Week 15

Let’s get started with the final session on the topic of stock management. Throughout this course, we've delved into the crucial roles and responsibilities that pharmacy technicians play in various aspects of stock management. Today, we conclude our exploration by focusing on two essential practices: stock rotation and the prevention of stock loss due to theft and fraud. Let's dive in!

Stock rotation

Read the following questions and take a few moments to answer them (it doesn’t matter where - in your head, on a piece of paper, or in your notes). This will help you to refresh your knowledge before you build on it with new information.

• What is meant by stock rotation?
• What are the advantages to the pharmacy of carrying out stock rotation practices?
• What are the advantages to the pharmacy customers of pharmacies of carrying out stock rotation practices?
• Are pharmacy technicians involved in stock rotation?

Before you test your knowledge in the next activity, read this short article (complete with a Futurama meme and cool infographics) about stock rotation.

Ready? Answer the following three questions to check what you’ve taken on board.

Expired medication

When carrying out stock management procedures and practices or during the dispensing process, you may come across expired medicines and products. You may have a pharmacy-specific SOP for expired items, but in general, the procedure will include the following steps:

1. Isolate the expired (out-of-date) item from the stock. This prevents it from being mixed in with in-date stock and being accidentally used.
2. Immediately notify the pharmacist of the expiry.
3. Check if there are any more expired items to be removed.
4. Count the amount removed and the amount left in stock.
5. Alter the computer system (Toniq/RxOne) to reflect the removal of expired items.
6. Discard the expired items into the hazardous waste container.

Theft and Fraud

Pharmacies face potential theft and fraud from both staff and customers. As part of the pharmacy team, you have a responsibility to carry out practices and procedures to prevent or minimise the chances of this occurring.

Let’s start by looking at the definition of Theft and Fraud:

• Theft can be defined as taking property (money, objects, goods etc.) that does not belong to you. According to the Crimes Act 1961, it is an act of dishonesty with the intent to permanently deprive the owner of the property.
• Fraud is also an act of dishonesty. It involves deliberately deceiving someone (individual, organisation, business etc.) in order to receive some form of gain in an unlawful or unfair manner. The gain could be property, money, goods, or other gains.

As we have heard, the results of this crime have not only meant that the pharmacy lost controlled drugs from the safe but also that the pharmacy could not provide full services to their customers for a period of time. Click on the labels or (+) symbols below to learn more about some of the other consequences of theft.

Consequences

How did your list compare to this one? Did you include the emotional and psychological consequences of this crime as well as the physical and financial? Add anything that you may have missed to your own list.

Security

There are security measures that pharmacies and other businesses may take to ensure their premises are protected from burglary and theft after hours.

These may include:

• Motion sensor lights
• Well-lit inside and outside
• Auditory alarm systems
• CCTV recording and monitoring
• Warning signage about onsite security measures
• Security company monitoring, drive-by surveillance or stationary guards
• Staff training for lock up and security measures upon leaving the premises
• Consultation with police and security companies for advice on security measures
• Regular checks and audits that security systems are functioning and maintained
• Physical barriers such as bars or grills over entry points

Shoplifting

The burglary we just looked at occurred after business hours, but what about customer theft during business hours? During business hours, customer theft, commonly known as "shoplifting" or "stealing," is a significant concern for pharmacies. Although the stolen quantities may seem small individually, they collectively lead to stock loss and increased expenses for the pharmacy. Over time, repeated incidents of this kind cause severe repercussions for the business. Let’s explore this type of theft and how to recognise when it may be occurring.

Customer behaviours that may indicate a shoplifting situation is occurring include:

• Standing very close to other customers
• They keep looking at the staff but don’t require assistance
• Repeatedly walking in and out of the pharmacy
• Lingering for a long time around one area of the pharmacy
• Acting nervous, fidgeting, randomly picking up and putting back items, avoiding eye contact
• Constantly scanning and looking around the pharmacy
• Large groups enter the pharmacy and then split up
• Wearing oversized clothes
• Carrying multiple bags or having a pushchair nearby
• Attempting to conceal their face with clothing or actions
• Leaving the pharmacy very quickly

If you notice behaviours that indicate a shoplifting situation, how you respond will depend on your pharmacy's SOP.

They may include:

• Continuing to observe the customer from a safe distance. They may not actually be planning to steal.
• Reporting your suspicions to your manager or senior colleague, who will take the appropriate, safe, and legal actions as per the SOPs.

Customer fraud

Customers may also commit acts that are fraudulent.

Fraudulent acts include:

• Switching price tags from expensive items with ones from less expensive items
• Stealing an item and then pretending it was purchased but is faulty, and then asking for a refund
• Using stolen credit cards to pay for items
• Forging or altering prescriptions

Prevention strategies

There are many strategies to prevent customer theft through shoplifting and fraud.

Here are some examples:

• Organise the pharmacy layout to avoid blind spots. If there are areas that can’t easily be seen by staff, then install convex mirrors or CCTV cameras.
• Provide customer service where staff welcome and acknowledge customers as they arrive, are attentive, and circulate within the shop to provide assistance. While doing so, they can observe behaviours within the store and minimise the opportunities for shoplifters to steal unobserved.
• Only accept returns with proof of purchase.

Pharmacies can also experience theft and fraud caused by staff. These types of theft and fraud may include:

Stealing	Staff members remove medicines and products for personal use from the pharmacy without paying. Theft is carried out by a staff member and a customer, family member or other person working together. This might include not charging the full amount or adding unpaid items to the order. Staff providing non-staff members access to the pharmacy for the purpose of theft.
Cash handling	Stealing money from the till. Not placing cash payments into the till. Mixing or transferring cash between different tills.
Identity and computer fraud	Staff use customer cards and numbers to purchase goods and services or to access their accounts. Altering stock records to cover up stolen stock.
Returns	Staff purchase goods using their staff discount and then refund the goods for full prices at a different branch of the store.

Unfortunately, stock loss through theft and fraud is an ongoing issue in the pharmacy environment, as it is with other retail businesses. It’s important that pharmacies use a variety of techniques to identify these losses so that they can respond and put in place preventative measures. As we have seen, stock loss through theft and fraud has a wide range of consequences and impacts not only for the pharmacy but also for customers and the wider community.

Give yourself a pat on the pat. That’s another week complete, ka pai!

Reconstitution

Bula, fakaalofa atu, and welcome to this session on the reconstitution of medicines.

In today’s session, we’re jumping back into the scenario with Samuel Smith and his Dad. You’ll continue to look at the practices and procedures for preparing to reconstitute the prescription below for Samuel.

Mixing

As you know, the stock bottle of antibiotic contains the antibiotic in a loose dry powder form. It will look like this picture. Stock bottles of antibiotic powder are usually in either a glass or plastic bottle.

Once you have shaken the dry powder, you will open the stock bottle and carefully pour in the water. The measuring glass will have a spout to make pouring easier.

How did you go with that question? If you didn’t get the correct answer, make sure you read the solution. It was a bit tricky, but a good way to learn!

Generally, you will be adding all the water or liquid to the powder at once. However, occasionally the instructions may recommend adding the liquid in parts. Why might this be?

Āta whakairo - think carefully before clicking on the (+) symbol to see the answer.

After mixing, you will check that the medicine is now free from clumps and is evenly mixed. The instructions or data sheet may indicate what the suspension will look like once reconstituted. The data sheet for Augmentin states that when reconstituted, the suspension is white to off-white in colour (Medsafe, n.d.).

Labelling the medicine

Now the reconstitution process is completed, you will print and attach the main medicine label as you would for any other medicine. Reconstituted medicines expire after 7-14 days, so you will need to ensure that you:

1. add the correct expiry date to the medicine label
2. the date to discard the medicine after
3. any other cautionary and advisory information.

Watch: Reconstitution of Oral Suspension (2:40 minutes)

Mātakitaki mai, watch the following video to view the reconstitution process. When you are done, answer the questions that follow in the documentation tool.

 

And just like that, you’ve completed another week of Introduction to Dispensing. Whakamihi, congratulations!

This week, we continue to explore the world of pathogens. So far, we have looked at bacteria and viruses, and today, we tackle fungi and parasites.

Fungi

From your learning on this programme, you will be familiar with some health conditions caused by fungal infections. Pause now to reflect on what these are and some of the anti-fungal OTC treatments we have discussed (you might like to jot down a list of what you can remember). This is a good learning strategy to recall and prepare your mind for the new learning to come.

Me tīmata tātau! - Let’s get started!

FUNgi facts

Fungi are simple organisms. They obtain their nutrients via absorption from the environment. They are unable to move. Fungi include mushrooms, moulds, and yeast. Fungi reproduce by budding. They are single-celled and have a cell wall. They have recognizable structures within that wall to perform certain functions, such as a nucleus and mitochondria.

Some fungi are present all the time in areas of the body, such as the mouth, skin, intestines, and vagina, and don’t cause harm. They are prevented from multiplying through competition from bacteria. Other fungi are dealt with by the body’s immune system.

Fungal infections, also known as mycoses, range from mild and unnoticed to severe and sometimes fatal. They are more common and serious in people who:

• are taking long-term antibiotic drugs
• are taking corticosteroid drugs
• are taking immunosuppressant drugs
• have immune deficiency disorders
• have diabetes.

Fungi types

Fungal infections can be divided into three types. Click on the (+) to get an overview of each type. (Please learn more about the conditions by clicking the hyperlinks in the first section below.)

Vaginal thrush – Mateīhi

Vaginal thrush is a common condition caused by a yeast infection in the vagina and surrounding area. The infection is usually Candida albicans but is also known as candida or vulvovaginal candidiasis. Candida lives harmlessly on the skin, in the mouth, gut, and vagina and is normally kept under control by harmless bacteria. But sometimes conditions change, and the yeast increases rapidly, causing symptoms.

⚠ When to refer to a pharmacist

As always, as a pharmacy technician, it is important to know when to refer to a pharmacist.

Refer when the patient:

• is less than 16 years or over 60 years
• is pregnant
• has a history of, or is concerned about, sexually transmitted diseases
• has not had abnormal vaginal discharge before
• has discoloured or strong-smelling discharge
• has lower abdominal pain or vaginal bleeding that is not a period/menstruation
• has thrush symptoms that have not settled despite appropriate treatment
• has thrush symptoms more than twice in six months
• has thrush symptoms plus other symptoms, such as fever, tiredness, or nausea.

Vaginal thrush treatment

Treatments for vaginal thrush may be topical or oral.

Topical treatments

Clotrimazole: broad-spectrum anti fungal

Dose form: External cream, internal cream or a solid pessary inserted into the vagina. Treatments may be single dose once, three, six, or longer day treatments. Advantages: Applied directly to the affected area, providing targeted treatment, immediate soothing and relief from itching and burning symptoms. Applicator for internal placement is provided. The cream can be applied externally as well. Pessaries can be less messy than cream as they dissolve slowly. Disadvantages: Using the applicator can be messy, inconvenient, and difficult if hand mobility is an issue. Pessaries might not provide the soothing relief that cream does and can be difficult to use.

Oral treatments

Fluconazole: broad-spectrum anti-fungal

Dose form: A single oral capsule is taken once at any time of day, with or without food. Advantages: Convenient route of administration that has a systemic effect. A single dose means there is no need to remember to take daily doses. There is no mess or application process required. Disadvantages: It can take a while to take effect and provide relief from symptoms. Potential systemic side effects, such as headache or nausea.

Nail fungal infections

Fungal infection of nails is common. About 5% of the population will have a fungal nail infection at some stage of their lives. Toenails are more commonly affected than fingernails. Infections happen when fungi get between the nail and the tissue underneath the nail called the nail bed.

⚠ When to refer to a pharmacist

Once you have assessed a customer with a fungal infection, they may have signs and symptoms that require you to refer to the pharmacist.

These are:

• The infection involves more than three nails or more than half of one nail.
• If there is oozing, blisters, swelling or foul odour around the nail.
• Presence of other symptoms such as increased thirst, urination, or flu-like symptoms.
• Recurrent nail infections or if previous treatments haven’t worked.
• People with diabetes, circulatory issues, immunosuppressed, pregnant or allergies to topical medicines.

Fungal infection treatments

Treatments for fungal infections of the nail may be topical or oral.

Nail solution

Poly-ureaurethane
Treats the fungal infection and damaged nails. Paint on nails and allow to dry. Apply once daily at bedtime.

Oral tablets

Terbinafine
Treats fungal infection of nails and skin. Given for six weeks when used on the nail, as it takes longer for the medicine to penetrate and treat the nail bed than the skin.

Nappy Rash

To ensure you have an understanding of what simple nappy rash is, its causes, treatment and prevention, read the Healthify webpage before you move on to the activity below. Healthify: Nappy Rash.

⚠ When to refer to a pharmacist

As a pharmacy technician, you should refer a nappy rash to the pharmacist when:

• the rash is severe, oozing, blistering, swollen or extends beyond the nappy area
• previous treatments have not worked, or the rash has worsened
• a similar rash has appeared elsewhere on the body
• a baby has medical conditions, feeding difficulties, or is currently on medications or supplements
• a baby has allergies or previous reactions to topical treatments

Nappy rash treatments

Topical treatments for nappy rash include antifungal preparations and combined antifungal and steroid preparations.

Antifungal with moisturiser

Miconazole Nitrate: treats fungal infections
Zinc Oxide: Mild antiseptic and moisturiser for a soothing effect. Apply to clean, dry skin at each nappy change for seven days.

Antifungal with steroid

Clotrimazole: broad-spectrum anti-fungal
Hydrocortisone: steroidal anti-inflammatory. Apply twice daily for no more than seven days.

In class, you will continue your learning on anti-infective agent treatments for fungal infections. For now, though, let’s move on to look at another pathogen… parasites!

Parasites

Parasites are disease-causing organisms that require a host to live and multiply. They depend on the host to get the nutrients they need and cause harm to the host. As they depend on the host for survival, they don’t often kill the host.

There are 3 main types of parasites that cause harm to the human body.

Click on the (+) to get an overview of each type:

From your previous studies, you will be familiar with the conditions caused by parasites and their OTC treatments. Therefore, this next section will revise and build on what you know already.

Threadworms

Threadworms (sometimes called pinworms) are Helminths, a type of parasite. They live in the GI tract of humans and feed off the nutrients the hosts get from eating food.

In the following activity, you will answer questions about this pathogen, including its treatment and prevention.

⚠ When to refer to a pharmacist

You must refer a person with threadworms when:

• there are reoccurring worm infections
• previous treatments have not worked
• the person has recently visited a developing country
• there are symptoms of worms and diarrhoea
• there are reports of blood in faeces or significant weight loss
• there are reports of broken skin around the anal area due to scratching
• children less than two years old
• people are immunosuppressed, pregnant, breastfeeding, or have allergies to medications

Scabies

Scabies is an ectoparasite. They burrow under the top layer of skin and feed off dead skin cells and cell fluid. It’s time for another activity! Answer the following questions and create your own resource.

⚠ When to refer to a pharmacist

When to refer a person with scabies to the pharmacist:

• Itch is localised to one area
• Severe rash or signs of infection
• Symptoms such as fever, swelling or intensely red skin
• Symptoms persisted or reoccurred despite treatment
• A child is less than two years old
• People taking medicines, including complementary products
• People who have skin conditions, are pregnant, breastfeeding, or have allergies to topical medications

To wrap up this week of learning, you’ll continue to look at parasites in today’s SDL activity. This will be an opportunity to revise and deepen your learning.

Kia pai mai hoki (that’s fantastic!), another week complete. You have conducted a lot of research on your own this week and directed your own learning, so you should be proud.