DRUG DISTRIBUTION SYSTEM Dispensing to In-Patients

Introduction It has been observed that a great deal of nursing time was consumed by frequent trips to the pharmacy to obtained medications and others ancillary supplies. As a result thereof, many administrators have requested the hospital pharmacist and nursing administrative staff to scrutinize present procedure and develop new system for the distribution and dispensing of drugs.

Drug dispensing is a pharmacy act and consists of the pharmacist removing two or more doses from a bulk drug container and place them in another container for subsequent use. Drug administration is a nursing act which consists of the removal or withdrawal of a single dose from the drug container and its administration to a patient on the order of a physician or dentist.

The following guidelines for planning and evaluating hospital drug distribution system are abstracted from the aforementioned statement: Before the initial dose of medication is administered the pharmacist should review the prescriber’s original order or a direct copy. Drugs dispensed should be as ready for administration to the patient as the current status of the pharmaceutical technology will permit, and must bear adequate identification including; name or names of drug, strength, or potency, route(s) of administration, expiration date, control number, and such other special instructions as may be indicated.

Facilities and equipment used to store drugs should be so designed that the drugs are accessible only to medical practitioner authorized to prescribe, to pharmacist authorized to dispense, or to nurses authorized to administer such drugs. d) Facilities and equipment used to store drugs should be designed to facilitate routine inspection of the drug prior to the time of administration. e) When utilizes automated (mechanical/electronic) devices as pharmaceutical tools, it is mandatory that provision be made to provide suitable pharmaceutical services in the event of failure of the device.

ASHSP pronounced that the pharmacist in charge shall be responsible for specifications both as to quality and source for purchase of all drugs, chemicals, antibiotics, biological and pharmaceutical preparations used in the treatment of patients. Since the pharmacist has the responsibility for the compounding, dispensing and manufacture of the drugs used in the hospital, he should also have the authority to specify the drugs used to be purchased. In large institutions with centralized purchasing, the pharmacist and the purchasing agent should work hand-in-hand, each recognizing the function of each other.

f) Such mechanical or electronic drug storage and dispensing devices, as require or encourage the repackaging of drug dosage form from the manufacturer’s original container, should permit and facilitate the use of a new package, which will assure the stability of each drug and meet USP standards for the packaging and storing of the drugs, In addition to meeting all other standards of good pharmacy practice.

Different systems of dispensing There are four systems in general for dispensing drug for inpatients. They may be classified as follows; i) Individual prescription order system ii) Complete floor stock system iii) Combination of (i) and (ii), and iv) The unit dose system.

(I) Individual Prescription Order System This system is generally used by the small and/or private hospital because of the reduced manpower requirement and the desirability for individualized service. Inherent in this system is the possible delay in obtaining the required medication and the increase in cost to the patient. At the same time there are very definite advantages: a) all medication orders are directly reviewed by the pharmacist b) provides for the interaction of pharmacist, doctor, nurse and patient and c) provides closer control of inventory.

(II) Complete Floor Stock System Regardless of the size of the hospital or specialty of care a supply of drugs is stored in the medicine cabinet of the nursing unit which is serviced by a unit dose system. And the drug stored in the nursing station depending upon the specialty of care is term as floor stock drugs. It should be in minimum quantity. Drugs in the nursing station may be divided into: a) Charged floor stock drugs, and b) Non-charged floor stock drugs.

Advantages i) ready availability of the required drugs; ii) elimination of drug returns; iii) reduction in the number of drug order transcriptions for the pharmacy; and iv) reduction the number of pharmacy personnel required. Disadvantages i) medication errors may increase because the review of medication orders is eliminated; ii) increased drug inventory on the pavilions; iii) greater opportunity for pilferage (to steal small items of little value, especially habitually); iv) increased hazards associated with drug deterioration; v) lack of proper storage facilities on the ward may require capital layout to provide them and iv) greater inroads (a gradual violation) are made upon the nurses’ time.

(III) Combination of Individual Prescription Order and Complete Floor Stock systems Falling into this category are those hospital which use the individual prescription or medication order system as their primary means of dispensing, but also utilize a limited floor stock. This combination system is probably the most commonly used in hospitals today and is modified the use of unit dose medications.

(IV) Unit Dose System The unit dose system of medication distribution is a pharmacy-coordinated method of dispensing and controlling medications in health care institutions. It is defined as- Those medications which are ordered, packaged, handled administered and charged in multiples of single dose units containing a predetermined amount of drug or supply sufficient for one regular dose, dose application or use.’

The unit dose system may differ in form depending on the specific needs of the institution. However, the following distinctive elements are basic to all unit dose system: medications are contained in a single unit packages they are dispensed in as ready-to-administer form as possible for most medications not more than a 24 hours supply of doses is delivered to or available at the patient-care area at any time.

With respect to other drug distribution system, numerous studies indicate that Unit dose system is: safer for the patient more efficient and economical for the institution, and a more effective method of utilizing professional resources.

Inherent Advantages of Unit Dose System Patient receive improved pharmaceutical services 24 hours a day and are charged for only those doses which are administered to them. All does of medication required at the nursing station are prepared by the pharmacy thus allowing the nurse more time for direct patient care Allows the pharmacists to interpret or check a copy of the physician’s original order thus reduction the incidence of medication errors Eliminates excessive duplication of orders and paper work at the nursing station and pharmacy

a decrease in the total cost of medication related activities Advantage cont.- a decrease in the total cost of medication related activities transfers intravenous preparation and drug reconstitution procedure to the pharmacy improved overall drug control and drug use monitoring more accurate patient billing for drugs the elimination or minimization of drug credits greater control by the pharmacist over pharmacy workload patterns and staff scheduling

Advantage cont.- a reduction in the size of drug inventories located in patient-care areas (eliminates bulky floor stock) greater adaptability to computerized and automated procedure regarding medication orders and delivery system. The pharmacists can get out of the pharmacy and onto the wards where they can perform their intended function as drug consultants and help providing the team effort that is needed for better patient care.

Unit-Dose Drug Distribution Procedure Medication is dispensed in a package that is ready to administer to the patient. Medications administered by any route, but oral, parenteral, and respiratory routes are especially common.

Rx Received and verified In-Patient Rx Written By Doctors Rx Received and verified By Pharmacist In Central Pharmacy Selection Dispensed and Filled In Medication cart Filling of Prescription by Technician/Phar Drug Strength Frequency Route Labeling Recorded in Patient’ Profile Regular Prescription File Patient’s Name, Bed #, Ward, Room # Before sending to ward checked by Pharmacist Sent to wards Controlled Prescription File

Step-by-Step outline of Unit Dose Procedure upon admission to the hospital, the patient is entered into the system. Diagnosis, allergies and other pertinent data are entered on to the patient profile card. direct copies of medication orders are sent to the pharmacist the medication order are entered on to the patient profile card

dosage schedule is coordinated with the nursing station Step-by-Step outline cont.- the pharmacist checks medication order for allergies, drug interaction, drug interactions, drug laboratory test effects and rationale of therapy dosage schedule is coordinated with the nursing station Pharmacy technician picks medication orders, placing drugs in bins of transfer cart per dosage schedule medication cart is filled for particular dosage schedule delivery.

Pharmacist checks cart prior to release Step-by-Step outline cont.- Pharmacist checks cart prior to release the nurse administers the medication and makes appropriate entry on the medication record - upon return to pharmacy, the cart is rechecked - throughout the entire sequence, the pharmacist is available for consultation by the doctors and nurses. In addition he/she is maintaining surveillance for discontinued orders.

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