Drugs that are safe and effective for use by the general public without a prescription are defined as over-the-counter (OTC) drugs. Patients / customers can find these drugs on shelves in pharmacies, but may also find them in non-pharmacy outlets, such as grocery stores, convenience marts and large discount retailers. In the U.S., there are more than 80 classes of OTC drugs, ranging from allergy medicines to pain relievers to weight loss products.
Since prescribing physicians are not involved in the sales of over-the-counter (OTC) medicines, written instructions on/in the medicine boxes are inefficient; therefore, druggists and pharmacists must play the role of caretakers in preventing customers’ accidents.
Professional Standards and Guidance for the Sale and Supply of Medicines
As a pharmacist, you must ensure that appropriate procedures for sales of OTC are in place and provide professional advice to aid the safe and effective use of medicines. When a patient or their caregiver requests advice on treatment, the pharmacist must get the necessary information in order to make an assessment whether self-care is appropriate, and to recommend a suitable product. You must also take into account any other specific information such as safe storage, or short expiration dates that the patient may need to be counseled on. If a sale is not considered suitable, you must explain the reasons to the patient and refer them to another healthcare professional when appropriate.
Only trained staff or employees undertaking required training can be involved in the sale or supply of an OTC medicine. They will refer customers/patients to the pharmacist or other registered healthcare professional when necessary.
Pharmacists and pharmacy technicians must follow a set of professional standards and guidance for the sale and supply of medicines. It is their responsibility to apply the seven principles of ‘The Code of Ethics’ to their daily work.
- Make the care of patients your first concern.
- Provide a proper standard of practice and care to those for whom you provide professional services.
- Seek all relevant information required to assess an individual’s needs and provide appropriate treatment and care. Where necessary, refer patients to other health or social care professionals or other relevant organizations.
- Seek to ensure safe and timely access to medicines and take steps to be satisfied of the clinical appropriateness of medicines supplied to individual patients.
- Encourage the effective use of medicines and be satisfied that patients, or those who care for them, know how to use their medicines.
- Be satisfied as to the integrity and quality of products to be supplied to patients.
- Ensure that you have access to the facilities, equipment and materials necessary to provide services to professionally accepted standards
In addition to the principles aforementioned, pharmaceutical stock standards must also be followed.
You must ensure that:
- You report to the proper agencies if you suspect you have been offered or supplied a counterfeit or defective medicine. Any such stock must be segregated from other pharmacy stock and must not be sold or supplied for the treatment of any person(s).
- You store pharmaceutical stock under suitable conditions, taking into consideration the stability of the drug.
- You pay attention to the protection of pharmaceutical stock from contamination, sunlight, atmospheric moisture and adverse temperatures.
- Your refrigerators used for pharmaceutical stock are capable of storing products between 35F and 46F. They must be equipped with a maximum/minimum thermometer, or other suitable alternative, which is checked on each day the pharmacy is open and the maximum and minimum temperatures recorded. Steps must be taken to rectify discrepancies in temperatures.
- All stocks of medicines in the pharmacy have batch and expiration details. Medicines must be removed from blister or foil packs only at the time of dispensing to assist an individual patient.
- Medicines returned to the pharmacy from a patient’s home, a care home or a similar institution are not supplied to another patient. While awaiting disposal, these medicines must be clearly marked and segregated from other stock.
As a pharmacist, you must consider the types of OTC medicines that may require intervention, e.g. those that have recently become available without prescription, those that may be subject to abuse or misuse, or where the marketing authorization for non-prescription use is restricted to certain conditions and circumstances. You must also be alert to requests for large quantities of certain meds and/or abnormally frequent requests (if there are reasonable grounds for suspecting misuse, you must refuse supply).
Other instances where particular care is exercised: supplying products for children, the elderly and other special groups or individuals, or where the product is for animal use.
You keep up to date with developments regarding new products and policies for health promotion and are aware of local and major national and topical health promotion initiatives.
In conclusion, the pharmacist plays a key role in ensuring that the balance of OTC use tips toward benefit rather than risk. The pharmacist is available at the point of purchase to help the patient select an appropriate OTC product, suggest non-pharmacologic therapy, or refer the patient to a physician when necessary. Pharmacists are trained to help patients determine when and how to treat themselves; when to see a physician; when diagnostic tests are appropriate; and when to use emergency health care services. As an extension of pharmaceutical care, pharmacists can counsel patients on the appropriate use of OTC products, thereby maximizing the benefits and reducing the risks.