Rational and irrational dispensing, use and prescribing of drugs

Reports from developing countries indicate that prescribing practices in which excessive, inadequate, incorrect prescribing and incorrect dispensing bring about unnecessary financial burden on national and individual health budgets. The rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, and at the lowest cost to them and their community.
Prescriptions should be written after a diagnosis or a health problem has been identified



For a medicine to be rationally used it must be given for an appropriate disease condition, suitable route of administration, including adequate dose, and optimal duration of treatment. For a medicine to be rationally used it must be given for an appropriate disease condition, suitable route of administration, including adequate dose, and optimal duration of treatment

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Irrational or non-rational use is the use of medicines in a way that is not compliant with rational use as defined above. Moreover, about one-third of the world’s population lacks access to essential medicines. Lack of access to medicines and inappropriate doses result in serious morbidity and mortality, inappropriate use and over-use of medicines waste resources. Worldwide more than 50% of all medicines are prescribed, dispensed, or sold inappropriately, while 50% of patients fail to take them correctly.

Drug use

Drug Use is the process of diagnosing, prescribing, labeling, packaging and dispensing to ensure adherence of the patient to the given drug treatment. The drug use process can be divided into four component:

Prescribing; doctors has overall responsibility for the care of the patient, prescribing or ordering medications as part of the treatment plan

Preparation and dispensing; the pharmacy department under the direction of a registered pharmacist, is responsible for preparing and dispensing medication.

Medication administration:  administering medication is generally the responsibility of the nursing staff and physician.

Monitoring the effect of drugs on the patient and ordering appropriate changes in therapy: Monitoring is the primary responsibility of the physician but all other members of the medical care team involved in the patient therapy are also responsible.

Rational prescribing

Prescriptions should be written after a diagnosis or a health problem has been identified. The prescription will present the necessary drugs and measures sufficient to heal or improve the state of the patient. The prescription must then contain all the necessary information clearly written.

Contents of a prescription

A prescription is a set of instructions written by a qualified prescriber to a dispenser for supply of drugs after counseling the patient on how to use the drug. It is very important that prescriptions are clearly written.
• Name of the patient and age (especially if a child),
• Date,
• Instructions about the prescribed drugs, including:
• Generic name and dosage form,
• Dose,
• Frequency of administration,
• Duration of treatment,
• Prescriber’s signature and name.

Known roman numerals usually written in prescriptions to represent dosage are: i, ii, iii, representing one, two and three. It is better to state dosage in terms of strength (e.g. 500 mg) than number of tablets.  This is because some drug products are available in different strengths (e.g. diazepam 5 mg and 10 mg).

Too many abbreviations, illegible writing or ambiguous instructions can lead to errors in dispensing. It is therefore recommended that prescriptions should be unambiguous and written legibly. Duration of treatment is usually indicated by denominators: 7 = days, 12 = months and 52 = weeks. For example, 1/7 = one day, 2/12 = two months and 1/52 = one week.

Rational dispensing
Dispensing. The preparation and distribution of a course of therapy to a patient, with appropriate instructions, based on a prescription.

Correct drug dispensing:

Dispensed drugs should be appropriately labelled so that the patient can benefit optimally from the use of the drug. Expired drugs should not be dispensed.
• The right patient is served,
• A desired dosage form of the correct drug is given,
• The prescribed dosage and quantity are given,
• The right container that maintains the potency of the drugs is used,
• The container is appropriately labelled,
• Clear instructions are delivered verbally to the patient.
• Ensure that the prescription has the name and signature of the prescriber and the stamp of the health facility
• Ensure that the prescription is dated and has the name of the patient.
• Avoid dispensing without a prescription or from an unauthorized prescriber.
• Check the name of the prescribed drug against that of the container.
• Check the expiration date on the container.
• Calculate the total cost of the drug to be dispensed on the basis of the prescription where applicable.
• Inform the patient about the cost of the drug.
• Issue a receipt for all payments.
• Hand over the dispensed drug

Problems associated with Irrational Use of Medicines

1. Treatment failure
2. Ineffective and unsafe treatment
3. Exacerbation or prolongation of illness.
4. Distress and harm to patient
5. Increase the cost of treatment
6. Rapid development of drug resistance
7.  Increase of toxicity risk 



Reference
https://www.who.int/medicines/areas/rational_use/en/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5419375/
https://ispub.com/IJPHARM/10/1/14081
https://www.msh.org/sites/msh.org/files/mds3-ch27-rationaluse-mar2012.pdf
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-017-2097-3
https://www.dovepress.com/rational-drug-use-evaluation-based-on-world-health-organization-core-d-peer-reviewed-fulltext-article-DHPS
https://accesspharmacy.mhmedical.com/content.aspx?legacysectionid=katzung14_ch65
Rational and irrational dispensing, use and prescribing of drugs Rational and irrational dispensing, use and prescribing of drugs Reviewed by gafacom on July 13, 2020 Rating: 5

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