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 the patient 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 i ndividual 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 of registered 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 and dispensing.
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 – Ibuprofen – Paracetamol Paracetamol Tablet Formula Ibuprofen – Ibuprofen – 400mg 400mg Paracetamol – 323 – 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 o orr use.” Advantages Patients receive improved pharmaceutical pharmaceutical service, and are charged for only those which are administered to them. All doses of medication required 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 duplication of orders and paper work at the nursing station and pharmacy. Eliminates credits. Transfers intravenous preparation and drug reconstitution 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 Medications are dispensed in ready-to-administer 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.
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 is set 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 Decentralized Unit-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 early recognizable 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 be obtained 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 the hospital 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 – maintains perpetual 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
