They reported that the amount of medicine they supplied depended on ethical considerations and the financial resources of clients. Despite the lack of regulations, the veterinarians had established their own guidelines. Most generally supplied a quantity sufficient for a period of one month of treatment, or for ongoing conditions, a period of six months of treatment.
For more acute conditions such as an infection, the medication provided was generally for a shorter period of supply such as for one to two weeks. By self- regulating the period of supply, the veterinarians were able to ensure that the animal was receiving the appropriate treatment and care necessary and not encouraging irrational use of medicines. This was especially important for medicines with a high abuse potential such as phenobarbitone. Vaccinations were reported to be the second most commonly administered medication during an animal consultation at the veterinary practices visited.
Class, indication for use and dose range of antimicrobials frequently prescribed and dispensed by veterinarians in the Dunedin region. However in some cases it was veterinary nurses often undertook the dispensing process and dispensed routine medications after communication with the veterinarian.
Two of the veterinary practices reported compounding medications in their own clinics and others used a compounding pharmacy Optimus Healthcare Limited in Auckland, New Zealand. Although it is not common practice for veterinarians to write prescriptions to be filled in community pharmacies, it does occur in specific situations. The cost of medicines dispensed by pharmacies is usually lower than the cost at the veterinary clinic.
While veterinarians acknowledged that it was not routine practice, they agreed that they would rather the animal have access to the medication. All five veterinary practices interviewed stated that the reason for prescriptions being written by veterinarians was if the patient required a medicine that the veterinary practice did not have in stock, or a medicine that was not commonly used e.
All five veterinary practices consulted reported involvement with pharmacists as part of their prescribing and dispensing processes, however two practices noted that this contact was on an occasional basis.
The reasons reported for the interaction with pharmacists was when a drug was not available as a veterinary formulation, a prescription would be written and taken to a pharmacy for dispensing, pharmacists were consulted to see if there was a cheaper generic product available from the pharmacy.
All practices reported having access to records from previous consultations. Records are valuable sources of information as well as legal documents, it is therefore imperative to utilize and maintain easily accessible, organised records.
In both disciplines records are stored electronically with the use of practice-based computer programs designed specifically for use in either pharmacy or veterinary practice. Because of their dual role as prescribers and dispensers for animals, veterinary software was often more complex than pharmacy dispensing software, because it includes medical history as well prescribing history.
Like pharmacy dispensing software, veterinary programs allow for the construction of labels for medication. Unlike pharmacy dispensing software, veterinary programs included fewer features like interaction prompting and essential medical information.
The prescribing veterinarian must also keep records of each prescription issued for five years and these should be cross-referenced to the details of the associated veterinary consultation ACVM Standard for Prescription Animal Remedy Veterinary Medicines, Section 2.
In both veterinary clinics and pharmacies, records were kept a minimum of 10 years and were usually maintained for the life of the patient, this complies with Section 45 of the Medicines Act , which states that every person in a business who supplies medicine must keep records for such period as may be prescribed.
In many instances it is more economical for the patient if the veterinarian writes a prescription, as the cost of the medicine dispensed by pharmacies is usually lower than the cost at the veterinary clinic. From our observations, the most common reason for prescriptions being written by veterinarians was if the patient required a medicine that the veterinary practice did not have in stock, or a medicine that was not commonly used.
Although veterinarians and their staff performed almost all dispensing, community pharmacies were sometimes used. There were two main reasons for this: lower price and wider range of products available. Pharmacies stock a more extensive range of medicines than veterinary practices, due to the vast array of human medical conditions requiring treatment.
The most likely reason for this difference is the government regulatory body PHARMAC funds many high-demand human medicines in New Zealand, whereas veterinary medicines are funded directly by the consumer. There appear to be no regulations or guidelines about the period of supply for medicines dispensed by veterinarians.
However, when veterinarians prescribe medicines to be dispensed by pharmacists, there is legislation regarding the period of supply. When veterinarians, or their staff, dispense medicines this is referred to as an authorization a documented instruction authorizing the sale or use of a medicine by a veterinarian Agricultural Compounds and Veterinary Medicines ACVM Standards for Prescription Animal Remedies, Section 2. A prescription refers to a documented instruction to dispense a medication and is usually intended for pharmacists or traders.
In the latter case, the medicine must be dispensed within 30 days of the date of writing and the prescription must specify a period of treatment, not exceeding six months ACVM Standards for Prescription Animal Remedies, Section 2. Thus there are more strict requirements for medicines dispensed to animals by community pharmacists compared with those dispensed by veterinarians.
Medicines dispensed to human patients are further restricted by legislation. Doctors are restricted to prescribing a maximum of three months supply of a medicine at any one time. Depending on the medication prescribed and the funding requirements, a pharmacist may dispense the total three months supply at once, or as a monthly dispensing. Controlled drugs for humans have their own requirements.
These can be prescribed for a maximum of one months supply and dispensed in quantities sufficient for either one week or 10 days treatment.
In some instances, veterinary nurses would aid in the dispensing of routine medication, under the direction of the veterinarian. This is in contrast to the tighter regulations in place in community pharmacy. Pharmacists also have ethical responsibilities to check that the doses are correct and the prescribed medicine is appropriate for the patient, before dispensing the medicine. If there is any uncertainty with these aspects or any component of the prescription, the pharmacist is obliged to contact the prescriber.
In veterinary practice, as it is the veterinarian who prescribes the medicine and does the majority of the dispensing, they are responsible for ensuring that the dose and medicine is appropriate for their patients. Thus, for animals, the veterinarian carries out the roles of both doctor and pharmacist, which means there is no verification of dosage or suitability by an independent source.
Pharmacists are in a suitable environment to provide medicines to the owners of animals, as they have both knowledge of medicines and access to supplies. Although we observed that it was not a common practice, there is definite potential for pharmacists to play a role in the veterinary field, as has been suggested by other authors. In Dunedin, both veterinarian clinics and pharmacies source the majority of their medicines from the same supplier.
This wholesaler does not restrict each professions to obtaining only medicines specific to their line of work, as both professions have access to both human and veterinary medicines. Where a product is not readily accessible, the veterinarians and pharmacists must either compound the product, order a suitable formulation or change the medication.
The general consensus is that on-site compounding is being phased out in both professions in favor of manufactured formulations that can be ordered through compounding companies. In the case of veterinary medicine, compounding may be ordered specific to the patient through companies such as Optimus, a compounding pharmacy that specializes in extemporaneous compounding of both veterinary and human medicine.
Pharmacists on the other hand are frequently required to compound these items for individual patients if the product is not readily available. The common classes of antimicrobials prescribed in a veterinary setting Table 2 are also routinely prescribed for use in humans and are regularly dispensed in community pharmacies. This highlights the potential for pharmacist involvement in veterinary medicine with the provision of a more affordable and convenient service for animal owners.
The emergence of antimicrobial resistance emphasizes the importance of ensuring the correct and appropriate use of antibiotics by veterinarians. With respect to labeling of medicines, the pharmacist must maintain a thorough, succinct process to produce a label adequate to the patient for both legal and ethical requirements.
In veterinary practice, this process is less regulated with the labels being made either by the veterinarian at the time of dispensing or authorization or by verbal sanctioning to veterinary nurses. Labeling of veterinary medicine has additional requirements to prescribed medicines intended for human use. Table 3 shows the common requirements that are requisites for the labeling of medicines in both professions, and additional information that must be included in the veterinary setting.
This could be easily incorporated into the label when dispensed in the pharmacy setting, and is not a significant barrier that would prevent large quantities of animal medicines from being dispensed in a community pharmacy. Legal labeling requirements for inclusion on veterinary products.
Records are valuable sources of information as well as legal documents, it is therefore imperative to utilize and maintain easily accessible organised records. Veterinary and pharmacy professions carry out overlapping roles with respect to protocols and procedures regarding medication use in healthcare settings. Closer relationships between pharmacy and the veterinary profession been established in some countries, in particular the United Kingdom and the USA.
For example, in the USA there are a number of compounding pharmacies for veterinary medicines and pharmacists on staff at veterinary hospitals across the country. Professional organizations, such as The Society of Veterinary Hospital Pharmacists, the International College of Veterinary Pharmacy and Veterinary Pharmacists Group of the Royal Pharmaceutical Society of Great Britain have also been established to promote and enhance the continued development of veterinary pharmacy.
In the United Kingdom, there are Prescribing Advisors who are pharmacists who work with general practitioners and primary care clinics to provide information on medicines management. The advice includes consistent best practice in prescribing and cost effective treatments that have the desired health outcomes for patients. We suggest that this is potentially a role that pharmacists could develop in association with veterinarians in New Zealand.
The creation of such specialized positions would also require the education and training of pharmacists interested in the role of veterinary prescriber in subject areas including animal anatomy, physiology, pharmacokinetics, animal behavior 3 and compounding for animal patients. As pharmacists are the medication experts in the community, they are familiar with the different formulations and applications of medicines.
In most instances, the medications used in the veterinary setting are the same as those used for the treatment of human conditions, and will not require an extensive expansion into different product lines as current human medications can be utilized within the different species.
We are most grateful to the veterinary practices in Dunedin who enthusiastically participated in this study. National Center for Biotechnology Information , U. Journal List Pharm Pract Granada v.
Pharm Pract Granada. Published online Mar Dunedin New Zealand. Arlene McDowell University of Otago. Pauline Norris University of Otago. Article notes Copyright and License information Disclaimer. Received Aug 24; Accepted Dec This article has been cited by other articles in PMC. Abstract Background Prescribing and dispensing of medicines are fundamental processes in providing healthcare for both human and animal patients. Objective The aims of this study were to gain information on veterinary prescribing and dispensing processes for companion animals in the Dunedin region of New Zealand.
Methods Open interviews were conducted with a selection of five veterinarians at practices in Dunedin. Results In New Zealand almost all dispensing of medicines for animals is carried out by veterinarians or their staff. Table 1 Questions asked during the interview with staff from the veterinary practices. Where are the records kept? How are the records categorised? Do you have a consultation recording guideline? Is there standard veterinary record dispensing software? Is there a standard treatment guideline for some conditions?
Where do vets compound and dispense veterinary medicines? Metadata Show full item record. Abstract Introduction: Medication errors are a major cause of illness and hospitalization of patients throughout the world. This study examines the situation regarding medication errors in the Armed Forces Hospital, Kuwait since no literature exists of any such studies for this country.
Several types of potential errors were studied by physicians, nurses and pharmacists. Their attitudes to the commission of errors and possible consequences were surveyed using questionnaires. Additionally, patient medical records were reviewed for possible errors arising from such actions such as the co-administration of interacting drugs.
Methods: This study included direct observations of physicians during the prescribing process, pharmacists while they dispensed medications and nurses as they distributed and administered drugs to patients. Nurses, pharmacists and physicians survey questionnaires: From the staff sent questionnaires a total of respondents comprising nurses All responses were analyzed and compared item-by-item to see if there were any significant differences between the three groups for each questionnaire item.
All three groups were most in agreement about their perception of hospital administration as making patient safety a top priority with regard to communicating with staff and taking action when medication errors were reported all means 3. Although nurses were generally less likely to perceive themselves as being able to communicate freely regarding reporting of errors compared to pharmacists there was no significant difference between the two groups.
Physicians had the most favorable response to perceiving new technology as helping to create a safer environment for patients and to the full utilization of such technologies within the institution in order to help prevent medical errors.
Scenario response - Responses to two scenarios outlining possible consequences, should a staff member commit a medication error, tended to be very similar among the three groups and followed the same general trend in which the later the error was discovered and the more grievous the patient harm, the more severe would be the consequences to the staff member. Interestingly, physicians saw themselves as less likely to suffer consequences and nurses saw themselves as more likely to suffer consequences should they have committed a medication error.
All three groups were more likely to see themselves as facing dismissal from their job if the patient were to die. The error rate was No wrong drug form was actually administered in the observational period. These were the total number of errors observed for the entire month period of the study. IV Result of Pharmacist observations: A total of doses were observed during the one month period. Observations were done for 3 hours per day each day that the study was carried out.
Result of Prescribers in Chart review for drug-drug interactions: The analysis of the drug-drug interactions showed that out of a total of prescriptions, had drug-drug interactions.
None were found to fall into the highest severity rating i. Only twenty-one interactions were rated 3 major , 87 interactions were rated moderate and 15 interactions were rated minor according the modified Micromedex scale. Patient education: All health care such as physician, pharmacist, and nurses have a responsibility to educate patient about their medication use and their health conditions to protecting them from any error can occur by wrong using drugs.
Conclusion This study has contributed to the field of medication errors by providing data for a Middle Eastern country for the very first time.
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