Drug dispensing is a very important job in HIV/AIDS-related treatment work. People must receive the correct amount of the correct drug, with the correct instructions. If a mistake is made, it can be very dangerous, as well as being a waste of resources.
Steps for dispensing HIV/AIDS-related drugs
It is important to:
• Make sure you understand the prescription. Check with the prescriber if you are unsure.
• Select the required drug from your store. Double-check the name of the drug, the strength and the form (such as whether it is a tablet, skin cream, injection or liquid medicine).
• Calculate how much of the drug is needed. For example, 10ml of antibiotic syrup three times daily for five days will be a total of 150ml.
• Count or measure the required amount. Do this on a clean surface, using clean measures or tools. Avoid touching drugs with your hands. For example, use a knife or a spoon to count tablets.
• If you have labels, write one to show the name of the drug, the strength, the directions for use, the person's name (or code number) and the date.
• Check again that you have dispensed the correct drug, the correct strength and the correct quantity.
• Hand the drugs to the person, explain how they should take the drugs and give any other information that they need. This is a very important part of dispensing. If drugs are not taken correctly, the patient and the provider have wasted time and money.
Giving the right information about the drugs is as important as dispensing the drug correctly. Information about drugs can be given verbally, but people can usually remember only two or three messages at a time. It is important to focus on the key messages for that particular drug. Ask the person receiving the drug to repeat the explanation back to you. This will show if they have understood the instructions and give you an opportunity to correct them, if necessary, or give them extra information.
Written information can also be given. It needs to be clear and in language that the user finds easy to understand. For example:
Take two tablets twice a day. It is best to take them with some food. So, take two tablets with your meal in the morning and two with your meal in the evening. You must keep taking the tablets until they are all gone. If you get a skin rash, stop taking them and come back to see us as soon as possible.
Pictures can also help, but must be clear and easy to understand. For example, 'Take two tablets twice a day - two in the morning and two at night' could be drawn as:
Information required about HIV/AIDS-related drugs
A person using or providing drugs needs to know:
• how much of the drug to use;
• how the drug should be used - swallowed, rubbed on the skin or inhaled;
• how often the drug should be used;
• for how long the drug should be used;
• whether the drug should be taken after food, before food, between meals or with water;
• what to avoid when taking the drug - such as specific foods, alcohol, milk or other drugs;
• common side-effects of taking the drug and what to do about them;
• possible effects on the child if the drug is taken by a pregnant or breastfeeding mother;
• what to do if the drug does not seem to work.
For example, both the person prescribing antiretroviral treatment and the person thinking of taking antiretroviral treatment need to know:
• accurate information about drugs;
• the cost of drugs;
• the cost of laboratory tests for monitoring treatment;
• that it is a life-long therapy; • that it is not a cure;
• that it can mean taking many pills;
• how to take the drugs - food, diet, etc.;
• the possible side-effects;
• the interactions with other drugs - TB drugs;
• the possibility of resistance - may mean changing combination of drugs.
Participatory group activity
To build skills in giving appropriate information when dispensing HIV/AIDS-related drugs.
Before starting this activity, the facilitator needs to develop two role plays about dispensing drugs to a person living with HIV/AIDS:
Role play 1: showing bad practice in dispensing HIV/AIDS-related drugs.
Role play 2: showing good practice in dispensing HIV/AIDS-related drugs.
The facilitator also needs to select people to act out the role plays and to make sure that they are confident about their roles before the activity begins.
1. Explain the aim of the activity.
2. Ask the first group of actors to perform their role play about bad practice in dispensing HIV/AIDS-related drugs.
3. Facilitate a group discussion about what was wrong or unhelpful about the way the drugs were prescribed in the role play. Encourage participants to ask each other questions and to make comments.
4. Ask the second group of actors to perform their role play about good practice in dispensing HIV/AIDS-related drugs.
5. Facilitate a group discussion about what was good or helpful about the way the drugs were prescribed in the role play. Encourage participants to ask each other questions and to make comments.
6. Facilitate a group discussion about what has been learned from the activity, based upon questions such as:
• What could be the results of bad practice in prescribing HIV/AIDS-related drugs?
• What are the two or three essential points of good practice that should always be remembered, whatever the circumstances?
• Encourage the actors not to overact in the role plays and to try to show the type of situations that might occur in real life.
• Encourage participants to identify simple and practical messages about good practice, so that they can use them in their everyday work on prescribing HIV/AIDS-related drugs.
At a skills-building workshop, NGO/CBO participants acted out a role play to illustrate bad practice in dispensing drugs to people with HIV/AIDS-related health problems:
Role play 1: A patient has finished her drugs, but tells the doctor that she has a stomach pain. The caregiver asks the doctor about the drugs, but he refuses to talk to her. He looks through his bag and gives several more drugs to the patient, quickly telling her how often to take them, but not checking to see if she has understood. Afterwards, the patient cannot remember the information and asks her caregiver what to do. Together they decide she should take one of each kind of tablet. The patient does this and develops a headache. When the doctor comes back again, he is angry. The caregiver tells him he should have explained better, but the doctor shouts at her and tells her it's none of her business.
The participants discussed the role play and noted that the doctor did not act responsibly, did not do his job well, and did not seem to know what to do about side-effects. They also noted that he should not only have information about drugs but training in how to dispense them well.
The NGO/CBO participants then acted out a role play to illustrate good practice in dispensing drugs to people with HIV/AIDS-related health problems:
Role play 2: The doctor comes to see a patient with a chest infection and cough. The doctor examines him thoroughly, and lifts him up so that he can breathe and cough more easily. He asks what medicines the patient has already taken, and if he has had any previous treatment from elsewhere. The patient says no, because other health workers are afraid to come near him in case they catch the infection. The doctor explains carefully how to take the medicines, why the patient should take them, and when he should take them. He writes the information down, and gets the patient to repeat the instructions back to him. The doctor also asks the patient's wife to repeat the instructions in case the patient does not remember them clearly. He tells them what side-effects to expect from the medicines and what to do about them. He also tells them about what other care is needed, such as sitting up when the patient needs to cough.
The participants discussed the role play and noted that the doctor had a good relationship with patient and family, a good way of explaining, and that the patient trusted the doctor. They also noted that talking about side-effects is important, because otherwise the patient might stop taking drugs when he should not.
Afterwards, the facilitator led a group discussion about what had been learned from the activity. For example, participants agreed that the results of bad practice vary from damaging the relationship between the treatment provider and patient to putting the patient's life in danger.
Reference: Adapted from a workshop on access to HIV-related treatment, Khmer HIV/AIDS NGO Alliance and the International HIV/AIDS Alliance, Cambodia, May 2001.