Dispensing During Off-Hours

Shams kursan

• The major criticism of small hospital was the lack of pharmaceutical service on 24 hours.

• Two major reasons for that are:

1. Shortage of trained personnel

2. Prohibitive costs

A. Use of the Nursing Supervisor

B. Emergency Boxes and Night Drug Cabinets

C. Use of Physicians

D. Pharmacist-On-Call

E. Purchased Service

Means of the hospitals to provide 24-hour a day pharmacy coverage

Use of the Nursing Supervisor

Use of the Nursing Supervisor

• It permit the evening and night nursing supervisor to enter the pharmacy and provide limited type of services

• The first and the most widely used

Use of the Nursing Supervisor

Disadvantage:1. Dangerous2. An illegal practice (in some areas)

Use of the Nursing Supervisor

• However; the advocator said:

There exists a correlation between the nurse selecting a medicine from the drug cabinet on the pavilion and selecting the same item from the pharmacy.

Use of the Nursing Supervisor

• The fallacy of this view:

The medication in nursing station have Already had the benefit of special packaging Handling and labeling by professionally competent.

• So, it should be practiced with caution(if it is the only mean available to small hospital)

Use of the Nursing Supervisor

• Nursing personnel serving in this category should be:

a. Specifically prohibited form compounding a mixture

b. Restricted to dispensing from the selection of pre-labeled and pre-packaged items

Emergency Boxes and Night Drug Cabinets

Emergency Boxes

• Is necessary to expedite treatment in situations where time is of the essence.

• So, the emergency box must be:

i. Large enoughii. Sufficiently compact(to facilitate handling items)

iii. Kept in a ready accessible place(known to all ward personnel)

iv. Ready for use at all times

Emergency Boxes

• In order to accomplish this goal;

The pharmacy should’ve reserve boxes prepared so that the units may be handled on an exchange basis reduce the period of time without a ready to use emergency box

Emergency Boxes

• If the hospital policy charge for the supplies used from emergency box

the nurse should prepare a charge ticket and submit it to the pharmacy with the used box

Emergency Boxes

• “Emergency cart” or “resuscitation cart”; Mobile units have on them the same basic supplies contained in emergency box plus :

i. Facilities for the administration of oxygenii. The application of suctioniii. A cardiac pacemaker

Emergency Boxes

• Emergency box must be checked on regular basis(monthly) by hospital pharmacist.

• In order to: Remove outdated Deteriorated medications

Emergency Boxes

• This system requires placing an inventory and product control card in the box

Emergency Boxes

• The objectives of the card;

1. Serves as an inventory of the emergency box2. Shows when the unit was last checked3. Provides the nursing personnel with

adequate directions for replenishing any item which may have been used.

The night drug supply cabinet

II. The night drug supply cabinet

An adjunct to the charge floor stock medications already on the pavilion.

Range from simple cabinets with drawers to large elaborate installations which include narcotic vaults and refrigerate compartments.

The night drug supply cabinet

• The large cabinets are usually constructed in the wall of the pharmacy →→ serviced from within the pharmacy →→ yet is accessible from the corridor side to authorized nursing personnel

The night drug supply cabinet

• It should be stocked with: Pre-packaged Labeled containers of the drugs

• Many hospitals also store certain medical and surgical supplies.(oxidized cellulose)

The night drug supply cabinet

• The nursing supervisor leave identified charge ticket Listing:– the item removed – To whom it was administered

The next morning the pharmacy personnel restock the unit and forward the charged ticket to accounting office.

Use of Physicians

Use of Physicians

• Require the physician enter the pharmacy and obtain any special medication not provided through:

• The floor stocks• Night cabinets • Emergency box

Use of Physicians

• drawbacks :

o A physician might waste a great deal of time searching for a product

o An unfair burden to place upon their already heavily taxed work hours.

Use of Physicians

• Advantage:

o The physician may be influenced to use available drug which will accomplish the same purpose

Pharmacist on call

Pharmacist on call

• In order to encourage this type of coverage, many administrators have developed: Bonus Extra pay plans

• A rotational plan of on-calls will not burden single individual

Purchased Service

Purchased Service

• Contracting with local community pharmacy for:

• Night• Holiday • vacation relief for the staff pharmacist

Purchased Service

Advantages

• Safe and legal • protect the drug needs of the

hospital and patient• safeguard the health needs of the

area on a round-the-clock basis.

Purchased Service

• Where there is more than one pharmacy in the community, care should be taken to avoid any claims of favoritism or politics

Purchased Service

• This may be accomplished by:• Develop a set of specifications and

requirement concerning the desired service• Request the local establishments to submit

their bids.

• Only the retail pharmacies with adequate staff, inventory, and delivery service can qualify to bid.

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