Top 5 Mistakes Vet Clinics Make When Dispensing Medications

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The diagnostics are done, the diagnosis made, and treatment plan has been decided. Now it’s time to dispense the necessary medications and send the client on their way to execute the plan. But are you sabotaging the plan before it even gets started with these five common medication dispensing mistakes?

1. Inappropriate packaging which makes it difficult for the client to prepare the correct dose or compromises drug stability

2. Pre-splitting tablets which may impact dosing accuracy and drug stability

3. Failure to emphasize important directions and warnings resulting in clients that aren’t storing, administering or handling the drug appropriately

4. No double check system which greatly increases the risk of errors occurring

5. Not counseling effectively thus decreasing the opportunity to catch potential errors and letting an opportunity to maximize client compliance slip by

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1. Inappropriate packaging

The packaging drug companies select may seem over the top or just plain annoying in some cases, but it was likely carefully selected based on drug stability considerations. While we typically only have a few standard options for drug dispensing, it does warrant some consideration with regard to both drug stability and client safety and ease-of use.

For stability, consider if the drug will be impacted by plastic. The majority of medications won’t be harmed, but ones to consider this for include injectable products and any liquids that come in a glass stock bottle. Consider if repackaging an injectable medication into several syringes for the client to use over the next few months may not be the best idea.

For client considerations, think about the use process. How does your packaging make it easier or harder for the client to get an accurate dose? Here are some questions to consider:

- Is the bottle/vial size appropriate for the quantity of medication.

o For solid dosage forms (e.g., tablets and capsules), the bottle should be the smallest size you have that fits the medication while leaving a bit of space at the top of the bottle.

o For liquid dosage forms, the bottle should be the smallest size you have while still leaving about 10 – 15ml of space at the top.

o Using an appropriate size bottle is more important for liquid medications than for solid dosage forms because liquid medications will have some volume lost on the sides of the bottle and larger bottles will result in more loss.

- If the medication is a liquid, did you insert a bottle stopper or provide an adapter cap to draw up the medication?

o There are stoppers that insert into plastic bottles that a syringe can be pushed into the bottle to facilitate withdrawing the liquid. These can have an open hole for the syringe which does create the possibility that the medication can spill if the bottle is tipped upside down without a syringe in it or cap on tight. There is also a version appropriate for hazardous drugs that has a self-sealing center to prevent spilling.

- If the medication is a liquid, did you provide an appropriately sized syringe with the dosage marked?

o The syringe should be about 25% larger than the necessary dose. For example, if the patient is receiving a dose of 0.55 ml, then a 1ml syringe is more appropriate than a 3 ml syringe. However, if the dose is 0.85 ml, then a 3ml syringe may be a better option.

o Syringe markings rub off with repeated use. Therefore, a dose mark sticker can be useful to help clients continue accurately measuring the medication, and it may be helpful to dispense a few syringes instead of just one.

- Did you put an appropriate cap on the bottle? The default should be a child-safety cap. However, these may not be appropriate for all clients as those that are elderly or have a disease affecting their hand strength and mobility may not be able to open child-safety caps. In those cases, it’s helpful to have a few non-safety options available if a client requests an alternative.

2. Pre-splitting tablets

When a patient needs a partial tablet for each dose, do you pre-split the entire amount being dispensed into half or quarter tabs to save the client the trouble? It’s a well-intentioned action, but probably not the best choice for preserving drug stability and dosing accuracy.

Consider this example. If a patient needs a 50mg dose once a day and the tablet being dispensed is 100 mg, the client should administer ½ tablet once daily. The drug may or may not be equally distributed throughout the tablet, but likely it’s pretty close to equal. However, regardless of whether a veterinary professional, a pharmacist, or a client splits the tablet in half, it’s probably not going to be split into exactly equal pieces. And that’s okay! If one 100 mg tablet is split and ½ is given today and ½ is given tomorrow, the patient will get 100 mg over the course of two days and that cycle will continue repeating every two days. Even if the actual amount is 40mg one day and 60 mg the next instead of the intended 50 and 50, as long as both halves of the tablet are used on consecutive days, it will keep balancing out to obtain pretty consistent drug levels. However, if all of the tablets in the bottle are pre-split, then this balancing doesn’t occur because the patient may get a series of slightly larger halves for a period and then a series of slightly smaller halves.

From the stability perspective, splitting tablets well in advance of administration has the potential to contribute to accelerated drug degradation. Some drugs have a coating on the tablet to help slow drug degradation and when that coating is compromised, drug degradation may occur prior to administration.

Instead of defaulting to pre-splitting tablets for all prescriptions with a partial tablet dose, make it an exception that is only used when the benefits outweigh the risks such as when a client is physically incapable of splitting the tablets themselves.

3. Failure to emphasize important directions and warnings

When dispensing medications with specific directions such as ‘store in the refrigerator’, ‘give with food’, ‘give without food’, or ‘don’t handle if pregnant’, you may tell the clients, type it into the directions, and/or put it into the discharge instructions. All of these have benefits, so if you are doing them, don’t stop. However, if you aren’t adding auxiliary labels to the packaging, you are missing out on an opportunity to ensure these directions are emphasized every time a medication dose is prepared. Think about it, verbal directions may be forgotten or not shared with others administering the medication, Handouts are likely being lost or disposed of well-before therapy concludes, and more words typed into the direction section of a tiny label make it more difficult to read the necessary directions. In contrast, auxiliary labels are bright colors that can be placed next to the label to emphasize these key points.

4. No double check system

Veterinary dispensing doesn’t have a requirement for a double-check system, but human error happens. If one person is responsible for filling a medication and providing it to the client without anyone else looking at it, then a valuable opportunity for preventing errors is being missed. Consider adding this basic safeguard into your practice if it’s not already included.

5. Not counseling effectively

Maybe your practice checks all of the above boxes but when it comes to giving the medication to the client, a technician hands it off and says, “Do you have any questions?” This situation forgoes a valuable opportunity to enhance client compliance with the drug therapy. Taking the time to go over each new medication with the client can have a valuable impact on their understanding and confidence with administering the medication, monitoring for efficacy and side effects, and returning to necessary follow-up appointments. New medication counseling should include (at a minimum) the following information:

- Name and description of the drug including what it’s being used for

- Route of administration, dosage and duration

- Adverse effects that are common or severe

- Special directions for proper use and storage

- Actions to take if a dose is missed

- Warnings and precautions provided by the manufacturer

- What to do when out of drug (conclude therapy, get a refill, have a recheck, etc.)

While it’s not necessary to counsel on every medication refill, there are situations when it is warranted. These include the following:

- The medication has a different appearance than previously such as when a generic is now being dispensed

- The medication is a different concentration than previously used

- The dose has changed

- There is reason to believe the medication hasn’t been being administered appropriately

Conclusion

The goal is right drug, right dose, right time, right route, and right patient while making it as easy and straight forward as possible for the client to get the medication into the patient. Correcting these five common mistakes can go a long way towards achieving that goal.

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About the Author:

Dr. Lauren Forsythe is an Assistant Professor at the University of Findlay College of Pharmacy. She is also a diplomat of the International College of Veterinary Pharmacists. Dr. Forsythe graduated from the University of Findlay, College of Pharmacy in 2015 and completed her veterinary pharmacy residency at Purdue’s Veterinary Teaching Hospital. She earned her MBA in 2024 from the University of Illinois.  Following completion of her residency, Dr. Forsythe spent three years at the UC Davis Veterinary Medical Teaching Hospital as a Clinical Pharmacist followed by four years at the University of Illinois College of Veterinary Medicine as a Clinical Assistant Professor of Pharmacy and the Pharmacy Service Head. In addition to her teaching position, Dr. Forsythe is a co-author of the book Drug Compounding for Veterinary Professionals and provides consulting services to veterinary practices through her company Foresight Pharma Solutions.