the actions of the provider regarding that complaint are documented, and
- the consumer receives all information held by the provider that is or may be relevant to the complaint.
- Within ten working days of giving written acknowledgement of a complaint, the provider must:
- decide whether the provider —
- accepts that the complaint is justified or
- does not accept that the complaint is justified or
- if it decides that more time is needed to investigate the complaint —
- determine how much additional time is needed, and
- if that additional time is more than 20 working days, inform the consumer of that determination and of the reasons for it.
- decide whether the provider —
- As soon as practicable after a provider decides whether or not it accepts that a complaint is justified, the provider must inform the consumer of —
- the reasons for the decision, and
- any actions the provider proposes to take and
- any appeal procedure the provider has in place.
That’s a lot to think about and reflect on! Take your time. You may want to jot down some notes to help you think more deeply about each of these rights.
Privacy
In your role as a pharmacy technician, you have access to information that is highly sensitive and personal to the people you provide health services to. In order to protect a health user's right to privacy and control over their personal information, we have several pieces of legislation and supporting codes.
Expand each of the labels below for a brief summary of the legislation/code:
Provides the general framework for promoting and protecting individual privacy. The Act established the role of the Privacy Commissioner to investigate complaints about interferences with individual privacy.
This is a Code of Practice issued by the Privacy Commissioner under section 32 of the Privacy Act, which gives extra protection to health information because of its sensitivity.
These regulations cover the form in which health information is to be retained and the obligations associated with the transfer of health information. It also set a minimum period of 10 years for which health information has to be held by health or disability service providers.
Privacy Act 2022
This act directs how organisations and businesses collect, store, use, and share a person’s personal information.
This means that a person will know:
- when their information is being collected
- how their information is used and that it is shared appropriately
- that their information is kept safe and secure
- that they can access their own information.
In Part 3, Section 22 of the act, there is a list of 13 privacy principles.
They can be broken into the following groupings:
| Principles | What it does | What it means |
|---|---|---|
| 1-4 | Directs how personal information is collected. | When, where, how and from whom it can be collected. |
| 5-7 | Directs how personal information is stored. | An individual can access their information and make corrections if it is wrong. |
| 8-13 | Directs how personal information is used and shared. | The information must be checked before it is appropriately shared to make sure it is up-to-date, accurate, complete, and not misleading. |
Health information privacy code 2020
The Privacy Act recognises that there is a need for different privacy rules for specific industries. The health industry, which includes pharmacy, is one of these industries. As a result, ‘codes of practice’ for these industries have been written.
The code of practice that applies to pharmacy is the Health Information Privacy Code 2020. This code applies to the health information about identifiable individuals and covers health information collected, used, held, and disclosed by health agencies.
The key concepts are:
- Agencies must know why they are collecting health information and collect only the information they need. Once health information has been collected from a patient for a particular purpose, it can be used or disclosed for that purpose without additional consent.
- Agencies need to let patients know how their information is going to be used and disclosed so the patients can make decisions about whether to provide it.
Health(needles and syringes) regulations 1998
New Zealand Needle Exchange Programme
Time to revisit another piece of legislation that you have looked at during your level 3 studies. The Health (Needles and Syringes) Regulations 1998 make it legal for sterile needles and syringes to be sold as part of the Needle Exchange Programme. The Regulations direct the sale of new needles and syringes as well as the return of used needles and syringes.
To recap:
- The Needle Exchange Programme is a nationwide programme funded by the government where people who are injecting drugs can access needles, syringes, and other equipment to support safe injecting practices.
- Many pharmacies throughout New Zealand participate in the Needle Exchange Programme. This means pharmacy customers over the age of 16 can purchase packs of needles and syringes. They can also return their used needles and syringes to the participating pharmacy for safe disposal.
Expired or unused medicines
As well as returned used needles and syringes, you may also serve customers who are returning medicine that is either unused or expired.
Medicines, regardless of whether they have been used or not, cannot be reused for another person for the following health and safety reasons:
- Storage - we have no way of knowing where or how the medicines have been stored. Some medicines must be stored below 25°C, some must be stored in the fridge, and some are very sensitive to moisture. If they were not stored correctly, the medicine may no longer work in the way it was meant to.
- Risks – we are unable to determine if the medicine has been tampered with or exposed to harmful elements
- Expiratory dates and batch numbers -these may be unclear or not identifiable if they have been repackaged.
- Identity of the medicine - some patients transfer their medicines to other containers at home, meaning the medicine named on the label may not be the medicine in the container.
- Recall issues – if a manufacturer recalls a medicine due to a problem with the medicine it is impossible to trace who has been given that medicine and if it has been recycled or reused.
Disposal of medicines
Pharmacies are provided with bins by medical waste companies. The bins are collected and disposed of by the waste company.
It is unethical to dispose of any medicines down the sink, which goes into the wastewater system, as this pollutes the environment and may cause harm to the public as well as breach local wastewater bylaws.
Disposal of CDs
Expired or unused controlled drugs returned to the pharmacy must be entered into the Controlled Drugs Register on a separate page, where all drugs to be disposed of will be written up. This is often a page in the back of the register. Returned controlled drugs must not be entered into stock for reuse.
Two pharmacists or a pharmacist and a responsible person, such as a doctor, will then sign the medicines out of the register and sign a record of destruction.
The record of destruction must give the following:
- the name and address of the pharmacy,
- the name, strength, form and quantity of each controlled drug
- the reason for destruction.
- It must be dated and signed by both people.
| Controlled drugs are destroyed using a controlled drugs destruction kit or by following a specific process to break the tablet down into a paste so that the medicine can no longer be used. This paste is then disposed of in the medical waste bin. |
Self-directed learning activities
The following activities will help you feel confident in your understanding of the material or expose areas you may want to review. They provide a great chance to put yourself in the shoes of a working pharmacy technician.
When you are ready, put on your pharmacy technician shoes and step into the next few activities. (Or do them in your slippers; that's the beauty of online learning.)
1. Consumer rights scenarios: Test your understanding of the rights of consumers. The quiz will provide answers as soon as you select one and automatically progress through the scenarios. Have fun!
2. Consumer protections scenarios: These three questions ask you to reflect on your learning to keep people safe from injury and being overheard.
3. Consumer safety scenarios: These three questions focus on used and surplus to need medicines and drugs.
Ka pai! You have completed the third week of Professional Practice.
Interpreting a prescription is a little like reading music.
Reading and interpreting a prescription
There are codes and abbreviations that have specific meanings and convey important information to the reader. As a pharmacy technician, you are expected to read and correctly interpret prescription codes and abbreviations in order to safely dispense medicines to the customer.
Abbreviations
You will be aware by now that many medical and health-related words stem from the ancient language of Latin. This is also true of the abbreviations used by prescribers to pharmacists to pass on prescription instructions. You will become familiar with the more commonly used abbreviations, but you may also come across ones that are not as common.
If in doubt about the meaning of an abbreviation, you should always check with your supervising pharmacist.
Here is an opportunity for you to practice learning these abbreviations.
Abbreviations are also used for instructions on how long the medicine is intended to be used. This tells the dispensing staff the quantity of the medicine to dispense.
In the activity below, you will see a list of period of supply abbreviations and meanings.
If not expressed as a period of supply, the prescriber will write the exact quantity of medicine you are to give.
The following activity provides two flip cards so you can test your knowledge of quantities for tablets and capsules.
Inhalers, accuhalers, Turbuhaler and nasal sprays usually contain 200 doses per original pack. There are some exceptions to look out for example, Flixotide inhalers contain 120 doses.
Example:
Prescription:
Ventolin inhaler 100 mcg
2 puffs bd
3/12
Working out quantities:
The Ventolin inhaler = 200 doses.
One puff = 1 dose.
3/12 = 3 months or 90 days.
Doing the math:
2 puffs bd (twice daily) = 4 doses each day
4 doses x 90 days = 360 doses.
360 doses ÷ by 200 doses = 1.8 inhalers
1.8 rounds up to 2 since you cannot dispense a partial inhaler.
The answer:
2 inhalers should be dispensed to ensure 360 doses are available.
Now it's your turn. Use the information above to make your calculations, and then enter them into the box provided and see if you were right!
Errors
It is important that you read abbreviations carefully and interpret them correctly; otherwise, serious and potentially life-threatening mistakes in dispensing can be made. Some abbreviations are more error-prone than others, meaning they are easily read incorrectly.
The Health Quality & Safety Commission New Zealand has compiled a list of the error-prone abbreviations, symbols and dose designations that should not be used and what to use instead.
Read through the lists below.
| Do Not Use | Use |
|---|---|
| Abbreviated chemical names (e.g. HCL) | Full name |
| Abbreviated medicine names (e.g. MTX, HCT) | Full name |
| µg or mcg | Microgram |
| U or IU | Unit or international unit |
| ng | Nanogram |
| OD, od or O.D. | Daily or intended time of administration |
| SC | Subcut or subcutaneous |
| SL | Subling or sublingual |
| mEq or milliequivalent | Millimole or mmol |
| Q.D, q.d, qd, QD | Daily |
| Decimal points without a leading zero (eg. .5mg) | Smaller units (eg 500 micrograms) or a leading zero eg. 0.5mg |
| A trailing zero (eg. 1.0mg, 100.0g) | Without a trailing zero eg, 1mg, 100g |
| Roman numerals (eg. ii, iv, x) | Words or 1, 2, 3 |
Reading accurately
As well as reading and interpreting abbreviations accurately, you must also always read medicine names with care. There are many medicines that have similar sounding or looking names. It goes without saying that misreading a medicine name can lead to serious errors in dispensing and potential harm to the customer.
Read through this list of mixed-up medicine name pairs. Can you see why they might be confused with each other? Is it the spelling or parts of the name that are similar? Do they sound similar?
| Intended medicine | Confused with |
|---|---|
| Allopurinol | Amlodipine |
| Amitriptyline | Nortriptyline |
| Amoxycillin | Amoxicillin and Clavulanic Acid |
| Clomipramine | Clonidine |
| Diastop | Diamide |
| Doxepin | Dothiepin |
| Fosamax plus | Fosamax |
| Humalog Mix | Humalog |
| Humulin 30/70 | Humulin NPH |
| Lorazepam | Loratidine |
| Loxalate | Loxamine |
| Maxitrol | Maxidex |
| Mesalazine | Sulfasalazine |
| M-Eslon | M-Enalapril |
| Noriday | Norimin |
| Panadeine | Paracetamol |
| Phenoxymethylpenicillin | Penicillamine |
| Phosphate-sandoz | Potassium chloride |
| Propylthiourical | Puri-Nethol |
| Quinine Sulphate | Quinipril |
| Sotalol | Nadolol |
| Tenoxicam | Tamoxifen |
| Zopiclone | Zyrtec |
From the table of confused medicine names above, find out what the following medicines are prescribed for:
You see that these commonly confused medicines are prescribed for very different uses! If the wrong medicine were dispensed, not only would the customer not have their health condition treated, but they would be at risk of serious harm from the unwanted medicine.
Reducing Reading Errors
Tall Man lettering is something you may not have heard about before. It is a printing strategy to help reduce reading errors.
Learn more about Tall Man lettering from the Aotearoa New Zealand Tall Man lettering list published by the Health Quality and Safety Commission, then answer the questions in the quiz. Download the June 2020 PDF list here.
Now, visit the HQSC website to read about Tall Man lettering before completing the short quiz to check your understanding.
Self-directed learning activities
Review your notes and resources from your learning in this course so far and make a post on the class forum - Week 3 - Introduction to Dispensing: SDL. You might like to:
- Ask a question —
- Are there any words you are not sure of the meaning?
- Do you have any questions about the topics covered so far in this course?
- Are you confused about anything and need clarification?
- Post a comment —
- Do you have any thoughts on the topics covered in the module so far?
- What is one new thing you learned this week?
- What did you find interesting or useful?
- Answer a question or reply to a comment —
- Review your classmates' posts and reply with an answer of your own:
- Do you agree or disagree with a comment?
- Do you have some information to share about —
- a topic
- article
- website
- video clip?
- Review your classmates' posts and reply with an answer of your own:
Whakamihi - you have completed the third week of Introduction to Dispensing!
Dose form advice and accessories
A large part of your role as a pharmacy technician is advising customers on how to get the most benefit from their medicines. You do this by offering information about dose forms and the accessories (equipment) they can use to assist with administering their medicine at home. As you know, prescription medicines will have labels and packaging that give directions for use, but it is important to provide this information verbally as well.
It is also important to check the customer has understood the instructions and be available to answer any questions they may have. You will spend time in class looking in detail at dose form advice and accessories but let’s start with an overview of the four dose forms.
| Solid | Accessories |
|
|
| Semi-solid | Accessories |
|
|
| Liquid | Accessories |
|
|
| Gas | Accessories |
|
|
Solid dose form: tablets
We are now going to explore one of the most common solid dose forms — tablets. In the following table, there are five different tablet types.
These are:
- Solid tablet
- Dispersible tablet
- Soluble tablet
- Enteric-coated tablet
- Modified release tablet
There are also two types of accessories that can be used with tablets to assist with administration. These are:
- Pill cutter
- Pill crusher
Your learning task is to:
- read and complete the following table. Complete sections that indicate that you are to [add text].
- download the table here.
- research how to take each tablet type
- research each of the tablet accessories
- note down the key points in the appropriate advice column
The key points will ensure you provide the customer with the information they need to get the optimal benefit from their prescribed tablets.
Semi-solid dose form
Many medications come as semi-solid dose forms. As we have done in the last learning activity, we will use a table to structure our learning about the semi-solid dose from. In the following table, you will see four different types of semi-solid dose forms.
These are:
- ointment
- cream
- gel
- paste.
The accessories that are used with these dose forms are applicators.
Applicators come in many different types depending on the medicine and site of application.
Your learning task is to read and complete the table of semi-solid dose forms.
- Download the table here
- Research how to apply each dose type
- Note down the key points in the appropriate advice column. These key points will ensure you provide the customer with the information they need to get the optimal benefit from their prescription
Here are some useful links that you may want to watch and read:
- Watch: How To Use Eye Ointment with AbrahamThePharmacist
- Read: How to use your eye ointment (.docx)
- Watch: How To Use Steroid Cream with AbrahamThePharmacist
- Read: Miconazole mouth gel at Healthify
Self-directed learning activities
Task 1: Watch this video and make your own notes about the advantages and disadvantages of the dose forms.
Task 2: Reflect on your own experience of taking medicine in different dose forms. Do you find one form easier to take than another?
Some people are more sensitive to taste than others, so they find medicines with strong tastes very hard to take. Other people struggle to swallow tablets and capsules-even small ones.
Do you have any hot tips on how to swallow tablets or deal with medicines with strong flavours? Share your experiences and hot tips on the class forum - Week 3 - Introduction to Patient Care - Task 2.
Task 3: Read this page at Healthify about medicine accessories for people with disabilities.
That's it! Well done. You have completed Week 3. Ka pai.
