MODULE 1 LAB (PRPM121L): Principles of Good Customer Service 2022

INTRODUCTION Interpersonal communication is an important consideration of patient-

centered care. It is difficult to achieve the desired output if you cannot
This module will give an communicate well. Unclear messages between pharmacy personnel
overview on different with patients or clients and of other health care providers may lead to
types of customers and different types of errors in medication therapy management. Pharmacy
proper way of handling personnel such as pharmacists, pharmacy technician and pharmacy
and conversing with assistant have a responsibility to ensure that patient or client
them. Interpersonal and understand how to properly use their medications. Pharmacists and
intercultural their staffs must be able to give value communication as an essential
communication is also element in building trust between patients, other health professionals
part of this module. and the pharmacy community.

INTENDED LEARNING OUTCOMES: HOW ARE WE GOING TO MOTIVATE PATIENTS TO CHANGE?

At the end of this module, you will learn to:
1. Observe the types of client in a drug establishment  Motivational Interviewing focuses on techniques to help
2. Explain the importance of interpersonal and intercultural motivate patients or clients to move through the stages of
communication change.
3. Apply the principles of good customer service, appropriate verbal,  As described by Miller and Rollnick, the following are the
and nonverbal cues in handling different kinds of patient principles and techniques of Motivational Interviewing.

1. Develop discrepancy
2. Elicit and reinforce “change talk”
3. Express empathy
M1L1: PRINCIPLES OF GOOD 4. Roll with resistance
5. Support self-efficacy
CUSTOMER SERVICE
The customer is a
person, group, system,
and organization that
one interacts with in
his/her day-to-day
function. In providing
customer service it
should not be merely  When you communicate you need to listen to your patient and
meeting customer client. There are four skills of effective listening.
expectations as per the
normal procedure, it 1. Attending behaviors
should not only be meeting the expectations but and exceeding the 2. Empathic responding
customers intellectual and emotional needs. 3. Paraphrasing
4. Summarizing
Customers are considered internal or external. Internal customers are
those employed or involved in the workplace providing service
and external customers not part of the organization or not employed
in the company who receiving the services being provided. One of the program in TESDA is to improve
pharmacy services in the Philippines, which is
Addition of customer service other than what is expected, example in a the certification for Pharmacy Services NC
drug outlet, merely giving the medication based on the prescription or III”, one of the common competencies
medication order but also giving additional services such as patient and include area which focuses on how to
medication counselling, free blood glucose, blood sugar and lipid level Maintain an Effective Relationship with
determination and others. Clients/Customers”.

Remember that clients who come to your outlets are experiencing

physical, emotional, and mental disturbances. Due to this, as  This competency includes the determination of the attitude,
pharmacists, you must be able to address their needs professionally. knowledge and also skills which are required in ensuring good
collaboration between the pharmacy assistants and pharmacist
There are different types of clients that require different approach to with the public.
address their needs. Customer service is very important and to assess
whether you are providing the needs of your patient or clients there is THERE ARE THREE ELEMENTS OF THE COMPETENCIES WHICH INCLUDE:
a need for review of the process and provided service and it can be 1. Maintain professional image.
done thru feedback and evaluation of feedbacks to serve as a basis for 2. Meet the client/ customer requirements
providing changes on the services. 3. Build credibility with customers/client

M1L3: HANDLING DIFFERENT TYPE OF

M1L2: INTERPERSONAL AND PATIENTS/CUSTOMERS
INTERCULTURAL COMMUNICATION

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MODULE 1 LAB (PRPM121L): Principles of Good Customer Service 2022
Whether you are a pharmacy technician, salesperson, cashier, or a
pharmacist, you will always find yourself needing good customer
service skills. Customer service in any industry is an important position.
Connecting with customers personally is an important part of doing

business. Businesses like your local pharmacy needs to be exceptionally

personable when handling customer’s personal prescriptions and over EVOCATION RATHER THAN EDUCATION
the counter medications.  “Motivation to change comes from within”.
 “Draw out" the client's true motivations for this change.
 Once these motivators are identified, the client can use them to
make the recovery process easier or to help them keep going
when they want to give up.
---THE END---
AUTONOMY OVER AUTHORITY
ADDITIONAL NOTES (M2L2 PPT):  Motivational interviewing recognizes that the true power for
making changes rests within the client.
WHY IS PATIENT-CENTERED COMMUNICATION SO CRUCIAL TO A  It is up to the client to take the actions necessary to change their
PROFESSIONAL PRACTICE? behavior. They must put in the work. This is self-empowering to
 It is difficult to achieve the desired output if you cannot the individual, but also gives them personal responsibility over
communicate well. their actions.
 Unclear messages between pharmacy personnel with patients
and of other health care providers may lead to different types of
errors in medication therapy management. PRINCIPLES OF MOTIVATIONAL INTERVIEWING:

1. Express empathy
THE COMMUNICATION PROCESS BETWEEN YOU AND YOUR PATIENT  Focus on understanding the situation from the client's POV.
SERVES TWO (2) PRIMARY FUNCTIONS:  Convey to patients that you understand the difficulty to change.
 Establishes the ongoing relationship between you and your  Pressuring patients to change increases resistance to change
patient; rather than helping to initiate and maintain change.
 Provides the exchange of information necessary to improve your
patients’ quality of life. 2. Develop discrepancy
 Based on the belief that a person becomes more motivated to
change once they see the mismatch between where they are and
INTERPERSONAL COMMUNICATION where they want to be.
 An important consideration of patient-centered care.  Help patients identify the discrepancy by highlighting the
 Interpersonal communication is a process in which two or more differences between the current and desired behaviors.
people exchange information through verbal and non-verbal
means, the information often takes the form of words, feelings, 3. Roll with resistance
gestures, and body language.  MI understands that change doesn't always happen just because
you want it. It's natural to change your mind many times about
 In order to meet our professional responsibilities, pharmacists whether you want to change your behavior and what that
have become more patient-centered in their provision of process or new lifestyle looks like.
pharmaceutical care.  Acknowledge to patients that their ambivalence and reluctance to
 Using effective communication skill is essential in the provision of change is understandable.
patient care.  Avoid argument and direct confrontation.
 If you see patients arguing with you, it is time to change the way
you are responding.
MOTIVATIONAL INTERVIEWING  Help them reach a new understanding of themselves and their
 Developed by William R. Miller and Stephen Rollnick behaviors by reframing or offering different interpretations of
 A counseling approach designed to help people find the certain situations.
motivation to make a positive behavior change.
4. Support self-efficacy
The Spirit of Motivational Interviewing  Self-efficacy is a person’s belief or confidence in their abiltiy to
perform a target behavior.
 Motivational interviewing should always be implemented with a  Show support to client’s self-efficacy by reinforcing their power to
particular "spirit." make the changes they want.
 According to Miller and Rollnick, the "spirit" is collaborative,  Soon, the client starts to recognize their strengths and ability to
evocative, and honors client autonomy. change their behavior for the better.

COLLABORATION INSTEAD OF CONFRONTATION

 A partnership formed between the counselor and the client. INTERCULTURAL COMMUNICATION
 This relationship is based on the point of view and experiences of  Communication between people from two different cultures.
the client.
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 MODULE 1 LAB (PRPM121L): Principles of Good Customer Service 2022
 It is a symbolic, interpretive, transactional, contextual process in
which people from different cultures create shared meanings.
 It requires an understanding that different cultures have different
customs, standards, social mores, and even thought patterns.
 It requires a willingness to accept these differences and adapt to
them.

BENEFITS OF INTERCULTURAL COMMUNICATION:

 Healthier communities
 Increased international, national, and local commerce
 Reduced conflict
 Personal growth

COMMON ISSUES IN COMMUNICATION:

 Verbal
 Hearing impairment
 Lack of information and understanding (medical jargons)
 Environmental barriers (distractions, noise, heavy
 accents, language differences, voice tone and speed)

 Written
 Lack of patient educational material
 Visual impairment
 Poor handwriting

SKILLS IN EFFECTIVE LISTENING:

1. Summarizing
 It means “cutting down to its bare essentials”
 Clarifying or simplifying complex ideas
 Explaining an idea in a shortened form

2. Paraphrasing
 “Formulating someone else’s ideas in your own words”
 Explaining an idea in your own words without changing the
original meaning of the idea

3. Empathic responding
 “Reflection of feeling” statements that verbally convey your
understanding of the essence or emotional meaning of another
person’s communication

4. Attending behaviors
 Are verbal and non-verbal behaviors displayed by the listener
indicating that the listener is paying attention to and is interested
in the speaker’s message
 This shows that patients are respected and encouraged to talk
about their thoughts and feelings, and they are being listened to
and taken seriously

TESDA PHARMACY SERVICES NC III

 One of the common competencies includes Maintain an Effective
Relationship with Clients/Customers.
 This competency covers the knowledge, skills and attitudes
required in building and maintaining effective relationship with
clients, customers, and the public.

THREE (3) ELEMENTS OF COMPETENCIES:

1. Maintain professional image
2. Meet the client/ customer requirements
3. Build credibility with customers/client

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 MODULE 2 LAB (PRPM121L): Patient Scripting and Incident Reporting 2022

INTRODUCTION with each and every medication we dispense, and it is our duty to
maintain our skills as patient educators so that we may convey
such information in an appropriate manner to our patients.
This module will cover how to
properly receive a patient and how
to acknowledge their presence,
giving importance to having a
standard in patient scripting. M2L2: INCIDENT REPORT
Another topic in this module is the
process on how to report untoward  Incident report is a detailed information in case of errors in the
incidents that may occur in a practice site. Incidents reports commonly include information
pharmacy area. such as the date and time it happened, the personnel involved,
details of the incident and actions taken if any.

INTENDED LEARNING OUTCOMES:

At the end of this module, you will learn to:
1. Create a standard patient script for receiving clients
2. Detect untoward incidents in dispensing functions that may need ONEISS ( Online National Electronic Surveillance System )
reporting  The Department of Health has an Online National Electronic
Surveillance System for hospital.

 As a nationwide undertaking, the DOH requires all health facilities

to adhere to all national policies and guidelines on injury
M2L1: PREPARATION OF STANDARD reporting. The DPCB is the central coordinating body for the
evaluation, processing, monitoring, and dissemination of data or
PATIENT SCRIPT information. Each health facility is required to report on a daily
basis all injury related cases through the Online National
 In receiving clients it is important that you acknowledge the Electronic Injury Surveillance System. While the DPCB has no
presence of the patient or client by greeting them. People regulatory power over the health facilities, it does have indirect
requiring service usually wanted to be given attention to. power thru the Health Facilities and Services Regulatory Bureau
(HFSRB). The DPCB as the highest policy making body can make
 According to Steve Leuck, PharmD, the acronym he uses recommendations to the HFSRB for appropriate actions on erring
is D.R.U.G. health facilities.

1. Dosage  The general objective of Online National Electronic Injury

 Discuss the dose of the medication, how it should be taken, any Surveillance System (ONEISS) is to make efficient and effective the
specific dosage timing issues, and what to do if the patient misses current systems and procedures of reporting injury-related data.
a dose. Specifically, ONEISS aims to:

2. Results 1. Promote efficiency to maximize time and effort in data collection,

 What should the patient expect while taking this medication? processing, validation, analysis, and dissemination of injury-
How is the drug working in the body, and how can the patient tell related data;
if the medication is working? It is also important for the patient to 2. Improve accuracy, reliability, integrity and timeliness of injury-
understand the consequences of nonadherence. related data;
3. Implement the most reliable and effective technology solution to
3. Underlying Issues interconnect with the different agencies and/or
 Potential issues that the patient needs to be aware of when taking beneficiaries/stakeholders of the injury related data; and
the medication, including: 4. Enforce standards on inputs, processes and outputs on injury-
o Does this medication have any Black Box Warnings? related data collection, analysis, report generation and feedback.
o Is the patient allergic to this medication?
o Is the patient taking any other medications that may interact  ONEISS shall be the standard reporting system for the collection,
with this medication? storage, analysis, and reporting of data pertaining to violence and
o Does this medication have any specific alcohol, grapefruit, or injury. ONEISS is the information system being implemented by
sun sensitivity warnings? the DOH in support of the Injury Program.
o Does this medication have an effect on any other disease
states that the patient may have?  The patient injury form it includes information such as:
o Are there any special precautions with the elderly, young, 1. Registry number
pregnant, or breast-feeding patients? 2. General Data
o Are there any other medication specific cautions or 3. Pre-admission data
precautions that should be discussed? 4. Hospital/facility data
5. ER/ OPD/ BHS/ RHU
4. General information 6. In-patient (for admitted cases only)
 Assess the patient's understanding of the above information.
Discuss how to properly store the medication, what to do about
refills, how to dispose of unused meds, and assure that the
patient knows who to call for questions.
---THE END---
 Speaking as a community pharmacist, many patients rely on us for
medication information and education. Therefore, we need to stay
current on our understanding of the important counseling topics

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MODULE 3 LAB (PRPM121L): Core Competencies in TESDA Pharmacy Services NC III 2022

INTRODUCTION  Demonstrate product knowledge on medicines

 Dispense pharmaceutical products
Part of the qualification for  Perform health promotion education, vigilance
“TESDA Pharmacy Service NC III” are
the basic, common and core
competencies. These competencies TRAINING DURATION:
could serve as a basis for TESDA
assessors in determining whether a Coverage No. of Hours
candidate, usually pharmacy
assistants is competent. Basic Competencies 22

The certification for

Pharmacy Services NC III, includes 22 Common Competencies 24
hours of basic competencies, 24 hours
of common competencies and 802 hours of core competencies. After
completion of these training, the candidate will undergo 200 hours of Core Competencies 802
industry exposure or internship. The program has a total of 1048 hours.
Please refer to TESDA Pharmacy Services NC III Training Regulation.
(Downloadable at tesda.gov.ph). Aside from the competencies skills Industry Exposure 200
needed it also provide four projects involving the nine core
competencies that serves a basic for assessment of the candidates
‘skills and knowledge. TOTAL 1048

INTENDED LEARNING OUTCOMES:

At the end of this module, you will learn to: EXAMINATION:
1. Differentiate basic, common and core competencies in pharmacy  Written Examination
services  Practical Examination
2. Perform general housekeeping
3. Create a planogram for the proper display of pharmaceutical
products CORE COMPETENCIES’ PROJECTS:
 Project 1:
 Practice good housekeeping
 Arrange and display pharmaceutical products
M3L1: CORE COMPETENCIES IN TESDA  Project 2:
PHARMACY SERVICES NC III  Perform good laboratory practices
 Adhere to good manufacturing practices
Pharmacy Services NC III
 A TESDA program that is awarded to a pharmacy assistant who  Project 3:
competently qualifies for the Pharmacy Services NC III  Monitor supply/inventory of pharmaceutical products
 “Certified Pharmacy Assistant”  Handle and control pharmaceutical products

 Project 4:
UNITS OF COMPETENCY:  Demonstrate product knowledge on medicines
 Dispense pharmaceutical products
 BASIC COMPETENCIES  Perform health promotion education, vigilance
 Lead workplace communication
 Lead small teams
 Develop and practice negotiation skills CORE COMPETENCIES:
 Solve problems related to work activities
 Use mathematical concepts and techniques 1. Practice Good Housekeeping
 Use relevant technologies  Perform housekeeping duties
o Housekeeping procedures are performed in line with
 COMMON COMPETENCIES company policy and regulations.
 Maintain an effective relationship with clients/customers  Follow health and safety practices in the area
(marketing) o Procedures to achieve a safe working environment in the
 Update industry knowledge and practice through continuing area are complied with in accordance with DOH/FDA safety
education standards
 Perform workplace security and safety practices
 Perform computer operations GOOD HOUSEKEEPING
 Use pharmaceutical calculation techniques and terminologies  Pharmacy is a healthcare institution; all areas must be cleaned
and the level of hygiene must be maintained.
 CORE COMPETENCIES  Housekeeping refers to the general cleaning including the floor,
 Practice good housekeeping walls, certain types of equipment, shelves, tables, and other
 Monitor supply/inventory of pharmaceutical products surfaces.
 Handle and control pharmaceutical products
 Arrange and display pharmaceutical products Importance of Good Housekeeping:
 Perform good laboratory practices  Reduce the number of microorganisms that may come in contact
 Adhere to good manufacturing practices with patients, visitors, staff and the community
 Provide a clean and pleasant atmosphere for patients and staff

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MODULE 3 LAB (PRPM121L): Core Competencies in TESDA Pharmacy Services NC III 2022
 Keep work areas neat and orderly o Products are accurately dispatched in a timely manner.
 Ensure safe working environment  Handling returned products or products for return
o Accurate documentation records are maintained, and credit
Cleaning Methods: process is completed in a timely manner
 Swabbing – cleaning an area with the use of an absorbent device
like a sponge.
 Sweeping – cleaning an area with a broom or brush. 3. Handle and Control Pharmaceutical Products
 Wiping – cleaning or drying an area by rubbing its surface with a  Comply with drug storage requirements
cloth. ○ Stocks are stored in accordance with manufacturer’s
 Disinfecting – cleaning an area with a disinfectant in order to specifications, regulatory and company policy and
destroy bacteria. procedures Storage conditions are monitored and
 Soaking – immersing a material in a liquid for a period of time. maintained in accordance with manufacturer’s instructions,
 De-scaling – removing hard deposit/s formed by chemicals in and company’s SOP.
water from metals or any other surfaces. ○ Stocks are arranged in shelves in accordance with first
expiry, first-out policy (FEFO).
Cleaning and Sanitizing Protocol: ○ Expiration dates are monitored in accordance with
 Cleaning must be done daily. institutional and regulatory guidelines.
 Cleaning materials and equipment must have its own storage area  Storage Conditions:
and returned after use. o Appropriate temperature and humidity
 Cleaning must occur: o Clean and regularly maintained area
 Cleanest to the dirtiest areas o Cold chain requirements
 Top to bottom o Well-lighted and secured
 Farthest area to door o Proper ventilation
 Prepare an adequate quantity of cleaning solutions, select an o Correct storage of hazardous substances
appropriate product. o With adequate space
 Each area of the pharmacy cleanroom shall have its own cleaning  Monitor inventory
bucket, each bucket must be clearly marked or labelled to prevent o Stock level requirements are monitored and reported
any possible contamination or critical work areas. according to SOP
 Allow the mops to soak in their respective buckets, in solution, for o Inventory counts are conducted regularly
approximately 5 minutes prior to the start of cleaning.
o Stock discrepancies are identified and reported to the
 Used cleaning materials must be placed in a designated area for
pharmacist for reconciliation and proper action
re-laundered or possible replacement.
 Dispense of waste
 Product spill off must be clean with water and wipe accordingly.
o Expired and damaged stocks identified and disposed in
 Dispose waste properly.
accordance with manufacturer’s and company’s policies,
 Apply basic pest control in schedule, use the safest product to
regulatory and environmental policies.
human and environment.
o Expired and damaged stock are segregated and labeled in
 Cleaning activities must be log daily.
specific containers and in accordance with established
procedures.
Cleaning Lay-out:
o Stock records updated after disposal and in accordance with
established procedures.

 Expired products
 Recalled products
 Damaged products
 Documentation
 Quarantine area – “no access to unauthorized personnel”.

2. Monitor Supply/Inventory of Pharmaceutical Products

 Examine the medicines in the assortment list or formulary
o Products are recognized by name, appearance, and shelf
 Dispense of waste may include but not limited to:
location.
o Returns to supplier
o Products are classified in accordance with market demand.
o Safe destruction according to regulatory requirements and
 Assist in procurement of materials and services from qualified
environmental protection guidelines
sources
 Receive and delivery of stocks
o Delivery specifications are checked whether it is an
4. Arrange and Display Pharmaceutical Products
accordance with Good Distribution Practices.
 Follow merchandising plan
o Product specifications of delivered stocks are compared with
o Products are displayed according to planogram.
purchased order in accordance with established procedures.
o Regular and timely replenishment of product display are
o Deviations from product specifications are recognized to
maintained with minimum disruption to customer or traffic
detect wrong, damaged, and fake medicines.
flow.
 Pack and dispatch orders
o Displays are placed and maintained in a safe and secure
o Products ordered are retrieved and properly packaged to
manner and in accordance with established procedures.
avoid breakages following established procedures.
o Price tags and proper labels are attached to the shelves
o Labeling, product, and delivery specifications, and delivery
correctly, and at the specified location according to company
information are checked in accordance with established
policy.
procedures.

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MODULE 3 LAB (PRPM121L): Core Competencies in TESDA Pharmacy Services NC III 2022
o Guides and product locators are placed within the store to o Equipment is used in accordance with manufacturers manual
facilitate ease of locating items and good laboratory practices.
 Follow display plan for promotional items
o Store policy and proecedures with regard to pricing and
promo discounts are implemented. Common Laboratory Work in Pharmacy: Non-sterile Ph. Preparation
o Promotional items are arranged based on merchandising  Reconstituting Oral Powder for Suspension
aggreement.
o Updated promo labels are attached and in accordance with
established procedures.
 Monitor promotional activities
o Client is interviewed regarding feedback on promos in
accordance with established procedures.
o Client feedback is documented in accordance with
established procedures.
o Store feedback on promos is reported to the pharmacists/
suppliers and in accordance with established procedures.

Tools in Reconstituting Oral Powder for Suspension:

5. Perform Good Laboratory Practices  Graduated cylinder
 Observe laboratory protocols (various sizes)
o Laboratory outfit is worn in accordance with established  Beaker
procedures.  Dropper
o Proper laboratory conduct is demonstrated at all times  Stirring rod
within store premises.  Distilled water
o Proper waste disposal is followed in accordance with good  Wipes
laboratory practices.  Head cap
o Use of logbook is maintained in accordnace with established  Face mask
procedures.  Gloves

GARBING
 Wearing of PPE and hygiene. Dispensing Oral Powder for Suspension:
 Order must be dirtiest to cleanest  The employee should inform the customer that this product
o Shoes/ shoe cover should be mixed with sufficient amount of distilled water in order
o Head cap/ cover to use it
o Face mask  Preferably, encourage the customer to let the pharmacist or
o Eyeshield pharmacy assistant to do the mixing
o Lab gown  The employee should inform the customer that once the powder
o Hand sanitation is mixed with water, it is stable in 14 days when refrigerated and
o Gloves (used for the protection from chemical exposure and 7 days at room temperature
prevention of drug contamination)  The employee should also inform the customer that there are
 Note: No Jewelries suspensions that will undergo sudden change in color when mixed
with water. This is due on producing the flavor of the suspension.
 Inform the customer to shake the drug every use.

Steps in Reconstituting Oral Powder for Suspension:

 Read the label to determine the exact quantity of water to be
mixed.
 Shake the bottle to make sure that powder inside are fully fine.
 Prepare and attached the auxiliary label such as “Shake well”,
“Keep refrigerated” and Beyond Used Date (BUD) – 7 days (RT) or
14 days (Ref) upon mixing.
 Demonstrate skills in laboratory measurements  Wash hands and wear PPE.
o Substances are accurately weighed using appropriate  Measure exact amount of water using the necessary equipment
techniques and weighing balance in accordance with Good and procedure and pour the distilled water to the powder
Laboratory Practices. gradually (in partition).
o Semi-solids, liquids, and liquid medicines are measured  Shake the bottle gently.
using appropriate glassware capacity in accordance with
Good Laboratory Practices. Procedure in Measuring Liquid Using Graduated Cylinder:
o Cross-contamination among substances is prevented at all  Place the graduated cylinder on a flat surface.
times.  View the height of the liquid in the cylinder with your eyes
 Maintain and store pharmacy glassware/device/equipment directly opposite the top of the liquid surface, the liquid will
o Cleaning solutions are used for each glassware, device, or tend to curve downward, this curve is called the meniscus.
equipment based on manufacturers/suppliers  Always read the lower meniscus.
recommendation.
o Cleaning and storage of pharmacy glasswares/ devices/
equipment are performed in accordance with established Auxiliary Label:
procedures
o Damaged on equipment and device or any laboratory
glassware are immediately attended to and reported to the
appropriate personnel.
o Polieices on the safe/quality use of equipment are complied
with.

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MODULE 3 LAB (PRPM121L): Core Competencies in TESDA Pharmacy Services NC III 2022
 Repacking Solid Oral Preparation  Demonstrate GMP in performing work activities
 Labeling  Complete documentation requirements to support GMP
 Counting and Transferring

7. Demonstrate Product Knowledge on Medicines

 Demonstrate adequate knowledge on OTC and selected
prescription medicines
o Generic names, brand names, stock keeping units (SKU),
dose regimen, and therapeutic classification, indication and
effects are identified in accordance with the inventory list.
Generic equivalent of OTC drugs are identified in accordance
with the generic menu card.
 Calculate quantity needed in the regimen of the whole
prescription.
o Appropriate quantity of medicine is computed to verify the
prescribed regimen of the doctor.
Tools in Dispensing Loose Solid Oral Preparation: o Incorrect quantitites based on calculations are referred to the
pharmacist.
o Where necessary amount and dosage and name of drugs in
prescriptiona are explained to customer.
 Advise proper use of OTC medicine under the supervision of the
pharmacist
o Information on indication and dosing, duration of
treatment, common side effect, precautions are provided
under the supervision of the pharmacist.
o Information on proper storage of OTC and prescription
medicines and what to do with missed dose are provided
under the supervision of the pharmacist.

Parts of a Pill Counting Tray:

8. Dispense Pharmaceutical Products
 Acknowledge patient/client
o Patient/ client is greeted in accordance with pharmacy
guidelines and procedures.
o Patient/client is asked what assistance can be extended.
Confidentiality, tactness and privacy maintained at all times
while interacting with clients/patients and/or passing on
relevant information to other pharmacy staff.
o First-In-First-Out (FIFO) procedure is followed for large
number of clients
 Process over-the-counter medicine order
o Upon receipt of the order, a guided recommendation of OTC
Procedures on Using a Pill Counting Tray: medicines are provided for minor symptoms following
 Gather the necessary materials established procedures.
 Prepare the label indicating the necessary o Generic OTC products on the menu card are offered to
 information including “Before Used Date (BUD) – 6 months upon identify preferred product of the patient/client.
transferring the medicines or the lesser date” and affix the label o Availability and quantity of medicines ordered are checked
to the container, set aside the container
against inventory on hand.
 Wash hands and wear PPE
o Any pharmaceutical and disease-based questions beyond the
 Clean the pill counting tray with a clean wipes
scope of the training are referred to the pharmacist.
 Pour approximate amount of pills into tray
o Product is retrieved from the shelves following established
 Count by fives and place correct amount of pills into chute
procedures.
 Close chute and pour pills into a container and seal properly
o Labels are prepared in accordance with regulatory
 Return the remaining pills in its original container.
requirements, ensuring legibility.
 Clean again the pill counting tray with a clean wipes and set aside.
o Ordered medicines are counted using appropriate devices
and packaged into a suitable container under pharmacist
NOTE IN CASE OF ACCIDENTAL DROP OR SPILL:
supervision.
 Package properly the product and place in a quarantine area
o Prepared product is endorsed to the pharmacist for checking
 Clean the area properly
following established procedures.
 Make an incident report
 Process prescription medicine order
 Prepare another one
o Prescription is checked for validity and completeness of
prescription details in accordance with legal and regulatory
requirements, upon receipt of the prescription.
6. Adhere to Good Manufacturing Practice (GMP)
o All available generic equivalents are offered to identify the
 Demonstrate understanding of GMP and concepts
preferred product of the patient following established
 Observe personal hygiene and conduct
procedures.
o GMP requirements on personal hygiene are complied with.
o Availability of medicines ordered is checked, and quantity of
Clothing is prepared, used, stored, and disposed in
order/s is/are confirmed.
accordance with GMP and company procedures and policies.
o Patient/client is questioned regarding any entitlement status
Movement inside the premises is observed according to area
with regard to the Health Care Benefits Scheme and
entry and exit procedures.
PhilHealth insurance when applicable or the mode of
o Sick or injured personnel at the workplace are reported to
payment.
authorized person.

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 MODULE 3 LAB (PRPM121L): Core Competencies in TESDA Pharmacy Services NC III 2022
o Prescription is endorsed to the pharmacist for validation
(signature).
o Pharmacist is assisted to dispense the prescription according
to the steps.
o For partially filled prescription, quantity of medicine
dispensed is subtracted and noted in the prescription pad
prior to returning to the client/patient.
o If the prescription is completely filled, prescription is kept
and filled.
 Receive payment and release exact change
o Where necessary, multiple orders from 2 or more customers
are noted and endorsed to cashier
o Prescription/ patient data is accurately and confidentially
entered into dispensing computer records according to
regulatory requirements
o Identity of the patient receiving the medicines is confirmed in
accordance with company policy and procedure.
o Change is accurately given, and official receipt is issued.

9. Perform Health Promotion, Education, and Vigilance

 Participate in health promotion and education campaigns
o Health information is provided to patients in accordance
with established procedures
o Patients are educated on self-care and rational &
responsible use of drug in accordance with established
procedures
o Information, education, and communication materials are
provided to the patients as needed
 Perform screening procedures for common diseases
o Basic screening procedures are performed in accordance
with established process
o Provide information to patients regarding common diseases,
minor ailments, and seasonal diseases in accordance with
established procedures
o Patients are referred to health facility for proper diagnosis
following established procedures
 Refer patients to appropriate health care professionals or facilities
o Trigger points for referral are identified following established
procedures
o Patients with minor health problems are referred to the
pharmacist
o Patients with major health problems are referred to other
health care professionals
 Advise patients on reporting unusual experience with medicines
o Objectives of reporting adverse drug events are explained to
patients in accordance with stablished procedures.
o Unusual or unexpected effects of drugs are gathered and
reported to pharmacost/
o Patients are encouraged to report any unusual experience in
the use of the medicine.
 Guide patients on how to fill-out form
o Instructions on how to fill-out the form are given to the
patients in accordance with FDA requirements or company
policy. Items that should be answered in the health vigilance
form are clarified to the patient.
o Patient responses are processed, tabulated, and summarized
and reported to store supervisor.

---THE END---

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MODULE 4 LAB (PRPM121L): Calculation of Doses 2022

INTRODUCTION Dose or Dose Size

 It is a quantitative term estimating the amount of drug that must
Posology is the branch of pharmacology that is concerned be administered to produce a biological response. It is the amount
with the determination of dosage. Dosage calculation means figuring of drug taken by the patient for the intended medicinal effect.
out the correct dose of a medication. Many times the medication dose
prescribed for the patient is different from the way the medication is Single Dose
supplied.  It refers to the amount of drug taken at one time.

For example, an order may be written for the patient to Total Dose or Daily Dose
receive “Amoxicillin 500mg tablet,” but the medication that comes  It refers to the amount of drug taken during the course of therapy.
from the pharmacy is “Amoxicillin 250 mg tablet.” In this case, you
calculate that the patient needs to take two tablets to achieve the full
500mg dose that was ordered. This is easy and can be done by mere GENERAL DOSE CALCULATIONS:
calculation in your head.
 A pharmacist often needs to calculate the size of a dose, the
But how about this order, “Morphine 15 mg injection” and number of doses, or the total quantity of medication to dispense.
the supplied medication is “Morphine ½ grain per milliliter.” With this For these calculations, the following equation is useful with the
situation, there is a need to convert the grain to milligram and then terms rearranged depending on the answer required. In using the
calculate the correct dosage. equation, the units of weight or volume must be the same for the
total quantity of the dose.
The above examples point out some of the factors related to
dosage calculations that you must learn as pharmacy students. These Number of doses (N) = Total Quantity (T)
include: abbreviations used in prescriptions, systems of measurement, Size of the Dose (S)
basic mathematical calculations, and formulas for computing drug
dosages. A. Calculations of the Number of Doses

There are three big steps to successfully calculate medication dosages: Examples:
1. Be competent in basic math skills
2. Know the measurement equivalent and conversions (1) If the dose of a drug is 200 mg, how many doses are contained in
3. Use calculation formulas correctly 10g?

In this module you will learn about the common calculations Solution:
involved in the community pharmacy and hospital pharmacy setting. Number of doses (N) = Total Quantity (T)
Size of the Dose (S)

INTENDED LEARNING OUTCOMES: Number of dose = 10 g/200mg

At the end of this module, you will learn to: = 10,000 mg/200 mg
1. Solve problems based on patient parameters, general dose = 50 doses
calculations, size of doses and total quantity of product.
2. Convert metric measurements to household measurements
3. Calculate doses based on patient parameters, IV Infusions, (2) If 1 tablespoon is prescribed as the dose, approximately how
parenteral admixtures, and rate of flow calculations. many doses will be contained in 1 pint the medicine?

Solution:
Number of doses (N) = Total Quantity (T)
Size of the Dose (S)
M4L1: CALCULATION OF DOSES
APPLICABLE IN COMMUNITY Number of dose = 1 pint / 1 tablespoon
= 473 mL / 15 mL
PHARMACY PRACTICE = 31.5 doses
= 32 doses
 An essential function of the pharmacist is to ensure that the
patient gets the intended drug in the correct amount.
 In all instances of providing patients with drug products, whether (3) If the dose of Paracetamol is 250 mg/5 mL, how many doses are
they may be manufactured dosage forms or preparation specially contained in a 120 mL bottle?
formulated by the pharmacist, the dose and dosage regimen must
always be verified for accuracy and appropriateness. Solution:
Number of doses (N) = Total Quantity (T)
TO AVOID AMBIGUITY, FAMILIARIZE YOURSELVES WITH THE Size of the Dose (S)
FOLLOWING DEFINITION OF TERMS:
Number of dose = 120 mL / 5 mL
Dosage Regimen = 24 doses
 It refers to the schedule of dosing which includes the time when
the doses are to be given (dosing frequency or dosing interval)
and the amount of medicine to be given at each specific time B. Calculations of the Size of a Dose
(dose or dose size).
Examples
Dosing Interval
 It is the time interval between doses. It ensures maintenance of (1) How many teaspoonfuls would be prescribed in each dose of an
plasma concentration of a drug within the therapeutic range for elixir if 180 mL contained 18 doses?
the entire duration of therapy.
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MODULE 4 LAB (PRPM121L): Calculation of Doses 2022
Solution: = 56 g needed for one week
Size of dose = Total Quantity = 60 g to be dispensed
Number of Doses

Size of dose = 180 mL / 18 doses

= 10 mL
= If 1 teaspoonful is 5 mL,
M4L2: CALCULATION OF DOSES
then 10 ml is equivalent to 2 teaspoonfuls APPLICABLE IN HOSPITAL
PHARMACY PRACTICE
(2) How many drops would be prescribed in each dose of a liquid
medicine if 15 mL contained 60 doses? The dispensing dropper  Dosage calculation is a mandatory skill for pharmacists in various
calibrates 32 drops/mL. practice settings most especially in the community and hospital
setting. As one of the members of the healthcare team, being
Solution: able to calculate correct dosages is paramount to safe practice.
Size of dose = Total Quantity
Number of Doses  Literatures have shown that improper dosage calculations are
common sources of medication errors. Medication errors due to
Size of dose = 15 mL / 60 doses improper dosage calculations can have serious or even fatal
= 0.25 mL consequences. Therefore, strong emphasis should be placed on
= If 1 mL is equivalent to 32 drops, dosage calculation throughout the pharmacy curriculum.
then 0.25 mL is equivalent to 8 drops.
A. CALCULATION OF DOSES BASED ON PATIENT PARAMETERS
 For certain drugs and certain patients, drug dosage is determined
(3) How many milliliters would be prescribed in each dose of an on the basis of specific patient parameters. These parameters
amoxicillin suspension if 105 mL contained 14 doses? include the patient’s age, height, weight, body surface area and
nutritional and functional status.
Solution:
Size of dose = Total Quantity 1. Pediatric Patients
Number of Doses  Pediatrics deal with children from birth through adolescence.
Because of the range in age and bodily development in this
Size of dose = 105 mL / 14 doses patient population, the inclusive groups are defined further as
= 7.5 mL follows:
o Neonate (newborn) – from birth to 1 month
o Infant – 1 month to 1 year
C. Calculations of the Total Quantity of a Product o Early childhood – 1 year through 5 years
o Late childhood - 6 years through 12 years
Examples: o Adolescence - 13 years through 17 years

(1) How many milliliters of a liquid medicine would provide a patient  One obvious difference between adults and pediatric patients is
with 2 tablespoonfuls twice a day for 8 days? size but remember that infants and children are not just little
adults. Other factors that should also be considered are age and
Solution: weight, overall health status, the condition of biologic systems
Total Quantity = Number of doses X Size of dose and stage of development of body systems for drug metabolism
and drug elimination.
The number of doses is 16 doses (2x/day for 8 days) and the size of
dose is 30 mL (15ml per 1 tbsp times 2 tbsp).  Among the special considerations in pediatric dosing are:
o Doses should be based on accepted clinical studies as
Total Quantity = Twice a day for 8 days X 2 tablespoonfuls reported in the literature.
= 16 doses X 30 mL o Doses should be age appropriately and generally based on
= 480 mL body weight or body surface area.
o Pediatric patients should be weighed as closely as possible to
the time of admittance to a health care facility and that
(2) How many grams of a drug will be needed to prepare 72 dosage weight recorded in kilograms.
forms if each is to contain 30 mg? o As available, pediatric formulations rather than those
intended for adults should be administered.
Solution: o All calculations of dose should be double-checked by a
Total Quantity = Number of doses X Size of dose second health professional.
o All caregivers should be properly advised with regard to
Total Quantity = 72 dosage forms X 30 mg dosage, dose administration and important clinical signs to
= 72 X 0.03 g (30mg/1000mg per gram) observe.
= 2.16 g o Calibrated oral syringes should be used to measure and
administer oral liquids.
(3) It takes approximately 4g of an ointment to cover an adult
patient’s leg. If a physician prescribes an ointment for a patient with 2. Geriatric/Elderly Patients
total leg eczema to be applied twice a day for 1 week, which of the  Geriatric deals with elderly patients. Geriatric patients require
following product sizes should be dispensed: 15g, 30g or 60g? special consideration when designing dosage regimens. Often the
organ systems of these patients are not functioning at top
Solution: efficiency because of the aging process or disease. Because some
Total Quantity = Number of doses X Size of dose clinical conditions important to the metabolism and excretion of
drugs, such as liver impairment and kidney dysfunction, are more
Total Quantity = Twice a day for 1 week X 4 g prevalent in the elderly, it is especially essential for the pharmacist
= 14 doses X 4g to have medical histories of these patients.
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MODULE 4 LAB (PRPM121L): Calculation of Doses 2022

 Dose determinations for elderly patients frequently require A.2. Calculations of Dose Based on Body Weight
consideration of some or all of the following:
o Therapy is often initiated with a lower-than-usual adult dose. Examples:
o Dose adjustment may be required based on the therapeutic
response. (1) The usual initial dose of chlorambucil is 150 ug/kg of body
o The patient’s physical condition may determine the drug weight. How many milligrams should be administered to a person
dose and the route of administration employed. weighing 154-lb?
o The dose maybe determined, in part, on the patient’s weight,
body surface area, health and disease status and Solution:
pharmacokinetic factors. Child’s dose = ___Drug dose in (mg)___ X Patient’s weight (kg)
o Concomitant drug therapy may affect drug/dose 1 (kg)
effectiveness.
o A drug’s dose may produce undesired adverse effects and = ___150 ug___ X 154-lb
may affect patient’s adherence. 1 kg
o Complex dosage regimens of multiple drug therapy may
affect patient adherence. = ___0.150 mg___ X 70 kg
1 kg
 With geriatric patients, modifications in dosing regimen are
usually given, when applicable, in drug information references = 10.5 mg
such as USP/DI, Drugs Facts and Comparison, Drug Information
Handbook, AHFS Drug Information, and product package inserts.
(2) The usual dose of sulfisoxazole for infants over 2 months of age
and children in 75 mg/kg body weight. What would be the dose for a
A.1. Calculation of Dose Based on Age child weighing 44 lb?

Examples: Solution:
Child’s dose = ___Drug dose in (mg)___ X Patient’s weight (kg)
(1) The dose of a drug for an adolescent is 300mg. Calculate the dose 1 (kg)
for a 9-year-old child.
= ___75 mg___ X 44-lb
Solution: 1 kg

Young’s Rule = ___75 mg___ X 20 kg

Child’s dose = ___Age___ X Adult dose 1 kg
Age + 12
= 1,500 mg
= __9__ X 300 mg
9+12
(3) A dose of Enoxaparin sodium injection is “1 mg/kg q12h SC.” If a
= __9__ X 300 mg graduated prefilled syringe containing 80 mg/0.8 mL is used, how
21 many milliliters should be administered per dose to a 154-lb patient?

= 128.57 mg Solution:
154 lb / 2.2lb per kg = 70 kg
1 mg/kg x 70 kg = 70 mg
(2) The dose of a drug for an adolescent is 500mg. Calculate the dose 80 mg : 0.8 mL = 70 mg : X
for a 9-year-old child using the Cowling’s Rule. Then X = 0.7 mL

Solution:
A.3. Calculations of Dose Based on Body Surface Area
 The BSA method of calculating drug doses is widely used for two
Cowling’s Rule
types of patient groups: cancer patients receiving chemotherapy
Child’s dose = Age in yrs next birthday X Adult dose
and pediatric patients.
24
A useful equation for the calculation of doses based on body surface
= 10 X 500 mg
area is:
24
Patient’s dose = ___Patient’s BSA (m2)___ X Drug dose (mg)
= 208.33 mg
1.73 m2
(3) The dose of a drug for an adult is 250 ug. Calculate the dose for a
6-month-old child. Patient’s dose = Drug dose in m2 X Patient’s BSA

Solution: Examples:
Fried’s Rule
Child’s dose = Age in months X Adult dose (1) If the adult dose of a drug is 100 mg, calculate the approximate
150 dose for a child with a BSA of 0.83 m2?

= 6 months X 250 ug Solution:

150 Patient’s dose = ___Patient’s BSA (m2)___ X Drug dose
1.73 m2
= 10 ug
= ___0.83 m2___ X 100 mg
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MODULE 4 LAB (PRPM121L): Calculation of Doses 2022
1.73 m2 how you would obtain the polymyxin B sulfate needed in preparing
the infusion.
= 47.98 mg
Solution:
Step 1 - 44 lb ÷ 2.2 lb/kg = 20 kg
(2) If the dose of a drug is 5 mg/m 2, what would be the dose for a Step 2 - 20 kg X 7500 units/kg = 150,000 units
patient with a BSA of 1.9 m2? Step 3 - 500,000 units : 10 mL = 150,000 units : X
X = 3 mL
Solution:
Patient’s dose = Drug dose in m2 X Patient’s BSA
= 5 mg/m2 X 1.9 m2 B.2. Rate of Flow Calculations
= 9.5 mg In this types of calculations, for a given volume, time period and
drop factor (gtts/mL), the required IV flow rate in drops per minute
(gtts/min) can be calculated using the following formula:
B. IV INFUSIONS, PARENTERAL ADMIXTURES AND RATE-OF-FLOW
CALCULATIONS Flow Rate (gtts/min) = Volume (mL) x Drop factor (gtts/mL)
Time (min)
Injections
 Sterile pharmaceutical solutions or suspensions of a drug Examples:
substance in an aqueous or non-aqueous vehicle.
(1) A medication order calls for 1000 mL of D5W to be administered
They are administered by needle into almost any part of the body: over an 8-hour period. Using an IV administration set that delivers
o joints (intra-articular) 10 drops/mL, how many drops per minute should be delivered to the
o joint fluid (intrasynovial) patient?
o spinal column (intraspinal)
o spinal fluid (intrathecal) Solution:
o arteries (intra-arterial), Flow Rate = Volume (mL) x Drop factor (gtts/mL)
o and in an emergency, even the heart (intracardiac). Time (min)

However, most injections are administered into: = 1000 mL x 10 gtts/mL

o vein (intravenous) 8 hours
o muscle (intramuscular)
o skin (intradermal or intracutaneous) = 1000 mL x 10 gtts/mL
o under the skin (subcutaneous or hypodermic). 480 min

 Depending upon their use, injections are packaged in small = 20.83 gtts/min
volumes in ampules or in prefilled disposable syringes for singe
use; in vials and pen-injectors for single- or multiple-dose use; or = 21 gtts/min
in large-volume plastic bags or glass containers for administration
by slow intravenous infusion.
(2) Calculate the daily infusion volume of D10W to be administered
B.1. Calculation in IV Infusions and Parenteral Admixtures to a neonate weighing 3 lb on the basis of 60 mL/kg/day. Using an
administration set that delivers 60 drops/mL at 20 drops per minute,
Examples: calculate the total time for the infusion.

(1) A physician orders enalaprilat 2 mg IVP for a hypertensive Solution:

patient. A pharmacist delivers several 1-mL injections, each Step 1 - 3 lb ÷ 2.2 lb/kg = 1.36 kg
containing 1.25 mg of enalaprilat. How many milliliters of the
injection should be administered? Step 2 - 1.36 kg X 60mL/kg/day = 81.60 mL/day

Solution: Step 3 ---- Time = Volume (mL) x Drop factor (gtts/mL)

mg : 1 mL = 2 mg : X Flow rate
X = 1.6 mL
Time (min) = 81.60 mL x 60gtts/mL
(2) A medication order for a patient weighing 154 lb. calls for 0.25mg 20 gtts/min
of amphotericin B per kilogram of body weight to be added to 500 mL
of a 5% dextrose injection. If the amphotericin B is to be obtained = 244.8 minutes or 245 min converted to hours
from a constituted injection that contains 50 mg/10 mL, how many 4 hours and 5 minutes
milliliters should be added to the dextrose injection?

Solution: (3) Gentamicin sulfate, 2.5 mg/kg, is prescribed for a 1.5 kg neonate.
Step 1 - 154 lb ÷ 2.2 lb (per kg) = 70 kg Calculate (a) the dose of the drug, and (b) when the drug is placed in
Step 2 - 70 kg X 0.25 mg/kg = 17.5 mg a 50-mL IV bag, the flow rate in mL/minute if the infusion is to run for
Step 3 - 50 mg : 10 mL = 17.5 mg : X 30 minutes.
X = 3.5 mL
Solution:

(3) A medication order for a child weighing 44 lb. calls for polymyxin Dose of the drug - 1.5 kg X 2.5 mg/kg = 3.75 mg
B sulfate to be administered by the intravenous drip method in a
dosage of 7500 units/kg body weight in 500 mL of 5% dextrose Flow Rate (mL/min) = Volume (mL)
injection. Using a vial containing 500,000 units of polymyxin B Time (min)
sulfate and 10 mL sodium chloride injection as the solvent, explain
= 50 mL

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 MODULE 4 LAB (PRPM121L): Calculation of Doses 2022
30 min
= 1.76 mL/min
*Note: This modified formula is used if the flow rate is expressed in
mL/min, but if the flow rate is expressed in gtts/min the complete
formula must be used.

(4) Ten milliliters of 10% calcium gluconate injection and 10 mL of

multivitamin infusion are mixed with 500 mL of a 5% dextrose
injection. The infusion is to be administered over 5 hours. If the
dropper in the venoclysis set calibrates 15 drops/mL, at what rate, in
drops per minute, should the flow be adjusted to administer the
infusion over the desired time interval?

Solution:
Step 1 - 10 mL + 10 mL + 5000 mL = 520 mL (total volume of solution
to be infused)

Step 2 - 5 hours X 60 min/hr = 300 minutes (total length of time of

infusion)

Step 3 --- Flow Rate = Volume (mL) x Drop factor (gtts/mL)

Time (min)

= 520 mL x 15 gtts/mL
300 min

= 25.99 or 26 gtts/min

---THE END---

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