الفهرس 
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Abstract
Medication use process involves several steps called prescribing, transcribing and documenting, dispensing, administering and monitoring. In the community setting, there are three general types of medication errors that can occur: those related to the prescribing process; those that occur when the medication is dispensed at the pharmacy; and those related to the patient’s use of the medication.
Every stage of the medication use process is susceptible to errors, but the steps most frequently associated with errors are prescribing and administration. Studies reported that prescribing errors are the most important source of medication errors. Dispensing errors occur at any stage of the dispensing process, from the receipt of the prescription in the pharmacy to the supply of a dispensed medicine to the patient.
Among the important causes of dispensing errors are work environment (as poor lighting, excessive noise, workload, interruptions); lack of quality control; missing patient information (as allergies, age, weight, pregnancy and lactation); and missing drug information (outdated references, unavailability of quick access to resources). The pharmacists confirms the legality, safety and appropriateness of the prescription order, checks the patient medication record before dispensing the prescription (when such records are kept in the pharmacy). The community pharmacist also ensures that the dose of medication is dispensed accurately, and dispenses the medication to the patient with appropriate counseling.
The current study was conducted to:
• Assess the community pharmacist’s practice in handling medical prescriptions and in patient counseling.
• Assess clarity and contents of medical prescriptions.
• Investigate the pharmacist’s perspective towards medical prescriptions clarity and contents and patient counseling process.
Subjects and methods:
The study was conducted using a cross sectional design. It included 200 pharmacists employed in 137 private community pharmacies (87 urban and 50 rural). Each pharmacist was observed twice while dispensing two prescriptions (after quick reviewing of the prescription by the researcher to assess its clarity and contents) and then was interviewed after dispensing. Prescriptions from / by any medical specialty were included. Total of 400 observations were taken for 200 pharmacists from different age groups and both genders. Data were collected about prescription handling (not over the counter (OTC)).
A list of all pharmacies in all health districts was obtained. Fifty pharmacies were randomly selected from rural areas and fifty pharmacies from urban areas. An additional 37 urban pharmacies were randomly selected to reach the required pharmacists’ sample size. The additional urban pharmacies were selected because the number of pharmacists working in rural community pharmacies was very little. The study was applied in morning and night shifts.
Data collection was done using a pre-designed observational checklist for observing pharmacists during dispensing prescriptions and during patient counseling. The data collected included: dispensing of drugs in the prescription correctly (as written in the prescription), actions taken if problems encountered during dispensing process, patient counseling points that should be carried out by the pharmacists during dispensing drugs, and the language used by pharmacists in talking with the patient/ purchaser and getting his/her feedback about their understanding of the supplied information. Another checklist for medical prescriptions review was designed and included data about clarity of the prescription and the most important contents that should be available in the prescription. Finally an interviewing questionnaire was designed to collect data regarding pharmacists perspective towards medical prescriptions clarity and contents and towards patient counseling process accessibility.
The study reported the following main results:
• The age of the pharmacists ranged between 20-74 years with mean age of 31.01 ± 10.83 years. Pharmacists aged 20 to less than 30 years of age constituted 63.5%. The proportion of males was 52.5% compared to 47.5% females. About two thirds (67.5%) of pharmacists graduated less than 10 years ago and 16.5% of them graduated 10 to less than 20 years ago. The maximum number of years of experience was 54 years. More than two thirds (69.5%) of pharmacists had less than 10 years of experience in community pharmacy work, 18.5% of them had 10 to 20 years of experience, while 12% had more than 20 years of experience. The mean years of experience was 9.22 ± 10.23. More than half of pharmacists (57.5%) attended pharmaceutical education sessions. Three quarters (75%) of pharmacists were from pharmacies in urban areas, while 25% of pharmacists were from pharmacies in rural areas. About two thirds of pharmacists (60.5%) were observed during morning shift and 39.5% during night shift.
• In almost all observations (98.5%), the pharmacists dispensed the medicine totally correct. In 20.7% of the observations the pharmacists had problems in the prescriptions dispensed as they was not clear or contained certain drug or dose that the pharmacist had objected to or had wrong directions of use. In more than half (55.4%) of these observations the pharmacists contacted the physician who wrote these prescriptions to clarify the issue. Concerning the disease non-pharmacological measures; unfortunately in 90.8% of the observations, pharmacists did not tell the patient about non-pharmacological measures that may help in managing the disease. In 91.2% of the observations, pharmacists told the patients the dose quantity. In 93.7% of the observations, pharmacists told the patients the dose frequencies. In 49.7% of the observations, pharmacists told the patients about duration of treatment. In 60.5% of the observations, pharmacists told the patients about the relation of drug to food. In only 29% of the observations, pharmacists told the patients information about drug related problems. In 56.25% of the observations, pharmacists did not tell the patient anything about special administration instructions. In 82.4% of the observations, pharmacists told the patients information about drug storage conditions. In only 5% of the observations, pharmacists told the patients information about missed dose. In 92.8% of the observations, pharmacists talked with the purchaser in lay language. In only 1% of the observations, pharmacists got the purchaser’s feedback about their understanding of the supplied information.
• In 1.3% of the observations, pharmacists had poor practice in handling prescriptions (less than 50% score), in 87.8% of them, pharmacists had fair practice (50-75% score), while in only 11% of them, pharmacists had good practice (>75%). In 10% of the observations, pharmacists had poor practice in patient counseling process, fair practice in 73%, and had good practice in 17% of them. Regarding the total practice, in 9.5% of observations, pharmacists had poor total practice, in 74% of them pharmacists had fair total practice, while in 16.5% of the observations, pharmacists had good total practice.
• There was significant association between practice regarding handling of medical prescriptions and age, while there was significant association between practice regarding patient counselling and age, years since graduation, years of experience, and area. There were significant association between total practice and area.
• It was found that less than half (43.5%) of prescriptions were totally clear to be read. physician’s sex was written in 82.7% of the prescriptions. Most of the prescriptions (82.8%) had physician’s name and contact number, 86.8% had patient’s name, only 14.5% had patient’s age, 4.3% had patient’s weight, 1.3% had patient’s contact number, 0.3% had patient’s allergies and in only 30.8% diagnosis was written. Most prescriptions (88.3%) had dose quantities for all prescribed drugs. Almost all prescriptions (94.3%) had dose frequencies for all prescribed drugs. Dosage forms for all prescribed drugs were included in 85% of prescriptions. Almost all prescriptions (93.3%) had strength (concentration) of the medication for all prescribed drugs. In only less than one third of prescriptions (29%) duration of treatment was written for all prescribed drugs. About two thirds (63.3%) of medical prescription had a fair score, while less than one third (32.5%) had good score. Only 4.3% of the prescriptions had poor score.
• Concerning pharmacists’ perspective during their practice, 84.8% of the pharmacists reported that the prescriptions unclarity was the most important problem encountered during reading prescriptions followed by impatience of patient/purchaser during dispensing process (28.4%). Regarding actions that are usually taken by a pharmacist when one of prescribed drugs is not clear, 77.9% of the pharmacists reported that calling the physician is the first action while 58.8% of them reported that they tried to predict the drug name from diagnosis or physician’s specialty. About half (53.5%) of pharmacists reported that contact with physician upon problem in prescription was moderate in communication ease, 21.5% of them reported that it was difficult, 19% said that it was easy. Regarding the most important counseling barriers, 50.5% of the pharmacists reported that work load was the most important counseling barrier, followed by poor response from patients (43.4%). Concerning continuous education programs usefulness in professional development, 93.5% of the pharmacists stated that continuous education programs were useful in professional development, while 6.5% of them did not believe in that.
It was concluded from the present study that the practice of most community pharmacists in Alexandria in respect to handling medical prescriptions and patient counseling was fair.
The most important recommendations of the study were:
• Pharmacists should keep self learning from trusted resources and evidence-based research all the time to be up to date and qualified community pharmacists.
• Ministry of Health should improve clarity of handwritten prescriptions by making a law that punishes physicians when writing unclear prescription and better to make all prescriptions electronic by law.
• Faculty of Pharmacy should make postgraduate studies and residency programs to be more focused on community pharmacy good practice