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Drug Distribution Systems

DRUG DISTRIBUTION SYSTEM TO INDOOR PATIENTS 

  Individual Prescription Order System

  „Complete‟ Floor Stock System 

  Combination of Individual Drug Order and Floor 

Stock System

  Unit Dose Dispensing System

Individual Prescription Order System

 In this system, Doctors write a prescription and thepatient is asked to get the medicines from licensed

medical store.

  Disadvantages 

  This system is costly

  There is time loss to get the medicines

  Advantages

  Reduction in no. of staffs in the hospital

  Prescription is directly reviewed by the

pharmacist at medical store

  Provides interaction of doctors, pharmacists and

the patients.

The ‘Complete’ Floor Stock System 

  The drugs are stored in pharmacy stores, supplied

to the wards on order and kept under the

supervision of registered nurse at nursing station.

  There are two types of drugs:

  Charge drugs: Costly drugs and obtained from

pharmacy store upon the receipt of prescription

order for individual patient.

  Non Charge drugs: Cheaper and commonly

used drugs.

  Advantages

  Easy and prompt delivery of the required drugs

  Elimination of drugs returns

  Reduction in the pharmacy staff members

  Reduction in the no. of drug order transcription

for the pharmacy.  Disadvantages

  Greater chances of drug interaction/adverse

drug reactions

  Increased drug inventory on the pavilions.

  Proper storage facilities in ward is required

  Greater opportunity for pilferage

  Greater load upon the nurse time.

Combination of Individual Drug Order and Floor Stock 

System

  Followed in the govt. and also in private hospitals.

  Requirements of drugs/surgical items are given to

the patient who purchase and deposit these items

in hospital wards/rooms under the supervision ofregistered nurse.

Selection of ‘Charge’ Floor Stock Drugs 

  The decision to which drugs should be placed

under the category of „charge‟ drugs depends on

Pharmacy and Therapeutics Committee (PTC).

  Once the floor stock list has been finalized, it is the

duty of hospital pharmacist to enforce the decision

of PTC and make the drug available.

  The clinical needs of the patients is given the due

weightage without seeing the financial status of

the patient.A list of non-charge floor stock drugs is prepared on the

basis of following criteria:

  The cost of preparation

  The frequency of use

  The quantity used

  The hospital budget

List of few non-charge floor stock drugs

Category

  Anti-allergies

  Antibiotics

  Anticoagulant

  Antihypertensive

  Cardiovascular agents

  Diuretics

  Miscellaneous

Preparations

  Phenergan Injection,

  Penicillin G potassium Inj.

  Heparin 10,000 units/1ml

  Reserpine Hcl 0.5mg/2ml

  Digoxin Injection

  Furosemide tablets

  Dextrose 50%

Prescribing of Floor Stock Drugs

  Method 1

  Prescription order is written on a separate blank 

paper by the physician  Method 2

  In this, a doctor writes a medicine in order form in

duplicate; one of which is received by the

pharmacist.

  Physicians are allowed to mix all types of orders

for the patients on one sheet. It provides the total

picture to the pharmacist what is happening to

the patient.

  Method 3

  In this nursing unit in-charge transcribes or copies

the physician‟s written order on another 

document called a drug regulation slip and send

it to a pharmacist in-charge for reviewing anddispensing.

Labelling of Floor Stock Drugs

  Stock drugs in the ward are not labelled with the

direction for use.

  Hence, stock medications bear a label which

shows the ward number, name and strength of

the preparation.

Example

Ward no. 3 A

Ibuprofen – Paracetamol Tablet

FormulaIbuprofen – 400mg

Paracetamol – 323 mg

UNIT DOSE DISPENSING

DEFINITION

  “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, application or use.”

Advantages

  Patients receive improved pharmaceutical service,

and are charged for only those which are

administered to them.

  All doses of medication required at nursing station

are prepared by pharmacy.

  Allows the pharmacists to interpret or check a copy

of the physician‟s original order. 

  Eliminates excessive duplication of orders and

paper work at the nursing station and pharmacy.

  Eliminates credits.

  Transfers intravenous preparation and drug

reconstitution procedures to the pharmacy.

  Promotes more efficient utilization of professional

and non-professional personnel.

  Reduces revenue losses.

  Conserves space in nursing units by eliminating bulky

floor stock.  Eliminates pilferage and drug waste.

  Extends pharmacy coverage and control

throughout the hospital.

  Communication of medication orders and delivery

systems are improved.

  The pharmacists can get out of the pharmacy and

onto the wards.

Important Aspects

  Medications are contained in, administered from,

single-unit or unit-dose packages.

  Medications are dispensed in ready-to-administer 

form.

 For most medications, not more than a 24- hour supply of doses is provided to or available at the

patient care area at any time.

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  Patient medication profile is concurrently

maintained in the pharmacy for each patient.

Methods of dispensing of unit doses

  Central Unit Dose Distribution system (CUDD)

  In this system, all in-patient drugs are dispensed in

unit doses and all the drugs are stored in main

pharmacy and dispensed at the time, the dose is

due to be given to the patient.

  Decentralized Unit Dose Distribution system (DUDD)

 Small pharmacy often called Satellite Pharmacy isset up on each floor of the hospital.

  The main pharmacy supplies the drugs to the

satellite pharmacies upon the receipt of

medication order.

Implementation of Unit Dose Dispensing

  Through the use of strip-packaging and vial and

syringe filling equipment in the hospital.

  Through the purchase of the packaging service

from an outside contractor or by the joint purchase

and sharing of equipment with a neighboring

hospital.

  Through the purchase of all drugs in unit dose

packages.

Outline of the procedure entailed in a DecentralizedUnit-Dose Distribution system

  Upon administration to the hospital, the patient is

entered into the system. Pertinent data are entered

on to the Patient Profile card.

  Direct copies of medication orders are sent to the

pharmacist.

  The medications ordered are entered on to the

Patient Profile card.

  Pharmacist checks medication order for allergies,

drug-interactions, drug-laboratory test effects and

rationale of therapy..

  Dosage scheduled is coordinated with the nursing

station.  Pharmacy technician picks medication orders,

placing drugs in bins of a transfer cart per dosage

schedule.

  Medication cart is filled for particular dosage

schedule delivery.

  Pharmacist checks cart prior to release.

  The nurse administers the medication and makes

appropriate entry on her medication record. Upon

return to the pharmacy, the cart is rechecked.

Emergency Drugs

  It consists of life saving medicines like adrenaline,

corticosteroids and insulin.

 These drugs are placed in a box which is earlyrecognizable and approachable.

  The hospital pharmacist is responsible for 

maintenance of emergency medicines.

DRUG DISTRIBUTION SYSTEM IN OUT-PATIENT DEPARTMENT

Location of Out-Patient Pharmacy

  Advantageous separate independent out-patient

pharmacy for better service.

  In small hospitals, a combined out-patient and in-

patient service can be provided.

  The pharmacy receives its supplies from medical

stores weekly but emergency supplies can beobtained at any time.

Layout of Out-Patient Department (OPD)

  This dept. should be well organized and it is the

department where there is maximum interaction

between the public and hospital.

  The waiting period for the patients can be reduced

by providing sufficient space for receiving and

filling of prescriptions.

  If there is a rush in OPD, more staff members should

be provided.

Types of Prescription Received

  General public

  Referred patient

  Patients who have been discharged from thehospital

  Private patient

DRUG PROCUREMENT, INVENTORY MANAGEMENT AND

CONTROL 

Procurement 

  The process of purchasing drug products, cosmetics,

skin care products and toiletries for the purpose of

selling them to the general public or consumers.

  Pharmacists procure and maintain good inventories.Inventory Control 

  Is of vital importance to pharmacies of all types.

  Effective control results in smaller investment.  For given profit, this leads to a greater return on

investment.

Effective inventory control consists of optimizing 2 goals: 

  Minimizing total inventory investments; and

  Carrying the right mix of products to satisfy patient

demand.

Inventory Control Techniques: 

  Manual Techniques 

  Want book  – list of items that a pharmacy needs

to order.

  Colored or dated price stickers – indicate the

time period during which a product is received.

  Computerized Inventory Control – maintainsperpetual control of inventories

  Open to Buy Budget (OTB) – considers only the

amount invested, and does not control the quantity

or salability of merchandise purchased.

Inventory Management 

  Good inventory management provides a

continuous flow of goods and directly matches the

quantity of goods kept in inventory with sales

demand.

4 Aspects of Inventory Management 

 Stock turnover 

  When to order 

  How much to order 

  Warehousing

Methods to Avoid Potential Lost Sales or Stock-out

Situations: 

  FIFO Method

  FEFO Method

  Bar Coding

Proper Storage and Handling 

1. Store pharmaceutical drug products according to the

storage condition specified in the label.

  Examples:

  Store in a cool place

  Store in a cold place  Protect from light

  Keep away from flame

2. When no storage condition is specified, it is

understood that the product should be protected from

excessive temperature, moisture and freezing.

3. Hazardous chemicals must be stored separately in

locked cabinet that is properly labeled.

4. In handling hazardous chemicals, always observe

safety measures like wearing of gloves, use of mask, etc.

5. In repackaging drug products, the following

packaging materials may be used:

  Vials, small plastic or glass containers

  Paper and plastic bags  Small boxes

  Prescription bottles

6. Do not dispense drug products if the following

physical signs are present:

  Presence of precipitates or solidification of liquid

drugs

  Change in color 

  Liquefaction of solid drugs like tablets, capsules or 

suppositories

  Rancidity of ointments and other medicated

applications